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Lyme Borreliosis in Children: A Tertiary Referral Hospital-Based Retrospective Analysis
Insights
Diagnosing Lyme borreliosis (LB) in children is challenging. This study found a low incidence of confirmed LB among pediatric cases with suspected Lyme disease, highlighting diagnostic difficulties for primary care physicians.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Clinical Diagnostics
Background:
- Lyme borreliosis (LB) is prevalent in adults, but pediatric studies are limited.
- Accurate diagnosis of LB in children presents challenges for healthcare providers.
Purpose of the Study:
- To determine the incidence of Lyme borreliosis (LB) in children with suspected Lyme disease.
- To evaluate diagnostic accuracy for pediatric LB in a Dutch tertiary referral center.
Main Methods:
- Retrospective chart review of 325 children with suspected Lyme disease.
- Utilized a modified classification system for categorizing clinical and laboratory findings.
- Analyzed medical history, symptoms, diagnostic tests, and final diagnoses.
Main Results:
- LB was diagnosed in 11.7% of all referred children (38/325).
- In a specialized Lyme clinic, 32.9% of referred children (28/85) received an LB diagnosis.
- Only 39.3% of referred Lyme-positive children had a definitive LB diagnosis; 12 had posttreatment LB syndrome.
Conclusions:
- A small proportion of children referred with suspected Lyme disease are diagnosed with definitive or probable LB.
- Highlights the diagnostic challenges faced by general practitioners and pediatricians in identifying pediatric Lyme borreliosis.
- Emphasizes the need for improved diagnostic strategies and awareness for pediatric Lyme disease.
Abstract:
Lyme borreliosis (LB) is an endemic disease in adults in Western countries. Although children may also be infected, pediatric studies on LB are scarce. This study aims to estimate the incidence of LB among children with a clinical suspicion for Lyme in a tertiary referral center in the Netherlands. Patient chart data on medical history, clinical signs and symptoms, diagnostic test results and diagnoses were collected using standardized case record forms. Patients were categorized based on clinical and laboratory findings using a modified, previously published classification system. We included 325 children, with a median age of 11.9 years, of whom 61.8% were female. LB was diagnosed in 38 of the referred children (11.7%). However, of the 85 patients who were specifically referred to the Lyme clinic, 28 (32.9%) were diagnosed with LB. Of the specifically referred Lyme-positive patients, 11 (39.3%) had a definitive LB diagnosis. Twelve children had a posttreatment LB syndrome. In line with previous reports in adults, only a small proportion of children referred with a suspicion of LB were diagnosed with definite or probable LB, which illustrates the difficulty in diagnosing LB by the general practitioner or pediatrician in a district hospital.
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