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Subacute multiple-site osteomyelitis caused by Borrelia burgdorferi
J Oksi1, J Mertsola, M Reunanen
1Department of Medical Microbiology, Turku University, Finland.
Summary
Borrelia burgdorferi can cause pediatric osteomyelitis, even with low antibody titers. Early diagnosis and ceftriaxone treatment are crucial for successful outcomes in Lyme borreliosis.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Rheumatology
Background:
- Lyme borreliosis is a tick-borne illness typically presenting with erythema migrans, though late-stage manifestations can be diverse.
- Osteomyelitis, a bone infection, is uncommon in Lyme borreliosis, particularly in pediatric cases with multiple affected sites.
Observation:
- A pediatric patient presented with severe, multi-site osteomyelitis.
- Borrelia burgdorferi was identified in bone lesions via culture and PCR, and in serum via PCR.
- The patient exhibited low-titer IgM antibodies, characteristic of early Lyme disease, despite the late-stage osteomyelitis presentation.
Findings:
- Hematogenous dissemination of Borrelia burgdorferi is suggested by the widespread bone lesions and positive serum PCR.
- Conventional antibiotics were ineffective, but ceftriaxone therapy resulted in a rapid and sustained cure.
- Polymerase chain reaction (PCR) proved highly sensitive for detecting Borrelia burgdorferi in clinical samples.
Implications:
- Borrelia burgdorferi should be considered in the differential diagnosis of pediatric subacute osteomyelitis.
- Accurate diagnostic methods, including PCR, are vital for identifying Borrelia burgdorferi in atypical presentations.
- Ceftriaxone is an effective treatment for Borrelia burgdorferi-induced osteomyelitis.