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Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group
M A Gerber1, E D Shapiro, G S Burke
1Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
Insights
Prompt antimicrobial treatment for early Lyme disease in children leads to excellent outcomes. Most children present with erythema migrans and recover fully, with no evidence of chronic or recurrent disease long-term.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Lyme disease incidence is highest in children.
- Limited prospective data exist on pediatric Lyme disease manifestations and outcomes.
Purpose of the Study:
- To prospectively investigate clinical features and outcomes of childhood Lyme disease.
- To provide data on treatment response and long-term prognosis in pediatric patients.
Main Methods:
- Prospective, longitudinal, community-based cohort study.
- Inclusion of children with newly diagnosed Lyme disease in an endemic area.
- Collection of clinical, demographic, serological data, and serial follow-up evaluations.
Main Results:
- 201 children enrolled (median age 7 years).
- Erythema migrans was the primary manifestation (66% single, 23% multiple lesions).
- 94% were asymptomatic after 4 weeks of antimicrobial therapy; no chronic/recurrent disease observed at mean 25.4-month follow-up.
Conclusions:
- Erythema migrans is the predominant early sign in pediatric Lyme disease.
- Prompt antimicrobial treatment ensures an excellent prognosis for early childhood Lyme disease.
- Long-term follow-up indicates a favorable outcome with conventional therapy.
Background:
Although the incidence of Lyme disease is highest in children, there are few prospective data on the clinical manifestations and outcomes in children.
Methods:
We conducted a prospective, longitudinal, community-based cohort study of children with newly diagnosed Lyme disease in an area of Connecticut in which the disease is highly endemic. We obtained clinical and demographic information and performed serial antibody tests and follow-up evaluations.
Results:
Over a period of 20 months, 201 consecutive patients were enrolled; their median age was 7 years (range, 1 to 21). The initial clinical manifestations of Lyme disease were a single erythema migrans lesion in 66 percent, multiple erythema migrans lesions in 23 percent, arthritis in 6 percent, facial-nerve palsy in 3 percent, aseptic meningitis in 2 percent, and carditis in 0.5 percent. At presentation, 37 percent of the patients with a single erythema migrans lesion and 89 percent of those with multiple erythema migrans lesions had antibodies against Borrelia burgdorferi. All but 3 of the 201 patients were treated for two to four weeks with conventional antimicrobial therapy, which was administered orally in 96 percent. All had prompt clinical responses. After four weeks, 94 percent were completely asymptomatic (including the two patients whose parents had refused to allow antimicrobial treatment). At follow-up a mean of 25.4 months later, none of the patients had evidence of either chronic or recurrent Lyme disease. Six patients subsequently had a new episode of erythema migrans.
Conclusions:
About 90 percent of children with Lyme disease present with erythema migrans, which is an early stage of the disease. The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents.