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Monaghan M, Norman S, Gierdalski M, Marques A, Bost JE, DeBiasi RL. Reply to Correspondence. Pediatr Res 2024; 95:3-4. [PMID: 37723215 DOI: 10.1038/s41390-023-02790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Maureen Monaghan
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephanie Norman
- Center for Translational Research, Children's Research Institute, Washington, DC, USA
| | - Marcin Gierdalski
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Center for Translational Research, Children's Research Institute, Washington, DC, USA
- Division of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - James E Bost
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Center for Translational Research, Children's Research Institute, Washington, DC, USA
- Division of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Roberta L DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Center for Translational Research, Children's Research Institute, Washington, DC, USA.
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Arnason S, Skogman BH. Effectiveness of antibiotic treatment in children with Lyme neuroborreliosis - a retrospective study. BMC Pediatr 2022; 22:332. [PMID: 35676665 PMCID: PMC9178872 DOI: 10.1186/s12887-022-03335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lyme neuroborreliosis (LNB) is a tick-borne infection caused by the spirochete Borrelia burgdorferi sensu lato complex with various neurological manifestations. The recommended treatment for LNB in Swedish children has been intravenous ceftriaxone 50–100 mg/kg × 1 (< 8 years of age) or oral doxycycline 4 mg/kg × 1 (≥ 8 years of age) for 10–14 days. Studies on adult LNB patients have shown equal efficacy for ceftriaxone and doxycycline, but no such studies have been conducted on pediatric LNB patients. The aim of this study is to retrospectively evaluate clinical outcome in children with LNB who have received intravenous ceftriaxone or oral doxycycline. Results Clinical and laboratory data from three previously conducted prospective studies on children with LNB (1998–2014) were retrospectively analyzed. A total of 321 children (1–19 years of age), who received antibiotic treatment for definite LNB or possible LNB, were included. Clinical outcome at the 2-month follow-up (recovery/non-recovery) was evaluated using Chi2 test and logistic multivariate regression analysis. Out of 321 LNB patients, 194 children (60%) had received ceftriaxone and 127 children (40%) had received doxycycline. When comparing clinical outcome between treatment groups, no difference was found (p = 0,217). Results did not change when incorporating relevant clinical and laboratory data into the logistic multivariate regression analysis. Conclusion In this large retrospective study, no difference in clinical outcome was found, independent of age, when comparing children who received ceftriaxone with those who received doxycycline, supporting an equal effectiveness for treatment of LNB pediatric patients. However, future randomized comparative treatment studies are warranted for evaluation of efficacy of antibiotic treatment in pediatric LNB patients.
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Affiliation(s)
- Sigurdur Arnason
- Department of Clinical Science, Intervention and Technology - CLINTEC, Alfred Nobels Allé 8, S-141 52, Huddinge, Sweden.,Department of Pediatric Infectious Diseases, Astrid Lindgren's Children's Hospital, Karolinska Vägen 22, S-171 64 Solna, Stockholm, Sweden
| | - Barbro H Skogman
- Center for Clinical Research Dalarna - Uppsala University, Nissers Väg 3, S-791 82, Falun, Sweden. .,Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Alfred Nobels Allé 8, S-141 52, Huddinge, Sweden. .,Department of Medical Sciences, Örebro University, Södra Grev Rosengatan 42 B, S-703 62, Örebro, Sweden.
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Pacheco A, Rutler O, Valenzuela I, Feldman D, Eskin B, Allegra JR. Positive Tests for Lyme Disease and Emergency Department Visits for Bell's Palsy Patients. J Emerg Med 2020; 59:820-827. [PMID: 32978030 DOI: 10.1016/j.jemermed.2020.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ("Lyme months"). OBJECTIVE Our aim was to determine whether positive tests for Lyme disease and visits are greater in the Lyme months than the rest of the year for patients with Bell's palsy in New Jersey emergency departments (EDs). METHODS We conducted a retrospective chart review from two New Jersey suburban EDs with consecutive patients from February 1, 2013 to January 31, 2018.We identified patients having Bell's palsy using the emergency physician diagnosis. We tabulated positive Lyme tests and visits for Bell's palsy by month of year. We calculated the ratio of positive tests and visits between the Lyme months and the rest of the year along with 95% confidence intervals (CIs). RESULTS There were 442 visits for Bell's palsy, 359 (81%) of these patients were tested for Lyme disease and 57 (16%) of the tests were positive. The Lyme months had 7.1 (95% CI 3.5-14.4) times more positive tests and 1.3 (95% CI 1.1-1.4) times more Bell's palsy visits than the rest of the year. Both measures peaked in July. CONCLUSIONS In a Lyme-endemic area, positive Lyme tests and ED visits for Bell's palsy are greatest in the Lyme months, peaking in July. This finding can help guide testing and treatment for patients in the ED with Bell's palsy during various months of the year.
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Affiliation(s)
| | | | | | | | - Barnet Eskin
- Morristown Medical Center, Morristown, New Jersey
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Garro A, Dash M, VanBuren JM, Nigrovic LE. Development of a pediatric Lyme meningitis symptom measurement instrument using a Delphi technique. Ticks Tick Borne Dis 2020; 11:101418. [PMID: 32299788 DOI: 10.1016/j.ttbdis.2020.101418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/13/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
Published Lyme meningitis treatment studies are limited by outcome measures that cannot capture day-to-day differences in clinical improvement. Our goal was to use expert consensus to develop a daily measurement instrument for assessing clinical improvement in children with Lyme meningitis. We assembled a panel of 24 nationally recognized Lyme disease experts to develop a pediatric daily symptom measurement instrument. Experts responded to four rounds of surveys, receiving feedback about the previous round prior to each subsequent round with anonymity for participants and responses. Using modified Delphi methods, we established a novel Lyme meningitis outcome instrument. The final Pediatric Lyme Meningitis Symptom Measurement instrument includes five items: headache (Likert scale), neck pain/stiffness (Likert scale), fever (yes/no), light sensitivity (yes/no) and vision problems (yes/no). We defined three consecutive days with a symptom score of zero as the minimum to define clinical improvement. Using expert consensus, we developed a novel Pediatric Lyme Meningitis Symptom Measurement instrument to measure treatment response daily for children with Lyme meningitis enrolled in clinical studies.
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Affiliation(s)
- Aris Garro
- Departments of Pediatrics and Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 125 Whipple Street, Providence, RI, USA.
| | - Miriam Dash
- Rhode Island Hospital, 593 Eddy Street, Providence, RI, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Harvard Medical School; Boston, MA and Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA
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Lopez SMC, Campfield BT, Nowalk AJ. Oral Management for Pediatric Lyme Meningitis. J Pediatric Infect Dis Soc 2019; 8:272-275. [PMID: 30169816 DOI: 10.1093/jpids/piy072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/18/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Guidelines for pediatric Lyme meningitis recommend treatment with parenteral therapy [1, 2]. Adult studies suggest that Lyme meningitis can be successfully treated with oral therapy. Our objective was to evaluate the clinical response, side effects and outcome of oral therapy for Lyme meningitis in the pediatric population compared with parenteral therapy in an area endemic for Lyme disease. METHODS We conducted a case series chart review from January 2012 to May 2017 of pediatrics patient diagnosed and treated for Lyme meningitis. We recorded clinical presentation, laboratory values, antimicrobial therapy and follow up after therapy to compare the efficacy of oral versus parenteral route of therapy. RESULTS We identified 38 patients diagnosed with Lyme meningitis. Thirty-two patients were discharge with exclusively oral therapy with: doxycycline and amoxicillin. We had only 2 patients developed potential adverse effects from oral doxycycline therapy. All patients treated with oral antibiotics had resolution of symptoms on follow up appointments. CONCLUSIONS Oral therapy for Lyme meningitis yields no serious adverse events, was well tolerated and showed resolution of symptoms.
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Affiliation(s)
- Santiago M C Lopez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pennsylvania
| | - Brian T Campfield
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pennsylvania.,Richard K. Mellon Institute for Pediatric Research, Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania
| | - Andrew J Nowalk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pennsylvania
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Neuroborreliosis in Swedish Children: A Population-based Study on Incidence and Clinical Characteristics. Pediatr Infect Dis J 2017; 36:1052-1056. [PMID: 28654563 DOI: 10.1097/inf.0000000000001653] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Borrelia burgdorferi is a common cause of bacterial meningitis, but there are very few studies on incidence in Europe. The aim of this study was to report the incidence and symptoms of neuroborreliosis in Swedish children. METHODS Medical records of children (< 15 years) treated for neuroborreliosis 2002-2014 were studied retrospectively. The patients were identified in the computerized registers of discharge diagnoses at the Departments of Pediatrics and Infectious Diseases in Gothenburg, Borås, Trollhättan and Halmstad using International Classification of Diseases 10 diagnosis codes G51.0, G01.9 and/or A69.1. Of those, patients with symptoms compatible with neuroborreliosis and a white blood cell count in cerebrospinal fluid ≥ 7 cells/mm with ≥ 80% mononuclear cells were included. Only children living in the city of Gothenburg and 10 surrounding municipalities were included. RESULTS Five hundred forty-eight children were included. The median age was 7 (1-14) years. The total incidence for the 13-year-period was 2.8/10,000 and remained unchanged during the period. The incidence was significantly higher in rural (4.0/10,000) than in urban municipalities (2.1/10,000). The most common presenting symptoms were headache (n = 335), fatigue (n = 330) and cranial nerve palsies (n = 329). The median duration of symptoms before admittance was 4.0 days for facial palsy and 14.0 days for other symptoms (P < 0.001). The median white blood cell count in cerebrospinal fluid was 129 (7-1069) cells/mm. CONCLUSIONS This study is the largest so far in a pediatric population. The incidence of neuroborreliosis was higher than in previous European reports. This might be explained by increased Borrelia awareness, the distribution of tick population in Sweden, and the possibility that Swedish children more frequently play outdoors.
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Dersch R, Hottenrott T, Schmidt S, Sommer H, Huppertz HI, Rauer S, Meerpohl JJ. Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis in children: a systematic review. BMC Neurol 2016; 16:189. [PMID: 27686962 PMCID: PMC5043629 DOI: 10.1186/s12883-016-0708-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many aspects of pharmacological treatment of Lyme neuroborreliosis in children, such as choice of drug, dosage, and duration are subject to intense debates, leading to uncertainties in patients' parents and healthcare providers alike. To assess the available evidence for pharmacological treatment for children with Lyme neuroborreliosis we conducted a systematic review. METHODS The comprehensive systematic literature search included randomized-controlled trials (RCTs) and non-randomized studies (NRS) on treatment of Lyme neuroborreliosis in children (age <18 years). Our primary outcome was neurological symptoms after treatment. Risk of bias was assessed with the Cochrane risk of bias tools for RCTs and NRS. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Two RCTs and four NRS were eligible for inclusion. Risk of bias in RCTs and NRS was generally high. Reporting of studies was generally poor. Regarding the primary outcome neurological symptoms at 1-3 months, no statistically significant difference could be found in cohort studies between doxycycline and beta-lactam antibiotics. In two RCTs comparing penicillin G and ceftriaxone, no patient experienced residual neurological symptoms at the last reported time points. Quality of evidence according to GRADE was judged very low. CONCLUSIONS Data is scarce and with limited quality. Several issues could not be addressed due to scarcity of information. No eligible study compared different treatment durations. According to the available evidence, there seems to be no difference between different antibiotic agents for the treatment of Lyme neuroborreliosis in children regarding neurological symptoms. We found no evidence that supports extended antibiotic regimes. REVIEW REGISTRATION Systematic review registration: CRD42014008839 .
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Affiliation(s)
- Rick Dersch
- Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110 Freiburg im Breisgau, Germany
- Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Tilman Hottenrott
- Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Stefanie Schmidt
- Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110 Freiburg im Breisgau, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Harriet Sommer
- Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Stefan-Meier-Str- 26, D-79104 Freiburg, Germany
| | - Hans-Iko Huppertz
- Prof.-Hess-Kinderklinik, Klinikum Bremen-Mitte, Sankt-Jürgen-Str. 1, D-28177 Bremen, Germany
| | - Sebastian Rauer
- Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106 Freiburg, Germany
| | - Joerg J. Meerpohl
- Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110 Freiburg im Breisgau, Germany
- Centre de Recherche Épidémiologie et Statistique INSERM Sorbonne Paris, Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris Cedex 04, France
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Skogman BH, Sjöwall J, Lindgren PE. The NeBoP score - a clinical prediction test for evaluation of children with Lyme Neuroborreliosis in Europe. BMC Pediatr 2015; 15:214. [PMID: 26678681 PMCID: PMC4682231 DOI: 10.1186/s12887-015-0537-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/12/2015] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis of Lyme neuroborreliosis (LNB) in Europe is based on clinical symptoms and laboratory data, such as pleocytosis and anti-Borrelia antibodies in serum and CSF according to guidelines. However, the decision to start antibiotic treatment on admission cannot be based on Borrelia serology since results are not available at the time of lumbar puncture. Therefore, an early prediction test would be useful in clinical practice. The aim of the study was to develop and evaluate a clinical prediction test for children with LNB in a relevant European setting. Method Clinical and laboratory data were collected retrospectively from a cohort of children being evaluated for LNB in Southeast Sweden. A clinical neuroborreliosis prediction test, the NeBoP score, was designed to differentiate between a high and a low risk of having LNB. The NeBoP score was then prospectively validated in a cohort of children being evaluated for LNB in Central and Southeast Sweden (n = 190) and controls with other specific diagnoses (n = 49). Results The sensitivity of the NeBoP score was 90 % (CI 95 %; 82–99 %) and the specificity was 90 % (CI 95 %; 85–96 %). Thus, the diagnostic accuracy (i.e. how the test correctly discriminates patients from controls) was 90 % and the area under the curve in a ROC analysis was 0.95. The positive predictive value (PPV) was 0.83 (CI 95 %; 0.75–0.93) and the negative predictive value (NPV) was 0.95 (CI 95 %; 0.90–0.99). Conclusion The overall diagnostic performance of the NeBoP score is high (90 %) and the test is suggested to be useful for decision-making about early antibiotic treatment in children being evaluated for LNB in European Lyme endemic areas. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0537-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbro H Skogman
- Paediatric clinic, Falun General Hospital, Nissers väg 3, S-791 82, Falun, Sweden. .,Center for Clinical Research (CKF) Dalarna-Uppsala University, S-791 31, Falun, Sweden.
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, S-581 85, Linköping, Sweden.
| | - Per-Eric Lindgren
- Department of Clinical and Experimental Medicine, Medical Microbiology, Linköping University, S-581 85, Linköping, Sweden. .,Microbiological Laboratory, Medical Services, County Hospital Ryhov, S-551 85, Jönköping, Sweden.
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Sonnleitner A, Trobisch A, Klobassa D, Zenz W. Borreliose im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3251-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Lantos PM. Chronic Lyme disease: the controversies and the science. Expert Rev Anti Infect Ther 2014; 9:787-97. [DOI: 10.1586/eri.11.63] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Drack FD, Weissert M. Outcome of peripheral facial palsy in children - a catamnestic study. Eur J Paediatr Neurol 2013; 17:185-91. [PMID: 23041225 DOI: 10.1016/j.ejpn.2012.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 08/25/2012] [Accepted: 09/01/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Even though the etiologies, therapies and prognoses of acute peripheral facial palsy (PFP) differ among children and adults, not many studies focus on children. METHODS We performed a retrospective study of 84 children, aged 10 months to 16 3/12 years, who were seen at the Children's Hospital of Eastern Switzerland between 1998 and 2007 due to PFP. Data about etiology, diagnostics and therapy were gathered from medical files, the outcome by questionnaires. Among 9 patients with residual symptoms, 6 returned for a follow-up visit and the results were documented with photographs. Recovery was graded by the House-Brackmann scale. RESULTS There were 83 unilateral and 1 bilateral case(s) of FP; neuroborreliosis (NB) causing 26 cases (31.0%), other infections 6 cases (7.1%) and toxicity of methotrexat 1 case (1.2%); 51 cases (60.7%) were classified as idiopathic (IPFP). Between the months June and November, the number of cases with NB rose to 53.3%, while there was no case between the months of January and April. Only 4 patients with IPFP received steroids. 75 patients (89.3%) recovered completely (HB-Grade I). 9 patients (10.7%) showed slight residual symptoms (HB-Grade II). Of these, 6 had IPFP, 1 had NB and 2 had otitis media (OM). DISCUSSION Almost a third of all palsies were caused by NB; during summer and fall, NB accounted for over half the cases. Patients with borreliosis showed a higher recovery rate than those with OM or IPFP. Almost 90% of the patients investigated recovered completely, even without steroid treatment. Residual symptoms were slight.
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Affiliation(s)
- Felicia D Drack
- Ostschweizer Kinderspital, Claudiusstrasse 6, 9006 St.Gallen, Switzerland.
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Skogman BH, Glimåker K, Nordwall M, Vrethem M, Ödkvist L, Forsberg P. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics 2012; 130:262-9. [PMID: 22802606 DOI: 10.1542/peds.2011-3719] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine long-term clinical outcome in children with confirmed Lyme neuroborreliosis (LNB) and to evaluate persistent subjective symptoms compared with a control group. METHODS After a median of 5 years, 84 children with confirmed LNB underwent a neurologic re-examination, including a questionnaire. Medical records were analyzed, and a control group (n = 84) was included. RESULTS The total recovery rate was 73% (n = 61). Objective neurologic findings, defined as "definite sequelae," were found in 16 patients (19%). The majority of these children had persistent facial nerve palsy (n = 11), but other motor or sensory deficits occurred (n = 5). Neurologic signs and/or symptoms defined as "possible sequelae" were found in another 7 patients (8%), mainly of sensory character. Nonspecific subjective symptoms were reported by 35 patients (42%) and 32 controls (38%) (nonsignificant). Affected daily activities or school performance were reported to the same extent in both groups (23% vs 20%, nonsignificant). CONCLUSIONS The long-term clinical recovery rate was 73% in children with confirmed LNB. Persistent facial nerve palsy occurred in 13%, whereas other motor or sensory deficits were found in another 14%. Neurologic deficits did not affect daily activities or school performance more often among patients than controls and should be considered as mild. Furthermore, nonspecific subjective symptoms such as headache, fatigue, or memory or concentration problems were reported as often among patients as controls and should not be considered as sequelae after LNB.
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Affiliation(s)
- Barbro H Skogman
- Center for Clinical Research in Dalarna (CKF), Nissersv. 3, SE-791 82 Falun, Sweden.
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15
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Oral antibiotic treatment and long-term outcomes of Lyme facial nerve palsy. Infection 2011; 39:239-45. [DOI: 10.1007/s15010-011-0107-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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Bhate C, Schwartz RA. Lyme disease. J Am Acad Dermatol 2011; 64:639-53; quiz 654, 653. [DOI: 10.1016/j.jaad.2010.03.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/18/2010] [Accepted: 03/03/2010] [Indexed: 12/28/2022]
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Abstract
Lyme neuroborreliosis (LNB) represents the second most frequent manifestation of Lyme disease (LD) in Europe after cutaneous involvement. In the USA, LNB represents the third most frequent manifestation of LD after cutaneous involvement and arthritis. The scope of this article is, in the light of recent publications, to review the specific manifestations of LNB in children including predictive models, and to discuss diagnosis criteria, new diagnostic tools and new therapeutic options. Differences in disease patterns between the USA and Europe are also highlighted.
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Affiliation(s)
- David Tuerlinckx
- Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Département de Pédiatrie, Yvoir, Belgium.
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Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 2009; 17:8-16, e1-4. [PMID: 19930447 DOI: 10.1111/j.1468-1331.2009.02862.x] [Citation(s) in RCA: 418] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- A Mygland
- Department of Neurology, Sorlandet Sykehus, Kristiansand, Norway.
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Borg R, Dotevall L, Hagberg L, Maraspin V, Lotric-Furlan S, Cimperman J, Strle F. Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis. ACTA ACUST UNITED AC 2009; 37:449-54. [PMID: 16012005 DOI: 10.1080/00365540510027228] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This prospective, open-label, non-randomized trial at the University Departments of Infectious Diseases in Ljubljana, Slovenia, and Göteborg, Sweden, was conducted to compare the kinetics of the cerebrospinal fluid (CSF) mononuclear cell count after 10-14 d of ceftriaxone or doxycycline for treatment of Lyme neuroborreliosis. 29 patients were treated with intravenous ceftriaxone 2 g daily in Ljubljana and 36 patients with oral doxycycline 400 mg daily in Göteborg. The study protocol included lumbar puncture before and 6-8 weeks after treatment initiation. There was a marked decrease (1.2 log10 x 10(6)/l) of the median CSF mononuclear cell count following treatment. With the assumption of a linear regression of the logarithmic mononuclear cell counts between the 2 lumbar punctures, no significant difference between the 2 antibiotic treatments could be found. All patients were clinically much improved after treatment. At 6 months follow-up 23 (79%) of the ceftriaxone- and 26 (72%) of the doxycycline-treated patients were completely recovered. Intravenous ceftriaxone or oral doxycycline was found to be effective, safe, and convenient for treatment of Lyme neuroborreliosis.
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Affiliation(s)
- Rebecca Borg
- Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden.
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Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatr Infect Dis J 2008; 27:1089-94. [PMID: 19008771 DOI: 10.1097/inf.0b013e31817fd423] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery. MATERIAL/METHODS Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174). RESULTS Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified. CONCLUSIONS Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.
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21
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Borrelia Antibodies in Children Evaluated for Lyme Neuroborreliosis. Infection 2008; 36:463-6. [DOI: 10.1007/s15010-008-6259-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 03/13/2008] [Indexed: 10/21/2022]
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22
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Abstract
Studies have shown that most patients diagnosed with chronic Lyme disease either have no objective evidence of previous or current infection with Borrelia burgdorferi or are patients who should be classified as having post-Lyme disease syndrome, which is defined as continuing or relapsing nonspecific symptoms (such as fatigue, musculoskeletal pain, and cognitive complaints) in a patient previously treated for Lyme disease. Despite extensive study, there is currently no clear evidence that post-Lyme disease syndrome is caused by persistent infection with B burgdorferi. Four randomized placebo-controlled studies have shown that antibiotic therapy offers no sustained benefit to patients who have post-Lyme disease syndrome. These studies also showed a substantial placebo effect and a significant risk of treatment-related adverse events. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and controlled trials of new approaches to the treatment and management of these patients are needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA.
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23
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Abstract
Lyme arthritis is one of the manifestations of Lyme disease and is caused by infection with Borrelia burgdorferi sensu lato. This article reviews the current knowledge regarding the epidemiology, etiology and pathogenesis as well as the clinical manifestations, the diagnosis, treatment and prognosis with special emphasis on children and adolescents.
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Affiliation(s)
- F Dressler
- Pädiatrische Pneumologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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24
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Tveitnes D, Øymar K, Natås O. Acute facial nerve palsy in children: how often is it lyme borreliosis? SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2007; 39:425-31. [PMID: 17464865 DOI: 10.1080/00365540601105764] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute facial nerve palsy in children may be caused by infection by Borrelia burgdorferi, but the incidence of facial nerve palsy and the proportion of facial nerve palsy caused by Lyme borreliosis may vary considerably between areas. Furthermore, it is not well known how often facial nerve palsy caused by Lyme borreliosis is associated with meningitis. In this population-based study, children admitted for acute facial nerve palsy to Stavanger University Hospital during 9 y from 1996 to 2004 were investigated by a standard protocol including a lumbar puncture. A total of 115 children with facial nerve palsy were included, giving an annual incidence of 21 per 100,000 children. 75 (65%) of these were diagnosed as Lyme borreliosis, with all cases occurring from May to November. Lymphocytic meningitis was present in all but 1 of the children with facial nerve palsy caused by Lyme borreliosis where a lumbar puncture was performed (n = 73). In this endemic area for Borrelia burgdorferi, acute facial nerve palsy in children was common. The majority of cases were caused by Lyme borreliosis, and nearly all of these were associated with lymphocytic meningitis.
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Affiliation(s)
- Dag Tveitnes
- Department of Paediatrics, University of Bergen, Norway
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25
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Hansmann Y. Le traitement des phases secondaires et tertiaires de la borréliose de Lyme. Med Mal Infect 2007; 37:479-86. [PMID: 17367972 DOI: 10.1016/j.medmal.2006.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 12/21/2022]
Abstract
The treatment of secondary and tertiary Lyme borreliosis is difficult because of antibiotic lack of efficacy. This fact may be explained by several factors: the specific pathophysiology, involving not only the presence of bacteria, but also immunological reactions. There is no specific method of diagnosis resulting in difficulties for good indication of treatment and to evaluate treatment efficacy. The literature review shows that ceftriaxone and doxycycline are the two most efficient antibiotics in this indication. Even if the methodology of the published studies is not always convincing, these two antibiotics proved their efficacy in articular as well as in neurological forms of the disease. In the late stage of borreliosis, antibiotics are less efficient. Various treatment modalities with different dosage or duration of treatment cannot let us conclude on a convincing regimen.
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Affiliation(s)
- Y Hansmann
- Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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26
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Abstract
Although pediatric Lyme borreliosis (LB) need not be a separate nosological entity, there are clinically important differences in presentation, antibiotic regimens and outcomes in children, which provide lessons that can be extrapolated to the disease as it affects adults. A large proportion of the worldwide data is obtained from children. The aim of this presentation is not to present an exhaustive review of the pediatric literature, but to review a selection of pediatric studies that have made a significant contribution to our body of knowledge in Lyme borreliosis.
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Affiliation(s)
- Sunil K Sood
- Pediatric Infectious Diseases, Schneider Children's Hospital at North Shore, Albert Einstein College of Medicine, Manhasset, NY 11030, USA.
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27
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Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. [PMID: 17029130 DOI: 10.1086/508667] [Citation(s) in RCA: 1257] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 08/21/2006] [Indexed: 12/19/2022] Open
Abstract
Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA.
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28
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Abstract
Tick-borne encephalopathies constitute a broad range of infectious diseases affecting the brain and other parts of the CNS. The causative agents are both viral and bacterial. This review focuses on the current most important tick-borne human diseases: tick-borne encephalitis (TBE; including Powassan encephalitis) and Lyme borreliosis. Rocky Mountain spotted fever (RMSF) and Colorado tick fever (CTF), less common tick-borne diseases associated with encephalopathy, are also discussed. TBE is the most important flaviviral infection of the CNS in Europe and Russia, with 10 000-12 000 people diagnosed annually. The lethality of TBE in Europe is 0.5% and a post-encephalitic syndrome is seen in over 40% of affected patients, often producing a pronounced impairment in quality of life. There is no specific treatment for TBE. Two vaccines are available to prevent infection. Although these have a good protection rate and good efficacy, there are few data on long-term immunity. Lyme borreliosis is the most prevalent tick-borne disease in Europe and North America, with >50 000 cases annually. Localised early disease can be treated with oral phenoxymethylpenicillin (penicillin V), doxycycline or amoxicillin. The later manifestations of meningitis, arthritis or acrodermatitis can be treated with oral doxycycline, oral amoxicillin or intravenous ceftriaxone; intravenous benzylpenicillin (penicillin G) or cefotaxime can be used as alternatives. The current use of vaccines against Lyme borreliosis in North America is under discussion, as the LYMErix vaccine has been withdrawn from the market because of possible adverse effects, for example, arthritis. RMSF and CTF appear only in North America. RMSF is an important rickettsial disease and is effectively treated with doxycycline. There is no treatment or preventative measure available for CTF.
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Affiliation(s)
- Göran Günther
- Infectious Diseases, Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University Hospital, Uppsala, Sweden.
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29
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Abstract
Nervous system infection with Borrelia burgdorferi frequently causes meningitis and rarely causes encephalomyelitis. Altered cognitive function also can occur in the absence of central nervous system infection. Recently developed serodiagnostic tools, such as the C6 assay, and appropriate use of Western blotting promise to improve diagnostic accuracy. Treatment trials have demonstrated the efficacy of relatively brief courses of oral antimicrobial agents, even in peripheral nervous system infection and meningitis. Several well-performed studies have clearly shown that prolonged antimicrobial treatment of "post-Lyme disease" is ineffective. Diagnosis and treatment of Lyme disease continue to improve.
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Affiliation(s)
- John J Halperin
- Department of Neurology, North Shore University Hospital, Manhasset, NY 11030, USA.
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30
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Abstract
OBJECTIVES The objectives of this study were to examine children with previous manifest neuroborreliosis and concommitant facial palsy to see whether there were any persisting symptoms and/or signs of persistent residual facial palsy. STUDY DESIGN Open, controlled prospective study. SETTING Tertiary referral center (University Hospital). PATIENTS The study was conducted on twenty-four patients with clinically manifest neuroborreliosis and facial palsy 3 to 5 years prior to the investigation. MAIN OUTCOME MEASURES Results of the clinical examination using the House-Brackmann scale were compared to results from two neuro-physiological examinations (qEMG and ENoG). RESULTS Approximately one-half of the patients with reported subjective symptoms of residual facial palsy had signs of slight dysfunction in the clinical examination using the House-Brackmann scale. There was no correlation between the subjective feeling of facial dysfunction and presence of clinical signs. Likewise, about one-half of the subjective facial dysfunction group, as well as the control group, were found to demonstrate pathological values in their neurophysiological examinations using qEMG and ENoG. CONCLUSIONS This study shows that the assumption is not true that all children who had neuroborreliosis with facial palsy will heal 100%. A small proportion of the children claim that several years after the infection, they have subjective symptoms of slight facial weakness on the affected side. Our study shows that some of these children, as well as some children without subjective symptoms of facial palsy, demonstrate a slight facial weakness when examined clinically. Likewise, signs of slight-to-moderate facial motor dysfunction were revealed in about half of the children with the two neurophysiological methods utilized in this study. It is interesting to note that there was no clear correlation between the presence of subjective symptoms, objective signs, and neurophysiological results.
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Affiliation(s)
- D Bagger-Sjöbäck
- Departments of Otolaryngology, Karolinska University Hospital, Stockholm, Sweden.
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31
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Wollina U, Krönert C, Heinig B. Bilateral callosities, plantar ulcers and peripheral neuropathy in a 15-year-old nondiabetic boy - think of neuroborreliosis. J Eur Acad Dermatol Venereol 2005; 19:259-60. [PMID: 15752310 DOI: 10.1111/j.1468-3083.2005.01012.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Abstract
Nervous system infection with Borrelia burgdorferi frequently causes meningitis and rarely causes encephalomyelitis. Altered cognitive function also can occur in the absence of central nervous system infection. Recently developed serodiagnostic tools, such as the C6 assay, and appropriate use of Western blotting, promise to improve diagnostic accuracy. Treatment trials have demonstrated the efficacy of relatively brief courses of oral antimicrobial agents, even in peripheral nervous system infection and meningitis. Several well-performed studies have clearly shown that prolonged antimicrobial treatment of "post-Lyme disease" is ineffective. Diagnosis and treatment of Lyme disease continue to improve.
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Affiliation(s)
- John J. Halperin
- Department of Neurology, North Shore University Hospital, Manhasset, NY 11030, USA.
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33
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Dedeoglu F, Sundel RP. Emergency department management of Lyme disease. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2004. [DOI: 10.1016/j.cpem.2003.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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35
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Nachman SA, Pontrelli L. Central nervous system Lyme disease. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2003; 14:123-30. [PMID: 12881800 DOI: 10.1053/spid.2003.127229] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Lyme disease is a disease caused by the spirochete, Borrelia burgdorferi. It is transmitted to humans via a bite from an infected tick. It has several classic stages or categories of illness, including early localized disease, early disseminated disease, and late disease. The focus of this article is on the manifestations, diagnosis, and treatment of Lyme disease of the central nervous system.
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Affiliation(s)
- Sharon A Nachman
- Stony Brook University, Department of Pediatrics, Stony Brook, NY 11794-8111, USA.
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