NEUROBORRELIOOSIN OIREET LAPSILLA

[Bb]

Lähettäjä: Soijuv Lähetetty: 6.7.2005 14:23

Acta Paediatr Suppl. 1993 Feb;386:1-75.


Epidemiology and clinical manifestations of Lyme borreliosis in childhood.
A prospective multicentre study with special regard to neuroborreliosis.

Christen HJ ,Hanefeld F ,Eiffert H ,Thomssen R .

Department of Pediatrics, University Hospital, Gottingen, Germany.

Lyme borreliosis is a tick-borne infection caused by the spirochete Borrelia
burgdorferi, whose discovery in 1982 solved an aetiological mystery
involving a variety of dermatological and neurological disorders and
explained their association with Lyme disease. Lyme borreliosis occurs
frequently and is readily treatable with antibiotics. Along with its
discovery, however, came the realization that it is difficult to diagnose
accurately, especially antibody diagnosis. False-positive antibody results
in particular led to gradual widening of the clinical spectrum, and
differential diagnosis became increasingly difficult. This prospective,
multicentre study presents a systematic description of Lyme borreliosis in
childhood, emphasizing epidemiological and clinical issues. Because,
predominantly, inpatients were examined, Lyme neuroborreliosis was the focus
of the study, with the chief concern being to minimize false-positive
results. To this end, we chose to narrow the diagnostic criteria, using the
presence of specific antibodies in the cerebrospinal fluid as the
determining factor. The epidemiological investigation was focused on the
incidence of Lyme neuroborreliosis in childhood in southern Lower Saxony as
well as on the prevalence of Lyme neuroborreliosis among acute-inflammatory
neurological illnesses in children. The clinical part of the study aimed at
establishing criteria for differential diagnosis in addition to the
detection of specific antibodies. The detection of specific IgM antibodies
using an IgM capture ELISA confirmed the presence of acute Lyme borreliosis.
The study examined 208 children with Lyme borreliosis, of whom 169 had Lyme
neuroborreliosis, from mid-1986 until the end of 1989. The yearly incidence
of Lyme neuroborreliosis in Lower Saxony was 5.8 cases/100,000 children aged
1 to 13. The manifestation index was 0.16, or one case of Lyme
neuroborreliosis per 620 infected children, compared with the presence of
specific antibodies against B. burgdorferi for children in the same age
group and region. Both the seasonal distribution of Lyme borreliosis, which
peaked in summer and autumn, as well as the information about when the tick
bites took place point to an incubation period of a few weeks. The most
frequent manifestation of Lyme neuroborreliosis in childhood was acute
peripheral facial palsy, found in 55% of all cases (n = 93). Lyme
borreliosis proved to be the most frequently verifiable cause of acute
peripheral facial palsy in children, causing every second case of this
disorder in summer and autumn

PMID: 8443440 [PubMed - indexed for MEDLINE]