Approach of pediatric neuroborreliosis

Abstract

Diagnosing Lyme neuroborreliosis in the pediatric population can be challenging, especially in absence of erythema chronicum migrans or explicit neurological symptoms. Consensus on the diagnostic process in children is lacking. This retrospective study gives an overview of most frequent presenting symptoms, work up and management at the University Hospitals Leuven, Belgium.

A retrospective analysis was performed of 20 pediatric patients with Lyme neuroborreliosis treated at the University Hospitals of Leuven from 2014 until 2019. Medical records were reviewed and data, including peripheral blood and cerebrospinal fluid results, imaging reports and treatment methods were collected.

All patients presented during spring or summer time. In only a minority of patients (25%) a history of a tick bite was reported, and erythema chronicum migrans lesions were never even noted. Clinical presentation varied but facial nerve palsy was the main presenting symptom (75%). Only fifty percent of these children had a positive immunoblot in peripheral blood, while eighty percent had intrathecal synthesis of Borrelia antibodies. All patients were treated with intravenous antibiotics, of which seventy percent had complete clinical resolution.  Fifteen percent of the patients had only minimal sequelae, other data were lacking.

Pediatric Lyme neuroborreliosis can be difficult to diagnose. Serological testing alone is not sufficient for the diagnosis. A lumbar puncture, although invasive, is necessary for confirmation of the diagnosis by detection of intrathecal synthesis of Borrelia antibodies. Overall, prognosis is good after adequate antibiotic treatment.