Natural history and long-term consequences of Lyme disease in children.

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Natural history and long-term consequences of Lyme disease in children.

1: N Engl J Med. 1991 Jul 18;325(3):159-63. Links

Comment in:

N Engl J Med. 1991 Dec 26;325(26):1886.

The long-term course of Lyme arthritis in children.

 

Szer IS,

Taylor E,

Steere AC.

Department of Pediatrics, Floating Hospital for Infants and Children, New

England Medical Center, Tufts University School of Medicine, Boston.

BACKGROUND AND METHODS. The natural history of Lyme disease is not

completely known. We studied the long-term course of Lyme arthritis in 46

children in whom the onset of the disease occurred between 1976 and 1979 and

who received no antibiotic therapy for at least the first four years of the

illness. RESULTS. Of the 46 children (age range, 2 to 15 years), 33 (72

percent) initially had erythema migrans, 7 (15 percent) had influenza-like

symptoms, and 6 (13 percent) had migratory joint pain. These manifestations

were followed by brief attacks of arthritis, particularly affecting the

knee. The percentage of children with recurrent episodes of arthritis

declined each year. By year 4, only 10 children still had a mean of two

episodes of arthritis per year; the duration of arthritis was generally

longer in older children (P less than 0.05). During the sixth year of

illness, two children (4 percent) had keratitis, and more than 10 years

after the onset of disease, a subtle encephalopathy developed in two other

children. Of the 39 children whom we were able to contact in 1988-1989, 12

(31 percent) still had occasional brief episodes of joint pain and 1 (3

percent) had marked fatigue. All 46 children had positive IgG antibody

responses to Borrelia burgdorferi throughout the illness and on long-term

follow-up. As compared with those who became asymptomatic, the children with

recurrent symptoms more often had IgM responses to the spirochete and had

significantly higher IgG titers (P less than 0.05). CONCLUSIONS. The course

of initially untreated Lyme disease in children may include acute infection

followed by attacks of arthritis and then by keratitis, subtle joint pain,

or chronic encephalopathy.

PMID: 2052061 [PubMed - indexed for MEDLINE]

 

1: J Rheumatol. 1994 Mar;21(3):454-61. Links

Lyme disease: an infectious and postinfectious syndrome.

 

Asch ES,

Bujak DI,

Weiss M,

Peterson MG,

Weinstein A.

Department of Medicine, New York Medical College, Valhalla 10595.

OBJECTIVE. To determine chronic morbidity and the variables that influence

recovery in patients who had been treated for Lyme disease. METHODS.

Retrospective evaluation of 215 patients from Westchester County, NY, who

fulfilled Centers for Disease Control case definition for Lyme disease, were

anti-Borrelia antibody positive and were diagnosed and treated at least one

year before our examination. RESULTS. Erythema migrans had occurred in 70%

of patients, neurological involvement in 29%, objective cardiac problems in

6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of

3.2 years after initial treatment. A history of relapse with major organ

involvement had occurred in 28% and a history of reinfection in 18%.

Anti-Borrelia antibodies, initially present in all patients, were still

positive in 32%. At followup, 82 (38%) patients were asymptomatic and

clinically active Lyme disease was found in 19 (9%). Persistent symptoms of

arthralgia, arthritis, cardiac or neurologic involvement with or without

fatigue were present in 114 (53%) patients. Persistent symptoms correlated

with a history of major organ involvement or relapse but not the continued

presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients

with persistent symptoms had predominantly arthralgia and fatigue.

Antibiotic treatment within 4 weeks of disease onset was more likely to

result in complete recovery. Children did not significantly differ from

adults in disease manifestations or in the frequency of relapse, reinfection

or complete recovery. CONCLUSION. Despite recognition and treatment, Lyme

disease is associated with significant infectious and postinfectious

sequelae.

PMID: 8006888 [PubMed - indexed for MEDLINE]

 

1: Pediatr Infect Dis J. 1998 Mar;17(3):189-96. Links

Neurocognitive abnormalities in children after classic manifestations of

Lyme disease.

 

Bloom BJ,

Wyckoff PM,

Meissner HC,

Steere AC.

Division of Rheumatology/Immunology, Tufts University School of Medicine,

and the Floating Hospital for Children, Boston, MA, USA.

BACKGROUND: In adults a subtle encephalopathy characterized primarily by

memory impairment, irritability and somnolence may occur months to years

after classic manifestations of Lyme disease. However, only limited

information is available about whether there is an equivalent disorder in

children. METHODS: Case series of five children seen in a Lyme disease

clinic in a university referral center for evaluation of neurocognitive

symptoms that developed near the onset of infection or months after classic

manifestations of Lyme disease. The diagnosis was based on clinical

symptoms, serologic reactivity to Borrelia burgdorferi and intrathecal

antibody production to the spirochete. Evaluation included detailed

neuropsychologic testing. After evaluation the children were treated with

intravenous ceftriaxone for 2 or 4 weeks. Follow-up was done in the clinic

and a final assessment was made by telephone 2 to 7 years after treatment.

RESULTS: Along with or months after erythema migrans, cranial neuropathy or

Lyme arthritis, the five children developed behavioral changes,

forgetfulness, declining school performance, headache or fatigue and in two

cases a partial complex seizure disorder. All five patients had IgG antibody

responses to B. burgdorferi in serum as well as intrathecal IgG antibody

production to the spirochete. Two patients had CSF pleocytoses and three did

not. Despite normal intellectual functioning the five children had mild to

moderate deficits in auditory or visual sequential processing. After

ceftriaxone therapy, the four children in whom follow-up information was

available experienced gradual improvement in symptoms. CONCLUSIONS: Children

may develop neurocognitive symptoms along with or after classic

manifestations of Lyme disease. This may represent an infectious or

postinfectious encephalopathy related to B. burgdorferi infection.

PMID: 9535244 [PubMed - indexed for MEDLINE