Clinical Features of Lyme Disease in Children
ABSTRACT & COMMENTARY
Synopsis: The characteristic erythema migrans lesion is found in 90% of children with newly diagnosed Lyme disease. Treatment with oral antimicrobial therapy is followed by prompt resolution of symptoms and few long-term sequelae.
Source: Gerber MA, et al. Lyme disease in children in southeastern Connecticut. N Engl J Med 1996;335:1270-1274.
Two hundred one connecticut children, 1-21 years of age, were diagnosed with Lyme disease in a prospective, longitudinal, community-based study. Ninety percent had typical skin rash (66% had a single erythema migrans and 23% had multiple erythema migrans lesions). Also present were arthritis in 6%, facial nerve palsy in 3%, aseptic meningitis in 2%, and carditis in 0.5%. At presentation, 37% of patients with a single erythema migrans lesion and 89% of these with multiple lesions had antibodies against Borrelia burgdorferi. One hundred ninety-eight children were treated with conventional doses of antibiotics (amoxicillin in 71%, doxycycline in 27%), most for 3-4 weeks. All had prompt clinical response. At later follow-up (mean, 25.4 months), none of the patients had evidence of recurrent or chronic Lyme disease.
COMMENT BY ROBERT BALTIMORE, MD, FAAP
Lyme disease is highly endemic in southeastern Connecticut, and pediatricians there are very familiar with the diagnosis and treatment of this "new" infectious disease. This prospective study from five pediatric practices in southeastern Connecticut documented the clinical manifestations, serology, treatment, and follow-up of 201 children with Lyme disease diagnosed over a 20-month period.
The characteristic erythema migrans lesion was seen in 186 (93%) children. One hundred children had single lesions, and the patients were classified as "early localized Lyme disease." Eighty-four children had multiple lesions and were classified as "early disseminated Lyme disease." Non-specific, flu-like symptoms were common. Thirteen children were classified as having late disease. All had arthritis and/or arthralgia. Only about one-third of children had a history of a recognized tick bite.
Antibiotic therapy, predominantly amoxicillin or doxycycline, was usually given orally for 2-3 weeks. This was followed by prompt and permanent resolution of symptoms.
Serologic confirmation of Borrelia infection was found in only about one-third of children with early disease, and one month after completion of antibiotic therapy, few of the remaining children had a seroconversion.
The authors conclude that the prognosis of children with early Lyme disease who are treated with appropriate antimicrobial therapy is excellent. (Dr. Baltimore is Professor of Pediatrics and Epidemiology and Public Health, Yale University School of Medicine.)
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