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Multicenter Study
. 2018 Jun 11;18(1):189.
doi: 10.1186/s12887-018-1163-2.

Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome - a prospective cohort study

Kesia Backman  1 , Barbro H Skogman  2   3
Affiliations
Multicenter Study

Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome - a prospective cohort study

Kesia Backman et al. BMC Pediatr. .

Abstract

Background: Erythema migrans (EM) is the most common manifestation of Lyme borreliosis (LB), caused by the spirochete Borrelia burgdorferi sensu lato. The infection can disseminate into the nervous system and cause Lyme neuroborreliosis (LNB), the second most frequent LB manifestation in children. The aim of this prospective cohort study is to describe the occurrence of EM among children with LNB and to evaluate possible differences in clinical characteristics or outcome between LNB patients with and without EM.

Method: Children being evaluated for LNB in southeast Sweden during the period 2010-2014 underwent a clinical examination, laboratory testing and filled out a questionnaire regarding duration and nature of symptoms, EM and the child's health. Children were classified according to European guidelines for LNB. Clinical recovery was evaluated at a 2-month follow-up.

Results: The occurrence of EM among children with LNB was 37 out of 103 (36%). Gender, age, observed tick bite, clinical features, duration of neurological symptoms or clinical outcome did not differ significantly between LNB patients with or without EM. However, facial nerve palsy was significantly more common among children with EM in the head and neck area.

Conclusion: EM occurred in 36% of children with LNB and the location on the head and neck was more common among children with facial nerve palsy. EM was not associated with other specific clinical characteristics or outcome. Thus, the occurrence of EM in children with LNB cannot be useful as a prognostic factor for clinical outcome. This aspect has not previously been highlighted but seems to be relevant for the paediatrician in a clinical setting.

Keywords: Children; Clinical outcome; Erythema migrans; Facial nerve palsy; Lyme neuroborreliosis.

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Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in this study involving human participants (children) were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval of the study was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Dnr 2010/106). Written informed consent was received from all parents/guardians.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Month of admission for patients (n = 295) being evaluated for Lyme neuroborreliosis (LNB)
Fig. 2
Fig. 2
Occurrence and location of erythema migrans (EM) among patients with Lyme neuroborreliosis (LNB) and controls
See this image and copyright information in PMC

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