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Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome - a prospective cohort study
Örebro Univ, Sch Med Sci, Örebro, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
2018 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 18, article id 189Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2018. Vol. 18, article id 189
Keywords [en]
Lyme neuroborreliosis, Erythema migrans, Facial nerve palsy, Clinical outcome, Children
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:uu:diva-358149DOI: 10.1186/s12887-018-1163-2ISI: 000434838800001PubMedID: 29890951OAI: oai:DiVA.org:uu-358149DiVA, id: diva2:1268078
Funder
Swedish Society of Medicine, SLS-498901Swedish Society of Medicine, SLS-93191Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2018-12-04Bibliographically approved

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Skogman, Barbro H.

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