Demographic features, clinical characteristics and laboratory findings in children with multiple erythema migrans in Slovenia.
OBJECTIVE
To identify demographic, clinical and laboratory characteristics of children with multiple erythema migrans (EM) in Slovenia.


METHODS
We prospectively studied patients aged 15 years and less, examined at our department for multiple EM in 1996 and 1997. Demographic and clinical data were collected by means of a questionnaire. In addition, basic haematological and biochemical investigations, serologic testing, and Borrelia cerebrospinal fluid and blood cultures were performed.


RESULTS
Ninety-five children (44 girls, 55 boys) aged 1 to 13.5 (median, 4.5) years fulfilled the inclusion criteria. A tick bite was recalled by 23%. The incubation period was 10.5 (range, 1 to 150) days, the duration of skin lesions before the initial examination 4 (range, 1 to 54) days, and the median number of skin lesions, 4.5 (range, 2 to 35). The initial disease was mild in 81% of patients. Local and systemic symptoms were reported by 11% and 30% of children, respectively. Clinical signs accompanying EM lesions were found in 42%. Cerebrospinal pleocytosis (predominantly lymphocytic) was seen in 18% of patients; none of them had frank clinical evidence of central nervous system involvement. Serum IgM and IgG antibodies were detected in 28% and 22% of children, respectively. In 3/79 (4%) patients, Borreliae were isolated from the blood and in 2/83 (2%) from the cerebrospinal fluid. In 2/81 (2%) children, borrelial IgG intrathecal antibody production was demonstrated.


CONCLUSIONS
Multiple EM in Slovene children is a mild disease. However, some patients had an associated, usually asymptomatic, infection of the central nervous system.
Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.
M
M
Arnez
D
D
Pleterski-Rigler
J
J
Ahcan
E
E
Ruzić-Sabljić
F
F
Strle
D000293:Adolescent; D000367:Age Factors; D001769:Blood / Q000382:microbiology; D015748:Borrelia burgdorferi Group / Q000276:immunology / Q000302:isolation & purification; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D015787:Erythema Chronicum Migrans / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid; D007223:Infant; D007964:Leukocytosis; D008297:Male; D011446:Prospective Studies; D017524:Slovenia / Q000453:epidemiology
D007074:Immunoglobulin G; D007075:Immunoglobulin M