Solitary and multiple erythema migrans in children: comparison of demographic, clinical and laboratory findings.
BACKGROUND
Data on European children with erythema migrans (EM) are limited.


METHODS
553 patients, 333 with solitary and 220 with multiple EM, diagnosed between 1996 and 2000, were included in the prospective study. Demographic, clinical and laboratory data including borrelial serum immunofluorescence assay antibody titers and Borrelia burgdorferi sensu lato blood culture results were obtained; findings in solitary and multiple EM were compared.


RESULTS
Comparison revealed that children with multiple EM were younger (4.5 vs 6.5 years; p = 0.0000), less often reported a tick bite at the site of later skin lesion (25% vs 46%; p = 0.0000), had a longer incubation period (22 vs 13 days; p = 0.0028), more frequently presented with a ringlike lesion (99% vs 86%; p = 0.0000), less often reported associated local (15% vs 41%; p = 0.0000) but not systemic symptoms (28% vs 26%, p = 0.6913), more frequently had abnormal findings on physical examination (35% vs 26%; p = 0.0264), and a higher frequency of laboratory abnormalities including the presence of borrelial serum antibodies as well as B. burgdorferi sensu lato isolated from blood (12% vs 6%; p = 0.0267); younger age and male sex were identified as risk factors for the isolation of Borrelia. 40/44 isolates were Borrelia afzelii.


CONCLUSIONS
Analysis of a large group of European children with solitary and multiple EM revealed several demographic, clinical and laboratory differences between the two groups.
Arnez
M
M
Dept. of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, SLO-1525 Ljubljana, Slovenia. maja.arnez@kclj.si
Pleterski-Rigler
D
D
Luznik-Bufon
T
T
Ruzic-Sabljić
E
E
Strle
F
F
D000293:Adolescent; D017677:Age Distribution; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D015331:Cohort Studies; D015787:Erythema Chronicum Migrans / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008193:Lyme Disease / Q000453:epidemiology / Q000473:pathology; D008297:Male; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012698:Serologic Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D017524:Slovenia / Q000453:epidemiology