Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome.
BACKGROUND
Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.


METHODS
Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).


RESULTS
Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.


CONCLUSIONS
Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.
Skogman
Barbro Hedin
BH
Pediatric Clinic at the University Hospital, Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. hedinskogman@ltdalarna.se
Croner
Stefan
S
Nordwall
Maria
M
Eknefelt
Mattias
M
Ernerudh
Jan
J
Forsberg
Pia
P
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi / Q000276:immunology; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid / Q000276:immunology; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013548:Sweden; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M; D002443:Ceftriaxone; D004318:Doxycycline