title: Pediatric tick-borne infections of the central nervous system in an endemic region of Sweden: a prospective evaluation of clinical manifestations.
abstract: Tick-borne encephalitis (TBE) and neuroborreliosis (NB) are well-known central nervous system (CNS) infections in children. Childhood tick-borne CNS infections are generally described as mild conditions. However, this view has recently been challenged, and the natural course, including potential sequelae, has been debated. If the diseases present with nonspecific symptoms and signs, some children may elude diagnosis. This study estimates the incidence of symptomatic tick-borne CNS infections in children under medical care and describes the spectrum of manifestations. One hundred twenty-four children with neurologic symptoms attending the Pediatric Emergency Department were included prospectively. Anti-TBE virus and anti-Borrelia serology results were analyzed together with inflammatory parameters in the blood and cerebrospinal fluid. Nearly one fourth of the children with neurologic symptoms were diagnosed with a tick-borne CNS infection (TBE, n = 10 [8%] and NB, n = 21 [16.8%]). In general, these children displayed an indistinct medical history and presented with nonspecific signs such as malaise/fatigue and headache. Diagnosis was based on analysis of acute and convalescent sera. Blood inflammatory parameters were nonspecific and did not contribute to the diagnostics.
  
  
  CONCLUSIONS
  Pediatric tick-borne CNS infections are unexpectedly common and should be considered in children with unspecific and unexplained acute CNS-related symptoms.
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, 141 86 Stockholm, Sweden. mikael.sundin@ki.se
authors.forename: Mikael
authors.initials: M
authors.lastname: Sundin
authors.forename: Magnus E A
authors.initials: ME
authors.lastname: Hansson
authors.forename: Mona-Lisa
authors.initials: ML
authors.lastname: Engman
authors.forename: Claes
authors.initials: C
authors.lastname: Orvell
authors.forename: Lars
authors.initials: L
authors.lastname: Lindquist
authors.forename: Katarina
authors.initials: K
authors.lastname: Wide
authors.forename: Karl-Johan
authors.initials: KJ
authors.lastname: Lidefelt
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood; D001898:Borrelia / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004675:Encephalitis, Tick-Borne / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D019353:Endemic Diseases; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology
chemical_list: D000907:Antibodies, Bacterial