title: Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study.
abstract: OBJECTIVE
  To evaluate the epidemiology of infectious meningitis in children in a Lyme borreliosis (LB) endemic area, and to study how clinical and laboratory characteristics may distinguish between different types of childhood meningitis.
  
  
  METHODS
  Retrospective, population based study.
  
  
  METHODS
  A paediatric department serving all children (62 000) in a costal LB endemic region of southwestern Norway.
  
  
  METHODS
  All children with cerebrospinal fluid pleocytosis aged 3 months to 14 years.
  
  
  METHODS
  Epidemiological, clinical and laboratory characteristics of different types of childhood meningitis.
  
  
  RESULTS
  Infectious meningitis was diagnosed in 211 children (annual incidence 38/100 000). Lyme meningitis (LM) was identified in 142 children (67%), non-Lyme aseptic meningitis in 46 children (22%) and bacterial meningitis in 23 children (11%). Age, month of admission and clinical and laboratory characteristics differed between the groups. An aetiological agent was found in 89% of children. The positive predictive value for having LM if the child had facial nerve palsy or head and/or neck stiffness (meningism) as the only symptom was 97% for both variables. Symptoms of cerebral involvement or signs of systemic inflammation were rare in children with LM compared to children non-Lyme aseptic meningitis.
  
  
  CONCLUSIONS
  LM was diagnosed in two-thirds of children with infectious meningitis in this LB endemic area. Distinct clinical characteristics distinguished the majority of children with LM from children with non-Lyme aseptic meningitis and bacterial meningitis.
authors.affiliation: Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway. tvda@sus.no
authors.forename: Dag
authors.initials: D
authors.lastname: Tveitnes
authors.forename: Olav Bjarte
authors.initials: OB
authors.lastname: Natås
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Skadberg
authors.forename: Knut
authors.initials: K
authors.lastname: Øymar
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D005155:Facial Nerve Diseases / Q000382:microbiology; D005260:Female; D006261:Headache / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D020852:Lyme Neuroborreliosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000453:epidemiology; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009664:Norway / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012621:Seasons