Lyme Disease in Children
Lyme Disease in children can be elusive, often dismissed and/or undertreated. As adults it is easy for most to identify and relate symptoms that we may be feeling, however as a child, it can be difficult to put symptoms into words or even voice that something may be wrong. It is important to keep Lyme Disease as a differential diagnosis when a child may have vague complaints or a parent or caregiver notices changes in a child’s behavior. Children with Lyme Disease may exhibit exhibit headache, irritability, fever, unilateral limb pain or joint pain, fatigue, lack of motivation or change in behavior, facial palsy, rash/erythema migranes, lymphadenopathy, myalgia, carditis and aseptic meningitis. These symptoms are all seen fairly “early” in disease manifestation, within a few weeks to months.
Lyme Disease is caused by pathogenic genomospecies of the spirochete Borrelia burgdorferi. This is the most common cause of Lyme Disease in the United States. Less often other genomospecies include Borellia mayonii that is more likely seen in Mid-western states. In Europe and Asia Borellia afzelii and Borellia gariniii are more often seen (Stanek, Wormser, Gray & Strle, 2012).
Children with Lyme Disease may exhibit headache, irritability, fever, unilateral limb pain or joint pain, fatigue, lack of motivation or change in behavior, facial palsy, rash/erythema migrans, lymphadenopathy, myalgia, carditis and aseptic meningitis. These symptoms are all seen fairly “early” in disease manifestation, within a few weeks to months. “Late” manifestations can include any of these symptoms and more commonly joint pain or “lyme arthritis” (Clin. Infect Dis, 2021). Lyme arthritis commonly affects one joint at a time, however multiple joints can also be affected. Knee pain is the most common joint affected in 90% of pediatric cases according to Lantos, Lipsett & Nigrovic, 2016.
It is important to keep in mind a child’s risk for exposure to an endemic area or history of a tick bite in the past. It is not unusualfor children to have a tick bite and never see the tick. It is important to build prevention strategies into a child’s daily routine such as checking prime spots around the hair line or in the hair, behind ears, around edges of clothing or warm places on the body including the groin or arm pits. If you see a tick bite and/or remove the tick, it is important to send the tick in for testing to guide potential treatment.
In early Lyme (within the first few weeks after exposure to a tick), a blood work evaluation may not be helpful in diagnosis. As in adults, early serological testing is not sensitive enough to be helpful with a confirmed diagnosis. For example, in a study including over 200 children with Lyme Disease, only 19% of those had a positive Immunoglobulin (IgG) for BorreliaBurgdorferi at the time of presentation with a rash (erythema migrans) (Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell,1996). If Lyme Disease is not recognized and treated early, the spirochete enters the bloodstream and then transfers to the tissues throughout the body, including joints, central nervous system and even the heart (Steere, 1989).
The longer a child has Lyme Disease and the later the testing takes place, it is more likely that the testing will not be as helpful for diagnosis, as the body may decrease its antibody production over time.
Resources
1. Bachman DT, Srivastava G. Emergency department presentations of Lyme disease in children. Pediatr Emerg Care 1998; 14:356.
2. Gerber MA, Shapiro ED, Burke GS, et al. Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med 1996; 335:1270.
3. Lantos PM, Lipsett SC, Nigrovic LE. False Positive Lyme Disease IgM Immunoblots in Children. J Pediatr 2016; 174:267.
4. Seltzer EG, Shapiro ED. Misdiagnosis of Lyme disease: when not to order serologic tests. Pediatr Infect Dis J 1996; 15:762.
5. Shapiro ED, Gerber MA. Lyme disease. Clin Infect Dis 2000; 31:533.
6. Steere AC. Lyme disease. N Engl J Med 1989; 321:586.
7. Bachman DT, Srivastava G. Emergency department presentations of Lyme disease in children. Pediatr Emerg Care 1998; 14:356.
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