Abstract
Introduction: Europe is an important endemic area for infection with the Borrelia burgdorferi sensu lato complex that includes several genospecies. Incidence and symptoms vary between areas.
B. garinii has high affinity to the central nervous system and is the main genospecies in the Czech Republic. Correct diagnosis of Lyme neuroborreliosis (LNB) is crucial for its therapy.
Diagnosis may be difficult and the infection may become chronic. The aim of this study was to determine the incidence of LNB and to establish clinical and laboratory findings in our pediatric patients.
Methods: Retrospective evaluation of clinical and laboratory data obtained over a two-year period on 286 children with neurological symptoms (unconsciousness, focal deficit, headache, meningeal syndrome etc.) who underwent a lumbar puncture to exclude neuroinflammation. Antibodies against borrelia (and neurotrophic viruses) in the cerebro-spinal fluid (CSF) and serum were determined.
Cytological, immunological and biochemical analysis of CSF were performed as well as the PCR for the presence of borrelial DNA. Results: An association between neurological symptoms and borrelial infection was confirmed in 58 children (median age 7.44 years; range 0.5-17.5 years).
Tick-bite was reported in 53% of children only and skin erythema in none of them. LNB was confirmed with laboratory tests in 53 children.
The other 5 children had no laboratory signs of inflammation in the CNS. The main presentations of LNB were peripheral facial nerve palsy (PFNP) in 69% and meningitis in 15%.
PFNP of borrelial etiology formed 53% of all PFNP in the period analyzed. Conclusion: LNB in children in the Czech Republic is very common.
Comprehensive diagnostic approach, including lumbar puncture, is crucial. Correct therapy at the right time may prevent the chronic course of the disease.