Skip to main content

Advertisement

SpringerLink
Log in

Clinical characteristics of Lyme neuroborreliosis in Dutch children and adults

  • Research
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Lyme neuroborreliosis (LNB) is a tick-borne infection caused by Borrelia burgdorferi which can affect the nervous system in adults and children. The clinical course of LNB in adults is often different than in children. Studies comparing these differences are scarce. The aim of this study was to compare the clinical characteristics and outcome of LNB between children and adults. We performed an observational retrospective study among patients with LNB who presented at Gelre Hospital from 2007 to 2020 and had cerebrospinal fluid pleocytosis. Data were collected from electronic medical records. A total of 127 patients with LNB were identified. Included were 58 children (median age 8 years) and 69 adults (median age 56 years). The incidence of LNB was 3.2 per 100,000 inhabitants per year. The most common neurological manifestation in adults and in children was facial nerve palsy (67%). Unilateral facial nerve palsy was more prevalent in children (85%) than in adults (42%) (P < 0.001). Headache was also more prevalent in children (59%) than in adults (32%) (P = 0.003). (Poly)radiculitis was more prevalent in adults (51%) than in children (3%) (P < 0.001), encephalitis was not reported in children. In children, the time between symptom onset and diagnosis was 10 days versus 28 days in adults (P < 0.001). Complete recovery was reported significantly more often in children (83%) compared to adults (40%) (P < 0.001).

   Conclusion: In a Lyme-endemic area in the Netherlands, LNB commonly presents with facial nerve palsy. Facial nerve palsy and headache are more prevalent in children, while radiculitis and encephalitis are mostly reported in adults.

What is Known:

• The clinical course of Lyme neuroborreliosis in adults is often different from children.

.

• The aim of this study was to compare the clinical characteristics and outcome of LNB between children and adults.

What is New:

• Lyme neuroborreliosis in the Netherlands commonly presents with facial nerve palsy.

• Facial nerve palsy and headache are more prevalent in children than in adults. Radiculitis and encephalitis are mostly reported in adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. van den Wijngaard CC, Brown V, Harms MG, et al (2017) Increase in the incidence and burden of Lyme borreliosis in the Netherlands between 2014 and 2017. https://www.rivm.nl/sites/default/files/2019-04/19.%20Hofhuis_Lyme%20borreliosis.pdf. Accessed 30 Dec 2022

  2. Krawczuk K, Czupryna P, Pancewicz S et al (2020) Comparison of neuroborreliosis between children and adults. Pediatr Infect Dis J 39:7–11. https://doi.org/10.1097/INF.0000000000002493

    Article  PubMed  Google Scholar 

  3. Christen H-J, Hanefeld F, Eiffert H, Thomssen R (1993) Epidemiology and clinical manifestations of Lyme borreliosis in childhood. Acta Paediatr 82:1–76. https://doi.org/10.1111/j.1651-2227.1993.tb18082.x

    Article  Google Scholar 

  4. Knudtzen FC, Andersen NS, Jensen TG, Skarphédinsson S (2017) Characteristics and clinical outcome of Lyme neuroborreliosis in a high endemic area, 1995–2014: a retrospective cohort study in Denmark. Clin Infect Dis 65:1489–1495. https://doi.org/10.1093/cid/cix568

    Article  CAS  PubMed  Google Scholar 

  5. Berglund J, Eitrem R, Ornstein K et al (1995) An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med 333:1319–1324. https://doi.org/10.1056/NEJM199511163332004

    Article  CAS  PubMed  Google Scholar 

  6. Tveitnes D, Natås OB, Skadberg Ø, Øymar K (2012) Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study. Arch Dis Child 97:215–220. https://doi.org/10.1136/archdischild-2011-300526

    Article  PubMed  Google Scholar 

  7. Øymar K, Tveitnes D (2009) Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe. Scand J Infect Dis 41:88–94. https://doi.org/10.1080/00365540802593453

    Article  PubMed  Google Scholar 

  8. Monteventi O, Steinlin M, Regényi M et al (2018) Pediatric stroke related to Lyme neuroborreliosis: data from the Swiss NeuroPaediatric Stroke Registry and literature review. Eur J Paediatr Neurol 22:113–121. https://doi.org/10.1016/j.ejpn.2017.10.010

    Article  CAS  PubMed  Google Scholar 

  9. Khan S, Singh N, Dow A, Ramirez-Zamora A (2015) Pediatric acute longitudinal extensive transverse myelitis secondary to neuroborreliosis. Case Rep Neurol. https://doi.org/10.1159/000438696

    Article  PubMed  PubMed Central  Google Scholar 

  10. McGlacken-Byrne A, McCloskey C, Fisher A, Mullaney P (2021) Lyme neuroborreliosis causing unilateral cerebellitis presenting as horizontal nystagmus in a 7-year-old: an unusual presentation to an ophthalmology service. J AAPOS. https://doi.org/10.1016/j.jaapos.2021.04.006

    Article  PubMed  Google Scholar 

  11. Rocha R, Lisboa L, Neves J et al (2012) Neuroborreliosis presenting as acute disseminated encephalomyelitis. Pediatr Emerg Care. https://doi.org/10.1097/PEC.0b013e318276c51d

    Article  PubMed  Google Scholar 

  12. Lopez MD, Wise C (2008) Acute ataxia in a 4-year-old boy: a case of Lyme disease neuroborreliosis. Am J Emerg Med. https://doi.org/10.1016/j.ajem.2008.03.029

    Article  PubMed  Google Scholar 

  13. Södermark L, Sigurdsson V, Näs W et al (2017) Neuroborreliosis in Swedish children: a population-based study on incidence and clinical characteristics. Pediatr Infect Dis J 36:1052–1056. https://doi.org/10.1097/INF.0000000000001653

    Article  PubMed  Google Scholar 

  14. Broekhuijsen-van Henten DM, Braun KPJ, Wolfs TFW (2010) Clinical presentation of childhood neuroborreliosis; neurological examination may be normal. Arch Dis Child 95:910–914. https://doi.org/10.1136/adc.2009.176529

    Article  PubMed  Google Scholar 

  15. Mygland Å, Ljøstad U, Fingerle V et al (2010) EFNS guidelines on the diagnosis and management of European lyme neuroborreliosis. Eur J Neurol 17:8–16. https://doi.org/10.1111/j.1468-1331.2009.02862.x

    Article  CAS  PubMed  Google Scholar 

  16. Marques AR (2015) Lyme neuroborreliosis Neuroinfectious Dis 21:1729–1744

    Google Scholar 

  17. Dutch Quality Institute for Health Care (CBO) (2013) Dutch national guideline for Lyme disease. https://www.rivm.nl/sites/default/files/2018-11/CBO%20richtlijn%20Lymeziekte%20definitief%20juli%202013.pdf. Accessed 30 Dec 2022

  18. Bierman SM, van Kooten B, Vermeeren YM et al (2019) Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands. Epidemiol Infect 147:e160. https://doi.org/10.1017/S0950268819000438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bruinsma RA, Smulders CA, Vermeeren YM et al (2021) Acute facial nerve palsy in children in a Lyme disease–endemic area in the Netherlands. Eur J Clin Microbiol Infect Dis 40:2455–2458. https://doi.org/10.1007/s10096-021-04273-8

    Article  CAS  PubMed  Google Scholar 

  20. Backman K, Skogman BH (2018) Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome – a prospective cohort study. BMC Pediatr 18:189. https://doi.org/10.1186/s12887-018-1163-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. IG&H Feitenboek locatieprofielentraject Gelre ziekenhuizen

  22. Eldin C, Raffetin A, Bouiller K et al (2019) Review of European and American guidelines for the diagnosis of Lyme borreliosis. Med Mal Infect 49:121–132. https://doi.org/10.1016/j.medmal.2018.11.011

    Article  CAS  PubMed  Google Scholar 

  23. Zomer TP, Bruinsma R, van Samkar A, Vermeeren YM, Wieberdink RG, van Kooten B, van Bemmel T (2022) Lyme neuroborreliosis with antibodies in cerebrospinal fluid but not in serum. Eur J Neurol 00:1–4. https://doi.org/10.1111/ene.15631

    Article  Google Scholar 

  24. Mikrogen Diagnostik (2019) RecomLine Borrelia, Instructions for use. https://www.mikrogen.de/english/products/product-overview/weitereinfo/borrelia-igg-1.html. Accessed 10 Nov 2022

  25. Reiber H, Lange P (1991) Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem. https://doi.org/10.1093/clinchem/37.7.1153

    Article  PubMed  Google Scholar 

  26. Christen HJ, Bartlau H, Hanefeld F et al (1990) Peripheral facial palsy in childhood – Lyme borreliosis to be suspected unless proven otherwise. Acta Paediatr Scand 79:1219–1224. https://doi.org/10.1111/j.1651-2227.1990.tb11413.x

    Article  CAS  PubMed  Google Scholar 

  27. Huppertz HI, Sticht-Groh V (1989) Meningitis due to Borrelia burgdorferi in the initial stage of Lyme disease. Eur J Pediatr 148:428–430. https://doi.org/10.1007/BF00595904

    Article  CAS  PubMed  Google Scholar 

  28. Rogerson A, Aidlen J, Jenis LG (2019) Persistent radiculopathy after surgical treatment for lumbar disc herniation: causes and treatment options. Int Orthop 43:969–973. https://doi.org/10.1007/s00264-018-4246-7

    Article  PubMed  Google Scholar 

  29. Skogman BH, Glimåker K, Nordwall M et al (2012) Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics 130:262–269. https://doi.org/10.1542/peds.2011-3719

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. A. van Samkar and R. A. Bruinsma contributed equally to this work.

Authors and Affiliations

  1. Lyme Centre Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, the Netherlands

    A. van Samkar, R. A. Bruinsma, Y. M. Vermeeren, R. G. Wieberdink, T. van Bemmel, B. van Kooten & T. P. Zomer

  2. Department of Pediatrics, Gelre Hospital, Apeldoorn, the Netherlands

    R. A. Bruinsma

  3. Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands

    Y. M. Vermeeren & T. van Bemmel

  4. Department of Neurology, Gelre Hospital, Apeldoorn, the Netherlands

    R. G. Wieberdink

  5. Department of Medical Microbiology and Infection Prevention, Gelre Hospital, Apeldoorn, the Netherlands

    P. M. den Reijer

Authors
  1. A. van Samkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. A. Bruinsma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. M. Vermeeren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. G. Wieberdink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. van Bemmel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. M. den Reijer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. van Kooten
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. P. Zomer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RB, YV, RW, TB, BK, and TZ contributed to the conception and design of the study. AS, RB, YV, RW, TB, BK, PR, and TZ contributed to acquisition and analysis of data. AS, RB, and TZ contributed to drafting the text or preparing the figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to T. P. Zomer.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Samkar, A., Bruinsma, R.A., Vermeeren, Y.M. et al. Clinical characteristics of Lyme neuroborreliosis in Dutch children and adults. Eur J Pediatr 182, 1183–1189 (2023). https://doi.org/10.1007/s00431-022-04749-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-022-04749-5

Keywords

Search

Navigation