Skip to main content

Advertisement

SpringerLink
Log in

Management of Lyme Disease in European Children: a Review for Practical Purpose

  • Pediatric Infectious Diseases (I Brook, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Lyme disease is a tick-borne zoonosis transmitted through a bite of a tick carrying a spirochete belonging to Borrelia species. In the last 20 years, the reported incidence of Lyme disease is increased by three times in Europe. Clinically, the illness develops through a primary stage with a typical skin rash (erythema marginatum), then a secondary stage with possible neurologic or cardiac involvement. The last stage (chronic Lyme disease) is mainly represented by arthritis or late neurological complications but nowadays is rarely seen due to precocious antibiotic use.

Recent Findings

The diagnosis of Lyme disease is essentially based on history in agreement with tick exposure (living/recent traveling in endemic area or tick bite) and clinical findings compatible with the disease. At present, no laboratory diagnostic tool available can neither establish nor exclude the diagnosis of Lyme disease. The management of Lyme disease should comprise a prophylactic administration of antibiotic in selected population (patients exposed to a tick bite in endemic regions) in which the typical signs of Lyme disease are not yet appeared; conversely, patients with current signs of Lyme disease should undergo a standard therapeutic course. First-line therapy should be oral tetracycline or oral penicillin/cephalosporin (in pediatric populations, beta-lactamic drugs are preferred). In severe courses, intravenous route should be preferred.

Summary

The aim of this review is to provide an updated guide to the management of pediatric Lyme patients, from prophylaxis to first- and second-line therapy in European setting.

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

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379:461–73.

    Article  PubMed  Google Scholar 

  2. Smith R, Takkinen J. Lyme borreliosis: Europe-wide coordinated surveillance and action needed? Euro Surveill. 2006;11:E060622.1.

    CAS  PubMed  Google Scholar 

  3. •• European Centre for Disease Prevention and Control (ECDC). Fact sheet Lyme borreliosis (Eng) - ECDC–Europa. 2014. http://ecdc.europa.eu/en/healthtopics/vectors/world-health-day-2014/documents/factsheet-lyme-borreliosis.pdf. Accessed 25 Sept 2016. Gives important information on the diffusion of Lyme disease in Europe, underlying regions at higher risk, with higher probability of infection, and where prophylaxis could be recommended.

  4. •• Centers for Disease Control and Prevention (CDC). Lyme disease data tables. Reported cases of Lyme disease by state or locality, 2005–2014. 2015. http://www.cdc.gov/lyme/stats/tables.html. Accessed 25 Sept 2016. Gives important information on the diffusion of Lyme disease in the USA, underlying regions at higher risk, with higher probability of infection, and where prophylaxis could be recommended.

  5. Derdáková M, Lencáková D. Association of genetic variability within the Borrelia burgdorferi sensu lato with the ecology, epidemiology of Lyme borreliosis in Europe. Ann Agric Environ Med. 2005;12:165–72.

    PubMed  Google Scholar 

  6. Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology. 1985;35:47–53.

    Article  CAS  PubMed  Google Scholar 

  7. Wormser GP, Halperin JJ. Toward a better understanding of European Lyme neuroborreliosis. Clin Infect Dis. 2013;57:510–2.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Christen HJ, Hanefeld F, Eiffert H, Thomssen R. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr. 1993;386:1–75.

    Article  CAS  Google Scholar 

  9. Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, Wolfson S, et al. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980;93:8–16.

  10. Fish AE, Pride YB, Pinto DS. Lyme carditis. Infect Dis Clin N Am. 2008;22:275–88. vi

    Article  Google Scholar 

  11. Woolf PK, Lorsung EM, Edwards KS, Li KI, Kanengiser SJ, Ruddy RM, et al. Electrocardiographic findings in children with Lyme disease. Pediatr Emerg Care. 1991;7:334–6.

    Article  CAS  PubMed  Google Scholar 

  12. McAlister HF, Klementowicz PT, Andrews C, Fisher JD, Feld M, Furman S. Lyme carditis: an important cause of reversible heart block. Ann Intern Med. 1989;110:339–45.

    Article  CAS  PubMed  Google Scholar 

  13. • Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17:69–79. Clinical case definition of Lyme borelliosis in Europe

  14. Gerber MA, Zemel LS, Shapiro ED. Lyme arthritis in children: clinical epidemiology and long-term outcomes. Pediatrics. 1998;102:905–8.

    Article  CAS  PubMed  Google Scholar 

  15. Szer IS, Taylor E, Steere AC. The long-term course of Lyme arthritis in children. N Engl J Med. 1991;325:159–63.

    Article  CAS  PubMed  Google Scholar 

  16. • Centers for Disease Control and Prevention (CDC). Lyme disease (Borrelia burgdorferi). 2011 Case Definition. 2011;https://wwwn.cdc.gov/nndss/conditions/lyme-disease/case-definition/2011/. Accessed 25 Sept 2016. Case definition of Lyme borelliosis in the USA.

  17. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089–134.

  18. Hauser U, Lehnert G, Wilske B. Validity of interpretation criteria for standardized Western blots (immunoblots) for serodiagnosis of Lyme borreliosis based on sera collected throughout Europe. J Clin Microbiol. 1999;37:2241–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Dressler F, Whalen JA, Reinhardt BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis. 1993;167:392–400.

    Article  CAS  PubMed  Google Scholar 

  20. Centers for Disease Control and Prevention (CDC). Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 1995;44:590–1.

    Google Scholar 

  21. •• Lantos PM, Branda JA, Boggan JC, Chudgar SM, Wilson EA, Ruffin F, et al. Poor positive predictive value of Lyme disease serologic testing in an area of low disease incidence. Clin Infect Dis. 2015;61:1374–80. A comprehensive review on serological diagnosis of Lyme disease.

  22. Branda JA, Linskey K, Kim YA, Steere AC, Ferraro MJ. Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide enzyme immunoassay. Clin Infect Dis. 2011;53:541–7.

    Article  CAS  PubMed  Google Scholar 

  23. •• Borchers AT, Keen CL, Huntley AC, Gershwin ME. Lyme disease: a rigorous review of diagnostic criteria and treatment. J Autoimmun. 2015;57:82–115. A complete review on clinical diagnosis of Lyme disease.

  24. Tjernberg I, Krüger G, Eliasson I. C6 peptide ELISA test in the serodiagnosis of Lyme borreliosis in Sweden. Eur J Clin Microbiol Infect Dis. 2007;26:37–42.

    Article  CAS  PubMed  Google Scholar 

  25. Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of lyme borreliosis. Clin Microbiol Rev. 2005;18:484–509.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sigal LH. The polymerase chain reaction assay for Borrelia burgdorferi in the diagnosis of Lyme disease. Ann Intern Med. 1994;120:520–1.

    Article  CAS  PubMed  Google Scholar 

  27. Liveris D, Schwartz I, Bittker S, Cooper D, Iyer R, Cox ME, et al. Improving the yield of blood cultures from patients with early Lyme disease. J Clin Microbiol. 2011;49:2166–8.

  28. Klempner MS, Schmid CH, Hu L, Steere AC, Johnson G, McCloud B, et al. Intralaboratory reliability of serologic and urine testing for Lyme disease. Am J Med. 2001;110:217–9.

    Article  CAS  PubMed  Google Scholar 

  29. Pachner AR, Steere AC, Sigal LH, Johnson CJ. Antigen-specific proliferation of CSF lymphocytes in Lyme disease. Neurology. 1985;35:1642–4.

    Article  CAS  PubMed  Google Scholar 

  30. Nadelman RB, Nowakowski J, Fish D, Falco RC, Freeman K, McKenna D, et al., Tick Bite Study Group. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001;345:79–84.

  31. Steere AC, Sikand VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. 2003;348:2472–4.

    Article  PubMed  Google Scholar 

  32. Nadelman RB, Luger SW, Frank E, Wisniewski M, Collins JJ, Wormser GP. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med. 1992;117:273–80.

    Article  CAS  PubMed  Google Scholar 

  33. Stupica D, Lusa L, Ruzić-Sabljić E, Cerar T, Strle F. Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55:343–50.

    Article  CAS  PubMed  Google Scholar 

  34. Barsic B, Maretic T, Majerus L, Strugar J. Comparison of azithromycin and doxycycline in the treatment of erythema migrans. Infection. 2000;28:153–6.

    Article  CAS  PubMed  Google Scholar 

  35. Terekhova D, Sartakova ML, Wormser GP, Schwartz I, Cabello FC. Erythromycin resistance in Borrelia burgdorferi. Antimicrob Agents Chemother. 2002;46:3637–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM, Rahn DW, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med. 1996;124:785–91.

  37. Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, et al. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995;39:661–7.

  38. Karlsson M, Hammers-Berggren S, Lindquist L, Stiernstedt G, Svenungsson B. Comparison of intravenous penicillin G and oral doxycycline for treatment of Lyme neuroborreliosis. Neurology. 1994;44:1203–7.

    Article  CAS  PubMed  Google Scholar 

  39. Kohlhepp W, Oschmann P, Mertens HG. Treatment of Lyme borreliosis. Randomized comparison of doxycycline and penicillin G. J Neurol. 1989;236:464–9.

    Article  CAS  PubMed  Google Scholar 

  40. Ljøstad U, Skogvoll E, Eikeland R, Midgard R, Skarpaas T, Berg A, et al. Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. Lancet Neurol. 2008;7:690–5.

  41. Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ. Treatment of late Lyme borreliosis—randomised comparison of ceftriaxone and penicillin. Lancet. 1988;1:1191–4.

    Article  CAS  PubMed  Google Scholar 

  42. Pfister HW, Preac-Mursic V, Wilske B, Einhäupl KM. Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study. Arch Neurol. 1989;46:1190–4.

    Article  CAS  PubMed  Google Scholar 

  43. Steere AC, Levin RE, Molloy PJ, Kalish RA, Abraham JH 3rd, Liu NY, et al. Treatment of Lyme arthritis. Arthritis Rheum. 1994;37:878–88.

  44. Schoen RT, Aversa JM, Rahn DW, Steere AC. Treatment of refractory chronic Lyme arthritis with arthroscopic synovectomy. Arthritis Rheum. 1991;34:1056–60.

    Article  CAS  PubMed  Google Scholar 

  45. Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345:85–92.

  46. Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60:1923–30.

  47. Feder HM Jr, Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP, et al., Ad Hoc International Lyme Disease Group. A critical appraisal of “chronic Lyme disease”. N Engl J Med. 2007;357:1422–30.

  48. Silver HM. Lyme disease during pregnancy. Infect Dis Clin N Am. 1997;11:93–7.

    Article  CAS  Google Scholar 

  49. Strobino BA, Williams CL, Abid S, Chalson R, Spierling P. Lyme disease and pregnancy outcome: a prospective study of two thousand prenatal patients. Am J Obstet Gynecol. 1993;169:367–74.

    Article  CAS  PubMed  Google Scholar 

  50. Maraspin V, Cimperman J, Lotric-Furlan S, Pleterski-Rigler D, Strle F. Treatment of erythema migrans in pregnancy. Clin Infect Dis. 1996;22:788–93.

    Article  CAS  PubMed  Google Scholar 

  51. NIH U.S. National Library of Medicine. Doxycycline. TOXNET® (TOXicology Data NETwork) Databases. 2016;https://toxnet.nlm.nih.gov/. Accessed 25 Sept 2016.

  52. Saivin S, Houin G. Clinical pharmacokinetics of doxycycline and minocycline. Clin Pharmacokinet. 1988;15:355–66.

    Article  CAS  PubMed  Google Scholar 

  53. Garcia-Monco JC, Frey HM, Villar BF, Golightly MG, Benach JL. Lyme disease concurrent with human immunodeficiency virus infection. Am J Med. 1989;87:325–8.

    Article  CAS  PubMed  Google Scholar 

  54. Cerný R, Machala L, Bojar M, Rozsypal H, Pícha D. Neuroborreliosis in an HIV-1 positive patient. Infection. 2006;34:100–2.

    Article  PubMed  Google Scholar 

  55. Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K. Syphilis and HIV co-infection. Eur J Intern Med. 2009;20:9–13.

    Article  PubMed  Google Scholar 

  56. Fürst B, Glatz M, Kerl H, Müllegger RR. The impact of immunosuppression on erythema migrans. A retrospective study of clinical presentation, response to treatment and production of Borrelia antibodies in 33 patients. Clin Exp Dermatol. 2006;31:509–14.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istituto Giannina Gaslini – Ospedale Pediatrico IRCCS, Largo G. Gaslini 5, 16147, Genoa, Italy

    Matteo D’Alessandro, Anna Loy & Elio Castagnola

Authors
  1. Matteo D’Alessandro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Loy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elio Castagnola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elio Castagnola.

Ethics declarations

Conflict of Interest

Drs. D’Alessandro, Loy, and Castagnola have no conflicts of interests to declare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Additional information

This article is part of the Topical Collection on Pediatric Infectious Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

D’Alessandro, M., Loy, A. & Castagnola, E. Management of Lyme Disease in European Children: a Review for Practical Purpose. Curr Infect Dis Rep 19, 27 (2017). https://doi.org/10.1007/s11908-017-0582-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-017-0582-9

Keywords

Search

Navigation