Pediatric tick-borne infections of the central nervous system in an endemic region of Sweden: a prospective evaluation of clinical manifestations
- 416 Downloads
Tick-borne encephalitis (TBE) and neuroborreliosis (NB) are well-known central nervous system (CNS) infections in children. Childhood tick-borne CNS infections are generally described as mild conditions. However, this view has recently been challenged, and the natural course, including potential sequelae, has been debated. If the diseases present with nonspecific symptoms and signs, some children may elude diagnosis. This study estimates the incidence of symptomatic tick-borne CNS infections in children under medical care and describes the spectrum of manifestations. One hundred twenty-four children with neurologic symptoms attending the Pediatric Emergency Department were included prospectively. Anti-TBE virus and anti-Borrelia serology results were analyzed together with inflammatory parameters in the blood and cerebrospinal fluid. Nearly one fourth of the children with neurologic symptoms were diagnosed with a tick-borne CNS infection (TBE, n = 10 [8%] and NB, n = 21 [16.8%]). In general, these children displayed an indistinct medical history and presented with nonspecific signs such as malaise/fatigue and headache. Diagnosis was based on analysis of acute and convalescent sera. Blood inflammatory parameters were nonspecific and did not contribute to the diagnostics. Conclusion: Pediatric tick-borne CNS infections are unexpectedly common and should be considered in children with unspecific and unexplained acute CNS-related symptoms.
KeywordsTBE Lyme disease Neuroborreliosis Pediatric Symptoms
This study was supported with unrestricted grants by Karolinska Institutet, the Stockholm County Council, and the Swedish Association of Persons with Neurological Disabilities.
None to declare.
- 3.Broekhuijsen-van Henten DM, Braun KP, Wolfs TF (2010) Clinical presentation of childhood neuroborreliosis; neurological examination may be normal. Arch Dis Child. doi: 10.1136/adc.2009.176529
- 5.Danielova V, Rudenko N, Daniel M, Holubova J, Materna J, Golovchenko M, Schwarzova L (2006) Extension of Ixodes ricinus ticks and agents of tick-borne diseases to mountain areas in the Czech Republic. Int J Med Microbiol 296(Suppl 40):48–53. doi: 10.1016/j.ijmm.2006.02.007 PubMedCrossRefGoogle Scholar
- 8.Hansson ME, Orvell C, Engman ML, Wide K, Lindquist L, Lidefelt KJ, Sundin M (2011) Tick-borne encephalitis in childhood: rare or missed? Pediatr Infect Dis J 30(4):355–357. doi: 10.1097/INF.0b013e3181fe3b5a00006454-201104000-00021 PubMedCrossRefGoogle Scholar
- 12.Kunze U (2010) Tick-borne encephalitis: from childhood to golden age does increased mobility mean increased risk? Conference report of the 11th meeting of the International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE). Vaccine 28(4):875–876. doi: 10.1016/j.vaccine.2009.11.032 PubMedCrossRefGoogle Scholar
- 25.Suss J (2008) Tick-borne encephalitis in Europe and beyond—the epidemiological situation as of 2007. Euro Surveill 13(26)Google Scholar