Management of paediatric Lyme disease in non-endemic and endemic areas: data from the Registry of the Italian Society for Pediatric Infectious Diseases

  • S. Esposito
  • E. Baggi
  • A. Villani
  • S. Norbedo
  • G. Pellegrini
  • E. Bozzola
  • E. Palumbo
  • S. Bosis
  • G. Nigro
  • S. Garazzino
  • N. Principi
  • for the SITIP Lyme Disease Registry


The purpose of this investigation was to determine how specialists in paediatric infectious diseases (PIDs) manage children with suspected Lyme disease (LD) by comparing their approaches in Italian endemic and non-endemic areas. A cross-sectional survey of the PID specialists participating in the Italian Society for Pediatric Infectious Disease (SITIP) Registry of LD was carried out between 1 January and 30 April 2012. A total of 160 children (80 living in endemic areas and 80 living in non-endemic areas) were diagnosed as having LD between 1 January 2005 and 31 December 2011. The clinical manifestations were erythema migrans in 130 cases (81.3 %), arthritis in 24 (15.0 %) and neuroborreliosis in six (3.8 %). Significant differences from the recommendations concerning serology and the tests to undertake were mainly observed in the children with erythema migrans, especially those living in non-endemic areas (p < 0.05). The children with erythema migrans who lived in non-endemic areas were treated with antibiotics significantly less frequently than those living in endemic areas (p < 0.05), and significantly fewer children with erythema migrans or arthritis living in non-endemic areas were treated with amoxicillin in comparison with those living in endemic regions (p < 0.05). The duration of antimicrobial therapy was significantly shorter than recommended in the children with erythema migrans or arthritis, especially those living in non-endemic areas (p < 0.05). Paediatric LD is also present in areas of Italy in which it is not considered endemic, but knowledge concerning its management is generally poor among PID specialists and characterised by enormous gaps in non-endemic areas.



This study was supported, in part, by a grant from the Italian Ministry of Health (Bando Giovani Ricercatori 2009).

We would like to thank all the participants of the SITIP Lyme Disease Registry: Marina Camilletti, Elena Danieli, Walter Peves Rios, Simone Sferrazza Papa, Leonardo Terranova, Maria Cristina Tischer, Alberto Zampiero (Milan); Patrizia Isoardi (Monza); Giorgio Bolla (Verona); Filippo Bernardi (Bologna); and Icilio Dodi (Parma).

Conflict of interest

The authors have no conflict of interest to declare.


  1. 1.
    Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL (1996) Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med 335:1270–1274PubMedCrossRefGoogle Scholar
  2. 2.
    Shapiro ED, Gerber MA (2000) Lyme disease. Clin Infect Dis 31:533–542PubMedCrossRefGoogle Scholar
  3. 3.
    Skogman BH, Ekerfelt C, Ludvigsson J, Forsberg P (2010) Seroprevalence of Borrelia IgG antibodies among young Swedish children in relation to reported tick bites, symptoms and previous treatment for Lyme borreliosis: a population-based survey. Arch Dis Child 95:1013–1016PubMedCrossRefGoogle Scholar
  4. 4.
    Stanek G, Wormser GP, Gray J, Strle F (2012) Lyme borreliosis. Lancet 379:461–473PubMedCrossRefGoogle Scholar
  5. 5.
    Feder HM Jr (2008) Lyme disease in children. Infect Dis Clin North Am 22:315–326PubMedCrossRefGoogle Scholar
  6. 6.
    Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al (2006) 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 43:1089–1134PubMedCrossRefGoogle Scholar
  7. 7.
    Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A et al (2011) Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect 17:69–79PubMedCrossRefGoogle Scholar
  8. 8.
    Huppertz HI, Bartmann P, Heininger U, Fingerle V, Kinet M, Klein R et al (2012) Rational diagnostic strategies for Lyme borreliosis in children and adolescents: recommendations by the Committee for Infectious Diseases and Vaccinations of the German Academy for Pediatrics and Adolescent Health. Eur J Pediatr. Epub Jul 11Google Scholar
  9. 9.
    Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK (2009) Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis 9:79PubMedCrossRefGoogle Scholar
  10. 10.
    Ramsey AH, Belongia EA, Chyou PH, Davis JP (2004) Appropriateness of Lyme disease serologic testing. Ann Fam Med 2:341–344PubMedCrossRefGoogle Scholar
  11. 11.
    Magri JM, Johnson MT, Herring TA, Greenblatt JF (2002) Lyme disease knowledge, beliefs, and practices of New Hampshire primary care physicians. J Am Board Fam Pract 15:277–284PubMedGoogle Scholar
  12. 12.
    Qureshi MZ, New D, Zulqarni NJ, Nachman S (2002) Overdiagnosis and overtreatment of Lyme disease in children. Pediatr Infect Dis J 21:12–14PubMedCrossRefGoogle Scholar
  13. 13.
    Murray T, Feder HM Jr (2001) Management of tick bites and early Lyme disease: a survey of Connecticut physicians. Pediatrics 108:1367–1370PubMedCrossRefGoogle Scholar
  14. 14.
    Fix AD, Strickland GT, Grant J (1998) Tick bites and Lyme disease in an endemic setting: problematic use of serologic testing and prophylactic antibiotic therapy. JAMA 279(3):206–210PubMedCrossRefGoogle Scholar
  15. 15.
    Henry B, Crabtree A, Roth D, Blackman D, Morshed M (2012) Lyme disease: knowledge, beliefs, and practices of physicians in a low-endemic area. Can Fam Physician 58:e289–e295PubMedGoogle Scholar
  16. 16.
    Vanthomme K, Bossuyt N, Boffin N, Van Casteren V (2012) Incidence and management of presumption of Lyme borreliosis in Belgium: recent data from the sentinel network of general practitioners. Eur J Clin Microbiol Infect Dis 31:2385–2390PubMedCrossRefGoogle Scholar
  17. 17.
    Pistone D, Pajoro M, Fabbi M, Vicari N, Marone P, Genchi C et al (2010) Lyme borreliosis, Po River Valley, Italy. Emerg Infect Dis 16:1289–1291PubMedCrossRefGoogle Scholar
  18. 18.
    Istituto Superiore di Sanità. Centro Nazionale Malattie Rare. Malattie rare esentate in Italia. Available online at:
  19. 19.
    Rizzoli A, Hauffe HC, Carpi G, Vourc’h GI, Neteler M, Rosà E (2011) Lyme borreliosis in Europe. Euro Surveill 16:pii=19906Google Scholar
  20. 20.
    Tory HO, Zurakowski D, Sundel RP (2010) Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. J Rheumatol 37:1049–1055PubMedCrossRefGoogle Scholar
  21. 21.
    Bremell D, Hagberg L (2011) Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell’s palsy). BMC Infect Dis 11:215PubMedCrossRefGoogle Scholar
  22. 22.
    Skogman BH, Croner S, Nordwall M, Eknefelt M, Ernerudh J, Forsberg P (2008) Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatr Infect Dis J 27:1089–1094PubMedCrossRefGoogle Scholar
  23. 23.
    Nigrovic LE, Thompson AD, Fine AM, Kimia A (2008) Clinical predictors of Lyme disease among children with a peripheral facial palsy at an emergency department in a Lyme disease-endemic area. Pediatrics 122:e1080–e1085PubMedCrossRefGoogle Scholar
  24. 24.
    Berglund J, Stjernberg L, Ornstein K, Tykesson-Joelsson K, Walter H (2002) 5-y follow-up study of patients with neuroborreliosis. Scand J Infect Dis 34:421–425PubMedCrossRefGoogle Scholar
  25. 25.
    Costello JM, Alexander ME, Greco KM, Perez-Atayde AR, Laussen PC (2009) Lyme carditis in children: presentation, predictive factors, and clinical course. Pediatrics 123:e835–e841PubMedCrossRefGoogle Scholar
  26. 26.
    Fish AE, Pride YB, Pinto DS (2008) Lyme carditis. Infect Dis Clin North Am 22:275–288PubMedCrossRefGoogle Scholar
  27. 27.
    Christen HJ, Hanefeld F, Eiffert H, Thomssen R (1993) Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl 386:1–75PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • S. Esposito
    • 1
  • E. Baggi
    • 1
  • A. Villani
    • 2
  • S. Norbedo
    • 3
  • G. Pellegrini
    • 4
  • E. Bozzola
    • 2
  • E. Palumbo
    • 4
  • S. Bosis
    • 1
  • G. Nigro
    • 5
  • S. Garazzino
    • 6
  • N. Principi
    • 1
  • for the SITIP Lyme Disease Registry
  1. 1.Pediatric Clinic 1, Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli e Regina ElenaMilanItaly
  2. 2.Pediatric Infectious Disease UnitIRCCS Ospedale Bambino GesùRomeItaly
  3. 3.Pediatric Emergency UnitIRCCS Burlo GarofaloTriesteItaly
  4. 4.Pediatric UnitSondrio HospitalSondrioItaly
  5. 5.Pediatric ClinicUniversity of L’AquilaL’AquilaItaly
  6. 6.Pediatric Infectious Diseases UnitOspedale Regina MargheritaTurinItaly

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