Diagnosing children with Lyme disease can be particularly difficult, especially when neurological symptoms are involved. The risk of misdiagnosis of neuroborreliosis is high because symptoms can mirror those of other illnesses and diseases. Children and older adults have the highest incidence of neuroborreliosis but symptoms differ even between these two patient groups, complicating matters for diagnosing physicians. What, then, are the key signs to watch out for that could incidate that a child has Lyme disease?
According to reports from the Dutch Paediatric Surveillance system, facial weakness is the most common presenting symptom in children with neurolyme. This symptom occurred in 71% of cases (47 children) examined over two years and was the only symptom in nine children (14%). Other symptoms of neuroborreliosis in children were:
- Neck pain.
Diagnosis of neurological Lyme disease was confirmed in 66 cases out of 89 reported. Neurological signs such as facial nerve palsy, other cranial nerve abnormalities and signs of meningeal infection were present in 79% of the cases reported. However, some 21% of the children had no neurological signs upon examination and although the number of subjective symptom complaints was higher in these patients it took longer to diagnose the children compared to the cases where objective neurological problems were apparent.
Atypical Symptoms of Lyme Disease in Children
That more than a fifth of the children presented with atypical symptoms of neuroborreliosis suggests that there is definitely room for caution in diagnosing neurolyme in kids, as well as the need for more extensive research into symptoms and access to centers such as the one just opened in British Columbia, Canada, to investigate more difficult cases. Children who have been exposed to ticks, who recall tick bites, and who have multiple symptoms and other typical antecedents of Borreliosis will require a lumbar puncture and cerebrospinal fluid analysis to either confirm or rule out bacterial infection with Borrelia as the cause of their symptoms.
Signs of Lyme Vary According to Geographical Location
A Norwegian study also noted that the symptoms of childhood neuroborreliosis are also likely to differ between geographical regions because of the presence of different strains of Borrelia. These researchers carried out a review of symptoms in children with suspected neuroborreliosis referred to Stavanger University Hospital between 1996 and 2006. All children underwent lumbar puncture and 143 were diagnosed with neuroborreliosis. Interestingly, all cases were diagnosed from April to December, suggesting seasonal variations in infection with Lyme disease.
The most common symptoms found in the confirmed cases of Lyme disease included symptoms of mild meningitis in 75% of the children, and/or facial nerve palsy in 69%. Radicular pain was present in less than 10% of cases (10 patients only), and only 27% of the children had erythema migrans (the Lyme disease rash) prior to the development of neurological symptoms. In all but five of the children, laboratory signs of meningitis were observed but it is easy to see why symptoms of neurolyme in children may be misdiagnosed as meningitis or other illness, especially when no tick bites have been noted.
Øymar K, Tveitnes D. Clinical characteristics of childhood Lyme neuroborreliosis in an endemic area of northern Europe. Scand J Infect Dis. 2009;41(2):88-94. doi: 10.1080/00365540802593453.
Broekhuijsen-van Henten DM, Braun KP, Wolfs TF. Clinical presentation of childhood neuroborreliosis; neurological examination may be normal. Arch Dis Child. 2010 Nov;95(11):910-4. doi: 10.1136/adc.2009.176529.