Lyme Neuroborreliosis: Aetiology and Diagnosis of Facial Palsy in Children from Tyrol

 

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Abstract

Background: Lyme neuroborreliosis (LNB) is the second most common manifestation of Borrelia burgdorferi sensu lato (s. l.) infection in Europe. LNB is difficult to differentiate from other aetiologies of aseptic meningitis. Diagnostic criteria for LNB in children are not established. Therfore, based on the epidemiology of LNB in children from Tyrol, the aim of our study was to point out the necessity of a clear definition of pediatric LNB to avoid underdiagnosis and overtreatment.

Patients and Methods: All medical charts of patients presented with acute peripheral facial palsy from January 2002 to December 2005 were reviewed. The patients were rediagnosed according to the criteria of the German Society of Neurology (DGN).

Results: We identified 66 patients with peripheral facial palsy. 30 children were handled as B. burgdorferi s. l. infection. 5 patients were overtreated with antibiotic therapy. After reevaluation according to the DGN criteria 7 cases were reclassified as possible, 16 cases as probable and 7 cases as confirmed LNB.

Conclusions: Utilization of the established DGN criteria for pediatric LNB might help to elucidate the propability of LNB. Prospective studies are required to establish a classification system. A diagnostic tool, based on laboratory and clinical data, should avoid overtreatment of pediatric LNB.

Zusammenfassung

Hintergrund: Die Lyme-Neuroborreliosis (LNB) ist die zweithäufigste Manifestation einer Infektion mit Borrelia burgdorferi sensu lato (s. l.) in Europa. Bislang sind keine diagnostischen Kriterien für die pädiatrische LNB etabliert. Basierend auf den epidemiologischen Daten der LNB bei Tiroler Kindern soll durch die vorliegende Untersuchung auf die Notwendigkeit von diagnostischen Richtlinien der pädiatrischen LNB hingewiesen werden.

Patienten und Methoden: Eingeschlossen wurden pädiatrische Patienten mit akuter peripherer Fazialisparese von Januar 2002 bis Dezember 2005. Die Diagnose der LNB wurde, basierend auf den Kriterien der Deutschen Gesellschaft für Neurologie (DGN), reevaluiert.

Ergebnisse: Von den 66 Patienten mit peripherer Fazialisparese hatten je 30 Patienten eine LNB und 30 Patienten eine idiopathische Fazialisparese. 5 Patienten wurden unnötigerweise antibiotisch behandelt. Basierend auf den Diagnosekriterien der DGN wurde die Diagnose der LNB reevaluiert: 7 Patienten wurden als mögliche, 16 Patienten als wahrscheinliche und 7 Patienten als gesicherte LNB eingestuft.

Schlussfolgerung: Es mangelt an Daten, um Diagnosekriterien für die LNB im Kindesalter vorzulegen. Die Anwendung der etablierten Diagnosekriterien der DGN in der Pädiatrie kann in der Diagnostik der LNB hilfreich sein. Es sind künftige Studien zur Entwicklung eines diagnostischen Standards zu fordern. Durch eine auf klinischen und laborchemischen Daten basierende Diagnostik der LNB kann eine Unterdiagnose und eine Übertherapie vermieden werden.

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Correspondence

Dr. Juergen Brunner

Innsbruck Medical University

Department of Pediatrics

Anichstraße 35

6020 Innsbruck

Austria

Phone: +43/512/504 23500

Fax: +43/512/504 25450

Email: juergen.brunner@uki.at