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Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study.

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By Tveitnes D, Natås OB, Skadberg Ø, Øymar K • www.ProHealth.com • March 1, 2012


Abstract

OBJECTIVE: To evaluate the epidemiology of infectious meningitis in children in a Lyme borreliosis (LB) endemic area, and to study how clinical and laboratory characteristics may distinguish between different types of childhood meningitis.

DESIGN: Retrospective, population based study.

SETTING: A paediatric department serving all children (62 000) in a costal LB endemic region of southwestern Norway.

PATIENTS: All children with cerebrospinal fluid pleocytosis aged 3 months to 14 years.

MAIN OUTCOME MEASURES: Epidemiological, clinical and laboratory characteristics of different types of childhood meningitis.

RESULTS: Infectious meningitis was diagnosed in 211 children (annual incidence 38/100 000). Lyme meningitis (LM) was identified in 142 children (67%), non- Lyme aseptic meningitis in 46 children (22%) and bacterial meningitis in 23 children (11%). Age, month of admission and clinical and laboratory characteristics differed between the groups. An aetiological agent was found in 89% of children. The positive predictive value for having LM if the child had facial nerve palsy or head and/or neck stiffness (meningism) as the only symptom was 97% for both variables. Symptoms of cerebral involvement or signs of systemic inflammation were rare in children with LM compared to children non- Lyme aseptic meningitis.

CONCLUSION: LM was diagnosed in two-thirds of children with infectious meningitis in this LB endemic area. Distinct clinical characteristics distinguished the majority of children with LM from children with non- Lyme aseptic meningitis and bacterial meningitis.

Arch Dis Child. 2012 Mar;97(3):215-20. doi: 10.1136/archdischild-2011-300526. Epub 2012 Jan 13. Research Support, Non-U.S. Gov't





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