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Lyme disease. The first pediatric case report in Abruzzo.

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Abstract

INTRODUCTION:

In the etiology of arthritis appearing in the first years of life is important to consider Borrelia burgdorferi infection, an ubiquitous zoonosis with a multisystemic pathology. The
disease may be characterised by striking clinical and laboratory variations conditioned by the patient’s immune response. The authors report the first case of
Lyme disease in infancy in Abruzzo, a region whose geographical situation and the presence of the National Park may be predisposed to the epidemic diffusion of borreliosis.

CASE REPORT:

The evolution of
disease, onset during the first year of life, was conditioned by antibiotic treatment administered owing to the presence of urinary tract infection secondary to malformative uropathy and the young patient’s immune response was initially characterised by the presence of anti-DNA and anti-nucleus antibodies and the late positivisation of specific borreliosis serology. The typical dermatological symptoms of the
disease were superimposed by secondary cutaneous eruptions secondary to antibiotic treatment, with a Jarisch-Herxheimer type reaction. The involvement of the right knee and both tibio-tarsal joints were subject to differential diagnosis with autoimmune connectivitis. The positivisation of specific serological tests completed the diagnostic process by definitively confirming the clinical suspicion. Antibacterial treatment led to full recovery.

CONCLUSIONS:

The experience confirms the difficulty of diagnosing
Lyme borreliosis. In the presence of clinical manifestations suggesting the
disease, patient and systematic serological tests must be performed. Antibiotic treatment in infants leads to excellent results in
Lyme arthritis.

Minerva Pediatr. 1997 Jan-Feb;49(1-2):53-7. English Abstract

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