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

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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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