Information on the etiology of Lyme neuroborreliosis (LNB) in children in Europe and the influence of Borrelia burgdorferi sensu lato species isolated from cerebrospinal fluid (CSF) on clinical presentation of LNB in children are limited.The study was monocentric. During its 17-year period, children younger than 15 years with presentation suggestive of LNB or confirmed Lyme borreliosis that had B. burgdorferi sensu lato isolated from CSF and had species of B. burgdorferi sensu lato identified by pulsed-field gel electrophoresis were included. Demographic and medical data were compared for children infected with Borrelia garinii to those infected with Borrelia afzelii.One hundred and fifty-three children had B. burgdorferi sensu lato isolated from CSF. In 71/113 (62.8%) and 42/113 (37.2%) patients, B. garinii and B. afzelii, respectively, were identified. Patients infected with B. garinii did not report symptoms suggestive of central nervous system (CNS) involvement or any other symptoms more often than patients infected with B. afzelii. Compared with children infected with B. afzelii, children infected with B. garinii had erythema migrans less often (18.3% vs. 45.2%) but had positive meningeal signs (69.0% vs. 38.1%), CSF lymphocytic predominance (97.1% vs. 75.0%), and elevated albumin CSF/serum quotient (80.6% vs. 50.0%) more often.In Slovenia, LNB in children is more often caused by B. garinii, followed by B. afzelii. The clinical picture of LNB in children caused by B. garinii is not more often suggestive of CNS involvement, but CNS inflammation is more pronounced in children infected with B. garinii, compared with children infected with B. afzelii.
Objectives. To establish the frequency of isolation of Borrelia burgdorferi sensu lato from blood of children with solitary erythema migrans (EM) in Europe, to determine the strains of the isolated borreliae and to compare the clinical course and the outcome of the disease according to positive and negative blood culture result. Methods. In the prospective study we included 134 consecutive patients younger than 15 years with solitary EM, referred to our institution in 1996 and 1997. One milliliter of blood was withdrawn before treatment and cultured in modified Kelly-Pettenkofer medium. Isolated borreliae were typed according to LRFP analysis. Patients were treated with either penicillin V or cefuroxime axetil for 14 days. The posttreatment course was surveyed by follow-up visits during 1 year. Results. B. burgdorferi sensu lato was isolated in 12 of 134 (9%) patients. Eleven blood isolates were typed: 10 were found to be B. afzelii and 1 was Borrelia garinii. Comparison of blood culture-positive and -negative patients revealed no differences in pretreatment characteristics or in posttreatment clinical course. However, worsening of local and/or systemic signs and symptoms at the beginning of antibiotic therapy (Jarish-Herxheimer's reaction) was identified more often in the blood culture-positive than in the blood culture-negative group (5 of 12 vs. 17 of 122, respectively;P = 0.0274). Conclusions. The isolation rate of B. burgdorferi sensu lato from the blood of children with solitary EM was 9%. The majority of the isolates were B. afzelii. Blood culture-positive patients treated with oral antibiotics were not at greater risk for unfavorable course of the disease than patients with negative blood culture result.
ABSTRACT The aim of the present study was to analyze and compare Borrelia strains isolated from two different specimens obtained simultaneously from individual patients with Lyme borreliosis. Fifty such patients and 50 corresponding pairs of Borrelia isolates (100 low-propagated strains) were subjected to genotypic and phenotypic analysis, including pulsed-field gel electrophoresis for species identification and plasmid profile determination and protein profile electrophoresis for the assessment of the presence and molecular masses of separated proteins. The strains were isolated from two distinct skin lesions (12 patients), skin and blood (28 patients), skin and cerebrospinal fluid (8 patients), and blood and cerebrospinal fluid (2 patients). Out of 100 isolates, 63 were typed as B. afzelii and 37 as B. garinii . From each individual specimen only a single Borrelia species was cultured. Comparison of 50 Borrelia strain pairs isolated from two different specimens of an individual patient revealed that 12/50 (24%) patients were simultaneously infected with two different Borrelia strains; in 3/50 (6%) patients strains differed at the species level, in 4 out of the remaining 47 (9%) patients a strain difference in plasmid profile was established, while 5 out of the remaining 43 (11%) patient strain pairs differed in regard to the protein profiles of the two concurrently isolated strains. The results of the present study indicate that human patients with Lyme borreliosis may simultaneously harbor different B. burgdorferi sensu lato strains.
Abstract We determined levels of tick-borne encephalitis (TBE) virus (TBEV) RNA in serum samples obtained from 80 patients during the initial phase of TBE in Slovenia. For most samples, levels were within the range of 3–6 log10 copies RNA/mL. Levels were higher in female patients than in male patients, but we found no association between virus load and several laboratory and clinical parameters, including severity of TBE. However, a weak humoral immune response was associated with a more severe disease course, suggesting that inefficient clearance of virus results in a more serious illness. To determine whether a certain genetic lineage of TBEV had a higher virulence potential, we obtained 56 partial envelope protein gene sequences by directly sequencing reverse transcription PCR products from clinical samples of patients. This method provided a large set of patient-derived TBEV sequences. We observed no association between phylogenetic clades and virus load or disease severity.
To determine how often Slovenian children with acute peripheral facial palsy are infected with Borrelia burgdorferi sensu lato, 52 patients with peripheral facial palsy were included in this prospective clinical study. According to case definitions, the diagnosis of Lyme borreliosis was established in 56% of those patients. The diagnosis was confirmed in 41%, probable in 28%, and possible in 31% of patients.
To establish the frequency and characteristics of Borrelia burgdorferi sensu lato bacteremia in Slovenian children with solitary and multiple erythema migrans, 1164 patients were included in this prospective study. Bacteremia was established in 11.4% of all patients, 15.8% of patients with multiple erythema migrans, and in 7.6% of patients with solitary erythema migrans. Bacteremia can be detected in children, with untreated erythema migrans, up to 39 days after the onset of skin rash.
Background: Comparison of clinical efficacy and adverse effects of treatment with azithromycin and amoxicillin in children with solitary erythema migrans (EM). Methods: Consecutive patients younger than 15 years with untreated solitary EM referred to our institution 2002–2003 were included in this unblinded prospective clinical study in which patients were alternatively treated with either azithromycin for 5 days or amoxicillin for 14 days. The efficacy of treatment of acute disease, development of minor and major manifestations of Lyme borreliosis and adverse effects of treatment were surveyed by follow-up visits during the first year after inclusion. Results: Eighty-four patients received azithromycin and 84 amoxicillin. Pretreatment characteristics in the 2 groups were comparable with the exception that patients in azithromycin group more often reported a tick bite at the site of later EM (69% versus 52%; P = 0.0400), had more often EM on the trunk (50% versus 26%; P = 0.0025) and reported longer duration of symptoms (median 3 versus 2 days; P = 0.0283). The posttreatment period revealed no significant differences between azithromycin and amoxicillin groups including the duration of EM (median 3 days; P = 0.8984) and the appearance of minor (12% versus 21%; P = 0.2146) and major manifestations (2.6% in each group) of Lyme borreliosis. Adverse effects of treatment were observed in 21% of patients treated with azithromycin and in 16% treated with amoxicillin, and the appearance of Jarisch–Herxheimer reaction was recorded in 7% and 15%, respectively (P = 0.1438). Conclusions: Comparison of azithromycin and amoxicillin for the treatment of children with solitary EM revealed comparable efficacy and adverse effects of treatment.
KliniËni primer / Case report Desetletna deklica z akutno vroËino, levkocitopenijo, trombocitopenijo in patološkimi jetrnimi encimi ten-year-old girl with fever, leukocytopenia, thrombocytopenia and pathological liver function IzvleËek V prispevku prikazujemo primer desetletne deklice z vroËino, trombocitopenijo, levkopenijo in
Slovenia is a highly endemic region for Lyme borreliosis. We present three patients with multiple erythema migrans and simultaneous isolation of Borrelia burgdorferi sensu lato from blood and cerebrospinal fluid. The patients were identified in a prospective study on children with multiple erythema migrans in whom central nervous system involvement was actively searched. The patients had no obvious symptoms and signs of central nervous system involvement. At the end of 14-day treatment with ceftriaxone the patients were free of signs and symptoms of borrelial infection. We stressed the importance of cerebrospinal fluid investigations and early appropriate antibiotic treatment in these patients.
We evaluate the incidence of Lyme meningitis (LM) in children with acute serous meningitis and compare demographic, clinical and laboratory findings in children with LM and non-LM. During 2004-2005, 122 children fulfilled the inclusion criteria for this prospective clinical study (age < 15 years, meningitis, without typical clinical sign for Lyme borreliosis on admission). Antibodies to B. burgdorferi sensu lato were determined in blood and cerebrospinal fluid (CSF) and isolation of B. burgdorferi sensu lato was performed. LM was confirmed by isolation of B. burgdorferi sensu lato from blood and/or CSF and/or seroconversion to borrelial antigens and/or demonstration of borrelial intrathecal antibody production and/or history of erythema migrans. LM was probable in patients with positive but unchanging borrelial serum antibody titers. LM (83% confirmed, 17% probable) was established in 41 (34%) patients. Demographic, clinical and neurologic findings were comparable between the two groups. Fever and peripheral leukocytosis were more common in non-LM and inappetence and lymphocytic pleocytosis in LM. Borrelial serum IgM and/or IgG was found in 25%, seroconversion in 39%, IgG intrathecal antibody production in 5% and isolation of B. burgdorferi sensu lato from CSF and blood in 41% and 22% of patients, respectively. LM was found in 34% of children with acute serous meningitis. It is impossible to distinguish LM from non-LM only from medical history, clinical examination and basic blood and CSF investigations. For this reason, other signs of Lyme borreliosis and microbiological studies on Lyme borreliosis are compulsory.
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