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Previous Volume 335:1270-1274 October 24, 1996 Number 17 Next

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ABSTRACT

Background Although the incidence of Lyme disease is highest in children, there are few prospective data on the clinical manifestations and outcomes in children.

Methods We conducted a prospective, longitudinal, community-based cohort study of children with newly diagnosed Lyme disease in an area of Connecticut in which the disease is highly endemic. We obtained clinical and demographic information and performed serial antibody tests and follow-up evaluations.

Results Over a period of 20 months, 201 consecutive patients were enrolled; their median age was 7 years (range, 1 to 21). The initial clinical manifestations of Lyme disease were a single erythema migrans lesion in 66 percent, multiple erythema migrans lesions in 23 percent, arthritis in 6 percent, facial-nerve palsy in 3 percent, aseptic meningitis in 2 percent, and carditis in 0.5 percent. At presentation, 37 percent of the patients with a single erythema migrans lesion and 89 percent of those with multiple erythema migrans lesions had antibodies against Borrelia burgdorferi. All but 3 of the 201 patients were treated for two to four weeks with conventional antimicrobial therapy, which was administered orally in 96 percent. All had prompt clinical responses. After four weeks, 94 percent were completely asymptomatic (including the two patients whose parents had refused to allow antimicrobial treatment). At follow-up a mean of 25.4 months later, none of the patients had evidence of either chronic or recurrent Lyme disease. Six patients subsequently had a new episode of erythema migrans.

Conclusions About 90 percent of children with Lyme disease present with erythema migrans, which is an early stage of the disease. The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents.

Source Information

From the Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford (M.A.G., G.S.B.); the Departments of Pediatrics (E.D.S., V.J.P.) and Epidemiology (E.D.S.) and the Children's Clinical Research Center (E.D.S.), Yale University School of Medicine, New Haven; and the Department of Pediatrics, University of Connecticut School of Medicine, Farmington (G.L.B.) — all in Connecticut.

Address reprint requests to Dr. Gerber at Connecticut Children's Medical Center, 282 Washington St., Hartford, CT 06106.

Full Text of this Article

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