Lymphoproliferative responses toBorrelia burgdorferi in the diagnosis of Lyme arthritis in children and adolescents

Abstract To assess the contribution of the lymphocyte proliferation assay in response to borrelial antigens to establishing a diagnosis of Lyme arthritis (LA) the response to two strains ofBorrelia burgdorferi was tested in peripheral blood lymphocytes of 103 children and adolescents with arthritis, among them 55 with LA and 48 control patients. Patients with LA had a significantly higher response to borrelial antigens than control patients. However, there were several patients with false positive and false negative test results. Specificity and sensitivity of the test were 78% and 77%. In patients with LA the test may turn positive after antibiotic therapy and remain positive for up to 19 months after the disappearance of arthritis. The test does not aid in prognosis or follow up. In one patient with seronegative LA specific lymphocyte proliferation and polymerase chain reaction for borrelialfla sequences in urine were positive.Conclusion Rarely the lymphocyte proliferation assay may aid in finding the correct diagnosis when clinical presentation and anti-borrelial serology do not match.     

Meningitis due toBorrelia burgdorferi in the initial stage of Lyme disease

Borrelia burgdorferi (B. b.) was isolated from cerebrospinal fluid from two children with aseptic meningitis. Serology forB. b. was initially negative or borderline and became positive during the subsequent course. Children with aseptic meningitis of unknown origin should be re-evaluated within 1 month to detect possible increasing antibody titres toB. b. Aseptic meningitis may be a stage 1 manifestation of Lyme disease.Abbreviations B. b. Borrelia burgdorferi - CSF cerebrospinal fluid - CNS central nervous system - ESR erythrocyte sedimentation rate - IFA immunofluorscence assay     

Evaluation of the polymerase chain reaction for the detection ofBorrelia burgdorferi in cerebrospinal fluid of children with acute peripheral facial palsy

Neuroborreliosis occasionally represents a diagnostic problem, especially in the early stage of the infection. The polymerase chain reaction (PCR) offers an attractive alternative to antibody testing. The aim of our study was to investigate the diagnostic potential of PCR in comparison to antibody tests in CSF of children with facial palsy. In contrast to other manifestations of neuroborreliosis, facial palsy is a welldefined clinical entity in which CSF findings allow an early distinction according to aetiology. The study included 17 children with neuroborreliosis, defined by the detection of specific IgM antibodies in CSF, and 20 children with facial palsy of unknown cause. Primers used for the nested PCR were generated from conserved sequences of the OspA-gene. Most of the cases in both subgroups have been examined within a few days after the onset of the paresis. Only in 2 out of 17 cases with neuroborreliosis could specific DNA be amplified. The PCR gave negative results in all cases of the control group.Conclusion The IgM capture ELISA is superior to PCR to support the clinical diagnosis of neuroborreliosis.     

Detection ofBorrelia burgdorferi by nested polymerase chain reaction in cerebrospinal fluid and urine of children with neuroborreliosis

Diagnosis of neuroborreliosis is often difficult since history and clinical presentation may be non-specific and serological tests may initially be negative. We therefore tested the polymerase chain reaction (PCR) for the detection of borrelial sequences in CSF and urine samples of consecutive children with neuroborreliosis seen in a single summer season. Four of eight children were negative in serum for antibodies toBorrelia burgdorferi. Two of eight children were PCR-positive in CSF and one other child was positive in urine. In two out of four children PCR was the only laboratory test confirming the clinical diagnosis. All children recovered after treatment with third generation cephalosporins. When seven of eight children were re-examined 6 months later all were healthy and antibodies toB. burgdorferi were detected in their serum. PCR may assist the paediatrician in establishing a diagnosis of neuroborreliosis; however, a negative result does not rule out neuroborreliosis. PCR is an adjunct, but no substitute for clinical judgement and serology.     

Lyme disease in Canada: Focus on children

Lyme disease, the most common tick-borne infection in Canada and much of the United States, is caused by the bacteria Borrelia burgdorferi. Peak incidence for Lyme disease is among children five to nine years of age and older adults (55 to 59 years of age). The bacteria are transmitted through the bite of infected black-legged ticks of the Ixodes species. The primary hosts of black-legged ticks are mice and other rodents, small mammals, birds (which are reservoirs for B burgdorferi) and white-tailed deer. Geographical distribution of Ixodes ticks is expanding in Canada and an increasing number of cases of Lyme disease are being reported. The present practice point reviews the epidemiology, clinical presentation, diagnosis, management and prevention of Lyme disease, with a focus on children.     

Demonstration ofBorrelia burgdorferi infection in a child with Guillain-Barré syndrome

A 4.5-year-old child suffered from rapidly evolving motor weakness with paresthesia and radicular pain in both legs, accompanied by an isolated elevation of protein levels in CSF. Isoelectric focusing revealed oligoclonal IgG produced in the cerebrospinal compartment only. The diagnosis of Guillain-Barré syndrome was confirmed by electrophysiological studies. High antibody titres againstBorrelia burgdorferi in the serum and specific antibodies in the CSF were demonstrable by ELISA and immunoblotting.B. burgdorferi specific DNA fragments were demonstrated in urine and CSF by means of a nested polymerase chain reaction (PCR), thus providing the borrelial aetiology and indicatingB. burgdorferi infection. Complete recovery was observed after treatment with high dose immunoglobulin and ceftriaxone and control urine specimens were PCR negative.     

Ascaris lumbricoides causing intestinal obstruction in children — a review of 33 cases

Intestinal obstruction in children due to Ascaris lumbricoides is a not uncommon entity in developing countries of Asia and Africa and more so in children of low socioeconomic status. It may produce either subacute or acute obstruction. Thirty-three children with intestinal obstruction due to Ascaris lumbricoides were seen in a period of 2.5 years (January 1984–July 1986) in the Children's Hospital Division of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. The clinical presentation, complications, and management are discussed in the light of pertinent literature.Offprint requests to: A. N. Gangopadhyay     

Arrhythmia or myocarditis: a novel clinical form of Legionella pneumophila infection in children without pneumonia

The possibility that L. pneumophila causes cardiac disorders without respiratory or pulmonary symptoms in childhood was investigated. Out of 20 children with cardiac troubles of unknown aetiology, three showed a four-fold antibody increase or fall in titre against L. pneumophila antigens by the IFA test. Two children, aged 7 months and 2.5 years, had self-limiting arrhythmia and a third, 10-year-old, was suffering from a severe myocarditis. There was no serologic evidence of concurrent infection by respiratory or coxsackie B viruses nor by M. pneumoniae. It is suggested that Legionella infection should be considered in cardiac diseases in childhood, even if pneumonia is lacking.Abbreviations CF complement fixation - IFA indirect fluorescent antibody     

Halofantrine efficacy in non-immune children with imported acute Plasmodium falciparum malaria Infection

A rising incidence of imported acute malaria has been observed in non-immune traveller children returning from the tropics to France. Halofantrine efficacy has been poorly assessed in non-immune children. In order to assess halofantrine efficacy in non-immune children with acute uncomplicated Plasmodium falciparum malaria, we collected data of children with positive blood smears in an open prospective study. Children with neurological manifestations, vomiting and congenital long QT were excluded. All children were hospitalised and received halofantrine (24 mg/kg divided into three doses per day) on an empty stomach. Persistent fever after day 3 defined failure. Relapse was defined by a positive blood smear with or without systemic symptoms within a 1 month follow-up period. In total, 52 children were enrolled. No failure was observed, but relapses occurred in 14/52. On univariate analysis, the mean age of children with relapse was significantly lower (P<0.05). Moreover, diarrhoea was more frequently associated with relapses (P<0.04). Age and diarrhoea were significant independent factors contributing to relapses. Conclusion:this study shows that with a relapse rate of 27%, this regimen with a 1-day course of halofantrine is not to be recommended.     

Successful intravenous immunoglobulin therapy for recurrent pneumococcal otitis media in young children

Serum immunoglobulin levels and naturally occurring antibody titres againstStreptococcus pneumoniae were measured in seven children aged 1–1.9 years with recurent pneumococcal acute otitis media (AOM). Three of them had low IgG₂ levels. Mean antibody levels of anti-pneumococcal IgG₁ and anti-pneumococcal IgG₂ were significantly lower in patients when compared to those of healthy controls and children who had less frequent episodes of AOM. Following treatment with intravenous immunoglobulin (IVIG) for 6 months, anti-pneumococcal IgG₁ and IgG₂ antibody levels increased and the number of episodes of AOM decreased in all patients. Following the discontinuation of IVIG therapy, no AOM episode occurred. Serum levels of anti-pneumococcal IgG₁ and IgG₂ were normal, which were measured in three subjects at 5,6, and 12 months after the cessation of IVIG therapy. These results suggested that delayed maturation of anti-pneumococcal antibody production caused recurrent AOM and this condition was corrected by IVIG therapy.     

Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

In five l-thyroxine-substituted hypothyroid children with partial epilepsy serum total thyroxine (T₄) and free T₄ (FT₄) significantly (P<0.01) decreased following 2 months of carbamazepine (CBZ) administration (20 mg/kg per BW per day) from mean (±SD) values of 12.7±1.1 g/dl and 15.5±1.8 pg/ml to mean values of 7.5±2.3 and 10.1±1.7, respectively. In all but one patient important changes in both serum total and free triiodothyronine (T₃, FT₃) were not observed; consequently T₃T₄ and FT₃FT₄ ratios significantly (P<0.05) increased in the whole series. Three subjects had post-treatment serum TSH that rose to hypothyroid levels parallel to a T₄ decrease. The negligible thyroid hormone secretion and the unmodified T₃-uptake (T₃U) or T₄-binding globulin (TBG) exclude direct effects of CBZ on thyroid gland and on carrier serum proteins, respectively. The findings observed, instead, might be due to accelerated T₄ metabolic clearance together with augmented T₄ to T₃ conversion rate, as previously demonstrated for diphenylydantoin. The sharp reduction in T₄ and FT₃ concentrations is the peripheral display of this event, which is associated with a decompensation of the metabolic status, as indicated by serum TSH enhancement. In all cases a supplement of l-thyroxine by itself was able to restore euthyroid TSH serum concentrations, suggesting that hypothyroidism in patients with partial epilepsy to whom CBZ had been administered requires a higher l-T₄ substitutive regimen.Abbreviations CBZ carbamazepine - DPH phentoin - T₄ thyroxine - T₃ triiodothyronine - TSH thyrotropin - FT₄ free T₄ - FT₃ free T₃ - rT₃ reverse T₃ - TBG thyroxine binding globulin - T₃U T₃ uptake - RIA radioimmunoassay Presented in part at the 23rd Annual Meeting of the European Society for Pediatric Endocrinology (Heidelberg, September 2–5, 1984) [5]     

Human immunodeficiency virus type 2 infection in children

Human immunodeficiency virus type 2 infection is rare in children. This virus can be acquired through transfusion and also by the maternofetal route, especially when the mother becomes infected during pregnancy. Diagnosis based on specific serologic tests is simple after the age of 18 months. In the perinatal period, however, viral isolation by culture or polymerase chain reaction DNA amplification or both appears to be less sensitive than in the case of human immunodeficiency virus type 1. Disease progression is far slower than with human immunodeficiency virus type 1, but severe immunodeficiency can occur. (J Pediatr 1997;130:994-7)     

Quality-of-life in children and adolescents with cystic fibrosis managed in both regional outreach and cystic fibrosis center settings in Queensland

OBJECTIVES: To assess the health-related quality-of-life (HRQOL) of children/adolescents with cystic fibrosis (CF) and compare HRQOL in children managed by cystic fibrosis outreach service (CFOS) with those treated in a cystic fibrosis center (CFC). To compare HRQOL of children with CF in Queensland with previously published HRQOL data from the United States and examine the relationship between HRQOL scores and pulmonary function. STUDY DESIGN: Participants were children/adolescents with CF and their parents managed by the Royal Children's Hospital Queensland at a CFC or CFOS. Two HRQOL surveys were used: PedsQL and Cystic Fibrosis Questionnaire (CFQ). RESULTS: There were 91 CFC and 71 CFOS participants with similar demographics. PedsQL total summary score was statistically higher in CFOS, P=.05. There was no significant difference in CFQ scores between groups. Queensland parents reported lower HRQOL for their children compared with US parents (P<.01) despite similar pulmonary function. Declining pulmonary function correlated with worse CFQ scores in adolescents, P<.05. CONCLUSIONS: Children living in regional Queensland reported as good as or slightly better HRQOL compared with children attending a CFC. Parent proxy HRQOL scores were generally low suggesting a reduced perception of HRQOL by parents for their children.