Borrelia burgdorferi sensu lato bacteremia in Slovenian children with solitary and multiple erythema migrans

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.     

Isolation of Borrelia burgdorferi sensu lato from blood of children with solitary erythema migrans

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 One milliliter of blood was withdrawn before treatment and cultured in modified Kelly-Pettenkofer medium.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.     

Glucagon therapy as a possible cause of erythema necrolyticum migrans in two neonates with persistent hyperinsulinaemic hypoglycaemia

Erythema necrolyticum migrans (ENM) usually presents as a cutaneous paraneoplastic phenomenon which is in most cases associated with a glucagon-producing tumour. Here it is for the first time described as a side-effect of glucagon treatment in persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI). In both patients, the skin lesions disappeared after discontinuation of glucagon administration. In the first child the erythema resolved without scarring within 10 days after glucagon was substituted with other medication while in the second patient healing followed subtotal pancreatectomy which rendered glucagon infusion unnecessary. Initially the clinical resemblance to atopic dermatitis is prone to cause diagnostic errors, especially in this age group. CONCLUSION: erythema necrolyticum migrans should be considered as a differential diagnosis in patients who develop erythematosquamous skin lesions under glucagon treatment.     

Lyme borreliosis in children

A total of 27 children with clinical symptoms indicative of Lyme borreliosis are described, 21 of which were seropositive. CNS symptoms were found in 17 of the seropositive childen (81%). Of these 21, 7 were CSF negative. Another 3 (with Bell's palsy and/or aseptic meningitis) were initially CSF negative but developed specific CSF titres 80, 65 and 120 days after the first lumbar puncture, respectively. Thus, seropositive children with aseptic meningitis and without initial signs of an infectious aetiology should be checked for a neuroborreliosis even when CSF negative in the first lumbar puncture. Antibiotic therapy undertaken in 26 children showed clinical recovery (Sodium penicillin, 300,000–500,000 units/kg per day for 14 days). One developed residual hypoacusis. Comparison of enzyme-linked immunosorbent assay (ELISA) IgG values from 27 cases with those of 30 healthy controls showed that elevated ELISA titres are a good indication of the disease. However, Lyme borreliosis can only be diagnosed correctly if the clinical symptoms conform with specific titres.Abbreviations Bb Borrelia burgdorferi - CNS central nervous system - CSF cerebrospinal fluid - EBV Epstein-Barr virus - ECM erythema chronicum migrans - ELISA enzyme-linked immunosorbent assay - Ig immunoglobulin - Lb Lyme borreliosis     

Cutaneous larva migrans

Cutaneous larva migrans is occasionally seen in pediatric emergency outpatient care settings. It results from infestation of hookworm larvae into the epidermis. The infestation is self-limited but may produce severe discomfort. The diagnosis relies entirely on clinical findings. Laboratory findings only support the clinical diagnosis but do not confirm it. Treatment is typically with topical thiabendazole, but oral thiabendazole may be indicated in severe cases.     

Multilocular Endocervical Polyp in a Five-Year-Old Girl

In childhood, benign tumon of the cervix and corpus uteri are very rare. Clinical and pathological findings of a benign multilocular cystic polyp of the cervix uteri in a 5-year-old girl are presented and the origin of the polyp is discussed.     

Childhood Lyme borreliosis in Europe

Lyme borreliosis is a multisystem disorder common in childhood. It is an acute and persistent anthropozoonotic infection caused by the spirochete Borrelia burgdorferi (Bb) which is transmitted by Ixodes ticks. After the tick bite in summer, erythema migrans, meningoradiculoneuritis, or carditis may develop within the same season. Later manifestations may be oligo-arthritis, progressive encephalomyelitis, or acrodermatitis chronica atrophicans. The most common course is probably asymptomatic. Connatal infection is possible. Diagnosis is established mainly by history and clinical manifestations. The antibody response to Bb can be measured in serum and cerebrospinal fluid. Tests may be false-negative early in the course of the disease or after early treatment. False-positive results may be caused by cross-reactions. Interpretation of test results must also consider unrelated anamnestic titres or asymptomatic infection. Treatment with appropriate antibiotics cures the disease in most patients, however some patients may not respond. The optimal drug has not yet been found. Best prophylaxis is by early removal of the tick from the skin.     

Lyme borreliosis in childhood]

Ten years after detection of Borrelia burgdorferi as the etiologic agent of Lyme borreliosis and after introduction of serological methods an overview of the disease in children is given and compared with own observations. In view of the wide clinical spectrum and the difficulties in interpreting serological results the early diagnosis of Lyme borreliosis is still problematic at present. On the other hand, in case of late diagnosis therapeutic failure and/or partial recovery may result. Data of 138 children with clinically suspected recent Lyme borreliosis demonstrate that the early diagnosis particularly of neuroborreliosis can only be ameliorated when a careful synopsis of all specific and nonspecific laboratory parameters available is done. Additionally, the results of a prospective randomized study of the treatment of acute neuroborreliosis (penicillin G sodium versus ceftriaxone) and results of liquor patency and half-life of ceftriaxone are presented.     

Cutaneous larva migrans in northern Germany

We report a 14-month-old female infant with typical cutaneous larva migrans, but without a history of travelling outside Germany. Cutaneous larva migrans is most commonly observed in and imported from tropical countries. Only a few cases have been described in northern Europe. This report serves as a reminder that under certain circumstances acquisition of this “tropical” parasite is possible even in non-tropical countries.