Effectiveness of Antibiotic Treatment in Children With Lyme Neuroborreliosis

What Is Lyme Neuroborreliosis in Children?

Lyme neuroborreliosis is a tick-borne disease caused by Spirochete Borrelia with multiple neurological manifestations. It occurs by transmitting the pathogen from an infected tick to a human host during a tick bite. This infection occurs both in children and adults, but it varies clinically.

Lyme neuroborreliosis is also called neurological Lyme. It is a secondary infection of Lyme disease, which involves the central nervous system. The bacteria invade the central nervous system, resulting in various neurological manifestations. Lyme neuroborreliosis occurs in 15% of people with Lyme disease.

Are Lyme Disease and Lyme Neuroborreliosis Similar?

No, Lyme neuroborreliosis is not exactly similar to Lyme disease. It is a secondary infection of Lyme disease that occurs when bacteria invade the central nervous system. The symptoms also vary from each other.

What Are the Symptoms of Lyme Disease?

• Neurological symptoms appear in the early stage of Lyme disease. They usually appear three to five weeks after the initial bite.

• But soon after the bite, the symptoms are flu-like.

• In every 100 cases, nine are with facial palsy, four with radiculoneuropathy, and two with meningitis or encephalitis.

• After the invasion of the bacteria into the brain, it affects the central nervous system, including the brain and spinal cord, and the peripheral nervous system, including the motor and sensory nerves, causing cranial neuritis, meningitis, myelitis, and vasculitis.

What Are the Symptoms of Lyme Neuroborreliosis?

The following are the symptoms of Lyme neuroborreliosis:

• Severe headaches.

• Fever.

• Stiff neck.

• Sensitivity to light.

• Radiculoneuritis can cause unilateral or bilateral facial paralysis (loss of muscle tone on one side of the which causes drooling of saliva, difficulty in making facial expressions and smiling), it causes muscle weakness, numbness or tingling in hands and feet, and sharp pain.

• The cranial nerves emerge from the brain stem. Inflammation of these cranial nerves is called cranial neuritis, affecting vision, eye movements, hearing, taste, smell, and head-turning.

• Central nervous system involvement also causes meningitis, myelitis, vasculitis, and encephalitis.

• Some people may notice symptoms in the following weeks or months, or years like memory disorders, sleep disorders, difficulty concentrating, irritability, and nerve damage to hands and legs.

• However, in young children, there is a chance of unspecific symptoms like loss of appetite, behavior problems, and fatigue.

• The symptoms may differ from adult to child.

What Are the Causes of Neurological Lyme Disease?

Lyme neuroborreliosis is a tick-borne disease caused by Spirochete Borrelia with multiple neurological manifestations. It occurs by transmitting the pathogen from an infected tick to a human host during a tick bite. This infection occurs both in children and adults, but it varies clinically. Not all ticks transmit Lyme disease; the tick which attaches to the body for 24 hours can only transmit the disease. It occurs by transmitting the pathogen from an infected tick to a human host during a tick bite.

What Are the Risk Factors for Lyme Neuroborreliosis?

• Working environment.

• People who play outdoor games for a longer time.

• Time of the year.

• Poor hygiene.

What Are the Important Tips for the Health Care Provider?

• In patients with facial paralysis where the patient cannot close their eyes, eye drops or eye patches have to be given to prevent the eyes from dryness.

• Two-step serologic testing is a diagnostic test that has been performed for the confirmation of Lyme neuroborreliosis. The first step is an enzyme immunoassay or immunofluorescence assay; if the first step does not detect any bacteria, then no need to proceed to the second step. If the first step shows a positive result, the healthcare professional will perform a western blot test to confirm the disease.

• Talk to patients about how to prevent tick bites and make them aware of infections caused by tick bites.

What Are the Best Ways to Prevent Tick Bites?

• Pets at home should be vaccinated.

• Dry clothes at high temperatures to kill ticks.

• Know where the ticks are more likely to be.

• Apply repellents on the skin, clothes, and camping gear, especially when you are mostly outdoors.

• Shower after coming from outside.

• Ask pest control how to keep the ticks away and take the required preventive measures.

• Maintenance of proper hygiene is most important if someone is playing outdoor games.

• Be alert for the symptoms of Lyme disease; if any symptoms are noticed, do not delay; visit any healthcare provider and start treatment immediately. Early diagnosis and treatment help in the proper maintenance of health and prevent further damage.

What Is the Treatment for Lyme Neuroborreliosis?

The treatment of Lyme neuroborreliosis includes the following:

• After the diagnosis of the disease, antibiotic therapy is the common treatment that is usually followed, but the antibiotic treatment should be continued for at least two weeks.

• Facial palsy and radicular neuritis are treated by intravenous antibiotic therapy; depending on the severity, the dosage is varied. Most of the symptoms of Lyme neuroborreliosis are cured fully by antibiotic therapy. The affected people respond well to antibiotic therapy. If it is not treated in the initial stages, it may cause permanent damage to the brain.

• All cases showed anti-Borrelia antibodies in cerebrospinal fluid or serum or with a positive Borrelia PCR in the CSF. The outcome was favorable in all cases after a two to three-week course of a third-generation cephalosporin.

• The most commonly used antibiotics are Doxycycline and Ceftriaxone; the dosage varies according to the severity. However, Doxycycline is not approved by the Food and Drug Authority (FDA) for children under eight years.

Conclusion:

Lyme neuroborreliosis is a secondary infection of Lyme disease, which occurs when the bacteria enters the central nervous system resulting in multiple neurological manifestations. The symptoms may vary from tingling and numbness to meningitis and neuritis. Early treatment and diagnosis may prevent the progression and severe stages of the disease. The patient responds very well to intravenous antibiotic therapy and recovers fully. The most commonly used antibiotics are Doxycycline and Ceftriaxone. However, Doxycycline is not approved by the FDA for children under eight years of age.