PDF(Pubmed)
Abstract：
Tracing the profile of pediatric Lyme borreliosis (LB) in Europe is difficult due to the interregional variation in its incidence and lack in notifications. Moreover, the identification of LB can be challenging. This study is an 18-year case series of 130 children and adolescents aged under 18 years referred to the Pediatric Infectious Diseases Unit at L. Sacco Hospital, Milan, with suspicion of LB, between January 2005 and July 2023. The routine serological workup consisted of a two-step process: an initial screening test followed by Western blot (WB). Forty-four (34%) patients were diagnosed with LB. The median age was six years, and 45% were females. Of the children with erythema migrans (EM), 33 (57%) were confirmed as having true EM, and, of these, 4 (12%) were atypical. Ten (23%) patients had early disseminated/late diseases, including facial nerve palsy (n = 3), early neuroborreliosis (n = 1), arthritis (n = 3), relapsing fever (n = 2), and borrelial lymphocytoma (n = 1). No asymptomatic infections were documented. Over seventy percent of confirmed LB cases (n = 31/44) recalled a history of tick bites; in this latter group, 19 (61%) were from the area of the Po River valley in Lombardy. Almost half of the children evaluated for LB complained of non-specific symptoms (fatigue, musculoskeletal pain, skin lesions/rash, and persistent headache), but these symptoms were observed in only two patients with confirmed LB. Most LB cases in our study were associated with EM; two-tier testing specificity was high, but we found frequent non-adherence to international recommendations with regard to the timing of serology, application of the two-step algorithm, and antibiotic over-prescription. Most children were initially assessed for a tick bite or a skin lesion suggestive of EM by a family pediatrician, highlighting the importance of improving awareness and knowledge around LB management at the primary healthcare level. Finally, the strengthening of LB surveillance at the national and European levels is necessary.
摘要：
在欧洲追踪小儿莱姆病（LB）的概况很困难，因为其发病率存在区域间差异，并且缺乏通知。此外，LB的鉴定可能具有挑战性。这项研究是一项为期18年的病例系列，涉及130名18岁以下的儿童和青少年，转诊到L.Sacco医院的儿科传染病科，米兰,怀疑LB，2005年1月至2023年7月。常规血清学检查包括两步过程：初始筛选测试，然后进行蛋白质印迹（WB）。44（34％）患者被诊断为LB。平均年龄是6岁,45%是女性。在患有偏头痛红斑（EM）的儿童中，33(57%)被确认为真正的EM，and,其中，4例（12%）为非典型。10例（23%）患者有早期传播/晚期疾病，包括面神经麻痹（n=3），早期神经性贝氏症（n=1），关节炎（n=3），复发性发热（n=2），和硼质淋巴细胞瘤（n=1）。没有记录到无症状感染。超过70％的确诊LB病例（n=31/44）回想起蜱叮咬史；在后一组中，19（61％）来自伦巴第的Po河谷地区。几乎一半的被评估为LB的儿童抱怨非特异性症状（疲劳，肌肉骨骼疼痛，皮肤损伤/皮疹,和持续性头痛)，但这些症状仅在2例确诊为LB的患者中观察到.我们研究中的大多数LB病例与EM相关；双层测试特异性很高，但是我们发现在血清学的时间安排方面经常不遵守国际建议，两步算法的应用，和抗生素过度处方。大多数儿童最初由家庭儿科医生评估为蜱叮咬或皮肤病变提示EM，强调在初级卫生保健水平上提高对LB管理的认识和知识的重要性。最后,在国家和欧洲层面加强LB监测是必要的。
