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.

Cardiac involvement, such as myocarditis and pericarditis, can be a severe complication of monkeypox virus (mpox) infection and could be related to other co-infections with cardiac involvement. Tecovirimat is an antiviral specifically designed to inhibit smallpox infection diffusion and approved by the FDA for other Orthopoxvirus infections; its efficacy in mpox-infected patients is not well established. We present the case of a cardiac complication during mpox infection in a previously undiagnosed Lyme disease in a 42-year-old man living with HIV. Two days after the typical maculopapular rash, the patient reported a rise in body temperature up to 39 °C, chest pain without irradiation, and shortness of breath. We found an increase in troponin level, a slight reduction in ejection fraction, and grade 2 AV block (Mobitz 1 and 2) with frequent sinus pauses (the longest of 10.1 s). Given the suspicion of myopericarditis with cardiac conduction system involvement, the patient was admitted to the Intermediate Care Unit for continuous monitoring and further evaluation. Treatment included Ibuprofen 600 mg every 12 hours (bid) and colchicine 1 mg once daily for anti-inflammatory purposes. Concomitantly, treatment with tecovirimat was started at 600 mg bid for a total of 14 days. Cardiac MRI with gadolinium showed mild interstitial edema and pericardial enhancement. However, despite the clinical and laboratory resolution of the acute phase, bradycardia with episodes of AV block persisted at follow-up, suggesting the possibility of an additional etiology. Thus, the patient was investigated for Lyme disease because high-degree AV block is the most common presentation of Lyme carditis. Serological results evidenced a previous Borrelia burgdorferi senso latu. We decided to start treatment with doxycycline 100 mg every 12h, even pending the uncertainty of the role of a previous Lyme disease in determining the cardiac rhythm disturbances. At the evaluation on day 44, the patient was systemically well, and after cardiologist consultation, pace-maker implantation was not deemed indicated. This case underscores the importance of considering alternative causes of carditis when the clinical picture remains unclear or persists after the acute phase.

Poly-microbial vector-borne infections may have contributed to neuropsychiatric symptoms in a boy diagnosed with autism spectrum disorder. Targeted antimicrobial treatment resulted in substantial improvement in cognitive (such as learning disabilities, focus, concentration) and neurobehavioral (such as oppositional, defiant, anti-social, disordered mood, immaturity, tics) symptoms.

BACKGROUND: Lyme neuroborreliosis (LNB), due to infection of the nervous system by the spirochete Borrelia burgdorferi, occurs in 15% of Lyme disease cases. However, neurovascular involvement is uncommon, especially recurrent stroke related to cerebral vasculitis in the absence of CSF pleocytosis.
METHODS: We report the case of a 58-year-old man without any medical history who exhibited recurrent strokes in the same vascular territory (left internal carotid). Multiple biological screening, neuroimaging methods, and cardiovascular examinations failed to provide a diagnosis and treatment that could have prevented recurrences. Finally, B. burgdorferi sensu lato serology testing in blood and cerebrospinal fluid enabled diagnosis of LNB, in relation to a cerebral vasculitis. The patient experienced no further stroke after four weeks of doxycycline treatment.
CONCLUSIONS: B. burgdorferi central nervous system infection must be considered in case of unexplained recurrent and/or multiple strokes, especially if cerebral vasculitis is suspected or demonstrated on neuroimaging.

Lyme disease can result in severe neuropsychiatric symptoms that may be resistant to treatment. The pathogenesis of neuropsychiatric Lyme disease is associated with autoimmune induced neuroinflammation. This case report describes an immunocompetent male with serologically positive neuropsychiatric Lyme disease who did not tolerate antimicrobial or psychotropic medications and whose symptoms remitted when he began psilocybin in microdosed (sub-hallucinogenic) amounts. A literature review of its therapeutic benefits reveals that psilocybin is both serotonergic and anti-inflammatory and therefore may offer significant therapeutic benefits to patients with mental illness secondary to autoimmune inflammation. The role of microdosed psilocybin in the treatment of neuropsychiatric Lyme disease and autoimmune encephalopathies warrants further study.

Lyme disease is an infectious tick-borne illness predominant in northeastern and midwestern United States. The clinical presentation varies significantly and only a few cases develop Lyme neuroborreliosis (LNB), which makes diagnosis difficult. A 59-year-old male visiting from Michigan presented to a hospital in Florida with an ischemic stroke with aphasia and acute confusion for two days. He had imaging that noted a subacute infarct in the left parietal lobe along with multiple areas of white matter signal abnormalities and CSF serology positive for Borrelia burgdorferi IgM and IgG antibodies. The patient was placed on ceftriaxone for 30 days and showed significant clinical improvement. We present a case of ischemic stroke with hemorrhagic conversion and an incidental finding of LNB.

Lyme disease is the most common tick-borne disease in the United States. Left untreated, it can lead to neuroborreliosis. Here we describe a case of early disseminated Lyme disease-associated Guillain Barre Syndrome in a previously healthy adult that early clinical suspicion and accurate testing led to proper diagnosis and case management. It is important to be aware of Guillain Barre Syndrome as an early consequence of Lyme disease especially during tick activity season. This case report is meant to raise awareness among clinicians and calls for protective measures especially where there is significant outdoor activity.

A 79-year-old Caucasian woman was admitted to the hospital with a 1-week history of general deterioration, describing malaise, abdominal pain, vomiting and diarrhea. Concomitantly, she presented with urinary retention. Laboratory tests revealed severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Patient reported a tick bite 1 month earlier, followed by erythema migrans. The diagnosis of Lyme disease was immediately suspected and confirmed by positive IgM and IgG serology. Symptoms and electrolyte disturbances completely resolved with a 2-week course of doxycycline. This case highlights the need to consider osis as a cause of hyponatremia and SIADH in an endemic region.

UNASSIGNED: Lyme carditis is an uncommon manifestation of Lyme disease. This report compares Lyme carditis presentation, management, and outcomes in pediatric and adult populations.
UNASSIGNED: Charts of pediatric and adult patients with heart block (PR interval >300 ms) and positive Lyme serologies hospitalized in Portland, Maine, between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described.
UNASSIGNED: Ten children and 20 adults were admitted for Lyme carditis between June and October. Ninety percent were male, and 87% had no prior cardiac history. Seventeen had outpatient evaluation before admission. Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment. The most common alternate diagnoses were viral illness and erythema multiforme. More children than adults had disseminated erythema migrans and fever. First-degree heart block was more prevalent in children, and Mobitz type 2 heart block was more prevalent in adults. Ten patients presented with syncope. Proportionately more adults needed temporary pacing. Children had shorter antibiotic durations compared with adults. Of the 30 cases, 27 had improved heart block, while 3 adults required a pacemaker at discharge. Nine children and 14 adults were discharged with a PR 200-300 ms. There was a single death in this series.
UNASSIGNED: Cases tended to be younger males. Most patients had some heart block on discharge. Of patients evaluated as outpatients, Lyme disease was suspected in 41%. Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.

The complex etiology of neurodegenerative disease has prompted studies on multiple mechanisms including genetic predisposition, brain biochemistry, immunological responses, and microbial insult. In particular, Lyme disease is often associated with neurocognitive impairment with variable manifestations between patients. We sought to develop methods to reliably detect Borrelia burgdorferi, the spirochete bacteria responsible for Lyme disease, in autopsy specimens of patients with a history of neurocognitive disease. In this report, we describe the use of multiple molecular detection techniques for this pathogen and its application to a case study of a Lyme disease patient. The patient had a history of Lyme disease, was treated with antibiotics, and years later developed chronic symptoms including dementia. The patient\'s pathology and clinical case description was consistent with Lewy body dementia. B. burgdorferi was identified by PCR in several CNS tissues and by immunofluorescent staining in the spinal cord. These studies offer proof of the principle that persistent infection with the Lyme disease spirochete may have lingering consequences on the CNS.