BOSTON — Persistent musculoskeletal pain, headache, fatigue, and cognitive dysfunction that occur for no apparent reason over a prolonged period of time are key elements of a clinical diagnosis of chronic Lyme disease in children, results of a retrospective study has shown.
“While there have been reports on the clinical manifestations of chronic Lyme disease in adults, there has not been a detailing of the clinical aspects of the condition in the pediatric population, making the diagnosis especially challenging,” said Sam T. Donta, M.D., at the annual meeting of the Infectious Disease Society of America.
In an effort to identify the most telling clinical symptoms, the reliability of serologic studies, and the effects of drug therapy, Dr. Donta reviewed the clinical histories, serologies, and treatment results of 101 patients aged 2-19 years who were evaluated at Falmouth Hospital in Massachusetts for possible chronic Lyme disease. Tick bites were known to have occurred in 24% of the patients included in the review.
Musculoskeletal symptoms occurred in approximately 90% of the patients, and fatigue, headache, and cognitive dysfunction were reported in 84%, 78%, and 74% of the patients, respectively. Other diagnostically indicative symptoms that occurred with some frequency included stomach pains or nausea (48%), paresthesias (46%), eye symptoms (40%), and fevers or sweats (39%), Dr. Donta noted. Typical and atypical rashes were reported in 15% and 25% of the patients, respectively.
Approximately 79% of the patients had multiple additional symptoms, such as dizziness, palpitations, and tremors, said Dr. Donta, who has private practices in infectious disease in Boston and Falmouth.
Bell's palsy, which is often the first neurologic symptom of Lyme disease, was reported in five patients. Of the total study population, 29 patients had undergone a brain SPECT (single photon emission computed tomography) scan, eight of which showed some changes in blood flow to various parts of the brain. Such changes, primarily to the temporal and frontal lobes, are present in about 75% of patients with chronic Lyme disease, Dr. Donta stated.
Western tests showed one or more reactions by IgM in 74% of the patients and by IgG in 82%. Enzyme immunoassay titers were positive in 65% of the patients tested. “Clearly, serologic studies can be helpful in supporting the clinical diagnosis,” said Dr. Donta, but they are not definitive on their own.
All of the patients in the cohort were treated with tetracycline or a combination of a macrolide antibiotic with hydroxychloroquine over a 4- to 8-month period, and 75% of them were cured or sustained clinical improvement, Dr. Donta noted.
The key is using appropriate antibiotics, adhering for a long enough period, and the earliest possible treatment.