Lyme Disease in Children

Introduction Lyme disease remains a prominent tick-borne illness throughout Europe [1, 2]. Case Presentation 6 year old patient was hospitalized in July due to severe headaches that were difficult to manage with medication. During the medical history collection, it was found that the patient had already visited the hospital four days earlier for headaches but was discharged with a diagnosis of a headache. Blood tests revealed mild leukocytosis with neutrophilia. Although no tick bite had been observed, due to the tick season in an endemic area, antibody tests for tick-borne encephalitis and Lyme disease pathogens were conducted. Laboratory tests confirmed antibodies against Lyme disease pathogens. Suspecting possible mild neuroborreliosis, a lumbar puncture was performed. Cerebrospinal fluid analysis revealed changes consistent with aseptic meningitis. Neuroborreliosis was diagnosed, and a two-week course of intravenous ceftriaxone was prescribed. Following the treatment, the patient's condition improved immediately; the headaches resolved, and blood test results normalized. Discussion In Lithuania, a total of 1,780 Lyme disease cases were registered in 2021. Lyme disease is transmitted by infected ticks of the Ixodes genus, which transmit the bacteria through their saliva during blood feeding [2]. Lyme disease most commonly presents with erythema migrans, typically appearing after a 1-3 week incubation period. After localized infection, there is a risk of dissemination to various tissues [3]. In children, the most common tick bite sites (ears, neck, and particularly the head) are very close to the central nervous system, which increases the risk of developing neuroborreliosis [4]. Neuroborreliosis is diagnosed based on clinical signs (facial nerve paralysis, meningitis, and/or polyradiculopathy), cerebrospinal fluid changes typical of aseptic lymphocytic meningitis, and the detection of specific antibodies against Lyme disease pathogens in both blood and cerebrospinal fluid [1, 2, 5]. The outcomes of the disease depend on early diagnosis and appropriate treatment strategies. Acute Lyme neuroborreliosis in children is treated with 2g of ceftriaxone intravenously for 14 days [6]. Conclusions For diseases with uncertain presentation, screening should focus on the area’s predominant pathogens.