Matteo D'Alessandro1, Anna Loy1, Elio Castagnola2. 1. Istituto Giannina Gaslini - Ospedale Pediatrico IRCCS, Largo G. Gaslini 5, 16147, Genoa, Italy. 2. Istituto Giannina Gaslini - Ospedale Pediatrico IRCCS, Largo G. Gaslini 5, 16147, Genoa, Italy. eliocastagnola@gaslini.org.
Abstract
PURPOSE OF REVIEW: Lyme disease is a tick-borne zoonosis transmitted through a bite of a tick carrying a spirochete belonging to Borrelia species. In the last 20 years, the reported incidence of Lyme disease is increased by three times in Europe. Clinically, the illness develops through a primary stage with a typical skin rash (erythema marginatum), then a secondary stage with possible neurologic or cardiac involvement. The last stage (chronic Lyme disease) is mainly represented by arthritis or late neurological complications but nowadays is rarely seen due to precocious antibiotic use. RECENT FINDINGS: The diagnosis of Lyme disease is essentially based on history in agreement with tick exposure (living/recent traveling in endemic area or tick bite) and clinical findings compatible with the disease. At present, no laboratory diagnostic tool available can neither establish nor exclude the diagnosis of Lyme disease. The management of Lyme disease should comprise a prophylactic administration of antibiotic in selected population (patients exposed to a tick bite in endemic regions) in which the typical signs of Lyme disease are not yet appeared; conversely, patients with current signs of Lyme disease should undergo a standard therapeutic course. First-line therapy should be oral tetracycline or oral penicillin/cephalosporin (in pediatric populations, beta-lactamic drugs are preferred). In severe courses, intravenous route should be preferred. The aim of this review is to provide an updated guide to the management of pediatric Lyme patients, from prophylaxis to first- and second-line therapy in European setting.
PURPOSE OF REVIEW: Lyme disease is a tick-borne zoonosis transmitted through a bite of a tick carrying a spirochete belonging to Borrelia species. In the last 20 years, the reported incidence of Lyme disease is increased by three times in Europe. Clinically, the illness develops through a primary stage with a typical skin rash (erythema marginatum), then a secondary stage with possible neurologic or cardiac involvement. The last stage (chronic Lyme disease) is mainly represented by arthritis or late neurological complications but nowadays is rarely seen due to precocious antibiotic use. RECENT FINDINGS: The diagnosis of Lyme disease is essentially based on history in agreement with tick exposure (living/recent traveling in endemic area or tick bite) and clinical findings compatible with the disease. At present, no laboratory diagnostic tool available can neither establish nor exclude the diagnosis of Lyme disease. The management of Lyme disease should comprise a prophylactic administration of antibiotic in selected population (patients exposed to a tick bite in endemic regions) in which the typical signs of Lyme disease are not yet appeared; conversely, patients with current signs of Lyme disease should undergo a standard therapeutic course. First-line therapy should be oral tetracycline or oral penicillin/cephalosporin (in pediatric populations, beta-lactamic drugs are preferred). In severe courses, intravenous route should be preferred. The aim of this review is to provide an updated guide to the management of pediatric Lyme patients, from prophylaxis to first- and second-line therapy in European setting.
Authors: Henry M Feder; Barbara J B Johnson; Susan O'Connell; Eugene D Shapiro; Allen C Steere; Gary P Wormser; W A Agger; H Artsob; P Auwaerter; J S Dumler; J S Bakken; L K Bockenstedt; J Green; R J Dattwyler; J Munoz; R B Nadelman; I Schwartz; T Draper; E McSweegan; J J Halperin; M S Klempner; P J Krause; P Mead; M Morshed; R Porwancher; J D Radolf; R P Smith; S Sood; A Weinstein; S J Wong; L Zemel Journal: N Engl J Med Date: 2007-10-04 Impact factor: 91.245