LYME-DISEASE IN CHILDREN IN SOUTHEASTERN CONNECTICUT

Background Although the incidence of Lyme disease is highest in childr en, there are few prospective data on the clinical manifestations and outcomes in children. Methods We conducted a prospective, longitudinal , community-based cohort study of children with newly diagnosed Lyme d isease in an area of Connecticut in which the disease is highly endemi c. We obtained clinical and demographic information and performed seri al antibody tests and follow-up evaluations. Results Over a period of 20 months, 201 consecutive patients were enrolled; their median age wa s 7 years (range, 1 to 21). The initial clinical manifestations of Lym e disease were a single erythema migrans lesion in 66 percent, multipl e erythema migrans lesions in 23 percent, arthritis in 6 percent, faci al-nerve palsy in 3 percent, aseptic meningitis in 2 percent, and card itis in 0.5 percent. At presentation, 37 percent of the patients with a single erythema migrans lesion and 89 percent of those with multiple erythema migrans lesions had antibodies against Borrelia burgdorferi. All but 3 of the 201 patients were treated for two to four weeks with conventional antimicrobial therapy, which was adminis tered orally in 96 percent. All had prompt clinical responses, After four weeks, 94 p ercent were completely asymptomatic (including the two patients whose parents had refused to allow antimicrobial treatment), At follow-up a mean of 25.4 months later, none of the patients had evidence of either chronic or recurrent Lyme disease. Six patients subsequently had a ne w episode of erythema migrans. Conclusions About 90 percent of childre n with Lyme disease present with erythema migrans, which is an early s tage of the disease. The prognosis is excellent for those with early L yme disease who are treated promptly with conventional courses of anti microbial agents. (C) 1996, Massachusetts Medical Society.