Characterization of Lyme meningitis and comparison with viral meningitis in children

Objectives. The objectives of this study were to characterize Lyme meningit is (LM) in the pediatric population; to compare LM with viral meningitis (V M) with respect to epidemiology, history and physical examination, and labo ratory data; and to provide means of early distinction of Lyme neuroborreli osis from other forms of aseptic meningitis. Methods. This retrospective analysis involved children admitted to Alfred I . duPont Hospital for Children between 1990 and 1996 whose discharge diagno ses indicated viral or aseptic meningitis or Lyme disease. LM was defined a s the presence of cerebrospinal fluid (CSF) pleocytosis with positive Lyme serology and/or erythema migrans. Patients were considered to have VM if th ey exhibited CSF pleocytosis and had a positive viral culture. Demographic, clinical, and laboratory data were collected for each patient, and patient s with LM were compared with age-matched patients with VM. Results. Of 179 patient records, 12 patients with LM and 10 patients with V M (all, >2 years old) were identified by using the above criteria. In compa ring LM patients with VM patients, we noted no differences among demographi c variables. Children with LM had significantly lower temperatures at the t ime of presentation. The presence of headache, neck pain, and malaise was s imilar for the two groups, but the duration of these symptoms was significa ntly longer among LM patients. Five children with LM had cranial neuropathi es. All but 1 LM patient exhibited either papilledema, erythema migrans, or cranial neuropathy. These three findings were absent in the VM group. On C SF analysis, LM patients had fewer white blood cells (mean, 80/mm(3) versus 301/mm(3)) and a significantly greater percentage of mononuclear cells tha n the VM patients. Conclusions. In this study, in a Lyme-endemic area, LM was about as common as VM in older children who were hospitalized with aseptic meningitis. Atte ntion to pertinent epidemiologic and historical data, along with physical a nd CSF findings, allows early differentiation of LM from VM.