Lyme Neuroborreliosis in Children Can Mimic Meningitis
Lyme neuroborreliosis can resemble meningitis in children
Diagnosis may be delayed by nonspecific symptoms
Serologic testing may take time to confirm infection
“The exact prevalence of NB [neuroborreliosis] in France is unknown because reporting is not required,” explains Guet-Revillet. “Nevertheless, the prevalence seems rare.”
The outcome for the 9 children “was favorable” after a 2- to 3-week course of third-generation cephalosporin.
However, the outcomes have not been so positive for other pediatric cases. According to the authors’ review of the literature:
“Rare manifestations associated with NB in children include myoclonia, ataxia, vertigo, cranial polyneuritis with the exception of facial nerve palsy, acute transverse myelitis, and benign and isolated intracranial hypertension.”
“Exceptional cases of acute disseminated encephalomyelitis and cerebrovascular complications such as stroke have been reported.”
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Why Lyme Neuroborreliosis in Children Can Be Difficult to Diagnose
Diagnosing Lyme neuroborreliosis in children can be extremely challenging, Guet-Revillet points out, “because of the clinical and biological similarity of [neuroborreliosis] to viral meningitis (especially herpes simplex virus and varicella-zoster virus meningitis) and tuberculous meningitis.”
This difficulty is exacerbated by the long delay involved in obtaining serological test results.
Neurologic Symptoms Reported in Children
Children with Lyme neuroborreliosis may present with a broad range of neurologic symptoms beyond facial nerve palsy.
Reported manifestations include:
- Myoclonia
- Ataxia
- Vertigo
- Cranial polyneuritis
- Acute transverse myelitis
- Intracranial hypertension
Rare cerebrovascular complications, including stroke-like presentations, have also been described.
Why Early Recognition Matters
Delayed diagnosis of Lyme neuroborreliosis in children may prolong symptoms and complicate treatment decisions.
Because Lyme neuroborreliosis can resemble viral or tuberculous meningitis, clinicians may initially pursue other infectious or neurologic explanations before considering tick-borne illness.
For related discussions, see:
Related Articles:
Long-term problems for some Lyme neuroborreliosis patients
Case report: Lyme neuroborreliosis more common in children
What happens to the brain during acute Lyme neuroborreliosis?
Clinical Takeaway
Lyme neuroborreliosis in children can mimic meningitis and other neurologic conditions.
Awareness of these overlapping presentations may help clinicians recognize Lyme disease earlier in children with unexplained neurologic symptoms.
Clinical judgment remains essential when serologic testing is delayed or inconclusive.
References:
- Guet-Revillet H, Levy C, Vallet C, et al. Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Arch Pediatr. 2019;26(3):133-137.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
