Pediatric PTLDS Symptoms: Children Remain Ill After Lyme Treatment
Pediatric PTLDS symptoms can persist in some children after Lyme disease treatment, leaving families and clinicians searching for answers.
The authors of a Netherlands study concluded that persistent symptoms were not due to active infection, largely because they lasted longer than 6 months.
“As more than 50% of the children had a duration of symptoms of more than 6 months, this further points towards other disorders than Lyme borreliosis eliciting the complaints,” according to Rashid from the Amsterdam Multidisciplinary Lyme Center. [1]
Rashid and colleagues cited prior research in support of avoiding additional antibiotic treatment. “There is increasing evidence that viable B. burgdorferi s.l. do not persist after conventional treatment with antimicrobials,” they wrote, suggesting that persistent symptoms should not be attributed to active infection.
In their study, only one child was diagnosed with antibiotic-refractory Lyme arthritis.
Evidence from Other Studies on Pediatric PTLDS Symptoms
Findings from other studies suggest a more complex picture.
Patients with early Lyme disease may continue to report pain, fatigue, and symptoms consistent with PTLDS even after standard antibiotic treatment. In a study from Johns Hopkins University School of Medicine, 6% of 107 patients developed PTLDS following a three-week course of doxycycline. [2]
In that study, retreatment was considered in selected cases. “Of the 107 cases, 8 were re-treated with antibiotics after the initial course because of new objective findings or persistent or evolving symptoms,” explains Bechtold from Johns Hopkins. [3]
Should Retreatment Be Reconsidered?
The differing conclusions between studies highlight ongoing uncertainty in the management of persistent Lyme symptoms.
While some researchers conclude that symptoms are not due to active infection, other clinical experiences suggest that a subset of patients may benefit from further evaluation and, in select cases, additional treatment.
It may be reasonable to re-examine children with persistent symptoms to determine whether retreatment or further diagnostic evaluation could be helpful.
Clinical Perspective
Pediatric PTLDS symptoms can be difficult to interpret and may reflect a range of underlying mechanisms, including immune dysregulation, persistent infection, or other coexisting conditions.
Clinicians should take persistent symptoms in children seriously and consider a comprehensive evaluation, particularly when symptoms interfere with daily functioning.
Individualized care remains essential given the variability in presentation and response to treatment.
Clinical Takeaway
Pediatric PTLDS symptoms may persist after standard Lyme disease treatment, and their underlying cause remains uncertain.
Further research and careful clinical evaluation are needed to determine which children may benefit from additional diagnostic workup or treatment.
Related Reading
- No neurologic damage in three children with Lyme disease and Powassan virus
- Tick bite prevention methods are failing our children
- 12-year-old boy suffers cardiac arrest due to Lyme disease
References
- Rashid AN, van Hensbroek MB, Kolader M, Hovius JW, Pajkrt D. Lyme Borreliosis in Children: A Tertiary Referral Hospital Based Retrospective Analysis. Pediatr Infect Dis J. 2017.
- Aucott JN, Soloski MJ, Rebman AW, et al. CCL19 as a Chemokine Risk Factor for Post-Treatment Lyme Disease Syndrome: A Prospective Clinical Cohort Study. Clin Vaccine Immunol. 2016.
- Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized Symptom Measurement of Individuals with Early Lyme Disease Over Time. Arch Clin Neuropsychol. 2017;32(2):129-141.
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
“Of the specifically referred Lyme positive patients, eleven (39.3%) had a definitive LB diagnosis”
so what sort of “modified, previously published classification system” excludes 60.7% of positive test results.
Published trials tend to focus their focus on the patients who meet their predefined criteria. It is clear from the trial that many patients do not meet this strict criteria. Doctor learn what they can from the few who meet strict criteria and have to use clinical judgment to determine which patients who do not meet the strict criteria who might benefit from treatment.
My first test was done in Holland in 2006. I keep getting reinfected.
Dispite being very ill the NHS still ignores my condition.
They have put me in a psychiatric hospital 3 times after coming into hospital very sick because they don’t like the condition. It annoys them.
They have taken me off my antibiotics and given me psychatric medication.