The study’s objective was to “evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States,” writes Sundheim. Participants had been treated at 8 different medical centers throughout the Northeast and UpperMidwest.

Of the 690 children with Lyme disease, 77 (11.2%) had a single EM lesion, 247 (35.7%) had early disseminated disease, and 366 (53.1%) had arthritis, wrote the authors. “Children with early and early-disseminated Lyme disease most frequently presented in the summer months (June through August).”

The authors acknowledged that results could not be applied to non-endemic areas of the country, as all the participating centers were located in regions endemic for Lyme disease.

The authors did not routinely test for co-infections. “Multiplex polymerase chain reaction panels for tick-borne co-infections have demonstrated that a substantial portion of adults with Lyme disease have co-infections.”

Editor’s comments: Sundheim et al. dismissed 2,490 children (78.3%) as clinical mimics. It would have been helpful if the authors had followed up these children to determine whether any of them might have presented with Lyme disease over time.

The authors did not appear to look for other manifestations of Lyme disease and focused rather on individuals with “early (single EM lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis).”