All Posts Tagged With: "pediatrics"

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20505978&retmode=ref&cmd=prlinks

Excerpt:

INTRODUCTION: Acute transverse myelitis (ATM) is a rare disorder
(1-8 new cases per million of population per year), with 20% of
all cases occurring in patients younger than 18 years of age.
Diagnosis requires clinical symptoms and evidence of inflammation
within the spinal cord (cerebrospinal fluid and/or magnetic
resonance imaging). ATM due to neuroborreliosis typically
presents with impressive clinical manifestations.
CASE PRESENTATION: Here we present a case of Lyme
neuroborreliosis-associated ATM with severe MRI and CSF findings,
but surprisingly few clinical manifestations and late conversion
of the immunoglobulin G CSF/blood index of Borrelia burgdorferi
sensu lato.
CONCLUSION:
Clinical symptoms and signs of neuroborrelial ATM may be minimal,
even in cases with severe involvement of the spine, as shown by
imaging studies. The CSF/blood index can be negative in the early
stages and does not exclude Lyme neuroborreliosis; if there is
strong clinical suspicion of Lyme neuroborreliosis, appropriate
treatment should be started and the CSF/blood index repeated to
confirm the diagnosis.

Excerpt:

OBJECTIVE: Children often develop arthritis secondary to Lyme
disease; however, optimal treatment of Lyme arthritis in
pediatric patients remains ill-defined.
We sought to characterize the outcomes of a large cohort of
children with Lyme arthritis treated using the approach
recommended by the American Academy of Pediatrics and the
Infectious Diseases Society of America. METHODS: Medical records
of patients with Lyme arthritis seen by rheumatologists at a
tertiary care children’s hospital from 1997 to 2007 were
reviewed. Patients were classified with antibiotic responsive or
refractory arthritis based on absence or presence of persisting
joint involvement 3 months after antibiotic initiation. Treatment
regimens and outcomes in patients with refractory arthritis were
analyzed.

RESULTS: Of 99 children with Lyme arthritis, 76 had arthritis
that responded fully to antibiotics, while 23 developed
refractory arthritis. Most patients with refractory arthritis
were successfully treated with nonsteroidal antiinflammatory
drugs (6 patients), intraarticular steroid injections (4), or
disease-modifying antirheumatic drugs (DMARD) (2). Five were lost
to followup. Six patients with refractory arthritis were
initially treated elsewhere and received additional antibiotic
therapy, with no apparent benefit.
Three subsequently required DMARD, while 3 had gradual resolution
of arthritis without further therapy. Antibiotic responsiveness
could not be predicted from our clinical or laboratory data.

CONCLUSION: Lyme arthritis in children has an excellent
prognosis. More than 75% of referred cases resolved with
antibiotic therapy. Of patients with antibiotic refractory
arthritis, none in whom followup data were available developed
chronic arthritis, joint deformities, or recurrence of infection,
supporting current treatment guidelines.

Linda’s comments:  Lyme Carditis in children is not getting the attention it should be getting.  Makes me wonder how many of the athletes who drop dead in their sport isn’t suffering from Lyme Carditis and have been grossly mis-diagnosed??

NEW YORK (Reuters Health) May 01 – Manifestations of Lyme carditis in children can range from asymptomatic first-degree heart block to fulminant myocarditis, physicians at Harvard Medical School report in the May issue of Pediatrics. Data from their case series indicate that older age, arthralgia, and cardiopulmonary symptoms were independent predictors of carditis in pediatric patients with early disseminated Lyme disease. Continued

Excerpt:

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

November 13, 2009 (Washington, DC) – The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States. Continued

NEW YORK (Reuters Health) May 01 – Manifestations of Lyme carditis in children can range from asymptomatic first-degree heart block to fulminant myocarditis, physicians at Harvard Medical School report in the May issue of Pediatrics. Data from their case series indicate that older age, arthralgia, and cardiopulmonary symptoms were independent predictors of carditis in pediatric patients with early disseminated Lyme disease. Continued