Share This Article:

Are There Undiagnosed TBE-, Herpes- or Enteroviral Infections among Children Being Evaluated for Lyme Neuroborreliosis?

Abstract Full-Text HTML XML Download Download as PDF (Size:2547KB) PP. 123-129
DOI: 10.4236/ojcd.2014.43020    2,187 Downloads   2,463 Views  

ABSTRACT

Lyme neuroborreliosis (LNB) in children is a challenging diagnosis based on clinical manifestations and laboratory findings. The aim of this study was to investigate whether herpes simplex virus (HSV) 1 or 2, varicella zoster virus (VZV), enterovirus or tick-borne encephalitis virus (TBEV) could be identified in cerebrospinal fluid (CSF) or serum from children being evaluated for LNB, in order to elucidate whether such infectious diseases may be missed by the clinician. Methods: Ninety-nine pediatric patients (n = 99) were retrospectively included from a previous study on LNB in southeast of Sweden. They had been diagnosed as “Possible LNB” or “Not determined” due to negative Borrelia antibody index in CSF. Routine polymerase chain reaction (PCR) methods were used for detection of herpes viral RNA or enteroviral DNA in CSF. An ELISA assay was used for detection of anti-TBEV antibodies (IgM and IgG) in serum. Results: One patient showed elevated anti-TBEV IgM and IgG antibodies in serum, indicating a current TBE infection. No positive PCR reactions for HSV 1 or 2, VZV or enterovirus were detected in CSF from any of the patients. In conclusion, our results suggest that undiagnosed herpes- or enteroviral infections are unlikely to explain CNS symptoms in children being evaluated for LNB, whereas missed TBE infections may occur. TBEV serology should be included when evaluating children for LNB in TBE endemic areas.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Skogman, B. , Forsberg, P. , Vene, S. and Akerlind, B. (2014) Are There Undiagnosed TBE-, Herpes- or Enteroviral Infections among Children Being Evaluated for Lyme Neuroborreliosis?. Open Journal of Clinical Diagnostics, 4, 123-129. doi: 10.4236/ojcd.2014.43020.

References

[1] Stanek, G. and Strle, F. (2003) Lyme Borreliosis. The Lancet, 362, 1639-1647.
http://dx.doi.org/10.1016/S0140-6736(03)14798-8
[2] Steere, A.C. (2006) Lyme Borreliosis in 2005, 30 Years after Initial Observations in Lyme Connecticut. Wiener klinische Wochenschrift, 118, 625-633. http://dx.doi.org/10.1007/s00508-006-0687-x
[3] Strle, F. and Stanek, G. (2009) Clinical Manifestations and Diagnosis of Lyme Borreliosis. Current Problems in Dermatology, 37, 51-110.
http://dx.doi.org/10.1159/000213070
[4] Bryant, K.A. and Marshall, G.S. (2000) Clinical Manifestations of Tick-Borne Infections in Children. Clinical and Diagnostic Laboratory Immunology, 7, 523-527.
[5] Shapiro, E.D. and Gerber, M.A. (2000) Lyme Disease. Clinical Infectious Diseases, 31, 533-542.
http://dx.doi.org/10.1086/313982
[6] Stanek, G., et al. (1996) European Union Concerted Action on Risk Assessment in Lyme Borreliosis: Clinical Case Definitions for Lyme Borreliosis. Wiener klinische Wochenschrift, 108, 741-747.
[7] Mygland, A., et al. (2010) EFNS Guidelines on the Diagnosis and Management of European Lyme Neuroborreliosis. European Journal of Neurology, 17, 8-16, e1-4.
[8] Sood, S.K. (2006) What We Have Learned about Lyme Borreliosis from Studies in Children. Wiener klinische Wochenschrift, 118, 638-642.
http://dx.doi.org/10.1007/s00508-006-0689-8
[9] Skogman, B.H., et al. (2008) Lyme Neuroborreliosis in Children: A Prospective Study of Clinical Features, Prognosis, and Outcome. Pediatric Infectious Disease Journal, 27, 1089-1094.
http://dx.doi.org/10.1097/INF.0b013e31817fd423
[10] Tveitnes, D., Oymar, K. and Natas, O. (2009) Laboratory Data in Children with Lyme Neuroborreliosis, Relation to Clinical Presentation and Duration of Symptoms. Scandinavian Journal of Infectious Diseases, 41, 355-362.
http://dx.doi.org/10.1080/00365540902787666
[11] Oymar, K. and Tveitnes, D. (2009) Clinical Characteristics of Childhood Lyme Neuroborreliosis in an Endemic Area of Northern Europe. Scandinavian Journal of Infectious Diseases, 41, 88-94.
http://dx.doi.org/10.1080/00365540802593453
[12] Christen, H.J., et al. (1993) Epidemiology and Clinical Manifestations of Lyme Borreliosis in Childhood. A Prospective Multicentre Study with Special Regard to Neuroborreliosis. Acta Paediatrica, 386, 1-75.
http://dx.doi.org/10.1111/j.1651-2227.1993.tb18082.x
[13] Tveitnes, D., et al. (2012) Lyme Meningitis, the Major Cause of Childhood Meningitis in an Endemic Area: A Population Based Study. Archives of Disease in Childhood, 97, 215-220.
http://dx.doi.org/10.1136/archdischild-2011-300526
[14] Khine, H., et al. (2008) Association between Herpes Simplex Virus-1 Infection and Idiopathic Unilateral Facial Paralysis in Children and Adolescents. The Pediatric Infectious Disease Journal, 27, 468-469.
http://dx.doi.org/10.1097/INF.0b013e31816507c3
[15] Furuta, Y., et al. (1998) Reactivation of Herpes Simplex Virus Type 1 in Patients with Bell’s Palsy. Journal of Medical Virology, 54, 162-166.
http://dx.doi.org/10.1002/(SICI)1096-9071(199803)54:3<162::AID-JMV3>3.0.CO;2-3
[16] Furuta, Y., et al. (2005) Varicella-Zoster Virus Reactivation Is an Important Cause of Acute Peripheral Facial Paralysis in Children. The Pediatric Infectious Disease Journal, 24, 97-101.
http://dx.doi.org/10.1097/01.inf.0000151032.16639.9c
[17] Furuta, Y., et al. (2001) Herpes Simplex Virus Type 1 Reactivation and Antiviral Therapy in Patients with Acute Peripheral Facial Palsy. Auris Nasus Larynx, 28, S13-S17. http://dx.doi.org/10.1016/S0385-8146(00)00105-X
[18] Kanerva, M., et al. (2013) Microbiologic Findings in Acute Facial Palsy in Children. Otology & Neurotology, 34, 82-87.
http://dx.doi.org/10.1097/MAO.0b013e318289844c
[19] Engstrom, M., et al. (2008) Prednisolone and Valaciclovir in Bell’s Palsy: A Randomised, Double-Blind, Placebo-Controlled, Multicentre Trial. The Lancet Neurology, 7, 993-1000.
http://dx.doi.org/10.1016/S1474-4422(08)70221-7
[20] Unuvar, E., et al. (1999) Corticosteroid Treatment of Childhood Bell’s Palsy. Pediatric Neurology, 21, 814-816.
http://dx.doi.org/10.1016/S0887-8994(99)00099-5
[21] Pitaro, J., Waissbluth, S. and Daniel, S.J. (2012) Do Children with Bell’s Palsy Benefit from Steroid Treatment? A Systematic Review. International Journal of Pediatric Otorhinolaryngology, 76, 921-926.
http://dx.doi.org/10.1016/j.ijporl.2012.02.044
[22] Shah, S.S., et al. (2005) Early Differentiation of Lyme from Enteroviral Meningitis. The Pediatric Infectious Disease Journal, 24, 542-545.
http://dx.doi.org/10.1097/01.inf.0000164767.73746.6e
[23] Arnez, M., et al. (2003) Etiology of Tick-Borne Febrile Illnesses in Slovenian Children. Annals of the New York Academy of Sciences, 990, 353-354. http://dx.doi.org/10.1111/j.1749-6632.2003.tb07388.x
[24] Lesnicar, G., et al. (2003) Pediatric Tick-Borne Encephalitis in 371 Cases from an Endemic Region in Slovenia, 1959 to 2000. The Pediatric Infectious Disease Journal, 22, 612-617.
http://dx.doi.org/10.1097/00006454-200307000-00009
[25] Sundin, M., et al. (2012) Pediatric Tick-Borne Infections of the Central Nervous System in an Endemic Region of Sweden: A Prospective Evaluation of Clinical Manifestations. European Journal of Pediatrics, 171, 347-352.
http://dx.doi.org/10.1007/s00431-011-1542-2
[26] Hansen, K., Pii, K. and Lebech, A.M. (1991) Improved Immunoglobulin M Serodiagnosis in Lyme Borreliosis by Using a Mu-Capture Enzyme-Linked Immunosorbent Assay with Biotinylated Borrelia burgdorferi Flagella. Journal of Clinical Microbiology, 29, 166-173.
[27] Hansen, K. and Lebech, A.M. (1991) Lyme Neuroborreliosis: A New Sensitive Diagnostic Assay for Intrathecal Synthesis of Borrelia burgdorferi-Specific Immunoglobulin G, A, and M. Annals of Neurology, 30, 197-205.
http://dx.doi.org/10.1002/ana.410300212
[28] Treib, J., et al. (1998) Prevalence of Antibodies to Tick-Borne Encephalitis Virus and Borrelia burgdorferi Sensu Lato in Samples from Patients with Abnormalities in the Cerebrospinal Fluid. Zentralblatt für Bakteriologie, 288, 253-266.
http://dx.doi.org/10.1016/S0934-8840(98)80048-0
[29] Lindquist, L. (2008) Tick-Borne Encephalitis (TBE) in Childhood. Acta Paediatrica, 97, 532-534.
http://dx.doi.org/10.1111/j.1651-2227.2008.00761.x
[30] Vene, S., et al. (1998) A Rapid Fluorescent Focus Inhibition Test for Detection of Neutralizing Antibodies to Tick-Borne Encephalitis Virus. Journal of Virological Methods, 73, 71-75.
http://dx.doi.org/10.1016/S0166-0934(98)00041-X
[31] Mengelle, C., et al. (2004) Use of Two Real-Time Polymerase Chain Reactions (PCRs) to Detect Herpes Simplex Type 1 and 2-DNA after Automated Extraction of Nucleic Acid. Journal of Medical Virology, 74, 459-462.
http://dx.doi.org/10.1002/jmv.20198
[32] Sauerbrei, A. and Wutzler, P. (2002) Laboratory Diagnosis of Central Nervous System Infections Caused by Herpesviruses. Journal of Clinical Virology, 25, S45-S51. http://dx.doi.org/10.1016/S1386-6532(02)00033-1
[33] Thoren, A. and Widell, A. (1994) PCR for the Diagnosis of Enteroviral Meningitis. Scandinavian Journal of Infectious Diseases, 26, 249-254.
http://dx.doi.org/10.3109/00365549409011792
[34] Kanerva, M., et al. (2007) Search for Herpesviruses in Cerebrospinal Fluid of Facial Palsy Patients by PCR. Acta Otolaryngol, 127, 775-779.
http://dx.doi.org/10.1080/00016480601011444
[35] Huttunen, P., et al. (2009) Differential Diagnosis of Acute Central Nervous System Infections in Children Using Modern Microbiological Methods. Acta Paediatrica, 98, 1300-1306.
http://dx.doi.org/10.1111/j.1651-2227.2009.01336.x
[36] Tuerlinckx, D., et al. (2003) Clinical Data and Cerebrospinal Fluid Findings in Lyme Meningitis versus Aseptic Meningitis. European Journal of Pediatrics, 162, 150-153.
[37] Waespe, N., Steffen, I. and Heininger, U. (2010) Etiology of Aseptic Meningitis, Peripheral Facial Nerve Palsy, and a Combination of Both in Children. The Pediatric Infectious Disease Journal, 29, 453-456.
http://dx.doi.org/10.1097/INF.0b013e3181c3cae6

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.