Incidence And Clinical Presentation Of Serologically Confirmed Paediatric Lyme Disease In Ireland Over A 5 Year Period

Background and aimsDespite the fact that one of the peaks of Lyme disease incidence occurs in childhood, there are no population-based studies of incidence in children in Ireland, or indeed Europe. We aimed to identify the incidence and clinical presentation of serologically confirmed Lyme disease in patients aged 1–18 years in Ireland over a 5-year period.MethodsA cross-sectional survey was conducted across all four laboratories in Ireland who perform in-house ELISA testing for Borrelia species (accredited to ISO 150189 standard). Between 2012–2016, all paediatric samples that were ELISA positive underwent confirmatory Western Blot testing through the Lyme Reference laboratory in the UK. For patients who were two-tier positive, an anonymous proforma was distributed by the respective Irish laboratories to their requesting clinicians to collect clinical details regarding their presentation, treatment and outcome.Results64 patients aged 1–18 with two-tier positive Borreliaserology were identified, representing just 2% of 2914 samples tested (1.1 per 100,000 children aged 1–18 per year). Proformas were returned for 52 (87%), of whom 48 (92%) had a clinical presentation consistent with Lyme disease. The mean age at presentation was 9.5 years. 27 (51.9%) cases were reportedly contracted in Ireland, predominantly in the west, and 22 children (45.8%) recalled a tick bite. 27 (56%) children in our cohort were characterised as having Lyme Disease (LD) without focal symptoms. 19 (70%) of those had solitary erythema migrans, and 3 (11.1%) had multiple erythema migrans. 92.5% of those with LD without focal symptoms were treated with oral antibiotics. Full symptom resolution was documented in 88.8% of cases. 20 (41.6%) children were characterised as having LD with focal symptoms. 11 (22.9%) had cranial nerve palsy without associated CNS involvement, and one child (2%) had arthritis. 8 children (16.6%) had LD with central nervous system involvement. Of the 19 children with CNS or cranial nerve involvement, 7 (36.8%) had a history of erythema migrans, involving the head/neck in all cases. Full symptom resolution was documented in 95% of children with LD with focal symptoms. There were no cases of carditis. No patient had a post Lyme disease syndrome. Of the 44 children in our cohort with documented antimicrobial treatment, treatment duration was appropriate in 39 cases (88.6%).ConclusionsDespite increasing public awareness, Lyme disease remains rare in Irish children. Presentation was predominantly with erythema migrans and neurological manifestations and importantly, all children for whom data were available, recovered with no long-term sequelae