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July 5, 1995, Vol 274, No. 1 >
ARTICLE | July 5, 1995

Pitfalls in the Diagnosis and Treatment of Lyme Disease in Children FREE

Henry M. Feder, Jr, MD; Margaret S. Hunt, MD
[+] Author Affiliations

Reprint requests to Department of Family Medicine, MC 3960, University of Connecticut Health Center, Farmington, CT 06030-3960 (Dr Feder).


JAMA. 1995;274(1):66-68. doi:10.1001/jama.1995.03530010080038
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References

Objective.  —To define pitfalls of diagnosis and treatment of Lyme disease in children.

Design.  —Case series.

Setting.  —A university Lyme disease clinic in a Lyme disease endemic area.

Patients.  —A total of 146 pediatric patients (mean age, 9.9 years) referred with possible Lyme disease.

Main Outcome Measures.  —Of the 146 patients, 56 (38%) were overdiagnosed, 12 (8%) were underdiagnosed, and 75 (51%) were correctly diagnosed with Lyme disease. Treatment errors were made for 19 (25%) of these 75 patients. In addition, three patients (2%) with tick bites were misdiagnosed or mistreated. Frequent pitfalls included misidentifying rashes as erythema migrans, ascribing nonspecific symptoms to Lyme disease, failing to ascribe fleeting objective symptoms to Lyme disease, and inappropriate antibiotic therapy for patients with Lyme disease.

Conclusions.  —Errors in the diagnosis and treatment of Lyme disease in children are common.(JAMA. 1995;274:66-68)

REFERENCES

1 +
Burgdorfer W, Barbour AG, Hayes SF, et al.  Lyme disease. Science . 1982;;216:1317-1319.
2 +
Steere AC.  Lyme disease. N Engl J Med . 1989;; 321:586-596.
3 +
Centers for Disease Control and Prevention.  Lyme disease: United States, 1991-1992. MMWR Morb Mortal Wkly Rep . 1993;;42:345-348.
4 +
Luger SW, Krauss E.  Serologic tests for Lyme disease. Arch Intern Med . 1990;;150:761-763.
5 +
Bakken LL, Case KL, Callister SM, et al.  Performance of 45 laboratories participating in a proficiency testing program for Lyme disease serology. JAMA . 1992;;268:891-895.
6 +
Rahn DW, Malawista SE.  Lyme disease. Ann Intern Med . 1991;;114:472-481.
7 +
Krause PJ, Feder HM Jr.  Lyme disease and babesiosis. Adv Pediatr Infect Dis . 1994;;9:183-209.
8 +
Fister RD, Weymouth LA, McLaughlin JC, Ryan RW, Tilton RC.  Comparative evaluation of three products for the detection of Borrelia burgdorferi antibody in human serum. J Clin Microbiol . 1984;; 27:2834-2837.
9 +
Feder HM Jr, Gerber MA, Krause PJ, et al.  Early Lyme disease. Pediatrics . 1993;;91:456-459.
10 +
Feder HM Jr, Gerber MA, Cartter ML, Sikand V, Krause PJ.  Prospective assessment of Lyme disease in a school-age population in Connecticut. J Infect Dis . 1995;;171:1371-1374.
11 +
Sigal LH.  Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med . 1990;;88:577-581.
12 +
Burdge DR, O'Hanion DP.  Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. Clin Infect Dis . 1993;;16:558-560.
13 +
Steere AC, Taylor E, McHugh GL, Logigian EL.  The overdiagnosis of Lyme disease. JAMA 1993;;269:1812-1816.
14 +
Shapiro ED, Gerber MA, Holabird NB, et al.  A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites. N Engl J Med . 1992;;327:1769-1773.
15 +
Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW.  Diagnosis of Lyme disease based on dermatologic manifestations. Ann Intern Med . 1991;;114:490-498.
16 +
Halperin JJ, Golightly M.  Lyme borreliosis in Bell's palsy. Neurology . 1992;;42:1268-1270.
17 +
Magnarelli LA, Miller JN, Anderson JF, Riviere GR.  Cross-reactivity of nonspecific treponemal antibody in serologic tests for Lyme disease. J Clin Microbiol . 1990;;28:1276-1279.
18 +
Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ.  Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet . 1990;;336:1404-1406.
19 +
Nadelman RB, Luger SW, Frank E, et al.  Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med . 1992;;117:273-280.
20 +
Feder HM Jr, Gerber MA, Luger SW, Ryan RW.  Persistence of serum antibodies to Borrelia burgdorferi in patients treated for Lyme disease. Clin Infect Dis . 1992;;15:788-793.

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1 +
Burgdorfer W, Barbour AG, Hayes SF, et al.  Lyme disease. Science . 1982;;216:1317-1319.
2 +
Steere AC.  Lyme disease. N Engl J Med . 1989;; 321:586-596.
3 +
Centers for Disease Control and Prevention.  Lyme disease: United States, 1991-1992. MMWR Morb Mortal Wkly Rep . 1993;;42:345-348.
4 +
Luger SW, Krauss E.  Serologic tests for Lyme disease. Arch Intern Med . 1990;;150:761-763.
5 +
Bakken LL, Case KL, Callister SM, et al.  Performance of 45 laboratories participating in a proficiency testing program for Lyme disease serology. JAMA . 1992;;268:891-895.
6 +
Rahn DW, Malawista SE.  Lyme disease. Ann Intern Med . 1991;;114:472-481.
7 +
Krause PJ, Feder HM Jr.  Lyme disease and babesiosis. Adv Pediatr Infect Dis . 1994;;9:183-209.
8 +
Fister RD, Weymouth LA, McLaughlin JC, Ryan RW, Tilton RC.  Comparative evaluation of three products for the detection of Borrelia burgdorferi antibody in human serum. J Clin Microbiol . 1984;; 27:2834-2837.
9 +
Feder HM Jr, Gerber MA, Krause PJ, et al.  Early Lyme disease. Pediatrics . 1993;;91:456-459.
10 +
Feder HM Jr, Gerber MA, Cartter ML, Sikand V, Krause PJ.  Prospective assessment of Lyme disease in a school-age population in Connecticut. J Infect Dis . 1995;;171:1371-1374.
11 +
Sigal LH.  Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med . 1990;;88:577-581.
12 +
Burdge DR, O'Hanion DP.  Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. Clin Infect Dis . 1993;;16:558-560.
13 +
Steere AC, Taylor E, McHugh GL, Logigian EL.  The overdiagnosis of Lyme disease. JAMA 1993;;269:1812-1816.
14 +
Shapiro ED, Gerber MA, Holabird NB, et al.  A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites. N Engl J Med . 1992;;327:1769-1773.
15 +
Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW.  Diagnosis of Lyme disease based on dermatologic manifestations. Ann Intern Med . 1991;;114:490-498.
16 +
Halperin JJ, Golightly M.  Lyme borreliosis in Bell's palsy. Neurology . 1992;;42:1268-1270.
17 +
Magnarelli LA, Miller JN, Anderson JF, Riviere GR.  Cross-reactivity of nonspecific treponemal antibody in serologic tests for Lyme disease. J Clin Microbiol . 1990;;28:1276-1279.
18 +
Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ.  Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet . 1990;;336:1404-1406.
19 +
Nadelman RB, Luger SW, Frank E, et al.  Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med . 1992;;117:273-280.
20 +
Feder HM Jr, Gerber MA, Luger SW, Ryan RW.  Persistence of serum antibodies to Borrelia burgdorferi in patients treated for Lyme disease. Clin Infect Dis . 1992;;15:788-793.

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