In the Journals

Antibiotics resolved Lyme disease symptoms within weeks

Antibiotic treatment promptly resolved the symptoms of most pediatric patients with early-disseminated or late-stage Lyme disease within 3 to 18 days, according to a study results published in the Journal of Pediatric Infectious Diseases Society.

“A clearly defined timetable for the expected resolution of Lyme symptomatology in children is lacking, although data specific to the resolution of Lyme neuroborreliosis in children recently emerged,” Mattia E. Chason, MD, a third-year resident at Children’s National Health System, and colleagues wrote. “Appropriate antibiotic therapy typically is successful for treating both early- and late-stage Lyme disease, yet recovery can occur at different rates, depending on disease manifestation and host factors.”

The researchers conducted a retrospective study of children who required hospitalization for early-disseminated and late-stage Lyme disease at a pediatric hospital in a region where Lyme disease is endemic. They included patients aged up to18 years who were admitted between 2008 and 2015.

Seventy-eight children (mean age at time of admission, 9.8 years; 55% white) were included in the study. Forty-six percent presented with symptoms consistent with early-disseminated Lyme disease and 54% presented with symptoms consistent of late-stage disease. Most patients had a diagnosis of Lyme disease.

Sixty-eight patients (87%) had received no therapy before presenting symptoms at the hospital. The researchers also noted that of patients who had undergone previous therapy, only one in 10 had received the correct dose of the appropriate antibiotics.

Patients in the study were treated with doxycycline, cefotaxime or ceftriaxone and were transitioned to an outpatient antibiotic regimen, with a median duration of 4.5 days of hospitalization and one outpatient follow-up.

Meningitis was the most common presentation of early-disseminated disease (83%). In 25 patients with meningitis who experienced headache, median duration of headache was 10 days, with 85% experiencing headache resolution in less than 7 days. The median duration of headache resolution was 3 days (range 1-67 days). The researchers noted that the duration of headache before admission was similar to prior study results describing characteristics of pediatric patients with Lyme neuroborreliosis and Lyme meningitis.

Most patients with late-stage disease had isolated arthritis, including monoarthritis of the knee, except for one patient who had arthritis with concomitant multiple erythema migrans rash. The 29 patients with arthritis experienced a median time to arthritis resolution of 18 days (range, 3-204 days).

“Full recovery occurred for most patients regardless of the duration of symptoms before their diagnosis, although recovery time was longer in patients with a prolonged duration of joint symptoms before treatment,” the researchers concluded. “Future prospective longitudinal studies in the pediatric population are needed to characterize more precisely the expected time course of recovery from all presentations of Lyme disease. This information is critical for guiding and informing practitioners’ and families’ expectations and to prevent complications associated with unproven therapies.”   by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

 

Antibiotic treatment promptly resolved the symptoms of most pediatric patients with early-disseminated or late-stage Lyme disease within 3 to 18 days, according to a study results published in the Journal of Pediatric Infectious Diseases Society.

“A clearly defined timetable for the expected resolution of Lyme symptomatology in children is lacking, although data specific to the resolution of Lyme neuroborreliosis in children recently emerged,” Mattia E. Chason, MD, a third-year resident at Children’s National Health System, and colleagues wrote. “Appropriate antibiotic therapy typically is successful for treating both early- and late-stage Lyme disease, yet recovery can occur at different rates, depending on disease manifestation and host factors.”

The researchers conducted a retrospective study of children who required hospitalization for early-disseminated and late-stage Lyme disease at a pediatric hospital in a region where Lyme disease is endemic. They included patients aged up to18 years who were admitted between 2008 and 2015.

Seventy-eight children (mean age at time of admission, 9.8 years; 55% white) were included in the study. Forty-six percent presented with symptoms consistent with early-disseminated Lyme disease and 54% presented with symptoms consistent of late-stage disease. Most patients had a diagnosis of Lyme disease.

Sixty-eight patients (87%) had received no therapy before presenting symptoms at the hospital. The researchers also noted that of patients who had undergone previous therapy, only one in 10 had received the correct dose of the appropriate antibiotics.

Patients in the study were treated with doxycycline, cefotaxime or ceftriaxone and were transitioned to an outpatient antibiotic regimen, with a median duration of 4.5 days of hospitalization and one outpatient follow-up.

Meningitis was the most common presentation of early-disseminated disease (83%). In 25 patients with meningitis who experienced headache, median duration of headache was 10 days, with 85% experiencing headache resolution in less than 7 days. The median duration of headache resolution was 3 days (range 1-67 days). The researchers noted that the duration of headache before admission was similar to prior study results describing characteristics of pediatric patients with Lyme neuroborreliosis and Lyme meningitis.

Most patients with late-stage disease had isolated arthritis, including monoarthritis of the knee, except for one patient who had arthritis with concomitant multiple erythema migrans rash. The 29 patients with arthritis experienced a median time to arthritis resolution of 18 days (range, 3-204 days).

“Full recovery occurred for most patients regardless of the duration of symptoms before their diagnosis, although recovery time was longer in patients with a prolonged duration of joint symptoms before treatment,” the researchers concluded. “Future prospective longitudinal studies in the pediatric population are needed to characterize more precisely the expected time course of recovery from all presentations of Lyme disease. This information is critical for guiding and informing practitioners’ and families’ expectations and to prevent complications associated with unproven therapies.”   by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.