Clinical data and cerebrospinal fluid findings in Lyme meningitis versus aseptic meningitis

Abstract

The purpose of this study was to characterise Lyme meningitis (LM) in a Belgian paediatric population and to suggest findings that could allow early distinction from aseptic meningitis (AM). The medical records of patients hospitalised between 1993 and 2000 and with a discharge diagnosis of LM (n=14) or AM (n=16) were retrospectively reviewed. The Kruskal-Wallis test was used to compare data. Of the patients, 16 were identified with AM and 14 with LM, amongst which 7 presented with isolated LM and 7 with associated peripheral facial palsy (PFP). Patients with AM, when compared with LM, complained of more pronounced signs and symptoms of meningitis (fever, headaches, and neck stiffness); they statistically displayed a shorter period of symptoms before admission (1.6 vs 15 days), higher neutrophilic component (mean 56% vs 2.4%), and lower protein levels (mean 0.39 vs 1.12 g/l) on cerebrospinal fluid analysis. In the neuroborreliosis group, the duration of symptoms was shorter and the cerebrospinal protein level was lower in cases of LM associated with PFP compared to isolated LM (mean 1.3 vs 15 days; mean 0.55 g/l vs 1.12 g/l). Conclusions. Our results suggest that some clinical data and laboratory findings may help the physician to diagnose aseptic or Lyme meningitis before completion of serologic testing. LM should be suspected in cases of meningitis with very low CSF neutrophilic counts and high protein levels associated with prolonged duration of symptoms, low grade fever, and absence of pronounced signs of meningitis.

Prediction of Lyme Meningitis in Children From a Lyme Disease–Endemic Region: A Logistic-Regression Model Using History, Physical, and Laboratory Findings

“…3 However, children in our study (18 of 27 [66.7%]) and others did not seem to have erythema migrans as frequently during LM. 5,7,13,14 The absence of erythema migrans in children with AM should not deter the clinician from obtaining Lyme serology, especially in Lyme-endemic regions.…”

“…5,7,13,14,[20][21][22][23] The etiology of a peripheral facial nerve palsy in children without Lyme disease includes a variety of infectious, neoplastic, structural, and idiopathic causes, most of which do not typically present with meningitis. [24][25][26][27] The only patient with AM in our study who had a cranial nerve palsy was found to have an abducens nerve palsy, which is also known to occur in Lyme disease, and was eventually diagnosed with multiple sclerosis.…”

“…1,4 Although a minority of children with Lyme disease present with Lyme meningitis (LM), distinguishing LM from aseptic meningitis (AM) in children who live in a Lyme disease-endemic region can be challenging, especially during the summer months when both LM and AM are at peak incidence. [5][6][7] Lyme-serology and viral cerebrospinal fluid (CSF) studies (eg, enterovirus polymerase chain reaction [PCR]) often require several days to report results; therefore, the clinician must decide whether to initiate treatment of LM with parental antibiotics while awaiting these results.…”

“…5,7 Eppes et al reported that 12 children with LM had a longer duration of headache, predominance of CSF mononuclear cells, and presence of cranial neuritis (eg, cranial nerve palsy or papilledema) when compared with children with confirmed enterovirus meningitis. 7 A recent European study of 14 children with LM and 16 children with AM described similar clinical and laboratory results.…”

“…7 A recent European study of 14 children with LM and 16 children with AM described similar clinical and laboratory results. 5 Despite the similar results of these 2 studies, the authors only compared the proportions or means of their findings between groups (eg, 2 , Kruskal-Wallis, and Fischer's exact tests). None of these statistical tests can determine what factors predict LM versus AM, nor can they simultaneously control for the influence of other variables on the outcome measure.…”