Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis in children: a systematic review

Dersch, Rick; Hottenrott, Tilman; Schmidt, Stefanie; Sommer, Harriet; Huppertz, Hans‐Iko; Rauer, Sebastian; Meerpohl, Joerg J

doi:10.1186/s12883-016-0708-y

Cited by 15 publications

(19 citation statements)

References 32 publications

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“…* 3 for adolescents and adults weighing at least 50 kg. bid, twice daily; IU, international units; iv, intravenously; po, by mouth; qd, (once) daily; qid, four times daily; tid, three times daily antibiotics to treat Lyme neuroborreliosis in children; furthermore, the available studies are of poor quality (31). All of them do, however, appear to document a favorable prognosis of Lyme neuroborreliosis in children.…”

Section: The Treatment Of Lyme Neuroborreliosis In Childrenmentioning

confidence: 99%

Lyme Neuroborreliosis

Rauer¹,

Kastenbauer²,

Fingerle³

et al. 2018

Deutsches Ärzteblatt International

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for the guideline group* T he scientists and physicians involved in research on Lyme neuroborreliosis agree that this disease can be reliably diagnosed and permanently stopped with a two-to three-week course of antibiotic treatment. There nonetheless exists a widespread fear that Lyme disease (as it is also called) can lead to a wide variety of nonspecific symptoms, such as chronic pain, fatigue, and difficulty concentrating, despite antibiotic treatment. This view often leads to repeated courses of antibiotic treatment being given for several months at a time, sometimes with serious adverse effects; there have even been a few deaths (e1-e3). The objective of the S3 guideline on Lyme neuroborreliosis issued by the German Society of Neurology (Deutsche Gesellschaft für Neurologie) is, therefore, to provide clear recommendations on the diagnosis and treatment of this disease which are based on a structured evidence and consensus process. Epidemiology Lyme borreliosis is an infectious disease that manifests itself primarily on the skin, in the nervous system, and in the joints. Five species of Borrelia burgdorferi that are pathogenic for human beings have been identified as the responsible organisms in Europe; they are transmitted by the bite of Ixodes ricinus, a species of hard tick. The number of new cases in Germany each year is variably estimated from 60 000 to over 200 000 (e4, e5), in the absence of precise figures. The seroprevalence of Borrelia-specific antibodies in healthy persons ranges from 5% to 20%, depending on their age and place of residence (e6-e8). According to German surveys, tick bites lead to seroconversion in 2.6%-5.6% of cases, and to overt disease in 0.3-1.4% (e9-e11). Method The first step in the creation of the guideline was a search for, and an assessment of, already existing guidelines on the subject, of which eight were found. Structured evaluation revealed that all of them had low quality scores, with the result that none of their recommendations could be adopted without further investigation (1). To assess the various proposed modes of antibiotic treatment, systematic literature searches were carried out in three databases: • Medline (via Ovid), • Embase (via Scopus), • and the Cochrane Central Register of Controlled Trials. Each included study was assessed in structured fashion (2, 3). The results for all of the included Summary Background: The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and treatment of this disease. Methods: The scientific literature was systematically searched and the retrieved publications were assessed at the German Cochrane Center (Deutsches Cochrane Zentrum) in Freiburg in the 12 months beginning in March 2014. In addition to the main search terms "Lyme disease," "neuroborreliosis," "Borrelia," and "Bannwarth," 28 further terms relating to neurological manifestations of the disease were used for the search in the Medline and Embase databases and in...

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Section: The Treatment Of Lyme Neuroborreliosis In Childrenmentioning

confidence: 99%

Lyme Neuroborreliosis

Rauer¹,

Kastenbauer²,

Fingerle³

et al. 2018

Deutsches Ärzteblatt International

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“…In childhood, the first-choice oral antibiotic is amoxicillin (50 mg/kg/day up to a maximum dose of 500 mg/day), which is why in this case we decided to use it, although penicillin V sodium, and ceftriaxone may also be used 37 .…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review of antibiotic therapy in children with Lyme borreliosis found no difference in therapeutic efficacy between different antibiotics 37 . Recurrences of Lyme borreliosis, especially third-stage arthritis, are treated with steroids 26 .…”

Section: Discussionmentioning

confidence: 99%

Uveitis associated with Lyme disease in Mexico

Rodríguez-García¹,

Arroyo-Garza²,

Patiño-Ramirez³

2020

RMOE

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Objective: Lyme disease is a rare multi-systemic infection and like in many other countries, in Mexico it is rarely considered in the differential diagnosis of certain forms of uveitis due to lack of knowledge about the risk factors of Borrelia burgdorferi infection. This report aims to review such risk factors, the clinical characteristics of ocular involvement, as well as the keys to suspect the disease in susceptible patients. Observations: A 4-year-old female with a 6-week history of bilateral red eye and blurred vision. The patient referred muscular and joints pain, skin rash, and respiratory symptoms 10 weeks before. She was previously treated for bilateral panuveitis with topical and systemic steroids during 20 days without improvement. Visual acuity was 20/200, with 3+ cells in the anterior chamber, and 2+ diffuse vitritis. Blurred right disk margins, perivascular sheathing, and multiple chorioretinal white-cream-colored infiltrates in the peripheral retina of both eyes. Multifocal chorioretinitis, papillitis, and vasculitis were diagnosed with a positive serology for B. burgdorferi. Treatment consisted in 250 mg of oral amoxicillin every 8 h for 3 weeks, with complete resolution of inflammation. Conclusions: The diagnosis of Lyme disease at early stages is difficult due to its unspecific signs and inconsistent serology. Uveitis due to B. burgdorferi must be considered in every patient at risk who presents with neuro-ophthalmologic manifestations associated with chronic bilateral uveitis refractory to steroid therapy.

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“…Para ello, se emplean 2 a 3 semanas de penicilina-G, doxiciclina, cefuroxima, cefotaxima o ceftriaxona en la mayoría de los casos 26 . En la infancia, el antibiótico oral de primera elección es la amoxicilina (50 mg/kg/día hasta una dosis máxima de 500 mg/día), es por ello que en este caso decidimos emplear dicho antibiótico, aunque también se puede emplear penicilina-V sódica y ceftriaxona 37 . Una revisión sistemática de la antibiótico-terapia en niños con borreliosis de Lyme no encontró diferencias en la eficacia terapéutica entre los diferentes antibióticos 37 .…”

Section: Tiempo De Aparición Y Método Diagnósticounclassified

“…En la infancia, el antibiótico oral de primera elección es la amoxicilina (50 mg/kg/día hasta una dosis máxima de 500 mg/día), es por ello que en este caso decidimos emplear dicho antibiótico, aunque también se puede emplear penicilina-V sódica y ceftriaxona 37 . Una revisión sistemática de la antibiótico-terapia en niños con borreliosis de Lyme no encontró diferencias en la eficacia terapéutica entre los diferentes antibióticos 37 . Las recurrencias de la borreliosis de Lyme, sobre todo la artritis en tercera etapa se trata con esteroides 26 .…”

Section: Tiempo De Aparición Y Método Diagnósticounclassified

Uveítis secundaria a Borreliosis de Lyme en México

Rodríguez-García¹,

Arroyo-Garza

Patiño-Ramirez

2018

Revista Mexicana De Oftalmología

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La borreliosis de Lyme es una infección multisistémica rara, y al igual que ocurre en otros países, en México rara vez se considera en el diagnóstico diferencial de ciertas formas de uveítis debido al desconocimiento de los factores de riesgo de contagio por Borrelia burgdorferi. El presente reporte tiene como objetivo revisar dichos factores de riesgo, las características clínicas de la afección ocular, así como su sospecha en pacientes susceptibles. Observaciones: Paciente femenina, 4 años, con ojo rojo y visión borrosa bilateral de 6 semanas de evolución. Mialgias-artralgias, erupción cutánea y cuadro respiratorio las 10 semanas previas. Tratada como panuveítis bilateral con esteroides tópicos y sistémicos por 20 días sin mejoría. Agudeza visual 20/200, células 3+ en cámara anterior y vitreítis difusa 2+ en ambos ojos. Pérdida de bordes del nervio óptico derecho; exudados perivasculares e infiltrados coriorretinianos color blanco-cremoso en la periferia en ambos ojos. Se diagnosticó coriorretinitis multifocal, papilitis y vasculitis retiniana con serología positiva para B. burgdorferi. Tratada con amoxicilina 250 mg cada 8 h por vía oral por 3 semanas con resolución del cuadro inflamatorio. Conclusiones: El diagnóstico de borreliosis de Lyme en etapas tempranas es difícil debido a los signos inespecíficos y la seroconversión inconstante. La uveítis por Borrelia burgdorferi debe considerarse en todo paciente bajo riesgo que presente manifestaciones neurooftalmológicas asociadas a uveítis bilateral crónica refractaria a tratamiento con esteroides.

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Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis in children: a systematic review

Cited by 15 publications

References 32 publications

Lyme Neuroborreliosis

Lyme Neuroborreliosis

Uveitis associated with Lyme disease in Mexico

Uveítis secundaria a Borreliosis de Lyme en México

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