Lyme meningitis, the major cause of childhood meningitis in an endemic area: a population based study
- 1Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
- 2Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- 3Laboratory of Clinical Biochemistry, Stavanger University Hospital, Stavanger, Norway
- 4Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Correspondence to Dag Tveitnes, Stavanger University Hospital, Department of Paediatrics, PO Box 8100, Stavanger N-4068, Norway;
Contributors DT drafted the study, performed the registration of data, performed statistical analyses, wrote a draft and completed the manuscript. He is guarantor. OBN contributed to the draft of the study, was the leader of the microbiological laboratory analyses, critically revised the manuscript and approved the final manuscript. ØS contributed to the draft of the study, was the leader of the biochemical laboratory analyses, critically revised the manuscript and approved the final manuscript. KØ supervised all parts of the study, the drafting, registration of data, and analyses, contributed significantly to the writing of the manuscript and approved the final manuscript.
- Received 21 December 2011
- Accepted 22 December 2011
- Published Online First 13 January 2012
Objective To evaluate the epidemiology of infectious meningitis in children in a Lyme borreliosis (LB) endemic area, and to study how clinical and laboratory characteristics may distinguish between different types of childhood meningitis.
Design Retrospective, population based study.
Setting A paediatric department serving all children (62 000) in a costal LB endemic region of southwestern Norway.
Patients All children with cerebrospinal fluid pleocytosis aged 3 months to 14 years.
Main outcome measures Epidemiological, clinical and laboratory characteristics of different types of childhood meningitis.
Results Infectious meningitis was diagnosed in 211 children (annual incidence 38/100 000). Lyme meningitis (LM) was identified in 142 children (67%), non-Lyme aseptic meningitis in 46 children (22%) and bacterial meningitis in 23 children (11%). Age, month of admission and clinical and laboratory characteristics differed between the groups. An aetiological agent was found in 89% of children. The positive predictive value for having LM if the child had facial nerve palsy or head and/or neck stiffness (meningism) as the only symptom was 97% for both variables. Symptoms of cerebral involvement or signs of systemic inflammation were rare in children with LM compared to children non-Lyme aseptic meningitis.
Conclusion LM was diagnosed in two-thirds of children with infectious meningitis in this LB endemic area. Distinct clinical characteristics distinguished the majority of children with LM from children with non-Lyme aseptic meningitis and bacterial meningitis.
Funding The Western Norway Regional Health Authority.
Competing interests None.
Ethics approval The regional ethical committee was consulted, but considered that a separate ethical licence for the study was not needed.
Provenance and peer review Not commissioned; externally peer reviewed.