Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.

Abstract

BACKGROUND:

Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB.

METHODS:

Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients.

RESULTS:

Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children.

CONCLUSIONS:

LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.

• Authors: M H Correll, N Datta, H S S Arvidsson, H A Melsom, A K Thielberg, M Bjerager, M C Brodsky, J P Saunte
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 99 Issue 10 Pg. 1401-4 (Oct 2015) ISSN: 1468-2079 [Electronic] England
• PMID: 25868792 (Publication Type: Case Reports, Journal Article, Video-Audio Media)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Anti-Bacterial Agents
• Antibodies, Bacterial

Topics

• Acute Disease
• Administration, Oral
• Adolescent
• Anti-Bacterial Agents (administration & dosage)
• Antibodies, Bacterial (immunology)
• Borrelia burgdorferi (immunology, isolation & purification)
• Child
• Child, Preschool
• Denmark (epidemiology)
• Enzyme-Linked Immunosorbent Assay
• Eye Infections, Bacterial (complications, epidemiology, therapy)
• Eye Movements (physiology)
• Female
• Humans
• Incidence
• Injections, Intravenous
• Lyme Neuroborreliosis (complications, drug therapy, epidemiology)
• Male
• Ocular Motility Disorders (drug therapy, epidemiology, etiology)
• Retrospective Studies