Document Detail

Early differentiation of Lyme from enteroviral meningitis.
MedLine Citation:
PMID:  15933566     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Differentiating Lyme meningitis from enteroviral meningitis remains difficult because both occur mostly in the summer and early fall. This distinction is clinically important because pathogen-specific diagnostic test results are not available immediately and only patients with Lyme meningitis require parenteral antibiotic therapy. OBJECTIVES: The objective of this study was to identify clinical and laboratory features that might help clinicians distinguish patients with Lyme meningitis from those with enteroviral meningitis. METHODS: This cross-sectional study compared patients diagnosed with Lyme or enteroviral meningitis evaluated at a large children's hospital between January 1, 1999 and September 20, 2002. RESULTS: Twenty-four patients with Lyme meningitis and 151 patients with enteroviral meningitis had median ages of 10.5 and 5.5 years, respectively (P < 0.0001). There was an equal proportion of boys with Lyme (63%) and enteroviral meningitis (62%; P = 1.0). The duration of symptoms before evaluation was longer for patients with Lyme meningitis (12 days) than with enteroviral meningitis (1 day; P < 0.0001). Cranial neuropathy was a presenting feature in 71% of children with Lyme meningitis. Cranial neuropathy, erythema migrans rash or papilledema occurred in 88% of patients with Lyme meningitis; no patients with enteroviral meningitis exhibited any of these findings (P < 0.0001). Lyme meningitis was unlikely when cerebrospinal fluid neutrophils exceeded 10% (negative predictive value, 99%). CONCLUSIONS: We identified several clinical and laboratory features that may permit early differentiation of Lyme from enteroviral meningitis. These results may assist clinicians with decisions regarding additional testing and empiric antibiotic therapy.
Samir S Shah; Theoklis E Zaoutis; Jacob Turnquist; Richard L Hodinka; Susan E Coffin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  24     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-03     Completed Date:  2005-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  542-5     Citation Subset:  IM    
Divisions of Infectious Diseases, The Children's Hospital of Philadelphia, PA, USA.
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MeSH Terms
Antibodies, Bacterial / blood
Borrelia burgdorferi / immunology
Cerebrospinal Fluid / cytology
Child, Preschool
Diagnosis, Differential
Enterovirus / isolation & purification
Enterovirus Infections / diagnosis*,  physiopathology,  virology
Immunoglobulin G / blood
Immunoglobulin M / blood
Infant, Newborn
Lyme Neuroborreliosis / diagnosis*,  microbiology,  physiopathology
Meningitis, Bacterial / diagnosis*,  microbiology,  physiopathology
Meningitis, Viral / diagnosis*,  physiopathology,  virology
Reg. No./Substance:
0/Antibodies, Bacterial; 0/Immunoglobulin G; 0/Immunoglobulin M

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