Session: Infectious Diseases 1: Atypical and unusual infections
613 - Impact of acute Lyme disease in children
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 613.5319
Lise E. Nigrovic, Boston Children's Hospital, Boston, MA, United States; Meagan Ladell, Medical College of Wisconsin, Milw, WI, United States; Laura Chapman, Brown Emergency Medicine, Barrington, RI, United States; Anupam B. Kharbanda, Chidlrens Minnesota, Minneapolis, MN, United States; Fran Balamuth, Perelman School of Medicine at the University of Pennsylvania, Philadelhia, PA, United States; Desiree Neville, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Amy Thompson, Nemours Children's Hospital, Wilmington, DE, United States
Professor of Pediatrics Boston Children's Hospital Boston, Massachusetts, United States
Background: While some children with Lyme disease have only mild symptoms, others require invasive procedures, parenteral antibiotics or hospitalization. Objective: Our goal was to describe the clinical impact of acute Lyme disease in a geographically diverse pediatric cohort. Design/Methods: We performed a prospective cohort study of children 1 to 21 years of age who presented to one of eight Pedi Lyme Net emergency departments between 2015 and 2024 for suspected Lyme disease. For this substudy, we selected those with confirmed Lyme disease, defined by either a clinician diagnosed erythema migrans (EM) lesion measuring at least 5 cm in diameter or positive two-tier Lyme disease serology within 30 days of enrollment. We defined Lyme disease stage as follows: early-localized (single EM lesion), early-disseminated (multiple EM lesions, facial palsy, meningitis, carditis) or late (arthritis). Results: Of 5,327 children enrolled, 1,284 (24.1%) had confirmed Lyme disease. Of these, 106 (8.3%) had early-localized, 515 (40.1%) early-disseminated disease and 663 (51.6%) late Lyme disease (Table). The median age was 8 years [interquartile range (IQR) 5-12 years] and 805 (62.7%) were male. Of the 266 (20.7%) who were hospitalized for Lyme disease management, the median duration of hospital stay was 2 days (IQR 1-3 days). 80 (15.5% of those with early-disseminated disease) had a lumbar puncture performed, 151 (22.8% of those with late disease) had a joint procedure and 133 (10.4% of all children with Lyme disease) received at least one dose of parenteral antibiotics.
Conclusion(s): Many children with Lyme disease have significant symptoms and require invasive procedures, parenteral antibiotic and/or hospitalization. Strategies to prevent Lyme disease have the potential to substantially reduce the health impact on children.
