1 - Unidade de Infecciologia, Área da Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central
2 - Unidade de Neuropediatria, Área da Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central
3 - Instituto Nacional de Saúde Doutor Ricardo Jorge
- Reunião internacional (38th Annual Meeting of the European Society for Paediatric Infectious Diseases
Resumo:
Background: Lyme neuroborreliosis is a rare disease. Variably affecting different areas of the neuroaxis, central or peripheric, it can present itself with early or late-onset symptomatology, depending on the age group and on the disease stage. Neurological symptoms may be its first manifestation or arise only after several months. Diagnosis is often difficult in low prevalence areas, such as Portugal, where the estimated incidence is of 0.04 per 100,000 inhabitants.
Methodology: In order to characterize neuroborreliosis cases in a tertiary pediatric hospital, a descriptive analysis of patients with neuroborreliosis confirmed by ELISA and immunoblot in blood and cerebrospinal fluid (CSF) samples between 2009 and 2019 was performed. Epidemiological, clinical and laboratory data was collected.
Results: In a total of 25 cases, neurological symptons were present in 56%. 48% patients lived in rural areas. Most frequent presenting symptoms comprised headache (n=6), diminished muscle strength (n=5), urinary retention (n=4), fever (n=4) and facial palsy (n=2). Diagnosis included meningoencephalitis (n=5), myeloradiculopathy (n=2), bilateral facial palsy (n=2), transverse myelitis (n=2), Guillan-Barré syndrome (n=1) and optical neuritis (n=1). Patients were treated with ceftriaxone (n=14), corticoids (n=7), immunoglobulin (n=5) and plasmapheresis (n=1). Sequelae ocurred in 57% of patients: motor with diminished strength, facial palsy (n=5), sensitive deficits (n=1), urinary disturbances (n=2).
Conclusions: Neurological presentation of borreliosis was found to be the most frequent in patients included in this study. Seasonal variabilitymay be related to vector activity, Ixodes ricinus. While typical neurological deficits were present in the majority of cases, atypical presentations did occur, representing the importance of CSF analysis on unusual cases. Neuroborreliosis is a severe disease in children with frequent sequelae.
Palavras Chave: neuroborreliose