Millner M, Schimek M G, Spork D, Schnizer M, Stanek G
Abteilung Neuropädiatrie, Universitäts-Kinderklinik, Auenbruggerplatz, Graz, Austria.
Eur J Pediatr. 1989 Apr;148(6):527-30. doi: 10.1007/BF00441549.
A total of 27 children with clinical symptoms indicative of Lyme borreliosis are described, 21 of which were seropositive. CNS symptoms were found in 17 of the seropositive children (81%). Of these 21, 7 were CSF negative. Another 3 (with Bell's palsy and/or aseptic meningitis) were initially CSF negative but developed specific CSF titres 80, 65 and 120 days after the first lumbar puncture, respectively. Thus, seropositive children with aseptic meningitis and without initial signs of an infectious aetiology should be checked for a neuroborreliosis even when CSF negative in the first lumbar puncture. Antibiotic therapy undertaken in 26 children showed clinical recovery (Sodium penicillin, 300,000-500,000 units/kg per day for 14 days). One developed residual hypoacusis. Comparison of enzyme-linked immunosorbent assay (ELISA) IgG values from 27 cases with those of 30 healthy controls showed that elevated ELISA titres are a good indication of the disease. However, Lyme borreliosis can only be diagnosed correctly if the clinical symptoms conform with specific titres.
共描述了27例有莱姆病临床症状的儿童，其中21例血清学呈阳性。17例血清学阳性儿童（81%）出现中枢神经系统症状。在这21例中，7例脑脊液检查为阴性。另外3例（患有贝尔氏面瘫和/或无菌性脑膜炎）最初脑脊液检查为阴性，但分别在首次腰椎穿刺后80、65和120天出现了特异性脑脊液滴度。因此，对于患有无菌性脑膜炎且无初始感染病因迹象的血清学阳性儿童，即使首次腰椎穿刺时脑脊液检查为阴性，也应检查是否患有神经型莱姆病。26例儿童接受了抗生素治疗，临床症状得到缓解（青霉素钠，每天300,000 - 500,000单位/千克，持续14天）。1例出现了残留听力减退。将27例病例的酶联免疫吸附测定（ELISA）IgG值与30例健康对照者的进行比较，结果显示ELISA滴度升高是该病的一个良好指标。然而，只有当临床症状与特定滴度相符时，才能正确诊断莱姆病。
