Södermark Liv, Sigurdsson Vignir, Näs Wilhelmina, Wall Pernilla, Trollfors Birger
From the *Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden; †Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; and ‡Department of Medicine, Karlstad Hospital, Karlstad, Sweden.
Pediatr Infect Dis J. 2017 Nov;36(11):1052-1056. doi: 10.1097/INF.0000000000001653.
Borrelia burgdorferi is a common cause of bacterial meningitis, but there are very few studies on incidence in Europe. The aim of this study was to report the incidence and symptoms of neuroborreliosis in Swedish children.
Medical records of children (< 15 years) treated for neuroborreliosis 2002-2014 were studied retrospectively. The patients were identified in the computerized registers of discharge diagnoses at the Departments of Pediatrics and Infectious Diseases in Gothenburg, Borås, Trollhättan and Halmstad using International Classification of Diseases 10 diagnosis codes G51.0, G01.9 and/or A69.1. Of those, patients with symptoms compatible with neuroborreliosis and a white blood cell count in cerebrospinal fluid ≥ 7 cells/mm with ≥ 80% mononuclear cells were included. Only children living in the city of Gothenburg and 10 surrounding municipalities were included.
Five hundred forty-eight children were included. The median age was 7 (1-14) years. The total incidence for the 13-year-period was 2.8/10,000 and remained unchanged during the period. The incidence was significantly higher in rural (4.0/10,000) than in urban municipalities (2.1/10,000). The most common presenting symptoms were headache (n = 335), fatigue (n = 330) and cranial nerve palsies (n = 329). The median duration of symptoms before admittance was 4.0 days for facial palsy and 14.0 days for other symptoms (P < 0.001). The median white blood cell count in cerebrospinal fluid was 129 (7-1069) cells/mm.
This study is the largest so far in a pediatric population. The incidence of neuroborreliosis was higher than in previous European reports. This might be explained by increased Borrelia awareness, the distribution of tick population in Sweden, and the possibility that Swedish children more frequently play outdoors.
伯氏疏螺旋体是细菌性脑膜炎的常见病因，但欧洲关于其发病率的研究非常少。本研究的目的是报告瑞典儿童神经型莱姆病的发病率及症状。
对2002年至2014年接受神经型莱姆病治疗的15岁以下儿童的病历进行回顾性研究。利用国际疾病分类第10版诊断编码G51.0、G01.9和/或A69.1，在哥德堡、博拉斯、特罗尔海坦和哈尔姆斯塔德的儿科和传染病科的出院诊断计算机登记系统中识别患者。其中，具有与神经型莱姆病相符的症状且脑脊液白细胞计数≥7个/立方毫米且单核细胞≥80%的患者被纳入。仅纳入居住在哥德堡市及其周边10个市镇的儿童。
共纳入548名儿童。中位年龄为7（1 - 14）岁。13年期间的总发病率为2.8/10000，在此期间保持不变。农村地区的发病率（4.0/10000）显著高于城市市镇（2.1/10000）。最常见的症状为头痛（n = 335）、疲劳（n = 330）和颅神经麻痹（n = 329）。面瘫患者入院前症状持续时间的中位数为4.0天，其他症状为14.0天（P < 0.001）。脑脊液白细胞计数的中位数为129（7 - 1069）个/立方毫米。
本研究是迄今为止儿科人群中规模最大的。神经型莱姆病的发病率高于先前欧洲的报告。这可能是由于对伯氏疏螺旋体的认识提高、瑞典蜱虫种群的分布以及瑞典儿童更频繁在户外玩耍的可能性。
