University of Pittsburgh-Carnegie Mellon University Medical Scientist Training Program, Pennsylvania.
Department of Orthopedic Surgery, New York University Langone Health, Pennsylvania.
Clin Infect Dis. 2019 Jan 18;68(3):426-434. doi: 10.1093/cid/ciy510.
Lyme disease is the most common reportable zoonotic infection in the United States. Recent data suggest spread of the Ixodes tick vector and increasing incidence of Lyme disease in several states, including Pennsylvania. We sought to determine the clinical presentation and healthcare use patterns for pediatric Lyme disease in western Pennsylvania.
The electronic medical records of all patients with an International Classification of Disease, Ninth Revision, diagnosis of Lyme disease between 2003 and 2013 at Children's Hospital of Pittsburgh were individually reviewed to identify confirmed cases of Lyme disease. The records of 773 patients meeting these criteria were retrospectively analyzed for patient demographics, disease manifestations, and healthcare use.
An Lyme disease increased exponentially in the pediatric population of western Pennsylvania. There was a southwestward migration of Lyme disease cases, with a shift from rural to nonrural zip codes. Healthcare provider involvement evolved from subspecialists to primary care pediatricians and emergency departments (EDs). Patients from nonrural zip codes more commonly presented to the ED, while patients from rural zip codes used primary care pediatricians and EDs equally.
The current study details the conversion of western Pennsylvania from a Lyme-naive to a Lyme-epidemic area, highlighting changes in clinical presentation and healthcare use over time. Presenting symptoms and provider type differed between those from rural and nonrural zip codes. By elucidating the temporospatial epidemiology and healthcare use for pediatric Lyme disease, the current study may inform public health measures regionally while serving as an archetype for other areas at-risk for Lyme disease epidemics.
莱姆病是美国最常见的报告性动物传染病。最近的数据表明，在美国的几个州，包括宾夕法尼亚州，伊蚊传播媒介和莱姆病的发病率都在增加。我们试图确定宾夕法尼亚州西部地区儿科莱姆病的临床表现和医疗保健使用模式。
对匹兹堡儿童医院 2003 年至 2013 年间国际疾病分类第 9 版诊断为莱姆病的所有患者的电子病历进行单独审查，以确定莱姆病的确诊病例。对符合这些标准的 773 名患者的记录进行回顾性分析，以确定患者的人口统计学特征、疾病表现和医疗保健使用情况。
莱姆病在宾夕法尼亚州西部地区的儿科人群中呈指数增长。莱姆病病例呈西南向迁移，从农村向非农村邮政编码转移。医疗服务提供者的参与从专科医生演变为初级保健儿科医生和急诊部（ED）。非农村邮政编码的患者更常到 ED 就诊，而农村邮政编码的患者同样使用初级保健儿科医生和 ED。
本研究详细描述了宾夕法尼亚州西部地区从莱姆病幼稚区到莱姆病流行区的转变，重点介绍了随着时间的推移临床表现和医疗保健使用的变化。农村和非农村邮政编码患者的症状和提供者类型不同。通过阐明儿科莱姆病的时空流行病学和医疗保健使用情况，本研究可能会为该地区的公共卫生措施提供信息，同时也为其他面临莱姆病流行风险的地区提供范例。
