Bachman D T, Srivastava G
Pediatric Emergency Services, Maine Medical Center, Portland, USA.
Pediatr Emerg Care. 1998 Oct;14(5):356-61.
To review the clinical characteristics and diagnostic evaluation of children with Lyme disease evaluated in an emergency department (ED) in an endemic area.
A retrospective review of the demographic, historical, clinical, and laboratory data of pediatric patients with a final diagnosis of Lyme disease.
The pediatric ED of an urban university hospital.
Children with Lyme disease evaluated during the three-year period from 1992 to 1994.
Twenty-nine children ranging in age from three to 19 years who were diagnosed with Lyme disease subsequent to a visit to a pediatric ED were identified. Four patients had early localized disease with erythema migrans and varying degrees of systemic symptoms. Ten had early disseminated Lyme disease, with multiple erythema migrans, neurologic involvement (including three patients with pseudotumor cerebri), or carditis. Fifteen cases of late Lyme disease with arthritis were identified. Recognition of Lyme arthritis proved particularly difficult; seven children were initially diagnosed as having septic arthritis, six of whom underwent arthrotomy. Marked elevations of the erythrocyte sedimentation rate and synovial fluid white blood cell counts were observed in these patients, making it difficult to distinguish Lyme disease from septic arthritis on the basis of laboratory findings.
Lyme disease is an infrequent, often difficult, diagnosis in children who present to an ED. Early disseminated and late disease predominate; classic erythema migrans is uncommon in the ED in comparison with other ambulatory venues. Diagnosis of Lyme arthritis may be difficult; exposure in an endemic area and clinical findings may help distinguish it from septic arthritis. Overall, underdiagnosis of Lyme disease may actually be more of a problem than overdiagnosis in the ED setting. Recognition of Lyme disease by emergency medicine practitioners requires familiarity with its epidemiology and its multiple manifestations.
回顾在流行地区急诊科（ED）接受评估的莱姆病患儿的临床特征和诊断评估。
对最终诊断为莱姆病的儿科患者的人口统计学、病史、临床和实验室数据进行回顾性研究。
城市大学医院的儿科急诊科。
1992年至1994年三年期间在该儿科急诊科接受评估的莱姆病患儿。
确定了29名年龄在3至19岁之间、在就诊于儿科急诊科后被诊断为莱姆病的儿童。4例患有早期局限性疾病，伴有游走性红斑和不同程度的全身症状。10例患有早期播散性莱姆病，有多个游走性红斑、神经系统受累（包括3例假性脑瘤患者）或心脏炎。确定了15例晚期莱姆病关节炎病例。事实证明，识别莱姆病关节炎特别困难；7名儿童最初被诊断为化脓性关节炎，其中6名接受了关节切开术。这些患者的红细胞沉降率和滑液白细胞计数显著升高，这使得根据实验室检查结果难以将莱姆病与化脓性关节炎区分开来。
莱姆病在就诊于急诊科的儿童中是一种不常见且常常难以诊断的疾病。早期播散性和晚期疾病占主导；与其他门诊场所相比，典型的游走性红斑在急诊科并不常见。莱姆病关节炎的诊断可能很困难；在流行地区的暴露情况和临床发现可能有助于将其与化脓性关节炎区分开来。总体而言，在急诊科环境中，莱姆病的漏诊实际上可能比误诊更是一个问题。急诊医学从业者识别莱姆病需要熟悉其流行病学和多种表现形式。
