1987: Lyme arthritis in children. An orthopaedic perspective.

1: J Bone Joint Surg Am. 1987 Jan;69(1):96-9. Links
Lyme arthritis in children. An orthopaedic perspective.
Culp RW, Eichenfield AH, Davidson RS, Drummond DS, Christofersen MR,
Goldsmith DP.
The cases of forty-three children with clinical and serological
evidence of Lyme arthritis that was diagnosed between August 1983 and
July 1985 were evaluated. The mean length of follow-up was twenty
months, with a range of five to thirty months. All of the children
lived in or had visited an area where the disease was known to be
endemic. Arthritis was the presenting feature in more than half of the
children, and half of the children had initially consulted an
orthopaedic surgeon, none of whom made the correct diagnosis. Only
twenty patients had a history of erythema chronicum migrans, the
characteristic rash that precedes the arthritis, and for only nineteen
children was there any recollection of having been bitten by a tick.
Three patients had Bell palsy and one had a popliteal cyst in
conjunction with the arthritis. All of the patients had oligoarticular
involvement. The knee was involved in all but two patients. Recurrent
attacks of synovitis were common. Effusion was the only radiographic
abnormality that was observed, and it was found in thirty-two patients.
The sedimentation rate was elevated in thirty of thirty-six patients.
Immunofluorescent serology for Lyme disease, which is sensitive and
specific, was uniformly positive. Of thirty-three patients who were
treated with oral administration of penicillin or tetracycline alone,
thirty-one responded, while two patients who had recurrent attacks of
the disease responded to parenteral administration of antibiotics. The
remaining ten patients responded to combinations of orally and
parenterally administered antibiotics. Longer follow-up is needed to
further document the apparently low rate of relapse after antibiotic
therapy in this young population.

PMID: 3805076 [PubMed - indexed for MEDLINE]

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