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The clinical presentation, treatment and outcome of serologically confirmed paediatric Lyme disease in the Republic of Ireland over a 5-year period: a retrospective cohort study

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Abstract

Lyme disease (LD) is the most common tick-borne illness in Europe. Population-based studies in European children are few. This study aimed to assess the incidence, clinical presentation, treatment and outcome of serologically confirmed paediatric LD in the Republic of Ireland over a 5-year period. A retrospective review of records from accredited laboratories performing Borrelia burgdorferi serological testing was undertaken. Proformas were distributed to clinicians of children and adolescents with positive Lyme serology. Data were requested regarding clinical presentation, treatment and outcome. Updated NICE guidelines were used to classify clinical cases. Serology testing for B. burgdorferi was performed on 2908 samples. Sixty-three (2.2%) children were two-tier positive, generating a crude annual incidence rate of 1.15/100,000. Proformas were returned for 55 (87%) and 47 met clinical and laboratory criteria for LD. Twenty-seven (57%) presented with non-focal symptoms (erythema migrans and/or influenza-like symptoms), and 20 (43%) with focal symptoms (cranial nerve involvement, 11; CNS involvement, 8; arthritis, 1). Median age at presentation was 8.2 (2.5–17.9) years. Seventeen (36%) acquired LD overseas. Twenty-five (83%) of the remaining 30 children acquired infection in the West/Northwest of Ireland. Full resolution of symptoms was reported in 97% of those with available data. Serologically confirmed LD in children is relatively rare in the Republic of Ireland. Ninety-eight percent of children tested were seronegative. Of the seropositive cases, 40% could have been diagnosed based on clinical findings alone. Neurological presentations (40%) were common. Full resolution of symptoms occurred in almost all (97%) where data were available.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Paediatrics, Regional Hospital Mullingar, Westmeath, Ireland

    Karina M. Forde & Michael J. O’Grady

  2. Department of Paediatric Infectious Diseases, Children’s Health Ireland, Crumlin and Temple St., Dublin, Ireland

    Karina M. Forde & Patrick J. Gavin

  3. National Virus Reference Laboratory, University College Dublin, Belfield, Dublin 4, Ireland

    Joanne O’Gorman

  4. Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, Salisbury, UK

    Matthew S. Dryden

  5. Department of Medical Microbiology, Galway University Hospital, Galway, Ireland

    Deirbhile Keady & Belinda Hanahoe

  6. Department of Medical Microbiology, University Hospital Limerick, Limerick, Ireland

    Colm McDonnell & Lorraine Power

  7. Department of Medical Microbiology, Cork University Hospital, Wilton, Cork, Ireland

    Bartley Cryan

  8. Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland

    James Sweeney

  9. CSTAR, University College Dublin, Belfield, Dublin 4, Ireland

    Karl F. Conyard

  10. Women’s and Children’s Health, University College Dublin, Belfield, Dublin 4, Ireland

    Michael J. O’Grady

Authors
  1. Karina M. Forde
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  2. Joanne O’Gorman
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Contributions

KF conceptualised and designed the study, collected, analysed and interpreted the de-identified data, drafted the initial manuscript and reviewed and revised the manuscript. JOG, MOG and PG conceptualised and designed the study, and provided critical review and revisions of the final manuscript. BC, BH, DK, JOG, LP and COD collected laboratory data, de-identified clinical cases and distributed questionnaires to referring clinicians. MD performed a search of the Lyme reference laboratory database to ensure accurate capture of clinical cases. KC contributed to the statistical analyses of the paper. JS provided statistical support for data analysis and interpretation. All authors approved the final version as submitted.

Corresponding author

Correspondence to Karina M. Forde.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from the Midland Regional Hospital’s Human Research Ethics committee prior to collection of data.

Consent to participate

Informed consent was waived owing to the retrospective nature of the study and de-identified data used.

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Not applicable.

Code availability

Data was coded and entered into a Microsoft Excel™ spread sheet (Microsoft Office 2011). Statistical analysis was undertaken using the statistical software package R (R Core Team 2016).

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Forde, K.M., O’Gorman, J., Gavin, P.J. et al. The clinical presentation, treatment and outcome of serologically confirmed paediatric Lyme disease in the Republic of Ireland over a 5-year period: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 40, 725–734 (2021). https://doi.org/10.1007/s10096-020-04064-7

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  • DOI: https://doi.org/10.1007/s10096-020-04064-7

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