A clinical case of persistent Lyme disease in a child

Abstract

Background. The relevance of the study is due to the frequent occurrence of Lyme disease (neuroborreliosis) in the spring-autumn period. Official record of Lyme disease in Ukraine has been conducted since 2000, although the first cases were identified in the 1990s. From 2001 to 2023, the incidence of Lyme borreliosis in Ukraine increased almost by 35 times. Materials and methods. The authors conducted a retrospective analysis of statistical data on Lyme borreliosis morbidity from 2000 to 2023 and the most common cases of infectious pathology in children during this period. As pediatric infectious disease specialists, the authors present a clinical case recently observed in the pediatric infectious unit in Poltava. Results. The diagnosis of Lyme borreliosis is made based on a characteristic clinical picture and a serological confirmation. The latter is crucial in the diagnosis of Lyme borreliosis and includes 2 stages. The first stage is the assessment of immunoglobulin M and G titers by the immunofluorescence assay (IFA). If the result is negative, further investigation is conducted within the first 30 days of symptoms onset by repeated IFA 4–6 weeks after the initial test. If the analysis is conducted ≥ 30 days after the onset of symptoms, further examinations are not carried out, and an alternative diagnosis should be suspected. In case of a doubtful or positive IFA result, the diagnosis is further confirmed by the Western blotting (the second stage). The authors present a case report of a 6-year-old girl M., hospitalized in the pediatric infectious unit of the CE “Municipal Clinical Hospital 1” (Poltava) in March 2023 with a diagnosis of Lyme disease (systemic tick-borne borreliosis), early disseminated stage, myalgia, arthralgia, subacute course, moderate severity. Acetonemic syndrome. Stage 1 deficiency anemia. Metabolic cardiomyopathy. Speech development delay. Conclusions. Therefore, it is crucial to recognize Lyme disease with a progressing or remitting disseminated form, as specific therapeutic approaches exist that are effective for this disabling condition.