Pediatric Neuroborreliosis: Current Challenges in Diagnosis and Treatment of Lyme Disease

Abstract

Introduction and Objective: Lyme disease is an infection caused by Gram-negative,
microaerophilic spirochetes of the Borrelia genus, transmitted to humans through the bite of
an infected tick, which serves as the vector of this disease. It is one of the most frequently
diagnosed tick-borne illnesses worldwide, with a rising incidence rate. Notably, children
represent an increasingly affected population, emphasizing the need for focused attention on
pediatric manifestations and management.
Brief Overview of Current Knowledge - Lyme disease progresses through three clinical
stages: early localized, early disseminated, and late stage. Each phase presents with
characteristic clinical manifestations.
 The early localized stage typically features erythema migrans, most often appearing on
the scalp, neck, shoulders, legs, or lower back.
 The early disseminated stage is marked by flu-like
symptoms, lymphadenopathy, arthralgia, myalgia, cranial nerve palsies—most
frequently involving the facial nerve (cranial nerve VII) —ocular involvement,
and lymphocytic meningitis.
 The late stage is characterized predominantly by pauciarticular arthritis, affecting large
joints—especially the knees. In some cases, cardiac manifestations may occur, such
as conduction abnormalities, myocarditis, or pericarditis.
This progression underscores the multisystemic nature of Lyme disease and highlights the
importance of early recognition and treatment to prevent long-term complications.