Are there other undiagnosed tick-borne infections in children being evaluated for Lyme neuroborreliosis?

BACKGROUND

There is an increasing amount of reported clinical cases of emerging tick-borne diseases (eTBDs) such as human granulocytic anaplasmosis, neoehrlichiosis, babesiosis and rickettsiosis. The incidence of eTBDs in children is rather unknown, potentially due to low awareness regarding these diseases among health professionals. The clinical picture may be unspecific and access to laboratory tests limited. We aimed to investigate the incidence and clinical manifestations of eTBDs, including possible co-infections, within a pediatric patient group evaluated for Lyme neuroborreliosis (LNB).

METHODS

In a cohort of Swedish children being evaluated for LNB (n = 235) during 2011-2014, samples and data on clinical manifestations and laboratory findings were prospectively collected. Plasma samples were analysed by real-time polymerase chain reaction (PCR) for detection of Anaplasma phagocytophilum, Neoehrlichia mikurensis, Babesia species (spp.) and Rickettsia spp. Cerebrospinal fluid from a subset of the patients was also analysed for Rickettsia spp. by real-time PCR.

RESULTS

No evidence of eTBDs, nor tick-borne co-infections, was found in the analysed samples from children evaluated for LNB.

CONCLUSIONS

We conclude that no evidence for potential eTBDs was found within a Swedish pediatric patient group with potential high exposure to tick-borne pathogens. However, given the indications of the emergence of ticks and several tick-borne pathogens, we suggest that eTBDs should be considered as differential diagnoses in patients with non-LNB, atypical LNB or unexplained fever and skin rashes, including a complete blood count and liver enzymes in the diagnostic workup.