Sensitivity of Two-Tiered Lyme Disease Serology in Children With an Erythema Migrans Lesion

Amy D Thompson; Fran Balamuth; Desiree N Neville; Laura L Chapman; Michael N Levas; Anupam B Kharbanda; John A Branda; Meagan M Ladell; Claire Loiselle; Lise E Nigrovic

doi:10.1093/jpids/piad073

Sensitivity of Two-Tiered Lyme Disease Serology in Children With an Erythema Migrans Lesion

J Pediatric Infect Dis Soc. 2023 Oct 28;12(10):553-555. doi: 10.1093/jpids/piad073.

Authors

Affiliations

¹ Division of Emergency Medicine, Nemours Children's Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA.
² Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Division of Emergency Medicine, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁴ Division of Pediatric Emergency Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁵ Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA.
⁷ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Research, Nemours Children's Hospital, Wilmington, Delaware, USA.
⁹ Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

PMID: 37756491
DOI: 10.1093/jpids/piad073

Abstract

In our prospective cohort of 192 children with a physician-diagnosed erythema migrans (EM) lesion, two-tier Lyme disease serology had higher sensitivity in children with multiple EM lesions (76.8% multiple lesions vs. 38.1% single EM; difference 38.7%, 95% confidence interval 24.8%-50.4%). The diagnosis of cutaneous Lyme disease should be based on careful physical examination rather than laboratory testing.

Keywords: Lyme disease; children; erythema migrans lesion; serology.

© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MeSH terms

Child
Erythema Chronicum Migrans* / diagnosis
Erythema Chronicum Migrans* / pathology
Humans
Lyme Disease* / complications
Lyme Disease* / diagnosis
Prospective Studies

Grants and funding

Global Lyme Alliance and Bay Area Lyme Foundation