Pitfalls in the diagnosis and treatment of Lyme disease in children
H. M. Feder Jr and M. S. Hunt
Department of Pediatrics, University of Connecticut Health Center, Farmington 06030-3960, USA.
OBJECTIVE--To define pitfalls of diagnosis and treatment of Lyme disease in
children. DESIGN--Case series. SETTING--A university Lyme disease clinic in
a Lyme disease endemic area. PATIENTS--A total of 146 pediatric patients
(mean age, 9.9 years) referred with possible Lyme disease. MAIN OUTCOME
MEASURES--Of the 146 patients, 56 (38%) were overdiagnosed, 12 (8%) were
underdiagnosed, and 75 (51%) were correctly diagnosed with Lyme disease.
Treatment errors were made for 19 (25%) of these 75 patients. In addition,
three patients (2%) with tick bites were misdiagnosed or mistreated.
Frequent pitfalls included misidentifying rashes as erythema migrans,
ascribing nonspecific symptoms to Lyme disease, failing to ascribe fleeting
objective symptoms to Lyme disease, and inappropriate antibiotic therapy
for patients with Lyme disease. CONCLUSIONS--Errors in the diagnosis and
treatment of Lyme disease in children are common.
