Pitfalls in the Diagnosis and Treatment of Lyme Disease in Children

doi:10.1001/jama.1995.03530010080038

Pitfalls in the Diagnosis and Treatment of Lyme Disease in Children

Henry M. Feder, Jr, MD;
Margaret S. Hunt, MD

From the Departments of Pediatrics (Drs Feder and Hunt) and Family Medicine (Dr Feder), University of Connecticut Health Center, Farmington. Dr Hunt is now with the Department of Pediatrics, University of Massachusetts, Worcester.

Abstract

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.

(JAMA. 1995;274:66-68)