Distinct Clinico-pathogenic Subgroups in Pediatric Lyme Neuroborreliosis
type: Article
item type: journalArticle
is part of: Open Forum Infect Dis
authors: Person
  surname: Sidorov
  given name: S.
authors: Person
  surname: Greiter
  given name: B. M.
authors: Person
  surname: Osuna
  given name: E.
authors: Person
  surname: Hackenberg
  given name: A.
authors: Person
  surname: Seiler
  given name: M.
authors: Person
  surname: Martin
  given name: R.
authors: Person
  surname: Marchesi
  given name: M.
authors: Person
  surname: von Felten
  given name: S.
authors: Person
  surname: Egli
  given name: A.
authors: Person
  surname: Berger
  given name: C.
authors: Person
  surname: Meyer Sauteur
  given name: P. M.
subject: Borrelia burgdorferi
subject: Lyme disease
subject: facial nerve palsy
subject: in relation to this manuscript.
subject: intrathecal antibody production
subject: meningitis
abstract: BACKGROUND: Lyme neuroborreliosis (LNB) is a common manifestation of Lyme disease in children. It is caused by the bacterium Borrelia burgdorferi and can affect both the peripheral nervous system (PNS) and the central nervous system (CNS). This study aimed to describe clinical and immunological features of LNB in children. METHODS: We performed a large retrospective cohort study of children diagnosed with LNB at the University Children's Hospital Zurich from 1 January 2006 to 31 December 2020. RESULTS: A total of 190 children diagnosed with LNB were included (median age, 7.6 years). Meningitis was the most frequent manifestation of LNB (n = 115, 60.5%), followed by isolated cranial neuropathy (iCN) (n = 55, 28.9%) and meningoradiculitis (n = 15, 7.9%). Five (2.7%) patients presented with rare, severe CNS manifestations, including acute myelitis and cerebral vasculitis. The most frequent specific clinical signs were facial palsy (n = 136, 71.6%) and a history of erythema migrans (n = 33, 17.4%). Borrelia burgdorferi-specific IgM and IgG antibody responses in cerebrospinal fluid (CSF) and blood were primarily directed against the following 3 antigens: VlsE, p41, and OspC, with broader responses in blood. Compared to patients with meningitis or meningoradiculitis, iCN patients had lower CSF inflammation, reduced positivity in B burgdorferi-specific tests (ELISA, immunoblot, and/or intrathecal antibody production), weaker antibody responses to VlsE, p41, and OspC, and shorter post-treatment symptom duration. CONCLUSIONS: Lyme neuroborreliosis in children presents with a broad clinical spectrum, with meningitis and iCN being the most common manifestations. We observed distinct clinico-pathogenic subgroups of LNB: iCN reflects a more localized, PNS-restricted disease, whereas meningitis and meningoradiculitis represent a more systemic involvement of both PNS and CNS. These findings may improve diagnostic accuracy and guide the management of children with LNB.
date: 2026-02-06
pages: ofaf812
coverage: 41648077

Open Forum Infect Dis
type: Journal
volume: 13
number: 2
alternative: Open Forum Infect Dis
identifier: DOI 10.1093/ofid/ofaf812
identifier: ISSN 2328-8957 (Print)