Symptoms
Symptoms Affecting Children
Children with Lyme can exhibit a variety of mild to severe symptoms.
Children may be unable to describe their symptoms in the same way as an adult. Pain, for example, may be expressed by rubbing or tapping on or near the painful area. Fatigue may be expressed by a child wanting to suddenly sit down or wanting to sit longer or more often than normal.
Below are some of the symptoms children can have that are linked to Lyme disease in the scientific literature.
Partial List of Signs & Symptoms
Associated With & Documented In
Children With Lyme Disease
- Fevers and/or chills
- Migratory pains and stiffness in joints
- Persisting joint involvement
- Muscle aches and pain
- Refractory arthritis
- Arthritis of the knee
- Lyme arthritis appearing as septic arthritis or juvenile rheumatoid arthritis
- Headaches- mild to severe (reported in over 90% of children)
- Brain diseases
- Night and day sweats
- Fatigue- mild (barely noticeable) to severe fatigue (bed ridden) often unrelieved by sleeping
- Fatigue with poor stamina
- Facial weakness
- Bilateral facial palsy (BFP)
- Wilting fatigue with some periods of energy in between episodes
- Myalgia
- Pruritis
- More difficult to identify in children
- Asymptomatic course in a large number of children
- In children the upper part of the body is more frequently affected (rash)
- Borrelial lymphocytoma most frequently located on the earlobe in children
- Idiopathic intracranial hypertension
- Highest rates of facial palsies are among children living in hyper endemic regions (5%)
- High cerebrospinal fluid (CSF) levels of mononuclear cells and albumin
- Lyme meningitis characterized by signs/symptoms similar to viral meningitis
- CSF concentration of proteins (more frequent or higher in children with Lyme meningitis)
- Concentration disorder
- Carditis more likely in children aged >10 years
- Children more likely to develop arthritis secondary to B. burgdorferi infection than adults
- Brief attacks of arthritis, particularly affecting the knee
- More likely to have arthritis as sole presenting symptom of disease
- Untreated Lyme arthritis associated with ocular and brain diseases
- Utero transmission of B. burgdorferi during pregnancy resulting in fetal involvement
- Further pediatric studies are needed
- Sore throats- often very painful
- Nausea
- Abdominal upset and/or pain
- Loss of appetite
- Anorexia
- Backache
- Hypotonia (floppy baby syndrome)
- Leg pain
- Nocturnal pain in back and legs
- Swollen and/or painful knee
- Swollen knee
- Chest pain (at least 70%)
- Acropapular dermatitis
- SENLAT Syndrome (aka TIBOLA/DEBONEL)
- Necrotic eschar of scalp
- Painful lymphandenopathy
- Joint involvement- knee and ankle
- Swelling of ear
- Blue-coloured earlobe
- Painless ear swelling with redness
- Pinna- deformed and floppy
- Enlarged, nontender jugulodigastric node
- Thickening of soft tissues with increased echogenicity and hyperemia
- Inflammation of the auricular cartilage
- Auricular chondritis
- Local itching or burning of rash
- Erysipelas may be confused with Lyme EM rash
- Similar to relapsing polychondritis
- Deformity of the pinna
- Weak gag and cough reflexes
- Auricular chrondritis
- Personality changes
- Erythema of ipsilateral surrounding face and jaw
- Problems with schoolwork (not seen previously)
- Dizziness or a floating feeling (vertigo)
- Shortness of breath
- Ataxia
- Ataxia
- Cerebellar ataxia
- Meningeal involvement
- Massive and rapid weight loss
- Vomiting
- Gastroenteritis
- Fever and Chills
- Asthenia
- Headache (severe)
- Torticollis
- Simple partial seizures
- Diffuse leptomeningeal inflammation
- Tiredness
- Hyperintense cervical cord lesion
- Upper-airway infection
- Hypotonia
- Dysarthria
- Weak gag and cough reflexes
- Hyperintense lesions
- Fluid-attenuated inversion recovery sequences on left posterior arm of the internal capsule
- Fluid-attenuated inversion recovery sequences in the medulla oblongata
- Fluid-attenuated inversion recovery sequences on subcortical occipital and parietal region
- Localized marrow edema
- Leptomeningeal and root enhancement
- Unexplained neurological symptoms
- Meningoencephalitis
- Meningoradiculitis
- Encephalomyelitis
- Dysarthia (difficult or unclear speech)
- Palpitations
- Syncope
- Excessive thirst
- Tourette's syndrome
- Inappropriate laughter
- Disorientation
- Noise sensitivity
- Pain or sensitivity in teeth
- Restricted mandibular opening
- Absence of lip notch
- Tinnitus
- Tingling
- Numbness
- Irritability
- Light sensitivity (indoors or out)
- Iridocyclitis
- Uveitis intermedia
- Abducens palsies
- Optical neuropathy
- Orbital myositis
- Conjunctivitis
- Infestation of eyelashes
- Forgetfulness
- Stiff neck
- Neck stiffness
- Neck pain
- Weakness
- Inability to think clearly
- Dementia
- Attention deficit disorder (ADD)
- Attention deficit hyperactivity disorder (ADHD)
- Cognitive Impairments
- Insomnia
- Hypersomnia
- Poor concentration
- Malaise
- Lethargy
- Acute hip pain
- Marrow edema
- Joint swelling
- Arthritis
- Ankle arthritis
- Oligoarthritis
- Monoarthritis
- Monoarticular arthritis
- Pauciarticular arthritis
- Temporomandibular joint effusion- TMJ
- Bed wetting
- Bladder pain
- Urinary urgency
- Testicular pain
- UTI's
- Menstrual irregularities
- Ocular motor disturbances
- Intracranial hypertension
- Keratitis
- Keratitis
- Nystagmus
- Problems with short-term memory
- Word finding problems
- Behavioral changes
- Difficulty thinking or expressing thoughts
- Poor working memory
- Panic attacks
- Depersonalization
- Outbursts- some violent
- Mood swings
- Meningomyeloradiculitis
- Nocturnal pain in back and legs
- Loud opening sound of the mitral valve
- Lumbar rigidity
- Thickened mitral valve with mild regurgitation
- Aseptic meningitis
- Stroke
- Myocardial muscle involvement
- Night terrors
- Autism spectrum disorder
- Ischemic and hemorrhagic lesions
- Auditory hallucinations
- Metamorphopsia
- Vasculitis
- Atypical location of lymphocytoma cutis
- Cerebral vasculitis
- Erythema migrans
- Multiple erythema migrans
- Borrelial lymphocytoma
- Acrodermatitis chronica atrophicans
- Acrodermatitis chronica atrophicans
- Difficulty learning new material in school
- Vision loss
- Blindness
- Optic neuritis
- Optic nerve involvement
- Bilateral papilledema along with right sixth cranial nerve palsy
- Photophobia
- Papilledema
- Papilledema caused by raised intracranial pressure
- Ptosis (drooping eye lid)
- Adie's pupil
- Uvetitis
- Diminished reflexes
- Transient synovitis
- Continued synovitis
- Peripheral neuropathy
- Distal parasthesias
- Oculomotor nerve paresis
- Paraesthesia
- Dysfunctional and cosmetic problems
- Persistent facial nerve palsy
- Radicular pain
- Facial nerve paralysis
- Bell's palsy
- Peripheral facial palsy
- Trochlear palsy
- Trochlear palsy
- Facial nerve palsies
- Mild facial palsy
- Motoric disturbances
- Morning stiffness
- Depression
- Cranial neuropathy
- Anxiety
- Weight loss
- Neurologic signs and/or symptoms defined as possible sequelae
- Vomiting
- Myelopathy
- Poliomyelitis
- Cranial polyneuritis
- Cranial nerve palsies
- Hearing loss
- Cochlear inflammation
- Myocarditis
- Transient myocardial dysfunction
- Heart block
- Complete antrioventricular block
- Stroke and stroke-like symptoms
- Transient focal neurological deficits
- Complete hemiparesis
- Paraesthesia
- Recurrent episodes of vertigo
- Short stenoses at the branching site of the left middle cerebral artery (MCA)
- Circumscript areas of malperfusion
- Thromboembolic events
- Increased CSF cell count
- CNS vasculitis
- Stenosis in the left posterior cerebral artery consistent with vasculitic inflammation
- MCA lesions
- Advanced heart block
- Advanced heart block
- Neurodevelopment delay
- Considerably large number of cases diagnosed in areas not considered endemic
- Depressed ventricular systolic function
- Cardiopulmonary symptoms
- Carditis
- Spinal cord swelling
- Increased white cell count
- High level of inflammation (higher in boys studied)
- Altered gait- jerky, uneven, labored, limp
- Torticollis (wryneck)
- Seizures
- Partial complex seizure disorder
- Delayed onset of illness
- Organ system involvement
- One or more coinfections
- Antibiotic-refractory arthritis
- Lower frequencies of Treg cells
- Higher expression of activation coreceptors
- Less effective inhibition of pro inflammatory cytokines
- Immune responses excessively amplified
- Immune dysregulation
- Transverse myelitis
- Acute myelitis
- Meningitis
- Lymphocytic meningitis
- Opsoclonus-myoclonus
- Myoclonus
- Radiculopathies
- Sensory abnormalities
- Usual and unusual symptoms from patient to patient
- Lyme meningitis diagnosed in two-thirds of children with infectious meningitis in Lyme endemic area
- Some clinicians in an LD-endemic area do not follow guidelines for diagnosing children suspected to have Lyme disease
- Broad range of neurologic disorders
- Severe acute cerebellar ataxia
- Acute hemiparesis
- Autonomic dysfunction
- Elevated CXCL13 levels in CSF
- Pleocytosis in cerebrospinal fluid
- Rasmussen Syndrome
- Jarisch-Herxheimer Reaction
- Asymptomatic Lyme (B. burgdorferi) infection (no visible symptoms)
- Alice in Wonderland Syndrome
- ALDY- inflammatory disease of skin similar to morphea
- Skin- central paleness, scaling, wrinkling, dermal atrophy, slight pigmentation, and telangiectasia
- Seventh nerve palsy
- Lethargy
- Irritability
- Negative PCR does not exclude it
- Multiple sclerosis
- Guillain–Barré syndrome
- Pseudotumor cerebri
- Cerebral vasculitis
- Focal neurological signs
- Mono- or oligoarthritis
- Eyes may be involved by keratitis, iridocyclitis, or uveitis intermedia
- Cardiac involvement may appear as AV block or carditis
- Acrodermatitis chronica atrophicans- a late skin manifestation of borreliosis
- Borrelial lymphocytoma, usually found at earlobes, nipples, or testicular sacks
- Fatigue without signs of mucous membrane involvement
- Summer flu
- Chronic headache
- Diminishing academic achievements
- In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite
- TBE (tick-borne encephalitis) displayed more long-term complaints (ie, fatigue, headache and irritability) compared to Lyme
- Difficult to diagnose due to vague symptomatology
- Significantly higher frequency of disabilities detected in the TBE (tick-borne encephalitis) children
- TBE (tick-borne encephalitis) and Lyme cause consequences (eg, prolonged convalescence, worries and financial loss) for families
- Mildly tender mass in right pre auricular region- mass became larger, and overlying skin turned purple
- Mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous
- Jarisch-Herxheimer's reaction at the beginning of treatment
- 26% had 1 or more complications
- 14% required a change in prescribed antibiotic therapy
- Ten percent of the patients had an adverse drug reaction
- Lyme borreliosis can affect almost all human organs
- Poor frustration management
- Neuropsychiatric impairments
- Serological tests have limited utility for follow-up
- Lyme disease shares many of the same physical manifestations as Autism Spectrum Disorder (ASD)
- All scores on SAP-O assessment improved after 6 months of antibiotic therapy.
- ASD/Lyme- improved speech, eye contact, sleep behaviors, and reduction of repetitive behaviors after 6 months antibiotic therapy
- Peripherally inserted central catheter-associated complication: 10% had a mechanical problem
- Peripherally inserted central catheter-associated complication: 1% had a venous thromboembolism
(*Please note this list above with references is not complete. It is a work in progress. May 2016/ July 2016/ June 2017)
Rashes- Only a few children (less than 10%) will get a "bulls-eye" or other kind of Lyme related rash. The rash may appear in hard-to-see places (scalp) and may be very short-lived and overlooked. Some rashes may not appear until after treatment begins (not to be confused with an allergy). See rash photos by clicking here.
Tick Bites- All species of ticks can transmit a variety of infectious organisms, some within a very short time (minutes to hours) after attachment. Do not think because it is a lone star tick or other kind of tick it can not transmit Lyme disease as some of the older literature suggests.
What's In A Tick That Can Make You Sick? Deer ticks, for example have been found to have 93 different kinds of bacteria, parasites, viruses, etc. Many organisms are known to be able to be transmitted to humans by the deer tick. With the other organisms, no one is sure if they can or can't be transmitted. Many children (and parents) do not remember the child having a tick bite. To learn how to properly remove a tick click here.
Dr. Daniel Cameron- QUOTE- "Children and adolescents have been misdiagnosed with a range of disorders including Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Obsessive Compulsive Disorder (OCD), and Tourettes."
Signs & Symptoms
Hypercoagulation / Heparin Therapy
Treatment for Pregnant & Pediatric Patients
Additional Information
What Doctors Need To Know About Pediatric Lyme Disease- by Ann Corson, MD- See attached pdf at the bottom of this page.
Psychiatry Ground Rounds (December 13, 2006)- Neuropsychiatric Manifestations of Tick Borne Diseases- by Ann Corson, MD- Click Here
Treatment of the Pregnant & Pediatric Patient- by Ann Corson, MD- Click Here
