Pediatric Lyme Disease Differential Diagnoses
- Author: Russell W Steele, MD; Chief Editor: Russell W Steele, MD more...
Diagnostic Considerations
Diagnosis may be made clinically in the early stages of disease by the presence of erythema migrans (EM) rash. However, in the absence of specific signs, particularly in the early stage of infection, the diagnosis of Lyme disease can be difficult because of the limitations of current diagnostic tests.
Testing should be performed in patients with aseptic meningitis, facial nerve palsy, or arthritis for Lyme disease if they live in or have traveled to an endemic area.
Of note, a recent retrospective cohort study validated the "Rule of 7's"—a clinical prediction rule that classifies children at low risk for Lyme meningitis (< 7 d of headache, < 70% cerebrospinal fluid mononuclear cells, and absence of seventh or other cranial nerve palsy). Results suggested patients classified using the Rule of 7’s were unlikely to have Lyme meningitis and could be managed in an outpatient setting while awaiting Lyme serology test results.[4]
Diagnosis of reinfection or recurrent infection is complicated by the persistence of antibody beyond the eradication of disease.
Because interpretation of testing is related to stage of disease and requires a 2-stage test, laboratory results are often misinterpreted. Clinicians unfamiliar with Lyme disease or Lyme testing may falsely exclude the diagnosis (early disease) or falsely diagnose disease (old antibody or using Western blot in those with negative enzyme-linked immunosorbent assay [ELISA] test results).
Myositis should also be considered.
Go to Lyme Disease for complete information on this topic.
Differential Diagnoses
- Arthritis, Septic
- Atrioventricular Block, Third Degree, Acquired
- Babesiosis
- Chronic Fatigue Syndrome
- Contact Dermatitis
- Ehrlichiosis
- Fibromyalgia
- Juvenile Rheumatoid Arthritis
- Meningitis, Aseptic
- Meningitis, Bacterial
- Mononucleosis and Epstein-Barr Virus Infection
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