Nevroborreliose hos barn Marcus Schmidt Overlege, barneavdelingen SØ

Transkript

1 Marcus Schmidt Overlege, barneavdelingen SØ

2 Utbredelse europeisk flått (Ixodes ricinus)

3 Tidlig lokalisert sykdom Tidlig disseminert sykdom Sen sykdom

4 Tidlig lokalisert sykdom Erytema migrans, borrelia lymfocytom Tidlig disseminert sykdom Nevroborreliose, karditt Sen sykdom Artritt, acrodermatitis chronica atrophicans, sen nevroborreliose

5 Tidlig lokalisert sykdom Erytema migrans, borrelia lymfocytom Tidlig disseminert sykdom Nevroborreliose, karditt Sen sykdom Artritt, acrodermatitis chronica atrophicans, sen nevroborreliose

6 Symptomer ved tidlig nevroborreliose (vanligvis 4-6 uker etter flåttbitt) Facialisparese (uni- eller bilateralt) (55%) Symptomer på lymfocytær meningitt (hodepine, nakkestivhet) (27%) Symptomer på encephalitt (ataxi, myelitt, nevritt med smerter og pareser)

7 Symptomer ved tidlig nevroborreliose (vanligvis 4-6 uker etter flåttbitt) Facialisparese (uni- eller bilateralt) (55%) Symptomer på lymfocytær meningitt (hodepine, nakkestivhet) (27%) Symptomer på encephalitt (ataxi, myelitt, nevritt med smerter og pareser)

8 Symptomer ved tidlig nevroborreliose (vanligvis 4-6 uker etter flåttbitt) Facialisparese (uni- eller bilateralt) (55%) Symptomer på lymfocytær meningitt (hodepine, nakkestivhet) (27%) Symptomer på encephalitt (ataxi, myelitt, nevritt med smerter og pareser)

9 65% Nevroborreliose som årsak ved facialisparese hos barn Acute facial nerve palsy in children: How often is it Lyme borreliosis? Scand J Infect Dis 2007;39:

10 MEN

11 Ned Tijdschr Geneeskd. 2012;156(51):A5157. Torticollis and seizures due to neuroborreliosis in a child [Article in Dutch] van Breemen MS1, van der Kuip M, Ang CW, van Furth AM, Wolf NI. Abstract BACKGROUND: In children, neuroborreliosis often manifests itself as cranial neuritis (particularly facial palsy) or aseptic meningitis. Presentation with torticollis and simple partial seizures resulting from diffuse leptomeningeal inflammation is rare. CASE DESCRIPTION: A seven-year-old boy who had developed torticollis and partial seizures, lost weight and was complaining of tiredness was seen by a paediatric neurologist. A brain and spinal cord MRI showed diffuse leptomeningeal enhancement, in combination with a hyperintense cervical cord lesion. Laboratory testing of serum and cerebrospinal fluid confirmed the diagnosis of neuroborreliosis. The boy was treated with intravenous ceftriaxone for 30 days and made a full recovery. CONCLUSION: As illustrated by this case neuroborreliosis can manifest itself atypically with torticollis, seizures and diffuse leptomeningeal enhancement due to inflammation. If there is leptomeningeal enhancement on MRI then neuroborreliosis should be included in the differential diagnosis. In childhood neuroborreliosis can be successfully treated and the prognosis is good

12 Pediatr Emerg Care Dec;28(12): doi: /PEC.0b013e318276c51d. Neuroborreliosis presenting as acute disseminated encephalomyelitis Rocha R1, Lisboa L, Neves J, García López M, Santos E, Ribeiro A. Abstract We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial

13 Nevroborreliose Viral meningitt

14 Nevroborreliose Viral meningitt Hjernenerveparese Hodepine Slapphet Lite uttalt nakkestivhet Sykehistorie >9 d Tydelig nakkestivhet Sykehistorie <6d (ofte 1-2 d)

15 Facialisparese hos barn Alltid spinalpunksjon pga mistanke om nevroborreliose

16 Diagnostikk l Klinikk l Sjeldent forandringer i blodprøver (CRP, LPK) l Serologi serum l Serologi spinalvæske (nevroborreliose-test) l Veldig sjeldent indikasjon for PCR l Andre testmetoder IKKE anbefalt

17 Kriterium I: Klinikk (nevrologiske symptomer) Kriterium II: Pleocytose med 5 celler i spinalvæsken Kriterium III: Positiv nevroborreliosetest Alle 3 kriterier oppfylt: Sikker nevroborreliose 2 kriterier oppfylt: Mulig nevroborreliose (hvis kriterium III ikke er oppfylt, må det være positiv serologi i serum etter 6 uker) EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis, EuropeanJournalofNeurology 2010, 17: 8 16

18 Behandling

19 Behandling Barn < 8 år: Ceftriaxon 75 mg/kg x 1 IV i 14 dager (max 2 g x 1)

20 Behandling Barn < 8 år: Ceftriaxon 75 mg/kg x 1 IV i 14 dager (max 2 g x 1) Barn > 8 år: Doxycyclin 2 mg/kg x 2 PO i 14 dager (max 100 mg x 2)

21 Langtidseffekter l Generelt veldig god prognose. l Veldig få sequeler etter nevroborreliose. l Oftest grad av persisterende facialisparese. l Ingen påvirkning av vanlige aktiviteter eller skoleprestasjoner. l Ingen hyppigere forekomst av hodepine, fatigue eller konsentrasjonsproblemer. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics Aug;130(2):262-9.

22 Hva med TBE? TBE = Tick born encephalitis (skogflåttencefalitt) l Vanlig i mange deler av Europa. l Første tilfellet i Østfold beskrevet (En tenåring med smerter, dobbeltsyn og ustø gange. Tidsskr Nor Legeforen 2013; 133:422-5). l Mest sannsynlig økende forekomst i fremtiden.

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24 Takk for oppmerksomheten