Would Parents Consent to a Comparative Effectiveness Trial of Oral Doxycycline Versus Intravenous Ceftriaxone for the Treatment of Children with Lyme Meningitis?

Children with Lyme meningitis are often treated with intravenous ceftriaxone, although oral doxycycline may be effective. Parents were surveyed after observing a video describing a hypothetical Lyme meningitis treatment trial. Eighty-four of 102 (82%) would consent to their child participating. Parents would accept 2 additional days of symptoms (noninferiority margin) with doxycycline even if ceftriaxone hastened symptom resolution.
Source: The Pediatric Infectious Disease Journal - Category: Infectious Diseases Tags: Brief Reports Source Type: research

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This study compared the fHIT with the Dynamic Visual Acuity assessed on a treadmill (DVAtreadmill) and Oscillopsia Severity Questionnaire (OSQ) in the context of objectifying the experience of oscillopsia in patients with BV. Methods: Inclusion criteria comprised: (1) summated slow phase velocity of nystagmus of
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusions OCB are important biomarkers that can support MRI diagnostics and help to avoid false-positive MS diagnoses. Therefore, the revised McDonalds criteria have increased the importance of the OCB. New biomarkers such as AQP4 have now established themselves in clinical practice, and others such as Anti-MOG and NfL are about to enter clinical routine. An important focus in the search for new biomarkers is the monitoring of therapy efficacy and the prediction of severe side effects. Many other CSF molecules such as CHI3L1, IL-6, or CXCL13 show potential as markers for clinical practice, but further research is nee...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
We report nine cases of pediatric neuroborreliosis collected by the National Observatory of Pediatric Bacterial Meningitis in France between 2001 and 2012. The nine children, aged 4-13 years, were identified in northern and eastern France and had the following clinical features: meningeal irritation alone or with facial palsy, or isolated facial palsy. All cases showed anti-Borrelia antibodies in cerebrospinal fluid or serum, or with a positive Borrelia PCR in the CSF. The outcome was favorable in all cases after a 2- to 3-week course of third-generation cephalosporin. On the basis of these nine pediatric cases, this study...
Source: Archives de Pediatrie - Category: Pediatrics Authors: Tags: Arch Pediatr Source Type: research
We report the case of a 9-year-old girl who suffered from headaches for several days and was shown to have opsoclonus and left peripheral facial palsy. Work-up excluded the diagnosis of neuroblastoma, but CSF analysis showed aseptic meningitis, and serology for Borrelia burgdorferi (Lyme) was positive. The outcome was favorable with complete regression of symptoms after treatment with ceftriaxone 2g/day for 3 weeks. Although rare, the diagnosis of Lyme neuroborreliosis must be raised in the presence of isolated opsoclonus, particularly if the clinical picture is incomplete and if other features, such as peripheral fac...
Source: Archives de Pediatrie - Category: Pediatrics Authors: Tags: Arch Pediatr Source Type: research
We report rare manifestation of a common disease and emphasize the importance of considering LD in the differential diagnosis of acute transverse myelitis, particularly in residents of endemic areas.
Source: IDCases - Category: Infectious Diseases Source Type: research
Conclusions/SignificanceThese preliminary results suggest the potential utility of CSF metabolomics as a rapid screening test to enhance diagnostic accuracies and improve patient outcomes.
Source: PLoS Neglected Tropical Diseases - Category: Tropical Medicine Authors: Source Type: research
We report on five cases of patients with a diagnosis of neuroborreliosis based on clinical symptoms, serologic tests and MR imaging results. However, neither of them fulfils the diagnostic criteria for definite neuroborreliosis. Are the diagnostic criteria still valid or is there a need to revis e them? Is our diagnosis correct? Are these cases post-Lyme auto-immune neuronal inflammation, and not due to still active spirochetal infection? Do we need to consider immunosuppressive therapy instead of third-generation cephalosporins?
Source: Acta Neurologica Belgica - Category: Neurology Source Type: research
Neurologic manifestations of nervous system infection with Borrelia burgdorferi, Borrelia garinii, and Borrelia afzelii are qualitatively similar, and include lymphocytic meningitis, cranial neuritis, radiculoneuritis, and other focal or multifocal mononeuropathies. Parenchymal central nervous system (CNS) infection occurs rarely. Neurobehavioral changes are common, but are rarely evidence of CNS infection. Diagnosis requires likely exposure and a finding with high diagnostic positive predictive value, specifically erythema migrans, or laboratory support, typically positive 2-tiered serologic testing. CNS infection is ofte...
Source: Neurologic Clinics - Category: Neurology Authors: Source Type: research
This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis...
Source: CONTINUUM: Lifelong Learning in Neurology - Category: Neurology Tags: Review Articles Source Type: research
This article can educate those engaged in imaging of the nervous system and serve as a comprehensive tool in clinical cases.Key Points•Diagnostic criteria for LNB emphasise exclusion of an alternative cause to the clinical symptoms.•MRI makes a crucial contribution in the diagnosis and follow-up of LNB.•MRI may have normal findings, or show neuritis, meningitis, myelitis, encephalitis or vasculitis.•White matter lesions are not a prominent feature of LNB.
Source: Insights into Imaging - Category: Radiology Source Type: research
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