0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
The Pediatric Forum |

Facial Palsy in Lyme Disease—Reply

Anita L. Belman, MD; P. K. Coyle, MD; Thomas Preston, PhD; Roger Grimson, PhD; Douglas Postels, MD; Leslie Reynolds, MD
Arch Pediatr Adolesc Med. 1998;152(9):929. doi:.
Text Size: A A A
Published online

Extract

In reply

The patients in our study were evaluated between 1988 and 1996.1(p1225) As we stated in our article1(p1227) confirmatory Western blot was not a standard of care practice for our patients, since it was not until August 1995 that the Centers for Disease Control and Prevention (CDC) recommended these studies and published criteria for interpretation.2 However, all of the children lived in an endemic Lyme disease area, had tick exposure, and developed new onset facial nerve palsy in the spring, summer, or fall. Other causes (mass lesions, varicella-zoster [Ramsey-Hunt], Epstein-Barr virus, and other rheumatologic disorders) were ruled out. These children were considered to have Lyme disease–associated facial nerve palsy (cranial neurities with detectable serum anti–B burgdorferi antibodies) according to the 1990 Lyme Disease National Surveillance Case Definition criteria of the CDC. We agree with Sood's comment regarding false-positive (and although he did not mention it, false-negative) results using ELISA of total antibodies to B burgdorferi. In fact we discussed this in our article.1(p1227) Of course, the false-positive rate in high endemic areas is much less than in nonendemic regions. The ELISA performed by Stony Brook University Hospital, Stony Brook, NY, is also considered to be one of the most reliable available. The diagnosis of Lyme disease is made on clinical and epidemiologic features based on the development of abnormal symptoms and signs consistent with B burgdorferi infection, failure to establish an alternative diagnosis, endemic area exposure as well as tick exposure. The CDC recommends laboratory confirmation for clinical syndromes other than physician-documented erythema migrans (EM). The most convincing laboratory support would be direct detection of the organism by culture. However, B burgdorferi culture requires the use of special (Barbour-Stoenner-Kelly) medium, which must be maintained for weeks for organisms to be detected, and unfortunately even then the yield is low. Polymerase chain reaction to detect B burgdorferi nuclei acid is a promising technique but now PCR assays remain experimental since they are not standardized for routine use on clinical samples. They also require meticulous detail to avoid contamination and false-positive results. Thus, serological tests to detect antibodies to the organism have been developed and are widely used. Both false-positive and false-negative results may occur.3 False-positive reactions may occur with other bacterial or viral infections, high autoantibody titers, or hypergammaglobulinemia. Furthermore, as we pointed out (page 1227) ELISA does not differentiate between active B burgdorferi infection and prior exposure, nor does Western blot. False-positive results may also occur, eg, in patients with rheumatoid arthritis where multiple antigen cross reactivity on Western blot has been noted.3 Serum IgM immunoblot assays during the acute phase of the infection followed by documentation of seroconversion by IgG immunoblot in the convalescent period is confirmatory as discussed by Sood. However it is possible that antibiotic therapy in early infection may blunt the immunologic response, thus in this scenario, seroconversion would not be demonstrated.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Erythema Migrans

The Rational Clinical Examination
Original Article: Does This Patient Have Erythema Migrans?

brightcove.createExperiences();