Skip to main content
Log in

Lyme-Arthritis bei Kindern und Jugendlichen

Lyme arthritis in children and adolescents

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Die Lyme-Arthritis ist eine Manifestation der durch die Infektion mit Borrelia burgdorferi sensu lato verursachten Lyme-Borreliose. In dieser Arbeit werden die aktuellen Erkenntnisse zur Epidemiologie, Ätiologie und Pathogenese sowie zu den klinischen Manifestationen und deren Diagnose, Behandlung und Prognose dargestellt, unter besonderer Berücksichtigung des Kinder- und Jugendalters.

Abstract

Lyme arthritis is one of the manifestations of Lyme disease and is caused by infection with Borrelia burgdorferi sensu lato. This article reviews the current knowledge regarding the epidemiology, etiology and pathogenesis as well as the clinical manifestations, the diagnosis, treatment and prognosis with special emphasis on children and adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Huppertz HI, Dressler F (2005) Lyme disease. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB (eds) Textbook of Pediatric Rheumatology. 5th edn. Elsevier Saunders, Philadelphia, pp 591–603

  2. Huppertz HI (1990) Childhood Lyme borreliosis in Europe. Eur J Pediatr 149: 814–821

    Article  PubMed  CAS  Google Scholar 

  3. Dressler F (1994) Lyme borreliosis in European children and adolescents. Clin Exp Rheumatol (Suppl 10) 12: S49

    Google Scholar 

  4. Berglund J, Eitrem R, Ornstein K et al. (1995) An epidemiologic study of Lyme disease in Southern Sweden. N Engl J Med 333: 1319–1327

    Article  PubMed  CAS  Google Scholar 

  5. Huppertz HI, Böhme M, Standaert SM et al. (1999) Incidence of Lyme borreliosis in the Würzburg region of Germany. Eur J Clin Microbiol Infect Dis 18: 697–703

    Article  PubMed  CAS  Google Scholar 

  6. Gerber MA, Shapiro ED, Burke GS et al. (1996) Lyme disease in children in southeastern Connecticut. N Engl J Med 335: 1270–1274

    Article  PubMed  CAS  Google Scholar 

  7. Huppertz HI, Karch H, Suschke HJ et al. (1995) Lyme arthritis in European children and adolescents. Arthritis Rheum 38: 361–368

    Article  PubMed  CAS  Google Scholar 

  8. Richter D, Postic D, Sertour N et al. (2006) Delineation of Borrelia burgdorferi sensu lato species by multilocus sequence analysis and confirmation of the delineation of Borrelia spielmanii sp. Nov. Int J Syst Evol Microbiol 56: 873–881

    Article  PubMed  CAS  Google Scholar 

  9. Fraser CM, Casjens S, Huang WM et al. (1997) Genomic sequence of a Lyme disease spirochaete, Borrelia burgdorferi. Nature 390: 580–586

    Article  PubMed  CAS  Google Scholar 

  10. Coburn J, Magoun L, Bodary SC et al. (1998) Integrins alpha(v)beta3 and alpha5beta1 mediate attachment of Lyme disease spirochetes to human cells. Infect Immun 66: 1946–1952

    PubMed  CAS  Google Scholar 

  11. Girschick HJ, Huppertz HI, Rüssmann H et al. (1996) Intracellular persistence of Borrelia burgdorferi in human synovial cells. Rheumatol Int 16: 125–132

    Article  PubMed  CAS  Google Scholar 

  12. Gross DM, Steere AC, Huber BT (1998) T helper 1 response is dominant and localized to the synovial fluid in patients with Lyme arthritis. J Immunol 160: 1022–1028

    PubMed  CAS  Google Scholar 

  13. Busch DH, Jassoy C, Brinckmann U et al. (1996) Detection of Borrelia burgdorferi–specific CD8 cytotoxic T-cells in patients with Lyme arthritis. J Immunol 157: 3534–3541

    PubMed  CAS  Google Scholar 

  14. Roessner K, Wolfe J, Shi C et al. (2003) High expression of Fas ligand by synovial fluid-derived γδ-T cells in Lyme arthritis. J Immunol 170: 2702–2710

    PubMed  CAS  Google Scholar 

  15. Shin JJ, Glickstein LJ, Steere AC (2007) High levels of inflammatory chemokines and cytokines in joint fluid and synovial tissue throughout the course of antibiotic-refractory Lyme arthritis. Arthritis Rheum 56: 1325–1335

    Article  PubMed  CAS  Google Scholar 

  16. Weigelt W, Schneider T, Lange R (1992) Sequence homology between spirochaete flagellin and human myelin basic protein. Immunol Today 13: 279–280

    Article  PubMed  CAS  Google Scholar 

  17. Sigal LH (1993) Cross-reactivity between Borrelia burgdorferi flagellin and a human axonal 64000 molecular weight protein. J Infect Dis 167: 1372–1378

    PubMed  CAS  Google Scholar 

  18. Kalish R, Leong JM, Steere AC (1993) Association of treatment-resistant chronic Lyme arthritis with HLA-DR4 and antibody reactivity to OspA and OspB of Borrelia burgdorferi. Infect Immun 61: 2774–2779

    PubMed  CAS  Google Scholar 

  19. Kamradt T, Lengl-Janssen B, Strauss AF et al. (1996) Dominant recognition of a Borrelia burgdorferi outer surface protein A peptide by T helper cells in patients with treatment-resistant Lyme arthritis. Infect Immun 64: 1284–1289

    PubMed  CAS  Google Scholar 

  20. Drouin EE, Glickstein L, Kwok WW et al. (in press) Human homologues of a Borrelia T cell epitope associated with antibiotic-refractory Lyme arthritis. Mol Immunol: Epub ahead of print

  21. Gross DM, Forsthuber T, Tary-Lehmann M et al. (1998) Identification of LFA-1 as a candidate autoantigen in treatment-resistant Lyme arthritis. Science 281: 703–706

    Article  PubMed  CAS  Google Scholar 

  22. Steere AC, Falk B, Drouin EE et al. (2003) Binding of outer surface protein A and human lymphocyte function-associated antigen 1 peptides to HLA-DR molecules associated with antibiotic treatment-resistant Lyme arthritis. Arthritis Rheum 48: 534–540

    Article  PubMed  CAS  Google Scholar 

  23. Huppertz HI, Karch H (1991) Die Lyme-Arthritis im Kindesalter: Monarthritis des Kniegelenks, klinisch nicht unterscheidbar von Monarthritiden unbekannter Ursache. Monatsschr Kinderheilkd 139: 759–764

    PubMed  CAS  Google Scholar 

  24. Hammers-Berggren S, Andersson U, Stiernstedt G (1992) Borrelia arthritis in Swedish children: clinical manifestations in 10 children. Acta Paediatr 81: 921–924

    Article  PubMed  CAS  Google Scholar 

  25. Gerber MA, Zemel LS, Shapiro ED (1998) Lyme arthritis in children: clinical epidemiology and long-term outcomes. Pediatrics 102: 905–908

    Article  PubMed  CAS  Google Scholar 

  26. Huppertz HI, Michels H (1996) Pattern of joint involvement in children with Lyme arthritis. Br J Rheumatol 35: 1016–1018

    Article  PubMed  CAS  Google Scholar 

  27. Huppertz HI, Münchmeier D, Lieb W (1999) Ocular manifestations in children and adolescents with Lyme arthritis. Br J Ophthalmol 83: 1149–1152

    PubMed  CAS  Google Scholar 

  28. Christoforo RL, Appel MH, Gelb RF, Williams CL (1987) Musculoskeletal manifestations of Lyme disease in children. J Pediatr Orthop 7: 527

    Google Scholar 

  29. Sigal LH, Patella SJ (1992) Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. Pediatrics 90: 523–528

    PubMed  CAS  Google Scholar 

  30. De Koning J, Bosma RB, Hoogkamp-Korstanje JAA (1987) Demonstration of spirochaetes in patients with Lyme disease with a modified silver stain. J Med Microbiol 23: 261–267

    Google Scholar 

  31. Golightly M (1993) Laboratory considerations in the diagnosis and management of Lyme borreliosis. Am J Clin Pathol 99: 168–174

    PubMed  CAS  Google Scholar 

  32. Nocton JJ, Dressler F, Rutledge BJ et al. (1994) Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. N Engl J Med 330: 229–234

    Article  PubMed  CAS  Google Scholar 

  33. Carlson D, Hernandez J, Bloom BJ et al. (1999) Lack of Borrelia burgdorferi DNA in synovial fluid samples from patients with antibiotic treatment–resistant Lyme arthritis. Arthritis Rheum 42: 2705–2709

    Article  PubMed  CAS  Google Scholar 

  34. Priem S, Rittig MG, Kamradt T et al. (1997) An optimized PCR leads to rapid and highly sensitive detection of Borrelia burgdorferi in patients with Lyme borreliosis. J Clin Microbiol 35: 685–690

    PubMed  CAS  Google Scholar 

  35. Jaulhac B, Chary-Valckenaere I, Sibila J et al. (1996) Detection of Borrelia burgdorferi by DNA amplification in synovial tissue samples from patients with Lyme arthritis. Arthritis Rheum 39: 736–745

    Article  PubMed  CAS  Google Scholar 

  36. Priem S, Burmester GR, Kamradt T et al. (1998) Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy. Ann Rheum Dis 57: 118–121

    Article  PubMed  CAS  Google Scholar 

  37. Karch H, Huppertz HI, Böhme M et al. (1994) Demonstration of Borrelia burgdorferi DNA in urine samples from healthy humans whose sera contain B. burgdorferi–specific antibodies. J Clin Microbiol 32: 2312–2314

    PubMed  CAS  Google Scholar 

  38. (1995) Recommendations for test performance and interpretation from the second national conference on serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep 44: 590–591

  39. Dressler F, Whalen JA, Reinhardt BN et al. (1993) Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 167: 392–400

    PubMed  CAS  Google Scholar 

  40. Hauser U, Lehnert G, Lobentanzer R et al. (1997) Interpretation criteria for standardized Western blots for three European species of Borrelia burgdorferi sensu lato. J Clin Microbiol 35: 1433–1444

    PubMed  CAS  Google Scholar 

  41. Hauser U, Lehnert G, Wilkske B (1999) Validity of interpretation criteria for standardized Western blots (immunoblots) for serodiagnosis of Lyme borreliosis based on sera collected throughout Europe. J Clin Microbiol 37: 2241–2247

    PubMed  CAS  Google Scholar 

  42. Rose CD, Fawcett PT, Gibney KM et al. (1996) Residual serologic reactivity in children with resolved Lyme arthritis. J Rheumatol 23: 367

    PubMed  CAS  Google Scholar 

  43. Nichol G, Dennis DT, Steere AC et al. (1998) Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis. Ann Intern Med 128: 37–48

    PubMed  CAS  Google Scholar 

  44. Dressler F, Yoshinari NH, Steere AC (1991) The T-cell proliferative assay in the diagnosis of Lyme disease. Ann Intern Med 115: 533–539

    PubMed  CAS  Google Scholar 

  45. Huppertz HI, Mösbauer S, Busch DH et al. (1996) Lymphoproliferative responses to Borrelia burgdorferi in the diagnosis of Lyme arthritis in children and adolescents. Eur J Pediatr 155: 297–302

    Article  PubMed  CAS  Google Scholar 

  46. Holl-Wieden A, Suerbaum S, Girschick HJ (2007) Seronegative Lyme arthritis. Rheumatol Int 27: 1091–1093

    Article  PubMed  CAS  Google Scholar 

  47. Huppertz HI, Bentas W, Haubitz I et al. (1998) Diagnosis of pediatric Lyme arthritis using a clinical score. Eur J Pediatr 157: 304–308

    Article  PubMed  CAS  Google Scholar 

  48. Ecklund K, Vargas S, Zurakowski D, Sundel RP (2005) MRI features of Lyme arthritis in children. AJR Am J Roentgenol 184: 1904–1909

    PubMed  Google Scholar 

  49. (1990) Case definitions for public health surveillance. MMWR Morb Mortal Wkly Rep 39: 19

  50. Zahid Qureshi M, New D, Zulqarni NJ, Nachman S (2002) Overdiagnosis and overtreatment of Lyme disease in children. Pediatr Infect Dis J 21: 12

    Article  Google Scholar 

  51. Huppertz HI, Karch H, Heesemann J (1995) Diagnostic value of synovial fluid analysis in children with reactive arthritis. Rheumatol Int 15: 167–170

    Article  PubMed  CAS  Google Scholar 

  52. Dattwyler RJ, Volkman DJ, Conaty SM et al. (1990) Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 336: 1404–1406

    Article  PubMed  CAS  Google Scholar 

  53. Dattwyler RJ, Halperin JJ, Volkman DJ et al. (1988) Treatment of late Lyme borreliosis – randomised comparison of ceftriaxone and penicillin. Lancet 1: 1191–1194

    Article  PubMed  CAS  Google Scholar 

  54. Weber K, Preac-Mursic V, Wilske B et al. (1990) A randomized trial of ceftriaxone versus oral penicillin for the treatment of early European Lyme borreliosis. Infection 18: 91–96

    Article  PubMed  CAS  Google Scholar 

  55. Pfister HW, Preac-Mursic V, Wilske B et al. (1989) Cefotaxime versus penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study. Arch Neurol 46: 1190–1194

    PubMed  CAS  Google Scholar 

  56. Müllegger RR, Millner MM, Stanek G et al. (1991) Penicillin G sodium and ceftriaxone in the treatment of neuroborreliosis in children – a prospective study. Infection 19: 279–283

    Article  PubMed  Google Scholar 

  57. Massarotti EM, Luger SW, Rahn DW et al. (1992) Treatment of early Lyme disease. Am J Med 92: 396–403

    Article  PubMed  CAS  Google Scholar 

  58. Eppes SC, Childs JA (2002) Comparative study of cefuroxime axetil versus amoxicillin in children with early Lyme disease. Pediatrics 109: 1173–1177

    Article  PubMed  Google Scholar 

  59. Dattwyler RJ, Luft BJ, Kunkel MJ et al. (1997) Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med 337: 289

    Article  PubMed  CAS  Google Scholar 

  60. Hansen K, Hovmark A, Lebeque AM et al. (1992) Roxithromycine in Lyme borreliosis: discrepant results of an in vitro and in vivo animal susceptibility study and a clinical trial in patients with erythema migrans. Acta Derm Venerol (Stockh) 72: 297–300

    Google Scholar 

  61. Weber K, Wilske B, Preac-Mursic V et al. (1993) Azithromycin versus penicillin V for the treatment of early Lyme borreliosis. Infection 21: 367

    Article  PubMed  CAS  Google Scholar 

  62. Strle F, Preac-Mursic V, Cimperman J et al. (1993) Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiologic findings. Infection 21: 83–88

    Article  PubMed  CAS  Google Scholar 

  63. Luft BJ, Dattwyler RJ, Johnson RC et al. (1996) Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med 124: 785–791

    PubMed  CAS  Google Scholar 

  64. Steere AC, Levin RE, Molloy PJ et al. (1994) Treatment of Lyme arthritis. Arthritis Rheum 37: 878–888

    Article  PubMed  CAS  Google Scholar 

  65. Wormser GP, Ramanathan R, Nowakowski J et al. (2003) Duration of antibiotic therapy for early Lyme disease. Ann Intern Med 138: 697–704

    PubMed  CAS  Google Scholar 

  66. Thorstrand C, Belfrage E, Bennet R et al. (2002) Successful treatment of neuroborreliosis with ten day regimens. Pediatr Infect Dis J 21: 1142

    Article  PubMed  Google Scholar 

  67. Eckman MH, Steere AC, Kalish RA et al. (1997) Cost effectiveness of oral as compared with intravenous antibiotic therapy for patients with early Lyme disease or Lyme arthritis. N Engl J Med 337: 357–363

    Article  PubMed  CAS  Google Scholar 

  68. Gasser R, Wendelin I, Reisinger E et al. (1995) Roxithromycin in the treatment of Lyme disease – update and perspectives. Infection (Suppl 1) 23: S39

  69. Bentas W, Karch H, Huppertz HI (2000) Lyme arthritis in children and adolescents: outcome 12 months after initiation of antibiotic therapy. J Rheumatol 27: 2025–2039

    PubMed  CAS  Google Scholar 

  70. American Academy of Pediatrics, Committee on Infectious Diseases (2000) Prevention of Lyme disease. Pediatrics 105: 142

    Article  Google Scholar 

  71. Hayes EB, Piesman J (2003) How can we prevent Lyme disease? N Engl J Med 348: 2424–2430

    Article  PubMed  Google Scholar 

  72. Fish D (1995) Environmental risk and prevention of Lyme disease. Am J Med (Suppl 4A) 98: 2S–8S

    Google Scholar 

  73. Crippa M, Rais O, Gern L (2002) Investigations on the mode and dynamics of transmission and infectivity of Borrelia burgdorferi sensu stricto and Borrelia afzelii in Ixodes ricinus ticks. Vector Borne Zoonotic Dis 2: 3

    Article  PubMed  Google Scholar 

  74. Nadelman RB, Nowakowski J, Fish D et al. (2001) Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med 345: 79–84

    Article  PubMed  CAS  Google Scholar 

  75. Warshafsky S, Nowakowski J, Nadelman RB et al. (1996) Efficacy of antibiotic prophylaxis for prevention of Lyme disease. J Gen Intern Med 11: 329–333

    Article  PubMed  CAS  Google Scholar 

  76. Adams WV, Rose CD, Eppes SC et al. (1999) Cognitive effects of Lyme disease in children: a 4 year followup study. J Rheumatol 26: 1190

    PubMed  CAS  Google Scholar 

  77. Salazar JC, Gerber MA, Goff CW (1993) Long-term outcome of Lyme disease in children given early treatment. J Pediatr 122: 591

    Article  PubMed  CAS  Google Scholar 

  78. Seltzer EG, Gerber MA, Cartter M et al. (2000) Long-term outcomes of persons with Lyme disease. JAMA 283: 609–616

    Article  PubMed  CAS  Google Scholar 

  79. Szer IS, Taylor E, Steere AC (1991) The long-term course of Lyme arthritis in children. N Engl J Med 325: 159–163

    Article  PubMed  CAS  Google Scholar 

  80. Hendrickx G, De Boeck H, Goossens A et al. (2004) Persistent synovitis in children with Lyme arthritis: two unusual cases. An immunogenetic approach. Eur J Pediatr 163: 646–650

    PubMed  Google Scholar 

  81. Adams WV, Rose CD, Eppes SC, Klein JD (1994) Cognitive effects of Lyme disease in children. Pediatrics 94: 185

    PubMed  CAS  Google Scholar 

  82. Bloom BJ, Wycoff PM, Meissner HC et al. (1998) Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatr Infect Dis J 17: 189–196

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Dressler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dressler, F., Huppertz, HI. Lyme-Arthritis bei Kindern und Jugendlichen. Z. Rheumatol. 67, 121–127 (2008). https://doi.org/10.1007/s00393-007-0245-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-007-0245-6

Schlüsselwörter

Keywords

Navigation