Correspondence re: m monaghan et al. Pediatric lyme disease: systematic assessment of post-treatment symptoms and quality of life

You have full access to this article via your institution. Download PDF As a physician working with children and adolescents, I read with great interest the article by Monaghan et al.

Pediatric Lyme disease: systematic assessment of post-treatment symptoms and quality of life. _Pediatric Research_, 2023.1 In it, the authors conclude that their “…findings have important

implications for clinicians treating children with Lyme disease (LD). Families should be counseled that full recovery is expected.” “Further, in a small percentage with prolonged symptoms

with or without impact on functioning, full recovery will likely eventually be achieved.” Unfortunately, this conclusion may be over-stated based on several study limitations. The analytic

sample is a small proportion of the target eligible population (102 or 25% of 402 eligible individuals), with respondents differing from non-respondents in terms of symptoms/stage at

original diagnosis and racial group, with meaningful difference in number of Black individuals in each group. These factors could have resulted in misclassification due to differential

response bias, with non-respondents having more persistent symptoms than respondents, leading to an underestimate of the true rate in the population. Additionally, the analyses done by the

authors do not include multivariable analyses to attempt to control for potential confounding by factors like race, sex, presentation, or adequacy of therapy. It may be that the sample

studied was too small for these analyses, but this limits interpretation of the results. Overall, the fact 22% of the parents reported that their child had at least one significant symptom

(fatigue, musculoskeletal pain, cognitive symptoms, depression) that persisted >6 months post treatment is clinically meaningful. Results from prior studies are inconsistent, likely due

to selection biases, age groups and types of symptoms being examined (Lyme arthritis vs. neurologic vs. psychiatric manifestations related to LD).2,3,4,5 For example, another small study by

Skogman et al. looked at 84 youth presenting with neuroborreliosis and found that 19% experienced definite sequelae at five-year follow-up.4 Fallon et al. studied approximately 12,000

individuals (children and adults) who were diagnosed with Lyme borreliosis over a 22-year period.5 The results indicated that individuals with Lyme disease had a 28% higher rate of mental

disorders compared to non-Lyme infected controls. Of note, more than a third or 38% of these individuals were age 19 and under. These data strongly suggest that _Borrelia_ infection in youth

may carry significant persistent neuropsychiatric morbidity. Overall, results from the Monaghan study should be stated more as hypothesis generating, rather than definitive. What is needed

are well-designed large, representative prospective studies looking at long term follow-up in youth with consistently documented Lyme disease that allow for determination of persistence of

and risk factors for different types of symptomatology. Given the large number of youths affected by Lyme disease, and trends for increasing rates over time, one-fifth or higher of

individuals exposed having persistent long-term post-Lyme symptoms would translate into a very large and clinically significant number whose function and well-being will be impacted during

critical developmental stages. REFERENCES * Monaghan M. et al. Pediatric Lyme disease: systematic assessment of post-treatment symptoms and quality of life. _Pediatr. Res._

https://doi.org/10.1038/s41390-023-02577-3 (2023). * Tory, H. O., Zurakowski, D. & Sundel, R. P. Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. _J.

Rheumatol._ 37, 1049–1055 (2010). Article  PubMed  Google Scholar  * Forde, K. M. et al. The clinical presentation, treatment and outcome of serologically confirmed pediatric Lyme disease

in the Republic of Ireland over a 5-year period: a retrospective cohort study. _Eur. J. Clin. Microbiol. Infect. Dis._ 40, 725–734 (2021). Article  CAS  PubMed  Google Scholar  * Skogman, B.

H. et al. Long-term clinical outcome after Lyme neuroborreliosis in childhood. _Pediatrics_ 130, 262–269 (2012). Article  PubMed  Google Scholar  * Fallon, B. A., Madsen, T., Erlangsen, A.

& Benros, M. E. Lyme Borreliosis and Associations with mental disorders and suicidal behavior: a Nationwide Danish Cohort Study. _Am. J. Psych._ 178, 921–931 (2021). Article  Google

Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Medical Arts Psychotherapy Assoc. PA, 33 Overlook Road Suite 406, New Jersey, 07901, Summit, USA Rosalie Greenberg

Authors * Rosalie Greenberg View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Rosalie Greenberg. ETHICS DECLARATIONS

COMPETING INTERESTS The author declares no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published

maps and institutional affiliations. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Greenberg, R. Correspondence re: M Monaghan et al. Pediatric Lyme

disease: systematic assessment of post-treatment symptoms and quality of life. _Pediatr Res_ 95, 2 (2024). https://doi.org/10.1038/s41390-023-02720-0 Download citation * Received: 12 May

2023 * Accepted: 21 May 2023 * Published: 08 July 2023 * Issue Date: January 2024 * DOI: https://doi.org/10.1038/s41390-023-02720-0 SHARE THIS ARTICLE Anyone you share the following link

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