Correspondence re: M Monaghan et al. Pediatric Lyme disease: systematic assessment of post-treatment symptoms and quality of life

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.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Anyone you share the following link with will be able to read this content: