Electrocardiograph Abnormalities in Children With Lyme Meningitis
Elizabeth J. Welsh 1,
Keri A. Cohn 2,3,4,
Lise E. Nigrovic 2,
Amy D. Thompson 5,
Elizabeth M. Hines 6,
Todd W. Lyons 2,4,
Andrew C. Glatz 7,8 and
Samir S. Shah 9,10,11
1 Department of Pediatrics, and Divisions of
2 Emergency Medicine, and
3 Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, and
4 Harvard Medical School, Boston, Massachusetts
5 Division of Emergency Medicine, Alfred I. duPont Hospital for Children, Wilmington, Delaware; Divisions of
6 Infectious Diseases, and
7 Cardiology, The Children's Hospital of Philadelphia, and
8 Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
9 Department of Pediatrics, University of Cincinnati College of Medicine, and Divisions of
10 Infectious Diseases
11 Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio
Received May 18, 2012.
Accepted July 3, 2012
J Ped Infect Dis (2012) doi: 10.1093/jpids/pis078 First published online: August 16, 2012
Objective The objective of the study was to estimate the prevalence of and identify risk factors for electrocardiographic (ECG) changes in children presenting with Lyme meningitis.
Design This was a cross-sectional study.
Setting The study was set in three large urban pediatric tertiary care centers.
Participants Children who were diagnosed with Lyme meningitis and underwent ECG testing were included.
Outcome measure The presence of an ECG abnormality associated with early-disseminated Lyme infection was the outcome measure.
Results Multivariable logistic regression was used to identify factors independently associated with ECG abnormalities. ECG testing was performed in 103 (66%) of 157 children with Lyme meningitis. The median age of these children was 10.8 years; 68% were male. ECG abnormalities, identified in 34 (33%) subjects, included one or more of the following: atrioventricular block (n = 16; 16%), ST-T wave changes (n = 14; 14%), and prolongation of the corrected QT interval (n = 11; 11%). In multivariate analysis, age ≥13 years and fever for ≥5 days were independently associated with ECG abnormalities. The probability of ECG abnormalities was greater than 50% in those with fever for ≥5 days or age ≥13 years, and if a subject fulfilled both criteria, the probability of ECG abnormalities was 83% (95% confidence interval: 50%–96%).
Conclusions Electrocardiographic abnormalities occur commonly in children with Lyme meningitis. While older children with prolonged fever were most likely to have such abnormalities, the clinical consequences of asymptomatic ECG abnormalities in children with Lyme meningitis are not known.
Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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