{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:48:04Z","timestamp":1780472884175,"version":"3.54.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Emergency Medicine Foundation"},{"DOI":"10.13039\/100014731","name":"Global Lyme Alliance","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014731","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Ixodes scapularis ticks can carry Borrelia species as well as other pathogens that cause human disease. The frequency of tick-borne infections and coinfections in children with suspected Lyme disease is unknown, creating clinical uncertainty about the optimal approach to diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We enrolled children aged 1\u201321 years presenting to 1 of 8 Pedi Lyme Net emergency departments for evaluation of Lyme disease. We selected cases with serologically or clinically diagnosed Lyme disease (erythema migrans or early neurologic disease) matched by symptoms, age, gender, and center to control subjects without Lyme disease. We tested whole blood samples collected at the time of diagnosis using a multiplex high-definition polymerase chain reaction (HDPCR) panel to identify 9 bacterial or protozoan pathogens associated with human disease. We compared the frequency of tick-borne coinfections in children with Lyme disease to matched controls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 612 selected samples, 594 (97.1%) had an interpretable multiplex HDPCR result. We identified the following non-Borrelia tick-borne infections: Anaplasma phagocytophilum (2), Ehrlichia chaffeensis (1), and Babesia microti (12). Children with Lyme disease were more likely to have another tick-borne pathogen identified than matched controls (15\/297 [5.1%] Lyme cases vs 0\/297 [0%]; difference, 5.1% [95% confidence interval, 2.7%\u20138.2%]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although a substantial minority of children with Lyme disease had another tick-borne pathogen identified, either first-line Lyme disease antibiotics provided adequate treatment or the coinfection was subclinical and did not require specific treatment. Further studies are needed to establish the optimal approach to testing for tick-borne coinfections in children.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofad121","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T13:31:05Z","timestamp":1679319065000},"source":"Crossref","is-referenced-by-count":4,"title":["Multiplex High-Definition Polymerase Chain Reaction Assay for the Diagnosis of Tick-borne Infections in Children"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6369-3997","authenticated-orcid":false,"given":"Lise E","family":"Nigrovic","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree N","family":"Neville","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh , Pittsburgh, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Chapman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Rhode Island Hospital , Providence, RI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Balamuth","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael N","family":"Levas","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Children\u2019s Wisconsin , Milwaukee, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy D","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Nemours Children\u2019s Health , Wilmington, DE , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupam B","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Children\u2019s Hospitals and Clinics of Minnesota , Minneapolis, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Gerstbrein","sequence":"additional","affiliation":[{"name":"Department of Pathology, Children\u2019s Wisconsin , Milwaukee, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Branda","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake W","family":"Buchan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Children\u2019s Wisconsin , Milwaukee, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for Pedi Lyme 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annually","volume":"310","author":"Kuehn","year":"2013","journal-title":"JAMA"},{"key":"2023041912225099600_ofad121-B4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.idc.2015.02.010","article-title":"Epidemiology of Lyme disease","volume":"29","author":"Mead","year":"2015","journal-title":"Infect Dis Clin North Am"},{"key":"2023041912225099600_ofad121-B5","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S1473-3099(15)00464-8","article-title":"Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study","volume":"16","author":"Pritt","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2023041912225099600_ofad121-B6","first-page":"271","article-title":"Serological survey in persons occupationally exposed to tick-borne pathogens in cases of co-infections with Borrelia burgdorferi, Anaplasma phagocytophilum, Bartonella spp. and Babesia microti","volume":"19","author":"Chmielewska-Badora","year":"2012","journal-title":"Ann Agric Environ Med"},{"key":"2023041912225099600_ofad121-B7","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1089\/vbz.2016.2082","article-title":"Powassan\/deer tick virus and Borrelia burgdorferi infection in Wisconsin tick populations","volume":"17","author":"Knox","year":"2017","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2023041912225099600_ofad121-B8","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1089\/vbz.2017.2110","article-title":"Powassan virus: an emerging arbovirus of public health concern in North America","volume":"17","author":"Hermance","year":"2017","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2023041912225099600_ofad121-B9","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.cll.2015.07.006","article-title":"Lyme disease coinfections in the United States","volume":"35","author":"Caulfield","year":"2015","journal-title":"Clin Lab 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