{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:56:41Z","timestamp":1789808201793,"version":"4.0.1"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,1,1]]},"abstract":"<jats:p>BACKGROUND. Differentiating Lyme meningitis (LM) from other forms of aseptic meningitis (AM) in children is a common diagnostic dilemma in Lyme disease\u2013endemic regions. Prior studies have compared clinical characteristics of patients with LM versus patients with documented enteroviral infections. No large studies have compared patients with LM to all patients presenting with AM and attempted to define a clinical prediction model.<\/jats:p><jats:p>OBJECTIVE. To create a statistical model to predict LM versus AM in children based on history, physical, and laboratory findings during the initial presentation of meningitis.<\/jats:p><jats:p>METHODS. Children older than 2 years presenting to the Alfred I. duPont Hospital for Children between October 1999 and September 2004 were identified if both Lyme serology and cerebrospinal fluid (CSF) were collected during the same hospital encounter. Patients were considered to have Lyme disease only if they met Centers for Disease Control and Prevention criteria (documented erythema migrans and\/or positive Lyme serology). Patients were eligible for study inclusion if they had documented meningitis (CSF white blood cell count: &amp;gt;8 per mm3). Retrospective chart review abstracted duration of headache and cranial neuritis (papilledema or cranial nerve palsy) on physical examination and percent CSF mononuclear cells. Using logistic-regression analysis, the type of meningitis (LM versus AM) was simultaneously regressed on these 3 variables. The Hosmer-Lemeshow test was performed and the area under the receiver operating characteristic curve was calculated.<\/jats:p><jats:p>RESULTS. A total of 175 children with meningitis were included in the final statistical model. Logistic-regression analysis included 27 patients with LM and 148 patients classified as having AM. Duration of headache, cranial neuritis, and percent CSF mononuclear cells independently predicted LM. The Hosmer-Lemeshow test revealed a good fit for the model, and the Nagelkerke R2 effect size demonstrated good predictive efficacy. Odds ratios based on the logistic-regression results were calculated for these variables. The final model was transformed into a clinical prediction model that allows practitioners to calculate the probability of a child having LM.<\/jats:p><jats:p>CONCLUSIONS. Longer duration of headache, presence of cranial neuritis, and predominance of CSF mononuclear cells are predictive of LM in children presenting with meningitis in a Lyme disease\u2013endemic region. The clinical prediction model can help guide the clinician about the need for parenteral antibiotics while awaiting serology results.<\/jats:p>","DOI":"10.1542\/peds.2005-0955","type":"journal-article","created":{"date-parts":[[2006,1,5]],"date-time":"2006-01-05T02:28:34Z","timestamp":1136428114000},"page":"e1-e7","source":"Crossref","is-referenced-by-count":50,"title":["Prediction of Lyme Meningitis in Children From a Lyme Disease\u2013Endemic Region: A Logistic-Regression Model Using History, Physical, and Laboratory Findings"],"prefix":"10.1542","volume":"117","author":[{"given":"Robert A.","family":"Avery","sequence":"first","affiliation":[{"name":"Department of Pediatrics"},{"name":"Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"},{"name":"Clinical Informatics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Glutting","sequence":"additional","affiliation":[{"name":"School of Education, University of Delaware, Newark, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Eppes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania"},{"name":"Division of Infectious Diseases, Alfred I. duPont Hospital for Children, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2006,1,1]]},"reference":[{"key":"2021120819432350200_R1","unstructured":"Centers for Disease Control and Prevention. Lyme disease: United States, 2001\u20132002. MMWR Morb Mortal Wkly Rep.\u20082004;53:365\u2013369"},{"key":"2021120819432350200_R2","unstructured":"Chow CC, Evans AS Jr, Noonan-Toly CM, et al. Lyme disease trends: Dutches county, New York, 1992\u20132000. Mt Sinai J Med.\u20082003;70:207\u2013213"},{"key":"2021120819432350200_R3","doi-asserted-by":"crossref","unstructured":"Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med.\u20081996;335:1270\u20131274","DOI":"10.1056\/NEJM199610243351703"},{"key":"2021120819432350200_R4","doi-asserted-by":"crossref","unstructured":"Eppes SC. Diagnosis, treatment, and prevention of Lyme disease in children. Paediatr Drugs.\u20082003;5:363\u2013372","DOI":"10.2165\/00128072-200305060-00002"},{"key":"2021120819432350200_R5","doi-asserted-by":"crossref","unstructured":"Tuerlinckx D, Bodart E, Garrino MG, de Bilderling G. Clinical data and cerebrospinal fluid findings in Lyme meningitis versus aseptic meningitis. Eur J Pediatr.\u20082003;162:150\u2013153","DOI":"10.1007\/s00431-002-1119-1"},{"key":"2021120819432350200_R6","doi-asserted-by":"crossref","unstructured":"Meissner HC, Gellis SE, Milliken JF Jr. Lyme disease first observed to be aseptic meningitis. Am J Dis Child.\u20081982;136:465\u2013467","DOI":"10.1001\/archpedi.1982.03970410083022"},{"key":"2021120819432350200_R7","doi-asserted-by":"crossref","unstructured":"Eppes SC, Nelson DK, Lewis LL, Klein JD. Characterization of Lyme meningitis and comparison with viral meningitis in children. Pediatrics.\u20081999;103:957\u2013960","DOI":"10.1542\/peds.103.5.957"},{"key":"2021120819432350200_R8","unstructured":"Centers for Disease Control and Prevention. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep.\u20081995;44:590\u2013591"},{"key":"2021120819432350200_R9","doi-asserted-by":"crossref","unstructured":"Fawcett PT, Rose CD, Gibney KM, Doughty RA. Correlation of seroreactivity with response to antibiotics in pediatric Lyme borreliosis. Clin Diagn Lab Immunol.\u20081997;4:85\u201388","DOI":"10.1128\/cdli.4.1.85-88.1997"},{"key":"2021120819432350200_R10","unstructured":"Tabachnick BG, Fidell LS. Using Multivariate Statistics. 4th ed. Boston, MA: Allyn & Bacon; 2001"},{"key":"2021120819432350200_R11","doi-asserted-by":"crossref","unstructured":"Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: Wiley; 1989","DOI":"10.2307\/2531779"},{"key":"2021120819432350200_R12","doi-asserted-by":"crossref","unstructured":"Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology.\u20081983;148:839\u2013843","DOI":"10.1148\/radiology.148.3.6878708"},{"key":"2021120819432350200_R13","doi-asserted-by":"crossref","unstructured":"Belman AL, Iyer M, Coyle PK, Dattwyler R. Neurologic manifestations in children with North American Lyme disease. Neurology.\u20081993;43:2609\u20132614","DOI":"10.1212\/WNL.43.12.2609"},{"key":"2021120819432350200_R14","doi-asserted-by":"crossref","unstructured":"Belman AL, Reynolds L, Preston T, Postels D, Grimson R, Coyle PK. Cerebrospinal fluid findings in children with Lyme disease-associated facial nerve palsy. Arch Pediatr Adolesc Med.\u20081997;151:1224\u20131228","DOI":"10.1001\/archpedi.1997.02170490050009"},{"key":"2021120819432350200_R15","doi-asserted-by":"crossref","unstructured":"Bo\u0308ttner A, Daneschnejad S, Handrick W, Schuster V, Liebert U, Kiess W. A season of aseptic meningitis in Germany: epidemiologic, clinical, and diagnostic aspects. Pediatr Infect Dis J.\u20082002;21:1126\u20131132","DOI":"10.1097\/00006454-200212000-00008"},{"key":"2021120819432350200_R16","doi-asserted-by":"crossref","unstructured":"Rice SK, Heinl RE, Thornton LL, Opal SM. Clinical characteristics, management strategies, and cost implications of a statewide outbreak of enterovirus meningitis. Clin Infect Dis.\u20081995;20:931\u2013937","DOI":"10.1093\/clinids\/20.4.931"},{"key":"2021120819432350200_R17","doi-asserted-by":"crossref","unstructured":"Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE. Neurologic abnormalities of Lyme disease. Medicine (Baltimore).\u20081979;58:281\u2013294","DOI":"10.1097\/00005792-197907000-00001"},{"key":"2021120819432350200_R18","doi-asserted-by":"crossref","unstructured":"Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology.\u20081985;35:47\u201353","DOI":"10.1212\/WNL.35.1.47"},{"key":"2021120819432350200_R19","doi-asserted-by":"crossref","unstructured":"Leake JAD, Albani S, Kao AS, et al. Acute disseminated encephalomyelitis in childhood: epidemiologic, clinical and laboratory features. Pediatr Infect Dis J.\u20082004;23:756\u2013764","DOI":"10.1097\/01.inf.0000133048.75452.dd"},{"key":"2021120819432350200_R20","doi-asserted-by":"crossref","unstructured":"Albisetti M, Schaer G, Good M, Boltshauser E, Nadal D. Diagnostic value of cerebrospinal fluid examination in children with peripheral facial palsy and suspected Lyme borreliosis. Neurology.\u20081997;49:817\u2013824","DOI":"10.1212\/WNL.49.3.817"},{"key":"2021120819432350200_R21","doi-asserted-by":"crossref","unstructured":"Bingham PM, Galetta SL, Athreya B, Sladky J. Neurologic manifestations in children with Lyme disease. Pediatrics.\u20081995;96:1053\u20131056","DOI":"10.1542\/peds.96.6.1053"},{"key":"2021120819432350200_R22","doi-asserted-by":"crossref","unstructured":"Christen HJ, Bartlau N, Hanefeld F, Eiffert H, Thomssen R. Peripheral facial palsy in childhood: Lyme borreliosis to be suspected unless proven otherwise. Acta Paediatr Scand.\u20081990;79:1219\u20131224","DOI":"10.1111\/j.1651-2227.1990.tb11413.x"},{"key":"2021120819432350200_R23","doi-asserted-by":"crossref","unstructured":"Jo\u0308rbeck HJA, Gustafsson PM, Lind HCF, Stiernstedt GT. Tick-borne Borrelia-meningitis in children: an outbreak in the Kalmar area during the summer of 1984. Acta Paediatr Scand.\u20081987;76:228\u2013233","DOI":"10.1111\/j.1651-2227.1987.tb10452.x"},{"key":"2021120819432350200_R24","doi-asserted-by":"crossref","unstructured":"Cook SP, Macartney KK, Rose CD, Hunt PG, Eppes SC, Reilly JS. Lyme disease and seventh nerve paralysis in children. Am J Otolaryngol.\u20081997;18:320\u2013323","DOI":"10.1016\/S0196-0709(97)90026-0"},{"key":"2021120819432350200_R25","doi-asserted-by":"crossref","unstructured":"Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergstro\u0308m T. Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis is children. Pediatr Infect Dis J.\u20082005;24:97\u2013101","DOI":"10.1097\/01.inf.0000151032.16639.9c"},{"key":"2021120819432350200_R26","doi-asserted-by":"crossref","unstructured":"Krishnamurthy SN, Weinstock AL, Smith SH, Duffner PK. Facial palsy, an unusual presenting feature of childhood leukemia. Pediatr Neurol.\u20082002;27:68\u201370","DOI":"10.1016\/S0887-8994(02)00394-6"},{"key":"2021120819432350200_R27","doi-asserted-by":"crossref","unstructured":"Walter RS, Eppes SC. Cat scratch disease presenting with peripheral facial nerve paralysis. Pediatrics.\u20081998;101(5). Available at: www.pediatrics.org\/cgi\/content\/full\/101\/5\/e13","DOI":"10.1542\/peds.101.5.e13"},{"key":"2021120819432350200_R28","doi-asserted-by":"crossref","unstructured":"Rothermel H, Hedges TR, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics.\u20082001;108:477\u2013481","DOI":"10.1542\/peds.108.2.477"},{"key":"2021120819432350200_R29","doi-asserted-by":"crossref","unstructured":"Kuiper H, Devriese PP, de Jongh BM, Vos K, Dankert J. Absence of Lyme borreliosis among patients with presumed Bell's palsy. Arch Neurol.\u20081992;49:940\u2013943","DOI":"10.1001\/archneur.1992.00530330062017"},{"key":"2021120819432350200_R30","doi-asserted-by":"crossref","unstructured":"Raucher HS, Kaufman DM, Goldfarb J, Jacobson RI, Roseman B, Wolff RR. Pseudotumor cerebri and Lyme disease: a new association. J Pediatr.\u20081985;107:931\u2013933","DOI":"10.1016\/S0022-3476(85)80193-1"},{"key":"2021120819432350200_R31","doi-asserted-by":"crossref","unstructured":"Kan L, Sood SK, Maytal J. Pseudotumor cerebri in Lyme disease: a case report and literature review. Pediatr Neurol.\u20081998;18:439\u2013441","DOI":"10.1016\/S0887-8994(97)00215-4"},{"key":"2021120819432350200_R32","doi-asserted-by":"crossref","unstructured":"McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis.\u20082001;32:236\u2013242","DOI":"10.1086\/318454"},{"key":"2021120819432350200_R33","doi-asserted-by":"crossref","unstructured":"McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS. Users' guides to the medical literature. XXII: how to use articles about clinical decision rules. JAMA.\u20082000;284:79\u201384","DOI":"10.1001\/jama.284.1.79"},{"key":"2021120819432350200_R34","doi-asserted-by":"crossref","unstructured":"Bonsu BK, Harper MB. Differentiating acute bacterial meningitis from acute viral meningitis among children with cerebrospinal fluid pleocytosis: a multivariable regression model. Pediatr Infect Dis J.\u20082004;23:511\u2013517","DOI":"10.1097\/01.inf.0000129689.58211.9e"},{"key":"2021120819432350200_R35","doi-asserted-by":"crossref","unstructured":"Freedman SB, Marrocco A, Pirie J, Dick PT. Predictors of bacterial meningitis in the era after Haemophilus influenzae. Arch Pediatr Adolesc Med.\u20082001;155:1301\u20131306","DOI":"10.1001\/archpedi.155.12.1301"},{"key":"2021120819432350200_R36","doi-asserted-by":"crossref","unstructured":"Hoen B, Viel JF, Paqout C, Ge\u0301rard A, Canton P. Multivariate approach to differential diagnosis of acute meningitis. Eur J Clin Microbiol Infect Dis.\u20081995;14:267\u2013274","DOI":"10.1007\/BF02116518"},{"key":"2021120819432350200_R37","doi-asserted-by":"crossref","unstructured":"Nigrovic LE, Kuppermann N, Malley R. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post\u2013Haemophilus influenzae era. Pediatrics.\u20082002;110:712\u2013719","DOI":"10.1542\/peds.110.4.712"},{"key":"2021120819432350200_R38","doi-asserted-by":"crossref","unstructured":"Oostenbrink R, Moons KGM, Donders ART, Grobbee DE, Moll HA. Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures. Acta Paediatr.\u20082001;90:611\u2013617","DOI":"10.1080\/080352501750258649"},{"key":"2021120819432350200_R39","doi-asserted-by":"crossref","unstructured":"Oostenbrink R, Moons KGM, Twijnstra MJ, Grobbee DE, Moll HA. Children with meningeal signs: predicting who needs empiric antibiotic treatment. Arch Pediatr Adolesc Med.\u20082002;156:1189\u20131194","DOI":"10.1001\/archpedi.156.12.1189"},{"key":"2021120819432350200_R40","doi-asserted-by":"crossref","unstructured":"Spanos A, Harrell FE Jr, Durack DT. Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. JAMA.\u20081989;262:2700\u20132707","DOI":"10.1001\/jama.262.19.2700"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/117\/1\/e1\/1010059\/zpe001060000e1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/117\/1\/e1\/1010059\/zpe001060000e1.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,6]],"date-time":"2023-05-06T02:34:55Z","timestamp":1683340495000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/117\/1\/e1\/67937\/Prediction-of-Lyme-Meningitis-in-Children-From-a"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1,1]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2006,1,1]]},"published-print":{"date-parts":[[2006,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2005-0955","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,1,1]]}}}