{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:34:54Z","timestamp":1788287694895,"version":"build-2803163510"},"reference-count":103,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Child Adolesc. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This retrospective chart review examined 37 youth with pediatric bipolar disorder from a private practice in the Lyme-endemic state of New Jersey, expanding on findings from 27 previously reported cases to explore the potential contribution of tick-borne infections to disease etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Diagnoses were based on DSM-IV-TR and DSM-V criteria using parent and child interviews, questionnaires, and school reports. Initial screening evaluated for possible PANDAS\/PANS, with testing for Group A beta-hemolytic streptococcus,\n                      <jats:italic>Borrelia burgdorferi<\/jats:italic>\n                      ,\n                      <jats:italic>Babesia<\/jats:italic>\n                      ,\n                      <jats:italic>Bartonella<\/jats:italic>\n                      , and\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      . Lyme disease testing included ELISA, Western Blot (IgM\/IgG), and immunoblots, interpreted per CDC guidelines. Other pathogens were assessed via IgM\/IgG titers, anti-streptolysin O, anti-DNAase B, fluorescent\n                      <jats:italic>in situ<\/jats:italic>\n                      hybridization, and blood cultures. A positive diagnosis required both laboratory evidence and clinician confirmation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Babesia<\/jats:italic>\n                      was detected in 51% (19\/37),\n                      <jats:italic>Bartonella<\/jats:italic>\n                      in 49% (18\/37),\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      in 38% (14\/37),\n                      <jats:italic>Borrelia burgdorferi<\/jats:italic>\n                      in 22% (8\/37), and Group A Streptococcus in 19% (7\/37). Overall, 92% (34\/37) had evidence of tick-borne exposure, with 81% (30\/37) meeting both laboratory and clinical criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>More than three-quarters of the cohort demonstrated confirmed tick-borne infections. Overlaps between bipolar disorder and tick-borne illness\u2014such as immune dysregulation, chronic symptomatology, and responsiveness to treatments like minocycline and anti-inflammatory agents\u2014support further exploration of infectious contributors to pediatric bipolar disorder. While limited by its single-practice retrospective design, these findings suggest that tick-borne pathogens may play a role in the pathogenesis of bipolar symptoms in youth, warranting larger, controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frcha.2025.1685016","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T05:29:28Z","timestamp":1762406968000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Investigating the frequency of tick-borne infections in a case series of 37 youth diagnosed with pediatric bipolar 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