• Dag Tveitnes, Olav Bjarte Natås, Øyvind Skadberg, and Knut Øymar.
• Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway. tvda@sus.no
• Arch. Dis. Child. 2012 Mar 1; 97 (3): 215-20.

ObjectiveTo evaluate the epidemiology of infectious meningitis in children in a Lyme borreliosis (LB) endemic area, and to study how clinical and laboratory characteristics may distinguish between different types of childhood meningitis.DesignRetrospective, population based study.SettingA paediatric department serving all children (62 000) in a costal LB endemic region of southwestern Norway.PatientsAll children with cerebrospinal fluid pleocytosis aged 3 months to 14 years.Main Outcome MeasuresEpidemiological, clinical and laboratory characteristics of different types of childhood meningitis.ResultsInfectious meningitis was diagnosed in 211 children (annual incidence 38/100 000). Lyme meningitis (LM) was identified in 142 children (67%), non-Lyme aseptic meningitis in 46 children (22%) and bacterial meningitis in 23 children (11%). Age, month of admission and clinical and laboratory characteristics differed between the groups. An aetiological agent was found in 89% of children. The positive predictive value for having LM if the child had facial nerve palsy or head and/or neck stiffness (meningism) as the only symptom was 97% for both variables. Symptoms of cerebral involvement or signs of systemic inflammation were rare in children with LM compared to children non-Lyme aseptic meningitis.ConclusionLM was diagnosed in two-thirds of children with infectious meningitis in this LB endemic area. Distinct clinical characteristics distinguished the majority of children with LM from children with non-Lyme aseptic meningitis and bacterial meningitis.

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