286. Rapid, One-Tier Diagnosis for Lyme Arthritis
Session: Poster Abstract Session: Bone and Joint Infections
Thursday, October 4, 2018
Room: S Poster Hall

Background: Lyme disease commonly present as arthritis (LA) and may mimic septic arthritis (SA). SA has worse prognosis and requires hospitalization. LA diagnosis guidelines suggest two-tiered algorithm. Results take 3-5 days to return, putting children at risk by mismanagement. For children with acute arthritis, timely recognition improves quality of care.

Methods: We retrieved charts of children with joint complaint in a Lyme endemic region (Jan 2011 – July 2016). We identified SA and LA and characterized presentations. We reviewed all Lyme [anti-VlsE] chemiluminescent immunoassay screens, (Jan 2015 – Jan 2017). Study was approved by IRB.

Results: We reviewed 705 charts. SA was found in 24 patients, including 5 with knee arthritis. 72 had confirmed LA, 70 in the knee [fig 1]. Laboratory and physical findings are summarized in table 1. 2,341 anti-VlsE screens reviewed. 92% were negative. Of the 88 patients with high levels (>8), 53% had arthritis [fig. 2].

Conclusion: In children with knee arthritis, LA is 14 times more common than SA. Delayed diagnosis put many children at risk of mismanagement. Physical and laboratory findings may direct clinical suspicion but are limited when differentiating between LA and SA. High value anti-VlsE screens suggest symptomatic disease and may confirm LA diagnosis within hours. This correlates with the hypothesis of this B. burgdoferi’s surface protein’s role in immune evasion, leading to dysregulated inflammation.

Figure 1: Study cohorts

Table 1: Lab and physical findings in children with knee SA and knee LA.

Lyme Arthritis – Knee (70)

Septic Arthritis – Knee (5)

P Value

N

Results (average)

Abnormal (%)

N

Result (average)

Abnormal (%)

Peripheral WBC

58

5 – 15 (8.9)

0

4

12.6 – 15.6 (14.5)

75

0.0009

Synovial WBC

28

2 – 115 (37)

100

5

3 – 186 (69)

100

0.1171

CRP (mg/dL)

54

0 – 104 (19)

70

3

10 – 156 (72)

100

0.2558

ESR (mm/hr)

63

6 – 97 (33)

75

4

17 – 33 (24.5)

100

0.0148

Lyme screen CLIA(*)

15

8.43 - >12.4 (12)

100

1

+ 0 / - 1

0

                         EIA(**)

43

+ 43 / - 0

100

1

+ 0 / - 1

0

Lyme WB IgG bands

66

5 – 10 (9)

100

                   IgM bands

65

0 – 3 (1)

41

Synovial Culture

26

+ 1 / - 25

4

5

+ 3 / - 2

60

Synovial PCR

21

+ 11 / - 10

54

2

+ 2 / - 0

100

Fever

64

+ 10 / - 54

16

4

+ 3 / - 1

75

Non weight bearing

70

+ 21 / - 49

30

4

+ 3 / - 1

75

 (*) Chemiluminescent immunoassay.

(**)Enzyme-linked immunoassay.

Figure 2: Lyme [anti-VlsE] CLIA screen (*)

 

Bazak Sharon, MD, Megan Reinhard, Undergraduate student, Mackenzie Diekmann, Medical Student, Liz Butler, Undergraduate student and Jeff Louie, MD, University of Minnesota, Minneapolis, MN

Disclosures:

B. Sharon, None

M. Reinhard, None

M. Diekmann, None

L. Butler, None

J. Louie, None

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