Garro et al developed a simple rule for identifying a child with meningitis who is unlikely to have Lyme meningitis. This can help to identify a child who should or who should not be worked up for Lyme disease. The authors are from Rhode Island Hospital, Dartmouth-Hitchcock Medical Center, University of Nebraska, Centers for Disease Control and Prevention, and Lifespan Academic Medical Centers.
Patient selection: child with aseptic meningitis in an area endemic for Lyme disease
Criteria for definite Lyme meningitis – both of the following:
(1) CSF pleocytosis
(2) one or both of the following:
(2a) positive serology confirmed by immunoblot
(2b) erythema migrans rash
PCR on CSF is available and may be an alternative criteria.
A child is considered low risk (< 10% risk) if all of the following are noted:
(1) headache < 7 days
(2) percent mononuclear cells in the CSF < 70%
(3) absence of any cranial nerve palsy (CN VII, other)
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