Solitary and multiple erythema migrans in children: Comparison of demographic, clinical and laboratory findings

Background: Data on European children with erythema migrans (EM) are limited. Patients and Methods: 553 patients, 333 with solitary and 220 with multiple EM, diagnosed between 1996 and 2000, were included in the prospective study. Demographic, clinical and laboratory data including borrelial serum immunofluorescence assay antibody titers and Borrelia burgdorferi sensu lato blood culture results were obtained; findings in solitary and multiple EM were compared. Results: Comparison revealed that children with multiple EM were younger (4.5 vs 6.5 years; p = 0.0000), less often reported a tick bite at the site of later skin Lesion (25% vs 46%; p = 0.0000), had a Longer incubation period (22 vs 13 days; p = 0.0028), more frequently presented with a ring-like Lesion (99% vs 86%; p = 0.0000), Less often reported associated local (15% vs 41%; p = 0.0000) but not systemic symptoms (28% vs 26%, p = 0.6913), more frequently had abnormal findings on physical examination (35% vs 26%; p = 0.0264), and a higher frequency of laboratory abnormalities including the presence of borrelial serum antibodies as welt as B. burgdorferi sensu Lato isolated from blood (12% vs 6%; p = 0.0267); younger age and mate sex were identified as risk factors for the isolation of Borrelia. 40/44 isolates were Borrelia afzeli. Conclusion: Analysis of a large group of European children with solitary and multiple EM revealed several demographic, clinical and laboratory differences between the two groups.