375 - Racial differences in the diagnosis of Lyme disease in children

Poster Number: 375
Publication Number: 375.206

Kathryn M. Sundheim, Boston Children's Hospital, Boston, MA, United States; kenneth michelson, Boston Children's Hospital, Boston, MA, United States; Fran Balamuth, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Amy Thompson, Sydney Kimmel Medical College of Thomas Jefferson University, Wilmington, DE, United States; Michael Levas, Medical College of Wisconsin, Milwaukee, WI, United States; Desiree Neville, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Anupam B. Kharbanda, University of Minnesota Medical School, Minneapolis, MN, United States; Laura Chapman, Brown Emergency Medicine, Providence, RI, United States; Lise E. Nigrovic, Boston Children's Hospital, Boston, MA, United States

Background: Erythema migrans (EM), the cutaneous manifestation of Lyme disease, can be challenging to identify in individuals with darkly pigmented skin. Racial differences in the diagnosis and presentation of Lyme disease may exist and could lead to disparities.

Objective: Our goal was to explore racial differences in the diagnosis and presentation of Lyme disease in children based on cutaneous findings.

Design/Methods: We conducted a multi-center prospective study of children presenting to 1 of 8 Pedi Lyme Net emergency departments with suspected Lyme disease. We defined a case of Lyme disease with either any EM lesion measuring at least 5 cm in diameter or a positive two-tier Lyme disease serology. After adjusting for patient age and county-level Lyme disease incidence, we evaluated the association between Black race compared to other races and the diagnosis of Lyme disease and, for children with Lyme disease, the presence of an EM lesion.

Results: Of the 3,468 enrolled children, 424 (12.2%) self-identified as Black, 2,662 (76.8%) White, 86 (2.5%) Asian, and 251 (7.2%) other races. Median county-level Lyme disease incidence was 57 reported Lyme cases per 100,000 inhabitants (range 0 to 484). Of the 795 children with Lyme disease (22.9% of enrolled), 88 (11.1% of Lyme cases) had a single EM lesion alone and 156 (19.6%) had EM with other Lyme disease symptoms. Compared to all other races, Black children were less likely to have Lyme disease diagnosed in the ED [adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.47, 0.83]. Of those with Lyme disease, Black children were less likely to have an EM lesion (aOR 0.38, 95% CI 0.16, 0.91).Conclusion(s): In our cohort of children with suspected Lyme disease, Black children were less likely to have Lyme disease diagnosed and less likely to have cutaneous findings. Further work is needed to understand the reasons for these differences.