Lyme disease in Canada: Focus on childrenEarly LD can occur without rash, and rash may not be detected by all patients in which it occurs. Without treatment, EM resolves spontaneously over a four-week period, on average.
Early disseminated disease: Approximately 20% of children with LD first present to a health care provider with multiple, rather than single, EM lesions. This rash usually occurs several weeks after the tick bite and consists of secondary annular, erythematous lesions similar to but typically smaller than the primary lesion. These lesions reflect spirochetemia with cutaneous dissemination.[4]
Other manifestations of early disseminated disease (with or without rash) include acute neurological signs, such as facial nerve palsy, papilledema and lymphocytic meningitis.[4][9] Children with facial palsy should be assessed for meningitis, especially if neck stiffness or severe headache occurs.[9][10][11] Lyme carditis, resulting in heart block, is rare in children.[4]
Late disease: Children treated with antimicrobial agents in the early stage of LD very rarely develop late disease.[4] The most common late-stage symptoms are pauciarticular arthritis affecting large joints, especially the knees, which may manifest weeks to months (mean four months) after the tick bite. Arthritis can occur without a history of earlier stages of illness. Peripheral neuropathy and central nervous system manifestations can also occur, although rarely during late disease in children.[4]
https://www.cps.ca/en/documents/positio ... e-childrenHenriëtte