Mycoplasma pneumoniae and Borrelia burgdorferi as cause for facial paralysis in children: single-center experience of 10 years

Aims: The causes for facial paralysis vary significantly in the literature, especially regarding Borrelia burgdorferi and Mycoplasma pneumoniae (M.p.). Borrelia burgdorferi is reported to be the cause in up to 32% of cases, Mycoplamsma pneumonia in up to 26%. The variance is explained in parts by the age at presentation, acuity of symptoms, or regional differences in the spectrum of pathogens.

Methods: We retrospectively analyzed serologic data of patients with facial paralysis that were hospitalized in an academic center in Germany during 2002 till 2012. A total of 188 patients were identified and included in the analysis.

Results: In 14.6% of cases neuroborreliosis could be confirmed as reason for the symptoms. In 9.6% of cases, the diagnosis was suspected. There was no case of a confirmed infection with Mycoplasma pneumonia as single cause for the facial paralysis. In only a single case, we found a suspected coinfection of B. burgdorferi and Mycoplasma pneumonia. The patient was an 11-year-old male patient with Bell palsy, and positive Western blotting of serum and CSF for B. burgdorferi (IgG and IgM). Further CSF showed positive findings for M.p. antibodies. After intravenous antibiotic treatment with ceftriaxone for 2 weeks, the patient showed full recovery.

Conclusion: In summary, the results of our analysis are comparable with most data in the literature. Infections with Mycoplasma pneumonia remains an exception as cause for facial paralysis. The relevance of the serologic finding of our presented case remains unclear.