Abstract
INTRODUCTION: This retrospective chart review examined 37 youth with pediatric bipolar disorder from a private practice in the Lyme-endemic state of New Jersey, expanding on findings from 27 previously reported cases to explore the potential contribution of tick-borne infections to disease etiology. METHODS: Diagnoses were based on DSM-IV-TR and DSM-V criteria using parent and child interviews, questionnaires, and school reports. Initial screening evaluated for possible PANDAS/PANS, with testing for Group A beta-hemolytic streptococcus, Borrelia burgdorferi, Babesia, Bartonella, and Mycoplasma pneumoniae. Lyme disease testing included ELISA, Western Blot (IgM/IgG), and immunoblots, interpreted per CDC guidelines. Other pathogens were assessed via IgM/IgG titers, anti-streptolysin O, anti-DNAase B, fluorescent in situ hybridization, and blood cultures. A positive diagnosis required both laboratory evidence and clinician confirmation. RESULTS: Babesia was detected in 51% (19/37), Bartonella in 49% (18/37), Mycoplasma pneumoniae in 38% (14/37), Borrelia burgdorferi in 22% (8/37), and Group A Streptococcus in 19% (7/37). Overall, 92% (34/37) had evidence of tick-borne exposure, with 81% (30/37) meeting both laboratory and clinical criteria. DISCUSSION: More than three-quarters of the cohort demonstrated confirmed tick-borne infections. Overlaps between bipolar disorder and tick-borne illness-such as immune dysregulation, chronic symptomatology, and responsiveness to treatments like minocycline and anti-inflammatory agents-support further exploration of infectious contributors to pediatric bipolar disorder. While limited by its single-practice retrospective design, these findings suggest that tick-borne pathogens may play a role in the pathogenesis of bipolar symptoms in youth, warranting larger, controlled studies.