Microbiologic findings in acute facial palsy in children

Otol Neurotol. 2013 Sep;34(7):e82-7. doi: 10.1097/MAO.0b013e318289844c.


Objective: Microbiologic causes of facial palsy in children were investigated.

Study design: Prospective clinical study.

Setting: Tertiary referral center.

Patients: Forty-six children aged 0 to 16 years with peripheral facial palsy.

Interventions: Paired serum samples and cerebrospinal fluid were tested to find indications of microbes associated with facial palsy. The microbes tested were herpes simplex virus 1 and 2, varicella-zoster virus, human herpesvirus-6, Mycoplasma pneumoniae, Borrelia burgdorferi, influenza A and B virus, picorna, cytomegalovirus, parainfluenza virus, respiratory syncytial virus, coxsackie B5 virus, adenovirus, and enterovirus, Chlamydia psittaci, and Toxoplasma gondii. Besides the routine tests in clinical practice, serum and cerebrospinal fluid samples were tested with a highly sensitive microarray assay for DNA of herpes simplex virus 1 and 2; human herpes virus 6A, 6B, and 7; Epstein-Barr virus, cytomegalovirus, and varicella zoster virus.

Results: Incidence for facial palsy was 8.6/100,000/children/year. Cause was highly plausible in 67% and probable in an additional 11% of cases. Borrelia burgdorferi caused facial palsy in 14 patients (30%), varicella zoster virus in 5 (11%) (one with concomitant adenovirus), influenza A in 3 (6%), herpes simplex virus 1 in 2 (4%) (one with concomitant enterovirus), otitis media in 2 (4%), and human herpesvirus 6 in 2 (4%). Mycoplasma pneumoniae, neurofibromatosis, and neonatal age facial palsy affected 1 child (2%) each.

Conclusion: Microbiologic etiology association of pediatric facial palsy could frequently be confirmed. Borreliosis was the single most common cause; hence, cerebrospinal fluid sampling is recommended for all pediatric cases in endemic areas. Varicella zoster virus accounted for 11% of the cases, being the second most common factor.

Trial registration: ClinicalTrials.gov NCT01537952.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Animals
  • Antibodies, Bacterial / analysis
  • Antibodies, Bacterial / cerebrospinal fluid
  • Antibodies, Viral / analysis
  • Antibodies, Viral / cerebrospinal fluid
  • Bacterial Infections / complications
  • Bacterial Infections / microbiology
  • Bell Palsy / microbiology*
  • Bell Palsy / virology*
  • Borrelia / immunology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Leukocyte Count
  • Lyme Neuroborreliosis / classification
  • Lyme Neuroborreliosis / microbiology
  • Male
  • Prospective Studies
  • Ticks
  • Virus Diseases / complications
  • Virus Diseases / virology


  • Antibodies, Bacterial
  • Antibodies, Viral

Associated data

  • ClinicalTrials.gov/NCT01537952