Lyme Disease and the heart

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
Joe Ham
Posts: 489
Joined: Fri 27 Jul 2007 6:15
Location: New Mexico, USA

Re: Lyme Disease and the heart

Post by Joe Ham » Mon 17 Nov 2008 20:00

Isr Med Assoc J. 2008 Jan;10(1):69-72.

Colchicine for the prevention of recurrent pericarditis.
http://www.ima.org.il/imaj/ar08jan-18.pdf

Markel G, Imazio M, Brucato A, Adler Y.
Sheba Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel.

The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, which occur in 15-32% of cases.

It was recently found that viral infection has a major role, but in many cases the cause is unknown.

The optimal method for prevention has not been fully established; accepted modalities include non-steroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. Based on the proven efficacy of colchicine in familial Mediterranean fever, several small and large-scale international clinical trials have shown the beneficial effect of colchicine therapy in preventing recurrent pericarditis.

Indeed, colchicine-treated patients consistently display significantly fewer recurrences, longer symptom-free periods, and even when attacks occur they are weaker and shorter in nature.

It was also found that pretreatment with corticosteroids substantially attenuates the efficacy of colchicine, as evidenced by significantly more recurrence episodes and longer therapy periods.

Colchicine is a safe and effective modality for the treatment and prevention of recurrent pericarditis, especially as an adjunct to other modalities, since it provides a sustained benefit superior to all current modalities. The safety profile seems superior to other drugs such as corticosteroids and immunosuppressive drugs.

PMID: 18300579 [PubMed - indexed for MEDLINE]

Snips from the full version:

Recurrent pericarditis
Recurrent pericarditis [RP] is generally manifested by recurrence of AP [Acute pericarditis] symptoms after resolution and elimination of the inciting agent [2-4]. RP develops in 15–32% of AP patients not treated with colchicine [3,5-6], usually within 18 to 20 months after the initial AP episode, but may occur after longer periods [6,7]. The disease usually has a relapsing-remitting pattern [2-4], but may be more chronic in some cases [8]. RP was defined in the CORE study as the combination of a documented initial AP attack with evidence of either recurrence or, less often, of persistent pericarditis [9].
The definition of recurrence includes pleuritic chest pain (most common symptom) and one or more of the following signs: fever, pericardial friction rub, ECG changes, echocardiographic evidence of pericardial effusion, and an elevation in the white blood cell count, erythrocyte sedimentation rate or C-reactive protein [9]. Elevated markers of inflammation confirm the diagnostic suspicion. There is a considerable variability in the number of recurrences and in the length of remission intervals among patients. Up to 50% have only one to two recurrences [7,9], usually over several months to a few years or, in some cases, as long as 15 years [3].
...
Autoreactive pericarditis can be determined only if other etiologies (infectious, neoplastic, systemic or metabolic) have been excluded and...
...
Importantly, previous therapy with corticosteroids in the CORE study was an independent predictor of further recurrences after colchicine therapy [9].
...

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Fri 28 Nov 2008 16:49

http://www.springerlink.com/content/u70209136m6288h3/

Lyme myocarditis diagnosed by indium-111-antimyosin antibody scintigraphy


Abstract
We report a new case of Lyme disease with cardiac manifestations, which has been possible to follow during the long period of 12 years. We have detected the usual ECG abnormalities, and concentric hypertrophic myocardiopathy, by echocardiography. The acute myocarditis was demonstrated by 111In-antimyosin scintigraphy, which showed global myocardial uptake of the tracer, constituting the first report, to our knowledge, of Lyme myocarditis diagnosed by this method.


The patient was clinically recoverd with cardiotonic and depletive therapy , bur unfortunally , she was found dead at her home one month later
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Sat 29 Nov 2008 17:58

1: Pol Merkur Lekarski. 2008 May;24(143):433-5.Links

Borreliosis--simultaneous Lyme carditis and psychiatric disorders--case report

[Article in Polish]


Legatowicz-Koprowska M, Gziut AI, Walczak E, Gil RJ, Wagner T.
Institute of Rheumatology in Warsaw, Department of Pathology, Poland. mlkoprowska@gmail.com

Borreliosis is a multisystemic disease transmitted by ticks. Its diagnosis still remains a challenge because of the varied clinical picture and of difficulties in detection of the etiological agent (Borrelia burgdorferi). We report a case of a 53-years-old woman admitted to the Clinic of Cardiology due to life-threatening arhythmias with simultaneous deficits in concentration and memory. A suspicion of borreliosis was driven from the presence of cardiac symptoms as well as of psychiatric and from the case histories of a tick bite. The diagnosis was confirmed both by specific serological test and endomyocardial biopsy which revealed spirochetes. The patient responded to treatment with doxycyclin and ceftriaxone. Cardiologic disorders retreated entirely, while cognitive deficits did only partly.

PMID: 18634389
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 15 Dec 2008 9:41

http://ats.ctsnetjournals.org/cgi/content/full/70/1/283


Possible relationship between degenerative cardiac valvular pathology and Lyme disease

Abstract

We report an unusual clinical presentation of Lyme carditis in a previously healthy 20-year-old black woman without any epidemiologic history of Lyme disease, fulminant in nature, involving a heart valve necessitating emergent mitral valve replacement, and requiring further surgical intervention because of the development of pericardial effusion and tamponade. A dilated right ventricle with normal contractility and severe tricuspid regurgitation with increase in the right atrial size diagnosed later remains under close surveillance

Introduction

Lyme borreliosis is a tick-borne bacterial infection caused by spirochete Borrelia burgdorferi. Lyme disease, originally described by Steere and associates [1] in 1977, is characterized by the diagnostic unique annular rash of erythema chronicum migrans accompanied by nonspecific systemic pathology. Cardiac manifestations occur in 8% to 10% of reported cases, but probably go undetected in many cases [2–4]. Lyme carditis was originally described as a mild, self-limited carditis, involving primarily the conduction system, although recent reports suggest that it may be more serious than previously suspected [3, 4], and may lead to heart failure and probably congestive cardiomyopathy [5, 6]. Nonetheless, Lyme carditis involving cardiac valves has not been reported previously [6]. We report an unusual clinical presentation of Lyme carditis, fulminant in nature, involving a heart valve necessitating emergent mitral valve replacement, and requiring further surgical intervention because of the development of pericardial effusion and tamponade

A previously healthy 20-year-old black woman without any epidemiological history of Lyme disease had consulted her physician with complaints of cough productive of yellowish sputum, chest pain, dyspnea, and occasional palpitations. There was no pharyngitis, adenopathy, arthritis, or rash. A physical examination was unremarkable with blood pressure 100/60 mm Hg, heart rate 90/min, and body temperature 98.6°C. Her chest x-ray was normal. The electrocardiogram showed a sinus rhythm with a first degree atrioventricular block. She was prescribed clarithromycin. A Lyme titer had been obtained that was positive to 6.33 enzyme-linked immunosorbent assay units. She had a western blot positive for the immunoglobulin G (IgG). Seven days later she was admitted to a hospital with severe respiratory distress syndrome requiring intubation and ventilatory support. Subsequently, she underwent tracheostomy and continued to be on mechanical ventilatory support, and was treated with broad spectrum antibiotics. An echocardiogram revealed initially moderate and later on severe mitral insufficiency. After two weeks of mechanical ventilatory support through tracheostomy she was emergently transferred to our hospital for further treatment. Repeat echocardiogram at our center confirmed ruptured chordae and severe mitral insufficiency. She was recommended to undergo emergent mitral valve surgery. An intraaortic balloon pump was inserted preoperatively from the right common femoral artery. At operation, all chordae arising from medial papillary muscle attaching to the anterior and partly to the posterior leaflets were ruptured. The left atrium was not dilated. The anterior leaflet was resected followed by the mitral valve replacement with a 27 mm St. Jude Medical (St. Jude Medical, Inc, St. Paul, MN) mechanical valve. The postoperative course was uneventful and she was discharged home with Coumadin therapy. Her laboratory findings at our center were as follows: antinuclear antibody, negative; cardiolipin antibody (IgG), negative; RPR, nonreactive; treponema pallidum antibody, negative; Legionella antibodies (IgG, IgM, IgA), negative; mycoplasma pneumoniae IgG, IgM, seropositive; antistreptolysin O (ASO), positive (titer 201); Lyme antibodies (IgG, IgM), positive; Lyme antibodies with enzyme linked fluorescent immunology (at the State Department of Diagnostic Immunology Laboratory [SDDIL]), reactive (antibody index = 1.96); Lyme immunoblot assay (at SDDIL), reactive (6 antigenic bands in IgG probe). Histopathology of the anterior mitral leaflet showed severe myxoid degeneration with infiltration of lymphocytes without any evidence of fibrinoid exudate and Aschoff bodies


One month after the discharge from our hospital the patient presented with complaints of upper quadrant abdominal pain, nausea, and vomiting. The abdominal ultrasound had incidentally revealed a pericardial effusion and she was transferred to our center for treatment. International Normalized Ratio upon admission was 1.9. Echocardiogram showed a large amount of pericardial effusion with right ventricular collapse in diastole. The left ventricular systolic function was preserved with good function of the mechanical valve. The patient underwent a left anterior thoracotomy and pericardial window for a pericardial effusion with tamponade. Nine hundred milliliters of serous fluid was evacuated from the pericardial cavity and the chest was closed leaving a drainage tube in the pericardial sac. On the first postoperative day the repeat echocardiogram showed the persisting depression of right ventricular function with a moderate amount of tricuspid regurgitation. The transesophageal echocardiography on the second postoperative day revealed a dilated right ventricle with normal contractility as well as flail chordae of the tricuspid valve and severe tricuspid regurgitation with an increase in right atrial size. The culture of her blood, urine, and pericardial fluid did not show any bacteriologic growth. Pericardial fluid neither did grow acid fast bacilli nor fungus after 21 and 56 days, respectively. Histopathology of pericardial specimen showed the evidence of lymphoplasmacytic pericarditis. Warthin-Starry stain for spirochete and special fungal stain were negative. Aschoff bodies were also absent. Postoperatively the patient did well, however, her chest tube was in longer because of increased serous drainage, and on the eighth postoperative day she was discharged home in good condition. Eleven months later, she remains well


Comment

Although it can cause acute myocarditis, the spectrum of cardiovascular manifestations associated with Lyme disease is no longer limited to its early stage [5]. In addition to the absence of the history of tick bite and cutaneous manifestations (erythema migrans) the areas of ambiguity include the lack of classic Lyme disease symptoms—fever, malaise, headache, mild neck stiffness, and arthralgia. The presence of the first degree heart block was the only clue to suspect Lyme disease and positive serologic tests favored the diagnosis of Lyme disease during the initial visit of our patient to her family physician. Despite the administration of clarithromycin, the acute development of respiratory distress syndrome and cardiomyopathy was quite unexpected in the case of Lyme disease. Despite a mild positive ASO titer (201), the absence of fibrinoid degeneration and Aschoff bodies in mitral valve leaflet histopathology and pericardial biopsy did not suggest rheumatic fever. The absence of caseating and noncaseating granulomas did not support tuberculous origin. Though the mycoplasma pneumonium antibodies were positive, no fungus was isolated from pericardial fluid after 21 days and pericardial specimen did not stain positive for fungus. Although the histology did not reveal the presence of spirochete in pericardial tissue, it was doubtful that the patient had viral endocarditis and postviral cardiomyopathy. Considering the possibilities of false seropositivity, the patient’s blood was sent to the state department of diagnostic immunology laboratory and it was confirmed positive for Lyme disease. Conceivably this is a very rare case of Lyme carditis involving the heart valve requiring surgical management. A high index of suspicion is required to make a diagnosis, especially for patients who may lack a suggestive history of tick exposure or residence in an endemic region [5]. The long-term follow-up would be helpful to study the further course of the Lyme heart valve disease in the future.
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Sat 27 Dec 2008 14:10

1: Dtsch Med Wochenschr. 2009 Jan;134(1-2):23-6. Epub 2008 Dec 17.

Reversible complete heart block by re-infection with Borrelia burgdorferi with negative IgM-antibodies

[Article in German]


Guenther F, Bode C, Faber T.
Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Freiburg, Freiburg, Germany. felix.guenther@uniklinik-freiburg-de

PAST HISTORY AND PHYSICAL EXAMINATION: A 38-year-old farmer presented at his general practitioner with dizziness. Physical examination was notable for a heart rate of 35 beats/min. The electrocardiogram (ECG) showed a complete (third degree) heart block with a bradycardic ventricular escape rhythm. The patient reported having had an rash on his right lower leg six weeks previously. After spreading centrifugally it had turned pale in its centre, then regressed and finally disappeared. After having been supplied with a temporary pacemaker in a county hospital the patient was transferred to our hospital. ADMISSION FINDINGS: The ECG showed pacemaker stimulation of the ventricle at about 60 beats/min. Without this stimulation the complete atrioventricular block persisted. Coronary heart disease was excluded by angiography and levocardiography revealed normal systolic left ventricular function. Serological findings were a positive titre of IgG-antibodies against Borrelia while the IgM titre was negative. THERAPY AND COURSE: The heart block disappeared under antibiotic therapy with ceftriaxon within eight days, after first changing to transitory second and first-degree atrioventricular block, and the pacemaker was removed. The patient did not develop any neurological symptoms. CONCLUSION: Cardiac involvement in Lyme disease can be the only manifestation of borreliosis. Possible reversibility under antibiotic therapy is an important aspect of diagnosis. In spite of atypical serology the combination of history, symptoms and serological findings will lead to the diagnosis Lyme disease.

PMID: 19090448
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

Joe Ham
Posts: 489
Joined: Fri 27 Jul 2007 6:15
Location: New Mexico, USA

Re: Lyme Disease and the heart

Post by Joe Ham » Sat 31 Jan 2009 6:16

The most disturbing aspect about this and other recent papers is that the doctors and researchers seem to think that they have discovered something new.
Even Alan Steere and IDSA recognized coronary problems secondary to Lyme disease many years ago. What planet have these guys been on?
Int J Cardiol. 2009 Jan 23. [Epub ahead of print]
Borrelia-like organism in heart capillaries of patient with Lyme-disease seen by electron microscopy.
http://www.ncbi.nlm.nih.gov/pubmed/19168240

Lalosevic D, Lalosevic V, Stojsic-Milosavljevic A, Stojsic D.
Faculty of Medicine, Department of Histology and Embryology, St. Hadjuk Veljkova 3, 21000 Novi Sad, Serbia; Clinical Center of Vojvodina, Novi Sad, Serbia.

Abstract
A case of a patient who developed an acute myocarditis due to Lyme disease is reported. An increased serum antibody titer to Borrelia burgdorferi suggested a diagnosis and in addition of basic clinical methods, endomyocardial biopsy performed and analyzed by transmission electron microscopy. The lumen of myocardial capillaries was founded mostly filled with detritus and fibrin precipitate, between them several bacterial fragments were identified.

The electron-microscopic characteristics of the microorganisms in this specimen, revealing irregularly coiled appearance and consistent thickness of 0.2 mum, correspond to the spiral-like structure of Lyme disease borrelia. The presence of fibrin deposits on the capillary endothelium and necrosis of myocardiocytes, suggests that the cardiopathy in our patient was represent borrelia-mediated damage of the hearth microcirculation.

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Sat 7 Feb 2009 10:44

http://heart.bmj.com/cgi/content/abstract/63/3/162
Range of atrioventricular conduction disturbances in Lyme borreliosis: a report of four cases and review of other published reports.

M R van der Linde, H J Crijns, J de Koning, J A Hoogkamp-Korstanje, J J de Graaf, D A Piers, A van der Galiën, K I Lie

Department of Cardiology, University Hospital, Groningen, The Netherlands.

Four patients with Lyme borreliosis had atrioventricular conduction disturbances. All four were positive for specific antibodies against Borrelia burgdorferi measured by indirect immunofluorescence tests. Biopsy specimens, which were obtained in three patients, showed band-like infiltrates of plasma cells and lymphocytes in the endocardium. There was diffuse infiltration of the interstitium of the myocardium by lymphocytes, plasma cells, and macrophages. In two patients single fibre necrosis was seen in the myocardium. Biopsy specimens of the heart showed spirochetes in all three patients and serial sections stained by the Bosma-Steiner technique showed that they resembled Borrelia burgdorferi. At follow up one patient had persistent complete atrioventricular block, despite treatment with antibiotics and corticosteroid, and a permanent pacemaker was implanted.
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Tue 24 Nov 2009 9:26

Z Kardiol. 2002 Dec;91(12):1053-60. Links

The Lyme carditis as a rare differential diagnosis to an anterior myocardial infarction

[Article in German]


Dernedde S, Piper C, Kühl U, Kandolf R, Mellwig KP, Schmidt HK, Horstkotte D.
Kardiologische Klinik, Herzzentrum Nordrhein-Westfalen Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.

An acute Lyme carditis affects about 0.3-4% of patients with Lyme borreliosis. The acute period of the disease may be associated with critical atrioventricular conduction abnormalities (complete heart block), supraventricular and ventricular arrhythmias as well a left ventricular failure. Normally, Lyme carditis is completely reversible. Therefore the prognosis largely depends on the management of the acute complications and early antibiotic therapy. Even if the symptoms are spontaneously reversible, antibiotic therapy should be applied to prevent a chronic cardiomyopathy and other manifestations of Lyme borreliosis. We report on a 47-year old patient with acute ECG changes initially suggesting an acute coronary syndrome. However, case history and the erythema migrans indicated an acute Lyme carditis which was confirmed serologically and by myocardial biopsy later.

PMID: 12490995
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Tue 24 Nov 2009 9:28

Wien Med Wochenschr. 1995;145(7-8):196-8. Links

Lyme borreliosis and cardiomyopathy

[Article in German]


Bergler-Klein J, Ullrich R, Glogar D, Stanek G.
Abteilung für Kardiologie, Klinik für Innere Medizin, Wien.

According to current opinion there is acute, self-limiting Lyme carditis, and chronic Lyme carditis. Acute Lyme carditis manifests mostly as transient conduction disorders of the heart (e.g. AV-blocking I to III), and as supraventricular and ventricular rhythm disturbances, pericarditis, myocarditis, and pancarditis in single cases. Chronic Lyme carditis is defined as a case of chronic heart failure confirmed by positive serology and endomyocardial biopsy. Anamnestic aid is rare. Neither tick-bites nor preceding or accompanying erythema chronicum migrans are constantly reported. Seropositivity and control of its specificity by western blot are indicative but no etiological proof. Even histological detection of spirochetes in endomyocardial tissue or cultivation of borrelia from endomyocardial biopsy are no final etiological proof of the respective cardial disorder. Those findings, however, are an indication for antibiotic treatment. According to the severity of the disorder, antibiotics are administered orally (penicillin or derivatives) or parenterally with penicillin or cephalosporins of the 3rd generation over 4 and 2 weeks, respectively.

PMID: 7610674
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Tue 24 Nov 2009 9:29

Eur Heart J. 1991 Aug;12 Suppl D:73-5. Links

Lyme borreliosis as a cause of myocarditis and heart muscle disease.

Klein J, Stanek G, Bittner R, Horvat R, Holzinger C, Glogar D.
Dept. of Cardiology, University of Vienna, Austria.

Lyme borreliosis (LB) is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the joints, heart and other organs. The aetiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB were first described, including acute conduction disorders, atrioventricular block, transient left ventricular dysfunction and even cardiomegaly. Pathohistological examination showed spirochaetes in cases of acute perimyocarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dilated cardiomyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia burgdorferi. On ELISA, 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochaetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease.

PMID: 1915460
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

Post Reply