Autopsy Study of Sudden Cardiac Death & Lyme Carditis
Posted: Sun 20 Mar 2016 6:03
Am J Pathol. 2016 Mar 8. pii: S0002-9440(16)00099-7. doi: 10.1016/j.ajpath.2015.12.027. [Epub ahead of print]
Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with LymeCarditis.
Muehlenbachs A1, Bollweg BC2, Schulz TJ3, Forrester JD4, DeLeon Carnes M2, Molins C4, Ray GS3, Cummings PM5, Ritter JM2, Blau DM2, Andrew TA6, Prial M7, Ng DL2, Prahlow JA8, Sanders JH2, Shieh WJ2, Paddock CD9, Schriefer ME4, Mead P4, Zaki SR2.
1 Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
2 Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
3 CryoLife, Inc, Kennesaw, Georgia.
4 Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado.
5 Office of the Chief Medical Examiner, Boston, Massachusetts.
6 Office of the Chief Medical Examiner, Concord, New Hampshire.
7 Office of the Medical Examiner, Goshen, New York.
8 The Medical Foundation, South Bend, Indiana; Indiana University School of Medicine-South Bend, South Bend, Indiana.
9 Rickettsial Zoonotic Diseases Branch, Division of Vector Borne Infectious Diseases, Atlanta, Georgia.
Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues.
Published by Elsevier Inc.
PMID: 26968341 [PubMed - as supplied by publisher]