Dilated cardiomyopathy associated with Bb infection

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Thu 7 May 2015 7:42

http://www.ncbi.nlm.nih.gov/pubmed/25939436

Herz. 2015 May 5. [Epub ahead of print]

Recent-onset dilated cardiomyopathy associated with Borrelia burgdorferi infection.

Kuchynka P1, Palecek T, Havranek S, Vitkova I, Nemecek E, Trckova R, Berenová D, Krsek D, Podzimkova J, Fikrle M, Danek BA, Linhart A.

Author information

1 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.

Abstract

BACKGROUND:

Several recent small studies have suggested a causal link between Lyme disease and dilated cardiomyopathy (DCM) by demonstrating the presence of the Borrelia burgdorferi (Bb) genome in the myocardium of patients with recent-onset DCM. The aim of this study was to further investigate the effect of targeted antibiotic treatment of Bb-related recent-onset DCM in a larger cohort of patients.

PATIENTS AND METHODS:

We performed endomyocardial biopsy (EMB) in 110 individuals (53 ± 11 years, 34 women) with recent-onset unexplained DCM, and detected the Bb genome in 22 (20 %) subjects. Bb-positive patients were subsequently treated with intravenous ceftriaxone for 21 days in addition to conventional heart failure medication.

RESULTS:

At the 1-year follow-up, a significant improvement in left ventricular (LV) ejection fraction (26 ± 6  vs. 44 ± 12 %; p < 0.01) and a decrease in LV end-diastolic (69 ± 7 vs. 63 ± 11 mm; p < 0.01) and end-systolic (61 ± 9 vs. 52 ± 4 mm; p < 0.01) diameters were documented. Moreover, a significant improvement in heart failure symptoms (NYHA class 3.4 ± 0.6 vs. 1.5 ± 0.7; p < 0.01) was also observed.

CONCLUSION:

Targeted antibiotic treatment of Bb-related recent-onset DCM in addition to conventional heart failure therapy is associated with favorable cardiac remodeling and improvement of heart failure symptoms.

PMID:
25939436
[PubMed - as supplied by publisher]


Here are some related articles (mostly in reverse date order):

http://www.ncbi.nlm.nih.gov/pubmed/22379178

Eur J Heart Fail. 2012 Jun;14(6):588-96. doi: 10.1093/eurjhf/hfs027. Epub 2012 Feb 29.

Detection of Borrelia burgdorferi sensu lato in endomyocardial biopsy specimens in individuals with recent-onset dilated cardiomyopathy.

Kubánek M1, Šramko M, Berenová D, Hulínská D, Hrbáčková H, Malušková J, Lodererová A, Málek I, Kautzner J.

Author information

1 Department of Cardiology, Institute for Clinical and Experimental Medicine, Videňská 1958/9, Prague, Czech Republic.

Abstract

AIMS:

Recent studies in patients with dilated cardiomyopathy (DCM) have detected the genome of Borrelia burgdorferi sensu lato (BBSL) in endomyocardial biopsy (EMB) specimens using a qualitative polymerase chain reaction (PCR), suggesting a causal link between Lyme disease and DCM in areas in which Lyme disease is endemic. We aimed to study this relationship using a comprehensive molecular analysis detecting BBSL in EMB samples.

METHODS AND RESULTS:

We performed a comprehensive histopathological, immunohistochemical, ultrastructural, and molecular analysis targeting cardiotropic viruses and BBSL in EMB specimens of 41 individuals with recent-onset DCM and 15 controls with end-stage coronary artery disease. Specifically, quantitative PCR and electron microscopy of EMB specimens were employed. In addition, autoantibodies and manifestation of autoimmune diseases were evaluated in both groups. Individuals with recent-onset DCM presented more frequently with myocardial BBSL persistence as compared with the control group (24% vs. 0%, P = 0.035). In contrast, the prevalence of parvovirus B19 and cytomegalovirus was similar in both groups. Sequence analysis of borrelial DNA revealed the following genospecies: Borrelia burgdorferi sensu stricto in three patients (30%), Borrelia afzelii in two patients (20%), and Borrelia garinii in four patients (40%), the results being inconclusive in one case. BBSL-positive DCM patients had a higher prevalence of organ-specific autoimmune diseases in comparison with the remaining DCM patients (50% vs. 16%, P = 0.030).

CONCLUSION:

Myocardial persistence of BBSL may be involved in the pathophysiology of DCM in individuals living in areas in which Lyme disease is endemic.

Comment in

Reading between the Lyme: is Borrelia burgdorferi a cause of dilated cardiomyopathy? The debate continues. [Eur J Heart Fail. 2012]

PMID:
22379178
[PubMed - indexed for MEDLINE]


http://onlinelibrary.wiley.com/doi/10.1 ... fs047/full

European Journal of Heart Failure

Volume 14, Issue 6, pages 567–568, June 2012

Editorial

Reading between the Lyme: is Borrelia burgdorferi a cause of dilated cardiomyopathy? The debate continues

Piccirillo Bryan J.1 andPride Yuri B.2,*

Article first published online: 18 FEB 2014

DOI: 10.1093/eurjhf/hfs047

This editorial refers to ‘Detection of Borrelia burgdorferi sensu lato in endomyocardial biopsy specimens in individuals with recent-onset dilated cardiomyopathy’, by M. Kubánek et al. doi:10.1093/eurjhf/hfs027

Lyme disease, caused by a group of spirochetes classified as Borrelia burgdorferi sensu lato (BBSL), is the most prevalent tick-borne illness in the northern hemisphere.[1] Infection can lead to cardiac complications in 0.5–10% of cases, with conduction disturbances, myocarditis, and pericarditis being the most described.[2] It has been hypothesized that Lyme disease may also be a cause of dilated cardiomyopathy in endemic areas. A variety of mechanisms cause dilated cardiomyopathy, including myocardial infarction and myocarditis.[3],[4] However, in the majority of cases, the aetiology remains idiopathic. Thus, diagnosis of Lyme disease in cases of idiopathic dilated cardiomyopathy could potentially improve the clinical outcome of patients with otherwise unknown causes of left ventricular dysfunction.

[snip]

The study also provides interesting insights into the pathophysiology of dilated cardiomyopathy and Lyme disease. Quantification of Borrelia DNA in myocardial samples from this study was significantly lower than what had previously been reported in primate studies.[15] In combination with the histopathology results of Borrelia-positive myocardium, this may indicate a more chronic inflammatory state possibly associated with a later stage of disease in this study population. The authors postulate that this may be why there was only a modest improvement in left ventricular function after antibiotic administration. In addition, the data indicate that a history of autoimmune disease may be linked to a greater susceptibility for developing a dilated cardiomyopathy when infected with Borrelia. Similar findings were shown in a recent report in rat and mice models indicating that there was longer myocardial persistence of B. burgdorferi in autoimmunity-susceptible animals.[16] Future investigations may be aimed at identification of inflammatory factors and receptors in the myocardium to explore an autoimmune connection further.

The authors report a very thorough analysis that shows a significantly higher prevalence of the B. burgdorferi genome in patients with new-onset dilated cardiomyopathy when compared with controls in an endemic region of the Czeck Republic. While this was a small study, it provides a foundation for larger epidemiological analyses, biomolecular investigation of inflammatory and infectious mechanisms, and larger control trials for antibiotic treatment. These results solidify the concept of an association between Lyme disease and idiopathic dilated cardiomyopathy.


http://www.ncbi.nlm.nih.gov/pubmed/20052487

Med Microbiol Immunol. 2010 May;199(2):139-43. doi: 10.1007/s00430-009-0141-6. Epub 2010 Jan 6.

Presence of Borrelia burgdorferi in endomyocardial biopsies in patients with new-onset unexplained dilated cardiomyopathy.

Palecek T1, Kuchynka P, Hulinska D, Schramlova J, Hrbackova H, Vitkova I, Simek S, Horak J, Louch WE, Linhart A.

Author information

1 1st Medical Faculty, 2nd Medical Department - Clinical Department of Cardiology and Angiology, Charles University of Prague, Prague, Czech Republic.

Abstract

Dilated cardiomyopathy (DCM) represents the third most common cause of heart failure and the most frequent cause of heart transplantation. Infectious, mostly viral, and autoimmune mechanisms, together with genetic abnormalities, have been reported as three major causes of DCM. We hypothesized that Lyme disease (LD), caused by spirochete Borrelia burgdorferi (Bb), might be an important cause of new-onset unexplained DCM in patients living in a highly endemic area for LD such as the Czech Republic. We performed endomyocardial biopsy (EMB) in 39 consecutive patients presenting with symptomatic unexplained left ventricular (LV) systolic dysfunction lasting no more than 12 months. In eight subjects (21%), Bb was detected in the EMB sample by polymerase chain reaction or by electron microscopy. None of these patients exhibited any form of atrioventricular block or other extracardiac manifestation of Bb infection. Serological testing identified IgG antibodies against Bb in only two cases and IgM antibodies in none. All affected patients were treated with intravenous ceftriaxone for 3 weeks. At 6 months follow-up, LV morphology and function as well as functional status of these patients significantly improved. In conclusion, Bb infection may represent an important cause of new-onset unexplained DCM in patients living in endemic regions such as the Czech Republic. Because the antibiotic treatment appears to be markedly effective and serological examination does not provide a tool for diagnosing the disease, EMB focused on the detection of Bb should be performed in all patients from endemic areas with new-onset unexplained DCM not responding to conventional therapy.

PMID:
20052487
[PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/17066741

Prague Med Rep. 2006;107(2):213-26.

Lyme borreliosis infection as a cause of dilated cardiomyopathy.

Bartůnek P1, Gorican K, Mrázek V, Varejka P, Veiser T, Hercogová J, Hulínská D, Janovská D.

Author information

1 Fourth Department of Medicine of the First Faculty of Medicine, Charles University in Prague, Czech Republic.
Abstract

The relatively low percent of patients affected with the cardiac form of Lyme borreliosis is difficult to diagnose, especially if the disease manifests itself in ways other than atrio-ventricular blockade. The advanced stage of Lyme carditis manifesting as dilated cardiomyopathy is a special case of this affliction. The authors of this report present clinical experience with an attempt to support the working hypothesis about involvement of Lyme borreliosis infection in the development of dilated cardiomyopathy. The patients were clinically examined thoroughly with special attention to the cardiovascular system. In addition to the basic clinical methods, the following procedures have been employed: dynamic Holter's electrocardiography, exercise ECG test, coronarography, and myocardial biopsy. From laboratory methods pertaining to the detection of Borrelia, ELISA method, Western blot, PCR, electron microscopy and histopathological analysis were used. In all three cases, clinical and laboratory findings provided the evidence of the borreliosis infection involvement in the development of dilated cardiomyopathy.

PMID: 17066741 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/11149272

Z Kardiol. 2000 Nov;89(11):1046-52.

[Acute myocarditis and cardiomyopathy in Lyme borreliosis].

[Article in German]

Scheffold N1, Sucker C, Bergler-Klein J, Kaag N, Cyran J.

Author information

1Medizinische Klinik I Schwerpunkt Kardiologie Klinikum Heilbronn Akademisches Lehrkrankenhaus der Universität Heidelberg Am Gesundbrunnen 20-24 D-74078 Heilbronn.

Abstract

Heart involvement of Lyme disease occurs in about 4-10% of patients with Lyme borreliosis. The most common manifestation is acute, self-limiting Lyme carditis, which manifests mostly as transient conduction disorders of the heart, pericarditis and myocarditis. Laboratory tests (ELISA, immunoblotting and PCR) usually have limited sensitivity and specificity, and criteria of performance and interpretation have not yet been fully evaluated. Therefore the laboratory evidence should only be interpreted in conjunction with other clinical and diagnostic features. Recently there has been convincing evidence published that long standing dilated cardiomyopathy in many cases is associated with a chronic Borrelia burgdorferi (BB) infection. Several studies showed a higher prevalence of BB antibodies in patients with severe heart failure in endemic areas (e.g., 26% versus 8% in healthy individuals). The isolation of spirochetes from the myocardium gave further evidence that BB may cause chronic heart muscle disease. In several studies antimicrobial treatment showed an improvement of the left ventricular function in patients with dilated cardiomyopathy associated with BB. However the duration of dilated cardiomyopathy before treatment plays an important part in the clinical outcome of BB-associated chronic myocarditis.

PMID: 11149272 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/9681041

Acta Med Austriaca. 1998;25(2):44-50.

[Cardiac manifestations of Lyme borreliosis with special reference to contractile dysfunction].

[Article in German]

Seinost G1, Gasser R, Reisinger E, Rigler MY, Fischer L, Keplinger A, Dattwyler RJ, Dunn JJ, Klein W.

Author information

1Klinischen Abteilung für Kardiologie, Medizinischen Universitätsklinik Graz, Osterreich.

Abstract

Borrelia burgdorferi infection (BBI) is suggested to be associated with dilated cardiomyopathy (IDC). Stanek et al. were able to cultivate Borrelia burgdorferi (BB) from myocardial biopsy tissue of a patient with longstanding dilated cardiomyopathy. Here we present a study in which we examined the effect of standard antibiotic treatment on the left ventricular ejection fraction (LV-EF) in patients with dilated cardiomyopathy associated with BBI. In this study we assessed the serum (IgG, IgM ELISA; Western Blot) and the history of 46 IDC-patients with specific respect spect to BBI (mean LV-EF: 30.4 +/- 1.3%; measured by cardiac catheterisation and echocardiography--length-area-volume method). All 46 patients received standard treatment for dilated cardiomyopathy: ACE-inhibitors, digitalis and diuretics. 11 (24%) patients showed positive serology and a history of BBI; 9 of these also had a typical history of tick bite and erythema chronicum migrans (ECM) and/or other organ involvement, 2 had no recollection of tick bite or EMC, but showed other BB-associated disorders (neuropathy, oligoarthritis). These 11 patients with BBI received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days. 6 (55%) recovered completely and showed a normal LV-EF after 6 months, 3 (27%) improved their LV-EF and 2 (18%) did not improve at all. This amounts to 9 (82%) recovery/improvement in the BB-group. The 35 patients who did not show positive serology or a history of BBI did not receive antibiotic treatment. In this group without BBI 12 (26%) showed recovery/improvement following the standard treatment of dilated cardiomyopathy (see above). Our results indicate that BBI could play a decisive role in the development of dilated cardiomyopathy, especially in a geographical region as Graz, where BB is endemic. While aware of the small number of BB-patients in this study, we nevertheless conclude that, in a remarkable number of patients with signs of BBI, dilated cardiomyopathy could be reversed and LV-EF improved upon standard antibiotic treatment.

PMID:
9681041
[PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/8877079

Cardiovasc Drugs Ther. 1996 Jul;10(3):351-60.

Reversal of Borrelia burgdorferi associated dilated cardiomyopathy by antibiotic treatment?

Gasser R1, Fruhwald F, Schumacher M, Seinost G, Reisinger E, Eber B, Keplinger A, Horvath R, Sedaj B, Klein W, Pierer K.

Author information

1 Department of Medicine, University of Graz, Austria.

Abstract

It is suggested that Borrelia burgdorferi infection could be associated with dilated cardiomyopathy (IDC). Stanek et al. were able to cultivate Borrelia burgdorferi from myocardial biopsy tissue of a patient with longstanding dilated cardiomyopathy. Here we present a study in which we examined the effect of standard antibiotic treatment on the left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy associated with Borrelia burgdorferi infection. In this study we assessed the serum (IgG, IgM Elisa) and history of 46 IDC patients with specific regard to Borrelia burgdorferi infection (mean LVEF 30.4 +/- 1.3%, measured by cardiac catheterization and echocardiography with the length-area-volume method). All 46 patients received standard treatment for dilated cardiomyopathy: ACE inhibitors, digitalis, and diuretics. Eleven (24%) patients showed positive serology and a history of Borrelia burgdorferi infection; nine of these also had a typical history of tick bite and erythema chronicum migrans (ECM) and/or other organ involvement, and two had no recollection of tick bite or ECM but showed other Borrelia burgdorferi-associated disorders (neuropathy, oligoarthritis). These 11 patients with Borrelia burgdorferi infection received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days. Six (55%) recovered completely and showed a normal LVEF after 6 months, three (27%) improved their LVEF, and two (18%) did not improve at all. This amounts to nine (82%) patients with recovery/improvement in the Borrelia burgdorferi group. The 35 patients who did not show positive serology or a history of Borrelia burgdorferi infection did not receive antibiotic treatment. In this group without Borrelia burgdorferi infection 12 (26%), showed recovery/improvement following the standard treatment of dilated cardiomyopathy (see earlier). Our results indicate that Borrelia burgdorferi infection could play a decisive role in the development of dilated cardiomyopathy, especially in a geographical region such as Graz, where Borrelia burgdorferi is endemic. While we are aware of the small number of Borrelia burgdorferi patients in this study, we nevertheless conclude that in a remarkable number of patients with signs of Borrelia burgdorferi infection, dilated cardiomyopathy could be reversed and LVEF improved.

PMID:
8877079
[PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/7610674

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

[Lyme borreliosis and cardiomyopathy].

[Article in German]

Bergler-Klein J1, Ullrich R, Glogar D, Stanek G.

Author information

1 Abteilung für Kardiologie, Klinik für Innere Medizin, Wien.

Abstract

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 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/1915460

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

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

Klein J1, Stanek G, Bittner R, Horvat R, Holzinger C, Glogar D.

Author information

1 Dept. of Cardiology, University of Vienna, Austria.

Abstract

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 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/pubmed/2294450

N Engl J Med. 1990 Jan 25;322(4):249-52.

Isolation of Borrelia burgdorferi from the myocardium of a patient with longstanding cardiomyopathy.

Stanek G1, Klein J, Bittner R, Glogar D.

Author information

1Hygiene Institute, University of Vienna, Austria.

PMID: 2294450 [PubMed - indexed for MEDLINE]

It seems to me that Lyme carditis involving problems with heart rhythm or heart block are mentioned much more often than dilated cardiomyopathy (involving the heart muscle) in the U.S. and Canada. I wonder if this is due to borrelia species/strain differences or because North American doctors are underestimating the possibility of dilated cardiomyopathy being caused (or at least triggered) by Lyme disease in some cases.
Last edited by RitaA on Thu 7 May 2015 9:16, edited 2 times in total.

RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Re: Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Thu 7 May 2015 8:04

http://www.ncbi.nlm.nih.gov/pubmed/15448708

Lab Invest. 2004 Nov;84(11):1439-50.

Cardiac involvement in non-human primates infected with the Lyme disease spirochete Borrelia burgdorferi.

Cadavid D1, Bai Y, Hodzic E, Narayan K, Barthold SW, Pachner AR.

Author information

1Department of Neurology and Neuroscience, UMDNJ-New Jersey Medical School, Newark, NJ, USA.

Abstract

To investigate cardiac involvement in the non-human primate (NHP) model of Lyme disease, we inoculated 39 adult Macaca mulatta with Borrelia burgdorferi sensu stricto strains N40 (BbN40) by needle (N=22, 14 immunocompetent (IC), seven permanently immunosuppressed (IS), and four transiently immunosuppressed (TISP)) or by tick-bite (N=4, all TISP) or strain 297 (Bb297) by needle (N=2 IS), or with B. garinii strains Pbi (N=4, 2 TISP and 2 IS), 793 (N=2, TISP) or Pli (N=2, TISP). Five uninfected NHPs were used as controls. Infection and inflammation was studied in the hearts and the aorta removed at necropsy 2-32 months after inoculation by (1) H&E and trichrome-staining; (2) immunohistochemistry and digital image analysis; (3) Western blot densitometry; and (4) TaqMan RT-PCR. All NHPs inoculated with BbN40 became infected and showed carditis at necropsy. The predominant cells were T cells, plasma cells, and macrophages. There was increased IgG and IgM in the heart independent of immunosuppression. The B-cell chemokine BLC was significantly increased in IS-NHPs. There was increased deposition of the complement membrane attack complex (MAC) in TISP and IS-NHPs. The spirochetal load was very high in all BbN40-inoculated IS-NHPs but minimal if any in IC or TISP NHPs. Double-immunostaining revealed that many spirochetes in the heart of BbN40-IS NHPs had MAC on their membranes. We conclude that carditis in NHPs infected with B. burgdorferi is frequent and can persist for years but is mild unless they are immunosupressed.

PMID: 15448708 [PubMed - indexed for MEDLINE] Free full text



http://chemport.cas.org/cgi-bin/sdcgi?A ... f2e64538fe

Significance of Borrelia infection in development of dilated cardiomypathy (a pilot study).

Bartunek P

Prague medical report, (2007) Vol. 108, No. 4, pp. 339-47. Journal code: 101227436. ISSN: 1214-6994. L-ISSN: 1214-6994..

A heart involvement known as Lyme carditis (LC), a consequence of Lyme borreliosis (LB), is relatively rare in contrast to the involvement of skin, joints and nervous system; it accounts for < 4% of all these patients in European countries. However, the diagnosis of the disease belongs to the most difficult challenges. While various forms of AV blocks dominate in the USA as confirmed by the literature, there is a clear predominance of arrhythmias of various incidence in the Czech Republic. The authors of this article focused on the form belonging to the rarest manifestations of LC, namely dilated cardiomyopathy (DCMP). The goal was to elucidate the etiological participation of Borrelia infection in the development of DCMP, which has attracted controversial opinions so far. In total, 33 patients with DCMP were enrolled in the study, 23 males and 10 females, with mean age 57.7 years (range 24-76 years). ELISA NRLB KC 90 method was used in all blood samples for detection of Borrelia infection (BI), Western blot method was used for confirmation, followed by identification of DNA of pathogenic Borreliae using PCR method. Bioptic material was examined by electronmicroscopy with an attempt to detect Spirochaetae in myocardium. 16 patients were excluded from the study owing to the absence of signs of LB. The study group included 17 patients (3 females, 13 males) with mean age 58 years (range 43-76 years), in whom the presence of Bb was proved by identification of DNA of pathogenic Borreliae or by electronmicroscopic detection of Spirochetae in myocardial bioptic sample. The findings obtained during the study confirmed that BI very probably participated in the development of dilated cardiomyopathy. It may be concluded that most of cases were either unapparent forms of LB or insufficiently treated cutaneous forms of this disease.


Is it possible that endomyocardial biopsies are performed less often in North America than in Europe?
Last edited by RitaA on Thu 7 May 2015 8:51, edited 1 time in total.

RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Re: Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Thu 7 May 2015 8:37

http://www.mayoclinic.org/diseases-cond ... n-20032887

Dilated cardiomyopathy is a disease of the heart muscle, usually starting in your heart's main pumping chamber (left ventricle). The ventricle stretches and thins (dilates) and can't pump blood as well as a healthy heart can. The term "cardiomyopathy" is a general term that refers to the abnormality of the heart muscle itself.

Dilated cardiomyopathy might not cause symptoms, but for some people it can be life-threatening. A common cause of heart failure — the heart's inability to supply the body with enough blood — dilated cardiomyopathy can also contribute to irregular heartbeats (arrhythmias), blood clots or sudden death.


http://www.mayoclinic.org/diseases-cond ... n-20032887

The cause of dilated cardiomyopathy often can't be determined (idiopathic). However, numerous factors can cause the left ventricle to dilate and weaken, including:

• Genetics
• Congenital heart defects
Infections, including those caused by bacteria, viruses, fungi and parasites
• Drug and alcohol abuse
• Certain cancer medications
• Exposure to toxins, such as lead, mercury and cobalt
• Coronary artery disease or heart attack
• High blood pressure (hypertension)
• Diabetes
• Complications of late-stage pregnancy


As I suspected, there is no mention of dilated cardiomyopathy here:

http://www.cdc.gov/lyme/signs_symptoms/ ... ditis.html

What you need to know about Lyme carditis

What is Lyme carditis, and what are the symptoms?

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the heart's upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call "heart block," which can be mild, moderate, or severe. Heart block from Lyme carditis can progress rapidly.

Patients may experience light-headedness, fainting, shortness of breath, heart palpitations, or chest pain. Patients with Lyme carditis usually have other symptoms such as fever and body aches, and they may have more specific symptoms of Lyme disease, such as the erythema migrans rash.

How common is Lyme carditis?

Based on national surveillance data from 2001-2010, Lyme carditis occurs in approximately 1% of Lyme disease cases reported to CDC.

How is Lyme carditis treated?

Lyme carditis can be treated with oral or intravenous (IV) antibiotics, depending on how severe it is. Some patients might need a temporary pacemaker.

Can Lyme carditis be fatal?


Yes. Between 1985 and 2008, medical journals reported four deaths, worldwide, as a result of Lyme carditis. In December 2013, CDC published a report describing three additional cases.

How long does it take for a person to recover from Lyme carditis?

Typically the patient receives antibiotic treatment for 14-21 days. Most symptoms are gone within 1-6 weeks.

Third Degree Heart Block

[image]

The heart on the left shows how an electrical signal flows from the atrioventricular node (AV node) to the chambers in the lower half of the heart, called the ventricles.

The heart on the right shows a case of third degree heart block. In this illustration, the electrical signal from the AV node to the ventricle is completely blocked. When this happens, the electrical signal of the atria (chambers at the top of the heart) does not transmit to the ventricles (chambers at the bottom of the heart), which causes the ventricles to beat at their own, slower rate.

Additional Resources

For more information about heart block, including a video, see: What is Heart Block? by the National Institutes of Health (NIH)

Lyme Carditis [PDF - 14 pages]
Reprinted from Infectious Disease Clinics of North America, Vol. 22/Ed. 2, Fish AE, Pride YB, Pinto DS, Lyme carditis, 275-288, Copyright 2008, with permission from Elsevier.

Page last reviewed: March 4, 2015
Page last updated: March 4, 2015


The heart muscle (as it relates to heart block) is mentioned here:

http://www.nhlbi.nih.gov/health/health- ... topics/hb/

What Is Heart Block?

Heart block is a problem that occurs with the heart's electrical system. This system controls the rate and rhythm of heartbeats. ("Rate" refers to the number of times your heart beats per minute. "Rhythm" refers to the pattern of regular or irregular pulses produced as the heart beats.)

With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.

Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.

Overview

Heart block is a type of arrhythmia (ah-RITH-me-ah). An arrhythmia is any problem with the rate or rhythm of the heartbeat.

Some people are born with heart block, while others develop it during their lifetimes. If you're born with the condition, it's called congenital (kon-JEN-ih-tal) heart block. If the condition develops after birth, it's called acquired heart block.

Doctors might detect congenital heart block before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause heart block. Congenital heart defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects.

Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage.

The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block.

Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. It maps the data on a graph for the doctor to review.


http://www.cdc.gov/lyme/resources/fish2008-508.pdf

Infect Dis Clin N Am 22 (2008) 275–288

Lyme Carditis

Airley E. Fish, MD, MPHa, Yuri B. Pride, MDb, Duane S. Pinto, MDa,*

a Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Palmer 415, Boston, MA 02215, USA
b Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Deaconess 311, Boston, MA 02215, USA


Although relatively rare, it has been suggested that B burgdorferi may play a causative role in chronic heart failure. This hypothesis originated from a 1990 European case report of a 54-year-old man with a 4-year history of dilated cardiomyopathy, high levels of serum B burgdorferi IgG, and a B burgdorferi culture-positive endomyocardial biopsy specimen [21]. These same investigators studied 72 patients who had idiopathic dilated cardiomyopathy, 55 patients who had coronary artery disease, and 61 healthy controls. Positive ELISA values were present in 26.4%, 12.7%, and 8.2% of subjects, respectively [63].

Further evidence suggesting a role of Lyme disease in the subsequent development of clinical congestive heart failure came from several other observational studies by European investigators. In Italy, two patients who had idiopathic dilated cardiomyopathy grew B burgdorferi from endomyocardial biopsy specimens. Both had complete resolution of their myocardial dysfunction after treatment with angiotensin converting enzyme inhibitors, digoxin, and penicillin [64]. A Dutch group noted improvement in left ventricular ejection fraction in eight of nine B burgdorferi-seropositive patients with idiopathic dilated cardiomyopathy who were treated with antibiotics. Six of the nine subjects sustained a complete recovery of myocardial function [65].

Interestingly, the ability to grow B burgdorferi from biopsy specimens and clinical improvement after antibiotic treatment in seropositive patients has not been replicated in the United States. A prospective study of 175 patients in the United States who had chronic heart failure showed a high false-positive ELISA rate and no improvement in heart failure with appropriate antibiotic therapy [66]. Seropositivity was higher among patients who had severe heart failure compared with blood donor controls, although not statistically significant (8.0% versus 3.0%; P ¼.07). Of 77 patients who had idiopathic dilated cardiomyopathy, 6 (7.8%) had positive ELISA tests with no significant difference according to cause of heart failure. Of these, five of six patients had negative confirmatory Western blot results. Six seroreactive patients were treated with antibiotics. None of the subjects had improvement in heart failure symptoms [46].

The different outcomes of these studies may be caused, at least in part, by differences in patient and control populations or in the serologic assays used. Additionally, as was stated previously, the causative organism of Lyme disease differs between the two regions, with infection by B burgdorferi sensu stricto and B burgdorferi sensu lato occurring more frequently in the United States and Europe, respectively.

...

Further studies are warranted to clarify the role that B burgdorferi plays in acute and chronic congestive heart failure. Nevertheless, it is reasonable to consider B burgdorferi infection in the differential diagnosis of dilated cardiomyopathy.

Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Dilated cardiomyopathy associated with Bb infection

Postby Lorima » Mon 18 May 2015 22:32

There's a book out, by a doctor who had LD, who went officially undiagnosed for many years, (he and his doctors postponed treatment until he was CDC-positive; they kept testing him until he had the right pattern of bands, and only then started treating!) And then only treated with the IDSA-recommended protocol, as I recall. He ended up almost dying of a slowly progressing dilated cardiomyopathy, was finally saved by a heart transplant. Weirdly, he doesn't seem very upset about the poor test protocol. I guess as a doctor and researcher he's used to that happening. ;)

The book is called Gone in a Heartbeat, by Neil Spector. I read the Kindle version. It is an enjoyable read.
http://www.amazon.com/Gone-Heartbeat-Ph ... +heartbeat
"I have to understand the world, you see."
Richard Feynman

RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Re: Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Mon 18 May 2015 22:57

Thanks so much for the book recommendation, Lorima! It's exactly the type of book I enjoy reading, so I'll be ordering it in the next day or so.

It has a 4.65 out of 5 stars rating on goodreads:

http://www.goodreads.com/book/show/2366 ... -heartbeat

Dr. Neil Spector, one of the nation's top oncologists, led a charmed life. He was educated at prestigious universities, trained at top medical centers, and had married the woman of his dreams. It seemed too perfect. And it was.

In 1994, it all came crashing down. He and his wife lost two unborn children. And a mysterious illness brought him to the brink of death. In his compelling memoir, "Gone in a Heartbeat," Dr. Spector describes in great detail how he was misdiagnosed and, despite being a medical insider, was often discounted by his fellow physicians.

As he recounts his own unorthodox approach to medicine and physician/patient relationships, Dr. Spector encourages readers to never surrender their power to a third party. He tells of courageous patients who served as role models, he conceded that doctors do a disservice to patients when "we treat them like statistics," and he advocates for educated patients who can make informed decisions collaboratively and not simply follow instructions.

In Dr. Spector's words: "To recognize that we are in control of our own bodies and destinies can be a powerful step toward true healing."

Readers of "Gone in a Heartbeat" will never view the medical profession the same again.

RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Re: Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Tue 19 May 2015 2:32

I asked this question in an earlier post:

RitaA wrote: Is it possible that endomyocardial biopsies are performed less often in North America than in Europe?


This isn't a complete answer to my question by any means, but the University of Maryland's website may provide a clue:

http://umm.edu/health/medical/ency/arti ... iomyopathy

Dilated cardiomyopathy

Definition

Dilated cardiomyopathy is a condition in which the heart becomes weakened and enlarged. As a result, the heart cannot pump enough blood to the rest of the body.

There are many types of cardiomyopathy. Dilated cardiomyopathy is the most common form.

Some experts use the term "dilated cardiomyopathy" for cases where the primary problem is with the muscle itself. This definition does not include weakness or enlargement that was caused by a heart attack or a heart valve problem.

[snip]

Heart biopsy, in which a small piece of heart muscle is removed, may be needed depending on the cause. However, this is rarely done.


I guess I'll have to read the book "Gone in a Heartbeat" to find out if Dr. Spector had a heart biopsy, and if so, what the results revealed.

RitaA
Posts: 2767
Joined: Thu 1 Jul 2010 8:33

Re: Dilated cardiomyopathy associated with Bb infection

Postby RitaA » Thu 25 Jun 2015 6:19

Here's a link to a recent interview with Dr. Spector about his delayed Lyme disease diagnosis:

http://nymag.com/scienceofus/2015/06/wh ... sease.html

ATYPICAL

June 15, 2015 10:54 a.m.

What It’s Like to Have Severe Lyme Disease

By Alexa Tsoulis-Reay


Return to “Published Studies”

Who is online

Users browsing this forum: Bing [Bot] and 3 guests