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Snik ME, Stouthamer NEIM, Hovius JW, van Gool MMJ. Bridging the gap: Insights in the immunopathology of Lyme borreliosis. Eur J Immunol 2024:e2451063. [PMID: 39396370 DOI: 10.1002/eji.202451063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 09/16/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024]
Abstract
Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato (Bbsl) genospecies transmitted by Ixodes spp. ticks, is a significant public health concern in the Northern Hemisphere. This review highlights the complex interplay between Bbsl infection and host-immune responses, impacting clinical manifestations and long-term immunity. Early localized disease is characterized by erythema migrans (EM), driven by T-helper 1 (Th1) responses and proinflammatory cytokines. Dissemination to the heart and CNS can lead to Lyme carditis and neuroborreliosis respectively, orchestrated by immune cell infiltration and chemokine dysregulation. More chronic manifestations, including acrodermatitis chronica atrophicans and Lyme arthritis, involve prolonged inflammation as well as the development of autoimmunity. In addition, dysregulated immune responses impair long-term immunity, with compromised B-cell memory and antibody responses. Experimental models and clinical studies underscore the role of Th1/Th2 balance, B-cell dysfunction, and autoimmunity in LB pathogenesis. Moreover, LB-associated autoimmunity parallels mechanisms observed in other infectious and autoimmune diseases. Understanding immune dysregulation in LB provides insights into disease heterogeneity and could provide new strategies for diagnosis and treatment.
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Affiliation(s)
- Marijn E Snik
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Noor E I M Stouthamer
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Melissa M J van Gool
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
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Isha S, Sharma R, Hannon RM, Sanghavi DK. A suspected case of Lyme disease causing complete heart block. Oxf Med Case Reports 2023; 2023:omad089. [PMID: 37771693 PMCID: PMC10530306 DOI: 10.1093/omcr/omad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 09/30/2023] Open
Abstract
Carditis is a rare complication of Lyme disease and usually presents in the early dissemination phase, several weeks after exposure to a tick bite. Conduction abnormalities are the most common manifestation of Lyme carditis. The presentation can vary from atrioventricular conduction delay (first-degree atrioventricular conduction block) to life-threatening situations, such as a complete heart block. Although such manifestations occur late, our case report describes an interesting case where the patient developed a complete heart block in the setting of acute Lyme disease. An elevated IgM with negative IgG Lyme serology titer, an unusual finding, initially led us to face a diagnostic dilemma. Our suspicion of a tick bite was affirmed when we detected a positive titer for Babesia microti, an organism carried by the same tick and a common co-infection with Lyme disease. The patient improved with antibiotic therapy and temporary pacemaker support during the initial few days of admission.
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Affiliation(s)
- Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rohan Sharma
- Department of Neurology and Neuro Critical Care, Mayo Clinic, Jacksonville, Florida, USA
| | - Rachel M Hannon
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Abstract
Lyme carditis is an uncommon manifestation of Lyme disease. Most cases present with heart block of varying degrees, but the spectrum of disease includes other transient arrhythmias and structural manifestations, such as myopericarditis or cardiomyopathy. Antibiotics hasten the resolution of Lyme carditis, and cardiac pacing can be an adjunctive therapy. Outcomes are generally good, but there are rare fatalities associated with Lyme carditis. The latter underscores the continued need for improved modes of prevention of Lyme disease and the importance of its early recognition and treatment.
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Affiliation(s)
- Richard V Shen
- Division of Infectious Diseases, Southcoast Physicians Group, 363 Highland Avenue, Fall River, MA 02720, USA.
| | - Carol A McCarthy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, 887 Congress Street, Suite 310, Portland, ME 04102, USA
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Borrelia burgdorferi inhibits NADPH-mediated reactive oxygen species production through the mTOR pathway. Ticks Tick Borne Dis 2022; 13:101943. [DOI: 10.1016/j.ttbdis.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022]
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Daraz YM, Abdelghffar O. Rash and Heart Block: A Unique Case of Lyme Carditis. Cureus 2022; 14:e21332. [PMID: 35186590 PMCID: PMC8849466 DOI: 10.7759/cureus.21332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/07/2022] Open
Abstract
Lyme disease is a multisystem disease that can present as a life-threatening condition known as Lyme carditis. While most commonly manifesting as a fluctuating atrioventricular block, Lyme carditis can also emerge as myocarditis and coronary artery events. This case report will detail the clinical scenario of a 23-year-old patient who presented with acute onset fluctuating atrioventricular block and erythema migrans and was found to have Lyme carditis. The patient was treated promptly with antibiotics, thus avoiding long-term Lyme disease sequela, with a complete resolution of his disease, including his high degree atrioventricular block.
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Abstract
OBJECTIVES First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility. DESIGN Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed. RESULTS A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG. CONCLUSIONS This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.
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Stanek G, Strle F. Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol Rev 2018; 42:233-258. [PMID: 29893904 DOI: 10.1093/femsre/fux047] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/16/2017] [Indexed: 12/23/2022] Open
Abstract
Lyme borreliosis is caused by certain genospecies of the Borrelia burgdorferi sensu lato complex, which are transmitted by hard ticks of the genus Ixodes. The most common clinical manifestation is erythema migrans, an expanding skin redness that usually develops at the site of a tick bite and eventually resolves even without antibiotic treatment. The infecting pathogens can spread to other tissues and organs, resulting in manifestations that can involve the nervous system, joints, heart and skin. Fatal outcome is extremely rare and is due to severe heart involvement; fetal involvement is not reliably ascertained. Laboratory support-mainly by serology-is essential for diagnosis, except in the case of typical erythema migrans. Treatment is usually with antibiotics for 2 to 4 weeks; most patients recover uneventfully. There is no convincing evidence for antibiotic treatment longer than 4 weeks and there is no reliable evidence for survival of borreliae in adequately treated patients. European Lyme borreliosis is a frequent disease with increasing incidence. However, numerous scientifically questionable ideas on its clinical presentation, diagnosis and treatment may confuse physicians and lay people. Since diagnosis of Lyme borreliosis should be based on appropriate clinical signs, solid knowledge of clinical manifestations is essential.
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Affiliation(s)
- Gerold Stanek
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia
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Role of glutathione metabolism in host defense against Borrelia burgdorferi infection. Proc Natl Acad Sci U S A 2018; 115:E2320-E2328. [PMID: 29444855 DOI: 10.1073/pnas.1720833115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pathogen-induced changes in host cell metabolism are known to be important for the immune response. In this study, we investigated how infection with the Lyme disease-causing bacterium Borrelia burgdorferi (Bb) affects host metabolic pathways and how these metabolic pathways may impact host defense. First, metabolome analysis was performed on human primary monocytes from healthy volunteers, stimulated for 24 h with Bb at low multiplicity of infection (MOI). Pathway analysis indicated that glutathione (GSH) metabolism was the pathway most significantly affected by Bb Specifically, intracellular levels of GSH increased on average 10-fold in response to Bb exposure. Furthermore, these changes were found to be specific, as they were not seen during stimulation with other pathogens. Next, metabolome analysis was performed on serum samples from patients with early-onset Lyme disease in comparison with patients with other infections. Supporting the in vitro analysis, we identified a cluster of GSH-related metabolites, the γ-glutamyl amino acids, specifically altered in patients with Lyme disease, and not in other infections. Lastly, we performed in vitro experiments to validate the role for GSH metabolism in host response against Bb. We found that the GSH pathway is essential for Bb-induced cytokine production and identified glutathionylation as a potential mediating mechanism. Taken together, these data indicate a central role for the GSH pathway in the host response to Bb GSH metabolism and glutathionylation may therefore be important factors in the pathogenesis of Lyme disease and potentially other inflammatory diseases as well.
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Applegren ND, Kraus CK. Lyme Disease: Emergency Department Considerations. J Emerg Med 2017; 52:815-824. [DOI: 10.1016/j.jemermed.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/21/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
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Chaudhry MA, Satti SD, Friedlander IR. Lyme carditis with complete heart block: management with an external pacemaker. Clin Case Rep 2017; 5:915-918. [PMID: 28588838 PMCID: PMC5458015 DOI: 10.1002/ccr3.934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 11/26/2022] Open
Abstract
Timely diagnosis and prompt initiation of treatment is essential in Lyme carditis to achieve favorable prognosis. Externalized permanent pacemaker with an active fixation lead as supportive pacing modality is a feasible option till complete resolution of conduction block with continued antibiotic therapy.
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Affiliation(s)
| | - Srinivasa D Satti
- Department of Cardiology and Electrophysiology Aultman Hospital Canton Ohio
| | - Ira R Friedlander
- Department of Cardiology and Electrophysiology Aultman Hospital Canton Ohio
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Abstract
Lyme disease is a common disease that uncommonly affects the heart. Because of the rarity of this diagnosis and the frequent absence of other concurrent clinical manifestations of early Lyme disease, consideration of Lyme carditis demands a high level of suspicion when patients in endemic areas come to attention with cardiovascular symptoms and evidence of higher-order heart block. A majority of cases manifest as atrioventricular block. A minority of Lyme carditis cases are associated with myopericarditis. Like other manifestations of Lyme disease, carditis can readily be managed with antibiotic therapy and supportive care measures, such that affected patients almost always completely recover.
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Affiliation(s)
- Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 448, Baltimore, MD 21287, USA
| | - Takaaki Kobayashi
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 725 North Wolfe Street, PTCB - Room 231, Baltimore, MD 21287, USA
| | - Yvonne Higgins
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 725 North Wolfe Street, PTCB - Room 231, Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Sheikh Zayed Tower, Room 7125R, Baltimore, MD 21287, USA
| | - Michael T Melia
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 448, Baltimore, MD 21287, USA.
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12
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Suspected inflammatory cardiomyopathy. Herz 2014; 40 Suppl 1:91-5. [DOI: 10.1007/s00059-014-4118-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/16/2014] [Accepted: 05/14/2014] [Indexed: 12/22/2022]
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Abstract
Background Lyme disease is an emerging zoonotic infection in Canada. As the Ixodes tick expands its range, more Canadians will be exposed to Borrelia burgdorferi, the bacterium that causes Lyme disease. Objective To review the clinical diagnosis and treatment of Lyme disease for front-line clinicians. Methods A literature search using PubMed and restricted to articles published in English between 1977 and 2014. Results Individuals in Lyme-endemic areas are at greatest risk, but not all tick bites transmit Lyme disease. The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a "bull's eye rash", fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms. Late Lyme disease in North America typically manifests with oligoarticular arthritis but can present with a subacute encephalopathy. Antibiotic treatment is effective against Lyme disease and works best when given early in the infection. Prophylaxis with doxycyline may be indicated in certain circumstances. While a minority of patients may have persistent symptoms, evidence does not demonstrate that prolonged courses of antibiotics improve outcome. Conclusion Clinicians need to be aware of the signs and symptoms of Lyme disease. Knowing the regions where Borrelia infection is endemic in North America is important for recognizing patients at risk and informing the need for treatment.
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Clinical features of 705 Borrelia burgdorferi seropositive patients in an endemic area of northern Italy. ScientificWorldJournal 2014; 2014:414505. [PMID: 24550705 PMCID: PMC3914583 DOI: 10.1155/2014/414505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lyme Borreliosis is a multisystemic infection caused by spirochetes of Borrelia burgdorferi sensu lato complex. The features of Lyme Borreliosis may differ in the various geographical areas, primarily between the manifestations found in America and those found in Europe and Asia. OBJECTIVE to describe the clinical features of Lyme Borreliosis in an endemic geographic area such as Friuli-Venezia Giulia in the Northeastern part of Italy. METHODS The medical records of patients resulted seropositive for Borrelia burgdorferi have been retrospectively recorded and analyzed. RESULTS Seven hundred and five patients met the inclusion criteria, 363 males and 342 females. Erythema migrans was the most common manifestation, detected in 437 patients. Other classical cutaneous manifestations included 58 cases of multiple erythema migrans, 7 lymphadenosis benigna cutis, and 18 acrodermatitis chronica atrophicans. The musculoskeletal system was involved in 511 patients. Four hundred and sixty patients presented a neurological involvement. Flu-like symptoms preceded or accompanied or were the only clinical feature in 119 patients. COMMENTS The manifestations of Lyme borreliosis recorded in this study are similar to the ones of other endemic areas in Europe, even if there are some peculiar features which are different from those reported in Northern Europe and in the USA.
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Palmieri JR, King S, Case M, Santo A. Lyme disease: case report of persistent Lyme disease from Pulaski County, Virginia. Int Med Case Rep J 2013; 6:99-105. [PMID: 24353444 PMCID: PMC3862396 DOI: 10.2147/imcrj.s51240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 50-year-old woman from Pulaski, Virginia, presented to a local clinic with headaches, fever, generalized joint pain, excessive thirst and fluid intake, and a progressing rash on her back. On physical examination, she had a large circular red rash on her back with a bull’s-eye appearance, 16 × 18 cm in diameter. Serologic tests confirmed a diagnosis of Lyme disease. The patient could recall a walk through the woods 3 weeks prior, although she never noticed a tick on her body. Following a prolonged course of antibiotics, this case report presents a patient with ongoing symptoms consistent with post-treatment Lyme disease.
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Affiliation(s)
- James R Palmieri
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Scott King
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Matthew Case
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Arben Santo
- Department of Pathology, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA
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Pseudoseizures in a preadolescent: does this case have a bite? Pediatr Emerg Care 2012; 28:691-5. [PMID: 22766586 DOI: 10.1097/pec.0b013e31825d21ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a preadolescent girl with acquired complete heart block most likely caused by viral myocarditis. The diagnosis was supported by endomyocardial biopsy and several immunohistological panels. A temporary pacemaker was used, and the child responded well to therapy with full recovery of cardiac conduction.
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Mener DJ, Mener AS, Daubert JP, Fong M. Tick tock. Am J Med 2011; 124:306-8. [PMID: 21435420 DOI: 10.1016/j.amjmed.2010.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 11/18/2010] [Accepted: 11/18/2010] [Indexed: 12/18/2022]
Affiliation(s)
- David J Mener
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
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Abstract
Although cardiac causes of chest pain in children are infrequent, arrhythmias are implicated in most cardiac related cases. The most common arrhythmias associated with chest pain are supraventricular tachycardias, but more ominous rhythms, such as ventricular tachycardia or bradycardias, can manifest as chest pain. Investigation of all children with chest pain suspected of arrhythmia should include detailed history and physical examination and a 12- or 15-lead electrocardiogram. In some cases echocardiogram, 24-hour Holter monitoring, exercise stress testing, or other cardiac evaluations may be indicated. Children with a history of cardiac disease or cardiac surgery are particularly at risk for arrhythmias and may experience chest pain in association with their arrhythmias.
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Abraham S, Reddy S, Abboud J, Jonnalagadda K, Ghanta SK, Kondamudi V. Brief, recurrent, and spontaneous episodes of loss of consciousness in a healthy young male. Int Med Case Rep J 2010; 3:71-6. [PMID: 23754893 PMCID: PMC3658225 DOI: 10.2147/imcrj.s11101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Lyme disease is caused by bacterial spirochete Borrelia burgdorferi and is transmitted by Ixodes scapularis and Ixodes pacificus ticks, which get infected while feeding on the reservoir host of the bacteria.1 About 248,074 cases of Lyme disease were reported by the US Centers for Disease Control and Prevention from 1992-2006.2 Over 95% of these cases are reported from the Northeastern and upper Midwestern United States.3 Carditis is usually a clinical manifestation/complication of Lyme disease and is seen in approximately 5% of untreated cases.4. CASE PRESENTATION A 32-year-old male Hispanic from Chile presented with brief episodes of loss of consciousness and awareness of irregular heart beat, and denied any history of tick bite. The patient was found to have a heart rate of 40 beats per minute and fluctuating variable atrioventricular blocks. A transvenous pacemaker was placed with good capture. The diagnosis was made with serological testing and gallium scanning. Treatment with antibiotics and continuous cardiac monitoring resulted in remarkable symptomatic improvement of the patient. CONCLUSION Absence of history or evidence of tick bite must not rule out the possibility of Lyme carditis in a patient with a transient heart block. Prompt recognition of this reversible cause of heart block is essential for avoiding implantation of an unnecessary, permanent pacemaker.
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Affiliation(s)
- Sherly Abraham
- Family Medicine Department, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sarath Reddy
- Faculty Attending Cardiology Department, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Joseph Abboud
- Faculty Attending Cardiology Department, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | | | - Sasi K Ghanta
- Family Medicine Department, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Vasantha Kondamudi
- Family Medicine Department, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Emkey GR, Stone JH. A 46-year-old woman with chin pain and a fainting spell. Arthritis Care Res (Hoboken) 2010; 62:434-8. [DOI: 10.1002/acr.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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IDSA Lyme Guidelines: Response to Dr. Gershon’s Letter. South Med J 2009. [DOI: 10.1097/smj.0b013e3181b26cb2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Russell Evan Berger
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA
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Costello JM, Alexander ME, Greco KM, Perez-Atayde AR, Laussen PC. Lyme carditis in children: presentation, predictive factors, and clinical course. Pediatrics 2009; 123:e835-41. [PMID: 19403477 DOI: 10.1542/peds.2008-3058] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to identify predictive factors for Lyme carditis in children and to characterize the clinical course of these patients. METHODS We reviewed all cases of early disseminated Lyme disease presenting to our institution from January 1994 through July 2008, and summarized the presentation and course of those patients with carditis. A case-control study was used to identify predictive factors for carditis. Controls were patients with early disseminated Lyme disease without carditis. RESULTS Of 207 children with early disseminated Lyme disease, 33 (16%) had carditis, 14 (42%) of whom had advanced heart block, including 9 (27%) with complete heart block. The median time to recovery of sinus rhythm in these 14 patients was 3 days (range: 1-7 days), and none required a permanent pacemaker. Four (12%) of 33 patients with carditis had depressed ventricular systolic function, 3 (9%) of whom required mechanical ventilation, temporary pacing, and inotropic support. Complete resolution of rhythm disturbances and myocardial dysfunction occurred in 24 (89%) of 27 patients for whom follow-up data were available. Most patients with carditis also had other systemic Lyme involvement. By using multivariate logistic regression analysis, we found that children >10 years of age, those with arthralgias, and those with cardiopulmonary symptoms were more likely to have carditis. CONCLUSIONS The spectrum of presentation for children with Lyme carditis is broad, ranging from asymptomatic, first-degree heart block to fulminant myocarditis. Variable degrees of heart block are the most common manifestation and occasionally require temporary pacing. Transient myocardial dysfunction, although less common, can be life-threatening. Advanced heart block resolves within 1 week in most cases. In children with early disseminated Lyme disease, older age, arthralgias, and cardiopulmonary symptoms independently predict the presence of carditis.
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Affiliation(s)
- John M Costello
- Harvard Medical School, Division of Cardiac Intensive Care, Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Bader 600, Boston, MA 02115, USA.
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Lyme carditis: sequential electrocardiographic changes in response to antibiotic therapy. Int J Cardiol 2008; 137:167-71. [PMID: 18684533 DOI: 10.1016/j.ijcard.2008.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Accepted: 05/03/2008] [Indexed: 01/11/2023]
Abstract
Lyme disease is a tick-borne spirochetal infection that may involve heart. The cardiac manifestations of Lyme disease including varying degrees of atrioventricular heart block occur within weeks to months of the infecting tick bite. This report describes a 43 year-old man with Lyme carditis who presented with complete heart block. The heart block resolved with ceftriaxone therapy. Lyme carditis should be considered in the differential diagnosis in patients who present with new onset advanced heart block.
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Abstract
Cardiovascular manifestations of Lyme disease were first reported nearly 30 years ago. This article describes Lyme carditis, its epidemiology, pathophysiology, methods of diagnosis, and treatment options.
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Affiliation(s)
- Airley E Fish
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Silver E, Pass RH, Kaufman S, Hordof AJ, Liberman L. Complete heart block due to Lyme carditis in two pediatric patients and a review of the literature. CONGENIT HEART DIS 2008; 2:338-41. [PMID: 18377450 DOI: 10.1111/j.1747-0803.2007.00122.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Carditis is a common manifestation of adult patients with Lyme disease affecting 4-10% of Lyme patients in the United States. However, children with Lyme disease rarely present with acute carditis. The management of pediatric patients with complete heart block (CHB) secondary to Lyme carditis has not been well described. We report the acute management of 2 pediatric patients that presented in CHB secondary to Lyme disease.
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Affiliation(s)
- Eric Silver
- New York Presbyterian Hospital, Columbia University, Division of Pediatric Cardiology, Arrhythmia Service, New York, NY, USA
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Lamaison D. Atteinte cardiaque dans la maladie de Lyme. Med Mal Infect 2007; 37:511-7. [PMID: 17629649 DOI: 10.1016/j.medmal.2006.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 11/27/2022]
Abstract
Cardiac manifestations of Lyme Borreliosis are relatively infrequent, occurring within weeks after the infectious tick bite (median of 21 days), and resulting at this stage from a direct borrelial infection of the myocardium, as indicated by reports of spirochete isolation from pericardium and myocardium. They may persist or appear in the late, tertiary phase of the illness, being then more likely due to infection-triggered autoimmunity. Lyme carditis typically presents with a fluctuating degree of atrioventricular block that spontaneously resolves in several days. Rarely, myocarditis may occur with or without pericardial involvement, in patients presenting with chest pain, ST depression or T wave inversion, mimicking an acute myocardial infarction, and various arrhythmias are reported, as well as pericardial effusion or heart failure. A complete recovery is usually observed, spontaneous or after antibiotherapy. Severe myocarditis or Pericarditis leading to death is exceptional. The diagnosis of Lyme carditis is based on the same association of clinical and laboratory features as in Lyme disease without cardiac involvement. But the occurrence of conduction disturbances in healthy young people suggests screening for other criteria of Lyme disease. The management of Lyme carditis does not differ from the treatment of Lyme disease without carditis and is mainly based upon the use of doxycycline or ceftriaxone.
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Affiliation(s)
- D Lamaison
- Service de cardiologie, CHU, place Henri-Dunant, 63000 Clermont-Ferrand, France.
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Mravljak M, Velnar T, Bricelj V, Ruzić-Sabljić E, Arnez M. Electrocardiographic findings in children with erythema migrans. Wien Klin Wochenschr 2006; 118:691-5. [PMID: 17160609 DOI: 10.1007/s00508-006-0697-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess electrocardiographic findings in children with erythema migrans and to compare them with findings obtained in a healthy control group of comparable age and with a similar proportion of boys and girls. METHODS Electrocardiograms were carried out in 147 children under the age of 15 years before treatment with antibiotics for erythema migrans (solitary 68 patients, multiple 79 patients) and in the control group of 148 healthy children. RESULTS Abnormal electrocardiographic findings were detected more often in healthy children than in patients (14% versus 5%; P = 0.0303) and among patients more often in boys than in girls (10% versus 0%; P = 0.0107). Electrocardiographic abnormalities characteristic for Lyme borreliosis, such as atrioventricular blocks, were rare: in patients with erythema migrans only one child had first-degree atrioventricular block; in the control group one child had first-degree and another had second-degree atrioventricular block. Patients with erythema migrans had shorter PR and RR intervals and lower R and S wave voltages in V1 than the healthy children. Comparison among patients with solitary and multiple erythema migrans did not reveal significant electrocardiographic differences. The frequency of electrocardiographic abnormalities in patients with erythema migrans was not associated with the presence of systemic symptoms, or with the presence of meningitis or the isolation of Borrelia burgdorferi sensu lato from the blood. CONCLUSIONS Electrocardiographic abnormalities in children with erythema migrans are mild, nonspecific and rare. The presence of clinical signs and symptoms indicative or suggestive of disseminated Lyme borreliosis is not associated with higher frequency of such abnormalities. Comparison of findings in patients with erythema migrans and healthy children revealed several distinctions, some of which might have been interpreted as a result of altered activity of the autonomic nervous system.
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Affiliation(s)
- Marija Mravljak
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
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Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. [PMID: 17029130 DOI: 10.1086/508667] [Citation(s) in RCA: 1275] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 08/21/2006] [Indexed: 12/19/2022] Open
Abstract
Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA.
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Affiliation(s)
- Jonathan R Kaltman
- The Cardiac Center of The Children's Hospital of Philadelphia and Division of Pediatric Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, USA.
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Wijetunga M. Atrioventricular conduction disturbances secondary to Lyme disease. Int J Cardiol 2005; 101:141. [PMID: 15860398 DOI: 10.1016/j.ijcard.2003.11.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2003] [Accepted: 11/18/2003] [Indexed: 11/18/2022]
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Abstract
Lyme borreliosis is the most common tick-transmitted disease in the northern hemisphere and is caused by spirochaetes of the Borrelia burgdorferi species complex. A complete presentation of the disease is an extremely unusual observation in which a skin lesion results from a tick bite and is followed by heart and nervous system involvement, and later on by arthritis. Late involvement of eye, nervous system, joints, and skin can also occur. The only sign that enables a reliable clinical diagnosis of Lyme borreliosis is erythema migrans. Other features of some diagnostic value are earlobe lymphocytoma, meningoradiculoneuritis (Garin-Bujadoux-Bannwarth syndrome), and acrodermatitis chronica atrophicans. The many other symptoms and signs have little diagnostic value. Microbial or serological confirmation of borrelial infection is needed for all manifestations of the disease except for typical early skin lesions. However, even erythema migrans might not be pathognomonic for Lyme borreliosis, especially in the southern part of the USA where there is no microbiological evidence for infection with the agent. Treatment with antibiotics is beneficial for all stages of Lyme borreliosis, but is most successful early in the course of the illness. Prevention relies mainly on avoiding exposure to tick bites but there is some interest in chemoprophylaxis and also in vaccine development following initial disappointments.
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Affiliation(s)
- Gerold Stanek
- Department of Hygiene and Medical Microbiology of the University Vienna, 1095 Wien, 15, Kinderspitalgasse, Austria.
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Schaarschmidt D, Oehme R, Kimmig P, Hesch RD, Englisch S. Detection and molecular typing of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks and in different patient samples from southwest Germany. Eur J Epidemiol 2003; 17:1067-74. [PMID: 12530764 DOI: 10.1023/a:1021286528058] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The prevalence of different genospecies of Borrelia burgdorferi sensu lato in infected ticks could be a determinant for the risk of acquiring Lyme borreliosis (LB) and its clinical presentation. A total of 7373 ticks and 2761 samples from LB patients from the same area in southwest Germany were analyzed by PCR to assess the frequency of the occurrence of LB-associated genospecies. Fifteen percent of the tick samples and 19% of the human samples were found positive for the presence of B. burgdorferi sensu lato. Further identification of 1106 B. burgdorferi sensu lato positive tick samples by reverse line blotting and 125 positive patient samples by nested PCR using species-specific primers revealed the occurrence of B. afzelii, B. burgdorferi sensu stricto, B. garinii and B. valaisiana. Both single-species and mixed infections were noted and a similar distribution of the different genospecies was found in ticks compared with human samples. It was also the purpose of this study to obtain more information about a possible correlation between the distribution of Borrelia species and clinical syndromes of LB. Skin biopsies of 59 patients with acrodermatitis chronica atrophicans and cerebrospinal fluid samples from 78 patients with possible neuroborreliosis were analyzed. In conclusion, the distribution of the different genospecies in ticks is the decisive factor for the occurrence of the different Borrelia genospecies in samples from LB patients. Borrelia afzelii is the predominant genospecies in all kind of samples from the observed area and there seems to be no association of particular Borrelia genospecies with distinct clinical manifestations of LB.
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Affiliation(s)
- D Schaarschmidt
- Fachbereich Biologie, Universität Konstanz, Universitätsstrasse, Konstanz, Germany.
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Hajjar RJ, Kradin RL. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-2002. A 55-year-old man with second-degree atrioventricular block and chest pain. N Engl J Med 2002; 346:1732-8. [PMID: 12037154 DOI: 10.1056/nejmcpc020017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Lyme disease is a vector-borne illness that can affect numerous organ systems during the early disseminated phase, including the heart. The clinical course of Lyme carditis is usually benign with most patients recovering completely. In rare instances, death from Lyme carditis has been reported. The cardinal manifestation of Lyme carditis is conduction system disease, which generally is self-limited. Heart block occurs usually at the level of the atrioventricular node but often is unresponsive to atropine sulfate. Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement can occur but generally is mild and self-limited. Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, EM, or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea. Serologic studies and endomyocardial biopsy can support the diagnosis in the correct clinical setting, and MR imaging, echocardiography, and gallium scanning have utility in selected circumstances. No treatment has been shown clearly to attenuate or prevent the development of Lyme carditis, but mild carditis generally is treated with oral antibiotics and severe carditis with intravenous antibiotics in an effort to eradicate the infection and prevent late complications of Lyme disease. There is conflicting evidence regarding the role that B. burgdorferi plays in the development and progression of chronic congestive heart failure. Because of the significant false-positive ELISA rate in this population and the unclear benefit of antibiotic therapy, confirmatory Western blot analysis is recommended. Routine therapy and screening of patients with idiopathic dilated cardiomyopathy is of limited utility and should be reserved for patients with clear history of antecedent Lyme disease or tick bite.
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Affiliation(s)
- Duane S Pinto
- Harvard Medical School, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Abstract
Lyme carditis is an uncommon manifestation of infection with Borrelia bugdorferi. It is easily treated with standard antibiotic regimens and prognosis is excellent, especially if treatment is prompt. For symptomatic or higher degrees of block, patients may require hospitalization for monitoring and occasionally temporary external pacing. Intravenous antibiotics are warranted for such patients. For less severe conduction disturbances, oral therapy suffices.
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Affiliation(s)
- H Bateman
- Division of Rheumatology and Connective Tissue Research, MEB-484, University of Medicine and Dentistry-Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA. E-mail: ;
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Canver CC, Chanda J, DeBellis DM, Kelley JM. Possible relationship between degenerative cardiac valvular pathology and lyme disease. Ann Thorac Surg 2000; 70:283-5. [PMID: 10921726 DOI: 10.1016/s0003-4975(00)01452-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- C C Canver
- Division of Cardiothoracic Surgery, Albany Medical College, New York 12208, USA.
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Satoskar AR, Elizondo J, Monteforte GM, Stamm LM, Bluethmann H, Katavolos P, Telford SR. Interleukin-4-deficient BALB/c mice develop an enhanced Th1-like response but control cardiac inflammation following Borrelia burgdorferi infection. FEMS Microbiol Lett 2000; 183:319-25. [PMID: 10675604 DOI: 10.1111/j.1574-6968.2000.tb08978.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Interleukin-4 has been reported to critically modulate Borrelia burgdorferi infection and Lyme arthritis in experimental murine models. To determine the in vivo role of IL-4 in controlling Lyme carditis, we compared immunological responses and the severity of cardiac inflammation in wild-type BALB/c (IL-4 +/+) and IL-4 deficient BALB/c (IL-4 -/-) mice infected with B. burgdorferi by tick-bite. At day 15 and 30 post-infection IL-4 -/- mice produced significantly greater titers of spirochete-specific IgG2a than the wild-type IL-4 +/+ mice, which produced significantly more spirochete-specific IgG1. Following in vitro antigenic stimulation with B. burgdorferi antigen, splenocytes from infected IL-4 -/- and IL-4 +/+ mice displayed similar magnitudes of proliferative responses at day 15 and 30 post-infection. At day 30 antigen-stimulated splenocytes from infected IL-4 -/- mice, however, produced significantly more IFN-gamma than those derived from similarly infected IL-4 +/+ mice, suggesting that Th1-influenced responses predominated in IL-4 -/- mice. Moreover, inflamed hearts from IL-4 -/- mice displayed higher levels of IFN-gamma and TNF-alpha transcripts as compared to IL-4 +/+ mice. At both time points antigen-stimulated splenocytes from IL-4 +/+ and IL-4 -/- mice produced significant amounts of IL-10 but those from IL-4 +/+ mice produced either no or little IL-4. Histopathology demonstrated typical Lyme carditis in both IL-4 +/+ and IL-4 -/- mice at day 15 and day 30. Although Borrelia-infected IL-4 -/- mice developed a more severe carditis on day 30, the carditis resolved by day 50, as it did in IL4 +/+ mice. These results indicate that although IL-4 may help limit the severity of Lyme carditis, its absence does not preclude resolution of cardiac lesions.
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Affiliation(s)
- A R Satoskar
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 665 Huntington. Avenue, Boston, MA 02115, USA
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Blaauw AA, van Loon AM, Schellekens JF, Bijlsma JW. Clinical evaluation of guidelines and two-test approach for lyme disease. Rheumatology (Oxford) 1999; 38:1121-6. [PMID: 10556266 DOI: 10.1093/rheumatology/38.11.1121] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The diagnosis of Lyme disease should be based on objective clinical signs and symptoms. In a clinical study, we have evaluated whether the recommended two-step approach for serodiagnosis of Lyme disease is useful in daily clinical practice and can influence clinical decision making. METHODS The signs and symptoms of patients with ongoing musculoskeletal complaints, assumed by their referring physician or themselves to be attributable to active or chronic Lyme disease, and of patients diagnosed as having Lyme disease, were evaluated. On the basis of clinical evaluation only, patients were classified into three groups: previous Lyme disease, active Lyme disease and no Lyme disease. Antibodies to Borrelia burgdorferi were determined by means of an enzyme-linked immunosorbent assay (ELISA), followed, when positive, by immunoblotting. RESULTS One hundred and three patients (41 males and 62 females, mean age 48.7 yr) participated in the study. Of the 49 patients classified as previous Lyme disease, 25 (51%) had antibodies to B. burgdorferi. All 10 patients with active Lyme disease had positive antibodies and 12 of the 44 patients (27%) classified as no Lyme disease had positive antibodies. No statistically significant differences were found between the percentage of positive immunoblots from patients with previous Lyme disease (72%) and patients with active Lyme disease (100%). In the group of no Lyme disease, five out of 12 patients had a negative immunoblot. Concerning serological testing, immunoblotting could have added additional information. However, immunoblotting did not influence clinical decision making in this group of patients. CONCLUSION Immunoblotting did not influence clinical decision making for the 47 patients with antibodies to B. burgdorferi in this study.
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Affiliation(s)
- A A Blaauw
- Department of Rheumatology, University Medical Centre, 3508 GA Utrecht, The Netherlands
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Abstract
Musculoskeletal complaints and findings can be features of Lyme disease and can occur following treatment. Only with a good understanding of the pathogenesis of these problems can further evaluation and a proper therapeutic scheme be developed.
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Affiliation(s)
- L H Sigal
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA
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Liebisch G, Sohns B, Bautsch W. Detection and typing of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks attached to human skin by PCR. J Clin Microbiol 1998; 36:3355-8. [PMID: 9774593 PMCID: PMC105329 DOI: 10.1128/jcm.36.11.3355-3358.1998] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Live Ixodes ricinus ticks attached to humans residing in Germany were examined for borreliae by dark-field microscopy and PCR. Borrelia species were identified by 16S rRNA sequence analysis, which showed the presence of several species, some not yet defined, and a high prevalence of multiply infected ticks.
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Affiliation(s)
- G Liebisch
- Institute of Medical Microbiology, Hannover Medical School, Hannover, Germany
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Affiliation(s)
- L H Sigal
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA
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Selected Infectious Diseases. Fam Med 1998. [DOI: 10.1007/978-1-4757-2947-4_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- C Briant
- Emergency Department, Hunterdon Medical Center, Flemington, New Jersey, USA
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