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[Acute myocarditis and cardiomyopathy in Lyme borreliosis]
N Scheffold1, C Sucker, J Bergler-Klein
1Medizinische Klinik I Schwerpunkt Kardiologie Klinikum Heilbronn Akademisches Lehrkrankenhaus der Universität Heidelberg Am Gesundbrunnen 20-24 D-74078 Heilbronn. Norbert-Scheffold@t-online.de
Insights
Lyme disease can affect the heart, causing Lyme carditis or chronic heart muscle issues. Early antimicrobial treatment may improve heart function in patients with Borrelia burgdorferi-associated dilated cardiomyopathy.
Area of Science:
- Infectious Diseases
- Cardiology
- Medical Microbiology
Context:
- Heart involvement in Lyme borreliosis affects 4-10% of patients.
- Acute Lyme carditis presents as transient conduction disorders, pericarditis, or myocarditis.
- Laboratory diagnostics for Lyme disease have variable sensitivity and specificity.
Purpose:
- To review the cardiac manifestations of Lyme disease.
- To discuss the association between chronic Borrelia burgdorferi infection and dilated cardiomyopathy.
- To evaluate the impact of antimicrobial treatment on Lyme carditis and chronic myocarditis.
Summary:
- Lyme carditis is typically acute and self-limiting, but chronic Borrelia burgdorferi infection is increasingly linked to dilated cardiomyopathy.
- Studies indicate a higher prevalence of Borrelia burgdorferi antibodies in heart failure patients from endemic areas.
- Isolation of spirochetes from the myocardium supports Borrelia burgdorferi as a cause of chronic heart muscle disease.
Impact:
- Antimicrobial treatment has shown promise in improving left ventricular function in Borrelia burgdorferi-associated dilated cardiomyopathy.
- The duration of dilated cardiomyopathy prior to treatment is a critical factor influencing clinical outcomes.
- Further research is needed to fully evaluate diagnostic criteria and treatment protocols for Lyme carditis and chronic Lyme-induced heart disease.
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.