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Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac
Insights
Lyme carditis, a serious complication of Lyme disease, disproportionately affects younger men and older adults. This cardiac condition requires prompt diagnosis and treatment to prevent severe outcomes.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health Surveillance
Background:
- Lyme disease is a tick-borne illness with potential cardiac complications, known as Lyme carditis.
- Previous reports highlighted sudden cardiac death linked to Lyme carditis, prompting further investigation.
Purpose of the Study:
- To investigate demographic disparities in Lyme carditis cases.
- To determine the mortality rate associated with Lyme disease and Lyme carditis.
- To identify additional deaths potentially linked to Lyme carditis.
Main Methods:
- Analysis of Lyme disease case reports submitted to the Centers for Disease Control and Prevention (CDC) between 2001-2010.
- Inclusion of clinical information, specifically Lyme carditis, defined as atrioventricular conduction block.
- Comparison of demographic data between patients with and without Lyme carditis.
Main Results:
- Over 1.1% of reported Lyme disease cases (1,876 out of 174,385 with clinical info) were identified as Lyme carditis.
- The median age for Lyme carditis patients was 43, with 65% being male, a significantly higher proportion than other Lyme disease manifestations.
- Carditis was more prevalent in men aged 20-39, women aged 25-29, and individuals aged 75 and older compared to the 55-59 age group.
Conclusions:
- Lyme carditis exhibits distinct demographic patterns, with higher incidence in specific younger adult and older adult age groups, and a notable male predominance.
- Understanding these demographic trends is crucial for targeted surveillance and prevention efforts for Lyme disease complications.
- Further research may be needed to fully elucidate the mechanisms and risk factors contributing to Lyme carditis in these populations.
Abstract:
On December 13, 2013, MMWR published a report describing three cases of sudden cardiac death associated with Lyme carditis. State public health departments and CDC conducted a follow-up investigation to determine 1) whether carditis was disproportionately common among certain demographic groups of patients diagnosed with Lyme disease, 2) the frequency of death among patients diagnosed with Lyme disease and Lyme carditis, and 3) whether any additional deaths potentially attributable to Lyme carditis could be identified. Lyme disease cases are reported to CDC through the Nationally Notifiable Disease Surveillance System; reporting of clinical features, including Lyme carditis, is optional. For surveillance purposes, Lyme carditis is defined as acute second-degree or third-degree atrioventricular conduction block accompanying a diagnosis of Lyme disease. During 2001-2010, a total of 256,373 Lyme disease case reports were submitted to CDC, of which 174,385 (68%) included clinical information. Among these, 1,876 (1.1%) were identified as cases of Lyme carditis. Median age of patients with Lyme carditis was 43 years (range = 1-99 years); 1,209 (65%) of the patients were male, which is disproportionately larger than the male proportion among patients with other clinical manifestations (p<0.001). Of cases with this information available, 69% were diagnosed during the months of June-August, and 42% patients had an accompanying erythema migrans, a characteristic rash. Relative to patients aged 55-59 years, carditis was more common among men aged 20-39 years, women aged 25-29 years, and persons aged ≥75 years.
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