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Lyme Carditis in Hospitalized Children and Adults, a Case Series
Richard V Shen1, Carol A McCarthy2, Robert P Smith1
1Division of Infectious Diseases, Maine Medical Center, Portland, Maine, USA.
Open Forum Infectious Diseases
|July 12, 2021
Summary
Early recognition of Lyme disease is crucial. This study found that Lyme carditis, a heart complication of Lyme disease, was often misdiagnosed in outpatient settings, delaying treatment for pediatric and adult patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pediatrics
Background:
- Lyme carditis is a rare but serious complication of Lyme disease.
- Understanding its presentation and outcomes in different age groups is important for clinical practice.
Purpose of the Study:
- To compare the presentation, management, and outcomes of Lyme carditis in pediatric versus adult populations.
- To identify factors contributing to delayed diagnosis and treatment.
Main Methods:
- Retrospective analysis of pediatric and adult patients hospitalized with Lyme carditis and heart block.
- Inclusion criteria: PR interval >300 ms and positive Lyme serologies.
- Data collected on medical history, clinical presentation, treatment, and outcomes.
Main Results:
- 30 patients (10 children, 20 adults) admitted for Lyme carditis.
- Most patients were male with no prior cardiac history.
- 41% had Lyme disease suspected in outpatient settings; only 12% received treatment.
- Children more frequently presented with disseminated erythema migrans and fever.
- Mobitz type 2 heart block more prevalent in adults; first-degree more in children.
- 27/30 patients improved heart block; 3 adults required pacemakers.
- One death occurred in the series.
Conclusions:
- Lyme carditis predominantly affects younger males.
- Many patients experience persistent heart block upon discharge.
- Delayed diagnosis and treatment in outpatient settings are common.
- Improved early recognition and management of Lyme disease could reduce Lyme carditis incidence.
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