More on the sudden deaths of 3 young people in the Northeast

LYME DISEASE - USA (05): CARDITIS, FATAL

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A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases

<http://www.isid.org>

Date: Fri 13 Dec 2013

Source: Fox News [edited]

<http://www.foxnews.com/health/2013/12/13/sudden-deaths-3-young-people-attributed-to-lyme-disease-cdc-says/>

The sudden deaths of 3 young people in the Northeast [of the USA] have

been attributed to complications of Lyme disease, Boston.com

reported.

According to the Centers for Disease Control and Prevention (CDC) [1],

each of the fatalities resulted from undetected heart inflammation --

also known as carditis -- caused by the tick-borne illness. About one

percent of Lyme disease sufferers develop carditis, which is typically

treatable with antibiotics or, in some cases, a pacemaker.

According to medical reports, only 4 other deaths can be attributed to

heart inflammation caused by Lyme disease. While the illness is a

growing problem in the Northeast, the CDC says that deaths related to

the disease are still rare, Boston.com reported.

The victims in the CDC's report were not identified, but each of the

deaths occurred between November 2012 and July 2013. The deceased were

between 26 and 38 years old. None of the victims had been diagnosed

with Lyme disease prior to their deaths.

One of the victims died in a car accident after his car veered off the

road. The victim was an organ donor, and the inflammation around his

heart was discovered during a pathology exam. It is believed he went

into cardiac arrest while driving, Boston.com reported. The other 2

victims also died after seemingly unexplainable collapses.

Medical professionals say these deaths should bring new urgency to the

search for a Lyme disease vaccine. "I think it is unconscionable and a

discredit to all parties -- public health, manufacturers, Lyme

activists -- that no Lyme vaccine is available to humans while there

is one for dogs," Stanley Plotkin, emeritus professor of pediatrics at

the University of Pennsylvania and a vaccine expert, told Boston.com

in an email.

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ProMED-mail from HealthMap Alerts

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[Reference

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1. CDC: Morbidity and Mortality Weekly Report Weekly. Three Sudden

Cardiac Deaths Associated with Lyme Carditis -- United States,

November 2012-July 2013. MMWR 2013; 62(49): 993-6. Available at

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm>.

Lyme carditis is a manifestation of early disseminated Lyme disease,

which results in secondary skin lesions and extracutaneous

manifestations that occurs during the initial weeks to months of

infection. Symptoms related to this stage occur in at least 50 percent

of all untreated patients. Carditis has been reported in up to 10

percent of cases of Lyme disease and can cause life-threatening

cardiac conduction abnormalities that can result in sudden death. The

diagnosis is made primarily on clinical grounds and confirmed by

serologic testing. Patients who have severe heart block with

hemodynamic instability frequently need placement of a temporary

cardiac pacemaker. The cardiac conduction block resolves completely

with antibiotic treatment.

The recent CDC publication, which the news release above refers to

(reference 1 above), describes 3 individuals who experienced sudden

cardiac death during November 2012-July 2013 and were found to have

evidence of Lyme carditis on postmortem examination. To quote from

this article (references omitted, available from the original

article):

"_Borrelia burgdorferi_ has been shown to affect all layers of the

heart, but tends to spare the great vessels and heart valves.

Inflammation is characteristically diffuse, perivascular,

lymphohistiocytic, and plasma cell-rich. Spirochetes can be found

within the myocardial cellular infiltrates; IHC [immunohistochemistry]

and PCR [polymerase chain reaction] testing can provide additional

evidence of infection. Although Lyme carditis usually is present in

conjunction with other features of the disease, such as erythema

migrans, arthritis, or neurologic disease, it can be observed

independently. The most common cardiac manifestation is

atrioventricular block, which can fluctuate between 1st, 2nd, and 3rd

degree. 2nd-degree or 3rd-degree atrioventricular block occurs in

approximately 0.8 percent of all Lyme disease cases reported to CDC.

Symptoms of atrioventricular block, including lightheadedness,

palpitations, shortness of breath, chest pain, and syncope can occur 4

days to 7 months after onset of disease, with a median of 21 days.

With appropriate therapy, prognosis is excellent, and signs of cardiac

involvement typically resolve within 1-6 weeks, depending on the

degree of conduction disturbance. Some cases of complete heart block

might require temporary pacing."

For discussions of Lyme disease in the US, see prior ProMED-mail

posts: Lyme disease - USA (04): underreporting 20130822.1894924; Lyme

disease - USA (03): (NY) increased incidence 20130513.1710851; Lyme

disease - USA: (PA, NJ) increased incidence 20120423.1111304; Lyme

disease - USA (03): (WI), human, canine 20110618.1867; Lyme disease -

USA (02): (PA) background 20110606.1727; and Lyme disease - USA: (PA,

WI) increased incidence 20110603.1694.

For pictures of ticks and erythema migrans lesions characteristic of

Lyme disease, see

<http://cid.oxfordjournals.org/content/43/9/1089.full> and

<http://www.cdc.gov/lyme/>. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at:

<http://healthmap.org/r/1hiS>.]