Sunday, December 15, 2013

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

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 13 Dec 2013
Source: Fox News [edited]

The sudden deaths of 3 young people in the Northeast [of the USA] have
been attributed to complications of Lyme disease,

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, 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, 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
in an email.

Communicated by:
ProMED-mail from HealthMap Alerts

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

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

"_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
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<>. - Mod.ML

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

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