Friday, May 1, 2015

Seven Studies on Lyme Carditis

Here are seven studies on deaths by heart damage caused by or associated with Lyme disease. 

Centers for Disease Control and Prevention

Three Sudden Cardiac Deaths Associated with Lyme Carditis —United States, November 2012–July 2013


December 13, 2013 / 62(49);993-996

Lyme disease* is a multisystem illness caused by Borrelia burgdorferi, a spirochete transmitted by certain species of Ixodes ticks. Approximately 30,000 confirmed and probable cases of Lyme disease were reported in the United States in 2012, primarily from high-incidence states in the Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) and upper Midwest (Minnesota and Wisconsin) (1,2). Common manifestations include cutaneous, neurologic, and rheumatologic signs and symptoms. Symptomatic infection of the heart is rare in recognized Lyme disease cases and usually resolves promptly with appropriate antibiotic therapy. Nonetheless, cardiac involvement occasionally can cause life-threatening cardiac conduction abnormalities. During November 2012–July 2013, one woman and two men (ranging in age from 26 to 38 years) from high-incidence Lyme disease states experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis. The three deaths were investigated by the Connecticut Department of Public Health, Massachusetts Department of Public Health, New Hampshire Department of Public Health, New York State Department of Health, and CDC. Donated corneas from two decedents had been transplanted to three recipients before the diagnosis of Lyme disease was established, but no evidence of disease transmission was found. Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions. Reducing exposure to ticks is the best method for preventing Lyme disease and other tickborne infections.§




Lyme disease: A case report of a 17-year old male with fatal Lyme carditis


E. Yooncorrespondence, E. Vail, G. Kleinman, P.A. Lento, S. Li, G. Wang, R. Limberger, J.T. Fallon


Received: February 8, 2015; Received in revised form: March 15, 2015; Accepted: March 16, 2015; Published Online: March 21, 2015


Department of Pathology, WestchesterMedical Center and New York MedicalCollegeValhallaNYUSA



Lyme disease is a systemic infection commonly found in the northeastern, mid-Atlantic and north-central regions of theUnited States. Of the many systemic manifestations of Lyme disease, cardiac involvement is uncommon and rarely causes mortality. We describe a case of a 17-year-old adolescent who died unexpectedly after a 2-week viral-like syndrome. Postmortem examination was remarkable for diffuse pancarditis characterized by extensive infiltrates of lymphocytes and focal interstitial fibrosis. In the cardiac tissue, Borrelia burgdorferi was identified via special stains, immunohistochemistry and PCR. The findings support Borrelia burgdorferi as the causative agent for his fulminant carditis and that the patient suffered fatal Lyme carditis. Usually, Lyme carditis is associated with conduction disturbances and is a treatable condition. Nevertheless, few cases of mortality have been reported in the literature. Here, we report a rare example of fatal Lyme carditis in an unsuspected patient.



Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node.


N. R. CaryB. FoxD. J. WrightS. J. CutlerL. M. Shapiro, and A. A. Grace

Author information ► Copyright and License information ►

This article has been corrected. SeePostgrad Med J. 1990 March; 66(773): 258.

This article has been cited by other articles in PMC.


A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.



Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Demonstration of spirochetes in the myocardium.


A 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. Because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed Babesia microti in 3% of his erythrocytes. Eighteen hours later, he died unexpectedly. Autopsy showed pancarditiswith a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. Antibody titers to both theLyme disease spirochete Borrelia burgdorferi and Babesia microti were elevated. The finding of spirochetes in the myocardium and the elevated antibody titers to Borrelia burgdorferi suggest that the patient died from cardiac involvement of Lyme disease.



Lyme borreliosis as a cause of myocarditis and heart muscle disease.

Klein JStanek GBittner RHorvat R,Holzinger CGlogar D.


Dept. of Cardiology, University of Vienna,Austria.


Lyme borreliosis (LB) is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the joints, heart and other organs. The aetiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB were first described, including acute conduction disorders, atrioventricular block, transient left ventricular dysfunction and even cardiomegaly. Pathohistological examination showed spirochaetes in cases of acute perimyocarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dilated cardiomyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia burgdorferi. On ELISA, 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochaetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease.




Cardiac Lyme disease - case report - A Fatality confirmed with Autopsy PCR study


Postmortem confirmation of Lyme carditis with polymerase chain reaction.

Fabio Tavora, Allen Burke, Ling Li, Teri J Franks, Renu Virmani in Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology


Fabio Tavora ; Allen Burke ; Ling Li ; Teri J. Franks ; Renu Virmani


Background: Cardiac involvement in Lyme disease is uncommon and typically manifests clinically by conduction disturbances. Postmortem identification of Borrelia burgdorferi has never been reported in a case of Lyme carditis. Methods and Results: We describe the case of a 37-year-old Caucasian man with a 1-month history of fevers, rash, and malaise who died unexpectedly on the day after he underwent medical evaluation. The only clinical cardiac abnormality found was that of second-degree atrioventricular block. At autopsy, a diffuse carditis, characterized by infiltrates of macrophages, lymphocytes, and eosinophils and primarily in an interstitial, endocardial, and perivascular distribution, was found. Serologic testing from blood drawn on the day before his death demonstrated IgG and IgM antibodies against B. burgdorferi, confirmed by Western blot. Postmortem polymerase chain reaction (PCR) performed in myocardial tissue amplified B. burgdorferi DNA encoding outer-surface protein A. Conclusions: Lyme carditis should be considered in the differential diagnosis of interstitial myocarditis with mixed inflammatory infiltrates. This diagnosis can be confirmed by PCR testing. © 2008 Elsevier Inc. All rights reserved.




Unclassified cardiomyopathy or Lyme carditis? A three year follow-up.

Authors: Konopka M, Kuch M, Braksator W, Walczak E, Jakuciń ski M, 
Lipowski D, Dłuż niewski M

Citation: Kardiol Pol 2013; 71(3): 283-5.

Location: Medical University

DOI: 10.5603/KP.2013.0043



Lyme carditis can be a clinical manifestation of the early disseminated stage of Lyme disease caused by the tick-transmitted pathogen Borrelia burgdorferi. We present the case of a 41 year-old Caucasian woman referred to our hospital with symptoms of fatigue, progressive exertional dyspnoea, supraventricular cardiac arrhythmia, and an enlarged heart revealed on chest radiography. Following an untypical result of transthoracic echocardiography, cardiac magnetic resonance was performed. This showed structural cardiac changes and focus of late gadolinium enhancement in the midwall of the apex region. Further diagnostic processes, including endomyocardial biopsy and serology tests, made it possible to diagnose Lyme carditis. Clinical observation was followed-up for three years.


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