Sunday, January 19, 2014

Heart Inflammation Linked to Lyme Disease in Three Deaths

A recent Morbidity and Mortality Weekly Report (MMWR) from the CDC discusses a recent outbreak of Lyme associated carditis. During November 2012 - July 2013, one woman and two men (age range 26-38) from states with high incidence of Lyme disease experienced sudden cardiac death. Diagnosis was confirmed post-mortem.

The three deaths were investigated by CT, MA, NH, and NY Public Health Departments, as well as the 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.

Death from Lyme carditis is extremely rare, however it should be considered in events of sudden cardiac death in patients from high-incidence Lyme regions.

Typical presentation of bull's eye rash associated with Lyme disease
Lyme disease is a systemic illness caused by Borrelia burdorferi, a spirochete transmitted by Ixodes tick species. There were approximately 30,000 confirmed and probable cases of Lyme disease reported in the United States in 2012, primarily from CT, DE, ME, MD, MA, NH, NJ, NY, PA, RI, VT, MN, and WI. Common manifestations include cutaneous (bull's eye rash), neurologic, and rheumatologic signs and symptoms. Lyme infections causing symptomatic infection of the heart is extremely rare, and will usually resolve with proper antibiotic therapy.

The detailed case reports of each of the three patients is available via the MMWR here. Briefly, it was found that two of the three patients had minor underlying heart conditions (hypertension, atherosclerosis, and Wolff-Parkinson-White syndrome which is a cardiac conduction abnormality) and did not present with the traditional bull's eye rash.

Two of the patients were found responsive, unfortunately the third patient had seen a physician one day prior to death and was prescribed clonazepam for anxiety (no EKG was performed, no antibiotics were prescribed).

Pathologically when observing Lyme associated carditis, diffuse, mixed, perivascular lymphoplasmacytic (primarily lymphocytes and plasma cells) infiltrates will be observed on examination of heart tissue. Immunohistochemistry, PCR, Warthin-Starry stain, Enzyme Immuno Assay, or and Western blot for bands at (23, 41, 58, and 66 kDa).

Adult deer tick - Ixodes scapularis
Lyme disease is a nationally notifiable disease and any suspected case of Lyme carditis should be reported to local or state public health authorities. Health-care providers should ask suspected Lyme patients about cardiac symptoms and obtain and EKG. Health-care providers should also ask patients with unexplained heart block about possible exposure to ticks.

Lance D. Presser has a PhD in Microbiology and Immunology and currently is a Public Health Laboratorian

Hire Lance as a consultant using Zintro.

1 comment:

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