The figure above shows a Warthin-Starry stain of cardiac tissue demonstrating
Borrelia burgdorferi spirochetes in one of three patients whose death
was associated with Lyme carditis during November 12-July 2013. Downloaded
from MMWR Morb Mortal Wkly Rep. 2013 Dec 13;62(49):993-6.
Borrelia burgdorferi, the organism which causes Lyme disease, infects the heart in an estimated
1% of patients. Lyme carditis is typically seen after an episode of the "summer flu"
which may be the initial manifestation of infection. Symptoms of carditis,
inflammation of the heart, tend to occur with the other manifestations
of disease - joint pains, rash, brain fog or other neurologic symptoms.
However in some patients a conduction defect - even complete heart block
- may be the only manifestation of infection with the
Common complaints when
Borrelia infects the heart range from no symptoms at all to palpitations, to severe
conduction abnormalities seen on EKG. There may be chest pain, heart dysfunction
because of inflammation, pericardial effusion (fluid surrounding the heart),
even congestive heart failure. The carditis is rarely fatal - although
a few fatalities have been reported.,
It is thought that the chief abnormality lies within the conduction system
of the heart as a direct effect of the
Borrelia spirochete, since the conduction defect does not appear to be responsive
to the usual pharmaceutical treatments for heart block. Temporary pacemakers
may be needed in about 35% of cases, and almost all cases resolve within
a few weeks, with the appropriate intravenous antibiotic therapy.,
Lyme carditis, downloaded from the CDC website "What you need to know
about Lyme carditis" 2/22/2014
Diagnosing Lyme carditis is just as difficult as diagnosing Lyme disease
itself. When there is historical evidence of Lyme disease (EM rash, tick
bit, arthritis, encephalitis or other manifestations of Lyme disease),
then the diagnosis is much easier. A positive ELISA test is helpful, a
positive Western Blot is helpful - but negative tests do not rule out
the diagnosis. Measurement of IgG and IgM antibodies to
Borrelia is helpful. Biopsy of the heart is not recommended, even though it might
Antibiotic therapy is generally effective - as with other manifestations
of Lyme disease - although the IDSA recommendations are almost certainly
inadequate for treatment of this chronic condition. Steroid treatment
is not recommended, as steroids may precipitate symptoms in joints or
the central nervous system.
The good news is that people generally recover from Lyme carditis, as long
as the Lyme disease and coinfections are treated.
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