carditis – F.I.G.H.T for your health!

Atrioventricular block in chronic Lyme disease

Linda — Wed, 20 Oct 2010 15:48:03 +0000

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20840915&retmode=ref&cmd=prlinks

Excerpt:

The tick bite transmitted Lyme disease is one of the most common
antropozoonosis, about 10 000 new infections are reported in
Hungary each year.
The progress and clinical presentation can vary, and carditis can
occur in later stages. A serologically verified Lyme disease
caused third degree atrioventricular block in young male
presenting with presyncope. Based on the tick-bites mentioned a
few weeks prior to hospital admission, Lyme carditis was
considered with the administration of antibiotics and monitor
observation.
Typical skin lesions were not recognized and laboratory findings
showed no pathology. An electrophysiological study recorded a
predominant supra-His atrioventricular block. Total regression of
conduction could be detected later and the serological tests
established an underlying Lyme disease. Currently no definite
treatment recommendation is available for the potentially
reversible Lyme carditis. The tick bite seemed to be the key on
our way to diagnosis; however, serological tests proved the
disease to be older than one year. A detailed medical history and
serological tests are essential in identifying the cause and
pacemaker implantation can be avoided. Orv. Hetil., 2010, 39,
1585-1590.

Antibody Testing for Early and Late Lyme Disease

Linda — Tue, 08 Dec 2009 06:28:47 +0000

Background.Standard 2‐tiered immunoglobulin G (IgG) testing has performed well in late Lyme disease (LD), but IgM testing early in the illness has been problematic. IgG VlsE antibody testing, by itself, improves early sensitivity, but may lower specificity. We studied whether elements of the 2 approaches could be combined to produce a second‐tier IgG blot that performs well throughout the infection.

Methods.Separate serum sets from LD patients and control subjects were tested independently at 2 medical centers using whole‐cell enzyme immunoassays and IgM and IgG immunoblots, with recombinant VlsE added to the IgG blots. The results from both centers were combined, and a new second‐tier IgG algorithm was developed.

Results.With standard 2‐tiered IgM and IgG testing, 31% of patients with active erythema migrans (stage 1), 63% of those with acute neuroborreliosis or carditis (stage 2), and 100% of those with arthritis or late neurologic involvement (stage 3) had positive results. Using new IgG criteria, in which only the VlsE band was scored as a second‐tier test among patients with early LD (stage 1 or 2) and 5 of 11 IgG bands were required in those with stage 3 LD, 34% of patients with stage 1, 96% of those with stage 2, and 100% of those with stage 3 infection had positive responses. Both new and standard testing achieved 100% specificity.

Conclusions.Compared with standard IgM and IgG testing, the new IgG algorithm (with VlsE band) eliminates the need for IgM testing; it provides comparable or better sensitivity, and it maintains high specificity.

Received 27 May 2009; accepted 10 August 2009; electronically published 30 November 2009.

Reprints or correspondence: Dr. John A. Branda, Clinical Microbiology Laboratory, GRB 526, Massachusetts General Hospital, Boston, MA 02114 (branda.john@mgh.harvard.edu).

Presented in part: 45th Annual Meeting of the Infectious Diseases Society of America, San Diego, CA, 4-7 October 2007; and 11th International Conference on Lyme Borreliosis and Other Tick‐Borne Diseases, Irvine, CA, 19-22 October 2008.

http://www.journals.uchicago.edu/doi/abs/10.1086/648674 Clinical Infectious Diseases 2010;50:000-000 © 2009 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2010/5001-00XX$15.00 DOI: 10.1086/648674 MAJOR ARTICLE

2‐Tiered Antibody Testing for Early and Late Lyme Disease Using Only an Immunoglobulin G Blot with the Addition of a VlsE Band as the Second‐Tier Test

John A. Branda,¹

Maria E. Aguero‐Rosenfeld,^3,4

Mary Jane Ferraro,^1,2

Barbara J. B. Johnson,⁵

Gary P. Wormser,⁴ and

Allen C. Steere²

Departments of ¹Pathology and ²Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Departments of ³Pathology and ⁴Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, New York; ⁵Division of Vector‐Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado

Lyme Carditis in Children Usually Transient but Can Be Life Threatening

Linda — Sun, 06 Dec 2009 04:34:34 +0000

Lyme Carditis in Children Usually Transient but Can Be Life Threatening

NEW YORK (Reuters Health) May 01 – Manifestations of Lyme carditis in children can range from asymptomatic first-degree heart block to fulminant myocarditis, physicians at Harvard Medical School report in the May issue of Pediatrics. Data from their case series indicate that older age, arthralgia, and cardiopulmonary symptoms were independent predictors of carditis in pediatric patients with early disseminated Lyme disease.

In untreated Lyme disease, signs and symptoms of early dissemination may manifest within weeks to months of a tick bite, Dr. John M. Costello and co-investigators note. To characterize the clinical course of Lyme carditis in children, they reviewed cases of 207 children treated between 1994 and 2008 for early disseminated Lyme disease.

Records showed that 33 (16%) had carditis, along with a wide range of systemic involvement. According to the Boston-based research team, only one patient presented with isolated carditis and no erythema migrans or noncardiac systemic manifestations. Duration of hospitalization ranged from 1 to 13 days, and there were no deaths.

Fourteen patients had advanced heart block, including 9 with complete block, but recovery of sinus rhythm took no more than 7 days.

In addition, among the 33 patients with carditis, 4 had depressed ventricular systolic function and 3 of them required mechanical ventilation, temporary pacing, and inotropic support.

Analysis showed that significant independent predictors of Lyme carditis were age over 10 years (adjusted odds ratio 8.3), arthralgias (OR 5.8), and cardiopulmonary symptoms (OR 76.8). Sensitivity and specificity of cardiopulmonary symptoms for Lyme carditis were 42% and 99%, respectively.

Of 27 patients for whom follow-up data were available, complete recovery occurred in 24. One patient had ongoing second-degree atriventricular block at 2.7 years. The other 2 patients had improved but still had mildly prolonged PR intervals at short-term follow-up.

Thus, Dr. Costello’s group states, “A full recovery should be expected with supportive care and antibiotic therapy.” However, they point out that 6 patients had prolonged corrected QT intervals and advise physicians “to avoid drugs that prolong the QT interval in these patients until the electrocardiogram has normalized.”

Pediatrics 2009;123:e835-e841.