Borrelia infection as a cause of carditis (a long-term study).

December 6, 2009

Bartunek P, Mrazek V, Gorican K, Bina R, Listvanova S, Zapletalova J.

Department of Internal Medicine IV, Charles University School of Medicine

I, Prague, Czech Republic.

BACKGROUND: Although the frequency of Lyme carditis is not high, it is one

of the most challenging conditions in terms of diagnosis. No long-term

studies that would help expand our body of knowledge concerning the

circumstances of its development and the natural course of this form of Lyme

borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have

been

reported to date. AIM: The authors sought to describe and assess the

consequences of a less common form of Lyme carditis (LC). An assessment of the

following aspects was made: a) the forms, natural history and sequelae of

the less common clinical appearances of LC, b) the role of antibiotic therapy

with reference to the late manifestations of LB. METHODS: Three patients

were selected from a group of 60 consecutive patients with demonstrated LC

during a follow-up period from 1987 to 2000. Patient no. 1 was being

followed for myocarditis with frequent ventricular extrasystoles, patient no. 2

for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late

manifestation of LB. In addition to routine examination at entry, the patients

were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG

monitoring, exercise testing (bicycle ergometry), investigations of antibodies

using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests)

and mineral levels. RESULTS: The study showed no significant correlation

between the clinical course and levels of specific antibodies. It confirmed

the concept that inadequate or no therapy with antibiotics in the initial

stage of the disease has a significant effect on the development of late

sequelae. CONCLUSION: Based on the long-term treatment of three patients with

less common, yet clinically urgent findings, the authors conclude that even

a relatively serious clinical course is associated with no major

limitations for affected individuals after an interval of several years.

PMID: 11233466

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