Presence of Borrelia burgdorferi in endomyocardial biopsies in patients with new

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: Med Microbiol Immunol. 2010 Jan 6; [Epub ahead of print]

 

Presence of Borrelia burgdorferi in endomyocardial biopsies in patients

with

new-onset unexplained dilated cardiomyopathy.

 

Palecek T, Kuchynka P, Hulinska D, Schramlova J, Hrbackova H, Vitkova I,

Simek

S, Horak J, Louch WE, Linhart A.

 

1st Medical Faculty, 2nd Medical Department - Clinical Department of

Cardiology

and Angiology, Charles University of Prague, Prague, Czech Republic,

tpalec.

 

Dilated cardiomyopathy (DCM) represents the third most common cause of

heart

failure and the most frequent cause of heart transplantation. Infectious,

mostly

viral, and autoimmune mechanisms, together with genetic abnormalities,

have been

reported as three major causes of DCM. We hypothesized that Lyme disease

(LD),

caused by spirochete Borrelia burgdorferi (Bb), might be an important

cause of

new-onset unexplained DCM in patients living in a highly endemic area for

LD

such as the Czech Republic.

 

We performed endomyocardial biopsy (EMB) in 39

consecutive patients presenting with symptomatic unexplained left

ventricular

(LV) systolic dysfunction lasting no more than 12 months. In eight subjects

(21%), Bb was detected in the EMB sample by polymerase chain reaction or by

electron microscopy. None of these patients exhibited any form of

atrioventricular block or other extracardiac manifestation of Bb infection.

 

Serological testing identified IgG antibodies against Bb in only two cases

and

IgM antibodies in none. All affected patients were treated with

intravenous

ceftriaxone for 3 weeks. At 6 months follow-up, LV morphology and function

as

well as functional status of these patients significantly improved.

 

In conclusion, Bb infection may represent an important cause of new-onset

unexplained DCM in patients living in endemic regions such as the Czech

Republic. Because the antibiotic treatment appears to be markedly

effective and

serological examination does not provide a tool for diagnosing the

disease, EMB

focused on the detection of Bb should be performed in all patients from

endemic

areas with new-onset unexplained DCM not responding to conventional

therapy.

 

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PMID: 20052487 [PubMed - as supplied by publisher]