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.
AimsRecent studies in patients with dilated cardiomyopathy (DCM) have detected the genome of Borrelia burgdorferi sensu lato (BBSL) in endomyocardial biopsy (EMB) specimens using a qualitative polymerase chain reaction (PCR), suggesting a causal link between Lyme disease and DCM in areas in which Lyme disease is endemic. We aimed to study this relationship using a comprehensive molecular analysis detecting BBSL in EMB samples. Methods and resultsWe performed a comprehensive histopathological, immunohistochemical, ultrastructural, and molecular analysis targeting cardiotropic viruses and BBSL in EMB specimens of 41 individuals with recent-onset DCM and 15 controls with end-stage coronary artery disease. Specifically, quantitative PCR and electron microscopy of EMB specimens were employed. In addition, autoantibodies and manifestation of autoimmune diseases were evaluated in both groups. Individuals with recent-onset DCM presented more frequently with myocardial BBSL persistence as compared with the control group (24% vs. 0%, P ¼ 0.035). In contrast, the prevalence of parvovirus B19 and cytomegalovirus was similar in both groups. Sequence analysis of borrelial DNA revealed the following genospecies: Borrelia burgdorferi sensu stricto in three patients (30%), Borrelia afzelii in two patients (20%), and Borrelia garinii in four patients (40%), the results being inconclusive in one case. BBSL-positive DCM patients had a higher prevalence of organ-specific autoimmune diseases in comparison with the remaining DCM patients (50% vs. 16%, P ¼ 0.030).
We developed a nested PCR assay that detects the recA gene of the Burkholderia cepacia complex in sputum. The product of the first PCR round is also used to identify the genomovar of the pathogen. The protocol achieves high sensitivity and specificity with simple interpretation of genomovar status.Burkholderia cepacia is a multiresistant and transmissible opportunistic pathogen that frequently impairs the clinical state of patients with cystic fibrosis (CF) (1,3,9,10 (5). To reduce the probability of BCC spreading among patients with CF, a reliable early test that detects small quantities of the bacteria in clinical samples is needed. Conventional microbiological diagnostics of the BCC based on the results of culture and subsequent biochemical identification is insufficient for this purpose because of the potential risk of misidentification or false negativity (7). Moreover, these methods are not able to reliably distinguish the genomovars of the BCC (21).To increase the sensitivity and specificity of diagnostic routines and to identify the genomovars, use of molecular genetic methods is inevitable. Two target genes are commonly used for BCC analysis: the 16S rRNA gene (11,19,20) and the recA gene (13, 16). The recA gene polymorphisms enable both differentiation of the BCC from other closely related bacteria and its sorting into genomovars. Moreover, the differences in the recA sequences within genomovar III led to the establishment of two recA clusters designated III-A and III-B.The present study sought (i) to develop a rapid diagnostic method for early detection of BCC organisms and determination of their genomovars directly from sputum and (ii) to assess the occurrence of the BCC genomovars in Czech patients with CF.From May 2001 to April 2002, we collected 211 sputum samples from 134 consecutive CF patients attending the Prague CF center (55 males, 79 females; age range, 0 to 33 years). All samples were examined for the presence of the BCC by culture and our novel PCR protocol. For cultivation, specimens were liquefied with a homogenization solution (0.9% NaCl, 50 mM KH 2 PO 4 , 35 mM NaOH, 1% N-acetyl-L-cysteine), shaken for 20 min at 800 rpm, and cultured on blood, chocolate, Endo, Sabouraud, and MacConkey agars. The last 53 samples were also cultured on the selective B. cepacia agar (Oxoid, Basingstoke, United Kingdom) that came into use during the study. All of the BCC isolates were identified by the API 20 NE system (Biomerieux, Marcy l'Etoile, France) in accordance with the supplier's protocol. For PCR analysis, sputum was mixed with an equal volume of the homogenization solution and shaken for 1 h at 800 rpm. DNA was extracted from 100 l of liquefied sputum with the AMPLICOR Respiratory Specimen Preparation Kit (Roche, Indianapolis, Ind.) in accordance with the manufacturer's instructions. To check the DNA content in extraction aliquots, real-time PCR quantitation of the human albumin gene as an equivalent of the human DNA content was done on an ABI 7700 system (Applied Biosystems, Foster City, Calif....
Chronic inflammation has been implicated as the underlying mechanism responsible for the pathophysiology of preterm labour. Mannose-binding lectin (MBL) plays a central role in the innate immune response and is thus an important component of the first line of defense. The aim of this study was to investigate whether serum concentrations of MBL correlated with the incidence of preterm birth and low birthweight in a cohort of women with signs of threatened preterm birth. A cohort of 60 patients who presented with regular contractions and/or short cervix (group A) between 24 and 32 weeks of gestation and 20 healthy controls (group B) who had no pregnancy complications and delivered at term were recruited into a prospective study. The following outcomes were recorded: presence of preterm labour and birthweight in all patients. MBL and high sensitivity C-reactive protein levels were measured in all serum samples. The serum concentrations of MBL were significantly reduced in patients with threatened preterm labour (Group A), compared to the control Group B. Furthermore, infants born to Group A mothers with MBL deficiency (n = 13, MBL ≤100 ng/mL) had significantly lower birthweights, compared to those born to Group A women with normal MBL serum concentrations (P < .0001). Our small cohort study demonstrated a strong association between MBL deficiency and preterm delivery, and associated low birthweight. MBL deficiency could thus be considered an important risk factor for preterm birth.
Inflammatory dilated cardiomyopathy (DCMi) represents an acquired form of dilated cardiomyopathy. Viral infection is the most common cause of DCMi. In contrast with other cardiotropic viruses, herpes simplex virus (HSV) is a very rare finding in endomyocardial biopsies of patients with dilated cardiomyopathy. We report a case of HSV-induced cardiomyopathy successfully treated with acyclovir.
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