Complete AV block in Lyme carditis: an important differential diagnosis

Semmler, Dominik; Blank, Robert; Rupprecht, Hans‐Jürgen

doi:10.1007/s00392-010-0152-8

Cited by 19 publications

(13 citation statements)

References 23 publications

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“…Temporary pacemaker insertion is indicated for patients with acute myocarditis who present with symptomatic atrioventricular (AV) block II or III. Lyme carditis patients can have varying degrees of AV conduction abnormalities (75). Persistent AV block III is rare, but necessitates permanent pacing.…”

Section: Nonsteroidal Anti-inflammatory Drugs and Colchicinementioning

confidence: 99%

Update on Myocarditis

Kindermann¹,

Barth²,

Mahfoud³

et al. 2012

Journal of the American College of Cardiology

806

741

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Myocarditis is an inflammatory disease of the heart frequently resulting from viral infections and/or post-viral immune-mediated responses. It is one of the important causes of dilated cardiomyopathy worldwide. The diagnosis is presumed on clinical presentation and noninvasive diagnostic methods such as cardiovascular magnetic resonance imaging. Endomyocardial biopsy remains the gold standard for in vivo diagnosis of myocarditis. The therapeutic and prognostic benefits of endomyocardial biopsy results have recently been demonstrated in several clinical trials. Although remarkable advances in diagnosis, understanding of pathophysiological mechanisms, and treatment of acute myocarditis were gained during the last years, no standard treatment strategies could be defined as yet, apart from standard heart failure therapy and physical rest. In severe cases, mechanical support or heart transplantation may become necessary. There is some evidence that immunosuppressive and immunomodulating therapy are effective for chronic, virus-negative inflammatory cardiomyopathy. Further investigations by controlled, randomized studies are needed to definitively determine their role in the treatment of myocarditis.

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Section: Nonsteroidal Anti-inflammatory Drugs and Colchicinementioning

confidence: 99%

Update on Myocarditis

Kindermann¹,

Barth²,

Mahfoud³

et al. 2012

Journal of the American College of Cardiology

806

741

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“…Another 34 articles were removed for: not in English, not a case report/series, or not reporting high‐degree AVB . The final 74 articles reported on 88 cases relevant to this study ).…”

Section: Resultsmentioning

confidence: 99%

Suspicious index in Lyme carditis: Systematic review and proposed new risk score

Besant

Wan

Yeung

et al. 2018

Clinical Cardiology

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Background Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high‐degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder. Hypothesis The likelihood that a patient's high‐degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool. Methods A systematic review of all published cases of LC with high‐degree AVB, and five cases from the authors' experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review. Results Of the 88 cases included, 51 (58%) were high‐risk, 31 (35.2%) intermediate‐risk, and 6 (6.8%) low‐risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that reported on all SILC variables, 24 (75%) cases were classified as high‐risk, 8 (25%) intermediate‐risk, and 0 low‐risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment. Conclusion The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high‐degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.

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“…Carditis is a common clinical feature of Lyme disease, with physical symptoms and medical complications linked to untreated infections (7,12,66). As SH100/pBBE22luc is unable to infect the heart during infection, it is possible that BB0744 is needed indirectly for the stabilization of an important cell envelope structure(s) that provides adhesion to host cells and thus promotes colonization of the heart and the subsequent development of carditis.…”

Section: Discussionmentioning

confidence: 99%

BB0744 Affects Tissue Tropism and Spatial Distribution of Borrelia burgdorferi

et al. 2015

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bBorrelia burgdorferi, the etiologic agent of Lyme disease, produces a variety of proteins that promote survival and colonization in both the Ixodes species vector and various mammalian hosts. We initially identified BB0744 (also known as p83/100) by screening for B. burgdorferi strain B31 proteins that bind to ␣ 1 ␤ 1 integrin and hypothesized that, given the presence of a signal peptide, BB0744 may be a surface-exposed protein. In contrast to this expectation, localization studies suggested that BB0744 resides in the periplasm. Despite its subsurface location, we were interested in testing whether BB0744 is required for borrelial pathogenesis. To this end, a bb0744 deletion was isolated in a B. burgdorferi strain B31 infectious background, complemented, and queried for the role of BB0744 following experimental infection. A combination of bioluminescent imaging, cultivation of infected tissues, and quantitative PCR (qPCR) demonstrated that ⌬bb0744 mutant B. burgdorferi bacteria were attenuated in the ability to colonize heart tissue, as well as skin locations distal to the site of infection. Furthermore, qPCR indicated a significantly reduced spirochetal load in distal skin and joint tissue infected with ⌬bb0744 mutant B. burgdorferi. Complementation with bb0744 restored infectivity, indicating that the defect seen in ⌬bb0744 mutant B. burgdorferi was due to the loss of BB0744. Taken together, these results suggest that BB0744 is necessary for tissue tropism, particularly in heart tissue, alters the ability of B. burgdorferi to disseminate efficiently, or both. Additional studies are warranted to address the mechanism employed by BB0744 that alters the pathogenic potential of B. burgdorferi.

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Complete AV block in Lyme carditis: an important differential diagnosis

Cited by 19 publications

References 23 publications

Update on Myocarditis

Update on Myocarditis

Suspicious index in Lyme carditis: Systematic review and proposed new risk score

BB0744 Affects Tissue Tropism and Spatial Distribution of Borrelia burgdorferi

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