Detection of Borrelia burgdorferi sensu lato in endomyocardial biopsy specimens in individuals with recent‐onset dilated cardiomyopathy

Abstract

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).

Lyme Carditis

“…The aim of this early initiated antibiotic treatment is to rapidly eliminate the spirochetes. Even though the data currently available do not provide conclusive evidence of the effect of this antibiotic regimen on prevalence of Borrelia burgdorferi in patients recently diagnosed with DCM as compared with controls (in [22]: in 24% Borrelia genome detectable in myocardial biopsy specimens versus 0% in the control group). While Palacek et al (31) observed a significant improvement of left ventricular function under antibiotic treatment in their patient population which tested positive for Borrelia genome, Kubanek et al (22) found no positive response to this therapy.…”

“…Cardiac magnetic resonance imaging (19, 20, e3, e4), myocardial biopsy (21,22) or electrophysiological examination (23,24) may provide valuable insights in individual cases, helping to confirm the diagnosis and establish a prognosis. Other often newer methods, such as the lymphocyte transformation test, Borrelia antigen test in urine, Borrelia spheroblast formation, or visual contrast sensitivity testing, cannot be recommended at present due to their low sensitivity and lack of replicability and standardization (1, 9).…”

“…While the same work group (29) demonstrated an increased prevalence of Borrelia antibodies in patients with DCM, this correlation could not be confirmed in later studies by Levolas (30) and Rees (e11). The latest studies (22,31), using a highly sensitive PCR method, found a significantly higher genome Figure 4: Cardiac magnetic resonance imaging with 4-chamber view a) of a patient with Lyme carditis along with first-degree AV block and complete left bundle-branch block: after gadolinium administration, multilocular lateenhancement (LE), situated subepicardially, mid-myocardially and subendocardially. b) In the short-axis view, LE is primarily situated in the midmyocardium; however, the septum is also affected, possibly the substrate of the affected conduction system (yellow arrow).…”

Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?

“…Non-viral infections as the cause of myocarditis are uncommon in our region, although in some endemic areas of the Czech Republic, Borrelia burgorferi is relatively often detected in recent onset dilated cardiomyopathy (RODCM) (ref. [18][19][20] ). Other possible causes of myocarditis are autoimmune or toxic factors.…”

Absence of Borrelia burgdorferi in the myocardium of subjects with normal left ventricular systolic function: a study using PCR and electron microscopy

“…Within the endemic region of Central Europe there is increasing evidence that Borrelia burgdorferi (Bb) may be associated with the development of DCM (ref. [5][6][7] ). To further support a causal relationship between the presence of Bb in the heart muscle and the development of DCM, demonstration of the absence of Bb in the myocardium of subjects with normal left ventricular (LV) systolic function is necessary.…”