Electrocardiographic findings in children with Lyme disease

Woolf, Paul K.; Lorsung, Erin M.; Edwards, Karen; Li, Karl I.; Kanengiser, Steven; Ruddy, Richard M.; Gewitz, Michael H.

doi:10.1097/00006565-199112000-00003

Cited by 44 publications

(20 citation statements)

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“…However, the incidence of abnormal ECG findings in asymptomatic patients with probable or definite Lyme borreliosis is higher, 29% in one study in children. 35 The clinical course of Lyme carditis is usually benign with most patients recovering completely. In rare instances, death has been reported.…”

Section: Discussionmentioning

confidence: 99%

Cardiac involvement in non-human primates infected with the Lyme disease spirochete Borrelia burgdorferi

Cadavid

Bai

Hodzic

et al. 2004

Laboratory Investigation

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To investigate cardiac involvement in the non-human primate (NHP) model of Lyme disease, we inoculated 39 adult Macaca mulatta with Borrelia burgdorferi sensu stricto strains N40 (BbN40) by needle (N ¼ 22, 14 immunocompetent (IC), seven permanently immunosuppressed (IS), and four transiently immunosuppressed (TISP)) or by tick-bite (N ¼ 4, all TISP) or strain 297 (Bb297) by needle (N ¼ 2 IS), or with B. garinii strains Pbi (N ¼ 4, 2 TISP and 2 IS), 793 (N ¼ 2, TISP) or Pli (N ¼ 2, TISP). Five uninfected NHPs were used as controls. Infection and inflammation was studied in the hearts and the aorta removed at necropsy 2-32 months after inoculation by (1) H&E and trichrome-staining; (2) immunohistochemistry and digital image analysis; (3) Western blot densitometry; and (4) TaqMan RT-PCR. All NHPs inoculated with BbN40 became infected and showed carditis at necropsy. The predominant cells were T cells, plasma cells, and macrophages. There was increased IgG and IgM in the heart independent of immunosuppression. The B-cell chemokine BLC was significantly increased in IS-NHPs. There was increased deposition of the complement membrane attack complex (MAC) in TISP and IS-NHPs. The spirochetal load was very high in all BbN40-inoculated IS-NHPs but minimal if any in IC or TISP NHPs. Double-immunostaining revealed that many spirochetes in the heart of BbN40-IS NHPs had MAC on their membranes. We conclude that carditis in NHPs infected with B. burgdorferi is frequent and can persist for years but is mild unless they are immunosupressed.

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Section: Discussionmentioning

confidence: 99%

Cardiac involvement in non-human primates infected with the Lyme disease spirochete Borrelia burgdorferi

Cadavid

Bai

Hodzic

et al. 2004

Laboratory Investigation

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“…Of the several thousand cases in the United States each year, up to 10% develop cardiac complications (5). The prevalence of asymptomatic carditis can be as high as 30% (56). Atrioventricular block is the most serious acute manifestation (55,56), but myocarditis and heart failure also occur (23,24).…”

mentioning

confidence: 99%

“…The prevalence of asymptomatic carditis can be as high as 30% (56). Atrioventricular block is the most serious acute manifestation (55,56), but myocarditis and heart failure also occur (23,24). The overall prognosis in most cases is good, although delayed recovery can occur (9).…”

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confidence: 99%

Cardiac Apoptosis in Severe Relapsing Fever Borreliosis

et al. 2005

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To investigate cardiac injury in borrelia carditis, we used antibody-deficient mice persistently infected with isogenic serotypes of the relapsing fever agent Borrelia turicatae. We studied infection in hearts 1 to 2 months after inoculation by TaqMan reverse transcription-PCR and immunohistochemistry (IHC) and inflammation by hematoxylin and eosin and trichrome staining, IHC, and in situ hybridization (ISH). We studied apoptosis by terminal transferase-mediated DNA nick end labeling assay and measured expression of apoptotic molecules by RNase protection assay, immunofluorescence, and immunoblot. All antibody-deficient mice, but none of the immunocompetent controls, developed persistent infection of the heart. Antibody-deficient mice infected with serotype 2 had more severe cardiac infection and injury than serotype 1-infected mice. The injury was more severe around the base of the heart and pericardium, corresponding to sites of marked infiltration by activated macrophages and upregulation of interleukin-6 (IL-6). Infected hearts showed evidence of apoptosis of macrophages and cardiomyocytes as well as significant upregulation of caspases, most notably caspase-1. We conclude that persistent infection with relapsing fever borrelias causes significant loss of cardiomyocytes associated with prominent infiltration by activated macrophages, upregulation of IL-6, induction of caspase-1, and apoptosis.

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“…However, mammalian model-based histopathology studies suggest that the actual rate of cardiac involvement may be much higher (e2). A study on pediatric patients with Lyme disease found ECG changes indicative of myocardial involvement in approximately 30% of patients (13).…”

Section: Pathogen and Prevalencementioning

confidence: 99%