Increasing Burden of Lyme Carditis in United States Children’s Hospitals

Beach, Cheyenne; Hart, Stephen A.; Nowalk, Andrew; Feingold, Brian; Kurland, Kristen; Arora, Gaurav

doi:10.1007/s00246-019-02250-9

Cited by 13 publications

(8 citation statements)

References 16 publications

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“…Table 1 presents summarized information of the LD case-finding algorithms identified in the 15 articles. Seven studies [ 7 – 11 , 14 , 15 ] used algorithms identifying LD cases from claims data using LD diagnosis codes only (International Classification of Diseases, 9th Revision [ICD-9], 088.81; ICD-10, A69.2, A69.2x). Four studies [ 3 , 12 , 13 , 16 ] used LD diagnosis codes and antibiotic dispensing records, and the remaining four studies [ 6 , 17 – 19 ] used serologic test order codes (Current Procedural Terminology [CPT], 86617, 86618) in conjunction with LD diagnosis codes and antibiotic dispensing records.…”

Section: Resultsmentioning

confidence: 99%

Healthcare claims-based Lyme disease case-finding algorithms in the United States: A systematic literature review

Nam

Willis²,

Mendelsohn³

et al. 2022

PLoS ONE

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Background and objective Lyme disease (LD) is the fifth most commonly reported notifiable infectious disease in the United States (US) with approximately 35,000 cases reported in 2019 via public health surveillance. However, healthcare claims-based studies estimate that the number of LD cases is >10 times larger than reported through surveillance. To assess the burden of LD using healthcare claims data and the effectiveness of interventions for LD prevention and treatment, it is important to use validated well-performing LD case-finding algorithms (“LD algorithms”). We conducted a systematic literature review to identify LD algorithms used with US healthcare claims data and their validation status. Methods We searched PubMed and Embase for articles published in English since January 1, 2000 (search date: February 20, 2021), using the following search terms: (1) “Lyme disease”; and (2) “claim*” or “administrative* data”; and (3) “United States” or “the US*”. We then reviewed the titles, abstracts, full texts, and bibliographies of the articles to select eligible articles, i.e., those describing LD algorithms used with US healthcare claims data. Results We identified 15 eligible articles. Of these, seven studies used LD algorithms with LD diagnosis codes only, four studies used LD diagnosis codes and antibiotic dispensing records, and the remaining four studies used serologic test order codes in combination with LD diagnosis codes and antibiotics records. Only one of the studies that provided data on algorithm performance: sensitivity 50% and positive predictive value 5%, and this was based on Lyme disease diagnosis code only. Conclusions US claims-based LD case-finding algorithms have used diverse strategies. Only one algorithm was validated, and its performance was poor. Further studies are warranted to assess performance for different algorithm designs and inform efforts to better assess the true burden of LD.

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Section: Resultsmentioning

confidence: 99%

Healthcare claims-based Lyme disease case-finding algorithms in the United States: A systematic literature review

Nam

Willis²,

Mendelsohn³

et al. 2022

PLoS ONE

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“…The increased prevalence appears to be driven by climate change, with resultant expansion of the tick habitat and an increased number of tick vectors [1,3]. With the increase in total LD cases, a concomitant 2.4-fold increase in Lyme carditis in children was noted in a study comparing total cases in 2007 to cases in 2013 [8]. Lyme carditis in children is rare, with an overall incidence of < 5% [9].…”

Section: Discussionmentioning

confidence: 99%

Chest palpitations in a teenager as an unusual presentation of Lyme disease: case report

et al. 2020

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Background The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children’s hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population. Case presentation The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery. Conclusions Lyme carditis occurs in < 5% of LD cases, but the “take-away” lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.

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“…Lyme disease is commonly seen in the northeast and mid-Atlantic regions. 9,10 Expansion of this disease has been recently noted in the Midwest. 9,11 It is transmitted via an Ixodes tick bite infected with Borrelia burgdorferi with an average incubation period of approximately 2 to 3 weeks.…”

Section: Brief Backgroundmentioning

confidence: 99%

“…9,10 Expansion of this disease has been recently noted in the Midwest. 9,11 It is transmitted via an Ixodes tick bite infected with Borrelia burgdorferi with an average incubation period of approximately 2 to 3 weeks. 12,13 Life-Threatening Clinical Presentation…”

Section: Brief Backgroundmentioning

confidence: 99%

Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

Lessner

Krawiec

2020

Journal of Pediatric Infectious Diseases

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When unrecognized and antibiotic delay occurs, Lyme disease, Rocky Mountain–spotted fever, babesiosis, and human ehrlichiosis and anaplasmosis can result in multiorgan system dysfunction and potentially death. This review focuses on the early recognition, evaluation, and stabilization of the rare life-threatening sequelae seen in tick-borne illnesses that require admission in the pediatric intensive care unit.

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Increasing Burden of Lyme Carditis in United States Children’s Hospitals

Cited by 13 publications

References 16 publications

Healthcare claims-based Lyme disease case-finding algorithms in the United States: A systematic literature review

Healthcare claims-based Lyme disease case-finding algorithms in the United States: A systematic literature review

Chest palpitations in a teenager as an unusual presentation of Lyme disease: case report

Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

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