Reversal of Borrelia burgdorferiassociated dilated cardiomyopathy by antibiotic treatment?
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It is suggested thatBorrelia burgdorferi infection could be associated with dilated cardiomyopathy (IDC). Stanek et al. were able to cultivateBorrelia burgdorferi from myocardial biopsy tissue of a patient with longstanding dilated cardiomyopathy. Here we present a study in which we examined the effect of standard antibiotic treatment on the left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy associated withBorrelia burgdorferi infection. In this study we assessed the serum (IgG, IgM Elisa) and history of 46 IDC patients with specific regard toBorrelia burgdorferi infection (mean LVEF 30.4±1.3%, measured by cardiac catheterization and echocardiography with the length-area-volume method). All 46 patients received standard treatment for dilated cardiomyopathy: ACE inhibitors, digitalis, and diuretics. Eleven (24%) patients showed positive serology and a history ofBorrelia burgdorferi infection; nine of these also had a typical history of tick bite and erythema chronicum migrans (ECM) and/or other organ involvement, and two had no recollection of tick bite or ECM but showed otherBorrelia burgdorferi-associated disorders (neuropathy, oligoarthritis). These 11 patients withBorrelia burgdorferi infection received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days. Six (55%) recovered completely and showed a normal LVEF after 6 months, three (27%) improved their LVEF, and two (18%) did not improve at all. This amounts tonine (82%) patients with recovery/improvement in the Borrelia burgdorferi group. The 35 patients who did not show positive serology or a history ofBorrelia burgdorferi infection did not receive antibiotic treatment. In thisgroup without Borrelia burgdorferi infection 12 (26%), showed recovery/improvement following the standard treatment of dilated cardiomyopathy (see earlier). Our results indicate thatBorrelia burgdorferi infection could play a decisive role in the development of dilated cardiomyopathy, especially in a geographical region such as Graz, whereBorrelia burgdorferi is endemic. While we are aware of the small number ofBorrelia burgdorferi patients in this study, we nevertheless conclude that in a remarkable number of patients with signs ofBorrelia burgdorferi infection, dilated cardiomyopathy could be reversed and LVEF improved.
Key Wordsheart failure dilated cardiomyopathy antibiotic ceftriaxone Lyme borreliosis Borrelia burgdorferi
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