Reversal of Borrelia burgdorferiassociated dilated cardiomyopathy by antibiotic treatment?
- 33 Downloads
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
Unable to display preview. Download preview PDF.
- 2.UnverferthDV.Dilated Cardiomyopathy. Mount Kisco, NY: Futura Publishing, 1986.Google Scholar
- 5.KleinW, GoebelR, BrandtD, MaurerE. Effect of nitroglycerin on patients with left heart failure. In: LichtlenPR, EngelHJ, SchreyA, SwanHJC, eds.Nitrates III, Cardiovascular effects. Berlin: Springer, 1981:488–494.Google Scholar
- 8.Report of the WHO/ISCF task force on the definition and classification of cardiomyopathies.Br Heart J 1980;44: 672–673.Google Scholar
- 9.Criteria Committee, New York Heart Association, Inc.Diseases of the Heart and Blood Vessels. Nomenclature and Criteria for Diagnosis, 6th ed. Boston: Little Brown, 1964.Google Scholar
- 15.KleinJ, StanekG, BittnerR, HolzingerC, GlogarD. Lyme borreliosis as a cause of myocarditis and heart muscle disease.Eur Heart J 1991;12(Suppl):D73-D75.Google Scholar
- 16.StanekG, KleinJ, BittnerR, GlogarD.Borrelia burgdorferi as an etiologic agent in chronic heart failure?Scand J Infect Dis 1991;777(Suppl):85–87.Google Scholar
- 17.Van derLindeMR. Lyme carditis: Clinical characteristics of 105 cases.Scand J Infect Dis 1991;77(Suppl):81–84.Google Scholar
- 24.GasserR, DusleagJ, ReisingerE et al. Reversal by ceftriaxone of dilated cardiomyopathy associated withBorrelia burgdorferi infection in an endemic area.Eur Heart J 1992; 13(Suppl):200.Google Scholar
- 25.GasserR, DusleagJ, ReisingerE et al. Reversibility by ceftriaxone of dilated cardiomyopathy associated withBorrelia burgdorferi infection.Circulation 1992;86:1807.Google Scholar
- 33.GuerroA, QueredaC, EscuerdoR, CoboJ, MorchilloR, Marti-BeldaP. Serologic diagnosis of Lyme disease. A pending problem.Enferm Infecc Microbiol Clin 1991;9: 335–338.Google Scholar
- 37.Lyme borreliosis: Detecting the great imitator.J Am Osteopath Assoc 1991;91:573–574, 577–578.Google Scholar
- 43.Dusleag J, Klein W, Eber B, Gasser R, Rotman B, Neurohumoral and hemodynamic data in patients with dilated cardiomyopathy; dependence upon systolic and diastolic dysfunction. 1st International Symposium on Heart Failure-Mechanism and Management, 1989, abstract book, p. 304.Google Scholar
- 44.DusleagJ, KleinW, LuhaO et al. Comparison of the left ventricular cineangiography, echocardiographic semiautomatic edge detection and 3-dimensional computer reconstruction in the assessment of left ventricular function.Eur Heart J 1992;13(Suppl):316.Google Scholar
- 45.VonPolenzHA. Lyme-Borreliose—die “neue” Zeckenbiß-krankheit. Sicherheit im öffentlichen Dienst (Zeitschrift der kommunalen und staatlichen Unfallversicherung) 1989;1: 4–6.Google Scholar
- 47.BurgdorferW. Lyme borreliosis: Ten years after discovery of the etiologic agent.Borrelia burgdorferi Infection 1991; 19:257–267.Google Scholar
- 48.BrycesonADM. Clinical pathology of the Jarisch-Herxheimer reaction.J Infect Dis 1966;133:696–703.Google Scholar
- 50.Fruhwald F, Dusleag J, Klein W, et al. Reversibility of dilated cardiomyopathy by low dose oral roxithromycin in a patient with chromic Lyme-borreliosis. Vth International Congress on Lyme Borreliosis, Arlington, VA, May 1992, abstract book.Google Scholar