scholarly journals Lyme Carditis in Hospitalized Children and Adults, a Case Series

2021 ◽  
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Case Series ◽  
Outpatient Setting ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme carditis is an uncommon manifestation of Lyme disease. This report compares Lyme carditis presentation, management, and outcomes in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block (PR >300ms) and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children and 20 adults were admitted for Lyme carditis between June and October. Ninety percent were male, and 87% had no prior cardiac history. Seventeen had outpatient evaluation prior to admission. Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment. The most common alternate diagnoses were viral illness and erythema multiforme. More children than adults had disseminated erythema migrans and fever. First-degree heart block was more prevalent in children, and Mobitz type 2 heart block was more prevalent in adults. Ten patients presented with syncope. Proportionately more adults needed temporary pacing. Children had shorter antibiotic durations compared to adults. Of the 30 cases, twenty-seven had improved heart block, while 3 adults required a pacemaker at discharge. Nine children and 14 adults were discharged with a PR 200-300ms. There was a single death in this series. Conclusion Cases tended to be younger males. Most patients had some heart block on discharge. Of patients evaluated as outpatients, Lyme disease was suspected in 41%. Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.

scholarly journals 134. A Comparison of Lyme Carditis in Children and Adults, a Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S95-S95
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Erythema Migrans ◽  
Case Series ◽  
Adult Patients ◽  
Male Predominance ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme disease is a common entity in Maine, and Lyme carditis is an uncommon manifestation of this disease. This case series describes and compares the presentation, management, and outcomes of Lyme carditis in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children (range 7–17, mean 12.4 years) and 20 adults (range 22–81, mean 41.4 years) were admitted for Lyme carditis in the examined period. All cases presented between June and October. Twenty-seven (90%) were male, and 26 (87%) had no prior cardiac history. Of the adults, 1 (5%) reported using cocaine, 4 (20%) opioids, and 6 (30%) marijuana. Seventeen (57%) had outpatient evaluation prior to admission. Ten patients (59%) were not recognized as having Lyme disease. One case suspected to have Lyme was not initially treated with doxycycline. The most common alternative diagnoses were a viral illness and erythema multiforme. No coinfections were noted. Proportionately more children than adults had disseminated erythema migrans (40% vs. 20%) and fever (60% vs. 35%). First degree heart block was more prevalent in children (40%), and Mobitz type 2 heart block was more prevalent in adults (55%). Ten patients (30%) presented with syncope. More adults than children needed temporary pacing, 9 (45%) vs. 2 (20%). Children had shorter antibiotic durations compared with adults (mean 19.8 days vs. 23.6 days) Twenty-seven (90%) had improved heart block. Three adult patients (10%) required a pacemaker following hospitalization. Nine (90%) children and 14 (70%) adults were discharged with a PR 200-300ms. There was a single death in this series, which occurred after discharge to another state. Conclusion Cases tended to be in younger patients with male predominance. Most patients still had some degree of heart block on discharge. The majority of patients were evaluated prior to hospitalization but Lyme disease was suspected in only 41%. Improved recognition of early Lyme disease and more prompt treatment may lead to decreased complications of Lyme carditis. Disclosures All authors: No reported disclosures.

scholarly journals Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Maxwell Eyram Afari ◽  
Fady Marmoush ◽  
Mobeen Ur Rehman ◽  
Umama Gorsi ◽  
Joseph F. Yammine
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Complete Heart Block ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Young Female ◽  
Cardiac Conduction ◽  
Lyme Carditis ◽  
Uncommon Presentation ◽  
Degree Heart Block

Carditis is an uncommon presentation of the early disseminated phase of Lyme disease. We present the case of a young female who presented with erythema migrans and was found to have first-degree heart block which progressed to complete heart block within hours. After receiving ceftriaxone, there was complete resolution of the heart block in sequential fashion. Our case illustrates the importance of early recognition and anticipation of progressive cardiac conduction abnormalities in patients presenting with Lyme disease.

Temporary Pacing in Complete Heart Block due to Lyme Disease: A Case Report

1989 ◽  
Vol 12 (8) ◽  
pp. 1433-1436 ◽  
Author(s):  
ISTVAN LORINCZ ◽  
ANDRAS LAKOS ◽  
PETER KOVACS ◽  
CSABA VARVOLGYI ◽  
PETER POLGAR ◽  
...  
Keyword(s):  
Case Report ◽  
Lyme Disease ◽  
Heart Block ◽  
Complete Heart Block ◽  
Temporary Pacing

scholarly journals Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
John N. Aucott ◽  
Lauren A. Crowder ◽  
Victoria Yedlin ◽  
Kathleen B. Kortte
Keyword(s):  
Infectious Disease ◽  
Lyme Disease ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Skin Lesions ◽  
Disease Diagnosis ◽  
Internet Survey ◽  
Appropriate Use ◽  
Bull's Eye ◽  
Use Of Medical Services

Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull’s-eye lesion and nontarget appearing lesions.Methods. A survey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease.Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans.Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient’s appropriate use of medical services for early Lyme disease diagnosis.

scholarly journals First case report of inducible heart block in Lyme disease and an update of Lyme carditis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Don Walter Kannangara ◽  
Sindhu Sidra ◽  
Patel Pritiben
Keyword(s):  
Case Report ◽  
Lyme Disease ◽  
Heart Block ◽  
Lyme Carditis ◽  
First Case

scholarly journals A Case Series on Neuroborreliosis- An Emerging Infection in India

2021 ◽  
Author(s):  
Rachna Sehgal ◽  
Meenakshi Bhatt
Keyword(s):  
Lyme Disease ◽  
Short Term Memory ◽  
Case Series ◽  
Disease Spread ◽  
Penicillin G ◽  
Lyme Carditis ◽  
Cranial Nerve Palsies ◽  
Ixodes Ticks ◽  
Sporadic Cases ◽  
Disseminated Disease

Lyme disease is a zoonotic disease spread by the bite of Ixodes ticks. These ticks are known to be found in wooded or grassy areas. The disease manifestations can be divided into early Lyme disease and late Lyme disease. The manifestations of late Lyme disease may include arthritis, cranial nerve palsies, short-term memory deficits and Lyme carditis. The disease is diagnosed by a two-step process of Enzyme immunoassay followed by Western blot Test. Disseminated disease is treated with Intravenous (IV) ceftriaxone, cefotaxime or penicillin G, or a combination of oral and IV regimens or in some cases, only oral drugs for up to 28 days. Lyme disease is endemic in temperate regions, especially in America. However, over the years the disease has been reported from various countries of Asia including in India, where there have been sporadic cases. Hereby, the author presents three paediatric cases with varied presentations. The neurological symptoms ranged from Lower Motor Neuron (LMN) facial nerve palsy to acute encephalitis. One patient also had non-erosive arthritis.

scholarly journals Evaluation of Selected Borrelia burgdorferi lp54 Plasmid-Encoded Gene Products Expressed during Mammalian Infection as Antigens To Improve Serodiagnostic Testing for Early Lyme Disease

2015 ◽  
Vol 22 (11) ◽  
pp. 1176-1186 ◽  
Author(s):  
Zachary P. Weiner ◽  
Rebecca M. Crew ◽  
Kevin S. Brandt ◽  
Amy J. Ullmann ◽  
Martin E. Schriefer ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Recombinant Proteins ◽  
Erythema Migrans ◽  
Disease Patient ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
Early Stages ◽  
Lyme Carditis ◽  
Mammalian Infection

ABSTRACTLaboratory testing for the diagnosis of Lyme disease is performed primarily by serologic assays and is accurate for detection beyond the acute stage of the infection. Serodiagnostic assays to detect the early stages of infection, however, are limited in their sensitivity, and improvement is warranted. We analyzed a series ofBorrelia burgdorferiproteins known to be induced within feeding ticks and/or during mammalian infection for their utility as serodiagnostic markers against a comprehensive panel of Lyme disease patient serum samples. The antigens were assayed for IgM and IgG reactivity in line immunoblots and separately by enzyme-linked immunosorbent assay (ELISA), with a focus on reactivity against early Lyme disease with erythema migrans (EM), early disseminated Lyme neuroborreliosis, and early Lyme carditis patient serum samples. By IgM immunoblotting, we found that recombinant proteins BBA65, BBA70, and BBA73 reacted with early Lyme EM samples at levels comparable to those of the OspC antigen used in the current IgM blotting criteria. Additionally, these proteins reacted with serum samples from patients with early neuroborreliosis and early carditis, suggesting value in detecting early stages of this disease progression. We also found serological reactivity against recombinant proteins BBA69 and BBA73 with early-Lyme-disease samples using IgG immunoblotting and ELISA. Significantly, some samples that had been scored negative by the Centers for Disease Control and Prevention-recommended 2-tiered testing algorithm demonstrated positive reactivity to one or more of the antigens by IgM/IgG immunoblot and ELISA. These results suggest that incorporating additionalin vivo-expressed antigens into the current IgM/IgG immunoblotting tier in a recombinant protein platform assay may improve the performance of early-Lyme-disease serologic testing.

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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Faith Myers ◽  
Pooja E. Mishra ◽  
Daniel Cortez ◽  
Mark R. Schleiss
Keyword(s):  
Chest Pain ◽  
Lyme Disease ◽  
Antibiotic Therapy ◽  
Heart Block ◽  
Left Ventricular ◽  
Uneventful Recovery ◽  
Lyme Carditis ◽  
Cardiac Symptoms ◽  
Disease Case ◽  
Pr Interval

Abstract 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.

Case 5

2020 ◽  
pp. 26-32
Author(s):  
Hilary Humphreys
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Erythema Migrans ◽  
Connective Tissue Diseases ◽  
The United States ◽  
Prophylactic Antibiotics ◽  
Skin Manifestation ◽  
Chronic Lyme Disease ◽  
Common Skin ◽  
Immune Assay

Erythema migrans is the most common skin manifestation of Lyme disease caused by Borrelia spp. There are some differences in the clinical presentation and aetiology between cases in Europe and the United States as the vectors and Borrelia spp. vary. The diagnosis is usually confirmed by serology, that is, enzyme immune-assay and Western blot, although there are other approaches such as PCR. Apart from erythema migrans, other manifestations include meningitis, heart block, and arthritis. There are a number of options for treatment, including tetracyclines and penicillins, and duration depends on the presence of complications. There is a limited if any role for prophylactic antibiotics to prevent acquisition after exposure to a tick. Much controversy surrounds chronic Lyme disease which may not be a real clinical entity and may mimic other conditions such as connective tissue diseases. There is no evidence that ongoing symptoms are due to persistent infection.

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