Een sportieve vijftiger met brutale syncope ten gevolge van Lyme carditis

2021 ◽  
Author(s):  
C. BAESTAENS ◽  
S. HELLEMANS
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Antibiotic Therapy ◽  
Medical History ◽  
Permanent Pacemaker ◽  
Serological Testing ◽  
Conduction Disturbances ◽  
Lyme Carditis ◽  
Life Threatening ◽  
Life Threatening Complication

A sportive man in his 50's from Philadelphia with a brutal syncope from Lyme carditis In the case of a syncope at a young age in a patient with no medical history - especially if he or she comes from endemic regions - Lyme disease should be excluded through serological testing. Lyme carditis is a potentially life-threatening complication after infection with the bacterium Borrelia burgdorferi. This is shown in the discussed case of a 51-year-old sportive man who registered for a consultation after a brutal syncope. Under antibiotic therapy, the severe conduction disturbances progressively cleared up and a permanent pacemaker could be avoided.

scholarly journals The Value of the Surface ECG for the Diagnosis and Management of Lyme Carditis

2020 ◽  
Vol 16 ◽  
Author(s):  
Cynthia Yeung ◽  
Mohammed Al-Turki ◽  
Adrian Baranchuk
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
Antibiotic Therapy ◽  
Atrioventricular Block ◽  
Systematic Approach ◽  
Young Patients ◽  
Diagnosis And Management ◽  
Lyme Carditis ◽  
Surface Ecg ◽  
High Degree

Lyme carditis (LC) is an early-disseminated manifestation of Lyme disease, most commonly presenting as high-degree atrioventricular block (AVB). The degree of AVB can fluctuate rapidly within minutes, and progression to third-degree AVB is potentially fatal if not recognized and managed promptly. However, the AVB in LC is often transient, and usually resolves with appropriate antibiotic therapy. LC should be on the differential diagnosis in young patients presenting with new high-degree AVB and factors that increase the index of suspicion for Lyme disease. The Suspicious Index in Lyme Carditis (SILC) score helps clinicians risk stratify for LC. A systematic approach to the diagnosis and treatment of LC minimizes the unnecessary implantation of permanent pacemakers.

scholarly journals Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259123
Author(s):  
Uwajachukwumma A. Uzomah ◽  
Guy Rozen ◽  
Seyed Mohammadreza Hosseini ◽  
Ayman Shaqdan ◽  
Pablo A. Ledesma ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Cardiac Conduction System ◽  
Permanent Pacemaker Implantation ◽  
System Disease ◽  
Lyme Carditis ◽  
Conduction System Disease

Background Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease. Methods A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality. Results Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05–1.07; P<0.001), complete heart block (OR: 21.5; 95% CI: 12.9–35.7; P<0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7–32.6; P<0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%). Conclusions Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.

scholarly journals Antibiotic Treatment of Animals Infected with Borrelia burgdorferi

2009 ◽  
Vol 22 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Gary P. Wormser ◽  
Ira Schwartz
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Short Term Memory ◽  
Scientific Evidence ◽  
Disease Symptoms ◽  
Chronic Lyme Disease ◽  
Methodological Concern ◽  
Uncertain Etiology

SUMMARY Despite resolution of the objective manifestations of Lyme disease after antibiotic treatment, a minority of patients have fatigue, musculoskeletal pain, and/or difficulties with concentration or short-term memory of uncertain etiology; these are called post-Lyme disease symptoms or, in more severe cases, post-Lyme disease syndrome or “chronic Lyme disease.” Several recent studies in which Borrelia burgdorferi-infected animals were treated with antibiotic therapy have demonstrated the presence of PCR positivity for B. burgdorferi DNA in the absence of culture positivity. In mice that were treated with antibiotic therapy, residual spirochetes could be taken up by ticks during a blood meal and could be transmitted to SCID mice. These spirochetes are attenuated; their presence is not associated with either inflammation or disease. In this review the methodology and findings of these studies are critically analyzed, and the significance of the results with regard to human Lyme disease is evaluated, with special emphasis on whether these studies provide useful insights into post-Lyme disease syndrome. A serious methodological concern is the failure to consider the pharmacokinetic-pharmacodynamic properties of the antibiotic in choosing the dosage regimen used. We conclude that there is no scientific evidence to support the hypothesis that such spirochetes, should they exist in humans, are the cause of post-Lyme disease syndrome.

scholarly journals A Case of Lyme Carditis Presenting with Atrial Fibrillation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Peter J. Kennel ◽  
Melvin Parasram ◽  
Daniel Lu ◽  
Diane Zisa ◽  
Samuel Chung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Borrelia Burgdorferi ◽  
Antibiotic Therapy ◽  
Unusual Presentation ◽  
Type I ◽  
Atrial Arrhythmias ◽  
Av Block ◽  
Lyme Carditis ◽  
Second Degree

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

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 PROFIL PENGGUNAAN ANTIBIOTIK PASIEN HAEC PASCA OPERASI DI RSUD DR. SOETOMO TAHUN 2015-2018

2018 ◽  
Vol 18 (2) ◽  
pp. 76-79
Author(s):  
Erfano Muhammad Falah
Keyword(s):  
Antibiotic Therapy ◽  
General Hospital ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Sampling Technique ◽  
Observational Research ◽  
Operative Surgery ◽  
Life Threatening ◽  
Life Threatening Complication

Abstract. HAEC (Hirschsprung-associated Enterocolitis) is one of serious and life-threatening complication of patient with HD (Hirschsprung’s Disease). The etiology of HAEC is still unknown until now, however, the existence of gram-negative bacterial especially C. Dificille has been linked to occurrence of patient with HAEC. HAEC frequently found at patient with HD post-operative surgery. The treatment for HD patient post-operative with HAEC are rectal irrigation, fluid therapy, and antibiotics. Because of the wide variety of sign and symptoms in HAEC post operative patient, under treatment has always been an issue that can leads to higher mortality in HAEC patient. Data of antibiotics application for HAEC post-operative patient in Dr. Soetomo General Hospital have not been collected. Because of the issue, writer is interested to effectuate case study about the used of antibiotics for HAEC patient post operative in  Dr. Soetomo General Hospital at period 2015-2018.Methods : This is a descriptive observational research that analyze through collecting data from medical record by retrospective. This research is using Total Sampling technique from 38 patients that going through HD operative surgery at Dr. Soetomo General Hospital from 2015 to 2018. From 38 patients that going through operative surgery, five patient experience HAEC as complication post HD operative surgery.Results : Five patient with HAEC with HD post-operative are successfully healed and dismissed from hospital. In four out of five patients Metronidazole was selected as the main antibiotic used (80%). Gentamicin was used in three patients using Metronidazole as the main antibiotic (60%). Ampicillin was used in 2 patients using Metronidazole as the main antibiotic (40%). There was only one patient who used metronidazole as a single antibiotic therapy. Ceftriaxone was used in one patient with Metronidazole as the main antibiotic and was used as a single antibiotic therapy in another patient with sepsis complication and diagnosed with HD at the aged below one week. Keywords : HAEC ; HD ; Hirschsprung-associated Enterocolitis ; Hirschsprung’s Disease ; Antibiotics ; Post-Operative  Abstrak. HAEC (Hirschsprung-associated Enterocolitis) merupakan suatu komplikasi yang serius dan dapat mengancam kehidupan pada pasien HD (Hirschsprung’s Disease). Etiologi dari HAEC masih belum dapat dipastikan sampai sekarang, namun adanya infeksi bakteri C. Dificille berkaitan erat dengan terjadinya HAEC. HAEC adalah salah satu komplikasi yang sering dijumpai pada pasien pasca operasi HD. Penanganan HAEC pasca operasi terdiri dari irigasi rektal, terapi cairan, dan antibiotik. Tanda dan gejala yang diperlihatkan pasien HAEC sangatlah bervariatif sehingga sering menyebabkan penanganan dibawah standar prosedur. Data mengenai penanganan dan terapi antibiotika pada pasien HAEC pasca operasi di RSUD Dr. Soetomo Surabaya belum diketahui, oleh karena itu penulis melakukan penelitian mengenai pemilihan antibiotika pada penanganan pasien HAEC pasca operasi HD di RSUD Dr. Soetomo Surabaya pada tahun 2015-2018.Metode : Penelitian dengan jenis observasional deskriptif yang menggunakan data rekam medis untuk melihat data pasien secara retrospektif. Penelitian menggunakan teknik Total Sampling pada 38 pasien yang menjalani operasi HD di RSUD Dr. Soetomo pada tahun 2015-2018. Pada 38 pasien yang menjalani operasi HD, terdapat 5 pasien mengalami komplikasi HAEC pasca operasi HDHasil : Didapatkan hasil lima pasien dengan HAEC pasca operasi HD sembuh dan keluar rumah sakit (100%). Pada empat dari lima pasien Metronidazol dipilih sebagai penggunaan antibiotik utama (80%). Gentamicin digunakan pada tiga pasien yang menggunakan Metronidazol sebagai antibiotik utama (60%). Ampicillin digunakan pada 2 pasien yang menggunakan Metronidazol sebagai antibiotik utama (40%). Hanya terdapat satu pasien yang menggunakan Metronidazol sebagai terapi antibiotik tunggal. Ceftriaxone digunakan pada salah satu pasien dengan Metronidazol sebagai antibiotik utama dan digunakan juga sebagai terapi antibiotik tunggal pada satu pasien lainnya yang mengalami HD dengan komplikasi sepsis pada usia dibawah satu minggu. Kata kunci : HAEC ;  HD ; Hirschsprung-associated Enterocolitis ; Hirschsprung’s Disease ; Antibiotik ; Pasca Operasi 

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.

scholarly journals Quantitative Measurement of C6 Antibody following Antibiotic Treatment of Borrelia burgdorferi Antibody-Positive Nonclinical Dogs

2007 ◽  
Vol 15 (1) ◽  
pp. 115-119 ◽  
Author(s):  
Steven A. Levy ◽  
Thomas P. O'Connor ◽  
Jancy L. Hanscom ◽  
Paulette Shields ◽  
Leif Lorentzen ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Untreated Control ◽  
Quantitative Measurement ◽  
Antibody Test ◽  
Treated Group ◽  
Data Points ◽  
Antibody Levels

ABSTRACTThe detection of antibody to theBorrelia burgdorferiC6peptide by use of enzyme-linked immunoassays is a widely accepted method for the diagnosis of Lyme disease spirochete infection in dogs and in humans. Antibody to the C6peptide is highly specific forB. burgdorferiand declines following treatment of dogs and humans exposed toB. burgdorferi. A quantitative assay for determining C6antibody levels was developed and used to measure changes in antibody levels following antibiotic treatment ofB. burgdorferiantibody-positive nonclinical dogs. One hundred thirty-two client-owned dogs were used in the study; 64 were negative, 53 of 68 positive animals received treatment, and 15 were untreated controls. Test sera were collected at 3, 6, and 12 months from seropositive dogs receiving treatment and untreated controls. Dogs in the treated group were assigned to moderate-to-high (≥29 U/ml)- and low (<29 U/ml)-C6-level groups because the change in the C6level after treatment was dependent on the level prior to treatment. There were significant declines in the 30 dogs with moderate-to-high initial C6levels that exceeded the maximal declines of the untreated control dogs in all cases at 6 months (16 data points) and 12 months (29 data points) posttreatment. There was little change in C6level following antibiotic therapy in the 23 dogs with low initial C6levels. The quantitative C6antibody test can be used to measure changes in C6antibody levels following treatment of antibody-positive nonclinical dogs.

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