: Med Microbiol Immunol. 2010 Jan 6; [Epub ahead of print]

Presence of Borrelia burgdorferi in endomyocardial biopsies in patients with
new-onset unexplained dilated cardiomyopathy.

Palecek T, Kuchynka P, Hulinska D, Schramlova J, Hrbackova H, Vitkova I, Simek
S, Horak J, Louch WE, Linhart A.

1st Medical Faculty, 2nd Medical Department - Clinical Department of Cardiology
and Angiology, Charles University of Prague, Prague, Czech Republic,
tpalec@lf1.cuni.cz.

Dilated cardiomyopathy (DCM) represents the third most common cause of heart
failure and the most frequent cause of heart transplantation. Infectious, mostly
viral, and autoimmune mechanisms, together with genetic abnormalities, have been
reported as three major causes of DCM. We hypothesized that Lyme disease (LD),
caused by spirochete Borrelia burgdorferi (Bb), might be an important cause of
new-onset unexplained DCM in patients living in a highly endemic area for LD
such as the Czech Republic.

We performed endomyocardial biopsy (EMB) in 39
consecutive patients presenting with symptomatic unexplained left ventricular
(LV) systolic dysfunction lasting no more than 12 months. In eight subjects
(21%), Bb was detected in the EMB sample by polymerase chain reaction or by
electron microscopy. None of these patients exhibited any form of
atrioventricular block or other extracardiac manifestation of Bb infection.

Serological testing identified IgG antibodies against Bb in only two cases and
IgM antibodies in none. All affected patients were treated with intravenous
ceftriaxone for 3 weeks. At 6 months follow-up, LV morphology and function as
well as functional status of these patients significantly improved.

In conclusion, Bb infection may represent an important cause of new-onset
unexplained DCM in patients living in endemic regions such as the Czech
Republic. Because the antibiotic treatment appears to be markedly effective and
serological examination does not provide a tool for diagnosing the disease, EMB
focused on the detection of Bb should be performed in all patients from endemic
areas with new-onset unexplained DCM not responding to conventional therapy.

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PMID: 20052487 [PubMed - as supplied by publisher]