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

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Abstract

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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Acknowledgments

Financial support by the Cardiovascular research project of the Charles University Prague, nr. 0021620817.

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Authors and Affiliations

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

    Tomas Palecek, Petr Kuchynka, Stanislav Simek, Jan Horak & Ales Linhart

  2. National Institute of Public Health, Prague, Czech Republic

    Dagmar Hulinska, Jana Schramlova & Hana Hrbackova

  3. 1st Medical Faculty, Institute of Pathology, Charles University of Prague, Prague, Czech Republic

    Ivana Vitkova

  4. Institute For Experimental Medical Research, Ullevaal University Hospital, Oslo, Norway

    William E. Louch

  5. Center For Heart Failure Research, University of Oslo, Oslo, Norway

    William E. Louch

  6. 2nd Medical Department - Clinical Department of Cardiology and Angiology, General University Hospital, U Nemocnice 2, 128 08, Prague 2, Czech Republic

    Tomas Palecek

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  1. Tomas Palecek
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  2. Petr Kuchynka
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  3. Dagmar Hulinska
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  4. Jana Schramlova
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  6. Ivana Vitkova
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  7. Stanislav Simek
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  8. Jan Horak
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  9. William E. Louch
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  10. Ales Linhart
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Correspondence to Tomas Palecek.

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T. Palecek and P. Kuchynka contributed equally to the study.

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Palecek, T., Kuchynka, P., Hulinska, D. et al. Presence of Borrelia burgdorferi in endomyocardial biopsies in patients with new-onset unexplained dilated cardiomyopathy. Med Microbiol Immunol 199, 139–143 (2010). https://doi.org/10.1007/s00430-009-0141-6

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  • DOI: https://doi.org/10.1007/s00430-009-0141-6

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