Motivation: A patient presents with new onset cardiomyopathy and heart failure. She lives in a Lyme endemic area. EKG does not show any conduction abnormalities - which is the more common manifestation of Lyme disease in cardiac disease - but ECHO shows dramatically decreased LVEF. This study examines the evidence for Lyme cardiomyopathy from a pathological perspective.
Study: Kubánek M, Šramko M, Berenová D, Hulínská D, Hrbáčková H, Malušková J, Lodererová A, Málek I, Kautzner J. Detection of Borrelia burgdorferi sensu lato in endomyocardial biopsy specimens in individuals with recent-onset dilated cardiomyopathy. Eur J Heart Fail. 2012 Jun;14(6):588-96. doi: 10.1093/eurjhf/hfs027.
Design and results: This study was a pathological/molecular analysis of endomyocardial biopsy (EMB) specimens for the Borrelia (Borrelia burgdorferi sensu lato) genome in cases of dilated cardiomyopathy (DCM). The authors compared EMB of patients with new-onset DCM and of patients with CAD (as controls). Specimens were analyzed by PCR and EM. There was a higher frequency of Borrelia burgdorferi sensu lato in the DCM (24%) versus the control group (0%) (p=0.035), while CMV and parvovirus B19 were similar in both groups. (Kubanek et al., 2012)
Thought: The presence of the Borrelia genome in EMB specimens of DCM does not PROVE causation - it does not necessarily prove that Lyme disease causes DCM. Lyme disease may be incidentally found in DCM, and/or related to another etiological factor for DCM. It is also important to ensure in these cases of DCM that there does not exist a more obvious etiology for cardiomyopathy. Nevertheless, I find these data supportive of the hypothesis that Lyme disease can be an underlying pathological etiology for cardiomyopathy. I will be sending off Lyme serologies for patients from endemic areas who present with new cardiomyopathy, especially if it is DCM.
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