Lyme Carditis: From Pathophysiology to Clinical Management

Pathogens

Gianfranco Sinagra¹  Eva Del Mestre¹  Giancarlo Vitrella¹  Matteo Castrichini¹  Paolo Manca¹  Cinzia Radesich¹  Kristen Medo²  Mario Chiatto³ 

[1] Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, 34127 Trieste, Italy;Division of Cardiology, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;Interventional Cardiology Department, Ospedale Civile dell’Annunziata, 87100 Cosenza, Italy;

关键词: Lyme carditis;    Lyme disease;    Borrelia burgdorferi;    atrioventricular block;    temporary pacing;    doxycycline;   

DOI  :  10.3390/pathogens11050582

来源: DOAJ

【 摘 要 】

Cardiac involvement is a rare but relevant manifestation of Lyme disease that frequently presents as atrioventricular block (AVB). Immune-mediated injury has been implicated in the pathogenesis of Lyme carditis due to possible cross-reaction between Borrelia burgdorferi antigens and cardiac epitopes. The degree of the AVB can fluctuate rapidly, with two-thirds of patients progressing to complete AVB. Thus, continuous heart rhythm monitoring is essential, and a temporary pacemaker may be necessary. Routinely permanent pacemaker implantation, however, is contraindicated because of the frequent transient nature of the condition. Antibiotic therapy should be initiated as soon as the clinical suspicion of Lyme carditis arises to reduce the duration of the disease and minimize the risk of complications. Diagnosis is challenging and is based on geographical epidemiology, clinical history, signs and symptoms, serological testing, ECG and echocardiographic findings, and exclusion of other pathologies. This paper aims to explain the pathophysiological basis of Lyme carditis, describe its clinical features, and delineate the treatment principles.

【 授权许可】

Unknown