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. 1994 May;71(5):459–461. doi: 10.1136/hrt.71.5.459

No evidence to implicate Borrelia burgdorferi in the pathogenesis of dilated cardiomyopathy in the United Kingdom.

D H Rees 1, P J Keeling 1, W J McKenna 1, J S Axford 1
PMCID: PMC483724  PMID: 8011411

Abstract

OBJECTIVE--To determine whether Borrelia burgdorferi is implicated in the pathogenesis of dilated cardiomyopathy in the United Kingdom. DESIGN--A controlled prospective study. Patients' notes were reviewed for evidence of Lyme disease and serum samples were tested by enzyme linked immunoadsorbent assay (ELISA) for antibodies to B burgdorferi. Samples with raised antibody concentrations were subsequently analysed by immunoblotting to determine their antibody binding specificity. SETTING--Tertiary referral centre. PATIENTS--97 consecutive patients with dilated cardiomyopathy diagnosed according to World Health Organisation criteria were studied. Serum samples were taken from two matched control groups. The first group (n = 38) was age, sex, and geographically matched. The second control group (n = 39) was environmentally matched and consisted of members of the patients' own households. MAIN OUTCOME MEASURES--Clinical evidence of Lyme disease. Presence of raised antibody concentrations to B burgdorferi. RESULTS--No patients had a previous illness compatible with Lyme disease. Analysis of the ELISA data showed eight of 97 patients with dilated cardiomyopathy (8.2%) and two of 77 controls (3.9%) had raised antibody concentrations. Immunoblot analysis, however, did not show binding patterns consistent with the presence of IgG specific for B burgdorferi in any of these samples. CONCLUSIONS--There was no clinical or serological evidence to implicate B burgdorferi in the pathogenesis of idiopathic dilated cardiomyopathy in the United Kingdom. In the absence of specific symptoms or likely exposure to B burgdorferi routine serological testing for Lyme disease in this group of patients is not recommended. Furthermore, raised antibodies to B burgdorferi are not diagnostic of active infection and ELISA results should be interpreted with caution unless specific B burgdorferi antibody bands have been found by immunoblot analysis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aretz H. T., Billingham M. E., Edwards W. D., Factor S. M., Fallon J. T., Fenoglio J. J., Jr, Olsen E. G., Schoen F. J. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987 Jan;1(1):3–14. [PubMed] [Google Scholar]
  2. Berg D., Abson K. G., Prose N. S. The laboratory diagnosis of Lyme disease. Arch Dermatol. 1991 Jun;127(6):866–870. [PubMed] [Google Scholar]
  3. Bianchi G., Rovetta G., Monteforte P., Fumarola D., Trevisan G., Crovato F., Cimmino M. A. Articular involvement in European patients with Lyme disease. A report of 32 Italian patients. Br J Rheumatol. 1990 Jun;29(3):178–180. doi: 10.1093/rheumatology/29.3.178. [DOI] [PubMed] [Google Scholar]
  4. Gasser R., Dusleag J., Reisinger E., Stauber R., Feigl B., Pongratz S., Klein W., Furian C., Pierer K. Reversal by ceftriaxone of dilated cardiomyopathy Borrelia burgdorferi infection. Lancet. 1992 May 9;339(8802):1174–1175. doi: 10.1016/0140-6736(92)90777-z. [DOI] [PubMed] [Google Scholar]
  5. Houwerzyl J., Root J. J., Hoogkamp-Korstanje J. A. A case of Lyme disease with cardiac involvement in the Netherlands. Infection. 1984 Sep-Oct;12(5):358–358. doi: 10.1007/BF01651154. [DOI] [PubMed] [Google Scholar]
  6. Laemmli U. K. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature. 1970 Aug 15;227(5259):680–685. doi: 10.1038/227680a0. [DOI] [PubMed] [Google Scholar]
  7. Ma B., Christen B., Leung D., Vigo-Pelfrey C. Serodiagnosis of Lyme borreliosis by western immunoblot: reactivity of various significant antibodies against Borrelia burgdorferi. J Clin Microbiol. 1992 Feb;30(2):370–376. doi: 10.1128/jcm.30.2.370-376.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Magnarelli L. A., Miller J. N., Anderson J. F., Riviere G. R. Cross-reactivity of nonspecific treponemal antibody in serologic tests for Lyme disease. J Clin Microbiol. 1990 Jun;28(6):1276–1279. doi: 10.1128/jcm.28.6.1276-1279.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Muhlemann M. F., Wright D. J. Emerging pattern of Lyme disease in the United Kingdom and Irish Republic. Lancet. 1987 Jan 31;1(8527):260–262. doi: 10.1016/s0140-6736(87)90074-2. [DOI] [PubMed] [Google Scholar]
  11. Reznick J. W., Braunstein D. B., Walsh R. L., Smith C. R., Wolfson P. M., Gierke L. W., Gorelkin L., Chandler F. W. Lyme carditis. Electrophysiologic and histopathologic study. Am J Med. 1986 Nov;81(5):923–927. doi: 10.1016/0002-9343(86)90370-0. [DOI] [PubMed] [Google Scholar]
  12. Stanek G., Klein J., Bittner R., Glogar D. Isolation of Borrelia burgdorferi from the myocardium of a patient with longstanding cardiomyopathy. N Engl J Med. 1990 Jan 25;322(4):249–252. doi: 10.1056/NEJM199001253220407. [DOI] [PubMed] [Google Scholar]
  13. Steere A. C., Batsford W. P., Weinberg M., Alexander J., Berger H. J., Wolfson S., Malawista S. E. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980 Jul;93(1):8–16. doi: 10.7326/0003-4819-93-1-8. [DOI] [PubMed] [Google Scholar]
  14. Vlay S. C. Complete heart block due to Lyme disease. N Engl J Med. 1986 Nov 27;315(22):1418–1418. doi: 10.1056/nejm198611273152214. [DOI] [PubMed] [Google Scholar]
  15. de Koning J., Hoogkamp-Korstanje J. A., van der Linde M. R., Crijns H. J. Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease. J Infect Dis. 1989 Jul;160(1):150–153. doi: 10.1093/infdis/160.1.150. [DOI] [PubMed] [Google Scholar]
  16. van der Linde M. R. Lyme carditis: clinical characteristics of 105 cases. Scand J Infect Dis Suppl. 1991;77:81–84. [PubMed] [Google Scholar]

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