REPOST:
Cardiac concerns and Lyme disease
from: Lyme Times, Number 10 Publication of Lyme Disease resource Center pg. 33

Oringinal article: Stanek, G. Klein, J, et al
title: Borrelia burgdorferi as an Etiologic agent in Chronic Heart Failure. Scandanavian J. of Infectious Disease--duppl. 77: 85-87, 1991

"Cardiac manifestations of Lyme borreliosis have been described by Steere and others as transient and self-limited. In 1990 Dr. Stanek and collegues presented a case of isolation of Borrelia burgdorferi from the myocardium of a patient with long standing cardiomyopathy who also had high serum IgG antibodies to Bb (N Eng J Med 1990;322:249-252). The current study was designed to examine an association or even an etiologic role for Bb in this chronic and persistent heart disorder.
"The sera of 72 patients suffering from chronic heart failure due to dialated cardiomyopathy were tested by ELISA for antibodies to Bb. 55 patients with coronary heart disease and 61 healthy blood donors served as controls. 26.4% of the study group were seropositive for antibodies to Bb. Virus serology excluded viral causes of heart disease, and syphilis serology excluded the possibility of serological cross-reactivity. Of the control groups, 12.7 % of patients with coronary heart disease and 8.2 % of the healthy blood donors had IgG antibodies to B. burgdorferi.
"The authors conclude that Bb infection should be considered in the differential diagnosis and etiology of dialated cardiomyopathy."
Gerald Stanek , MD
Hygiene Institute of the University of Vienna
Kinderspitalgasse 15
A-1085 Wien, Austria
__________

Title:[The cardiac and neurological manifestations of Lyme borreliosis in congenital first-degree AV block]Authors:Stille-Siegener M, Eiffert H, Vonhof S Source:Dtsch Med Wochenschr 1996 Oct 18;121(42):1292-6
Organization:Abteilung fur Kardiologie, Medizinische Klinik sowie Hygiene-Institut, Universitat Gottingen.

Abstract:
HISTORY AND CLINICAL FINDINGS: A 19-year-old youth was hospitalised because of sudden onset of incomplete lid closure and drooping mouth on the left. He regularly walked through fields and woods; three weeks before admission he had noted swelling and reddening on his neck, which he thought was due to an insect bite. When 9 years old a functional heart murmur and 1 degree AV block (P-R interval 0.25s) had been found. Physical examination showed peripheral facial paresis and a 2/6 systolic murmur over the aortic area. INVESTIGATIONS: As Borreliosis (Lyme disease) was suspected, relevant laboratory tests were performed. These revealed specific IgM antibodies against Borrelia burgdorferi. Polymerase chain reaction demonstrated B. burgdorferi-specific DNA in cerebrospinal fluid and urine. The ECG showed 1 degree AV block (P-R interval 0.28s). TREATMENT AND COURSE: Ceftriaxone was administered at once (4 g, followed by 2 g daily intravenously for 14 days). The P-R interval increased to maximally 0.31 s and transient incomplete right bundle branch block developed on the second day. Long-term ECG monitoring also revealed ventricular arrhythmias (Lown IVb), but they gradually disappeared. The neurological signs regressed completely within five days of the start of treatment, while the P-R interval had returned to its initial value of 0.25 s 3 months later. CONCLUSION: The case makes clear that an ECG should be recorded in borreliosis even in the absence of cardiac symptoms. Hospitalisation with long-term monitoring becomes necessary if it is abnormal.

Keywords:
Adult, Case Report, Ceftriaxone, ADMINISTRATION & DOSAGE, Cephalosporins, ADMINISTRATION & DOSAGE, Combined Modality Therapy, Electrocardiography, English Abstract, Facial Paralysis, DIAGNOSIS, ETIOLOGY, THERAPY, Heart Block, CONGENITAL, COMPLICTIONS, DIAGNOSIS, THERAPY, Heart Murmurs, DIAGNOSIS, ETIOLOGY, THERAPY, Human, Lyme Disease, COMPLICATIONS, DIAGNOSIS, THERAPY, Male, Pacemaker, Artificial, Remission Induction

Language: Ger

Unique ID: 97062356
_______________________________
1993 Physicians World Communication Group
"Lyme disease should be considered as a potential etiology for any
cardiac
abnormality when the patient lives in an endemic area and evidence of
another pathogenetic cause is lacking. Evaluation of such patients should include serology studies and further tests as necessary to make a
definitive diagnosis of Lyme carditis. Antibiotic treatment follows recommended guidelines."

Authors: Vegsundv, Nordeide, jenum,Reikvam
Title: Cardiac Manifestations of Borrelia burgdorferi Infection
Source: Tidsskr Nor Laegeforen 1993 Sept. 30;113(23):2911-2

Abstract: Lyme borreliosis, caused by the tick-borne spirochete Borrelia burgdorferi, has been found to cause a variety of clinical syndromes
including cardiomyopathy, dermatopathy, neuropathy, and arthropathy. Lyme carditis was originally described as a mild self-limited carditis,
primarily involving the conduction system. However, recent reports suggest that cardiac involvement may be more serious than previously suspected, and
may cause heart failure and probably congestive cardiomyopathy. _________________
Authors: Klein, Stanek, Bittner, Horvat, Holzinger, Glogar
Title: Lyme borreliosis as a cause of myocarditis and heart muscle disease Source: Eur Heart J 1991 Aug;12 Suppl D:73-5

Abstract: Lyme borreliosis is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the
joints, heart and other organs. The aetiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB
were first described, including acute conduction disorders,
atrioventricular block, transient left ventricular dysfunction and even cardiomegaly. Pathohistological examination showed spirochetes in cases of acute myopericarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dialated cardimyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia
burgdorferi. On Elisa 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease. ____________________________-
Authors: Vorob'eva, Volegova, Burylovl, Tkachenko, Koz'minykh, Altpova
Title: The clinical picture and course of the nonerythematous form of
ixodid tick-borne borreliosis
Source: Med Parazitol 1995 July-Sep;(3):12-5

Abstract: The territory of the Perm region is highly endemic in Ixodes
(B. garnii and B. afzeli)-borne borreliosis. The clinical manifestations
of ERYTHEMA-LESS
Ixodes-borne borreliosis were studied in the 1991-1994 epidemiological
seasons. A total of 54 patients were examined in the acute stage of
infection and 4-6 months later. There were common symptoms of damage to
the central nervous system in early infection and pronounced signs of
damage to the central and peripheral nervous systems in the late period
which was characterized by cardiovascular diseases as disturbances of automatism functions, conduction, diffuse and local muscle changes. ____________________________-
Authors: Lesniak, Lirman, Antiufev
Title: Heart disorders in Lyme disease
Source: Klin Med 1994;72(1):45-7

Abstract: The paper presents literature data on clinical manifestations, instrumental diagnosis and pathohistological changes in Lyme carditis.
Three cases were analyzed. The emphasis is placed on the necessity of differential diagnosis with Lyme disease ia all cases of unclear
myocarditis and cardiac arrhythmia, especially in the territories endemic
for tick-borne diseases.
_______________________________
source: Clinical Manifestations of Lyme Disease in the United States Connecticut Medicine June 1989; Volume 53, No.6 pg. 327-330 Trock,M.D.,Craft,M.D., Rahn,M.D.

"Cardiac Manifestations
"Lyme carditis .......may be the initial manifestation of Lyme disease. Fluctuating degrees of atrioventricular block, including first degree heart block and Mobitz type 1 block, including first degree heart block and Mobitz type 1 block, are the most common features of carditis, but may progress to complete heart block requiring a temporary pacemaker. The cardiac conduction abnormalities of Lyme diseae are usually brief, lasting days to weeks and generally do not require permanent cardiac pacing. However, one recently described patient had residual Mobitz Type 1 block 16 months after removal of a temporary pacemaker for Lyme carditis.
"Less common cardiac manifestations have included arrythmias (supraventricular tachycardia and premature ventricular contractions) and myopericarditis with tansient cardiomegaly and left ventricular
dysfunction. This latter problem may be mistaken for acute rheumatic fever when cutaneous and joint manifestations are also present. EKG changes in
such patients may include diffuse T-wave flattening or inversion, rarely ST segment depression. The diagnosis of Lyme disease should be considered in
all cases of unexplained heart block, because it is treatable with antibiotics."
___________________________________
"......First, we
have electrophysiologicaly documented the diffuse nature of the conduction system involvement that can occur in the disease...."

Lyme Carditis - Electrophysiologic and Histopathologic Study
The American Journal of Medicine; Nov. 1986 vol. 81 pg. 923-927
Reznick,D.O., et al (From the Section of Cardiology, Department of
Internal Medicine, and the of Pathology, Chicago College of Oteopathic Medicine, Chicago, Illinois...)

"....Lyme disease, . The cardiac abnormalities that may result from this disease have been reviewed by Steere et al . The most common cardiac manifestation is a conduction system disturbance with varying degrees of atrioventricular block. Myocarditis has been described on clinical
grounds, supported by electrocardiographic changes and radionuclide ventriculographic evidence of mild left ventricular dysfunction. We report herein a case of Lyme disease with biopsy proved myocarditis and possible spirochete identification within the cardiac biopsy specimen. The diffuse nature of the conduction system abnormality, which was the principal
feature in this case, was documented
electrophysiologically................Our case demonstrates several
important features of Lyme carditis not previously reported......First, we
have electrophysiologicaly documented the diffuse nature of the conduction system involvement that can occur in the disease..........Our experience suggests that patients with Lyme carditis who exhibit any conduction abnormality require hospitalization and close electrocardiographic
monitoring. The rapid progression from 2:1 atroiventricular block to
complete heart block with subsidary pacemaker failure in our patient underscores the need to consider early temporary pacemaker therapy in
patients with Lyme carditis, even when the initial conduction abnormality
may appear benign........"
____________________________
Authors: Hammers-Berggren S, Griondahl A, Karlsson M, von Arbin M,
Carlsson A., Stiernstedt G

Title: Screening for neuroborreliosis in patients with stroke

Source: Stroke 1993 Sept;24(9):1393-6

Abstract: Background and Purpose: Borrelia burgdorfei, the etiologic
agent of Lyme disease, can cause different neurological manifestations. We studied the prevalence of Lyme neuroborreliosis in patients with stroke. .......Conclusions: We conclude that Lyme neuroborreliosis may imitate
stroke, but screening for antibodies against B burgdorferi seems to be of little value and may be replaced by a CAREFUL medical history.

Neurology 43(12): 2705-2707 (Dec 1991)
Stroke Due to Lyme Disease
Reik L. Jr.
Department of Neurology, University of Conn. Health Center, Farmington 06030-1845.

A 56 year old Connecticut woman suffered multiple strokes 18 months after antibiotic treatment for early Lyme disease with facial palsy.
Pleocytosis, intrathecal synthesis of anti-Borrelia burgdorferi antibody,
and the response to antibiotic treatment substantiated the diagnosis of neuroborreliosis. This is the first report of stroke caused by Lyme
disease aquired in North America.
_____________________________
other info on heart disease and infectious agents
OLD, OLD POST

Health magazine from November/December 1997 there is an article
titled
"Could you Catch a Heart Attack?" by Michael Mason. There have been some
studies done that have linked a bacterium called Chlamydia pneumoniae to heart
disease. "....Discovered in 1965 but firmly identified only a decade ago, C.
pneumoniae is an airborne contagion responsible for 10% of respiratory
illnesses people usually call flu. But the consequences of infection may
reverberate long after a week of bed rest. Some experts now believe the bug
can travel from the lungs to the heart, cloggeing arteries and triggering
heart attacks.....A high reading of low-density lipoprotein--bad
cholesterol--is a sign of upcoming heart trouble, but it doesn't catch
everyone at risk: Half of all heart attacks happen to people with levels
considered normal. A recent study from Havard University suggests that
doctors might be able to forecast heart disease by also testing for certain
signs of CHRONIC INFECTION. And prediction is just the beginning. Guiding
most of the research into C. pneumoniae is the hope that heart attacks may be
treated, even prevented, by some of our cheapest, most widely available drugs:
ANTIBIOTICS.
"Think it sounds crazy? You're not alone--the idea has critics aplenty.But
consider what we have learned about peptic ulcers. Everyone used to think
they were caused by stress, spicy food, or too much stomach acid. Now we know
most ulcers result from an infection with the stomach dwelling bacterium
called Helicobacteer pylori, which can be eradicated with ANTIBIOTICS.
..........500,000 Americans die of coronary heart disease each year, more than
are killed by any other illness.
"The numbers, or more precisely, the way the numbers have risen and fallen
over the years, provide ammunition for researchers who believe infection may
explain at least some cases of heart disease. Though the data are
surprisingly skimpy, heart attacks are thought to have first struck Americans
in significant numbers in the 1920's. This " disease of affluence," (sound
like another disease you know?)
"we were told, resulted from ever-richer diets and a national aversion to
physical labor. Death rates rose for the next three decades.....
"But in the early 1960's something strange happened. Atherosclerosis began
to retreat. Across the country, fewer people were dying from heart attacks.
"Experts attributed the good news to a decline in smoking, vigorous
treatment of high cholesterol and high blood pressure, and other improvements
in medical care. But as death rates continued to drop, scientists realized
that those factors couldn't fully explain the phenomenon. Today the nation
is lazier and fatter than ever---yet mortality from cardiovascular disease has
fallen 50% from its historic high.
".....to epidemiologists like Thomas Grayston at the University of Washington,
the century's rise and fall of heart attack deaths describe a familiar figure.
It is the arc scientists see when they chart the course of a contagion
spreading through a vulnerable population and then tapering as resistance
developes. It is an epidemic in slow motion."
"Grayston discovered C. pneumoniae and brought the pest to scientific
prominence. Although he believes the microbe may play a role in all heart
attacks--not just in 10 to 15 percent suggested by other researchers--he is
not a crusader.....Indeed, he recalls. his reaction to the first evidence that
his discovery might be involved in heart disease was doubt verging on
disbelief.
"Grayston stumbled on C. pneumoniae 30 years ao in Taiwan while testing a
vaccine against the sexually transmitted form of chlamydia, which can
sometiimes lead to blindness as well as veneral disease. From the eye of a
child with failing vision, he swabbed a germ that resembled no known species
of chlamydia. Puzzled, he stored athe bacterium in a freezer in his Seattle
lab.
"In 1985 Grayston again encountered the same microbe, this time in blood
samples taken from flu sufferers in Finland. The bug could cause mild
pneumonia, it turned out, and was transmitted by coughs and sneezes.....His
Finnish colleagues began testing flu victims for infection.
One day, technicians at a government lab discovered that most of the blood
samples in a recently arrived shipment were testing positive. Fearing another
flu epidemic in the making, the lab workers rushed the results to their
superiors. But the blood was not from flu patients, the scientists learned.
It had been drawn from heart attack survivors at Helsinki University's Central
Hospital and sent over by a researcher investigating whether such patients
were likely to suffer a wide variety of infections....He and a colleague began
a larger comparison in Seattle.
".... The results made Grayston feel like someone who reads in the
newspaper that an old aquaintance is an ax murderer. People with and without
blocked arteries were likely to have antibodies to C. pneumoniae, they found,
but levels averaged 2.5 percent higher among heart patients. Those with the
greatest amount in their blood were twice as likely as those with the least to
have atherosclerosis.
"A number of studies have since confirmed that antibodies to the microbe
are present more often or in greater quantities in patients with blocked
arteries than in healthy people. 'The association is not questionable
anymore,' says Grayston. 'Of course, an association doesn't prove anything
either. The organism could be present without causing the disease.'...... "....recent findings hint that C. pneumoniae isn't an innocent bystander in
coronary artery disease, says Carolyn Black, head of laboratory research into
chlamydia at the Centers for Disease Control and Prevention. There's plenty
of evidence that the bug can make it out of the lungs and into the
bloodstream. Several researchers have discovered telltale signs of C.
pneumoniae-bits of DNA or proteins from the microbe's outer coat--in plaque
taken from the clogged arteries of heart patients. And just last year, after
a 56-year old man in Louisville, Kentucky, had a heart transplant,
cardiologists managed to retrieve and culture a colony of C. pneumoniae from
the plaque that had throttled his heart. It was the first time the living
bacterium had been dragged from an artery and made to reproduce in the
lab--the gold stantdard for identification.......
"The scenario may look something like this, says Grayston:" (this is the part
of the article that made me think about the Lyme spirochete and the
similarities it has with C. pneumoniae) "An unfortunate soul inhales C.
pneumoniae. To fight off the bacteria, the immune system sends
macrophages---cells that are supposed to destroy invaders---to the lungs. Lab
tests have shown, though, that the microbe CAN SURVIVE BEING GOBBLED UP BY
IMMUNE CELLS. Now the macrophages carry the wily bugs throughout the body.
Everywhere they go, they assail the arterial walls, entering cells to
reproduce.
"Because macrophages seek out trouble spots, C. pneumoniae are often carried to
places where there's already an arterial injury---say, from a deposit of bad
cholesterol. As the bacteria damage or kill cells in the coronary arteries,
more macrophages arrive to repair the injury, but they only bring more of the
intruder. A pile of macrophages, reproducing bacteria, and other detritus
forms in the arterial wall. As it grows it bulges into the bloodstream and
narrows the artery, setteint the stage for a clot to choke off blood flow. "This process couldn't happen overnight. Atherosclerosis takes years to
develope," (so does late Lyme) "and if infection plays a part , it cannot come
and go like the flu; it must PERSIST in the body, somehow evading the immune
system. Scientists know the microbe has that ability." (same with Lyme)
"If one common germ could cause heart disease, how many others might be
culpable? People infected with the bacteria that cause gum disease...for
instance, seem to be at about double the risk of cardiovascular disease.( One
reseacher brings a slide to conferences: 'Floss of die,' it says.)...
"The number of deaths from heart attacks, remember, began to fall in the early
1960's. The American diet hasn't significantly improved, and exercise had not
yet become a priority. But something had changed and chlamydia experts think
they know what it was: Broad-spectrum antibiotics, particularly tetracycline,
had come into wide use.
"According to this theory, when doctors started prescribing the new wonder
drugs, they unwittingly unleashed a weapon against C. pneumoniae. Though no
one even knew the bug existed, the rate of infection started to decline. And
so did the incidence of heart attack.
"Experts may never know if there was really a connection . But that hasn't
stopped them from trying to make the pattern repeat itself. At St. George's
Hospital in London, cardiologist Sandeep Gupta recently gave an antibiotic
called azithromycin to 40 heart attack survivors infected with C. pneumoniae.
He gave 20 similar patients a placebo. After 18 months, the patients on the
antibiotic were four times less likely to have chest pains and other signs of
heart trouble.
" 'It's exciting,' Gupta says. 'We could be able to make a real
difference in this disease with antibiotics.'
"This time U.S. scientists are greeting the news from abroad with something
other that skepticism. They're scambling to start antibiotic studies of their own......."

A ProMED-mail post

Chalamydia pneumoniae & stroke or cardiac disease: RFI 980321032308
Chlamydia pneumoniae & stroke or cardiac disease (02) 980326225812]

Date: Wed, 25 Mar 1998 21:31:44 -0500
From: Adriaan Klinkenberg <F.Klinkenberg@Elsevier.nl>

Chlamydia pneumonae: A Treatable Cause of Atherosclerosis? Antimicrobics
and Infectious Diseases Newsletter, Volume 16 Number 1 (March 1998) p.1-4. James A.S. Muldowney III, Sarnoff Research Fellow in Cardiology, Dept of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

Chlamydia pneumoniae infection induces inflammatory changes in the aortas
of rabbits.
Infection and Immunity, Volume 65, p. 4832-4835 (1997). K. Laitinen, A. Laurila, L. Pyhala, M. Leinonen, and P. Saikku (National
Public Health Institute, Finland).

Also, the Merieux Foundation will be organizing a meeting titled Infections
and Atherosclerosis, in Annecy, France, 28-31 December 1998.

A ProMED-mail post

[see also:
Chalamydia pneumoniae & stroke or cardiac disease: RFI 980321032308]

Date: Sun, 22 Mar 1998 00:43:21 EST

There are many studies ongoing. Pfizer has a 3,000 person multi-center trial with azithromycin preventing cardiovascular events (Wizard trial). I have been interested in the association and have been treating my patients for 2 years now, and I have to admit that zithromax seems to prevent events in patients with positive antibodies to _C. pneumoniae_.

--
George Cuchural Jr. MD FACP
e-mail: GEORGECUCH@aol.com


Vital Signs: Health and Medical News

Authors: Sarah Henry, Rachele Kanigel, Rob Waters.

[Hippocrates 11(12): 14-16, 18, 21-22, 1997. © 1997 Time Publishing Ventures Inc.]
______________________________________
Another Reason to Floss

Heidelberg, Germany

Most people brush and floss to protect their teeth and gums. Now research suggests that good dental hygiene could help ward off strokes.

Evidence has been building that infectious agents like Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus may contribute to heart disease (see "Are Heart Attacks Contagious?"). Since strokes, like heart attacks, occur when blood vessels clog, researchers at the University of Heidelberg wondered if there might also be a link between chronic infections and strokes. The team compared the infection histories of 336 hospital patients, half of whom had suffered an ischemic stroke and half of whom hadn't. The results: The stroke rate was two and a half times greater for patients with cavities, dental lesions, and periodontal disease than for those with healthy gums and teeth. And patients who had battled chronic bronchitis in the previous two years were twice as likely as others to have had a stroke.

Scientists aren't ready to say that chronic infections actually cause cardiovascular disease and stroke. The German team did not control for diet, antioxidant levels, and some other factors that might account for the findings. But researchers are already talking about two plausible explanations for how infections contribute to heart disease.One is that microbes travel through the bloodstream and infect the arteries. Another is that infections cause systemic inflammation, which damages the heart and blood vessels. ____________________________________________________________-

--- SoupGate-Win32 v1.05
* Origin: fsxNet Usenet Gateway (21:1/5)