BORRELIOOSIN AIHEUTTAMA SYDÄNTULEHDUS

[Bb]

Lähettäjä: Soijuv Lähetetty: 4.2.2005 9:41

Tapausselostus 2 lapsesta joilla oli vakava borrelioosin aiheuttama sydäntulehdus:


Lyme carditis

Abstract number: 903_r2326

Krbkova L.

Objectives:

To report two severe cases of Lyme carditis in children and to point out the impact of early antibiotic therapy.

Patients:

Two children were admitted to Children's University Hospital in Brno with complete heart block of unknown origin. Basic laboratory tests, electrocardiogram (ECG), serology for cardiotropic viruses and Lyme borreliosis were performed. Prior heart disease was excluded.

Results:

Previous tick bite was noticed in one child, stay in endemic area in the second one. Onset of the first cardiac symptoms: weakness, palpitations, syncope and chest pain in July and September, suggested borrelial aetiology. Acute ECG changes showing complete heart block allowed to initiate the antibiotic therapy (ceftriaxone/cefotaxime). Four to seven days later, first-degree heart block was registered, I.PQ 0.36 s/II.0.39 s. In one case an escape rhythm persisted (PQ 0.38?0.50 s) for 8 days. One month later, no symptoms or signs of atrioventricular disturbance and normal PQ 0.16?0.17 s were present. High titres of IgM antibodies against B. burgdorferisensu stricto were confirmed in the first samples, five specific antigens reacting in immunoblot. Seroconversion was detected in 18 days. In the second child, significant decline of specific IgM and IgG titres was found 2 months later, only OspC and p41 were detectable in immunoblot. Cephalosporins of the third generation were given for 28 days intravenously. Neither child did require temporary cardiac pacing.

Conclusion:

Cardiac manifestation was seen for the first time in our children. Borrelial infection caused by B. burgdorferi sensu stricto is rarely seen in Europe. Early diagnosed severe involvement of the heart with appropriate antibiotic therapy had an excellent prognosis for both children even associated with critical atrioventricular conduction abnormality. Four-week course of antibiotic treatment was sufficient to prevent further sequelae and effectively eradicated borrelial infection. The prognosis depended on the management of the acute stage.