Fatal Lyme Carditis in New England: Two Case Reports
Authors: Grace E. Marx, Jillian Leikauskas, Katherine Lindstrom, Erin Mann, Sarah Reagan-Steiner, Eduard Matkovic, Jennifer S. Read, Patsy Kelso, Natalie A. Kwit, Alison F. Hinckley, Mark A. Levine, Catherine Brown
Journal: Annals of Internal Medicine (2019)

Letters4 February 2020Fatal Lyme Carditis in New England: Two Case ReportsGrace E. Marx, MD, MPH, Jillian Leikauskas, MPH, Katherine Lindstrom, MD, Erin Mann, MPH, Sarah Reagan-Steiner, MD, MPH, Eduard Matkovic, MD, Jennifer S. Read, MD, MS, MPH, DTM&H, Patsy Kelso, PhD, Natalie A. Kwit, DVM, MPH, Alison F. Hinckley, PhD, Mark A. Levine, MD, and Catherine Brown, DVM, MSc, MPHGrace E. Marx, MD, MPHCenters for Disease Control and Prevention, Fort Collins, Colorado (G.E.M., A.F.H.)Search for more papers by this author, Jillian Leikauskas, MPHVermont Department of Health, Burlington, Vermont (J.L., P.K., N.A.K., M.A.L.)Search for more papers by this author, Katherine Lindstrom, MDCape Cod Office of the Chief Medical Examiner, Sandwich, Massachusetts (K.L.)Search for more papers by this author, Erin Mann, MPHMassachusetts Department of Public Health, Jamaica Plain, Massachusetts (E.M., C.B.)Search for more papers by this author, Sarah Reagan-Steiner, MD, MPHCenters for Disease Control and Prevention, Atlanta, Georgia (S.R., E.M.)Search for more papers by this author, Eduard Matkovic, MDCenters for Disease Control and Prevention, Atlanta, Georgia (S.R., E.M.)Search for more papers by this author, Jennifer S. Read, MD, MS, MPH, DTM&HVermont Department of Health and University of Vermont, Burlington, Vermont (J.S.R.)Search for more papers by this author, Patsy Kelso, PhDVermont Department of Health, Burlington, Vermont (J.L., P.K., N.A.K., M.A.L.)Search for more papers by this author, Natalie A. Kwit, DVM, MPHVermont Department of Health, Burlington, Vermont (J.L., P.K., N.A.K., M.A.L.)Search for more papers by this author, Alison F. Hinckley, PhDCenters for Disease Control and Prevention, Fort Collins, Colorado (G.E.M., A.F.H.)Search for more papers by this author, Mark A. Levine, MDVermont Department of Health, Burlington, Vermont (J.L., P.K., N.A.K., M.A.L.)Search for more papers by this author, and Catherine Brown, DVM, MSc, MPHMassachusetts Department of Public Health, Jamaica Plain, Massachusetts (E.M., C.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0483 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Lyme disease is the most common vector-borne disease in the United States, and it is hyperendemic in the Northeast (1). In the United States, the spirochete Borrelia burgdorferi causes Lyme disease and is transmitted by the bite of an infected black-legged tick. Carditis is a rare manifestation that can usually be treated successfully with a short course of antibiotics (2). However, it can present with many symptoms, and its severity can change rapidly and unpredictably (3). Death can occur when Lyme carditis is untreated. Before this report, only 9 fatal cases were reported in the literature (4, 5).Objective: ...References1. Schwartz AM, Hinckley AF, Mead PS, et al. Surveillance for Lyme disease - United States, 2008–2015. MMWR Surveill Summ. 2017;66:1-12. [PMID: 29120995] doi:10.15585/mmwr.ss6622a1 CrossrefMedlineGoogle Scholar2. Yeung C, Baranchuk A. Diagnosis and treatment of Lyme carditis: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;73:717-26. [PMID: 30765038] doi:10.1016/j.jacc.2018.11.035 CrossrefMedlineGoogle Scholar3. Fuster LS, Gul EE, Baranchuk A. Electrocardiographic progression of acute Lyme disease. Am J Emerg Med. 2017;35:1040. [PMID: 28279540] doi:10.1016/j.ajem.2017.02.052 CrossrefMedlineGoogle Scholar4. Forrester JD, Meiman J, Mullins J, et al; Centers for Disease Control and Prevention (CDC). Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death—United States. MMWR Morb Mortal Wkly Rep. 2014;63:982-3. [PMID: 25356607] MedlineGoogle Scholar5. Muehlenbachs A, Bollweg BC, Schulz TJ, et al. Cardiac tropism of Borrelia burgdorferi: an autopsy study of sudden cardiac death associated with Lyme carditis. Am J Pathol. 2016;186:1195-205. [PMID: 26968341] doi:10.1016/j.ajpath.2015.12.027 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado (G.E.M., A.F.H.)Vermont Department of Health, Burlington, Vermont (J.L., P.K., N.A.K., M.A.L.)Cape Cod Office of the Chief Medical Examiner, Sandwich, Massachusetts (K.L.)Massachusetts Department of Public Health, Jamaica Plain, Massachusetts (E.M., C.B.)Centers for Disease Control and Prevention, Atlanta, Georgia (S.R., E.M.)Vermont Department of Health and University of Vermont, Burlington, Vermont (J.S.R.)Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0483.This article was published at Annals.org on 22 October 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byA Case of Lyme Carditis With Variable Heart Block Successfully Treated With Oral DoxycyclineElectrocardiogram as a Lyme Disease Screening TestLyme Carditis With Complete Heart Block Successfully Treated With Oral DoxycyclineLyme disease: A cause of polymorphic ventricular tachycardia 4 February 2020Volume 172, Issue 3Page: 222-224KeywordsAntibioticsEnzyme linked immunosorbent assayInfectious diseasesLyme diseaseMyocarditisNauseaPrimary care physiciansSpirochetesTicksWestern blot ePublished: 22 October 2019 Issue Published: 4 February 2020 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...