Introduction
Methods
Very likely
| Acute onset of cardiac symptomsa
|
+ ECG abnormality consistent with Lyme carditisb
| |
+ positive serology
c for Borrelia
| |
Or: | Acute onset of cardiac symptomsa
|
+ no ECG abnormality consistent with Lyme carditis
b/no ECG performed | |
+ positive serologyc for Borrelia
| |
+ anamnestic tick bite/anamnestic erythema migrans/diagnosed Lyme arthritis/ | |
diagnosed Lyme neuroborreliosis | |
+ clinical recovery after antibiotic treatment | |
Likely
| Acute onset of cardiac symptomsa
|
+ positive serologyc for Borrelia
| |
+ clinical recovery after antibiotic treatment | |
Or: | ECG abnormality consistent with Lyme carditisb
|
+ positive serologyc for Borrelia
| |
Or: | Acute onset of cardiac symptomsa
|
+ ECG abnormality consistent with Lyme carditisb
| |
+ Borrelia serology not performed | |
+ anamnestic tick bite/anamnestic erythema migrans/diagnosed Lyme arthritis/ | |
diagnosed Lyme neuroborreliosis | |
+ clinical recovery after antibiotic treatment/recovery ECG | |
Possible
| Acute onset of cardiac symptomsa
|
+ positive serologyc for Borrelia
| |
+ anamnestic tick bite/anamnestic erythema migrans/diagnosed Lyme arthritis/ | |
diagnosed Lyme neuroborreliosis | |
Or: | Acute onset of cardiac symptomsa
|
+ positive serologyc for Borrelia
| |
Or: | Acute onset of cardiac symptomsa
|
+ Borrelia serology not performed | |
+ anamnestic tick bite/anamnestic erythema migrans/diagnosed Lyme arthritis/ | |
diagnosed Lyme neuroborreliosis | |
Not Lyme carditis
| Negative serologyc for Borrelia
|
Results
Incidence questionnaire sent to GPs
|
N
|
(% of 9178)
|
Response to question on Lyme carditis | 3067 |
(33.4 %)
|
GP practice population | 7,682,803 | |
Reports of diagnosed Lyme carditis | 39 | |
Annual incidence of Lyme carditis in 2009 and 2010 per 10 million inhabitants, based on 39 GP reports of Lyme carditis per 7,682,803 practice population
| ||
Crude incidence for Lyme carditis | 25 | (95 % CI: 18–34)/10,000,000 |
Medical record review
|
N
|
(% of 22)
|
Response on GP reported cases | 22 | |
GP unable to recall identity | 7 |
(31.8 %)
|
Unwilling to cooperate | 4 |
(18.2 %)
|
Invalid reports of Lyme carditis | 3 |
(13.6 %)
|
Medical records reviewed | 8 |
(36.4 %)
|
Classification of reviewed medical records
|
N
|
(% of 11)
|
Very likely diagnosis | 6 |
(54.5 %)
|
Likely diagnosis | 1 |
(9.1 %)
|
Possible diagnosis | – | |
Not Lyme carditis | 1 |
(9.1 %)
|
Invalid report of Lyme carditis, not reviewed | 3 |
(27.3 %)
|
Clinical presentation within 2009 or 2010
|
N
|
(% of 8)
|
3 |
(37.5 %)
| |
Adjusted
a
annual incidence of Lyme carditis in 2009 and 2010 per 10 million inhabitants
| ||
Incidence for Lyme carditis | 6 | (95 % CI: 4–8)/10,000,000 |
National numbers | 10 |
Case#, Classification | Date clinical presentation | Gender & age | Cardiac symptoms (duration) | Relevant anamnesis | Serology & clinical chemistry | ECG, Chest X-ray | Treatment & clinical course |
---|---|---|---|---|---|---|---|
1, Very likely | July 2007 | Male 52 | Dyspnoea, angina pectoris (2–4 weeks) | Tick bite, EM (2–4 weeks) | ELISA IgG & IgM positive Immunoblot positive | ECG n.a. Chest X-ray: not performed | Clinical recovery, 2–4 weeks after 100 mg doxycycline b.i.d. for 30 days |
2, Very likely | May 2010 | Male 49 | Palpitations, dyspnoea, syncope, angina pectoris, dizziness, fatigue (3 weeks) | EM, radiculitis (3 weeks) | ELISA positive Immunoblot positive. Intrathecal antibody response after 1st antibiotic treatment. | ECG: 1st degree AV-block Chest X-ray: not performed | No recovery after 100 mg doxycycline b.i.d. for 21 days Clinical and ECG recovery, 1 week after ceftriaxone 2 g q.d. IV for 14 days. Temporary pacemaker |
3, Very likely | November 2005 | Male 58 | Dyspnoea, fatigue (1 month) | Flu-like symptoms (3 months) | ELISA IgG & IgM positive Immunoblot positive | ECG: ST-segment change (flat ST-wave inferolateral) Chest X-ray: not performed | No recovery after 100 mg doxycycline b.i.d. for 21 days No recovery after ceftriaxone 2 g q.d. IV for 14 days |
4, Very likely | September 2009 | Female 85 | Palpitations, dyspnoea, orthopnoea/oedema, dizziness, fatigue (3 weeks) | EM (1 month) | ELISA IgG positive | ECG: 3rd degree AV-block Chest X-ray: cardiomegaly decompensatio cordis | After 100 mg doxycycline b.i.d. for 21 days, plus permanent pacemaker, diuretic, anticoagulant, Clinical recovery |
5, Very likely | September 2005 | Male 60 | Dyspnoea, dizziness, fatigue (3 weeks) | Tick bite (3 weeks) | ELISA IgG positive Immunoblot positive | ECG: 3rd degree AV-block Chest X-ray: no abnormalities | Clinical and ECG recovery, 2 weeks after ceftriaxone 2gr q.d. IV for 14 days |
6, Very likely | February 2011 | Female 75 | Dyspnoea, dizziness, fatigue (1–2 days) | Frequent exposure to tick bites, flu-like symptoms (duration n.a.) | ELISA IgM positive Immunoblot negative | ECG: 3rd degree AV-block Chest X-ray: no abnormalities | Clinical improvement and full ECG recovery, 2- 4 weeks after 100 mg doxycycline b.i.d. for 21 days, with permanent pacemaker, beta blocker, carbasalate calcium |
7, Likely | November 2010 | Male 70 | Palpitations (2 weeks) | 2007: Tick bite, EM Potential arrhythmogenic medication for present hypertension: beta blocker, calcium channel blocker | ELISA IgG positive Immunoblot positive | ECG no abnormalities Chest X-ray: not performed | Some temporary clinical improvement 2 weeks after 100 mg doxycycline b.i.d. for 14 days |
8, Not Lyme carditis | December 2011 | Male 70 | Syncope, dizziness (1 year) | 2005: LB with facial palsy, treated with ceftriaxone 2 g q.d. IV for 14 days Potential arrhythmogenic medication for hypertension, atrial fibrillation, mitral valve insufficiency: beta blocker | ELISA negative | ECG: no abnormalities Chest X-ray: cardiomegaly | Clinical recovery without antibiotic treatment. Start anticoagulant |