Borrelia infection as a cause of carditis (a long-term study).

BACKGROUND: Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date. AIM: The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB. METHODS: Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels. RESULTS: The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae. CONCLUSION: Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.

[Informational value of the prevalence of antiborrelia antibodies in a healthy and at risk population]. / Výpovední hodnota prevalence antiboreliových protilátek u zdravé a rizikové populace.

The authors tried to confirm data on the prevalence of antiborrelia antibodies class IgM and IgG in the local healthy population (200 blood donors) and in subjects with an increased risk of infection (forestry labourers, forestry workers and huntsmen). All blood samples were analyzed in the National Reference Laboratory for Lyme borreliosis CEM (LB) in the National Institute of Public Health in Prague by the ELISA NRLB KC 90 method and in case of a positive result they were confirmed by the Western blot Lyme method. All patients completed a special questionnaire used as a standard procedure in the consultation centre for LB. In the group of blood donors 100 men were examined, mean age 33.5 years and 100 women, mean age 24.4 years. In 26 positive antibodies against Borrelia burgdorferi (Bb) were confirmed, but on invitation to medical examination only 22 attended, 11 men and 11 women (10.1%). Examination of antiborrelia antibodies by the ELISA method proved positivity of class IgM 7 times and of class IgG 9 times. By the Western blot method (WB) class IgG was confirmed three times. In the risk group 39 men were examined, mean age 40.6 years and 32 women. In 12 of them (17.9%) positivity of antiborrelia antibodies against Borrelia burgdorferi (Bb) was proved by the ELISA method as well as the WB method. If the percentage confidence interval of the control group is taken as a basis for comparison, then the value of the risk group is within this interval at a significance value of alpha = 0.01. In the conclusion the authors discuss the problem of interpretation of positive serological results and the pitfalls of their evaluation not only from the aspect of validity of laboratory findings, due to the absence of standardization of methods, but also with regards to obscure aspects of the persistence of IgM antibodies after years of lege artis antibiotic treatment.