Ehrlichiosis Induced Aseptic Meningitis and Second-Degree Heart Block in an Adolescent Male.

We present a previously healthy 16-year-old male with ehrlichiosis-induced aseptic meningitis and subsequent second-degree heart block.

A case of complete heart block in a patient with HIV and leptospirosis.

A 32 year-old patient presented with a two-week duration of fever with hepato-splenomegaly with dizziness spells for two days. The patient was found to have HIV and to be leptospira positive. Electrocardiogram showed complete heart block which disappeared after antibiotic treatment. Our case is unique because a combination of HIV, leptospirosis and complete heart block has never before been described in literature.

Listeriosis in pregnancy complicated by postpartum heart block.

BACKGROUND: Listeria monocytogenes is a food-borne pathogen that primarily affects pregnant women. Cardiac involvement is an uncommon complication of infection. We present a case of a gravida with Listeria bacteremia at 36 weeks of gestation. CASE: Two of a patient's blood cultures grew L monocytogenes after she experienced chills, headache, myalgia, and diarrhea. The patient was treated with antibiotics for 48 hours, and then labor was induced, resulting in a normal delivery with a healthy neonate. On day 5 postpartum, the patient developed progressive heart block, resulting in a third-degree block, which required a pacemaker. An electrocardiogram done 30 days after hospital discharge demonstrated an atrial-sensed, ventricularly paced rhythm, which indicated that the heart block had not resolved. CONCLUSION: Heart block is a rarely reported and possibly overlooked complication of listeriosis. Mothers with listerial infection should be screened for cardiac complications to avoid unexpected decompensation.

[Lyme carditis--rare cause of dilated cardiomyopathy and rhythm disturbances]. / Lymeská karditida--vzácná prícina dilatacní kardiomyopatie a poruch srdecního rytmu.

Case report of young woman presents involvement of dilated cardiomyopathy and rhythm disturbances in 18 months after infection of tick, with direct assessment of spirochetes in myocardial tissue. Cardial decompensation occured after asthma exacerbation, complicated by bronchopneumonia. Rhythm disturbances and heart failure gradually subside after parenteral antibiotic treatment and peroral treatment of heart failure. Nevertheless there is a long-lasting persistence of dilated cardiomyopathy with significant systolic dysfunction, which is supposedly last consequence of Borrelia infection. Resynchronic therapy combinated with cardioverter-defibrilator primary considering was postponed for improvement clinical condition and myocardial electric stability. There is demonstrating complicated serologic diagnostics of Lyme disease in discussion. Lyme carditis would be part of differential diagnosis in rhythm disturbances and cardiomyopathy of unknown etiology, including serious or fatal events.

[Ictero-haemorrhagic leptospirosis with a cardiac presentation in a patient returning from an endemic zone]. / Leptospirose ictéro-hémorragique de presentation cardiaque chez une patiente de retour de zone d'endémie.

On returning from a tropical area, the occurrence of rapidly evolving cardiogenic shock in an infectious context should quickly suggest the diagnosis, for which specific treatment can affect the outcome. The dramatic case of a young female presenting with ictero-haemorrhagic leptospirosis diagnosed post-mortem, demonstrated this pathology with the unusual association of complete atrio-ventricular block and myocarditis in a haemorrhagic context.

[Atrioventricular heart block in Lyme disease]. / Bloc atrioventriculaire complet sur borréliose de Lyme: aspects etectrocardiographiques, diagnostiques et microbiologiques.

Lyme disease is the most common tick-borne disease in Europe and in the United States. In comparison to dermatological, neurological and rheumatological manifestations, heart disease is quite rare. Atrioventricular heart block is nevertheless the most frequent cardiological manifestation. We hereby report the case of a patient with high degree heart block due to Lyme disease. We focus on the electrocardiographical evolution during antibiotic therapy, as well as on microbiological and diagnostic aspects. Lyme disease is a rare cause of conduction disturbances but it is treatable and potentially reversible.

Fatal complete atrioventricular block as a complication of bacterial sepsis in a premature newborn.

We report on a premature infant with a body weight < 900 g who developed complete heart block as a complication of Enterobacter bacteremia. The infant could be successfully paced using a transcutaneous pacemaker for a limited time. Histopathological examination of the heart did not reveal any abnormalities of the specialized conduction system.

[Cardiac manifestations of Lyme borreliosis]. / Objawy kardiologiczne w przebiegu boreliozy z Lyme.

Lyme borreliosis is increasing in Poland in both incidence and recognition with 655 cases reported in 1997 and 3574 in 2003. Approximately 4% of patients will develop cardiac manifestations--the least well documented complication of Lyme disease. Cardiac involvement usually occurs within weeks to months of the infecting tick bite and includes varying degrees of atrioventricular block as the commonest manifestation and tachyarrhythmias, myopericarditis, mild cardiac muscle dysfunction. There has been evidence that long standing dilated cardiomyopathy may be associated with chronic Borrelia burgdorferi infection. Patients with atrioventricular block have good prognosis. Most cases resolve within 1 to 2 weeks. Temporary, but almost never permanent, cardiac pacing may be required for some patients. Cardiac manifestations of Lyme disease are treatable with antibiotics. Lyme carditis should be taken into consideration in patients with acute as well as chronic heart diseases.

Complete heart block resulting from quadricuspid aortic valve penicillin-resistant pneumococcal endocarditis: a case report.

A 62-year-old woman was referred to hospital to be treated for complete heart block with syncope. A quadricuspid aortic valve without vegetation and aortic valve regurgitation (AR) were observed by transesophageal echocardiography. Blood culture showed penicillin-resistant Streptococcus pneumoniae. The patient received a permanent pacemaker implantation (VDD type) and was given antibiotics. Although infection improved, heart failure was not improved because AR hemodynamic changes became worse. An aortic valve replacement was performed using a prosthesis on the 26th day of hospitalization. The patient recovered and was discharged.

Intravenous gamma-globulin therapy in myocarditis complicated with complete heart block: Report of one case.

Myocarditis complicated with complete heart block is rare in childhood. We report a case of 4-year-old child presented with complete heart block which may have been caused by Mycoplasma pneumoniae. Under emergent temporal pacing, patient experienced cardiogenic shock with pulmonary edema eventually. The cardiopulmonary function was improved with atrial rhythm at the 6th hour later after intravenous infusion with high-dose gamma-globulin (IVIG). The IVIG therapy may have immunomodulatory effects and serve as a potential adjunctive therapy for fulminant myocarditis.

[Therapy and prognosis of infectious complete atrioventricular block in children]. / Traitement et pronostic du bloc auriculo-ventriculaire complet infectieux de l'enfant.

From 1983 to 1997, we have studied ten children with complete atrioventricular block likely due to myocarditis in order to assess its prognosis and to define a therapeutic strategy. Their age ranged from 6 days to 16 years (median: 4.1 years). All were admitted for sudden complete block, with symptoms in seven: syncope or fainting, seizures, collapse. Three had an asymptomatic bradycardia which was detected on routine auscultation in children with fever or already hospitalized; fever was present in 5. The disease was related to infection on biological data in 4 cases (1 listeriosis and 3 seroconversions for Epstein Barr or cytomegalic or Coxsackie B viruses), on a myocardial biposy in 1 case and on scintigraphic data in 1 case. In the remaining 4, indirect arguments were considered such as infectious context, normal recent ECG, favourable outcome. Five children were given intravenous isoprenalin with ventricular tachycardia in 3. Five were treated with steroids and 3 with specific antiviral agents. Seven patients were paced temporarily. One child died, 6 recovered totally and 3 have a permanent block with a definitive pacemaker implanted in 2. In conclusion, sudden acquired complete atrioventricular blocks are often ill-tolerated in children and have to be treated with transient pacing. Recovery occurs as a rule but some of these blocks may be definitive. Infective myocarditis is likely to be the cause of the disease even if the pathogen agent cannot always be identified.

Atrioventricular block in a toxic child: do not forget diphtheria.

We describe a 4.5-year-old girl who presented with severe febrile throat infection and who, after a few days, developed ventricular tachycardia followed by atrioventricular block. Although a pacemaker was inserted, she died of cardiogenic shock. Throat cultures were positive for Corynebacterium diphtheriae.