Abstract 15341: Detection of Borrelia Burgdorferi and Cardiotropic Viruses in Endomyocardial Biopsy Specimens in Patients with Recent-Onset Dilated Cardiomyopathy.
Introduction: Borrelia burgdorferi is a potentially cardiotropic micro-organism. There are limited data about its role in the pathogenesis of dilated cardiomyopathy (DCM). We aimed to describe the prevalence of borrelia burgdorferi and cardiotropic viruses in specimens from endomyocardial biopsy (EMB) in DCM patients. Furthermore, we wanted to correlate their presence in EMB with serological methods.
Methods: EMB was performed in 33 DCM patients (pts) with a history of heart failure shorter than 6 months ( age 44±6 years, 22 males (67%), NYHA class 2.7± 0.8, duration of symptoms 2.2±1.7 months, LVEF 24±9%). Only one pt had a history of treated Lyme disease. In each patient, three EMB samples were assessed using polymerase chain reaction (PCR) to detect cytomegalovirus, Ebstein-Barr virus, human herpes virus-6, parvovirus B19 (PVB19), adenoviruses, enteroviruses and borrelia burgdorferi. We performed serological tests of these agents and Western Blot to detect borreliosis. In those patients with a borrelia-positive PCR, we performed electrone microscopy of EMB specimen.
Results: The following micro-organisms were detected in EMB: PVB19 (median 227 copies/μg of extracted DNA) in 20 pts (61%), borrelia burgdorferi in 9 pts (27%), enterovirus in 1 pt (3%). PVB19 and borrelia burdorferi were detected simultaneously in 7 pts. Electrone microscopy of EMB samples confirmed borrelias in 7 pts (78%) from 9 pts with a borrelia-positive PCR. All patients with a PVB19-positive PCR had IgG antibodies against PVB19, but no patient expressed specific IgM antibodies. Just 4 pts (44%) from 9 pts with a borrelia-positive PCR presented with a positive serology of borreliosis, 3 pts had positive IgG antibodies, 1 pt IgM antibodies.
Conclusion: We observed a high prevalence of borrelia burgdorferi in EMB specimens in patients with recent-onset DCM. The low sensitivity of serological tests detecting borreliosis may reflect either intracellular persistence of borrelias or impaired immune response. Further studies are needed to evaluate pathophysiologic and therapeutic consequences of these findings. Supported by the grant IGA NS-9697/2008.
- © 2010 by American Heart Association, Inc.