The U.S. Centers for Disease Control (CDC) last week reported on three sudden cardiac deaths associated with Lyme carditis, or inflammation of the heart, in the Northeast between November 2012 and July 2013.
The CDC said that while symptomatic infection of the heart is rare in recognized Lyme disease cases and usually resolves promptly with appropriate antibiotic therapy, there is a risk of life-threatening complications.
The CDC study reported that in the past 13 months, one woman and two men ranging in age from 26 to 38 years from high-incidence Lyme disease states experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis.
Approximately 30,000 confirmed and probable cases of Lyme disease were reported in the United States in 2012, primarily from high-incidence states in the Northeast and upper Midwest, according to the report published in the CDC’s morbidity and mortality weekly report for December 12.
The three deaths were investigated by the Connecticut Department of Public Health, Massachusetts Department of Public Health, New Hampshire Department of Public Health, New York State Department of Health, and CDC. The health investigators were alerted to the cases by a doctor who saw signs of Lyme infection in organs being prepared for transplants.
“Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions,” the CDC report said. “Reducing exposure to ticks is the best method for preventing Lyme disease and other tickborne infections.”
In the first case, in November 2012, a Massachusetts resident died after his automobile veered off the road. Interviews with next-of-kin revealed that the patient had described a nonspecific illness with malaise and muscle and joint pain during the two weeks preceding death. The patient lived alone with a dog that was reported to have ticks frequently. Tests in connection with transplant showed evidence of Lyme inflammation.
In the second case, in July 2013, a New York state resident experienced chest pain and collapsed at home. Cardiopulmonary resuscitation was unsuccessful, and the patient was pronounced dead at a local hospital. The patient had no known tick contact or rash but was reported to be a hiker. Evidence of Lyme was discovered during cornea transplant procedures.
In the case of the third patient, in July, a Connecticut resident collapsed while visiting New Hampshire and was pronounced dead at a local hospital. The patient had complained of episodic shortness of breath and anxiety during the 7–10 days before death. A physician consulted one day before death prescribed clonazepam for anxiety; an EKG was not performed, nor were any antibiotics prescribed. The patient lived on a heavily wooded lot and had frequent tick exposure; there was no known history of cardiovascular disease. An autopsy revealed evidence of Lyme infection.
The report noted it described three cases of sudden cardiac death associated with Lyme carditis, with subsequent transplantation of corneas from two of the decedents into three recipients. “Only rarely has death been attributed to Lyme carditis,” the report said, “and review of pathology reports at tissue bank A did not identify any additional confirmed cases among 20,000 cardiac specimens received since 2004. Whether the preexisting heart conditions found in two patients increased their risk for death is unclear.”
The report added, “Medical examiners and pathologists should be aware that Lyme carditis is a potential, albeit rare, cause for sudden cardiac death in persons from high-incidence Lyme disease areas.”
The CDC said prompt recognition and early, appropriate therapy for Lyme disease is essential. Health care providers should ask patients with suspected Lyme disease about cardiac symptoms and obtain an EKG if indicated. Conversely, they should ask patients with unexplained heart block about possible exposure to infected ticks. Health care providers also should remind their patients of steps to prevent infection, including use of repellent, daily tick checks, prompt showering after potential exposure, and landscape management. The three deaths described in this report underscore the need for better methods of primary prevention of Lyme disease and other tickborne infections, the CDC said.
“This is not a new phenomenon,” Dr. Joseph D. Forrester, a CDC scientist and one of the authors of the paper published last Thursday, told the Boston Globe. “However, given the severity of what happened and the tragedy of three young people to die suddenly, it was very important to investigate these cases.”
Catherine M. Brown, Massachusetts public health veterinarian and one of the authors of the report, told the Globe that it underscores the need to prevent Lyme disease in the first place and to identify it early so that patients get appropriate antibiotic treatment.
Dr. Stanley Plotkin, emeritus professor of pediatrics at the University of Pennsylvania and a vaccine specialist, told the Globe the CDC report shows the urgent need for a vaccine against Lyme.
His son, Alec, collapsed in August 2005 outside Philadelphia while walking his dog. An alert doctor at the hospital Alec was taken to realized he had Lyme and successfully treated him with antibiotics and a pacemaker.
“I think it is unconscionable and a discredit to all parties — public health, manufacturers, Lyme activists — that no Lyme vaccine is available to humans while there is one for dogs,” he told the Globe in an e-mail.
Sam Telford, professor of infectious diseases at the Tufts University School of Veterinary Medicine and well known tick researcher who has focused much of his research on the islands, said he is not surprised by the news of three deaths associated with Lyme carditis.
” It is well known that 4 to 10 percent of all untreated early Lyme cases have some signs of heart issues due to Lyme disease,” Mr. Telford said in an email to The Times. “Most will spontaneously resolve with no treatment. Deaths have been rare … When one infects lab mice, the most reproducible lesion is always inflammation of the heart muscles, nerves, and aortic valve. Every single mouse gets it within 21 days of infection. It disappears within 2 weeks with no residual signs. It is amazing how much potential damage is there, yet it resolves with no further effects.”
Mr. Telford said that with all of the known cases of Lyme there is no evidence that it is anything but a rare condition. “We also have no evidence that communities where Lyme disease has been common for 30 or more years, like Martha’s Vineyard, are sites where people are keeling over because of long term effects on the heart,” he said. “There is absolutely no reason to believe that the bacteria have changed to become more virulent.”
Mr. Telford agrees with Dr. Plotkin on the need for a vaccine and shares his frustration. “I was hoping that folks more powerful than I, such as the CDC would take up the cause after my pounding on the table at the International Lyme meeting,” he told The Times. “Nothing will happen, sadly, until one of our legislators in Washington, or someone very rich drops from a Lyme induced conduction abnormality and starts a personal vendetta to rid us of the scourge.”