Deaths prompt look at Lyme carditis
Health officials are taking a closer look at tickborne disease after the sudden deaths of three young adults from Lyme carditis.
The Centers for Disease Control and Prevention reported Friday the victims were between the ages of 26 and 38 and lived in areas with a high incidence of Lyme disease in Massachusetts, New York and Connecticut.
LYME DISEASE CASES
- There were 3,342 cases of confirmed
- Lyme disease and 1,708 cases of probable
- Lyme disease in Massachusetts in 2012.
- Barnstable County had 290 confirmed and
- probable cases; Dukes County, 83; and
- Nantucket County, 65.
- Source: Massachusetts Department of
- Public Health
All the deaths occurred within the past 13 months, according to the CDC's Morbidity and Mortality Weekly Report.
While it's been known for decades that Lyme bacteria can infect the heart, the infection rarely has been associated with cardiac death, Dr. Catherine Brown, veterinarian with the Massachusetts Department of Public Health, said.
Between 1985 and 2008, the CDC identified only four deaths worldwide from Lyme carditis. The recent spate of cases in the American Northeast led researchers to wonder if a cluster were developing, Brown said.
"We were all nervous," she said. "Has something changed?"
None of the three recent victims was being treated for Lyme at the time of death, but all of them tested positive post-mortem after their organs were donated to transplant programs, according to the CDC.
The Massachusetts victim was the first to die, found unresponsive in a car that had veered off the road in November 2012.
There was no evidence of traumatic injury and the individual had no serious pre-existing medical conditions, according to the CDC.
But family members said the victim, who lived alone with a dog that frequently got ticks, had complained about experiencing malaise and muscle and joint pain in the two weeks leading up to death.
The New York state resident, a hiker, experienced chest pain and collapsed at home in July.
The person's past medical history included a diagnosis of Wolff-Parkinson-White syndrome, a cardiac abnormality.
A tissue bank found inflammation of cardiac material consistent with Lyme, whose presence was confirmed by CDC testing.
That same month, a Connecticut resident collapsed while visiting New Hampshire and was pronounced dead at a local hospital.
The victim had complained of shortness of breath and anxiety for about a week leading up to death and had been prescribed clonazepam for anxiety the day before collapsing, according to the CDC.
The discoveries prompted the tissue bank to review 20,000 records of cardiac tissue donation and to consult with the CDC and public health departments of the states involved, Brown said.
She said no other cases of possible Lyme carditis were discovered.
"Everything shows this is still an extraordinarily rare event," Brown said. "It happens but it's rare."
Carditis is an inflammation of the heart muscle, Dr. Lawrence McAuliffe, a cardiologist in Hyannis,
said.
He said carditis symptoms share similarities with other coronary problems: chest pain, shortness of breath, palpitations, fatigue and malaise.
But carditis victims also may experience fever and weight loss, McAuliffe said.
Lyme carditis can be treated with oral or intravenous antibiotics, although some patients might need a temporary pacemaker, the CDC says.
Carditis also can set off problems with the electrical functioning of the heart and result in fainting or near-fainting episodes, McAuliffe said.
If not treated properly, carditis sometimes leads to chronic cardiomyopathy and congestive heart failure, he said.
Cases of Lyme carditis tend to happen early in the disease process, occurring within the first three months of infection, according to Dr. Sam Donta, an infectious disease specialist from Falmouth who is a member of the Barnstable County Lyme/Tickborne Diseases Task Force.
"I'd agree it's rare," he said.
Lyme patients who develop chronic conditions often report chest pains and palpitations, Donta said.
But in many cases the symptoms seem to be associated with a nonlethal but distressing disregulation of the automatic nervous system, he said.
"As part of Lyme disease it seems like the nervous system can be sensitized," Donta said.
The public health message remains the same, Brown said. Use tick repellents, avoid tick-friendly areas and do regular tick checks, she said.
And if symptoms arise, see a health provider early, Brown said. Classic symptoms of Lyme include fever, chills, flulike malaise and muscle pains. Sometimes sufferers get a rash.
"It's not something where you should just ignore it," Brown said. "We have huge amounts of Lyme disease everywhere in the commonwealth."
The message to physicians is "to think out of the box a little about symptoms that seem odd or inexplicable," McAuliffe said.
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