Shivam Patel, Pharm.D.
Dr. Shivam Patel has graduated from Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy with a Doctor of Pharmacy degree. He is a PGY1 Pharmacy Resident at Martinsburg VA Medical Center. His professional interests include critical care, infectious disease, and ambulatory care. After completion of his PGY1 residency, Dr. Patel hopes to continue to serve veterans and become a Clinical Pharmacy Specialist.

Complication of Lyme Disease: Lyme Carditis

NOVEMBER 28, 2017
The prevalence of Lyme disease has increased over the years. Lyme disease has been found on every continent except Antarctica.1 There is a higher incidence rate on the East Coast of than the United States than in the Midwest or on the West Coast. As of 2015, Pennsylvania had the most confirmed cases of Lyme disease, with 7,351 dating back to 2005.2 A total of 28, 453 cases of Lyme disease were confirmed in 2015.2 The bacteria associated with this disease is Borrelia burgdorferi.2  Blacklegged tick that are infected by this bacterium are able to transmit Lyme disease. 

Diagnosis of the disease can be tough. Lymedisease.org defines Lyme disease as the “The Great Imitator,” as the symptoms are non-specific and mimic symptoms of other potential diagnoses, such as chronic fatigue syndrome and fibromyalgia. Early phases of Lyme disease present with flu-like symptoms, such as chills, fever, and muscle pain. In the early phase of Lyme disease, one specific presentation is an Erythema Migrans rash. This is described as a bull’s eye-type rash. A rash may not always be present in a patient who has Lyme disease. Disseminated phases of Lyme disease can present with additional complications, such as cognitive changes, Lyme arthritis, and Lyme carditis.

Lyme carditis is a progressive complication of the unsuccessful treatment of Lyme disease or unrecognized Lyme disease infection. Cardiac symptoms include chest pain, palpitations, and EKG changes associated with heart block. The Lyme bacterium can infect all parts of the heart, including the conduction system around the atrioventricular node, potentially causing the heart block associated with Lyme carditis.3 The cardiac inner and outer membranes, muscle, vessels, or valves can become infected also.

For prophylaxis of suspicion of tick bite, the International Lyme and Associated Diseases Society 2014 guidelines for treatment of Lyme disease recommend doxycycline 100 to 200mg twice daily for 20 days.4 The 2006 Infectious Disease Society of America guidelines for treatment of Lyme disease recommend a single dose of doxycycline 200 mg for prophylaxis after a tick bite.5 There is much controversy on which dosing regimen should be followed.

Treatment of Lyme carditis has similar recommendations between the 2 guidelines and also recommendations by the American Heart Association for Lyme Carditis. The recommended regimen is Ceftriaxone 2 gm IV daily 14 to 21 days.3,4,5 Depending on the severity of the disease, a temporary pacemaker may also be warranted for patients who have advanced heart block. There are limited studies on whether parenteral therapy is superior to oral therapy for Lyme carditis.

The progression of Lyme disease can be prevented with proper diagnosis and initial treatment. The prevalence of Lyme disease within a geographic location can help aid consideration of the illness as a differential diagnosis and proper testing to take place. Treatment is readily available for Lyme disease, and complications of this illness can be avoided.
 
Reference


1. Chronic Lyme Disease. Lymedisease.org. . Accessed November 24, 2017.
2. Centers for Disease Control and Prevention. Lyme Disease. cdc.gov/lyme/index.html. Updated November 16, 2017. Published November 24, 2017.
3. Krause PJ, Bockenstedt LK. Cardiology patient pages. Lyme disease and the heart. Circulation. 2013;127(7):e451-4. doi: 10.1161/CIRCULATIONAHA.112.101485
4. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, Erythema Migrans rashes and persistent disease. Expert Rev Anti Infect Ther. 201412(9): 1103-35. doi: 10.1586/14787210.2014.940900. 
5. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–134. 

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