REVERSAL OF BORRELIA-BURGDORFERI ASSOCIATED DILATED CARDIOMYOPATHY BYANTIBIOTIC-TREATMENT

It is suggested that Borrelia burgdorferi infection could be associate d with dilated cardiomyopathy (IDC). Stanek et al. were able to cultiv ate Borrelia burgdorferi from myocardial biopsy tissue of a patient wi th longstanding dilated cardiomyopathy. Here we present a study in whi ch we examined the effect of standard antibiotic treatment on the left ventricular ejection fraction (LVEF) in patients with dilated cardiom yopathy associated with Borrelia burgdorferi infection. In this study we assessed the serum (IgG, IgM Elisa) and history of 46 IDC patients with specific regard to Borrelia burgdorferi infection (mean LVEF 30.4 +/- 1.38, measured by cardiac catheterization and echocardiography wi th the length-area-volume method). All 46 patients received standard t reatment for dilated cardiomyopathy: ACE inhibitors, digitalis, and di uretics. Eleven (24%) patients showed ; positive serology and a histor y of Borrelia burgdorferi infection; nine of these also had a typical history of tick bite and erythema chronicum migrans (ECM) and/or other organ involvement, and two had no recollection of tick bite or ECM bu t showed other Borrelia burgdorferi-associated disorders (neuropathy, oligoarthritis). These 11 patients with Borrelia burgdorferi infection received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days. Six (55%) recovered completely and showed a normal LVEF after 6 months, three (27%) improved their LVEF, and two (18%) d id not improve at all. This amounts to nine (82%) patients with recove ry/improvement in the Borrelia burgdorferi group. The 35 patients who did not show positive serology or a history of Borrelia burgdorferi in fection did not receive antibiotic treatment. In this group without Bo rrelia burgdorferi infection 12 (26%), showed recovery/improvement fol lowing the standard treatment of dilated cardiomyopathy (see earlier). Our results indicate that Borrelia burgdorferi infection could play a decisive role in the development of dilated cardiomyopathy, especiall y in a geographical region such as Graz, where Borrelia burgdorferi is endemic. While we are aware of the small number of Borrelia burgdorfe ri patients in this study, we nevertheless conclude that in a remarkab le number of patients with signs of Borrelia burgdorferi infection, di lated cardiomyopathy could be reversed and LVEF improved.