title: Subacute bartonella infection in Swedish orienteers succumbing to sudden unexpected cardiac death or having malignant arrhythmias.
abstract: During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.
authors.affiliation: Department of Medical Sciences, Uppsala University Hospital, Sweden. lars.wesslen@medsci.uu.se
authors.forename: L
authors.initials: L
authors.lastname: Wesslen
authors.forename: C
authors.initials: C
authors.lastname: Ehrenborg
authors.forename: M
authors.initials: M
authors.lastname: Holmberg
authors.forename: S
authors.initials: S
authors.lastname: McGill
authors.forename: E
authors.initials: E
authors.lastname: Hjelm
authors.forename: O
authors.initials: O
authors.lastname: Lindquist
authors.forename: E
authors.initials: E
authors.lastname: Henriksen
authors.forename: C
authors.initials: C
authors.lastname: Rolf
authors.forename: E
authors.initials: E
authors.lastname: Larsson
authors.forename: G
authors.initials: G
authors.lastname: Friman
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000382:microbiology*; D001344:Autopsy; D001473:Bartonella / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D001474:Bartonella Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D004269:DNA, Bacterial / Q000032:analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial