title: Detection of Borrelia burgdorferi sensu lato in endomyocardial biopsy specimens in individuals with recent-onset dilated cardiomyopathy.
abstract: OBJECTIVE
  Recent studies in patients with dilated cardiomyopathy (DCM) have detected the genome of Borrelia burgdorferi sensu lato (BBSL) in endomyocardial biopsy (EMB) specimens using a qualitative polymerase chain reaction (PCR), suggesting a causal link between Lyme disease and DCM in areas in which Lyme disease is endemic. We aimed to study this relationship using a comprehensive molecular analysis detecting BBSL in EMB samples.
  
  
  RESULTS
  We performed a comprehensive histopathological, immunohistochemical, ultrastructural, and molecular analysis targeting cardiotropic viruses and BBSL in EMB specimens of 41 individuals with recent-onset DCM and 15 controls with end-stage coronary artery disease. Specifically, quantitative PCR and electron microscopy of EMB specimens were employed. In addition, autoantibodies and manifestation of autoimmune diseases were evaluated in both groups. Individuals with recent-onset DCM presented more frequently with myocardial BBSL persistence as compared with the control group (24% vs. 0%, P = 0.035). In contrast, the prevalence of parvovirus B19 and cytomegalovirus was similar in both groups. Sequence analysis of borrelial DNA revealed the following genospecies: Borrelia burgdorferi sensu stricto in three patients (30%), Borrelia afzelii in two patients (20%), and Borrelia garinii in four patients (40%), the results being inconclusive in one case. BBSL-positive DCM patients had a higher prevalence of organ-specific autoimmune diseases in comparison with the remaining DCM patients (50% vs. 16%, P = 0.030).
  
  
  CONCLUSIONS
  Myocardial persistence of BBSL may be involved in the pathophysiology of DCM in individuals living in areas in which Lyme disease is endemic.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Videňská 1958/9, Prague, Czech Republic. milos.kubanek@ikem.cz
authors.forename: Miloš
authors.initials: M
authors.lastname: Kubánek
authors.forename: Marek
authors.initials: M
authors.lastname: Šramko
authors.forename: Dagmar
authors.initials: D
authors.lastname: Berenová
authors.forename: Dagmar
authors.initials: D
authors.lastname: Hulínská
authors.forename: Hana
authors.initials: H
authors.lastname: Hrbáčková
authors.forename: Jana
authors.initials: J
authors.lastname: Malušková
authors.forename: Alena
authors.initials: A
authors.lastname: Lodererová
authors.forename: Ivan
authors.initials: I
authors.lastname: Málek
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D016009:Chi-Square Distribution; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D015995:Prevalence; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013223:Statistics as Topic; D013997:Time Factors