title: Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis.
abstract: Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues.
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: vkd6@cdc.gov.
authors.forename: Atis
authors.initials: A
authors.lastname: Muehlenbachs
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Brigid C
authors.initials: BC
authors.lastname: Bollweg
authors.affiliation: CryoLife, Inc, Kennesaw, Georgia.
authors.forename: Thadeus J
authors.initials: TJ
authors.lastname: Schulz
authors.affiliation: Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Forrester
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Marlene
authors.initials: M
authors.lastname: DeLeon Carnes
authors.affiliation: Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado.
authors.forename: Claudia
authors.initials: C
authors.lastname: Molins
authors.affiliation: CryoLife, Inc, Kennesaw, Georgia.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Ray
authors.affiliation: Office of the Chief Medical Examiner, Boston, Massachusetts.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Cummings
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jana M
authors.initials: JM
authors.lastname: Ritter
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Blau
authors.affiliation: Office of the Chief Medical Examiner, Concord, New Hampshire.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Andrew
authors.affiliation: Office of the Medical Examiner, Goshen, New York.
authors.forename: Margaret
authors.initials: M
authors.lastname: Prial
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dianna L
authors.initials: DL
authors.lastname: Ng
authors.affiliation: The Medical Foundation, South Bend, Indiana; Indiana University School of Medicine-South Bend, South Bend, Indiana.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Prahlow
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jeanine H
authors.initials: JH
authors.lastname: Sanders
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Wun Ju
authors.initials: WJ
authors.lastname: Shieh
authors.affiliation: Rickettsial Zoonotic Diseases Branch, Division of Vector Borne Infectious Diseases, Atlanta, Georgia.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.affiliation: Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Schriefer
authors.affiliation: Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado.
authors.forename: Paul
authors.initials: P
authors.lastname: Mead
authors.affiliation: Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000328:Adult; D001344:Autopsy; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D016757:Death, Sudden, Cardiac / Q000473:pathology*; D005260:Female; D006321:Heart / Q000382:microbiology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D008193:Lyme Disease / Q000473:pathology*; D008297:Male; D009205:Myocarditis / Q000473:pathology*; D060888:Real-Time Polymerase Chain Reaction
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M