莱姆病与心脏移植：一例临床病例报告及文献综述
Lyme disease and heart transplantation: presentation of a clinical case and a literature review.
作者信息
Pilypas Audrius Aurelijus, Raišelienė Giedrutė, Valaikienė Jurgita
机构信息
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
出版信息
Acta Med Litu. 2019;26(3):173-180. doi: 10.6001/actamedica.v26i3.4147.
BACKGROUND
Lyme disease, the most common anthropozoonosis, is a transmissible natural focal infection affecting various organs and systems. Also known as Lyme borreliosis, it is caused by Borrelia spirochetes, which are distributed by ticks of the genus Ixodes. Early diagnosis is difficult due to frequent occurrence of atypical symptoms, unnoticed tick bites, the absence of migratory erythematous lesions, and symptoms occurring during the non-tick season. If not diagnosed and treated in time, dissemination of the infection occurs and various complications develop since borrelias damage not only the skin but also the nervous system, joints, and, in rare cases, the heart and eyes.
MATERIALS AND METHODS
This article presents a clinical case of Lyme borreliosis-induced myocarditis, which led to the development of dilated cardiomyopathy and, consequently, urgent cardiac transplantation. According to our data, this is one of the first described cases of this complication in the world.
RESULTS AND CONCLUSIONS
When diagnosed in time and treated properly, the prognosis of Lyme myocarditis is usually good. In most cases, the atrioventricular block disappears within 1-2 weeks of antibiotic treatment and the implantation of a temporary pacemaker is rarely needed. In those rare cases of a chronic infection, dilated cardiomyopathy may develop; thus if a sudden atrioventricular block occurs, the physician should be vigilant and perform the necessary tests to exclude the diagnosis of Lyme disease.
RESULTS AND CONCLUSIONS
When diagnosed in time and treated properly, the prognosis of Lyme myocarditis is usually good. In most cases, the atrioventricular block disappears within 1-2 weeks of antibiotic treatment and the implantation of a temporary pacemaker is rarely needed. In those rare cases of a chronic infection, dilated cardiomyopathy may develop; thus if a sudden atrioventricular block occurs, the physician should be vigilant and perform the necessary tests to exclude the diagnosis of Lyme disease.
背景
莱姆病是最常见的人兽共患病，是一种可传播的自然疫源性感染，可影响多个器官和系统。它也被称为莱姆疏螺旋体病，由疏螺旋体属的博氏疏螺旋体引起，通过硬蜱属的蜱传播。由于非典型症状频繁出现、蜱叮咬未被注意、游走性红斑病变缺失以及在非蜱季节出现症状，早期诊断较为困难。如果不及时诊断和治疗，感染会扩散并引发各种并发症，因为博氏疏螺旋体不仅会损害皮肤，还会损害神经系统、关节，在极少数情况下还会损害心脏和眼睛。
材料与方法
本文介绍了一例莱姆疏螺旋体病诱发心肌炎的临床病例，该病例导致扩张型心肌病的发展，进而需要紧急进行心脏移植。根据我们的数据，这是世界上首次描述的该并发症病例之一。
结果与结论
如果及时诊断并正确治疗，莱姆心肌炎的预后通常良好。在大多数情况下，抗生素治疗1 - 2周内心房传导阻滞会消失，很少需要植入临时起搏器。在那些罕见的慢性感染病例中，可能会发展为扩张型心肌病；因此，如果突然出现房室传导阻滞，医生应保持警惕并进行必要的检查以排除莱姆病的诊断。
结果与结论
如果及时诊断并正确治疗，莱姆心肌炎的预后通常良好。在大多数情况下，抗生素治疗1 - 2周内心房传导阻滞会消失，很少需要植入临时起搏器。在那些罕见的慢性感染病例中，可能会发展为扩张型心肌病；因此，如果突然出现房室传导阻滞，医生应保持警惕并进行必要的检查以排除莱姆病的诊断。
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