Lyme endocarditis recognized by PCR testing

Of their article “Lyme disease: A uncommon reason for infective endocarditis,” Gomez-Tschrnko and colleagues describe a affected person with culture-negative Lyme endocarditis who was recognized primarily based on PCR tissue evaluation. [1]

A 40-year-old man offered to the emergency division with a headache that had been ongoing for five days and intermittent numbness in his left arm.

CT scan and MRI of the mind revealed acute subarachnoid hemorrhage and the affected person was admitted to the neurology unit for medical administration of acute stroke.

Further testing “redemonstrated the beforehand seen density on the mitral valve along with perforation of the valve leaflet with 4þ mitral regurgitation,” the authors state.

“We current a brand new case of culture-negative Lyme endocarditis highlighting scientific traits that ought to set off tissue PCR to diagnose this pathogen in circumstances of culture-negative endocarditis,” the authors state.

The affected person underwent a median sternotomy with cardioplegic arrest for aortic valve substitute and mitral valve restore.

Given the affected person’s publicity to cats and livestock and his squirrel-hunting historical past, he was examined for Coxiella and Bartonella.

One week after the affected person’s discharge from the hospital, PCR testing from mitral valve tissue returned constructive for Borrelia burgdorferi.

The affected person was handled efficiently with doxycycline.

There was initially a low suspicion for Lyme endocarditis due to the shortage of earlier erythema migrans or recollection of latest contact with ticks.

“Convalescent serology was by no means rechecked 3 weeks after this preliminary presentation, and consequently he went undiagnosed, permitting for late problems to come up which will have been prevented with follow-up titers,” the authors level out.

Authors conclude:

• “… it’s crucial to remember that Borrelia species are a documented reason for infective endocarditis.”
• “It is very important maintain this uncommon causative organism within the differential prognosis in circumstances of culture-negative endocarditis when the valve pathology suggests an uncommon sample and it’s important to ship tissue for PCR to substantiate the prognosis.”