Is Lyme disease associated with adrenal insufficiency and bradyarrhythmias?

From the Guidelines

Lyme disease associated adrenal insufficiency and bradyarrhythmias require immediate medical attention, with treatment focusing on antibiotics for the underlying infection and supportive care for the complications, including temporary cardiac pacing for symptomatic bradycardia as recommended by the Infectious Diseases Society of America (IDSA) 1.

Key Considerations

• Adrenal insufficiency in Lyme disease is managed with corticosteroid replacement therapy, such as hydrocortisone 15-25mg daily in divided doses, alongside antibiotics for the Lyme infection 1.
• Bradyarrhythmias, often presenting as atrioventricular blocks, are treated with prompt antibiotic therapy, which may include intravenous ceftriaxone 2g daily for 14-21 days in severe cases, and temporary cardiac pacing for symptomatic bradycardia or high-degree heart blocks 1.
• Hospital admission with continuous ECG monitoring is recommended for patients with significant PR prolongation (PR >300 milliseconds), other arrhythmias, or clinical manifestations of myopericarditis 1.

Management Approach

• Temporary pacing modalities are preferred over permanent pacemaker implantation for managing symptomatic bradycardia due to Lyme carditis that cannot be managed medically, as per the IDSA guidelines 1.
• Patients should be closely monitored during treatment with serial ECGs and adrenal function tests to ensure resolution of the complications.
• The choice of antibiotic therapy, such as doxycycline or ceftriaxone, depends on the severity of the disease and the presence of neurological involvement or other complications.

Clinical Implications

• Early recognition and treatment of Lyme disease complications are crucial to prevent long-term morbidity and mortality.
• A high index of suspicion for Lyme disease is necessary in endemic areas, especially during the peak transmission seasons.
• Collaboration between infectious disease specialists, cardiologists, and other healthcare professionals is essential for the optimal management of patients with Lyme disease associated adrenal insufficiency and bradyarrhythmias.

From the Research

Lyme Disease and Cardiac Manifestations

• Lyme disease is a tick-borne illness that can cause cardiac complications, including atrioventricular block, myopericarditis, and congestive heart failure 2.
• Cardiac manifestations of Lyme disease can occur in up to 8% of patients, with a median onset of 21 days from the appearance of erythema migrans 2.
• The most common cardiac manifestation of Lyme disease is atrioventricular block, which can fluctuate rapidly and may require temporary cardiac pacing 3.

Bradyarrhythmias and Lyme Disease

• Bradyarrhythmias, including sinus bradycardia and high-degree atrioventricular block, can occur in patients with Lyme disease 4, 5.
• These arrhythmias can be asymptomatic or may cause symptoms such as lightheadedness, chest pain, and syncope 5.
• Treatment with antibiotics, such as ceftriaxone, is essential to reduce the duration of the disease and minimize the risk of complications 3.

Adrenal Insufficiency and Lyme Disease

• There is no direct evidence in the provided studies to suggest a link between Lyme disease and adrenal insufficiency.
• However, it is possible that patients with Lyme disease may experience systemic inflammation and immune-mediated responses that could potentially affect multiple organ systems, including the adrenal glands 6.

Diagnosis and Treatment

• Diagnosis of Lyme carditis is challenging and requires a high clinical suspicion, particularly in patients from endemic regions with unexplained cardiac symptoms and electrocardiogram abnormalities 5, 3.
• Treatment with antibiotics, such as ceftriaxone, is essential to reduce the duration of the disease and minimize the risk of complications 4, 3.
• Temporary cardiac pacing may be required in some cases, but permanent pacemaker implantation is generally contraindicated due to the transient nature of the condition 3, 2.