Does Lyme carditis differ in children vs. adults?

In their article, “Lyme Carditis in Hospitalized Children and Adults, a Case Series,” Shen and colleagues compare, for the first time, the presentation, management, and outcomes of Lyme carditis in the pediatric versus adult populations.

The authors analyzed charts of pediatric and adult patients with heart block and a positive Western Blot test for Lyme disease, who were hospitalized at Maine Medical Center. The study included 10 children and 20 adults who were admitted for Lyme carditis between January 2010 and December 2018.¹ The children’s mean age was 12.4 years. The adult mean age was 41.4 years.

The case series found:

• 90% of the Lyme carditis patients were male, with 87% having no prior cardiac history.
• All cases presented between June and October.
• Of the 13 cases who noted symptom onset, 76% presented within 3 weeks of illness.
• Out of 30 patients, 17 were evaluated at an outpatient facility. “Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment.”

“Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.”

• Children with Lyme carditis were more likely to present with disseminated erythema migrans and fever. Otherwise, children and adults had similar symptom presentations, exhibiting predominantly presyncope and syncope.
• “There was no statistical difference between pediatric and adult cases with regards to heart block type or other cardiac complications,” the authors write. “However, the most common heart block in pediatric cases was first-degree (40%) vs second-degree Mobitz type 2 in adult cases (55%).”
• Adults were more likely to require a pacemaker (60%) compared with 20% of children. “Proportionately more adults needed temporary pacing,” the authors write, while “Children had shorter antibiotic durations…”

“… there is room for improving outpatient diagnosis and treatment of early Lyme disease, even in a high-incidence state like Maine.”

• Out of the 30 cases, 27 had improved heart block, while 3 adults required a pacemaker at discharge. One patient died.

The authors point out that the majority of these cases were evaluated by an outpatient provider before carditis developed. However, only 41% of the patients were diagnosed with or suspected to have Lyme disease at that visit.

Furthermore, even fewer (12%) of those patients received appropriate antibiotics.

“Overall, there were no major differences seen between the presentations or outcomes of pediatric and adult Lyme carditis cases,” the authors write.

“Earlier diagnosis and treatment would likely have prevented carditis and the need for hospital admission,” the authors conclude.

“… there is room for improving outpatient diagnosis and treatment of early Lyme disease, even in a high-incidence state like Maine.”