Is Lyme Disease in Mexico Underdiagnosed? Lyme Carditis Case
Lyme disease may be overlooked in Mexico
Heart rhythm abnormalities can complicate diagnosis
Delayed recognition may affect outcomes
Questions remain about whether Lyme disease in Mexico is underrecognized and whether Lyme carditis symptoms are being missed in patients with unexplained heart problems.
A published case involving severe Lyme carditis highlights how delayed diagnosis may contribute to complications when cardiac symptoms are initially attributed to other causes.
The authors describe the case of a 23-year-old woman who presented to the hospital with dyspnea, chest pain, and third-degree atrioventricular (AV) block on electrocardiogram (ECG).
Because Lyme carditis symptoms can overlap with many cardiac conditions, diagnosis may be delayed. Additional discussion of cardiac presentations can be found in the broad range of Lyme carditis presentations.
Severe heart block led to pacemaker placement
A temporary pacemaker was implanted while clinicians pursued an extensive evaluation for other causes of advanced heart block.
Eventually, Lyme disease testing was performed and met Centers for Disease Control and Prevention (CDC) two-tier testing criteria.
Despite treatment with a three-week course of intravenous ceftriaxone, the patient ultimately required a permanent pacemaker.
“At 3-month follow-up, she was still dependent on pacing,” wrote Carrizales-Sepulveda and colleagues.
Could Lyme disease in Mexico be underrecognized?
The authors argued that the patient lived in an endemic region and had previously sought care four weeks earlier with symptoms consistent with Lyme carditis.
According to CDC criteria cited by the authors, a region may be considered endemic if confirmed locally acquired cases exist or if infected tick populations are established.
Despite this, officials questioned whether Borrelia burgdorferi circulates in Mexico and whether Lyme disease should have been considered.
Published data cited by the authors reported a seroprevalence of 6.2% in northeastern Mexico and 3.4% in Mexico City using ELISA followed by Western blot confirmation.
These findings raise broader questions regarding diagnostic limitations and testing challenges in Lyme disease.
Recognizing Lyme carditis symptoms earlier
Lyme carditis symptoms may include chest pain, shortness of breath, palpitations, dizziness, syncope, or conduction abnormalities including heart block.
These symptoms overlap with heart complications associated with Lyme disease and may be difficult to recognize when Lyme disease is not considered in the differential diagnosis.
Because cardiac involvement may occur alongside neurologic or systemic symptoms, clinicians often need to consider broader symptom patterns. Additional discussion can be found in Lyme disease symptoms guide.
The authors concluded that Lyme carditis should remain part of the differential diagnosis when patients present with unexplained conduction abnormalities.
“We agree that in our country other causes should be ruled-out first, however, there is no reason to leave out [Lyme carditis] as a diagnosis,” they wrote.
They concluded that Lyme disease in Mexico “might be under looked, underdiagnosed, and underreported.”
Can ticks in Mexico carry Lyme disease?
Questions about whether ticks in Mexico carry Lyme disease continue to generate debate. Investigators cited by the authors argue that infected tick populations and human exposure may exist in some regions, although prevalence estimates remain uncertain.
Because travel histories and regional exposure may be overlooked, clinicians may need to consider Lyme disease when compatible symptoms and exposure risks exist.
Frequently Asked Questions
Is there Lyme disease in Mexico?
Published reports suggest Lyme disease cases have been identified in Mexico, although questions remain regarding prevalence and geographic distribution.
What are Lyme carditis symptoms?
Symptoms may include chest pain, palpitations, dizziness, shortness of breath, fainting, or heart rhythm abnormalities such as AV block.
Can Lyme disease cause third-degree heart block?
Yes. Lyme carditis has been associated with conduction abnormalities ranging from mild delays to complete heart block.
Do ticks in Mexico carry Lyme disease?
Research remains ongoing. Some investigators argue infected tick populations exist in parts of Mexico, while prevalence estimates remain debated.
Can Lyme disease cause chest pain or shortness of breath?
Yes. Lyme carditis may lead to chest discomfort, palpitations, dizziness, shortness of breath, or conduction abnormalities affecting heart rhythm.
Can Lyme carditis require a pacemaker?
Some patients recover conduction after treatment, but severe or delayed cases may occasionally require temporary or permanent pacing support.
Clinical Takeaway
Lyme carditis remains an important consideration when patients present with unexplained conduction abnormalities, chest pain, shortness of breath, or heart block, particularly when symptoms overlap with infectious or neurologic conditions.
This case raises questions about whether Lyme disease may be underrecognized in parts of Mexico and whether earlier consideration could improve outcomes.
Delayed recognition of Lyme carditis symptoms may increase the risk of severe cardiac complications and long-term pacing requirements.
Related Articles
Patients can die when Lyme carditis is not treated
Treatment guidelines for Lyme carditis
Study identifies 189 children with Lyme carditis
Heart problems linked to Lyme disease
References
- Carrizales-Sepulveda EF, Jimenez-Castillo RA, Vera-Pineda R. Advanced AV-block: Is it time to consider Lyme carditis as a differential diagnosis in Mexico? J Electrocardiol. 2020.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
