Subacute bartonella infection in Swedish orienteers succumbing to sudden unexpected cardiac death or having malignant arrhythmias

Scand J Infect Dis. 2001;33(6):429-38. doi: 10.1080/00365540152029891.

Abstract

During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Bacterial / blood
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / microbiology*
  • Autopsy
  • Bartonella / genetics
  • Bartonella / immunology
  • Bartonella / isolation & purification*
  • Bartonella Infections / complications*
  • Bartonella Infections / diagnosis
  • Bartonella Infections / epidemiology
  • Bartonella Infections / transmission
  • DNA, Bacterial / analysis
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / etiology*
  • Humans
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Risk Factors

Substances

  • Antibodies, Bacterial
  • DNA, Bacterial