Key result
Bartonella infection links to sudden cardiac death in orienteers, driven by suspected myocarditis.
Why the study?
An increasing number of sudden unexpected cardiac deaths occurred in young Swedish male elite orienteers with myocarditis and ARVC-like features, but the underlying cause was unclear.
Is Bartonella infection associated with sudden unexpected cardiac death and ARVC-like disease in young elite orienteers?
Observational (n=16)
Is Bartonella infection associated with sudden unexpected cardiac death and ARVC-like disease in young elite orienteers?
Bartonella-induced subacute myocarditis may be a major pathogenetic factor in the development of ARVC-like disease and sudden unexpected cardiac death in elite athletes.
Bartonella detection in orienteer myocarditis cases is hypothesis-generating; larger studies needed before any clinical implications.
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.
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Lars Wesslén (2001) conducted an observational in Sudden unexpected cardiac death (n=16). Bartonella infection was evaluated on Presence of Bartonella spp. DNA and antibodies. Bartonella spp. DNA was detected in 5 of 5 tested deceased Swedish orienteers, and antibodies were present in 6 of 7 cases, suggesting Bartonella-induced myocarditis as a cause of sudden cardiac death.
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