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Pediatr Cardiol. 2019 Nov 14. doi: 10.1007/s00246-019-02250-9. [Epub ahead of print]

Increasing Burden of Lyme Carditis in United States Children's Hospitals.

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Division of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.
Division of Pediatric Infectious Diseases, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Heinz College/School of Architecture, Carnegie Mellon University, Pittsburgh, PA, USA.


We sought to characterize the shifting epidemiology and resource utilization of Lyme disease and associated carditis in US children's hospitals. We hypothesized that the Lyme carditis burden has increased and that hospitalizations for Lyme carditis are costlier than those for Lyme disease without carditis. The PHIS database was queried for Lyme disease encounters between January 1, 2007 and December 31, 2013. Additional diagnostic codes consistent with carditis identified Lyme carditis cases. Demographic, clinical, and resource utilization data were analyzed. All costs were adjusted to 2014 US dollars. Lyme disease was identified in 3620 encounters with 189 (5%) associated with carditis. Lyme disease (360 cases in 2007 vs. 672 in 2013, p = 0.01) and Lyme carditis (17 cases in 2007 vs. 40 in 2013, p = 0.03) both significantly increased in frequency. This is primarily accounted for by their increase within the Midwest region. Carditis frequency among cases of Lyme disease was stable (p = 0.15). Encounters for Lyme carditis are dramatically costlier than those for Lyme disease without carditis [median $9104 (3741-19,003) vs. 922 (238-4987), p < 0.001] The increase in Lyme carditis cases in US children's hospitals is associated with an increased Lyme disease incidence, suggesting that there has not been a change in its virulence or cardiac tropism. The increasing number of serious cardiac events and costs associated with Lyme disease emphasize the need for prevention and early detection of disease and control of its spread.


Epidemiology; Lyme carditis; Lyme disease; Pediatrics; Sudden death


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