Clinical Features of Acute and Fulminant Myocarditis in Children　– 2nd Nationwide Survey by Japanese Society of Pediatric Cardiology and Cardiac Surgery –

Abstract

Background: The 1st nationwide survey by the Japanese Society of Pediatric Cardiology and Cardiac Surgery of acute or fulminant myocarditis (AMC/FMC) in children revealed that the survival rate of FMC was only 51.6%. The 2nd nationwide survey was performed to evaluate the recent outcomes of pediatric myocarditis. Methods and Results:Questionnaires regarding patients aged ≤18 years with AMC/FMC during the period from January 2006 to December 2011 were mailed. A total of 221 cases (age 6.5±5.3 years, 116 boys and 105 girls) were reported. There were 145 (65.6%) and 74 cases (33.5%) of AMC/FMC, respectively; the type of myocarditis was not reported in the remaining 2 cases (0.9%). Viruses were identified in 56 cases (25.3%), including coxsackie B in 9 and influenza A in 8. Histopathology by either endomyocardial biopsy or autopsy was obtained in 38 cases (19.2%). Intravenous immunoglobulin was effective in 49 (34.3%) of 143 cases. Steroid therapy was effective in 20 (32.8%) of 61 cases. Mechanical circulatory support was given in 54 cases (24.4%) and 94.2% of them were patients with FMC. The survival rates for the whole study population, acute myocarditis, and FMC were 75.6%, 91.0%, and 48.6%, respectively. Conclusions:The survival rate of children with myocarditis was almost identical to that of 10 years ago. (Circ J 2016; 80: 2362 -2368

Pediatric Cardiomyopathies

“…72–74 Parvovirus B19, influenza, Epstein-Barr, HIV, coxsackie virus, herpes, and adenovirus have all been identified. 73–77 Murine models of myocarditis (coxsackie or adenoviral) demonstrate evidence of disruption of several important pathways in the innate and activated immune systems. 78, 79 The enteroviral protease 2A has been demonstrated to cleave the cytoskeletal protein- dystrophin which results in severe DCM.…”

Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies

“…More severe symptoms occur in infants and young children [ 227 , 228 ]. Acute flaccid paralysis [ 229 ], neonatal enteroviral sepsis [ 230 ], myocarditis/pericarditis [ 231 , 232 ], hepatitis, pancreatitis, pneumonia, and atypical hemolytic uremic syndrome [ 233 ] are severe manifestations seen in immunocompetent people. Chronic infections have been seen in immunocompromised patients [ 234 ].…”

Dilated Cardiomyopathy in Paediatric Population: A Review

“…17,18 Parvovirus B19, influenza, Epstein-Barr, HIV, coxsackie virus, herpes, and adenovirus have all been identified. 19,20 Toxic Causes of DCM: Pediatric DCM can occur after exposure to toxins, such as anthracycline exposure during chemotherapy. The mechanism of anthracyclineinduced injury is incompletely understood, but oxidative stress and reactive oxygen species activation may play a key role in cell damage.…”