Cytomegalovirus-associated heart muscle disease

Abstract

Human cytomegalovirus (CMV) can persist in many organs after primary infection. Not only is it suspected to cause morbidity during reactivation in patients under immunosuppression, but it may also induce long-term latency by chronic disease, e.g. in the myocardium. Endomyocardial biopsies of 27 patients with active myocarditis, 35 patients with healing, 41 patients with healed and 25 patients with ongoing myocarditis according to the Dallas Criteria and 52 patients with dilated cardiomyopathy (DCM) and the biopsies of 25 healthy heart donors were studied for persisting CMV-DNA by polymerase chain reaction (PCR) and in-situ hybridization (ISH). CMV-DNA could be assessed in 5-14% of patients in the different stages of myocarditis and in 22% of patients with DCM. Although two biopsies of the control group showed a positive result, studies by in-situ hybridization demonstrated that in patients with heart muscle disease CMV persists in all cell types including myocytes, whereas in the controls it is only found in interstitial cells. CMV antigens could not be detected in the myocardium with our methods. It must be assumed that infection by CMV is more a persistent or latent than an active infection.

Cytomegalovirus hepatitis and myopericarditis

“…Subclinical transaminitis is the most common finding in immunocompetent patients, and elevations of alkaline phosphatase and total bilir ubin are less typical [1,3,4] . Pericarditis and myocarditis have been described in immunocompetent patients with acute CMV infection [5,6] . We have found only one case reporting simultaneous infection of liver and myopericardia with cytomegalovirus [7] .…”

Histologic and In Situ Viral Findings in the Myocardium in Cases of Sudden, Unexpected Death

“…In cases of sudden, unexpected death, serology is usually not available, and viral cultures have relatively low sensitivity, especially in the autopsy setting (8). In situ hybridization analyses for DNA viruses, which are associated with high copy number, show both high sensitivity and specificity, as documented in cases of cytomegalovirus and adenovirus-associated myocarditis (12)(13)(14). However, most cases of viral myocarditis are associated with RNA viruses, in which the viral genome number may be below the detection threshold of the assay, which is about 10 copies per cell (15)(16)(17).…”

Hepatitis C Virus from the Hearts of Patients with Myocarditis and Cardiomyopathy

“…On the other hand, some of the studies examining the association of enteroviruses with dilated cardiomyopathy have been negative (Baboonian and Treasure, 1997). Etiologic roles for other viruses, particularly adenovirus and cytomegalovirus (Schonian et al, 1995) have also been reported.…”