High Frequency of Detection by PCR of Viral Nucleic Acid in The Blood of Infants Presenting with Clinical Myocarditis

Abstract

Specific viruses are associated with pediatric myocarditis, but the prevalence of viral DNAemia detected by blood polymerase chain reaction (PCR) is unknown. We evaluated the prevalence of known cardiotropic viruses (enterovirus, adenovirus, human herpesvirus 6, and parvovirus B19) in children with clinical myocarditis (n = 21). Results were compared to pediatric controls with similar viral PCR testing. The majority of positive PCR (89 %) was noted in children ≤12 months of age at diagnosis compared to older children. Infant myocarditis patients (8/10) had increased the prevalence of PCR positivity compared to infant pediatric controls (4/114) (p < 0.0001). Other than age, patient characteristics at diagnosis were similar between PCR-positive and PCR-negative patients. Both PCR-negative myocarditis infants had clinical recovery at follow-up. Of the PCR-positive myocarditis infants, 4 had clinical recovery, 2 developed chronic cardiomyopathy, 1 underwent heart transplant, and 1 died. Infants with clinical myocarditis have a high rate of blood viral positivity, which is higher compared to older children with myocarditis and healthy infant controls. Age-related differences in PCR positivity may be due to differences in host and/or virus characteristics. Our findings suggest that viral blood PCR may be a useful diagnostic tool and identify patients who would potentially benefit from virus-specific therapy.

MicroRNA‑381 protects myocardial cell function in children and mice with viral myocarditis via targeting cyclooxygenase‑2 expression

“…Because the clinical manifestations of VM are atypical, the prognosis of the children is seriously affected if the diagnosis and treatment are not timely (11). The pathological changes of myocardial cells are the main pathological changes in VM, and they include direct damages to cardiac muscle cells by virus and immune damages (12). Patients with persistent VM have poor prognosis, with an average 5-year survival rate of about 50%.…”

Human Parvoviruses

“…B19V infection can be followed by serious cardiac disease, especially pediatric myocarditis. Other viruses are more frequently associated clinically or found by molecular methods in endocardial biopsy specimens (832). The clinical course of B19V myocarditis can be severe, with significant morbidity and mortality, including the need for a transplant.…”

“…B19V infection, detected most often by serological evidence of recent infection and sometimes by the detection of viral genomes in cardiac tissue, has been reported in myocarditis in the fetus (see the section on hydrops below), in infancy, during childhood, and among young adults (174,176,(832)(833)(834)(835)(836)(837)(838)(839)(840). In one center's series of 19 pediatric patients, the presenting symptoms were upper respiratory and gastrointestinal symptoms; all infected children had ventricular dysfunction, 2 died, and 3 required heart transplantation (176).…”

Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children

“…showed 80% of 21 immunocompetent infants with myocarditis were positive for a cardiotropic virus from blood PCR tests, (of which 21 two were positive for HHV-6) compared to <4% of healthy 22 controls. [ 9 ] HHV-6 has been detected in 43% of patients from a review of archival tissue specimen from pediatric patients with idiopathic DCM or congenital heart diseases. [ 10 ] With these considerations in mind, we conducted this literature review with two specific aims (i) to summarize clinical profile of immunocompetent children with HHV-6 suspected myocarditis or DCM and (ii) to examine HHV-6 as a definite etiological agent for pediatric immunocompetent patients with myocarditis and DCM.…”