Myocarditis in children presenting with acute febrile illness

Abstract

Objective: Myocarditis is the inflammatory disease of myocardium. The objective of this study was to determine the prevalence of myocarditis in children presenting with acute febrile illness, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis and to know the outcome and etiological agents causing myocarditis. Methods: This prospective observational study was done in 125 children aged 1-15 years presenting with acute febrile illness. Patients were diagnosed as suspicious case of myocarditis on the basis of expanded criteria of myocarditis. Suspicious myocarditis patients were compared with those who did not have myocarditis in terms of clinical feature, investigation and outcome and were also investigated for etiology. Results: 43 patients were diagnosed as suspected myocarditis according to expanded criteria. Mean age was 6.1 ± 3.4 years and male: female ratio was 1.2:1. A significant association was present between patients with myocarditis and following signs and symptoms: chest pain, palpitation, dyspnea, swelling of body, pedal edema, abdominal tenderness, hepatomegaly and crepitations. Following investigations were significantly abnormal in patients with myocarditis: hypokalaemea, billirubin >1.2 mg/dl, mean AST and ALT, CPK-MB and BNP. Conclusions: Children with myocarditis present with symptoms that can be mistaken for other system involvement. When clinical suspicion of myocarditis exists, chest-X ray, cardiac enzymes and echocardiography are sufficient as screening tests. Many common causes of acute onset fever can cause myocaditis. Therefore its diagnosis is necessary for prompt treatment.

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

“…Comparing our results to the 2016 Indian study, which found 43 individuals with a possible diagnosis of myocarditis, we also found differences in the mean age and gender distribution. The Indian study indicated a mean age of 6.1 ± 3.4 years and a male-to-female ratio of 1.2:1 [ 13 ] in contrast to our study's lower mean age and a closer approximation of gender distribution. Variations in illness prevalence among regions, genetic predispositions, environmental factors, diagnostic standards, and healthcare accessibility are some of the causes that could be causing these variances.…”

“…In our study, the most common symptom was shortness of breath (99%) while chest pain (6.1%) was the least common symptom; a study in India reported similar results with shortness of breath as being the most common symptom reported by 83.7% of the patients, while 39.5% of the patients reported chest pain [13]. A study by Durrani et.al.…”

Characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital.

“…As per institutional criteria, 43 (60.6%) children were admitted in intensive care unit while remaining 28 (39.4%) were admitted in the ward. 15 It is also evident from the past studies that that children presenting with acute myocarditis frequently present with gastrointestinal symptoms but these can be confused with gastroenteritis and might make the diagnosis difficult. [16][17][18] Although, we did not evaluate etiological aspects of acute myocarditis in the present study but some researchers have pointed out that different types of etiological agents can probably induce different kinds of clinical features as Mahrholdt KU showed that children having parvo virus B19 were commonly presenting with complaints of abdominal pain.…”