Parvovirus B19 Myocarditis Causes Significant Morbidity and Mortality in Children

Abstract

Although parvovirus B19 (PVB19) currently is the most common cause of viral myocarditis, limited pediatric data exist. Whereas other viruses infect cardiomyocytes, PVB19 targets coronary endothelium, leading to myocardial ischemia and dysfunction. A retrospective review investigated patients with polymerase chain reaction (PCR)-verified PVB19 myocarditis at Texas Children's Hospital and Arkansas Children's Hospital (January 2005 to August 2008). The primary end points of the study were transplant-free survival and circulatory collapse (death, mechanical support, or transplantation). For the 19 patients identified (age, 6 months to 15 years), the most common presenting symptoms were respiratory and gastrointestinal. At admission, all the patients demonstrated ventricular dysfunction requiring inotropic support (median ejection fraction, 24 %; median left ventricle end-diastolic diameter [LVEDD] z-score, 4.6). Whereas T-wave abnormalities were common, ST elevation was evident in five patients (two died and three required transplantation). Serum B-type natrietic peptide was elevated in all 12 patients tested (range, 348-8,058 pg/ml), and troponin I was high in 7 of 9 patients (range, 0.04-14.5 ng/ml). Of the 15 patients with circulatory collapse, nine received mechanical support, eight underwent successful transplantation, and five died. Only six patients (32 %) experienced transplant-free survival, and five patients had full recovery of function at discharge. In the transplant-free survival group, ST changes on presenting electrocardiography were less likely (p = 0.03), and the admission LVEDD z-score tended to be lower (3.3 vs 5.6; p = 0.08). In children, PVB19 myocarditis causes significant mortality and morbidity. Although mechanical intervention can support patients in the initial stage of decompensated heart failure, patients with PVB19 myocarditis often demonstrate persistent dysfunction requiring medical therapy and transplantation.

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…The most common causes of myocarditis are viral, including enteroviruses, adenoviruses, and parvovirus B19. 558 Foerster and colleagues 559 reported superior survival in children with viral cardiomyopathy compared with idiopathic DCM in a multicenter Pediatric Cardiomyopathy Registry study; time to death, transplantation, and echocardiographic normalization 3 years after presentation in the biopsy-confirmed myocarditis and probable myocarditis groups were significantly better than in patients with idiopathic DCM. 559 If myocarditis is suspected, evaluation of nasal swab and stool for viruses, as well as blood polymerase chain reaction tests, can aid in the diagnosis.…”

Diagnosis and Treatment of Myocarditis in Children in the Current Era

“…13 Although enteroviruses have classically been identified as the prime viral agent, new techniques to extract viral genome from myocardium with polymerase chain reaction techniques have in both children and adults revealed previously unrecognized viruses such as adenovirus, parvovirus B19, human herpesvirus 6, hepatitis C, Epstein-Barr virus, and cytomegalovirus. 2,3,[14][15][16][17][18][19] Interestingly, the pattern of identified viral pathogens in myocarditis has evolved over the last 20 years from enteroviruses and adenoviruses to primarily parvovirus and herpesvirus 6. Endomyocardial fibroelastosis, a once frequent cause of infantile dilated cardiomyopathy that is now rarely seen, was linked to the mumps virus via viral polymerase chain reaction analysis of archived pathological sample, suggesting that its reduced prevalence might be attributed to immunization.…”

Parvovirus B19 myocarditis in children: an observational study

“…However, an uncommon presentation of this common virus is myocarditis, which can cause fulminant heart failure1–5 and develop into a dilated cardiomyopathy 6. Although case reports increasingly identify PVB19 as a cause of myocarditis in children,1–5 7–13 there is only a single published series which reports that the short term outcome has significant mortality and morbidity 5. The aim of this paper is to report our centre's experience of the clinical presentation, course and outcome of children with PVB19 myocarditis in particular regarding the medium term outcome.…”