Successful management of fulminant influenza A subtype H1N1 myocarditis

Cobas, Miguel; Abbo, Lilian M.; Santos, Miguel Oliveira; Baccini-Jauregui, Clara; Pham, Si M.

doi:10.1136/bcr.02.2010.2763

Cited by 6 publications

(9 citation statements)

References 19 publications

(11 reference statements)

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“…There have been approximately 44 cases of influenza‐associated myocarditis in adult patients described in case reports and case series (Table ) . Among those reported, 52% (23/44) occurred in men and 68% (30/44) occurred in patients under 40 years of age.…”

Section: Resultsmentioning

confidence: 99%

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

Sellers

Hagan

Hayden

et al. 2017

Influenza Resp Viruses

330

308

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Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra‐pulmonary complications of influenza infection, using organ‐specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra‐pulmonary complications is critical to determining the true burden of influenza infection and initiating organ‐specific supportive care.

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Section: Resultsmentioning

confidence: 99%

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

Sellers

Hagan

Hayden

et al. 2017

Influenza Resp Viruses

330

308

View full text Add to dashboard Cite

show abstract

“…Our literature review identified 75 unique cases (55 adult and 20 pediatric patients) from 56 case reports, and 5 case series describing 2 to 8 patients each, published from 1959 through 2021 [ 2 , 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ,…”

Section: Resultsmentioning

confidence: 99%

“…Circulatory support consisted of inotropes/vasopressors (used in 58.7% of the cases) and MCS, including extracorporeal membrane oxygenation (ECMO), in 18 cases (24%), intra-aortic balloon pump (IABP) in 9 (12%), and ventricular assist device (VAD) in 7 cases (9.3%). VAD devices used were Impella in four cases [ 20 , 25 , 34 , 60 ], Bi-VAD in two, and catheter-based VAD in one case [ 18 , 50 , 68 ]. Only 1 out of 17 patients with isolated pericarditis required inotropic/vasopressor support compared to 44 out of 58 myopericarditis cases ( p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Influenza Myopericarditis and Pericarditis: A Literature Review

Radovanovic

Petrović

Barsoum

et al. 2022

JCM

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Myopericarditis is a rare complication of influenza infection. The presentation may range from mild and frequently unrecognized, to fulminant and potentially complicated by cardiogenic and/or obstructive shock (tamponade), which is associated with high mortality. We performed a review of literature on all influenza pericarditis and myopericarditis cases according to PRISMA guidelines using the PubMed search engine of the Medline database. Seventy-five cases of influenza myopericarditis and isolated pericarditis were identified from 1951 to 2021. Influenza A was reported twice as often as influenza B; however, influenza type did not correlate with outcome. Men and elderly patients were more likely to have isolated pericarditis, while women and younger patients were more likely to have myopericarditis. All included patients had pericardial effusion, while 36% had tamponade. Tamponade was more common in those with isolated pericarditis (41.2%) than myopericarditis (13.8%). Cardiogenic shock was more common in patients with myopericarditis (64%), with an overall mortality rate of 14.7%. Nearly 88% of the recovered patients remained without long-term complications reported. Conclusion: Influenza A appears a more common cause of pericarditis and myopericarditis. Isolated pericarditis was more commonly associated with tamponade but without reported deaths, whereas myopericarditis was more commonly associated with cardiogenic shock and death (19%).

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“…Fortunately, there are clinical reports of influenza-induced fulminant myocarditis successfully treated with intravenous peramivir. 46 , 47 Therefore, new studies are warranted to investigate the potential value of antiviral therapies in cases with heart infection in the clinic.…”

Section: Discussionmentioning

confidence: 99%

Human influenza A virus causes myocardial and cardiac-specific conduction system infections associated with early inflammation and premature death

Filgueiras-Rama

Vasilijevic

Jalife

et al. 2020

Cardiovascular Research

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Aims Human influenza A virus (hIAV) infection is associated with important cardiovascular complications, although cardiac infection pathophysiology is poorly understood. We aimed to study the ability of hIAV of different pathogenicity to infect the mouse heart, and establish the relationship between the infective capacity and the associated in vivo, cellular and molecular alterations. Methods and results We evaluated lung and heart viral titres in mice infected with either one of several hIAV strains inoculated intranasally. 3D reconstructions of infected cardiac tissue were used to identify viral proteins inside mouse cardiomyocytes, Purkinje cells, and cardiac vessels. Viral replication was measured in mouse cultured cardiomyocytes. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used to confirm infection and study underlying molecular alterations associated with the in vivo electrophysiological phenotype. Pathogenic and attenuated hIAV strains infected and replicated in cardiomyocytes, Purkinje cells, and hiPSC-CMs. The infection was also present in cardiac endothelial cells. Remarkably, lung viral titres did not statistically correlate with viral titres in the mouse heart. The highly pathogenic human recombinant virus PAmut showed faster replication, higher level of inflammatory cytokines in cardiac tissue and higher viral titres in cardiac HL-1 mouse cells and hiPSC-CMs compared with PB2mut-attenuated virus. Correspondingly, cardiac conduction alterations were especially pronounced in PAmut-infected mice, associated with high mortality rates, compared with PB2mut-infected animals. Consistently, connexin43 and NaV1.5 expression decreased acutely in hiPSC-CMs infected with PAmut virus. YEM1L protease also decreased more rapidly and to lower levels in PAmut-infected hiPSC-CMs compared with PB2mut-infected cells, consistent with mitochondrial dysfunction. Human IAV infection did not increase myocardial fibrosis at 4-day post-infection, although PAmut-infected mice showed an early increase in mRNAs expression of lysyl oxidase. Conclusion Human IAV can infect the heart and cardiac-specific conduction system, which may contribute to cardiac complications and premature death.

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Successful management of fulminant influenza A subtype H1N1 myocarditis

Cited by 6 publications

References 19 publications

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

Influenza Myopericarditis and Pericarditis: A Literature Review

Human influenza A virus causes myocardial and cardiac-specific conduction system infections associated with early inflammation and premature death

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