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.
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Funding
This work was supported by research grants from the Myocarditis Foundation and the Children’s Discovery Institute of Washington University and Saint Louis Children’s Hospital. Funding for the collection of control patient data was provided by Grant [UAH2AI083266-01] from the National Institute of Allergy and Infectious Disease, Grant [UL1 RR024992] from the National Institutes of Health, National Center for Research Resources and Washington University Institute for Clinical and Translational Sciences, and training Grant [T32HD049338] from the National Institute of Child Health and Human Development.
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Simpson, K.E., Storch, G.A., Lee, C.K. et al. High Frequency of Detection by PCR of Viral Nucleic Acid in The Blood of Infants Presenting with Clinical Myocarditis. Pediatr Cardiol 37, 399–404 (2016). https://doi.org/10.1007/s00246-015-1290-6
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DOI: https://doi.org/10.1007/s00246-015-1290-6