title: Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults.
abstract: OBJECTIVE
  The purpose of this study was to analyze cardiac tissue and blood for viral genomes using polymerase chain reaction (PCR) to define the common viral etiologies of myocarditis by age group.
  
  
  BACKGROUND
  Enteroviruses are considered the most common cause of myocarditis at all ages. Diagnosis relies on viral cultures, serology, and cardiac histology, which lack sensitivity, as well as PCR. However, in many cases enteroviruses are not detected.
  
  
  METHODS
  Cardiac samples were obtained for PCR analysis from patients with myocarditis (n = 624) and dilated cardiomyopathy (DCM) (n = 149). Patients were analyzed by age group, including neonates (n = 116), infants (n = 191), toddlers (n = 87), children (n = 110), adolescents (n = 92), and adults (n = 177). After nucleic acids had been extracted from an endomyocardial biopsy, an explant, or autopsy samples, PCR and reverse transcription PCR were performed to detect the genomic sequences of enterovirus, adenovirus, cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), parvovirus, respiratory syncytial virus (RSV), and influenza A virus.
  
  
  RESULTS
  Viral genome was amplified (adenovirus = 142, enterovirus = 85, CMV = 18, parvovirus = 6, influenza A = 5, HSV = 5, EBV = 3, RSV = 1) from 239 (38%) of the 624 samples from myocarditis patients, including 26 patient samples in which dual infection was found. Virus was detected in 30 (20%) of 149 DCM patient samples; only adenovirus (n = 18) and enterovirus (n = 12) were detected.
  
  
  CONCLUSIONS
  Polymerase chain reaction identified adenovirus as the most common virus in the myocardium of children and adults with myocarditis and DCM. Although enteroviruses are also found in these patients, they appear to be a less common cause of myocarditis than adenovirus.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Bowles
authors.forename: Jiyuan
authors.initials: J
authors.lastname: Ni
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kearney
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schultheiss
authors.forename: Robert
authors.initials: R
authors.lastname: McCarthy
authors.forename: Joshua
authors.initials: J
authors.lastname: Hare
authors.forename: J Timothy
authors.initials: JT
authors.lastname: Bricker
authors.forename: Karla R
authors.initials: KR
authors.lastname: Bowles
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification*; D000258:Adenovirus Infections, Human / Q000150:complications* / Q000821:virology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000302:isolation & purification; D006321:Heart / Q000821:virology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009205:Myocarditis / Q000150:complications / Q000821:virology*; D016133:Polymerase Chain Reaction; D014777:Virus Diseases / Q000150:complications