Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults.
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.
Bowles
Neil E
NE
Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
Ni
Jiyuan
J
Kearney
Debra L
DL
Pauschinger
Matthias
M
Schultheiss
Heinz-Peter
HP
McCarthy
Robert
R
Hare
Joshua
J
Bricker
J Timothy
JT
Bowles
Karla R
KR
Towbin
Jeffrey A
JA
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