A myocarditis outbreak with fatal cases associated with adenovirus subgenera C among children from Havana City in 2005.
BACKGROUND
Among multiple causes of acute myocarditis, viral infection, especially that due to enteroviruses and adenoviruses, is the leading cause. In the summer 2005 an outbreak of a febrile syndrome accompanied by acute cardiac decompensation occurred in infants and young children in Havana City. Eleven patients had a rapid evolution of disease and there were 8 fatalities from cardiac failure secondary to myocarditis.


OBJECTIVE
The aim of the present study was to determine the etiological agent responsible for this outbreak.


METHODS
Children admitted to the pediatric hospitals of Havana City from July 3 to August 2 with this clinical presentation were studied. Forty samples of necropsy tissue, cerebrospinal fluid, stools and serum were tested by molecular methods for 14 respiratory viruses, 6 herpesviruses and generic enteroviruses and flavirus and alfaviruses. Viral isolation was performed in A-549 cells. Isolated viruses were typed by sequence analysis.


RESULTS
Adenovirus genome was detected in 6 of the 8 fatal cases-the lungs in 5 (63%) and the myocardium in 3 (37%). In two fatal cases, viral genome was detected in both lung and myocardium. Adenovirus was isolated in five fatal cases. In all three non-fatal cases, adenovirus genome was detected and adenovirus was isolated into two. Sequence analysis showed that adenovirus type 5 was the only isolate from fatal cases and adenovirus 1 the only isolate in non-fatal cases. No other viruses were found by PCR or isolation techniques.


CONCLUSIONS
Adenovirus was the etiologic agent implicated in this myocarditis outbreak and adenovirus type 5 was associated with fatal outcome.
Savón
Clara
C
Tropical Medicine Institute Pedro Kourí, Havana, Cuba. clara@ipk.sld.cu
Acosta
Belsy
B
Valdés
Odalys
O
Goyenechea
Angel
A
Gonzalez
Grehete
G
Piñón
Alexander
A
Más
Pedro
P
Rosario
Delfina
D
Capó
Virginia
V
Kourí
Vivian
V
Martínez
Pedro A
PA
Marchena
Juan J
JJ
González
Guelsys
G
Rodriguez
Hermis
H
Guzmán
María G
MG
D000258:Adenovirus Infections, Human / Q000453:epidemiology / Q000401:mortality / Q000821:virology; D000260:Adenoviruses, Human / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D000293:Adolescent; D045744:Cell Line, Tumor; D002648:Child; D002675:Child, Preschool; D003462:Cuba / Q000453:epidemiology; D004196:Disease Outbreaks; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000821:virology