title: First report on fatal myocarditis associated with adenovirus infection in Cuba.
abstract: Myocarditis is caused frequently by viral infections of the myocardium. In the past, enteroviruses (EV) were considered the most common cause of myocarditis in all age groups. Other viruses that cause myocarditis are adenovirus and influenza viruses. Parvovirus B19 infection is associated sometimes with myocarditis. Members of the Herpesviridae family, cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6) have been associated occasionally with myocarditis. During an atypical outbreak of acute febrile syndrome, eight children, with ages from 5 months to 15 years, died in cardiogenic shock due to myocarditis in July-August 2005, in the city of Havana, Cuba. Nested polymerase chain reaction (nPCR) and nested reverse transcription-PCR (nRT-PCR) were carried out on fresh heart muscle and lung tissue to analyze the genomic sequences of adenovirus, CMV, HHV-6, herpes simplex virus, Epstein-Barr virus (EBV), varizella zoster virus, influenza virus A, B, C, respiratory syncytial virus (RSV) A and B, parainfluenza viruses, rhinoviruses, coronavirus, flaviruses and enteroviruses. Evidence was for the presence of the adenovirus genome in 6 (75%) of the children. Phylogenetic analyses of a conserved hexon gene fragment in four cases showed serotype 5 as the causal agent. No others viruses were detected. Histological examination was undertaken to detect myocardial inflammation. After exclusion of other possible causes of death, the results indicated that viral myocarditis was the cause of death in patients with adenovirus infection.
authors: Respiratory Viruses Laboratory, Virology Department, Division of Microbiology, Instituto de Medicina Tropical Pedro Kourí, Havana, Cuba. odalys@ipk.sld.cu
authors: Odalys
authors: O
authors: Valdés
authors: Belsy
authors: B
authors: Acosta
authors: Alexander
authors: A
authors: Piñón
authors: Clara
authors: C
authors: Savón
authors: Angel
authors: A
authors: Goyenechea
authors: Grehete
authors: G
authors: Gonzalez
authors: Guelsys
authors: G
authors: Gonzalez
authors: Lidice
authors: L
authors: Palerm
authors: Luis
authors: L
authors: Sarmiento
authors: Mas Lago
authors: ML
authors: Pedro
authors: Pedro A
authors: PA
authors: Martínez
authors: Delfina
authors: D
authors: Rosario
authors: Vivian
authors: V
authors: Kourí
authors: María Guadalupe
authors: MG
authors: Guzmán
authors: Alina
authors: A
authors: Llop
authors: Inmaculada
authors: I
authors: Casas
authors: Ma Pilar
authors: MP
authors: Perez Breña
mesh_terms: D000256:Adenoviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D000257:Adenoviridae Infections / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000821:virology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003462:Cuba / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D016679:Genome, Viral / Q000235:genetics; D006321:Heart / Q000821:virology; D006801:Humans; D007223:Infant; D008168:Lung / Q000821:virology; D008297:Male; D009205:Myocarditis / Q000401:mortality / Q000473:pathology / Q000821:virology*; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D012770:Shock, Cardiogenic / Q000401:mortality / Q000473:pathology / Q000821:virology*