The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts.
OBJECTIVE
Multiple viruses have been detected in cardiac tissue, but their role in causing myocarditis remains controversial. Viral diagnostics are increasingly used in forensic medicine, but the interpretation of the results can sometimes be challenging. In this study, we examined the prevalence of adenovirus, enterovirus, and parvovirus B19 (PVB) in myocardial autopsy samples from myocarditis related deaths and in non-inflamed control hearts in an effort to clarify their significance as the causes of myocarditis in a forensic material.


METHODS
We collected all autopsy cases diagnosed with myocarditis from 1992 to 2010. Eighty-four suicidal deaths with morphologically normal hearts served as controls. Polymerase chain reaction was used for the detection of the viral genomes (adenovirus, enterovirus, and PVB) in myocardial tissue specimens. The distinction between acute and persistent PVB infection was made by the serological determination of PVB-specific immunoglobulins M and G.


RESULTS
PVB was detected in 33 of 112 (29 %) myocarditis cases and 37 of 84 (44 %) control cases. All of the samples were negative for the presence of adenovirus and enterovirus. Serological evidence of an acute PVB infection, determined by the presence of immunoglobulin M, was only present in one case. In the remaining cases, PVB was considered to be a bystander with no or limited association to myocardial inflammation.


CONCLUSIONS
In this study, adenovirus, enterovirus, and PVB were found to be rare causes of myocarditis. The detection of PVB in myocardial autopsy samples most likely represents a persistent infection with no or limited association with myocardial inflammation. The forensic investigation of myocardial inflammation demands a thorough examination, including special attention to non-viral causes and requires a multidisciplinary approach.
Department of Clinical Medicine, Centre for Clinical Research, Vendsyssel Hospital, Aalborg University, Bispensgade 37, 9800, Hjørring, Denmark, tsn@retsmedicin.au.dk.
Trine Skov
TS
Nielsen
Jakob
J
Hansen
Lars Peter
LP
Nielsen
Ulrik Thorngren
UT
Baandrup
Jytte
J
Banner
D000256:Adenoviridae / Q000235:genetics / Q000302:isolation & purification*; D000257:Adenoviridae Infections / Q000401:mortality / Q000473:pathology / Q000821:virology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001344:Autopsy; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000302:isolation & purification; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000401:mortality / Q000473:pathology / Q000821:virology*; D005260:Female; D053803:Forensic Genetics / Q000379:methods; D006321:Heart / Q000821:virology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D010322:Parvoviridae Infections / Q000401:mortality / Q000473:pathology / Q000821:virology*; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012698:Serologic Tests; D055815:Young Adult
D000914:Antibodies, Viral; D015415:Biomarkers; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M