High Frequency of Detection by PCR of Viral Nucleic Acid in The Blood of Infants Presenting with Clinical Myocarditis.
Specific viruses are associated with pediatric myocarditis, but the prevalence of viral DNAemia detected by blood polymerase chain reaction (PCR) is unknown. We evaluated the prevalence of known cardiotropic viruses (enterovirus, adenovirus, human herpesvirus 6, and parvovirus B19) in children with clinical myocarditis (n = 21). Results were compared to pediatric controls with similar viral PCR testing. The majority of positive PCR (89 %) was noted in children ≤12 months of age at diagnosis compared to older children. Infant myocarditis patients (8/10) had increased the prevalence of PCR positivity compared to infant pediatric controls (4/114) (p < 0.0001). Other than age, patient characteristics at diagnosis were similar between PCR-positive and PCR-negative patients. Both PCR-negative myocarditis infants had clinical recovery at follow-up. Of the PCR-positive myocarditis infants, 4 had clinical recovery, 2 developed chronic cardiomyopathy, 1 underwent heart transplant, and 1 died. Infants with clinical myocarditis have a high rate of blood viral positivity, which is higher compared to older children with myocarditis and healthy infant controls. Age-related differences in PCR positivity may be due to differences in host and/or virus characteristics. Our findings suggest that viral blood PCR may be a useful diagnostic tool and identify patients who would potentially benefit from virus-specific therapy.
Department of Pediatrics, Washington University in Saint Louis School of Medicine, 1 Children's Place, 8th Floor NWT, Campus Box 8116, Saint Louis, MO, 63110, USA. Simpson_k@kids.wustl.edu.
Kathleen E
KE
Simpson
Department of Pediatrics, Washington University in Saint Louis School of Medicine, 1 Children's Place, 8th Floor NWT, Campus Box 8116, Saint Louis, MO, 63110, USA.
Gregory A
GA
Storch
Department of Pediatrics, Washington University in Saint Louis School of Medicine, 1 Children's Place, 8th Floor NWT, Campus Box 8116, Saint Louis, MO, 63110, USA.
Caroline K
CK
Lee
Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Suite NP2350, Oklahoma City, OK, 73104, USA.
Kent E
KE
Ward
Department of Pediatrics, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA.
Saar
S
Danon
Department of Pediatrics, University of Missouri Kansas City, School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Catherine M
CM
Simon
Department of Pediatrics, University of Nebraska Medical Center/Creighton University, School of Medicine, 111 N. 84th Street, Omaha, NE, 68114, USA.
Jeffrey W
JW
Delaney
Pediatrix Cardiology of Springfield, Mednax National Medical Group, 4350 South National Ave, Springfield, MO, 65810, USA.
Alan
A
Tong
Department of Pediatrics, Washington University in Saint Louis School of Medicine, 1 Children's Place, 8th Floor NWT, Campus Box 8116, Saint Louis, MO, 63110, USA.
Charles E
CE
Canter
D000256:Adenoviridae / Q000302:isolation & purification*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood*; D004770:Enterovirus / Q000302:isolation & purification*; D005260:Female; D006321:Heart / Q000821:virology; D016027:Heart Transplantation; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D016732:Parvovirus B19, Human / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D014481:United States
D004279:DNA, Viral
DNAemia; Myocarditis; Pediatric cardiology