title: Parvovirus B19 myocarditis in children: an observational study.
abstract: BACKGROUND
  The advent of PCR testing for the presence of viral genomes has led to the identification of parvovirus B19 (PVB19) as a causative agent of myocarditis.
  
  
  METHODS
  The clinical presentation, course and outcome of children with PVB19 myocarditis was ascertained through a retrospective review. The PVB19 viral genome was detected by PCR from whole blood or endomyocardial biopsy specimens in patients presenting with new onset heart failure.
  
  
  RESULTS
  Seventeen patients presented at a median age of 1.3 years (range: 0.4-15.4 years) in cardiac failure with a mean fractional shortening of 15±3%. Eleven patients required mechanical ventilation and intravenous inotropes and seven required extra-corporeal mechanical oxygenation. Four of the five deaths occurred in patients who had a short prodromal illness of less than 48 hours. All patients with ST segment elevation died (n=4). All non-fulminant cases survived. Event-free survival occurred in 11/17 (65%) patients. Five (29%) patients died and one patient underwent heart transplantation. Complete recovery of cardiac function occurred within a median of 12 months (range: 1-48) in five patients. There was incomplete recovery in five patients and one patient had persistent dilated cardiomyopathy.
  
  
  CONCLUSIONS
  PVB19 can cause a devastating myocarditis in children. Children with fulminant myocarditis, ST segment changes or a short prodrome have the worst outcome. Transplantation may be considered, but is rarely required in the acute period if mechanical circulatory support is utilised. If the initial presentation is survived, recovery of the myocardium can occur even in those who had fulminant myocarditis.
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.
authors.forename: Trisha V
authors.initials: TV
authors.lastname: Vigneswaran
authors.affiliation: Departments of Microbiology, Virology and Infection Prevention and Control, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London, London, UK.
authors.forename: Julianne R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: Departments of Microbiology, Virology and Infection Prevention and Control, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK UCL Division of Infection and Immunity, University College London, London, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Breuer
authors.affiliation: Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy / Q000821:virology*; D010322:Parvoviridae Infections / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016732:Parvovirus B19, Human / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Cardiology; Ecmo; Infectious Diseases; Intensive Care