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High Frequency of Detection by PCR of Viral Nucleic Acid in The Blood of Infants Presenting with Clinical Myocarditis

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Abstract

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.

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References

  1. Andrews RE et al (2008) New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United kingdom and Ireland. Circulation 117(1):79–84

    Article  PubMed  Google Scholar 

  2. Bauer S et al (2002) Severe Coxsackie virus B infection in preterm newborns treated with pleconaril. Eur J Pediatr 161(9):491–493

    Article  CAS  PubMed  Google Scholar 

  3. Colvin JM et al (2012) Detection of viruses in young children with fever without an apparent source. Pediatrics 130(6):e1455–e1462

    Article  PubMed Central  PubMed  Google Scholar 

  4. Cooper LT Jr (2009) Myocarditis. N Engl J Med 360(15):1526–1538

    Article  CAS  PubMed  Google Scholar 

  5. Daliento L et al (2003) Successful treatment of enterovirus-induced myocarditis with interferon-alpha. J Heart Lung Transplant 22(2):214–217

    Article  PubMed  Google Scholar 

  6. Daubeney PE et al (2006) Clinical features and outcomes of childhood dilated cardiomyopathy: results from a national population-based study. Circulation 114(24):2671–2678

    Article  PubMed  Google Scholar 

  7. Durani Y et al (2009) Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med 27(8):942–947

    Article  PubMed  Google Scholar 

  8. Florescu DF, Keck MA (2014) Development of CMX001 (Brincidofovir) for the treatment of serious diseases or conditions caused by dsDNA viruses. Expert Rev Anti Infect Ther 12(10):1171–1178

    Article  CAS  PubMed  Google Scholar 

  9. Florescu DF et al (2012) Safety and efficacy of CMX001 as salvage therapy for severe adenovirus infections in immunocompromised patients. Biol Blood Marrow Transplant 18(5):731–738

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Heim A et al (1996) Recombinant interferons beta and gamma have a higher antiviral activity than interferon-alpha in coxsackievirus B3-infected carrier state cultures of human myocardial fibroblasts. J Interferon Cytokine Res 16(4):283–287

    Article  CAS  PubMed  Google Scholar 

  11. Kuhl U et al (2003) Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation 107(22):2793–2798

    Article  PubMed  Google Scholar 

  12. Lim BK et al (2015) Soluble coxsackievirus B3 3C protease inhibitor prevents cardiomyopathy in an experimental chronic myocarditis murine model. Virus Res 199:1–8

    Article  CAS  PubMed  Google Scholar 

  13. Lipshultz SE et al (2003) The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 348(17):1647–1655

    Article  PubMed  Google Scholar 

  14. Pevear DC et al (1999) Activity of pleconaril against enteroviruses. Antimicrob Agents Chemother 43(9):2109–2115

    PubMed Central  CAS  PubMed  Google Scholar 

  15. Rotbart HA, Webster AD, Pleconaril G (2001) Treatment registry, treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis 32(2):228–235

    Article  CAS  PubMed  Google Scholar 

  16. Towbin JA et al (2006) Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 296(15):1867–1876

    Article  CAS  PubMed  Google Scholar 

  17. Yun SH et al (2012) Antiviral activity of coxsackievirus B3 3C protease inhibitor in experimental murine myocarditis. J Infect Dis 205(3):491–497

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by research grants from the Myocarditis Foundation and the Children’s Discovery Institute of Washington University and Saint Louis Children’s Hospital. Funding for the collection of control patient data was provided by Grant [UAH2AI083266-01] from the National Institute of Allergy and Infectious Disease, Grant [UL1 RR024992] from the National Institutes of Health, National Center for Research Resources and Washington University Institute for Clinical and Translational Sciences, and training Grant [T32HD049338] from the National Institute of Child Health and Human Development.

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Correspondence to Kathleen E. Simpson.

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No author has any potential conflicts of interest pertaining to this research study or manuscript.

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Simpson, K.E., Storch, G.A., Lee, C.K. et al. High Frequency of Detection by PCR of Viral Nucleic Acid in The Blood of Infants Presenting with Clinical Myocarditis. Pediatr Cardiol 37, 399–404 (2016). https://doi.org/10.1007/s00246-015-1290-6

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  • DOI: https://doi.org/10.1007/s00246-015-1290-6

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