Pediatric Infectious Disease

Register      Login

VOLUME 3 , ISSUE 3 ( July-September, 2021 ) > List of Articles

REVIEW ARTICLE

Viral Myocarditis in Children: A Review

Jayranganath Mahimarangaiah, Varun Marimuthu

Keywords : Children, COVID-19, India, Intravenous immunoglobulin, Laboratory diagnosis, Myocarditis, Pediatric, Review, Severe acute respiratory syndrome coronavirus 2, Viral

Citation Information : Mahimarangaiah J, Marimuthu V. Viral Myocarditis in Children: A Review. Pediatr Inf Dis 2021; 3 (3):99-104.

DOI: 10.5005/jp-journals-10081-1266

License: CC BY-NC 4.0

Published Online: 16-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

In viral myocarditis, viral invasion of the heart can lead to direct and indirect inflammatory destruction of the myocardium. Various etiological agents, ranging from enterovirus to adenovirus can cause myocarditis. The clinical presentation is heterogeneous and can end up in a dilated cardiomyopathy phenotype, leading to major mortality, morbidity, and years lost in children. Early recognition and diagnosis with echocardiogram, endomyocardial biopsy, and cardiac MRI is important. Treatment options include with immunosuppression and immunomodulation in the early phases and may require cardiac transplantation in end-stage heart failure.


PDF Share
  1. Richardson P. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation. 1996;93:841–842.
  2. Kearney MT, Cotton JM, Richardson PJ, et al. Viral myocarditis and dilated cardiomyopathy: mechanisms, manifestations, and management. Postgrad Med J 2001;77(903):4–10. DOI: 10.1136/pmj.77.903.4.
  3. Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343(19):1388–1398. DOI: 10.1056/NEJM200011093431908.
  4. Nugent AW, Daubeney PEF, Chondros P, et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med 2003;348(17):1639–1646. DOI: 10.1056/NEJMoa021737.
  5. Arola A, Pikkarainen E, Sipilä JO, et al. Occurrence and features of childhood myocarditis: a nationwide study in Finland. J Am Heart Assoc 2017;6(11):e005306. DOI: 10.1161/JAHA.116.005306.
  6. Råsten-Almqvist P, Eksborg S, Rajs J. Myocarditis and sudden infant death syndrome. APMIS Acta Pathol Microbiol Immunol Scand 2002;110(6):469–480. DOI: 10.1034/j.1600-0463.2002.100605.x.
  7. Shimizu C, Rambaud C, Cheron G, et al. Molecular identification of viruses in sudden infant death associated with myocarditis and pericarditis. Pediatr Infect Dis J 1995;14(7):584–588. DOI: 10.1097/00006454-199507000-00006.
  8. Towbin JA, Lowe AM, Colan SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 2006;296(15):1867–1876. DOI: 10.1001/jama.296.15.1867.
  9. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an american heart association scientific statement from the council on clinical cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation 2006;113(14):1807–1816. DOI: 10.1161/CIRCULATIONAHA.106.174287.
  10. Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol 2012;59(9):779–792. DOI: 10.1016/j.jacc.2011.09.074.
  11. Abdel-Aty H, Boyé P, Zagrosek A, et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 2005;45(11):1815–1822. DOI: 10.1016/j.jacc.2004.11.069.
  12. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020.1585.
  13. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5.
  14. Magnani Jared W, William DG. Myocarditis. Circulation 2006;113(6):876–890. DOI: 10.1161/CIRCULATIONAHA.105.584532.
  15. Kabra SK, Juneja R, Jain Y, et al. Myocardial dysfunction in children with dengue haemorrhagic fever. Natl Med J India 1998;11:59–61.
  16. Miranda CH, Borges MC, Schmidt A, et al. A case presentation of a fatal dengue myocarditis showing evidence for dengue virus-induced lesion. Eur Heart J Acute Cardiovasc Care 2013;2(2):127–130. DOI: 10.1177/2048872613475889.
  17. Mahfoud F, Gartner B, Kindermann M, et al. Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J 2011;32(7):897–903. DOI: 10.1093/eurheartj/ehq493.
  18. Kawai C. Idiopathic cardiomyopathy a study on the infectious-immune theory as a cause of the disease. Jpn Circ J 1971;35(7):765–770. DOI: 10.1253/jcj.35.765.
  19. Kühl U, Pauschinger M, Seeberg B, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005;112(13):1965–1970. DOI: 10.1161/CIRCULATIONAHA.105.548156.
  20. Caforio ALP, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the european society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 2013;34(33):2636–2648. DOI: 10.1093/eurheartj/eht210.
  21. Neumann DA, Lane JR, Allen GS, et al. Viral myocarditis leading to cardiomyopathy: do cytokines contribute to pathogenesis? Clin Immunol Immunopathol 1993;68(2):181–190. DOI: 10.1006/clin.1993.1116.
  22. Gauntt CJ. Roles of the humoral response in coxsackievirus B-induced disease. Curr Top Microbiol Immunol 1997;223:259–282.
  23. Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. The myocarditis treatment trial investigators. N Engl J Med 1995;333(5):269–275. DOI: 10.1056/NEJM199508033330501.
  24. Herskowitz A, Campbell S, Deckers J, et al. Demographic features and prevalence of idiopathic myocarditis in patients undergoing endomyocardial biopsy. Am J Cardiol 1993;71(11):982–986. DOI: 10.1016/0002-9149(93)90918-3.
  25. Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003;348(17):1647–1655. DOI: 10.1056/NEJMoa021715.
  26. Chang Y-J, Hsiao H-J, Hsia S-H, et al. Analysis of clinical parameters and echocardiography as predictors of fatal pediatric myocarditis. Andò G, ed., PLoS ONE 2019;14(3):e0214087. DOI: 10.1371/journal.pone.0214087.
  27. Butto A, Rossano JW, Nandi D, et al. Elevated troponin in the first 72 h of hospitalization for pediatric viral myocarditis is associated with ECMO: An analysis of the PHIS+ database. Pediatr Cardiol 2018;39(6):1139–1143. DOI: 10.1007/s00246-018-1871-2.
  28. Butts RJ, Boyle GJ, Deshpande SR, et al. Characteristics of clinically diagnosed pediatric myocarditis in a contemporary multi-center cohort. Pediatr Cardiol 2017;38(6):1175–1182. DOI: 10.1007/s00246-017-1638-1.
  29. Hsiao J-F, Koshino Y, Bonnichsen CR, et al. Speckle tracking echocardiography in acute myocarditis. Int J Cardiovasc Imaging 2013;29(2):275–284. DOI: 10.1007/s10554-012-0085-6.
  30. Manalo R, Bourget L, Garg A, et al. Does myocardial strain remain abnormal long after normalization of ejection fraction in patients with acute myocarditis? Echocardiography 2019;36(3):609–612. DOI: 10.1111/echo.14260.
  31. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC white paper. J Am Coll Cardiol 2009;53(17):1475–1487. DOI: 10.1016/j.jacc.2009.02.007.
  32. Baccouche H, Mahrholdt H, Meinhardt G, et al. Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J 2009;30(23):2869–2879. DOI: 10.1093/eurheartj/ehp328.
  33. Banka P, Robinson JD, Uppu SC, et al. Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study. J Cardiovasc Magn Reson 2015;17(1):96. DOI: 10.1186/s12968-015-0201-6.
  34. Aretz TH. Myocarditis. a histopathologic definition and classification. Am J Cardiovasc Pathol 1986;1:3–14.
  35. VanderPluym CJ, Adachi I, Niebler R, et al. Outcomes of children supported with an intracorporeal continuous-flow left ventricular assist system. J Heart Lung Transplant Off Publ Int Soc Heart Transplant 2019;38(4):385–393. DOI: 10.1016/j.healun.2018.09.015.
  36. O'Connor MJ, Lorts A, Davies RR, et al. Early experience with the HeartMate 3 continuous-flow ventricular assist device in pediatric patients and patients with congenital heart disease: a multicenter registry analysis. J Heart Lung Transplant 2020;39(6):573–579. DOI: 10.1016/j.healun.2020.02.007.
  37. Schranz D, Akintuerk H, Bailey L, et al. Pulmonary artery banding for functional Regeneration of end-stage dilated cardiomyopathy in young children. Circulation 2018;137(13):1410–1412. DOI: 10.1161/CIRCULATIONAHA.117.029360.
  38. Prochnau D, Surber R, Kuehnert H, et al. Successful use of a wearable cardioverter-defibrillator in myocarditis with normal ejection fraction. Clin Res Cardiol 2010;99(2):129–131. DOI: 10.1007/s00392-009-0093-2.
  39. Lin KY, Kerur B, Witmer CM, et al. Thrombotic events in critically ill children with myocarditis. Cardiol Young 2014;24(5):840–847. DOI: 10.1017/S1047951113001145.
  40. Chen H, Lui J, Yang M, Corticosteroids for viral myocarditis (Cochrane review). Cochrane Libr. (4).
  41. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: The TIMIC study. Eur Heart J 2009;30(16):1995–2002. DOI: 10.1093/eurheartj/ehp249.
  42. Drucker NA, Colan SD, Lewis AB, et al. Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994;89(1):252–257. DOI: 10.1161/01.CIR.89.1.252.
  43. Klugman D, Berger JT, Sable CA, et al. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 2010;31(2):222–228. DOI: 10.1007/s00246-009-9589-9.
  44. Prasad AN, Chaudhary S. Intravenous immunoglobulin in children with acute myocarditis and/or early dilated cardiomyopathy. Indian Pediatr 2014;51(7):583–584. DOI: 10.1007/s13312-014-0456-2.
  45. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, in patients with moderate-to-severe heart failure: results of the anti-TNF therapy against congestive heart failure (ATTACH) trial. Circulation 2003;107(25):3133–3140. DOI: 10.1161/01.CIR.0000077913.60364.D2.
  46. Mann DL, McMurray JJV, Packer M, et al. Targeted anticytokine therapy in patients with chronic heart failure: results of the randomized etanercept worldwide evaluation (RENEWAL). Circulation 2004;109(13):1594–1602. DOI: 10.1161/01.CIR.0000124490.27666.B2.
  47. Coyle J, Igbinomwanhia E, Sanchez-Nadales A, et al. A recovered case of COVID-19 myocarditis and ARDS treated with corticosteroids, tocilizumab, and experimental AT-001. JACC Case Rep [Internet] 2020;2(9):1331–1336. DOI: 10.1016/j.jaccas.2020.04.025Available from: http://www.sciencedirect.com/science/article/pii/S2666084920304319.
  48. Radbel J, Narayanan N, Bhatt PJ. Use of tocilizumab for COVID-19-induced cytokine release syndrome: a cautionary case report. Chest [Internet] 2020;158(1):e15–e19. DOI: 10.1016/j.chest.2020.04.024Available from: http://www.sciencedirect.com/science/article/pii/S0012369220307649.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.