Myocarditis in children presenting with acute febrile illness
Keywords:
Myocarditis, Troponin I, Echocardiography, Children
Abstract
Objective: Myocarditis is the inflammatory disease of myocardium. The objective of this study was to determine the prevalence of myocarditis in children presenting with acute febrile illness, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis and to know the outcome and etiological agents causing myocarditis.
Methods: This prospective observational study was done in 125 children aged 1-15 years presenting with acute febrile illness. Patients were diagnosed as suspicious case of myocarditis on the basis of expanded criteria of myocarditis. Suspicious myocarditis patients were compared with those who did not have myocarditis in terms of clinical feature, investigation and outcome and were also investigated for etiology.
Results: 43 patients were diagnosed as suspected myocarditis according to expanded criteria. Mean age was 6.1 ± 3.4 years and male: female ratio was 1.2:1. A significant association was present between patients with myocarditis and following signs and symptoms: chest pain, palpitation, dyspnea, swelling of body, pedal edema, abdominal tenderness, hepatomegaly and crepitations. Following investigations were significantly abnormal in patients with myocarditis: hypokalaemea, billirubin >1.2 mg/dl, mean AST and ALT, CPK-MB and BNP.
Conclusions: Children with myocarditis present with symptoms that can be mistaken for other system involvement. When clinical suspicion of myocarditis exists, chest-X ray, cardiac enzymes and echocardiography are sufficient as screening tests. Many common causes of acute onset fever can cause myocaditis. Therefore its diagnosis is necessary for prompt treatment.
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References
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2. Kearney MT, Cotton JM, Richardson PJ, Shah AM. Viral myocarditis and dilated cardiomyopathy: mechanisms, manifestations, and management. Postgrad Med J 2001 Jan; 77(903):4–10.
3. Vashist S, Singh GK. Acute myocarditis in children: current concepts and management. Curr Treat Options Cardiovasc Med. 2009 Oct;11(5):383-91. [PubMed]
4. Robinson J, Hartling L, Vandermeer B, Crumley E, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004370. [PubMed]
5. Kuhl U, Pauschinger M, Bock T, Klingel K, Schwimmbeck CP, Seeberg B, et al. Parvovirus B19 infection mimicking acute myocardial infarction. Circulation 2003 Aug 26;108(8):945-50. [PubMed]
6. Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, Clunie S, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA. 2006 Oct 18;296(15):1867–1876.
7. Feldman AM, McNamara D. Medical progress: Myocarditis. N Engl J Med. 2000 Nov 9;343(19):1388–1398.
8. Chang YJ, Chao HC, Hsia SH, Yan DC. Myocarditis presenting as gastritis in children. Pediatr Emerg Care. 2006 June;22(6):439–440. [PubMed]
9. Bohn D, Benson L. Diagnosis and management of pediatric myocarditis. Paediatr Drugs. 2002;4(3):171–181. [PubMed]
10. Levi D, Alejos J. Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol. 2001 March;16(2):77–83.[PubMed]
11. Kotilainen P, Lehtopolku M, Hakanen AJ. Myopericarditis in a patient with Campylobacter enteritis: a case report and literature review. Scand J Infect Dis. 2006;38(6-7):549–552. [PubMed]
12. Dancea AB. Myocarditis in infants and children: a review for the paediatrician. J Paediatr Child Health. 2001;343:1388–1398.
13. Drucker NA, Colan SD, Lewis AB, Beiser AS, Wessel DL, Takahashi M, Baker AL, et al. Globulin treatment of acute myocarditis in the pediatric population. Circulation. 1994 Jan;89(1):252–257. [PubMed]
14. Roeland J, Gibson DG. Recommendations for standardization of measurements from M-mode echocardiograms. Eur Heart J 1980 Oct;1(5):375–8. [PubMed]
15. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978 Dec;58(6):1072–83. [PubMed]
16. C Kampmann, C M Wiethoff, A Wenzel, G Stolz,M Betancor, C-F Wippermann, R-G Huth, P Habermehl,M Knuf, T Emschermann, H Stopfkuchen. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe Heart 2000 June;83(6):667–672.
17. Braunwald’s heart desease, 8th ed. Philadelphia, PA:Saunders Elsevier;2007:1775-1791.
18. Rady HI, Zekri H. Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement. J Pediatr (Rio J). 2015 Jan-Feb;91(1):93-7. doi: 10.1016/j.jped.2014.05.011. [PubMed]
19. Soongswang J, Durongpisitkul K, Nana A, Laohaprasittiporn D, Kangkagate C, Punlee K, et al. Cardiac troponin T: a marker in the diagnosis of acute myocarditis in children. Pediatr Cardiol. 2005 Jan-Feb;26(1):45-9. [PubMed]
20. Schwartz J, Sartini D, Huber S. Myocarditis susceptibility in female mice depends upon ovarian cycle phase at infection. Virology 2004 Dec 5;330(1):16-23. [PubMed]
21. Chang YJ, Chao HC, Hsia SH, Yan DC. Myocarditis presenting as gastritis in children. Pediatr Emerg Care. 2006 Jun;22(6):439-40. [PubMed]
22. Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol. 2002 May;12(5):1179-87. [PubMed]
23. Durani Y, Egan M, Baffa J, Selbst SM, Nager AL. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med 2009 Oct;27(8):942-7. doi: 10.1016/j.ajem.2008.07.032.
24. Freedman SB, Haladyn JK, Floh A, Kirsh JA, Taylor. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics 2007 Dec;120(6):1278-85. [PubMed]
25. Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J. 2000;140:111–120. [PubMed]
26. Chemnitz G, Schmidt E, Schmidt FW, Gahl K, Lobers J. The creatinine kinase MB isoenzyme in heart failure and inflammation. In:Lang H, ed. Creatinine kinase Isoenzyme. Berlin, Germany: Springer- Verlag..1981:165-169. [PubMed]
27. Drucker NA, Newburger JW. Viral myocarditis: diagnosis and management. Adv Pediatr. 1997;44:141–171. [PubMed]
28. Keith JD, Rowe RD, Vlad P, eds. Heart Disease in Infancy and Childhood. New York, NY: Macmillan; 1978. [PubMed]
29. Oakley CM. Myocarditis, pericarditis and other pericardial diseases. Heart. 2000 Oct;84(4):449-54. [PubMed]
30. Herrera JM. Cardiac lesion in vivax malaria. Study of a case with coronary and myocardial damage. Arch Inst Cardiol Mex. 1960 Jan-Feb;30:26-36.
31. Khattak AL, Ali W, Samore NA, Idris M, Khan MN, Pasha W. Complicated plasmodium falciparum malaria initially presenting as myocardites. J Ayub Med Coll Abbottabad. 2014 Jul-Sep;26(3):413-5. [PubMed]
32. Kabra, S.K., Juneja, R., Madhulika, Jain, Y., Singhal, T., Dar, L. et a. , Myocardial dysfunction in children with dengue haemorrhagic fever. Natl Med J India. 1998 Mar-Apr;11(2):59-61. [PubMed]
33. C.R. Burt, J.C. Proudfoot, M. Roberts, R.H. Horowitz. Fatal myocarditis secondary to Salmonella septicemia in a young adult J Emerg Med. 1990 May-Jun;8(3):295-7.
34. Frustaci A, Abdulla AK, Caldarulo M, Buffon A. Fatal measles myocarditis. Cardiologia. 1990 Apr;35(4):347-9. [PubMed]
35. Haddad F, Berry G, Doyle R, Martineau P, Leung T, Racine N. Active Bacterial Myocarditis: A Case Report and Review of the Literature. J Heart Lung Transplant. 2007 Jul;26(7):745-9
36. Salvi A, Della Gazia E, Silvestri F, Camerini F. Acute rickettsial myocarditis and advanced atrioventricular block: diagnosis and treatment aided by endomyocardial biopsy. Int Cardiol. 1985 Apr;7(4):405-9. [PubMed]
37. Klugman D, Berger JT, Sable CA, He J, Khandelwal SG, Slonim AD. Pediatric patients hospitalized with myocarditis: a multi- institutional analysis. Pediatr Cardiol. 2010 Feb;31(2):222-8. ssdoi: 10.1007/s00246-009-9589-9.
38. La Scola B, Raoult D. Laboratory diagnosis of Rickettsioses: Current approach to diagnosis of old and new rickettsial Diseases. J Clin Microbiol 1997 Nov;35(11):2715-27. [PubMed]
39. Gajanan N. Sapkal, Vijay P. Bondre, Pradip V. Fulmali, Pooja Patil, V, Gopalkrishna, Vipul Dadhania, et al. Enteroviruses in Patients with Acute Encephalitis, Uttar Pradesh, India. Emerg Infect Dis. 2009 Feb; 15(2): 295–298. [PubMed]
40. Fuse K, Kodama M, Okura Y, Ito M, Hirono S, Kato K, et al. Predictors of disease course in patients with acute myocarditis. Circulation. 2000 Dec 5;102(23):2829-35. [PubMed]
CITATION
DOI: 10.17511/ijpr.2016.i03.09
Published: 2016-03-31
How to Cite
Dr Shahla Abrar, Dr Mohammed Junaid ansari, Dr Mahima Mittal, Dr Anita Mehta, Dr Bhoopendra Sharma, Dr S.K. Srivastava, Dr Rachna Bhatnagar, & Dr K.P. Kushwaha. (2016). Myocarditis in children presenting with acute febrile illness. Pediatric Review: International Journal of Pediatric Research, 3(3), 188-195. https://doi.org/10.17511/ijpr.2016.i03.09
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Copyright (c) 2016 Author (s). Published by Siddharth Health Research and Social Welfare Society
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