tetano
Editor, Senior Moderator
Can J Cardiol. 2011 Jun 6. [Epub ahead of print]
Influenza Myocarditis and Myositis: Case Presentation and Review of the Literature.
Kumar K, Guirgis M, Zieroth S, Lo E, Menkis AH, Arora RC, Freed DH.
Source
Institute of Cardiovascular Sciences, St. Boniface Research Centre, Winnipeg, Manitoba, Canada; Department of Surgery, Section of Cardiac Surgery, University of Manitoba, St. Boniface General Hospital Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
Abstract
Myocarditis, a general inflammatory condition of the heart muscle, can result from a variety of etiologies, the most common being viral. Despite common pathogens, concomitant myocarditis and myositis remains a rare event. Although a common cause of respiratory illness, extrapulmonary infections with influenza are infrequent. We describe the case of a patient who presented to our center with concomitant "seasonal" H1N1 influenza A myocarditis further complicated by pan-myositis. The patient's condition rapidly declined, eventually requiring biventricular mechanical support, in addition to multilimb fasciotomies. The cardiac support required was progressive, from a percutaneous left ventricular assist device, to extracorporeal membrane oxygenation, to eventual biventricular assist device support for bridge-to-transplantation. This case motivated a detailed review of the literature (a total of 29 cases were identified), in which we found that patients with influenza myocarditis/myositis were predominantly female (63%) and young (mean age 33.2 years) and continue to have a high incidence of morbidity and mortality (27%). As a result of its atypical pattern, the 2009 H1N1 pandemic strain has gained attention. From our review, we found 7 patients with of 2009 H1N1 pandemic influenza myocarditis. Serial serum cytokine analysis did not demonstrate a "cytokine storm," which has been associated with other virulent influenza strains. The PB1-F2 marker in particular has been associated with a vigorous cytokine response. The 2009 H1N1 and "seasonal" influenza strains lack this marker. In those patients with community-acquired influenza, interleukin-6 has been shown to correlate with symptoms. For patients with myocarditis resulting in shock, mechanical circulatory support has gained acceptance as a means to recovery or transplantation.
Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
PMID:
21652168
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21652168
Influenza Myocarditis and Myositis: Case Presentation and Review of the Literature.
Kumar K, Guirgis M, Zieroth S, Lo E, Menkis AH, Arora RC, Freed DH.
Source
Institute of Cardiovascular Sciences, St. Boniface Research Centre, Winnipeg, Manitoba, Canada; Department of Surgery, Section of Cardiac Surgery, University of Manitoba, St. Boniface General Hospital Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
Abstract
Myocarditis, a general inflammatory condition of the heart muscle, can result from a variety of etiologies, the most common being viral. Despite common pathogens, concomitant myocarditis and myositis remains a rare event. Although a common cause of respiratory illness, extrapulmonary infections with influenza are infrequent. We describe the case of a patient who presented to our center with concomitant "seasonal" H1N1 influenza A myocarditis further complicated by pan-myositis. The patient's condition rapidly declined, eventually requiring biventricular mechanical support, in addition to multilimb fasciotomies. The cardiac support required was progressive, from a percutaneous left ventricular assist device, to extracorporeal membrane oxygenation, to eventual biventricular assist device support for bridge-to-transplantation. This case motivated a detailed review of the literature (a total of 29 cases were identified), in which we found that patients with influenza myocarditis/myositis were predominantly female (63%) and young (mean age 33.2 years) and continue to have a high incidence of morbidity and mortality (27%). As a result of its atypical pattern, the 2009 H1N1 pandemic strain has gained attention. From our review, we found 7 patients with of 2009 H1N1 pandemic influenza myocarditis. Serial serum cytokine analysis did not demonstrate a "cytokine storm," which has been associated with other virulent influenza strains. The PB1-F2 marker in particular has been associated with a vigorous cytokine response. The 2009 H1N1 and "seasonal" influenza strains lack this marker. In those patients with community-acquired influenza, interleukin-6 has been shown to correlate with symptoms. For patients with myocarditis resulting in shock, mechanical circulatory support has gained acceptance as a means to recovery or transplantation.
Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
PMID:
21652168
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21652168