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Cherukuri ASS, Belay NF, Nasereldin DS, Mohammed DO, Mohamed S, Elkhazeen A, Ghobriel NG, Alatta L, Alsafi W, Abdalla Y, Brry G, Abdelrahman N. Varicella-Zoster Virus Myocarditis: Early Clinical Diagnosis and Outcome. Cureus 2023; 15:e38015. [PMID: 37223180 PMCID: PMC10204613 DOI: 10.7759/cureus.38015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/25/2023] Open
Abstract
Varicella-zoster virus (VZV) is a viral infection that causes chickenpox and shingles. Although it is usually self-limiting, it can lead to severe complications, especially in pediatric and immunocompromised patients. VZV was first discovered as a cause of myocarditis in 1953. In this review article, we aim to investigate the early clinical diagnosis of myocarditis in VZV infections and the efficacy of the VZV vaccine in preventing myocarditis. The literature search was done using PubMed, Google Scholar, and Sci-Hub databases. A high VZV mortality rate was noted among adults, infants, and immunocompromised patients. The early diagnosis and treatment of VZV myocarditis can reduce mortality.
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Affiliation(s)
| | - Naod F Belay
- Geriatrics, Michigan State University, East Lansing, USA
| | | | | | - Suzan Mohamed
- Geriatrics, Michigan State University, East Lansing, USA
| | | | | | - Lina Alatta
- Geriatrics, Michigan State University, East Lansing, USA
| | - Wail Alsafi
- Geriatrics, Michigan State University, East Lansing, USA
| | - Yaseen Abdalla
- Geriatrics, Michigan State University, East Lansing, USA
| | - Gamila Brry
- Geriatrics, Michigan State University, East Lansing, USA
| | - Nadir Abdelrahman
- Family Medicine - Geriatrics, Michigan State University College of Human Medicine, East Lansing, USA
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Schultheiss HP, Baumeier C, Aleshcheva G, Bock CT, Escher F. Viral Myocarditis-From Pathophysiology to Treatment. J Clin Med 2021; 10:jcm10225240. [PMID: 34830522 PMCID: PMC8623269 DOI: 10.3390/jcm10225240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.
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Affiliation(s)
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - C-Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Abstract
A 2-month-old girl with normal development and no previous physical illnesses was resuscitated having been found lifeless on her back at home. On admission to Paediatric Intensive Care, she had severe metabolic disturbance, associated with an extremely troubling neurological signs. She died 2 hours later. A full body CT scan did not reveal injury and her parents declined an autopsy. Peripheral blood and cerebrospinal fluid samples were sterile. However, a broad-range PCR coupled with electrospray-ionisation mass spectrometry onto the PLEX-ID automat of peripheral blood revealed the presence of varicella zoster virus. There was a specific viral load in whole blood of 20 542 copies/ml. It is presumed that Varicella myocarditis was the likely cause of death. Our case illustrates the potential usefulness of a broad range PCR strategy in determining infectious causes of death in sudden infant death. Varicella is a potential cause of sudden infant death.
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Affiliation(s)
- Stéphane Dauger
- PICU (SMUR) Réanimation Pédiatrique, Assistance Publique - Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Jerome Le Goff
- Service de Virologie, Assistance Publique, Hopitaux de Paris, Virologie, Hôpital St. Louis, Paris, France
| | - Anna Deho
- PICU (SMUR) Réanimation Pédiatrique, Assistance Publique - Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Peter Jones
- PICU (SMUR) Réanimation Pédiatrique, Assistance Publique - Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.,Department of Respiratory, Critical Care and Anesthesia, Institute of Child Heath - Great Ormond Street, London, UK.,UMR 1153, INSERM, Paris, France.,SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Paris, France
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Abstract
A 12-year-old male child with Down syndrome, who had recovered from congenital heart disease, succumbed to severe varicella myocarditis. His clinical presentation at admission mimicked acute coronary syndrome. Analysis of this case throws insight into several aspects of varicella myocarditis.
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