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Mutithu DW, Aremu OO, Mokaila D, Bana T, Familusi M, Taylor L, Martin LJ, Heathfield LJ, Kirwan JA, Wiesner L, Adeola HA, Lumngwena EN, Manganyi R, Skatulla S, Naidoo R, Ntusi NAB. A study protocol to characterise pathophysiological and molecular markers of rheumatic heart disease and degenerative aortic stenosis using multiparametric cardiovascular imaging and multiomics techniques. PLoS One 2024; 19:e0303496. [PMID: 38739622 PMCID: PMC11090351 DOI: 10.1371/journal.pone.0303496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD), degenerative aortic stenosis (AS), and congenital valve diseases are prevalent in sub-Saharan Africa. Many knowledge gaps remain in understanding disease mechanisms, stratifying phenotypes, and prognostication. Therefore, we aimed to characterise patients through clinical profiling, imaging, histology, and molecular biomarkers to improve our understanding of the pathophysiology, diagnosis, and prognosis of RHD and AS. METHODS In this cross-sectional, case-controlled study, we plan to recruit RHD and AS patients and compare them to matched controls. Living participants will undergo clinical assessment, echocardiography, CMR and blood sampling for circulatory biomarker analyses. Tissue samples will be obtained from patients undergoing valve replacement, while healthy tissues will be obtained from cadavers. Immunohistology, proteomics, metabolomics, and transcriptome analyses will be used to analyse circulatory- and tissue-specific biomarkers. Univariate and multivariate statistical analyses will be used for hypothesis testing and identification of important biomarkers. In summary, this study aims to delineate the pathophysiology of RHD and degenerative AS using multiparametric CMR imaging. In addition to discover novel biomarkers and explore the pathomechanisms associated with RHD and AS through high-throughput profiling of the tissue and blood proteome and metabolome and provide a proof of concept of the suitability of using cadaveric tissues as controls for cardiovascular disease studies.
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Affiliation(s)
- Daniel W. Mutithu
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
| | - Olukayode O. Aremu
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
| | - Dipolelo Mokaila
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
| | - Tasnim Bana
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
| | - Mary Familusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Department of Civil Engineering, University of Cape Town, Cape Town, South Africa
| | - Laura Taylor
- Division of Forensic Medicine and Toxicology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Lorna J. Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Laura J. Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Jennifer A. Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Max-Delbrück-Center (MDC) for Molecular Medicine, Helmholtz Association, Berlin, Germany
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Henry A. Adeola
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Evelyn N. Lumngwena
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Rodgers Manganyi
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sebastian Skatulla
- Department of Civil Engineering, University of Cape Town, Cape Town, South Africa
| | - Richard Naidoo
- Division of Anatomical Pathology, Department of Pathology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Ntobeko A. B. Ntusi
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South African Medical Research Council, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research, University of Cape Town, Cape Town, South Africa
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de Sousa PMB, Silva EA, Campos MAG, Lages JS, Corrêa RDGCF, Silva GEB. Fatal Myocarditis following COVID-19 mRNA Immunization: A Case Report and Differential Diagnosis Review. Vaccines (Basel) 2024; 12:194. [PMID: 38400177 PMCID: PMC10891853 DOI: 10.3390/vaccines12020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Carditis in childhood is a rare disease with several etiologies. We report a case of infant death due to pericarditis and myocarditis after the mRNA vaccine against COVID-19 (COVIDmRNAV). A 7-year-old male child received the first dose of the COVIDmRNAV and presented with monoarthritis and a fever non-responsive to oral antibiotics. The laboratory investigation showed signs of infection (leukocytosis, high levels of c-reactive protein). His condition rapidly deteriorated, and the patient died. The autopsy identified pericardial fibrin deposits, hemorrhagic areas in the myocardium, and normal valves. A diffuse intermyocardial inflammatory infiltrate composed of T CD8+ lymphocytes and histiocytes was identified. An antistreptolysin O (ASO) dosage showed high titers. The presence of arthritis, elevated ASO, and carditis fulfills the criteria for rheumatic fever. However, valve disease and Aschoff's nodules, present in 90% of rheumatic carditis cases, were absent in this case. The temporal correlation with mRNA vaccination prompted its inclusion as one of the etiologies. In cases of myocardial damage related to COVID-19mRNAV, it appears to be related to the expression of exosomes and lipid nanoparticles, leading to a cytokine storm. The potential effects of the COVID-19mRNAV must be considered in the pathogenesis of this disease, whether as an etiology or a contributing factor to a previously initiated myocardial injury.
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Affiliation(s)
- Pedro Manuel Barros de Sousa
- University Hospital of the Federal University of Maranhão, Barão de Itapari Street 227, São Luís 65020-070, MA, Brazil; (P.M.B.d.S.)
| | - Elon Almeida Silva
- University Hospital of the Federal University of Maranhão, Barão de Itapari Street 227, São Luís 65020-070, MA, Brazil; (P.M.B.d.S.)
| | - Marcos Adriano Garcia Campos
- Clinical Hospital of Botucatu Medical School, São Paulo State University, Professor Mário Rubens Guimarães Montenegro Avenue, Botucatu 18618-687, SP, Brazil
| | - Joyce Santos Lages
- University Hospital of the Federal University of Maranhão, Barão de Itapari Street 227, São Luís 65020-070, MA, Brazil; (P.M.B.d.S.)
| | | | - Gyl Eanes Barros Silva
- University Hospital of the Federal University of Maranhão, Barão de Itapari Street 227, São Luís 65020-070, MA, Brazil; (P.M.B.d.S.)
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
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Vieira PPAC, Pereira RF, Branco CEB, Rosa VEE, Vieira MLC, Demarchi LMMF, Silva LS, Guilherme L, Tarasoutchi F, Sampaio RO. Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery-Impact on Late Prognosis. Diagnostics (Basel) 2023; 13:3252. [PMID: 37892073 PMCID: PMC10606607 DOI: 10.3390/diagnostics13203252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Rheumatic fever (RF) and rheumatic heart disease (RHD) are still highly prevalent, particularly in low- and middle-income countries. RHD is a neglected and underdiagnosed disease for which no specific laboratory diagnostic test is completely reliable. This is a retrospective observational study, which included 118 patients with RHD who underwent cardiac surgery from 1985 to 2018. The aim of this investigation was to evaluate the clinical, epidemiological, echocardiographic and pathological characteristics in two cohorts of RHD patients: one cohort with Aschoff bodies present in their pathological results and the other without such histopathological characteristics. No conventional clinical and laboratory tests for RHD myocarditis were able to identify active carditis during the preoperative phase of valve repair or replacement. Patients who had Aschoff bodies in their pathological results were younger (median age of 13 years (11-24 years) vs. 27 years (17-37 years), p = 0.001) and had higher rate of late mortality (22.9% vs. 5.4%, p = 0.043). In conclusion, the presence of Aschoff bodies in pathological findings may predict increased long-term mortality, emphasizing the importance of comprehensive pathology analysis for suspected myocarditis during heart surgery.
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Affiliation(s)
| | | | - Carlos Eduardo Barros Branco
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Vitor Emer Egypto Rosa
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Marcelo Luiz Campos Vieira
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Lea Maria Macruz Ferreira Demarchi
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Livia Santos Silva
- Clinical Hospital, Santa Marcelina University, Sao Paulo 08270-140, Brazil;
| | - Luiza Guilherme
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Flavio Tarasoutchi
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
| | - Roney Orismar Sampaio
- Heart Institute (InCor), São Paulo University Medical School, Sao Paulo 05403-000, Brazil; (C.E.B.B.); (M.L.C.V.); (L.M.M.F.D.); (L.G.); (F.T.)
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Mutithu DW, Roberts R, Manganyi R, Ntusi NAB. Chronic rheumatic heart disease with recrudescence of acute rheumatic fever on histology: a case report. Eur Heart J Case Rep 2022; 6:ytac278. [PMID: 35865226 PMCID: PMC9295691 DOI: 10.1093/ehjcr/ytac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/13/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Rheumatic heart disease (RHD) is endemic in sub-Saharan Africa where it is the leading cause of cardiovascular mortality in the young. Rheumatic heart disease results from recurrent episodes of acute rheumatic fever (ARF), which are often difficult to diagnose clinically. Acute rheumatic fever may be diagnosed based on the revised Jones Criteria 2015 for the diagnosis of ARF. Histologically, acute rheumatic valvulitis manifests with active inflammation characterized by lymphocytic infiltration, Aschoff bodies, and Anitschkow cells. Chronic rheumatic valvulitis is associated with neovascularization, and/or dystrophic calcification. The combination of histological features of both ARF and chronic RHD is a rare finding. Case summary Here we report on a case of a 59-year-old woman with mixed aortic and mitral valve disease of probable rheumatic aetiology (elevated C-reactive protein and prolonged PR interval) and with histological evidence of lymphocytic infiltration, Aschoff bodies, and fibrinoid necrosis admixed with features of chronic RHD. Discussion Cases of chronic RHD admixed with ARF are very rare; however, they should be considered in regions with a high prevalence of RHDs.
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Affiliation(s)
- Daniel W Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur , J46, Old Main Building, Main Road, Observatory, Cape Town 7925 , South Africa
| | - Riyaadh Roberts
- Division of Anatomical Pathology, National Health Laboratory Service and University of Cape Town , Cape Town 7925 , South Africa
| | - Rodgers Manganyi
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital , Cape Town 7925 , South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur , J46, Old Main Building, Main Road, Observatory, Cape Town 7925 , South Africa
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town , Cape Town 7925 , South Africa
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Szaluś-Jordanow O, Stabińska-Smolarz M, Czopowicz M, Moroz A, Mickiewicz M, Łobaczewski A, Chrobak-Chmiel D, Kizerwetter-Świda M, Rzewuska M, Sapierzyński R, Grzegorczyk M, Świerk A, Frymus T. Focused Cardiac Ultrasound Examination as a Tool for Diagnosis of Infective Endocarditis and Myocarditis in Dogs and Cats. Animals (Basel) 2021; 11:ani11113162. [PMID: 34827894 PMCID: PMC8614417 DOI: 10.3390/ani11113162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/22/2022] Open
Abstract
Symptoms of infective endocarditis (IE) and myocarditis are usually nonspecific and include fever, apathy, and loss of appetite. This condition can lead to severe heart failure with ascites or/and fluid in the thoracic cavity or/and in the pericardial sac. We describe infective endocarditis and myocarditis in 3 dogs and 4 cats. In all animals, the initial diagnosis was performed on the basis of a focused cardiac ultrasound examination performed by a general practitioner after a training in this technique. The initial findings were confirmed by a board-certified specialist in veterinary cardiology. Post mortem positive microbiological results from valves were obtained in 4 of 7 patients. Methicillin-resistant Staphylococcus aureus was confirmed in 2 cases and Staphylococcus epidermidis was confirmed in 2 cases, one of which included Enterococcus sp. coinfection. Histopathological examination confirmed initial diagnosis in 5 of 7 animals. In the remaining 2 patients, the time elapsed from the onset of clinical symptoms to death was about 1 month and no active inflammation but massive fibrosis was found microscopically. This is, to our best knowledge, the first report of IE and myocarditis diagnosed in small animals using focused cardiac ultrasound examination. Therefore, we conclude that common usage of this technique by trained general veterinarians may increase the rate of diagnosed patients with these conditions.
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Affiliation(s)
- Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
- Correspondence:
| | | | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Andrzej Łobaczewski
- Round-the-Clock Veterinary Clinic Auxilium, Królewska Street 64, 05-822 Milanówek, Poland;
| | - Dorota Chrobak-Chmiel
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Magdalena Kizerwetter-Świda
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Magdalena Rzewuska
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Rafał Sapierzyński
- Department of Pathology and Veterinary Diagnostic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
| | - Michał Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chałbińskiego 5 Street, 02-004 Warsaw, Poland;
| | - Anna Świerk
- Round-the-Clock Veterinary Clinic LEGWET, Jagiellońska 20, 05-120 Legionowo, Poland;
| | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
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Rosa VEE. Histopathological Characterization of Mitral Valvular Lesions in Patients With Rheumatic Heart Disease: Is Inflammation Also to Blame for Chronic Valvular Heart Disease Progression? Arq Bras Cardiol 2021; 116:413-414. [PMID: 33909768 PMCID: PMC8159542 DOI: 10.36660/abc.20201244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vitor Emer Egypto Rosa
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilUnidade Clínica de Valvopatias do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor HC FMUSP), São Paulo, SP - Brasil.,Correspondência: Vitor Emer Egypto Rosa • Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo - Brasil, E-mail:
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Affiliation(s)
- Alida L P Caforio
- Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Renzo Marcolongo
- Clinical Immunology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Guilherme L, Köhler KF, Faé KC. Editorial: Frontiers in Autoimmune Disease: Rheumatic Fever and Rheumatic Heart Disease. Front Pediatr 2015; 3:91. [PMID: 26579501 PMCID: PMC4623398 DOI: 10.3389/fped.2015.00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/14/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Luiza Guilherme
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Karen F Köhler
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Kellen C Faé
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo , São Paulo , Brazil
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