Savón Clara, Acosta Belsy, Valdés Odalys, Goyenechea Angel, Gonzalez Grehete, Piñón Alexander, Más Pedro, Rosario Delfina, Capó Virginia, Kourí Vivian, Martínez Pedro A, Marchena Juan J, González Guelsys, Rodriguez Hermis, Guzmán María G
Tropical Medicine Institute Pedro Kourí, Havana, Cuba.
J Clin Virol. 2008 Oct;43(2):152-7. doi: 10.1016/j.jcv.2008.05.012. Epub 2008 Jul 25.
Among multiple causes of acute myocarditis, viral infection, especially that due to enteroviruses and adenoviruses, is the leading cause. In the summer 2005 an outbreak of a febrile syndrome accompanied by acute cardiac decompensation occurred in infants and young children in Havana City. Eleven patients had a rapid evolution of disease and there were 8 fatalities from cardiac failure secondary to myocarditis.
The aim of the present study was to determine the etiological agent responsible for this outbreak.
Children admitted to the pediatric hospitals of Havana City from July 3 to August 2 with this clinical presentation were studied. Forty samples of necropsy tissue, cerebrospinal fluid, stools and serum were tested by molecular methods for 14 respiratory viruses, 6 herpesviruses and generic enteroviruses and flavirus and alfaviruses. Viral isolation was performed in A-549 cells. Isolated viruses were typed by sequence analysis.
Adenovirus genome was detected in 6 of the 8 fatal cases-the lungs in 5 (63%) and the myocardium in 3 (37%). In two fatal cases, viral genome was detected in both lung and myocardium. Adenovirus was isolated in five fatal cases. In all three non-fatal cases, adenovirus genome was detected and adenovirus was isolated into two. Sequence analysis showed that adenovirus type 5 was the only isolate from fatal cases and adenovirus 1 the only isolate in non-fatal cases. No other viruses were found by PCR or isolation techniques.
Adenovirus was the etiologic agent implicated in this myocarditis outbreak and adenovirus type 5 was associated with fatal outcome.
在急性心肌炎的多种病因中，病毒感染，尤其是肠道病毒和腺病毒感染，是主要病因。2005年夏天，哈瓦那市的婴幼儿中爆发了一种伴有急性心功能不全的发热综合征。11例患者病情迅速发展，8例因心肌炎继发心力衰竭死亡。
本研究旨在确定此次疫情的病原体。
对7月3日至8月2日因该临床表现入住哈瓦那市儿科医院的儿童进行研究。采用分子方法对40份尸检组织、脑脊液、粪便和血清样本检测14种呼吸道病毒、6种疱疹病毒、肠道病毒属、黄病毒属和甲病毒属。在A - 549细胞中进行病毒分离。对分离出的病毒进行序列分析分型。
8例死亡病例中有6例检测到腺病毒基因组——5例（63%）在肺中，3例（37%）在心肌中。2例死亡病例在肺和心肌中均检测到病毒基因组。5例死亡病例中分离出腺病毒。在所有3例非死亡病例中均检测到腺病毒基因组，2例分离出腺病毒。序列分析显示，5型腺病毒是死亡病例的唯一分离株，1型腺病毒是非死亡病例的唯一分离株。通过PCR或分离技术未发现其他病毒。
腺病毒是此次心肌炎疫情的病原体，5型腺病毒与死亡结局相关。
