Ukimura Akira, Satomi Hidetoshi, Ooi Yukimasa, Kanzaki Yumiko
Department of General Internal Medicine, Osaka Medical College, Takatsuki 569-8686, Japan.
Influenza Res Treat. 2012;2012:351979. doi: 10.1155/2012/351979. Epub 2012 Dec 17.
Acute myocarditis is a well-known complication of influenza infection. The frequency of myocardial involvement in influenza infection varies widely, with the clinical severity ranging from asymptomatic to fulminant varieties. The worst cases can result in death due to impaired cardiac function, although such fulminant myocarditis associated with influenza infection is rare, as shown by previous papers. Following the 2009 influenza pandemic, we reported on the clinical features of a cohort of 15 patients in Japan with H1N1pdm2009 myocarditis. In our subsequent survey of the literature for case reports or series of patients with myocarditis associated with H1N1pdm2009, we identified 58 detailed cases. We discuss here the high prevalence of fulminant myocarditis (36/58, 62%) among patients reported to have myocarditis associated with H1N1pdm2009. Mechanical circulatory support was required in 17 of the patients with fulminant myocarditis, 13 of whom recovered. We stress the need for increased awareness of influenza-associated myocarditis; such knowledge will facilitate earlier diagnosis and treatment of this fatal complication during future influenza pandemics.
急性心肌炎是流感感染的一种众所周知的并发症。流感感染中心肌受累的频率差异很大，临床严重程度从无症状到暴发性不等。最严重的病例可因心功能受损而导致死亡，不过如先前文献所示，与流感感染相关的这种暴发性心肌炎很罕见。2009年流感大流行之后，我们报告了日本一组15例感染2009年甲型H1N1流感病毒心肌炎患者的临床特征。在我们随后对有关感染2009年甲型H1N1流感病毒相关心肌炎患者的病例报告或系列病例的文献调查中，我们确定了58例详细病例。我们在此讨论在报告的感染2009年甲型H1N1流感病毒相关心肌炎患者中暴发性心肌炎的高患病率（36/58，62%）。17例暴发性心肌炎患者需要机械循环支持，其中13例康复。我们强调需要提高对流感相关性心肌炎的认识；此类知识将有助于在未来流感大流行期间对这种致命并发症进行更早的诊断和治疗。
