Histopathology Department, Sheffield Children's NHS FT, Sheffield, UK.
Forensic Microbiology Laboratory, Instituto Nacional de Toxicología y Ciencias Forenses, Madrid, Spain.
Pediatr Dev Pathol. 2021 Jul-Aug;24(4):327-336. doi: 10.1177/10935266211007262. Epub 2021 Apr 19.
Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths.
Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009-2019. Data retrieved included histological features, microbiology and clinical history.
23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected.
Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.
急性心肌炎是一种以年轻人为主要发病群体的心肌炎症性疾病，可导致猝死。病因包括感染因子（多为病毒）、系统性疾病和毒素。我们旨在描述尸检中表现为猝死的婴幼儿心肌炎患者的特征。
对 2009 年至 2019 年期间突然和意外死亡的 813 例婴幼儿尸检进行回顾性评估。检索的数据包括组织学特征、微生物学和临床病史。
在 813 例尸检中，有 23 例符合急性心肌炎，1 例为与丙型肝炎病毒相关的扩张型心肌病。PCR 鉴定出肠道病毒（7 例）、细小病毒（7 例，其中 2 例还伴有 HHV6 和 1 例伴有 EVB）、甲型流感病毒（1 例）、副流感病毒 3 型（1 例）。2 例为超敏性心肌炎，1 例为 A 组链球菌，5 例为特发性心肌炎。肠道病毒在婴儿中较为常见（7/10），在新生儿中与脑膜炎或先天性心肌炎相关。超过 50%的患者年龄小于 2 岁，且所有患者均未得到临床怀疑。
心肌炎占所有儿科猝死的近 3%。肠道病毒和细小病毒是最常见的病毒。本回顾性分析显示，患者经历了病毒症状，但仍未被怀疑，这突出了提高对心肌炎的临床认识的必要性。
