Esmel-Vilomara Roger, Dolader Paola, Izquierdo-Blasco Jaume, Balcells Joan, Sorlí Moisés, Escudero Fuensanta, Vera Elena, Gran Ferran
Pediatric Cardiology, Vall d'Hebron Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Pediatric Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
Eur J Pediatr. 2022 May;181(5):2045-2053. doi: 10.1007/s00431-022-04406-x. Epub 2022 Feb 9.
Parvovirus B19 is one of the most frequent causes of pediatric myocarditis, associating high mortality rates or need for cardiac transplantation. The aim of this study is to describe the clinical course of Parvovirus B19 myocarditis in children with emphasis on the role of endomyocardial biopsy and cardiac magnetic resonance, and the use of an innovative therapeutic strategy. Eleven patients and 12 episodes of polymerase chain reaction (PCR)-confirmed Parvovirus B19 myocarditis were prospectively collected for 14 years. Diagnosis was confirmed either histopathologically or by magnetic resonance. A life-threatening clinical presentation is described, similar to previous series, but with 83.3% overall survival without transplantation. We also present a case of recurrent myocarditis, which is extraordinarily rare. Electrocardiographic patterns presented chiefly peaked p waves, low QRS voltages, and negative T waves on inferior or lateral leads. Endomyocardial biopsy is the gold standard diagnostic test; alternatively magnetic resonance could be a useful diagnostic tool. A good concordance between myocardial and blood PCRs was observed. Seven patients received treatment with corticosteroids and beta interferon and all underwent a significant cardiac function improvement.
A severe clinical presentation is reported, similar to previous reports but with better outcomes. Endomyocardial biopsy is the gold standard diagnostic test; alternatively magnetic resonance may be used. Both blood and myocardium PCR can be used in children to establish the microbiological etiology. Steroids with IFNß could be a useful therapeutic option, although further multicenter studies are needed to confirm these results.
• Parvovirus B19 is one of the most frequent causes of myocarditis in children. It is associated with a fulminant clinical presentation. • Endomyocardial biopsy is the gold standard diagnostic test but it is an invasive procedure.
• Myocarditis may recur in pediatrics, even it is extraordinarily rare. • IFNβ with steroids may be a useful therapeutic option to improve the outcomes.
细小病毒B19是小儿心肌炎最常见的病因之一，常伴有高死亡率或需要进行心脏移植。本研究的目的是描述儿童细小病毒B19心肌炎的临床病程，重点关注心内膜心肌活检和心脏磁共振成像的作用，以及一种创新治疗策略的应用。前瞻性收集了14年间11例患者的12次经聚合酶链反应（PCR）确诊的细小病毒B19心肌炎病例。诊断通过组织病理学或磁共振成像得以证实。描述了一种危及生命的临床表现，与既往系列报道相似，但总体生存率达83.3%，无需进行移植。我们还报告了1例复发性心肌炎病例，极为罕见。心电图表现主要为P波高尖、QRS波低电压以及下壁或侧壁导联T波倒置。心内膜心肌活检是金标准诊断检查；此外，磁共振成像可能是一种有用的诊断工具。观察到心肌PCR与血液PCR结果具有良好的一致性。7例患者接受了皮质类固醇和β干扰素治疗，所有患者的心功能均有显著改善。
报告了一种严重的临床表现，与既往报道相似，但预后更佳。心内膜心肌活检是金标准诊断检查；也可使用磁共振成像。血液和心肌PCR均可用于儿童以确定微生物病因。皮质类固醇与干扰素β可能是一种有效的治疗选择，尽管需要进一步的多中心研究来证实这些结果。
• 细小病毒B19是儿童心肌炎最常见的病因之一。它与暴发性临床表现相关。• 心内膜心肌活检是金标准诊断检查，但它是一种侵入性操作。
• 小儿心肌炎可能复发，尽管极为罕见。• 干扰素β联合皮质类固醇可能是改善预后的有效治疗选择。
