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Adenoviruses and enteroviruses as pathogens in myocarditis and dilated cardiomyopathy
I M Grumbach1, A Heim, P Pring-Akerblom
1Department of Internal Medicine, Georg-August-Universität, Göttingen, Germany. imgrum@uic.edu
Background:
Enteroviruses were detected in up to 50% in myocardium of patients with myocarditis and dilated cardiomyopathy, the latter being considered as a result of a prior subclinical myocarditis. A wide range of other infectious agents are being discussed as pathogens, often only based on reports of single cases. Adenovirus genome was recently identified in a significant number in the myocardium of paediatric patients with myocarditis. However, data on the role of adenoviruses for the aetiopathogenesis of myocarditis in adult patients is missing so far. Therefore, we studied the prevalence of adenoviral and enteroviral genome in myocardium of adults with myocarditis and dilated cardiomyopathy.
Methods:
15 patients were diagnosed at baseline with myocarditis, 16 patients with dilated cardiomyopathy according to clinical and histological criteria. Endomyocardial biopsies of these patients and 8 control patients with non-infectious heart diseases were evaluated by polymerase chain reactions for enterovirus and adenovirus genome.
Results:
Enteroviral genome was detected in 27.3% patients with myocarditis or dilated cardiomyopathy, whereas adenoviral genome was not identified in any patient. Samples from control subjects systematically yielded negative results.
Conclusions:
From our data, it seems doubtful that adenoviruses are major pathogens of myocarditis or DCM, whereas enterovirus genome was identified in a significant number of patients with both diseases.
Insights
Enteroviruses were detected in adult myocarditis and dilated cardiomyopathy (DCM) patients, but adenoviruses were not found. This suggests enteroviruses, not adenoviruses, are significant pathogens in these heart conditions.
Area of Science:
- Cardiology
- Virology
- Pathogen Identification
Background:
- Enteroviruses are found in up to 50% of myocarditis and dilated cardiomyopathy (DCM) cases.
- Adenovirus has been implicated in pediatric myocarditis, but its role in adults is unclear.
- Other infectious agents are suspected but lack robust evidence.
Purpose of the Study:
- To investigate the prevalence of adenovirus and enterovirus genomes in adult patients with myocarditis and DCM.
- To clarify the etiological role of adenoviruses in adult myocarditis and DCM.
Main Methods:
- Endomyocardial biopsies from 15 myocarditis patients, 16 DCM patients, and 8 controls were analyzed.
- Polymerase chain reaction (PCR) was used to detect enterovirus and adenovirus genomes.
- Control patients had non-infectious heart diseases.
Main Results:
- Enteroviral genome was detected in 27.3% of patients with myocarditis or DCM.
- Adenoviral genome was not identified in any myocarditis or DCM patients.
- Control samples tested negative for both viral genomes.
Conclusions:
- Adenoviruses are unlikely to be major pathogens in adult myocarditis or DCM.
- Enteroviruses are confirmed as significant pathogens in a considerable number of myocarditis and DCM cases.
- Further research into viral etiologies of heart disease is warranted.