First report on fatal myocarditis associated with adenovirus infection in Cuba

Area of Science:

• Cardiology
• Virology
• Pediatrics

Background:

• Myocarditis, inflammation of the heart muscle, is often triggered by viral infections.
• Enteroviruses were historically considered the primary cause of myocarditis, but other viruses like adenovirus and influenza are also implicated.
• An unusual outbreak of acute febrile syndrome resulted in pediatric deaths from myocarditis.

Purpose of the Study:

• To investigate the cause of death in eight children who died from myocarditis during an outbreak in Havana, Cuba.
• To identify the specific viral agent responsible for the observed cases of acute myocarditis and cardiogenic shock.

Main Methods:

• Nested polymerase chain reaction (nPCR) and nested reverse transcription-PCR (nRT-PCR) were used to detect viral genomes in heart and lung tissues.
• A broad range of viruses were screened, including adenovirus, herpesviruses, influenza, and enteroviruses.
• Histological examination was performed to confirm myocardial inflammation.

Main Results:

• Adenovirus genomes were detected in 75% (6 out of 8) of the affected children.
• Phylogenetic analysis identified adenovirus serotype 5 as the causal agent in four cases.
• No other viral pathogens were detected in the samples, and histological findings confirmed myocarditis.

Conclusions:

• Adenovirus, specifically serotype 5, was identified as the causative agent of viral myocarditis in this pediatric outbreak.
• The findings highlight adenovirus as a significant cause of severe, fatal myocarditis in children.
• This study underscores the importance of considering adenovirus in the etiology of unexplained myocarditis, particularly during outbreaks.