[Viral myocarditis and classical virology. Clinico-virologic and experimental data]

A viral etiology of myocarditis has been proven stringently only in a few cases and mostly enteroviruses have been shown to be involved. In fact, a virological diagnosis of viral myocarditis is still rarely possible today. Virus isolation from heart-tissue is hard to achieve and biopsies, if at all, are often performed too late. Successful virus isolation from other materials (e.g. faeces, throat swab) or a serological diagnosis of acute virus infection cannot easily be correlated etiologically with cardial symptoms, depending of course also on the kind of virus infection diagnosed. To prove an acute infection serologically a fourfold rise in antibody titer or for some viruses specific IgM has to be detected. A group specific diagnosis of "acute enterovirus infection" is not reliably possible at the moment. The neutralization test is the only relatively type specific test in enterovirus serology. Intraserotypic virus variants cannot be detected by normal serology. Even when determining neutralizing IgM-antibodies, interpretation of results raises problems due to long persistence and possible cross reactivity. In case of suspected viral myocarditis clinicians should institute early and broad virological diagnostic measures. Virologists have to establish methods for virus or antigen determinations by molecular biological means. Furthermore, a fast and easy serological method for the diagnosis of an "acute enterovirus infection' would be very helpful. For research on the pathogenesis established animal models have to be used.