Parvovirus B19 myocarditis in children: a diagnostic and therapeutic approach
Roger Esmel-Vilomara1,2, Paola Dolader3, Jaume Izquierdo-Blasco4
1Pediatric Cardiology, Vall d'Hebron Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain. roger.esmel@gmail.com.
Insights
Parvovirus B19 myocarditis in children presents severely but has improved outcomes with a novel therapy. Diagnosis via endomyocardial biopsy or MRI is key, with blood PCR showing good concordance.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Viral Myocarditis
Background:
- Parvovirus B19 is a frequent cause of pediatric myocarditis, often presenting with severe symptoms.
- Endomyocardial biopsy is the gold standard for diagnosis but is invasive.
Observation:
- This study prospectively analyzed 11 pediatric patients with Parvovirus B19 myocarditis over 14 years.
- A rare case of recurrent myocarditis was documented.
- Key ECG findings included peaked P waves, low QRS voltages, and negative T waves.
Findings:
- Diagnosis was confirmed by endomyocardial biopsy or cardiac MRI, with good concordance between blood and myocardial PCR.
- Despite a severe presentation, overall survival was 83.3% without transplantation.
- Treatment with corticosteroids and interferon-beta led to significant cardiac function improvement.
Implications:
- Cardiac MRI is a valuable diagnostic alternative to biopsy for pediatric myocarditis.
- Combined steroid and interferon-beta therapy shows promise for treating Parvovirus B19 myocarditis.
- Further multicenter studies are needed to validate these therapeutic outcomes.
Abstract:
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.
Conclusion:
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.
What Is Known:
• 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.
What Is New:
• Myocarditis may recur in pediatrics, even it is extraordinarily rare. • IFNβ with steroids may be a useful therapeutic option to improve the outcomes.
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