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Cardiac manifestations during a Coxsackie B5 epidemic
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Coxsackie B5 virus caused acute myopericarditis in 18 patients during a 1965 Finland epidemic. Most patients recovered fully, with ECG changes persisting in only one case.
Area of Science:
- Virology
- Cardiology
- Epidemiology
Background:
- A Coxsackie B5 epidemic occurred in Finland in autumn 1965.
- Acute myopericarditis cases were admitted to Kuopio Central Hospital.
Purpose of the Study:
- To investigate the clinical features and outcomes of acute myopericarditis during a Coxsackie B5 epidemic.
- To identify the causative viral agents and assess patient recovery.
Main Methods:
- Retrospective analysis of 18 patients with acute myopericarditis.
- Viral isolation from fecal samples.
- Serological testing for neutralizing antibodies against Coxsackie viruses.
- Clinical assessment including ECG and echocardiography.
Main Results:
- Coxsackie B5 virus was isolated in 12 cases; Coxsackie A9 in one case.
- Elevated antibody titers against Coxsackie B5 were found in 16 cases.
- All patients experienced fever; ECG changes were universal.
- Cardiac tamponade occurred in one patient; aseptic meningitis in five.
- All patients recovered, with one showing persistent ECG changes at follow-up.
Conclusions:
- Coxsackie B5 virus is a significant cause of acute myopericarditis during epidemics.
- Myopericarditis typically resolves with good prognosis, though ECG abnormalities may persist.
- Prompt diagnosis and supportive care are crucial for managing myopericarditis.
Abstract:
During a widespread Coxsackie B5 epidemic which occurred in Finland in the autumn of 1965 18 patients with acute myopericarditis were admitted to Kuopio Central Hospital (530 beds, representing a hospital district with 270,000 inhabitants) within a period of three months.The mean age of these patients was 28 years. Twelve were males and six were females.In 12 cases Coxsackie B5 virus and in one case Coxsackie A9 virus were isolated from the faeces. A significant increase in neutralizing antibodies or high antibody titres (>/=1:128) were noted in 16 cases against Coxsackie B5 and in one case against Coxsackie A9. In two cases the cause of the myopericarditis remained obscure.All the patients had fever. Six showed all classical criteria of pericarditis: chest pain, pericardial rub, E.C.G. changes, and radiologically observable enlargement of the heart. As regards the various criteria, E.C.G. changes were found in all cases. Signs of cardiac tamponade were observed in one patient. Five, in addition, showed aseptic meningitis.All the patients recovered. Twelve were re-examined at an average of seven months after discharge from hospital. All were symptom-free except one, who still showed E.C.G. changes.