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Association of varicella, myocarditis, and congestive cardiomyopathy
Insights
Varicella (chickenpox) can cause heart problems, including myocarditis and cardiomyopathy, in children. This cardiac involvement is often unsuspected and warrants consideration in pediatric varicella cases.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Pathology
Background:
- Varicella (chickenpox) is a common childhood viral illness.
- Cardiac complications of varicella are not widely recognized.
- Reye's syndrome is a serious condition associated with varicella.
Purpose of the Study:
- To investigate the frequency and nature of cardiac involvement in children with active varicella.
- To determine if myocardial dysfunction is a common complication of varicella infections in children.
Main Methods:
- Retrospective analysis of children who died with active varicella, examining for myocarditis.
- Prospective evaluation of hospitalized children with active varicella using echocardiography, ECG, and serum enzymes.
- Correlation of cardiac findings with Reye's syndrome in the prospective cohort.
Main Results:
- 11 of 17 children (65%) in the retrospective study had unsuspected interstitial myocarditis.
- In the prospective study, 4 of 6 children (67%) with active varicella and Reye's syndrome showed evidence of myocardial involvement.
- Cardiac dysfunction was consistent with acute congestive cardiomyopathy.
Conclusions:
- The heart is frequently involved in pediatric varicella infections.
- Myocarditis and cardiomyopathy should be considered in the differential diagnosis of children with varicella, especially those with Reye's syndrome.
- Further investigation into the mechanisms and long-term implications of varicella-associated cardiac dysfunction is warranted.
Abstract:
A retrospective study of children dying with active varicella revealed 11 of 17 cases who had unsuspected interstitial myocarditis at the time of their death. In addition, a prospective study of 6 children, consecutively admitted to the hospital with active varicella, were evaluated for evidence of cardiac dysfunction by echocardiography, ECG, and serum enzyme levels. All 6 children had Reye's syndrome in association with active varicella. Evidence of myocardial involvement, consistent with acute congestive cardiomyopathy, was documented in 4 of the 6 children. This study suggests that the heart is commonly involved in varicella infections and that cardiac involvement should be considered in children with this disease.