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[Acute infectious myocarditis in children. Apropos of 2 series from Lyon]
M Gouton1, S Di Filippo, F Sassolas
1Hôpital cardiovasculaire et pneumologique Louis-Pradel, Lyon.
Insights
Acute infectious myocarditis in children has high early mortality but survivors have a good long-term outlook. Early diagnosis and intervention are crucial for improving outcomes in pediatric myocarditis.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Context:
- Acute infectious myocarditis presents significant challenges in pediatric care.
- Retrospective analysis of cases from two distinct hospital units highlights differing patient cohorts and outcomes.
- Early symptoms are often non-specific, complicating timely diagnosis.
Purpose:
- To evaluate the initial outcomes and long-term prognosis of acute infectious myocarditis in children.
- To compare clinical presentations and mortality rates between intensive care and cardiology units.
- To identify common etiological agents and clinical signs associated with severe pediatric myocarditis.
Summary:
- A retrospective study analyzed 12 pediatric intensive care unit (PICU) admissions and 81 pediatric cardiology unit follow-ups for acute infectious myocarditis.
- PICU cases showed high early mortality (42%) with non-specific symptoms and poor left ventricular function (fractional shortening 17%).
- Cardiology unit patients, followed long-term, often presented with cardiac failure (71%), with viruses identified as the common cause.
Impact:
- Despite poor initial outcomes in severe cases, survivors of childhood infectious myocarditis generally experience a favorable long-term prognosis.
- Findings underscore the need for heightened clinical suspicion and advanced diagnostic capabilities for early detection.
- Understanding disease presentation and outcomes informs treatment strategies and resource allocation in pediatric critical care and cardiology.
Abstract:
Acute infectious myocarditis in childhood has a very poor initial outcome, but the long-term outlook is relatively good for the survivors. This retrospective study was based on cases of acute myocarditis admitted to two hospital departments with different modes of recruitment. Firstly, a polyvalent paediatric intensive care unit where 12 children (mean age 12 months) were admitted during the acute phase of myocarditis. The initial symptoms were non-specific and misleading, the diagnosis being established at autopsy in 9 cases. Only 4 children presented with typical cardiac failure. The clinical signs were hepatomegaly, sinus tachycardia, cardiomegaly, ECG ST-T wave changes and biological signs of multiple organ failure. Left ventricular function was very poor with a fractional shortening of only 17%. The causal agent was usually viral. The clinical course was marked by a high early mortality (11/26, 42%) within 23 hours of hospital admission. Secondly, a paediatric cardiology unit where 81 children (mean age 15 months) were followed up after acute infectious myocarditis. Thirteen cases were taken from our first series and were included for long-term follow-up; 76.5% had premonitory signs of infection and 71% were in cardiac failure, Classes III or IV, during the hospital admission. The causal agent was identified in 30 cases (37%) and was usually a virus (22 cases). Treatment was classical (association of digitalis, diuretics, angiotensin converting enzyme inhibitors, anticoagulants and beta-sympathomimetics when necessary).(ABSTRACT TRUNCATED AT 250 WORDS)