Enteroviruses and heart disease

Enteroviruses are ubiquitous, and most individuals encounter numerous serotypes during their lifetime. Infection of the heart is an unusual occurrence but enteroviruses are nevertheless the commonest viral agents of acute myocarditis. The introduction of new serological and molecular virological detection methods has improved the diagnosis of acute enteroviral heart disease and has also provided information on its epidemiology and pathogenesis. There remains, however, much debate on whether cardiac damage results directly from viral infection of myocytes and the ensuing immune response, or indirectly from autoimmune mechanisms. Enteroviruses are also associated with chronic cardiac disease, most notably chronic dilated cardiomyopathy. Recently the strength of this associated has been somewhat weakened by conflicting experimental evidence, but this is still an open question. Further studies are required to delineate the true role of enteroviruses in acute and chronic myocardial disease, to understand its pathogenesis more completely, and to apply this knowledge to the development of preventive or therapeutic treatment regimens.