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Influenza Myocarditis and Myositis: Case Presentation and Review of the Literature.
MedLine Citation:
PMID:  21652168     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Myocarditis, a general inflammatory condition of the heart muscle, can result from a variety of etiologies, the most common being viral. Despite common pathogens, concomitant myocarditis and myositis remains a rare event. Although a common cause of respiratory illness, extrapulmonary infections with influenza are infrequent. We describe the case of a patient who presented to our center with concomitant "seasonal" H1N1 influenza A myocarditis further complicated by pan-myositis. The patient's condition rapidly declined, eventually requiring biventricular mechanical support, in addition to multilimb fasciotomies. The cardiac support required was progressive, from a percutaneous left ventricular assist device, to extracorporeal membrane oxygenation, to eventual biventricular assist device support for bridge-to-transplantation. This case motivated a detailed review of the literature (a total of 29 cases were identified), in which we found that patients with influenza myocarditis/myositis were predominantly female (63%) and young (mean age 33.2 years) and continue to have a high incidence of morbidity and mortality (27%). As a result of its atypical pattern, the 2009 H1N1 pandemic strain has gained attention. From our review, we found 7 patients with of 2009 H1N1 pandemic influenza myocarditis. Serial serum cytokine analysis did not demonstrate a "cytokine storm," which has been associated with other virulent influenza strains. The PB1-F2 marker in particular has been associated with a vigorous cytokine response. The 2009 H1N1 and "seasonal" influenza strains lack this marker. In those patients with community-acquired influenza, interleukin-6 has been shown to correlate with symptoms. For patients with myocarditis resulting in shock, mechanical circulatory support has gained acceptance as a means to recovery or transplantation.
Authors:
Kanwal Kumar; Mina Guirgis; Shelley Zieroth; Evelyn Lo; Alan H Menkis; Rakesh C Arora; Darren H Freed
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-6
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  -     ISSN:  1916-7075     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Institute of Cardiovascular Sciences, St. Boniface Research Centre, Winnipeg, Manitoba, Canada; Department of Surgery, Section of Cardiac Surgery, University of Manitoba, St. Boniface General Hospital Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
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