Cardiac Manifestations During a Coxsackie B5 Epidemic

Helin, M; Savola, Juha‐Matti; Lapinleimu, K

doi:10.1136/bmj.3.5610.97

Cited by 93 publications

(25 citation statements)

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“…Similar number of patients were admitted in studies conducted by Sainani et al [20] and A. G. Ferriera et al [21] The number of patients in their studies were 55 over a period of 2 years and 15 over a period of 1 year respectively. The age of presentation in our study varied between 13 years and 70 years, which was comparable with the study conducted by M. Helin et al, [22] in which the age varied between 9 years and 65 years. Male-to-female sex ratio in our study was 1.35, comparable with study conducted in Thailand by Naorawarut, Dechkum, Yoawapa Pangsawan et al in 1987-1989 (M:F=1.24).…”

Section: Discussionsupporting

confidence: 91%

“…[27] Among the 15 patients positive for Coxsackie serology, 12 patients showed ≥4 fold rise in antibody titres in acute and convalescent sera, whereas 3 patients had very high titres only during the acute phase [Table 3] reflecting that the patients may have presented when the antibody titres had already peaked. Similar trends were shown in many patients by Helin et al [22] and David O'Neil, John D. McArthur et al, [28] where patients presented with significant high titres during the acute phase.…”

Section: Discussionsupporting

confidence: 79%

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Prevalence and Implications of Coxsackie Virus in Myopericarditis, Prospective Tertiary Care Study

Ismail¹,

Rasool²,

Rashid³

et al. 2016

jemds

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The serological prevalence of coxsackie virus in myocarditis, pericarditis and myopericarditis is largely unknown in our population. The implications of coxsackie virus as causative agent in myopericarditis has not been studied so far in our population. AIMS AND OBJECTIVESThe aims and objectives of this study were to study the serological prevalence of Coxsackie virus in acute pericarditis and myocarditis in a Tertiary Centre and to study the clinical profile of Coxsackie myopericarditis. MATERIAL AND METHODSOur study was a prospective study done from November 2010 -October 2012, the samples were taken from 40 patients with the diagnosed cases of myocarditis, pericarditis and myopericarditis. Myocarditis and pericarditis were diagnosed as per standard guidelines, Enzyme Immunoassay (ELISA) for the determination of IgM antibodies to Coxsackie virus B (CoxB) in human acute and convalescent sera was done. RESULTSOur study comprised of forty patients with mean age of 35.3 years with M:F ratio of 1.35. Among the 40 patients 11 patients were diagnosed with pericarditis (27.50%), 14 with myocarditis (35.00%) and 15 patients with myopericarditis (37.50%). Among the 40 studied patients, 15 were positive for Coxsackie serology. Among the serology positive patients, 6 had diagnosis of myopericarditis (40.00%), 6 had diagnosis of myocarditis (40.00%) and 3 had diagnosis of pericarditis (20.00%). The clinical features of coxsackie positive and negative individuals did not differ significantly; breathlessness (93% vs 76%), chest pain (73% vs 76%), fever (60% vs 60%), cough (46 vs 32%), CCF (53 vs 48%) respectively. Ejection fraction less than 45% was seen in 40% of positive vs 32% of serology negative patients. CONCLUSIONCoxsackie virus as an aetiological factor was found in about one-third of cases of acute myopericarditis. However, the clinical presentation and echocardiographic characteristics did not differ from Coxsackie negative myopericarditis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 79%

Prevalence and Implications of Coxsackie Virus in Myopericarditis, Prospective Tertiary Care Study

Ismail¹,

Rasool²,

Rashid³

et al. 2016

jemds

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“…However, it is interesting to note that poliovirus is closely related to another picornavirus, coxsackievirus, and the data supporting a link between coxsackievirus and autoimmunity are compelling. Epidemiological studies have shown an increased incidence of viral myocarditis following endemic coxsackievirus B infections (22). It has also been proposed that molecular mimics of coxsackievirus B3 contribute to heart disease in a murine model of myocarditis (20).…”

Section: Discussionmentioning

confidence: 99%

Proteolytic Cleavage of the Catalytic Subunit of DNA-Dependent Protein Kinase during Poliovirus Infection

Graham

Gustin

Rivera

et al. 2004

J Virol

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DNA-dependent protein kinase (DNA-PK) is a serine/threonine kinase that has critical roles in DNA double-strand break repair, as well as B-and T-cell antigen receptor rearrangement. The DNA-PK enzyme consists of the Ku regulatory subunit and a 450-kDa catalytic subunit termed DNA-PK CS . Both of these subunits are autoantigens associated with connective tissue diseases such as systemic lupus erythematosus (SLE) and scleroderma. In this report, we show that DNA-PK CS is cleaved during poliovirus infection of HeLa cells. Cleavage was visible as early as 1.5 h postinfection (hpi) and resulted in an approximately 40% reduction in the levels of native protein by 5.5 hpi. Consistent with this observation, the activity of the DNA-PK CS enzyme was also reduced during viral infection, as determined by immunoprecipitation kinase assays. Although it has previously been shown that DNA-PK CS is a substrate of caspase-3 in vitro, the protein was still cleaved during poliovirus infection of the caspase-3-deficient MCF-7 cell line. Cleavage was not prevented by infection in the presence of a soluble caspase inhibitor, suggesting that cleavage in vivo was independent of host caspase activation. DNA-PK CS is directly cleaved by a picornaviral 2A protease in vitro, producing a fragment similar in size to the cleavage product observed in vivo. Taken together, our results indicate that DNA-PK CS is cleaved by the 2A protease during poliovirus infection. Proteolytic cleavage of DNA-PK CS during poliovirus infection may contribute to inhibition of host immune responses. Furthermore, cleavage of autoantigens by viral proteases may target these proteins for the autoimmune response by generating novel, or "immunocryptic," protein fragments.

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“…Several studies have documented persistent and progressive symptoms, along with chest X-ray and electrocardiogram abnormalities, following acute viral myocarditis (predominately coxsackieviruses) (8,50,120,131,132). Miklozek et al followed 16 patients diagnosed as having viral myocarditis by using serial cardiac function tests.…”

Section: Clinical Diseasementioning

confidence: 99%

Clinical and experimental aspects of viral myocarditis

et al. 1989

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Picornaviruses are frequently implicated as the etiological agents of acute myocarditis. This association is based historically on serological evidence of rising antibody titers to specific pathogens and more recently on identification of viral genomic material in endocardial biopsy specimens through in situ hybridization. Only rarely is infectious virus isolated from either the patient or the heart during periods of maximum myocardial inflammation and injury. Thus, despite a probable viral etiology, much interest centers on the role of the immune system in cardiac damage and the likelihood that the infection triggers an autoimmune response to heart-specific antigens. Heart-reactive antibodies and T cells are found in most myocarditis patients, and immunosuppressive therapy has proven beneficial in many, though not all, cases. Furthermore, murine models of coxsackievirus group B type 3-induced myocarditis also demonstrate that virus infection initiates autoimmunity and that these autoimmune effectors are predominately responsible for tissue injury. How virus-host interactions overcome presumed self-tolerance to heart antigens is discussed, and evidence supporting various theories of virus-initiated autoimmunity and disease pathogenesis are delineated.

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Cardiac Manifestations During a Coxsackie B5 Epidemic

Cited by 93 publications

References 9 publications

Prevalence and Implications of Coxsackie Virus in Myopericarditis, Prospective Tertiary Care Study

Prevalence and Implications of Coxsackie Virus in Myopericarditis, Prospective Tertiary Care Study

Proteolytic Cleavage of the Catalytic Subunit of DNA-Dependent Protein Kinase during Poliovirus Infection

Clinical and experimental aspects of viral myocarditis

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