Viral Nucleic Acids in the Serum Are Dependent on Blood Sampling Site in Patients with Clinical Suspicion of Myocarditis

Pawlak, Agnieszka; Przybylski, Maciej; Durlik, Marek; Gil, Katarzyna; Nasierowska‐Guttmejer, Anna; Byczkowska, Katarzyna; Ziemba, Andrzej; Gil, Robert J.

doi:10.1159/000452834

Cited by 4 publications

(8 citation statements)

References 34 publications

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“…In some types of viral infection, viremia is frequently observed during the acute phase of infection. Furthermore, viral nucleic acids are released from the actively infected myocardium site and can be detected in the serum samples of myocarditis . Bowles et al examined eight different viruses in the blood samples of myocarditis patients using PCR, but the detection rate of the viral genome was only 1%.…”

Section: Discussionmentioning

confidence: 99%

“…We could not perform PCR to confirm the presence of these RNA viruses because sequence coverage was too low to design PCR primers.Thus, they might be pathogens of myocarditis; however, the possibility of contamination or misannotation at analysis should be considered.In some types of viral infection, viremia is frequently observed during the acute phase of infection. Furthermore, viral nucleic acids are released from the actively infected myocardium site and can be detected in the serum samples of myocarditis 36. Bowles et al11 examined eight different viruses in the blood samples of myocarditis patients using PCR, but the detection rate of the viral genome was only 1%.…”

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confidence: 99%

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Identification of potential pathogenic viruses in patients with acute myocarditis using next‐generation sequencing

Takeuchi

Kawada

Horiba

et al. 2018

Journal of Medical Virology

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Myocarditis is an inflammatory disease of the myocardium and leads to cardiac dysfunction and heart failure. Although viral infections are considered to be the most common etiology of myocarditis, the identification of the causative virus is still challenging. Recently, next-generation sequencing (NGS) has been applied in the diagnosis of infectious diseases. The aim of the current study was to comprehensively analyze potential pathogenic microorganisms using NGS in the sera of patients with myocarditis. Twelve pediatric and five adult patients hospitalized for acute myocarditis were included. Serum samples in the acute phase were obtained and analyzed using NGS to detect pathogen-derived DNA and RNA. Viral sequence reads were detected in 7 (41%) of the 17 myocarditis patients by NGS. Among these patients, detection of Epstein-Barr virus, human parvovirus B19, torque teno virus, and respiratory syncytial virus reads by NGS was consistent with polymerase chain reaction or antigen test results in one patient each. A large number of human pegivirus reads were detected from one patient by RNA sequencing; however, its pathogenicity to human is unknown. Conversely, the number of detected virus-derived reads was small in most cases, and the pathophysiological role of these viruses remains to be clarified. No significant bacterial or fungal reads other than normal bacterial flora was detected. These data indicate that comprehensive detection of virus-derived DNA and RNA using NGS can be useful for the identification of potential pathogenic viruses in myocarditis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Identification of potential pathogenic viruses in patients with acute myocarditis using next‐generation sequencing

Takeuchi

Kawada

Horiba

et al. 2018

Journal of Medical Virology

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“…Researches have shown that a systemic Th1/Th2 imbalance exist during the clinical phase of myocarditis. Analysis of peripheral CD4+ T cells in a patient with acute myocarditis demonstrated that Th1 was dominant during the acute phase and coincided with increased serum levels of creatine kinase (CK), while Th2 predominated during the recovery phase and was accompanied by decreased CK levels (80). Consistent with this, restoring the Th1/Th2 inflammatory cytokine balance hindered the progression of autoimmune myocarditis (81).…”

Section: Th1/th2 Balancementioning

confidence: 88%

Dysregulated CD4+ T Cells and microRNAs in Myocarditis

Wang

Han

2020

Front. Immunol.

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Myocarditis is a polymorphic disease complicated with indeterminate etiology and pathogenesis, and represents one of the most challenging clinical problems lacking specific diagnosis and effective therapy. It is caused by a complex interplay of environmental and genetic factors, and causal links between dysregulated microribonucleic acids (miRNAs) and myocarditis have also been supported by recent epigenetic researches. Both dysregulated CD4+ T cells and miRNAs play critical roles in the pathogenesis of myocarditis, and the classic triphasic model of its pathogenesis consists of the acute infectious, subacute immune, and recovery/chronic myopathic phase. CD4+ T cells are key pathogenic factors underlying the development and progression of myocarditis, and the effector and regulatory subsets, respectively, promote and inhibit autoimmune responses. Furthermore, the reciprocal interplay of these subsets influences the pathogenesis as well. Dysregulated miRNAs along with their mRNA and protein targets have been identified in heart biopsies (intracellular miRNAs) and body fluids (circulating miRNAs) during myocarditis. These miRNAs show phase-dependent changes, and correlate with viral infection, immune status, fibrosis, destruction of cardiomyocytes, arrhythmias, cardiac functions, and outcomes. Thus, miRNAs are promising diagnostic markers and therapeutic targets in myocarditis. In this review, we review myocarditis with an emphasis on its pathogenesis, and present a summary of current knowledge of dysregulated CD4+ T cells and miRNAs in myocarditis.

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“…In the study of Jeserich et al [2] in Germany using nested RT-PCR, 38% of peripheral leukocytes and/or plasma samples of MCI patients were virus positive. In another study, the viral nucleic acids were detected in ventricular and peripheral serum, and Endomyocardial biopsy (EMB) samples of 14%, 20%, and 46% patients with MCI, respectively [4]. In general, the incidence of VMC varies in different studies appear to depend on the geographical distribution, various virus identification methods and sample sites.…”

Section: Discussionmentioning

confidence: 99%

“…Viral myocarditis (VMC) is an important cause of morbidity and mortality in different age groups from infants to the elderly, but most occur in children and adults younger than 40 years [4,5]. VMC is the most common cause of inflammatory heart disease and its incidence is tending to increase further in the twenty-first century [6,7].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Viral Myocarditis in Children with Clinical Suspicion of Myocarditis by Multiplex Real-time PCR in Birjand Vali-Asr Hospital, East of Iran

Salehi

Yousefi

2019

Preprint

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Background Viral myocarditis (VMC) is one of the common heart diseases to endanger human health in different age groups, especially children. The aim of this study was diagnosis of viral myocarditis in children with clinical suspicion of myocarditis by multiplex Real-time PCR in Birjand Vali-Asr hospital.Methods This cross-sectional research conducted on 19 patients with clinical suspicion of myocarditis who had evidence of microbial infections in recent weeks. Routine electrocardiogram and dynamic ECG examinations, auxiliary laboratory testing and echocardiographic evaluation were performed. Multiplex Real-time PCR by Neuro kit was used for detection of viral agents in blood or pericardial fluid samples.Results The results indicated that 4 out of 19 (21.05%) patients with myocarditis were found to be virus positive. The spectrum of viral agents was included HHV-6/7, Parvovirus B-19, EBV, VZV and Adenoviruses. A co-infection of HHV-6/7 and Parvovirus B-19 was found in the one patient. ECG findings such as sinus tachycardia with ST-T changes, premature ventricular contraction and complete heart block were found in VMC patients. The predominant echocardiographic features in the patients with VMC were a low ejection fraction, mitral regurgitation and severe pericardial effusion with hypotension. AST and LDH abnormal increase were found in the some patient.Conclusions Our findings highlight the importance of identification of VMC in children with clinical suspicion of myocarditis. The present study emphasizes the importance of PCR-based assays for detection of viral agents in myocarditis patients with symptoms of virus infection.

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Viral Nucleic Acids in the Serum Are Dependent on Blood Sampling Site in Patients with Clinical Suspicion of Myocarditis

Cited by 4 publications

References 34 publications

Identification of potential pathogenic viruses in patients with acute myocarditis using next‐generation sequencing

Identification of potential pathogenic viruses in patients with acute myocarditis using next‐generation sequencing

Dysregulated CD4+ T Cells and microRNAs in Myocarditis

Diagnosis of Viral Myocarditis in Children with Clinical Suspicion of Myocarditis by Multiplex Real-time PCR in Birjand Vali-Asr Hospital, East of Iran

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