West nile virus myocarditis causing a fatal arrhythmia: a case report

Kushawaha, Anurag; Jadonath, Sunil; Mobarakai, Neville

doi:10.1186/1757-1626-2-7147

Cited by 25 publications

(24 citation statements)

References 13 publications

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“…28 The cardiac case deserves brief comment. It was thought that this patient's abnormal liver biochemistry was due to ischaemic hepatitis, but he was found to have acute hepatitis E. This has been described with a number of other viral infections 29,30 and another similar case associated with locally acquired hepatitis E has been observed in Scotland (Ken Simpson, personal communication). Clinicians should therefore make a diagnosis of ischaemic hepatitis with caution in this context, and consider the possibility of hepatitis E infection.…”

Section: Discussionmentioning

confidence: 77%

Extra‐hepatic manifestations of autochthonous hepatitis E infection

Woolson

Forbes

Vine

et al. 2014

Aliment Pharmacol Ther

135

115

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Summary Background Autochthonous (locally acquired) hepatitis E is increasingly recognised in developed countries, and is thought to be a porcine zoonosis. A range of extra‐hepatic manifestations of hepatitis E infection have been described, but have never been systematically studied. Aim To report the extra‐hepatic manifestations of hepatitis E virus. Methods Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1). Results Eight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain‐Barré syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40 years, range 34–92 years, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 0.015) compared to cases without neurological symptoms [median age 64 years (range 18–88 years), median ALT 1135 IU/L]. One patient presented with a cardiac arrhythmia,twelve patients (11.3%) presented with thrombocytopenia, fourteen (13.2%) with lymphocytosis and eight (7.5%) with a lymphopenia, none of which had any clinical consequence. Serum electrophoresis was performed in 65 patients at presentation, of whom 17 (26%) had a monoclonal gammopathy of uncertain significance. Two cases developed haematological malignancies, acute myeloid leukaemia and duodenal plasmacytoma, 18 and 36 months after presenting with acute hepatitis E infection. Conclusions A range of extra‐hepatic manifestations can occur with hepatitis E. Neurological and haematological features of hepatitis E infection are relatively frequent in this UK cohort, and result in significant morbidity which warrants further study.

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Section: Discussionmentioning

confidence: 77%

Extra‐hepatic manifestations of autochthonous hepatitis E infection

Woolson

Forbes

Vine

et al. 2014

Aliment Pharmacol Ther

135

115

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“…Alternatively, the ECG abnormalities may have been caused by brainstem infection, because serum creatine kinase activity was not elevated to pathological levels in infected hamsters (data not shown). The lack of overt myocarditis, evidence for skipped beats (arrhythmia), and gastrointestinal involvement may reflect the human disease in as much as cardiomyopathy is only rarely observed [44], [45], whereas GI distress is a predominant symptom of WNV infection in hospitalized patients of one study [4], and cardiac arrhythmia occurred in all groups of patients with fever, meningitis, or encephalitis in a Colorado study [9]. The implications of these cardiac data in the hamsters and in the human disease await further investigations.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Nervous Dysfunction in Hamsters Infected with West Nile Virus

et al. 2011

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Clinical studies and case reports clearly document that West Nile virus (WNV) can cause respiratory and gastrointestinal (GI) complications. Other functions controlled by the autonomic nervous system may also be directly affected by WNV, such as bladder and cardiac functions. To investigate how WNV can cause autonomic dysfunctions, we focused on the cardiac and GI dysfunctions of rodents infected with WNV. Infected hamsters had distension of the stomach and intestines at day 9 after viral challenge. GI motility was detected by a dye retention assay; phenol red dye was retained more in the stomachs of infected hamsters as compared to sham-infected hamsters. The amplitudes of electromygraphs (EMGs) of intestinal muscles were significantly reduced. Myenteric neurons that innervate the intestines, in addition to neurons in the brain stem, were identified to be infected with WNV. These data suggest that infected neurons controlling autonomic function were the cause of GI dysfunction in WNV-infected hamsters. Using radiotelemetry to record electrocardiograms and to measure heart rate variability (HRV), a well-accepted readout for autonomic function, we determined that HRV and autonomic function were suppressed in WNV-infected hamsters. Cardiac histopathology was observed at day 9 only in the right atrium, which was coincident with WNV staining. A subset of WNV infected cells was identified among cells with hyperplarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) as a marker for cells in the sinoatrial (SA) and atrioventricular (AV) nodes. The unique contribution of this study is the discovery that WNV infection of hamsters can lead to autonomic dysfunction as determined by reduced HRV and reduced EMG amplitudes of the GI tract. These data may model autonomic dysfunction of the human West Nile neurological disease.

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“…It has been reported that cardiopulmonary manifestations were the most common complication of WNV that resulted in death [7]. Kushawaha et al [8] Our patient experienced two episodes of bradyarrhythmias resulting in code blues during his hospital stay leading to the decision to proceed with a permanent pacemaker. With aggressive cardiac intervention, our patient was able to regain cardiac stability and be transferred to a subacute facility to continue rehabilitation for his improving quadriplegia.…”

Section: Causes Of Idioventricular Rhythmmentioning

confidence: 71%