(Circulation. 1997;96:3549-3554.)
© 1997 American Heart Association, Inc.
Articles |
Association of Parvovirus B19 Genome in Children With Myocarditis and Cardiac Allograft Rejection
Diagnosis Using the Polymerase Chain Reaction
From the Departments of Pediatrics (K.O.S., J.N., S.W.D., R.J.G., N.E.B., G.R., D.L.K., J.K.P., J.A.T.), Pathology (D.L.K.), and Molecular and Human Genetics (J.A.T.), Texas Children's Hospital and Baylor College of Medicine, Houston, Tex; Department of Pathology (B.B.R.), University of Texas, Dallas, Tex; Departments of Laboratory Medicine (G.M.S.), Children's Hospital, and Pathology (G.M.S.), The Ohio State University, Columbus, Ohio; and Department of Pediatrics (R.E.C.), Loma Linda University Children's Hospital, Loma Linda, Calif. Dr. Schowengerdt is now at the University of Florida School of Medicine, Gainesville.
Correspondence to Jeffrey A. Towbin, MD, Pediatric Cardiology, Baylor College of Medicine, One Baylor Plaza, Room 333E, Houston, TX 77030. E-mail jtowbin{at}bcm.tmc.edu
Background Inflammatory diseases of the heart, including myocarditis and cardiac transplant rejection, are important causes of morbidity and mortality in children. Although viral infection may be suspected in either of these clinical conditions, the definitive etiology is often difficult to ascertain. Furthermore, the histology is identical for both disorders. Coxsackievirus has long been considered the most common cause of viral myocarditis; however, we previously demonstrated by polymerase chain reaction (PCR) analysis that many different, and sometimes unexpected, viruses may be responsible for myocarditis and cardiac rejection. In this study, we describe the association of parvovirus genome identified through PCR analysis of cardiac tissue in the clinical setting of myocarditis and cardiac allograft rejection.
Methods and Results Myocardial tissue from endomyocardial biopsy, explant, or autopsy was analyzed for parvovirus B19 using primers designed to amplify a 699–base pair PCR product from the VP1 gene region. Samples tested included those obtained from patients with suspected myocarditis (n=360) or transplant rejection (n=200) or control subjects (n=250). Parvoviral genome was identified through PCR in 9 patients (3 myocarditis; 6 transplant) and no control patients. Of the 3 patients with myocarditis, 1 presented with cardiac arrest leading to death, 1 developed dilated cardiomyopathy, and the other gradually improved. Four of the 6 transplant patients had evidence of significant rejection on the basis of endomyocardial biopsy histology. All transplant patients survived the infection.
Conclusions Parvovirus is associated with myocarditis in a small percentage of children and may be a potential contributor to cardiac transplant rejection. PCR may provide a rapid and sensitive method of diagnosis.
Key Words: parvovirus • polymerase chain reaction • myocarditis • rejection
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