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Han S, Liu J, Feng Z, Mao Y, Gao H, Xie Z, Qian S, Xu L. Fulminant myocarditis associated with human rhinovirus A66 infection: a case report. Front Pediatr 2024; 12:1480724. [PMID: 39529970 PMCID: PMC11551029 DOI: 10.3389/fped.2024.1480724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/14/2024] [Indexed: 11/16/2024] Open
Abstract
Background Human rhinoviruses (HRVs) are among the most common pathogens of upper respiratory infections, and they are responsible for the common cold. An increasing number of studies have shown that HRV is associated with more severe illness. However, HRV-associated fulminant myocarditis has rarely been reported. Patient presentation A previously healthy 8-year-old boy developed fever, fatigue, and vomiting for 3 days, with a subsequent exacerbation accompanied by confusion lasting for 9 h. The day before admission, the patient presented with oliguria, confusion, and hypotension, and he was suspected of having myocarditis. The patient was transferred to our hospital for further diagnosis and treatment. On admission, rough and moist rales were detected, and the heart sounds were muffled, accompanied by an irregular heart rhythm and a gallop. An electrocardiogram (EKG) revealed a wide QRS complex, ST-segment depression, premature ventricular contractions, and complete right bundle branch block. Laboratory tests revealed that brain natriuretic peptide (BNP), N-terminal pro BNP (NT-pro BNP), and cardiac biomarkers, such as troponin I, creatinine kinase (CK), and creatinine kinase-MB (CK-MB) were elevated. Additionally, echocardiography revealed an ejection fraction of approximately 28%. The child developed severe cardiac dysfunction and tissue hypoperfusion, and the cardiogenic shock could not be corrected despite active drug therapy. He had indications for ECMO implantation. A rarely reported rhinovirus, namely, A66, was detected in his bronchoalveolar lavage fluid and oropharyngeal swabs via metagenomic next-generation sequencing and a PCR assay. Bacterial culture of all the samples yielded negative results. Conclusions This case presents a patient with severe human rhinovirus A66 infection, which is likely responsible for fulminant myocarditis. This report facilitates prompt diagnosis and treatment of fulminant myocarditis. Clinicians should consider rhinovirus as a possible pathogen of fulminant myocarditis, especially when patients present with symptoms or signs of heart involvement.
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Affiliation(s)
- Shuaibing Han
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Centre for Respiratory Diseases, National Key Discipline of Paediatrics (Capital Medical University), Beijing Paediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Liu
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
- Department of Paediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Ziheng Feng
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Centre for Respiratory Diseases, National Key Discipline of Paediatrics (Capital Medical University), Beijing Paediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiyang Mao
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
- Department of Paediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Hengmiao Gao
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
- Department of Paediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Zhengde Xie
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Centre for Respiratory Diseases, National Key Discipline of Paediatrics (Capital Medical University), Beijing Paediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Suyun Qian
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
- Department of Paediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Lili Xu
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Centre for Respiratory Diseases, National Key Discipline of Paediatrics (Capital Medical University), Beijing Paediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
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Badrinath A, Bhatta S, Kloc A. Persistent viral infections and their role in heart disease. Front Microbiol 2022; 13:1030440. [PMID: 36504781 PMCID: PMC9730422 DOI: 10.3389/fmicb.2022.1030440] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Viral infections are the culprit of many diseases, including inflammation of the heart muscle, known as myocarditis. Acute myocarditis cases have been described in scientific literature, and viruses, such as parvovirus B19, coxsackievirus B3, or more recently, SARS-CoV-2, were the direct cause of cardiac inflammation. If not treated, myocarditis could progress to dilated cardiomyopathy, which permanently impairs the heart and limits a person's lifespan. Accumulated evidence suggests that certain viruses may persist in cardiac tissue after the initial infection, which could open up the door to reactivation under favorable conditions. Whether this chronic infection contributes to, or initiates, cardiac damage over time, remains a pressing issue in the field of virus-induced heart pathology, and it is directly tied to patients' treatment. Previously, large case studies found that a few viruses: parvovirus B19, coxsackievirus, adenovirus, human herpesvirus 6, cytomegalovirus and Epstein-Barr virus, are most commonly found in human endomyocardial biopsy samples derived from patients experiencing cardiac inflammation, or dilated cardiomyopathy. SARS-CoV-2 infection has also been shown to have cardiovascular consequences. This review examines the role of viral persistence in cardiac inflammation and heart disease, and discusses its implications for patients' outcomes.
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Kinobe R, Wiyatno A, Artika IM, Safari D. Insight into the Enterovirus A71: A review. Rev Med Virol 2022; 32:e2361. [PMID: 35510476 DOI: 10.1002/rmv.2361] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Enterovirus A71 is a major causative pathogen of hand, foot and mouth disease. It has become a global public health threat, and is especially important for infants and young children in the Asian-Pacific countries. The enterovirus A71 is a non-enveloped virus of the Picornaviridae family having a single-stranded positive-sense RNA genome of about 7.4 kb which encodes the structural and nonstructural proteins. Currently there are no US FDA-approved vaccines or antiviral therapy available against enterovirus A71 infection. Although enterovirus A71 vaccines have been licenced in China, clinically approved vaccines for widespread vaccination programs are lacking. Substantial progress has recently been achieved on understanding the structure and function of enterovirus A71 proteins together with information on the viral genetic diversity and geographic distribution. The present review is intended to provide an overview on our current understanding of the molecular biology and epidemiology of enterovirus A71 which will aid the development of vaccines, therapeutics and other control strategies so as to bolster the preparedness for future enterovirus A71 outbreaks.
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Affiliation(s)
- Robert Kinobe
- Department of Biochemistry, Faculty of Mathematics and Natural Sciences, Bogor Agricultural University, Bogor, Indonesia
| | - Ageng Wiyatno
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - I Made Artika
- Department of Biochemistry, Faculty of Mathematics and Natural Sciences, Bogor Agricultural University, Bogor, Indonesia.,Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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Traverse EM, Hopkins HK, Vaidhyanathan V, Barr KL. Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome. Trop Med Infect Dis 2021; 6:108. [PMID: 34206332 PMCID: PMC8293388 DOI: 10.3390/tropicalmed6030108] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In adults, case reports include symptoms ranging from tachycardia and arrythmia, to myocarditis and cardiac arrest. In children, case reports describe symptoms such as arrythmia, myocarditis, and heart failure. Case reports of perinatal and neonatal CHIKV infections have also described cardiovascular compromise, including myocardial hypertrophy, ventricular dysfunction, myocarditis, and death. Myocarditis refers to inflammation of the heart tissue, which can be caused by viral infection, thus becoming viral myocarditis. Since viral myocarditis is linked as a causative factor of other cardiomyopathies, including dilated cardiomyopathy, in which the heart muscle weakens and fails to pump blood properly, the connection between CHIKV and the heart is concerning. We searched Pubmed, Embase, LILACS, and Google Scholar to identify case reports of CHIKV infections where cardiac symptoms were reported. We utilized NCBI Virus and NCBI Nucleotide to explore the lineage/evolution of strains associated with these outbreaks. Statistical analysis was performed to identify which clinical features were associated with death. Phylogenetic analysis determined that CHIKV infections with cardiac symptoms are associated with the Asian, the East Central South African, and the Indian Ocean lineages. Of patients admitted to hospital, death rates ranged from 26-48%. Myocarditis, hypertension, pre-existing conditions, and the development of heart failure were significantly correlated with death. As such, clinicians should be aware in their treatment and follow-up of patients.
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Affiliation(s)
- Elizabeth M. Traverse
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
| | - Hannah K. Hopkins
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
| | | | - Kelli L. Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
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Artika IM, Wiyatno A, Ma'roef CN. Pathogenic viruses: Molecular detection and characterization. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 81:104215. [PMID: 32006706 PMCID: PMC7106233 DOI: 10.1016/j.meegid.2020.104215] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Pathogenic viruses are viruses that can infect and replicate within human cells and cause diseases. The continuous emergence and re-emergence of pathogenic viruses has become a major threat to public health. Whenever pathogenic viruses emerge, their rapid detection is critical to enable implementation of specific control measures and the limitation of virus spread. Further molecular characterization to better understand these viruses is required for the development of diagnostic tests and countermeasures. Advances in molecular biology techniques have revolutionized the procedures for detection and characterization of pathogenic viruses. The development of PCR-based techniques together with DNA sequencing technology, have provided highly sensitive and specific methods to determine virus circulation. Pathogenic viruses potentially having global catastrophic consequences may emerge in regions where capacity for their detection and characterization is limited. Development of a local capacity to rapidly identify new viruses is therefore critical. This article reviews the molecular biology of pathogenic viruses and the basic principles of molecular techniques commonly used for their detection and characterization. The principles of good laboratory practices for handling pathogenic viruses are also discussed. This review aims at providing researchers and laboratory personnel with an overview of the molecular biology of pathogenic viruses and the principles of molecular techniques and good laboratory practices commonly implemented for their detection and characterization.
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Affiliation(s)
- I Made Artika
- Biosafety Level 3 Unit, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia; Department of Biochemistry, Faculty of Mathematics and Natural Sciences, Bogor Agricultural University, Darmaga Campus, Bogor 16680, Indonesia.
| | - Ageng Wiyatno
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia
| | - Chairin Nisa Ma'roef
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia
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Chow J, Murphy J, Subedi A, Jyothidasan A. Rhinovirus-associated dilated cardiomyopathy. IDCases 2020; 19:e00702. [PMID: 32021801 PMCID: PMC6992979 DOI: 10.1016/j.idcr.2020.e00702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 01/06/2023] Open
Abstract
Rhinovirus is the main cause of the common cold. There is little to no published literature of rhinoviral associated myocarditis. We report a rare case of rhinovirus infection in a patient with myocarditis leading to dilated cardiomyopathy. Infection is an established cause of myocarditis. Prodromal "flu-like" symptoms in a young patient with unexplained heart failure should raise concern for viral myocarditis. Diagnosis is often made by clinical presentation and not by endomyocardial biopsy due to invasiveness. Polymerase chain reaction is a rapid test that supports the diagnosis and may elucidate the role of the virus in myocarditis. Defining causes and mechanisms leading to this severe cardiovascular condition may prove critical to targeted therapy. Physician should be aware that rhinovirus as a possible pathogen for severe myocarditis and dilated cardiomyopathy.
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Affiliation(s)
- Jeffrey Chow
- Cape Fear Valley Medical Center, Internal Medicine Resident, 1638 Owen Drive, Fayetteville, North Carolina, United States
| | - Joey Murphy
- University of Campbell, Medical Student, 1 Fort Bragg, Fort Bragg, North Carolina, United States
| | - Ashish Subedi
- Cape Fear Valley Medical Center, Faculty of Medicine, 1638 Owen Drive, Fayetteville, North Carolina, United States
| | - Amudhan Jyothidasan
- Cape Fear Cardiology Associates, Cardiologist, 3634 Cape Fear Dr, Fayetteville, North Carolina, United States
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Setianingsih TY, Wiyatno A, Hartono TS, Hindawati E, Rosamarlina, Dewantari AK, Myint KS, Lisdawati V, Safari D. Detection of multiple viral sequences in the respiratory tract samples of suspected Middle East respiratory syndrome coronavirus patients in Jakarta, Indonesia 2015-2016. Int J Infect Dis 2019; 86:102-107. [PMID: 31238156 PMCID: PMC7110706 DOI: 10.1016/j.ijid.2019.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The identification and analysis of viral etiological agents from suspected Middle East respiratory syndrome coronavirus (MERS-CoV) cases admitted to Prof. Dr. Sulianti Saroso Infectious Disease Hospital (IDH) using molecular assays. METHODS Biological samples were collected from 13 hospitalized patients suspected of MERS-CoV infection in Prof. Dr. Sulianti Saroso IDH from July 2015 to December 2016. The majority of patients presented with pneumonia, with symptoms including fever (≥37.5 °C), labored breathing, and cough, and with a history of travel to the Middle East. Viral RNA was isolated and converted to cDNA, which was used as a template for the detection of 12 viral panels using conventional PCR and sequencing. RESULTS Viral etiological agents detected in the patients were enterovirus D68, dengue virus type 3, rhinovirus C, human coronavirus 229E, herpes simplex virus type 1, influenza virus H1N1, influenza virus H3N2, human metapneumovirus, and rhinovirus A60. CONCLUSIONS The sequences of nine viral agents under different taxa were detected in suspected MERS-CoV patients, including influenza virus, paramyxovirus, coronavirus, enterovirus, human metapneumovirus, and herpesvirus.
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Affiliation(s)
| | - Ageng Wiyatno
- Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | | | - Evi Hindawati
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
| | - Rosamarlina
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
| | | | - Khin Saw Myint
- Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | - Vivi Lisdawati
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
| | - Dodi Safari
- Eijkman Institute of Molecular Biology, Jakarta, Indonesia.
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Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. PLoS One 2018; 13:e0207440. [PMID: 30444898 PMCID: PMC6239303 DOI: 10.1371/journal.pone.0207440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Central nervous system (CNS) viral infections are important causes of morbidity and mortality worldwide but the systematic survey of patients admitted to hospitals with CNS infections in many countries, including Indonesia, is limited. To obtain more information regarding the causes of CNS infections in Indonesia, this study was performed to detect and identify viral agents associated with CNS infections amongst in-patients at a referral hospital in Manado, North Sulawesi, Indonesia. Adult patients admitted to R.D. Kandou General Hospital with presumed CNS infection were enrolled. Cerebrospinal fluid, serum, and throat swab samples were collected and tested using molecular, serological, and virus isolation assays. A confirmed viral etiology was established in three and a probable/possible in 11 out of 74 patients. The most common was herpes simplex virus 1 (7/74, 9.5%), followed by Epstein-Barr virus (2/74, 2.7%), cytomegalovirus (1/74, 1.4%), enterovirus D68 (1/74, 1.4%), rhinovirus A (1/74, 1.4%), dengue virus (1/64, 1.6%), and Japanese encephalitis virus (1/64, 1.6%). There were 20 fatal cases (27.0%) during hospitalization in which eight were associated with viral causes. We identified herpes simplex virus 1 as the most common cause of CNS infection among adults in North Sulawesi with most of the cases remaining undiagnosed. Our study highlights the challenges in establishing the etiology of viral CNS infections and the importance of using a wide range of molecular and serological detection methods to identify CNS viruses.
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