1/11. Influenza A myocarditis developing in an adult liver transplant recipient despite vaccination: a case report and review of the literature.Solid organ transplant recipients receiving chronic immunosuppressive agents are at increased risk to acquire influenza virus despite vaccination. myocarditis is a known but rare complication of influenza infection. We present the first adult liver transplant recipient who received prophylactic vaccination but developed influenza A myocarditis. This may occur in solid organ transplant recipients, because they have reduced response to protein vaccines, which may leave them vulnerable to infections. Studies are needed to evaluate if antiviral chemoprophylaxis in solid organ transplant recipients during influenza season would be an effective preventive therapy against influenza in this high-risk population.- - - - - - - - - - ranking = 1keywords = myocarditis (Clic here for more details about this article) |
2/11. influenza a virus infection complicated by fatal myocarditis.Influenza virus typically causes a febrile respiratory illness, but it can present with a variety of other clinical manifestations. We report a fatal case of myocarditis associated with influenza A infection. A previously healthy 11-year-old girl had malaise and fever for approximately 1 week before a sudden, witnessed fatal collapse at home. autopsy revealed a pericardial effusion, a mixed lymphocytic and neutrophilic myocarditis, a mild lymphocytic interstitial pneumonia, focal bronchial/bronchiolar mucosal necrosis, and histologic changes consistent with asthma. infection with influenza A (H3N2) was confirmed by virus isolation from a postmortem nasopharyngeal swab. Attempts to isolate virus from heart and lung tissue were unsuccessful. Immunohistochemical tests directed against influenza A antigens and in situ hybridization for influenza A genetic material demonstrated positive staining in bronchial epithelial cells, whereas heart sections were negative. Sudden death is a rare complication of influenza and may be caused by myocarditis. Forensic pathologists should be aware that postmortem nasopharyngeal swabs for viral culture and immunohistochemical or in situ hybridization procedures on lung tissue might be necessary to achieve a diagnosis. Because neither culturable virus nor influenza viral antigen could be identified in heart tissue, the pathogenesis of influenza myocarditis in this case is unlikely to be the result of direct infection of myocardium by the virus. The risk factors for developing myocarditis during an influenza infection are unknown.- - - - - - - - - - ranking = 1.8keywords = myocarditis (Clic here for more details about this article) |
3/11. Clinical manifestations of influenza a myocarditis during the influenza epidemic of winter 1998-1999.OBJECTIVES: The clinical features of myocarditis that developed during the influenza epidemic of winter 1998-1999 were investigated to emphasize the need for medical attention to this disease. methods: Nine patients were treated under diagnoses of acute myocarditis during the winter of 1998-1999. Five (two males and three females, mean age 52 /- 18 years) were examined with myocarditis associated with influenza A. The diagnosis of influenza A myocarditis was based on electrocardiographic and echocardiographic abnormalities, increased creatine kinase levels and at least a four-fold increase in influenza a virus titers using paired sera. RESULTS: All patients had preceding flu-like symptoms and fever. Cardiac involvement developed between 4 and 7 days after the onset of influenza symptoms. dyspnea progressively worsened in three patients, one went into shock and one had persistent fever, cough and mild dyspnea without apparent cardiac symptoms. Three patients had ST elevation associated with Q waves and one had complete left bundle branch block. The creatine kinase levels were abnormally increased and global wall motion of the left ventricle on echocardiography was decreased in all patients. Two patients had diagnoses of fulminant myocarditis. One patient died of pneumonia following cerebral infarction, but the left ventricular dysfunction normalized in the remaining four patients. CONCLUSIONS: Cardiac involvement occurred between 4 and 7 days after the onset of influenza symptoms, and worsening dyspnea was the most common symptom. electrocardiography, echocardiography and creatine kinase levels should be checked to determine the potential for cardiac involvement when patients present with suspected influenza associated with worsening dyspnea or prolonged weakness. Increasing the awareness of influenza myocarditis may help in the earlier identification and treatment of this disease during influenza epidemics.- - - - - - - - - - ranking = 2keywords = myocarditis (Clic here for more details about this article) |
4/11. Two cases of influenza with impaired ocular movement.Complications of influenza include respiratory disorders (pneumonia, bronchitis and croup) and occasionally myocarditis, myositis, encephalitis, encephalopathy and Reye's syndrome, which may be life-threatening and cause various sequelae. We report two patients who developed unusual complications of influenza infection: one had ptosis and impaired ocular movement, and the other suffered from guillain-barre syndrome with paralysis of the extraocular muscles.- - - - - - - - - - ranking = 0.2keywords = myocarditis (Clic here for more details about this article) |
5/11. A case of influenza subtype A virus-induced fulminant myocarditis: an experience of percutaneous cardio-pulmonary support (PCPS) treatment and immunohistochemical analysis.A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.- - - - - - - - - - ranking = 1.6keywords = myocarditis (Clic here for more details about this article) |
6/11. Successful explantation of a ventricular assist device following fulminant influenza type A-associated myocarditis.We report a case of fulminant myocarditis associated with refractory ventricular fibrillation following influenza A infection. Histologic examination was consistent with myocarditis and serology confirmed the viral etiology. The patient was supported with biventricular assist devices for 20 days during which her refractory ventricular fibrillation resolved spontaneously. This is the first documented case of resolution of prolonged ventricular fibrillation while on a ventricular assist device. This case suggests those patients with fulminant viral myocarditis and refractory ventricular arrhythmias may be supported successfully with ventricular assist devices until myocardial recovery takes place.- - - - - - - - - - ranking = 1.4keywords = myocarditis (Clic here for more details about this article) |
7/11. Recurrent fulminant viral myocarditis with a short clinical course.A 75-year-old man recovered from an episode of acute influenza. A myocarditis with a normalized level of serum cardiac troponin t, but less than 2 weeks after recovery, he rapidly fell into cardiogenic shock and died of fulminant myocarditis. The autopsied heart showed marked inflammatory cell infiltration that mainly consisted of mononuclear cells positive for CD8, suggesting that the second bout of myocarditis was caused by viral re-infection.- - - - - - - - - - ranking = 1.4keywords = myocarditis (Clic here for more details about this article) |
8/11. Virus associated hemophagocytic syndrome accompanied by acute respiratory failure caused by influenza A (H3N2).A 40-year-old Japanese woman was admitted to Oita University Hospital with progressive dyspnea, consciousness disturbance and severe cytopenias. Her chest roentgenogram showed diffuse bilateral infiltrates. She was therefore forced to receive mechanical ventilation. bone marrow aspiration disclosed numerous hemophagocytic histiocytes, thus suggesting her condition to be hemophagocytic syndrome. In addition, she also developed myocarditis and renal failure. Pulsed methylprednisolone, gamma-globulin, granulocyte colony-stimulating factor and sivelestat sodium hydrate were administrated, and thereafter the patient recovered from cytopenia and organ failure. Afterwards, influenza A H3N2 was detected from bronchial extracts. We should recognize that an influenza a virus infection can induce hemophagocytic syndrome and acute respiratory failure as the initial manifestations of multiple organ failure.- - - - - - - - - - ranking = 0.2keywords = myocarditis (Clic here for more details about this article) |
9/11. The use of intravenous ribavirin to treat influenza virus-associated acute myocarditis.We studied three patients with influenza virus-associated fulminant myocarditis; one was infected by type B and the others by type A influenza virus. In one patient, dissemination of type A (H1N1) virus to the myocardium was demonstrated, and viremia complicated the clinical course despite the use of oral amantadine HCl and ribavirin aerosol. All patients were treated with iv ribavirin, two initially and the third after viremia was detected during hyperacute rejection of a cardiac transplant. No significant adverse effects could be directly attributed to therapy, and viral shedding abruptly terminated coincident with its use; however, both patients treated shortly after onset of myocarditis died. The third required support by an artificial heart, and died 8 mo later. Immunotyping of myocardial tissues in two cases revealed an initial predominance of T helper cells. Serial endomyocardial biopsies available from one of these demonstrated a subsequent marked decrease in the T helper cell population as inflammation and necrosis subsided during and following therapy.- - - - - - - - - - ranking = 1.2keywords = myocarditis (Clic here for more details about this article) |
10/11. Fatal influenza A myocarditis with isolation of virus from the myocardium.A previously healthy 27-year-old woman developed an acute cardiac failure one week after onset of influenza-like respiratory infection, and died on her fourth day in hospital. Intravital differential diagnosis included myocardial infarction because of ECG changes and massive elevation of myocardial enzymes. autopsy revealed severe myocarditis and intact coronary arteries. At microscopic examination the myocardium was heavily infiltrated with lymphocytes, and there was a marked myocytolysis. influenza a virus was isolated from the myocardial tissue. An immunological mechanism of myocardial damage is suggested.- - - - - - - - - - ranking = 1keywords = myocarditis (Clic here for more details about this article) |
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