1/11. Varicella myocarditis in an adult.A 24 year old male with varicella myocarditis was admitted with chest pain and fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4, and inverted T waves in leads V5 and V6. creatine kinase (CK) was raised to 435 U/l (CK-MB 36 U/l), troponin i was 63.4 microgram/l, and lactate dehydrogenase was 359 U/l, suggesting cardiac involvement of varicella infection. The left ventricle was dilated (58 mm) and left ventricular ejection fraction was globally reduced (ejection fraction 45%). myocarditis was confirmed by endomyocardial biopsy. The patient was treated with specific varicella hyperimmunoglobulins, aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow up the patient recovered completely. This case report is a reminder that a varicella infection can cause myocarditis in adults. early diagnosis and appropriate treatment of this rare form of myocarditis may lead to complete recovery.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/11. Fatal parvovirus myocarditis in a 5-year-old girl.infection with parvovirus B19 is common in children and typically causes mild illness. We report here the case of a 5-year-old girl who died suddenly, 2 weeks after the clinical diagnosis of a parvoviral infection (erythema infectiosum). Microscopic examination of the heart showed severe myocarditis with extensive T-cell and macrophage infiltration. Cultures, serology, and molecular analyses of serum for enteroviridae, adenovirus, influenza, varicella zoster, cytomegalovirus, and herpes simplex viruses were negative. Quantitative polymerase chain reaction (PCR) analysis for parvovirus B19 in peripheral blood, however, showed active infection (91,000 genomes/mL serum; 2.4 genomes/mononuclear cell). Despite the presence of myocarditis, immunostaining for parvoviral surface antigens was negative in the heart. Quantitative PCR analysis of paraffin sections showed that myocardial parvoviral content was significantly less than that of the normal appearing kidney and within the range predicted simply by tissue blood content. Thus, parvovirus B19 infection can be complicated by fatal myocarditis. Because the virus does not appear to have infected the heart, per se, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium. HUM PATHOL 32:342-345.- - - - - - - - - - ranking = 0.25keywords = varicella (Clic here for more details about this article) |
3/11. Cardiac complications in children following infection with varicella zoster virus.infection with varicella zoster virus, leading to chicken pox in susceptible hosts, is usually a benign self-limiting disease conferring immunity in those affected. Cardiac complications are rare, but when present may lead to severe morbidity or mortality. We have recently encountered three children, all of whom developed significant cardiac complications secondary to infection with varicella. myocarditis has long been associated with such infection. The pathological mechanism is presumed similar to other cardiotropic viruses, where both direct cytopathic and secondary auto-immune effects contribute to myocardial cellular destruction and ventricular dysfunction. Complications include arrhythmias and progression to dilated cardiomyopathy. pericarditis, and secondary pericardial effusion, related to infection with the virus is most commonly associated with secondary bacterial infiltration. Both cardiac tamponade and chronic pericardial constriction may result. endocarditis complicating varicella has only been described in the last fifteen years, and is associated with the emergence of virulent strains of both streptococcus and staphylococcus, the two organisms most commonly associated with endocarditis. The exact mechanism by which varicella causes secondary bacterial endocarditis remains unclear. Whilst cardiac complications of infection with the varicella zoster virus are rare, the resulting complications are potentially life threatening. Evidence of varicella-induced carditis must be aggressively pursued in any child with signs of acute cardiac decompensation in whom chicken pox is confirmed or suspected.- - - - - - - - - - ranking = 2.5keywords = varicella (Clic here for more details about this article) |
4/11. Reye's syndrome associated with acute myocarditis and fatal circulatory failure.We describe an eight-month-old infant who had an unusually fulminant and fatal course of Reye's syndrome. The patient died 36 hours after admission because of irreversible circulatory failure not associated with clinical symptoms of increased intracranial pressure or cerebral herniation. autopsy revealed the pathognomonic fatty degeneration of the liver and heart of Reye's syndrome, but the brain was normal. In addition, a marked inflammatory infiltration of the myocardium was also observed, which indicated that acute myocarditis had been the preceding underlying disease. This case report emphasizes the fact that the viral prodrome preceding Reye's syndrome may not be as benign as often observed with influenza and varicella. Acute myocarditis and Reye's syndrome are also a combination which may result in fatal cardiovascular collapse.- - - - - - - - - - ranking = 0.25keywords = varicella (Clic here for more details about this article) |
5/11. Fatal varicella in a healthy girl.A fatal case of chickenpox in a healthy 6-year-old girl is reported. She presented with hemorrhagic bullae from thrombocytopenia and then progressed rapidly to disseminated infection involving many systems causing myocarditis, pneumonitis and hepatitis. A peculiar blood picture with marked leukocytosis (leukemoid reaction) is revised and discussed.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
6/11. The scale of myocardial involvement in varicella myocarditis.Two patients with varicella myocarditis are described. An arrhythmia associated with complete recovery occurred in the first patient whereas intractable congestive heart failure complicated by hemiplegia resulted in a fatal outcome in the other case. We stress the extent of myocardial involvement produced by the herpes zoster virus in the setting of varicella.- - - - - - - - - - ranking = 1.5keywords = varicella (Clic here for more details about this article) |
7/11. life-threatening dysrhythmias in varicella myocarditis.Varicella myocarditis is an unusual complication of a common childhood disease. Two patients with life-threatening dysrhythmias and circulatory failure are reported. One patient required permanent pacemaker implantation for acquired complete heart block, not previously described with varicella infection. Previously reported cases of varicella myocarditis are reviewed.- - - - - - - - - - ranking = 1.5keywords = varicella (Clic here for more details about this article) |
8/11. Fatal varicella in a healthy young adult.A healthy adult presented with severe neurological disturbance 4 d after developing chicken-pox. Although pneumonic and renal problems were also present the neurological state dominated the clinical picture. After the patient's sudden death an autopsy revealed that renal and cerebral problems were secondary to myocardial involvement. This was of an unusual type for varicella with features of dilated cardiomyopathy resembling that previously related to Coxsackie infections. We conclude that cardiac problems in this patient produced anoxic brain damage and subsequently death.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |
9/11. Varicella zoster myocarditis progressing to cardiomyopathy and cardiac transplantation.The case of a 12 year old schoolgirl with heart failure due to varicella myocarditis is reported. heart failure and cardiogenic shock were evident 21 days after the appearance of the rash, and cardiac transplantation was performed two weeks later. myocarditis is a serious complication of varicella zoster infection and heart failure may be fulminant. Endomyocardial biopsy changes consistent with myocarditis were documented six days after the start of heart failure. The histological changes, however, developed into those of idiopathic dilated cardiomyopathy (with anisonucleosis and fibre width variation) over a seven day period. This case provides further evidence for the link between viral myocarditis and idiopathic cardiomyopathy and underlines the value of immediate endomyocardial biopsy in heart failure of recent onset. Cardiac transplantation led to a rapid and full recovery.- - - - - - - - - - ranking = 0.5keywords = varicella (Clic here for more details about this article) |
10/11. Complete heart block in a child with varicella.A case of varicella myocarditis in a previously healthy 6-year-old child was reviewed. The patient presented with third-degree heart block and shock as the sole manifestation of her cardiac involvement. Bradyarrhythmias required temporary transvenous pacing. Intravenous acyclovir was used. The patient recovered without permanent sequelae. The natural history, clinical presentation, and treatment of varicella myocarditis are reviewed.- - - - - - - - - - ranking = 1.5keywords = varicella (Clic here for more details about this article) |
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