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Myocarditis associated with 2009 influenza A (H1N1) virus in children

Published online by Cambridge University Press:  15 April 2010

Alban-Elouen Baruteau ,
Nicolas Boimond  and
Duksha Ramful
Alban-Elouen Baruteau*
Affiliation:
CHR Félix Guyon, Service de Réanimation Néonatale et Pédiatrique, Saint-Denis de La Réunion, F-97405, France Centre Chirurgical Marie Lannelongue, Service des Cardiopathies Congénitales, Le Plessis Robinson, F-92350, France
Nicolas Boimond
Affiliation:
CHR Félix Guyon, Service de Réanimation Néonatale et Pédiatrique, Saint-Denis de La Réunion, F-97405, France
Duksha Ramful
Affiliation:
CHR Félix Guyon, Service de Réanimation Néonatale et Pédiatrique, Saint-Denis de La Réunion, F-97405, France
*
Correspondence to: Dr A.-E. Baruteau, MD, Service de Réanimation Néonatale et Pédiatrique, Centre Hospitalier Régional Félix Guyon, Allée des Topazes, 97405 Saint-Denis de La Réunion, France. Tel: 02 62 90 58 30; Fax: 02 62 90 58 32; E-mail: alban.baruteau@wanadoo.fr
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Abstract

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Type
Letter to the Editor
Information
Cardiology in the Young , Volume 20 , Issue 3 , June 2010 , pp. 351 - 352
Copyright
Copyright © Cambridge University Press 2010

Sir,

The very interesting articles reporting characteristics of hospitalised patients with 2009 influenza A (H1N1) encouraged us to write this commentary letter. In the main cohorts of 2009, H1N1 adult and paediatric patients published to date, no viral myocarditis has been reported.Reference Dominguez-Cherit, Lapinsky and Macias1–Reference Jain and Goldman9 However, a large number of patients required intensive care unit admission and mechanical ventilation for acute respiratory distress. Most of them presented with arterial hypotension or shock requiring inotropic support or extracorporeal membrane oxygenation.Reference Lister, Reynolds and Parslow3

We would like to share our experience in our paediatric intensive care unit, where three hospitalised children developed myocarditis during the epidemic wave in Reunion Island (Indian Ocean) from July, 2009 to October, 2009, epidemic peak – week 30 to 38. Myocarditis was fulminant in two cases, presenting with an acute-onset heart failure and cardiogenic shock. Clinical characteristics of these three patients are summarised in Table 1. Influenza A (H1N1) was confirmed by specific reverse transcription – polymerase chain reaction on naso-pharyngeal swabs and by serologic analysis.

Table 1 Clinical characteristics of 2009 H1N1 myocarditis in paediatric patients, Reunion Island.

LVEF = left ventricular ejection fraction, PICU = paediatric intensive care unit

Data on the prevalence of myocarditis in children are limited and autopsy studies have shown that it often stayed undiagnosed. Myocarditis may be seen in severe forms of many infectious diseases.

Our report demonstrates that the 2009 Influenza A (H1N1) virus is cardiotropic and emphasises that a prompt cardiologic examination including a transthoracic echocardiography is warranted in H1N1-infected patients in case of acute respiratory distress or haemodynamic instability. If fulminant myocarditis is recognised and patients aggressively supported in a timely manner, full recovery can be obtained with a low mortality rate.Reference Gupta, Markham, Drazner and Mammen10 We hope that sharing information in this field would be useful for the management of critically-ill H1N1-infected patients.

References

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Figure 0

Table 1 Clinical characteristics of 2009 H1N1 myocarditis in paediatric patients, Reunion Island.