Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- 37 Endocarditis of natural and prosthetic valves: treatment and prophylaxis
- 38 Acute pericarditis
- 39 Myocarditis
- 40 Mediastinitis
- 41 Vascular infection
- 42 Infections of cardiovascular implantable electronic devices and VAD
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
39 - Myocarditis
from Part VI - Clinical syndromes: heart and blood vessels
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- 37 Endocarditis of natural and prosthetic valves: treatment and prophylaxis
- 38 Acute pericarditis
- 39 Myocarditis
- 40 Mediastinitis
- 41 Vascular infection
- 42 Infections of cardiovascular implantable electronic devices and VAD
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
DEFINITION
Myocarditis is a rare, potentially deadly, and often underdiagnosed cause of heart failure that primarily affects children and young adults. Historically, the diagnosis of myocarditis was confirmed by analysis of endomyocardial biopsy specimens. The Dallas criteria, proposed in 1986, define myocarditis as an inflammatory cellular infiltrate of the myocardium with or without myocyte necrosis and/or degeneration of adjacent myocytes. These criteria have been criticized due to inter-reader variability in interpretation, low sensitivity due to sampling error, discrepancy with other markers of viral infection and immune activation in the myocardium and lack of prognostic value. Immunohistochemical stains that detect cellular surface antigens such as anti-CD3, anti-CD4, and anti-CD28 (T lymphocytes), anti-CD8 (macrophages), and Class I and II anti-human leukocyte antigens may have greater sensitivity than the Dallas criteria and may have prognostic value.
In patients with previously unexplained heart failure, the presence of viral genomes may indicate active infectious lymphocytic myocarditis. The most common viruses screened in patients with suspected myocarditis are parvovirus B19 (PVB19), adenovirus, enterovirus, cytomegalovirus, Epstein–Barr virus, herpes simplex virus 1 and 2, human herpesvirus 6 (HHV-6), and hepatitis C virus.
Fulminant myocarditis is described as acute onset of severe heart failure due to viral myocarditis. Cardiac sarcoidosis is a rare form of inflammatory myocarditis distinguished histologically by non-necrotizing interstitial granulomas. Idiopathic giant cell myocarditis (GCM) is another rare form of inflammatory myocarditis that is characterized histologically by multinucleated giant cells, myocyte necrosis, and a lymphocytic inflammatory infiltrate.
- Type
- Chapter
- Information
- Clinical Infectious Disease , pp. 260 - 267Publisher: Cambridge University PressPrint publication year: 2015