Micro - 4th Asessment - Viral Carditis And Arthritis - 2007

VIRAL CARDITIS AND VIRAL ARTHRITIS

Fourth Medical, 2007 Prof. Widad Al-Nakib, FRCPath.

Viral Carditis Disease Myocarditis/pericarditis/ cardiomyopathy

Virus Coxsackie B and other enteroviruses

Feature Recrudescences

Encephalomyocarditis syndrome

Coxsackie B, echoviruse 11, others

Neonatal

Patent ductus arteriosus, Pulmonary artery stenosis, septal defects

Rubella (congenital rubella syndrome)

Prenatal

Hydrops fetalis Endocardial fibroelastosis

Parvovirus B19 Mumps

Prenatal Prenatal

Table4 Humandiseases causedby enteroviruses Poliovirus

CoxsackieA virus

CoxsackieB virus

Echovirus

Enterovirus (other)

Asymptomatic infection

Yes

Yes

Yes

Yes

Yes

Meningitis

Yes

Yes

Yes

Yes

Yes

Paralysis

Yes

Yes

Yes

Yes

No

Febrile exanthems

No

Yes

Yes

Yes

Yes

Acute respiratory disease

No

Yes

Yes

Yes

Yes

Myocarditis

No

Yes

Yes

Yes

No

Orchitis

No

No

Yes

Yes

No

ENTEROVIRUSES •

PATHOGENESIS

MYOCARDITIS • Coxsackievirus A andB(and also Echoviruses) can cause myocarditisin neonates and young children • Fever, chestpains, arrhythmiaand even cardiac failurecan result • Mortalityrates are high • In young adults, an acutebenignpericarditis may also be cause by Coxsackieviruses

DIAGNOSIS OF ENTEROVIRUS CARDITIS • Demonstrating viral of enterovirus RNA by PCR in pericardial fluids, throat swabs, stools.Only enterovirus OR enteroviral RNA in pericardial fluids demonstrate a direct association between infection and disease. • Virus isolation is not entirely satisfactory.

PREVENTION AND TREATMENT OF ENTEROVIRAL CARDITIS

There is no specific preventative measures or treatment of enterovirus carditis.Only general supportive measures

CONGENITAL RUBELLA HEART DEFECTS

Congenital Rubella Syndrome • Infection may affect all organs • May lead to fetal death or premature delivery • Infection early in pregnancy most dangerous (<12 weeks gestation) • Organ specificity generally related to stage of gestational infection 43

Congenital Rubella Syndrome • Deafness • Cataracts • Heart defects • Microcephaly • Mental retardation • Bone alterations • Liver and spleen damage 44

CONGENITAL RUBELLA SYNDROME IN A NEW BORN

CONGENITAL RUBELLA SYNDROME IN A NEW BORN

Rubella

Laboratory Diagnosis • Isolation of rubella virus from clinical specimen • Significant rise in rubella IgG by any standard serologic assay • Positive serologic tests for rubella specific IgM antibody • Positive serologic test for rubella specific IgM antibody in cord or neonatal blood to diagnose congenital rubella 48

Measles Mumps Rubella (MMR) Vaccine • Contains live, attenuated virus • 12 months is recommended and minimum age for MMR (younger in some countries) • If child younger than 9 months, maternal antibody may interfere • Revaccinate in 6 months to 5 years (school entry age) 50

Immunization of Women of Childbearing Age • Determine if pregnant or likely to become so in next 3 months • Exclude those who say “Yes” • For others: • Explain theoretical risk of infection • Administer vaccine 52

MUMPS CARDITIS

Mumps Virus

20

Swelling of Glands in a Child with Mumps

26

MUMPS AND CARDITIS • Prenatal Mumps has been associated with endocardial fibroelastosis.

Mumps: Laboratory Diagnosis • Isolation of virus from saliva, CSF and urine during and after illness • Identification of virus isolated in tissue culture – characteristic cytopathic effect on host cells • Fourfold antibody rise using paired sera is diagnostic of mumps infection • Demonstrating positive mumps virus – specific IgM in serum 31

Measles Mumps Rubella (MMR) Vaccine • Contains live, attenuated virus • 12 months is recommended and minimum age for MMR (younger in some countries) • If child younger than 9 months, maternal antibody may interfere • Revaccinate in 6 months to 5 years (school entry age) 50

PARVOVIRUS CARDITIS • Occurs as a complication of a congenital/prenatal parvovirus infections such as hydrops fetalis due to B19 virus. Hydrops fetalis is marked by generalized edema, which is presumed to result in severe anemia and congestive cardiac failure in the fetus

LABORATORY DIAGNOSIS OF PARVOVIRUS INFECTIONS

• Demonstrating Virus-Specific IgM in blood or cord blood. • Demonstrating Viral DNA by PCR in the blood • Demonstrating of Viral DNA in situ is useful in acute or chronic infections

TREATMENT AND PREVENTION OF PARVOVIRUS INFECTIONS • No specific treatment or preventative measure, only supportive treatment including blood transfusion or giving normal human immunoglobulin. Both has been shown to have beneficial

Viral Arthritis Virus Ross River Chikungunya O’nyong-nyong Sindbis Mayaro Dengue West Nile Oropouche Rubella Parvovirus B19 Hepatitis B

Distribution Australia, Pacific islands Africa, South Asia East Africa Africa, Asia, Europe South America Tropics worldwide Africa, Asia, Mediterranean Brazil Worldwide Worldwide Worldwide

Features

Arboviral fevers and polyarthritis

Especially in adult females Especially in adult females Immunologically mediated

VIRAL ARTHRITIS • Arhtritis, usually accompanied by fever and myositis,with or without a rash, is a common presentation of infections with many arboviruses. Arthritis and arthralgia are common features of rubella and parvovirus infections in adults particularly females. • The arthralgia sometimes observed in the prodromal stages of hepatitis B is immunologically mediated