Changes in serum cardiac myosin light chain 1 levels in children with fulminant myocarditis during continuous blood purification

Summary Objective: To investigate the changes in serum cardiac myosin light chain 1 (CMLC-1) levels in children with fulminant myocarditis (FM) during continuous blood purification (CBP), as well as to analyze its correlation with other laboratory indexes. Method: Twenty-four (24) children with FM who underwent CBP were enrolled. Before and during treatment (48 and 72 hours after treatment, or death), the optical density value of serum CMLC-1 was measured using enzyme-linked immunosorbent assay, and then the serum CMLC-1 concentration was calculated. The correlations between CMLC-1 OD value change and laboratory indexes including creatine kinase-MB (CK-MB), troponin, myohemoglobin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analyzed. Results: The serum CMLC-1 concentration significantly increased in the children with FM and decreased obviously during CBP therapy. In the same period, the change of CMLC-1 concentration were positively correlated with creatine kinase-MB (r=0.528), troponin (r=0.726), myohemoglobin (r=0.702), and NT-proBNP levels (r=0.589). Conclusion: The serum CMLC-1 concentration increases significantly in children with FM, but CBP therapy can effectively control this increase.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

Short-term therapy with simvastatin reduces inflammatory mediators and heart inflammation during the acute phase of experimental Chagas disease

Trypanosoma cruzi infection induces progressive cardiac inflammation that leads to fibrosis and modifications in the heart architecture and functionality. Statins, such as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, have been studied due to their pleiotropic roles in modulating the inflammatory response. Our goal was to evaluate the effects of simvastatin on the cardiac inflammatory process using a cardiotropic strain of T. cruzi in a murine model of Chagas cardiomyopathy. C57BL/6 mice were infected with 500 trypomastigotes of the Colombian strain of T. cruzi and treated with an oral dose of simvastatin (20 mg/Kg/day) for one month and inflammatory and morphometric parameters were subsequently evaluated in the serum and in the heart, respectively. Simvastatin reduced the total cholesterol and inflammatory mediators (interferon-gamma, tumour necrosis factor-alpha, CCL2 and CCL5) in the serum and in the heart tissue at 30 days post-infection. Additionally, a proportional reduction in heart weight and inflammatory infiltration was observed. Simvastatin also reduced epimastigote proliferation in a dose-dependent manner in vitro and was able to reduce blood trypomastigotes and heart amastigote nests during the acute phase of Chagas disease in vivo. Based on these data, we conclude that simvastatin exerts a modulatory effect on the inflammatory mediators that are elicited by the Colombian strain of T. cruzi and ameliorates the heart damage that is observed in a murine model of Chagas disease.

A Case of Acute Eosinophilic Myopericarditis Presenting with Cardiogenic Shock and Normal Peripheral Eosinophil Count

Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically. A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.

Correlation between the severity of carditis and the level of acute phase reactants and anti-streptolysin O titer in acute rheumatic fever: a Retrospective study in Shiraz

In order to find the correlation between the severity of carditis in acute rheumatic fever [ARF] and the erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and anti-streptolysin O [ASO] titers, we performed a retrospective study in Shiraz on one-hundred and four patients. The mean age of the patients was 11 years. Fever was seen in 85.5%, arthralgia in 95.2%, arthritis in 81.7%, carditis in 82.5%, chorea in 3:8%, and subcutaneous nodules in 0.9% of patients. Mitral regurgitation was the most frequent valvar involvement [79.6%]. Sixteen patients [15.4%] had severe carditis. The ESR level was >/= 20 Wintrobe units in 98.0%, the CRP was elevated in 83.0%, and the ASO titer was >/= 400 Todd units in 91.0% of patients. There was no significant statistical difference between those patients with mild and severe carditis concerning the level of ESR, CRP, and ASO titers. There was also no significant statistical difference between the level of these parameters and the presence or absence of carditis, and the patient's age [8 years old]

Effect of Indian red scorpion (Mesobuthus tamulus concanesis, Pocock) venom on thyroxine and triiodothyronine in experimental acute myocarditis and its reversal by species specific antivenom.

Acute myocarditis was induced in dogs and rabbits by injection of scorpion (M. tamulus concanesis, earlier called Buthus tamulus) venom by s.c., i.m. or i.v. routes. A decrease in thyroxine (T4) levels was observed following i.v. injection of venom in dogs. In rabbits the venom (i.m.) did not elicit any change in T4 levels. Envenomation (s.c.) resulted in a reduction in triiodothyronine (T3) levels in dogs. Venom injection (s.c.) along with i.v. administration of the species specific antivenom (AScVS) did not cause any change in T3 and T4 levels in general. However an increase in T3 levels following AScVS was observed in envenomated dogs. The results suggest that scorpion envenomation caused an autonomic storm releasing massive amounts of catecholamines, angiotensin II, suppressed insulin secretion and reduced circulating T4 and T3 levels. Decrease in thyroid hormones results in fall in body temperature. Changes in the body temperature may increase the sensitivity of the scorpion venom and influence the course of toxicity.

Fulminant diptheretic myocarditis.

Five cases of fulminant diphtheritic myocarditis are described. Among them, three had extensive faucial diphtheria. Two had minor ECG abnormalities like low voltage QRS complexes. One of the three cases of severe diphtheria had atrioventricular dissociation, one developed LBBB leading to complete heart block, and the last one had ventricular tachycardia. Three of the five children died; all of them had major ECG abnormalities. Prognosis was also related to SGOT levels.

Increased osmotic fragility of red cells in dogs with acute myocarditis produced by scorpion (Buthus tamulus) venom.

Stings from scorpions (Buthus tamulus) produce acute myocarditis and can result in death in children and adults. Acute myocarditis was induced in anaesthetised dogs by intravenous injection of 4 mg/kg venom (Buthus tamulus). Myocarditis was confirmed by ECG. Blood was collected before and 30 minutes after venom treatment and processed for osmotic fragility. An increase in osmotic fragility of red cells in addition to initial hypertension followed by hypotension were observed in venom treated animals. These results suggest that scorpion venom causes autonomic storm and the released catecholamines were responsible for acute myocarditis, changes in the blood pressure and increased osmotic fragility of red cells.