Assuntos
Anticorpos Antivirais/sangue , Antígenos Virais/isolamento & purificação , Infecções por Coxsackievirus/diagnóstico , DNA Viral/isolamento & purificação , Enterovirus/imunologia , Enterovirus/isolamento & purificação , Animais , Biomarcadores/sangue , Testes de Fixação de Complemento , Infecções por Coxsackievirus/classificação , Infecções por Coxsackievirus/virologia , Diagnóstico Diferencial , Enterovirus/classificação , Enterovirus/genética , Testes de Inibição da Hemaglutinação , Humanos , Testes de Neutralização , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Manejo de Espécimes , Virologia/métodosRESUMO
HISTORY AND CLINICAL FINDINGS: A 28-year-old woman was admitted after syncope which had been preceded by several flulike episodes. There was no history of any other serious disease. Physical examination was unremarkable. Heart sounds were regular and normal, there were no murmurs. INVESTIGATIONS: White cell count was 9400/microliter, with a normal differential count. Erythrocyte sedimentation rate and C-reactive protein were also normal. Virus serology revealed no abnormality. The electrocardiogram (ECG) showed complete (third degree) atrioventricular (AV) block with an idioventricular rhythm of 38 beats/min and right bundle branch block pattern. TREATMENT AND COURSE: A temporary transvenous pacemaker was inserted on the first hospital day. As myocarditis was suspected a right ventricular endomyocardial biopsy was obtained. Histological and immunohistological examinations demonstrated no unequivocal findings. But molecular-biological tests revealed. Coxsackie-B3 virus genome. The pacemaker was removed on the 6th day, when the ECG had shown intermittent second degree AV block. Regular sinus rhythm with a PR interval of 0.18 s was recorded on day 12, and 24-hour ECG monitoring for several days until her discharge on the 18th day confirmed this rhythm throughout. CONCLUSION: In aetiologically undetermined disease molecular-biological techniques can be indispensable for the exact diagnosis and may be decisive for administering specific treatment.
Assuntos
Infecções por Coxsackievirus/virologia , Enterovirus Humano B/genética , Genoma Viral , Bloqueio Cardíaco/virologia , Coração/virologia , Síncope/virologia , Adulto , Bloqueio de Ramo/classificação , Bloqueio de Ramo/terapia , Bloqueio de Ramo/virologia , Estimulação Cardíaca Artificial , Infecções por Coxsackievirus/classificação , Infecções por Coxsackievirus/terapia , Diagnóstico Diferencial , Eletrocardiografia , Eletrocardiografia Ambulatorial , Endocárdio/virologia , Feminino , Bloqueio Cardíaco/classificação , Bloqueio Cardíaco/terapia , Humanos , Reação em Cadeia da Polimerase , Sensibilidade e EspecificidadeRESUMO
Seventy-seven consecutive patients with dilated cardiomyopathy underwent left ventricular endomyocardial biopsy. In 20 biopsies (26%) enteroviral RNA was detected by in-situ hybridization. After an average observation period of more than 2 years only one patient had died in the enterovirus positive (ev+) group compared with 11 deaths and four heart transplantations in the enterovirus negative (ev-) group. After a mean follow-up of 16 +/- 9 months haemodynamic evaluation of the surviving ev+ patients showed significantly better results with respect to left ventricular ejection fraction and left ventricular end-diastolic diameter. The four ev+ patients with haemodynamic deterioration were given interferon-alpha, 3 million units subcutaneously every other day for six months. No severe side effects were seen and all four patients improved according to their haemodynamic and clinical parameters. In two of the four patients enteroviral RNA was not detectable in a subsequent biopsy.