Myocarditis Linked to Pandemic H1N1 Flu in Children

Several cases of this rare complication found over a one month period
By A. Agrawal, PhD
HealthDay Reporter

THURSDAY, Feb. 11 (HealthDay News) -- Several cases of fulminant myocarditis, a rare complication of viral infection, have been identified among children infected with H1N1 pandemic influenza during a one month period, according to the results of a retrospective chart review published online Feb. 10 in the Journal of the American College of Cardiology.

Noting that fulminant myocarditis can be a complication of influenza infection, András Bratincsák, M.D., and colleagues from Rady Children's Hospital in San Diego reviewed the charts of all patients at their institution who were diagnosed with H1N1 influenza A infection during October 2009 for evidence of myocarditis.

The researchers identified four cases of influenza-associated myocarditis based on elevated cardiac enzymes, a significant acute decrease in left ventricular systolic function by echocardiography, or histologic evidence. The three children with fulminant myocarditis showed no evidence of sepsis or bacterial infection. Fulminant myocarditis resulted in death in one case and a requirement for extracorporeal membrane oxygenation support in two cases. Of the three children with decreased systolic function, two recovered within five to seven days.

"Our observations warrant a high index of suspicion for myocarditis in children with H1N1 influenza A infection," Bratincsák and colleagues conclude. "Timely intervention with circulatory support may decrease morbidity and mortality, with the potential for a favorable cardiac prognosis."

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