Enteroviral myocarditis in children

Enteroviruses result in a third of cases of acute myocarditis. In some cases of acute forms of pericarditis and myocarditis in pericardial and myocardial fluid, Coxsackie B viruses, as well as their RNAs, were found.

Enterovirus myocarditis can be found mainly in newly born people, as well as adolescents and youth;Two-thirds of the cases are male.

Development of the disease

The disease begins to develop like an acute respiratory disease, then fever, dyspnea, chest pain, arrhythmia begin to occur, and heart failure is occasionally observed. In half the situations, you can listen to the noise of friction of the pericardium. On the electrocardiogram, it is possible to detect elevation of the ST segment in combination with changes in the T wave. Often serum activity increases the isozymes of the heart.

The disease occurs in newborns in a fairly severe form, older children and adults recover to their fullest. In ten percent of situations, dilated cardiomyopathy begins to develop, and occasionally constrictive pericarditis.

The etiological significance of Coxsackie viruses can be confirmed by finding them in the area of ​​the cardiac muscle and brain of deceased sick people. Infection occurs from the mother in utero, or from children in the same ward of the delivery ward. The maximum changes in deceased children are observed in skeletal muscles, myocardium and CNS.Macroscopically, the fullness of the internal organs was noted with small hemorrhages in the epicardium and pleura, and an increase in the size of the heart.

Microscopically managed to detect a picture of the acute form of such a disease as myocarditis enterovirus in children: muscle fibers of different thicknesses with loss of transverse striation, in places the fibers look thinned, some are necrotic. Characteristic are the so-called. Foci of calcification.

Interstitial tissue looks edematous, and it contains infiltrates from polynucleomic leukocytes, histiocytes, plasma cells, and also lymphocytes.

Endocardium appears edematous, infiltrated segment-nuclear leukocytes. These changes are very pronounced in the area of ​​the left ventricle, interventricular septum, as well as the posterior papillary muscles of the left ventricle.

Changes in the region of the striated musculature are similar to those described above - one can observe the so-called. Zeckerovskoe rebirth. Described is the death from myocarditis, which is caused by the Coxsackie virus, in older children, and also in adults. The changes found in the central nervous system are similar to those described above - meningitis begins to develop together with diffuse or focal encephalitis. In addition to the most frequent and severe lesions, it is possible to detect changes in other organs: atelectasis of the lungs and fullness, foci of necrosis and inflammatory processes in the region of the liver, kidneys, pancreas, spleen, adrenals.

In addition to a disease such as enteroviral myocarditis in children, serous pericarditis is also described in infants, older children, and adults.

Musician in 1979 described necrotizing myocardium in children, which is caused by a Coxsackie infection characterized by diffuse or focal necrosis of muscle fibers, the presence of calcifications, a cellular reaction in intensive form, and occasionally the rapid development of pericarditis.

ECHO-infection

The catarrhal form of ECHO-infections, as well as Coxsackie, is capable of developing according to the type of respiratory infections with syndromes, through which enterovirus infections can be manifested.

The gastroenteric( intestinal) form is combined every time with catarrhal phenomena from the position of the respiratory tract. This form was observed in preschool and school children, and it was accompanied by vomiting, headaches, nausea, abdominal pain and intestinal disorders.

Also interesting are the changes that were found in the area of ​​the appendectomy, because the overall picture of the development of the disease in the case of this form is very similar to the acute form of appendicitis. In the case of histological examination in the muscular wall of the appendix, cell infiltrates were found with damage to individual muscle fibers, very similar to those that were described in detail when myocarditis was treated in children.

From the islets, it was possible to isolate the virus, and the antigen of the Coxsackie viruses of forms A and B was detected by using a special method of immunofluorescence.

Tissue damage in the case of Coxsackie infection of a variety of organs, the secretion of viruses, spinal cord, myocardium, brain and other organs in the blood, undoubtedly, very vividly testifies in favor of viremia.

The enterovirus exantheme is predominantly caused by ECHO viruses, but it can also happen that it occurs in the case of Coxsackie infection, and also manifests by the formation of polymorphic pink spotted or spotted rashes in the face, trunk, extremities. Described are outbreaks, as well as serious epidemics of ECHO-infections, in which case the rash on the skin was one of the most frequent forms of the manifestation of the disease. German researchers who managed to observe the pandemic of ECHO-infections, found the following variations of exanthema: red-anemic, scarlet-like, hemorrhagic with a tendency to form bubbles, koreal, erythematous. A. Kimura together with co-authors in 1977 thanks to the method of light microscopy were able to detect balloon dystrophy of the epidermal cells, swelling, as well as cellular infiltration of the dermis. Eosinophilic inclusions were found in the nucleus of some epidermal cells that are located near the vessels. A redistribution of the chromatin of the nuclei was found by the method of electron microscopy in the epidermal cell region, in the cytoplasm - Coxsackie infection in the form of correctly placed particles.