Myocarditis in children presenting with acute febrile illness

Objective: Myocarditis is the inflammatory disease of myocardium. The objective of this study was to determine the prevalence of myocarditis in children presenting with acute febrile illness, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis and to know the outcome and etiological agents causing myocarditis. Methods: This prospective observational study was done in 125 children aged 1-15 years presenting with acute febrile illness. Patients were diagnosed as suspicious case of myocarditis on the basis of expanded criteria of myocarditis. Suspicious myocarditis patients were compared with those who did not have myocarditis in terms of clinical feature, investigation and outcome and were also investigated for etiology. Results: 43 patients were diagnosed as suspected myocarditis according to expanded criteria. Mean age was 6.1 ± 3.4 years and male: female ratio was 1.2:1. A significant association was present between patients with myocarditis and following signs and symptoms: chest pain, palpitation, dyspnea, swelling of body, pedal edema, abdominal tenderness, hepatomegaly and crepitations. Following investigations were significantly abnormal in patients with myocarditis: hypokalaemea, billirubin >1.2 mg/dl, mean AST and ALT, CPK-MB and BNP. Conclusions: Children with myocarditis present with symptoms that can be mistaken for other system involvement. When clinical suspicion of myocarditis exists, chest-X ray, cardiac enzymes and echocardiography are sufficient as screening tests. Many common causes of acute onset fever can cause myocaditis. Therefore its diagnosis is necessary for prompt treatment.