Key result
Parvovirus B19 and Influenza co-infection triggers fatal cytokine-mediated fulminant myocarditis in a child.
Why the study?
Co-infections of cardiotropic viruses are rarely reported, and the mechanisms of viral interactions leading to acute myocarditis remain unknown.
Case Report (n=1)
Highlights the rare but fatal potential of viral co-infections triggering a cytokine storm and acute fulminant myocarditis in pediatric patients.
Warrants vigilance for co-infection myocarditis in critically ill children; hypothesis-generating for cytokine storm triggers.
Parvovirus-B19 (PVB19) is a frequent causative agent of myocarditis. For unclear reasons, viral reactivation can cause acute myocarditis, a leading cause of sudden death in the young. Influenza A/H1N1(2009) virus (IAV/H1N1) is known for causing flu/pneumonia, but the heart is rarely involved. Co-infections of cardiotropic viruses are rarely reported and the mechanisms of viral interactions remain unknown. A 5-year old girl had a flu-like syndrome, when she suddenly presented with a respiratory distress and cardiac arrest. At autopsy, the lungs were found haemorrhagic. Lungs' histology showed severe bronchiolitis, diffuse haemorrhagic necrosis, and mononuclear inflammation. In the heart, a moderate inflammation was found with no necrosis. IAV/H1N1 was detected in nasal and tracheal swabs, lungs, and the heart. The viral load was high in the lungs, but low in the heart. PVB19 was detected in the heart with a high viral load. Viral co-infection increases the risk of severe outcome but the mechanisms of interaction between viruses are poorly understood. In our case, viral loads suggested a reactivated PVB19-induced acute myocarditis during an IAV/H1N1 pneumonia. Viral interactions may involve an IAV/H1N1-induced cytokine storm, with a fulminant fatal outcome. Clinically, our case shows the importance of investigating inflammatory pathways as therapeutic targets.
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Callon et al. (2021) conducted a case report in Fulminant myocarditis and pneumonia (n=1). Co-infection of Parvovirus B19 and Influenza A/H1N1 was evaluated on Autopsy findings of tissue damage and viral loads. Viral co-infection with Parvovirus B19 and Influenza A/H1N1 caused a cytokine storm leading to fatal fulminant myocarditis and pneumonia in a 5-year-old girl.
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