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Fulminant myocarditis implicated in pediatric influenza A (H1N1) cases
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Novel influenza A (H1N1) may be more commonly associated with severe forms of myocarditis than previously encountered influenza strains, physicians at Rady Children’s Hospital in San Diego warned after identifying the first known cases associated with the H1N1 strain in pediatric patients.
“Our observations warrant a high index of suspicion for myocarditis in children with H1N1 influenza A infection,” researchers from the hospital wrote in a letter to the editors of the Journal of the American College of Cardiology.
After performing a retrospective chart review on all patients admitted to the hospital with an H1N1 diagnosis during October 2009, the researchers identified four cases of acute myocarditis, three of which were diagnosed as fulminant myocarditis with fatal or near-fatal outcomes. One child died, most likely from acute atrioventricular block, and two required extracorporeal membrane oxygenation support and experienced gradual improvements in ventricular systolic function during a one-week period, the researchers wrote.
Fulminant myocarditis caused by viral infection is an uncommon form of myocarditis, they emphasized, with only a few cases associated with influenza A virus reported in the literature and just two cases with a viral etiology identified at their hospital in the previous three years.
“Early detection and aggressive management are paramount. Timely intervention with circulatory support may decrease morbidity and mortality, with the potential for a favorable cardiac prognosis,” the researchers wrote.
Bratincsak A. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.01.004.