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      Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus

      case-report
      Author(s):
      Publication date (Print):
      Journal: Annals of Saudi Medicine
      Publisher: King Faisal Specialist Hospital and Research Centre

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          Abstract

          The novel Middle East respiratory syndrome coronavirus (MERS-CoV) has been identified as a cause of pneumonia; however, it has not been reported as a cause of acute myocarditis. A 60-year-old man presented with pneumonia and congestive heart failure. On the first day of admission, he was found to have an elevated troponin-I level and severe global left ventricular systolic dysfunction on echocardiography. The serum creatinine level was found mildly elevated. Chest radiography revealed in the lower lung fields accentuated bronchovascular lung markings and multiple small patchy opacities. Laboratory tests were negative for viruses known to cause myocarditis. Sputum sample was positive for MERS-CoV. Cardiovascular magnetic resonance revealed evidence of acute myocarditis. The patient had all criteria specified by the International Consensus Group on CMR in Myocarditis that make a clinical suspicion for acute myocarditis. This was the first case that demonstrated that MERS-CoV may cause acute myocarditis and acute-onset heart failure.

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          Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

          Theo M. Bestebroer, Albert Osterhaus, Sander van Boheemen … (2012)
          A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
          Article 0 comments Cited 3035 times – based on 0 reviews     Review now
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            Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus

            Abdullah Assiri, Allison McGeer, Trish M. Perl … (2013)
            In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response.
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              Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology.

              Heiko Mahrholdt, Christine Goedecke, Anja Wagner … (2004)
              Myocarditis can occasionally lead to sudden death and may progress to dilated cardiomyopathy in up to 10% of patients. Because the initial onset is difficult to recognize clinically and the diagnostic tools available are unsatisfactory, new strategies to diagnose myocarditis are needed. Cardiovascular MR imaging (CMR) was performed in 32 patients who were diagnosed with myocarditis by clinical criteria. To determine whether CMR visualizes areas of active myocarditis, endomyocardial biopsy was taken from the region of contrast enhancement and submitted to histopathologic analysis. Follow-up was performed 3 month later. Contrast enhancement was present in 28 patients (88%) and was usually seen with one or several foci in the myocardium. Foci were most frequently located in the lateral free wall. In the 21 patients in whom biopsy was obtained from the region of contrast enhancement, histopathologic analysis revealed active myocarditis in 19 patients (parvovirus B19, n=12; human herpes virus type 6 [HHV 6], n=5). Conversely, in the remaining 11 patients, in whom biopsy could not be taken from the region of contrast enhancement, active myocarditis was found in one case only (HHV6). At follow-up, the area of contrast enhancement decreased from 9+/-11% to 3+/-4% of left ventricular mass as the left ventricular ejection fraction improved from 47+/-19% to 60+/-10%. Contrast enhancement is a frequent finding in the clinical setting of suspected myocarditis and is associated with active inflammation defined by histopathology. Myocarditis occurs predominantly in the lateral free wall. Contrast CMR is a valuable tool for the evaluation and monitoring of inflammatory heart disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Saudi Med
                Journal ID (iso-abbrev): Ann Saudi Med
                Title: Annals of Saudi Medicine
                Publisher: King Faisal Specialist Hospital and Research Centre
                ISSN (Print): 0256-4947
                ISSN (Electronic): 0975-4466
                Publication date (Print): Jan-Feb 2016
                Volume: 36
                Issue: 1
                Pages: 78-80
                Affiliations
                From the Department of Cardiology, King Khalid University Hospital, Riyadh, Saudi Arabia
                Author notes
                Correspondence: Dr. Tariq Alhogbani, Department of Cardiology, King Khalid University Hospital, King Saud University, Riyadh 11352 Saudi Arabia, T: (+966) 505-245494, tariqmfh@ 123456yahoo.com
                Article
                Publisher ID: asm-1-78
                DOI: 10.5144/0256-4947.2016.78
                PMC ID: 6074274
                PubMed ID: 26922692
                SO-VID: c97e88e9-8e7d-4b73-addf-5f71e5a87b71
                Copyright © Copyright © 2016, Annals of Saudi Medicine
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Subject: Case Report

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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