PMID- 34774573 OWN - NLM STAT- MEDLINE DCOM- 20220311 LR - 20220311 IS - 1097-6833 (Electronic) IS - 0022-3476 (Linking) VI - 242 DP - 2022 Mar TI - Spectrum of Viral Pathogens Identified in Children with Clinical Myocarditis (Pre-Coronavirus Disease-2019, 2000-2018): Etiologic Agent Versus Innocent Bystander. PG - 18-24 LID - S0022-3476(21)01076-3 [pii] LID - 10.1016/j.jpeds.2021.11.011 [doi] AB - OBJECTIVE: To identify the etiologies of viral myocarditis in children in the pre-coronavirus disease 2019 era. STUDY DESIGN: This was a retrospective review of all patients (age <18 years) diagnosed with myocarditis and hospitalized at Rady Children's Hospital San Diego between 2000 and 2018. RESULTS: Twenty-nine patients met inclusion criteria. Of 28 (97%) patients who underwent testing for viruses, polymerase chain reaction was used in 24 of 28 (86% of cases), and 16 of 24 (67%) detected a virus. Pathogens were rhinovirus (6), influenza A/B (4), respiratory syncytial virus (RSV) (3), coronavirus (3), parvovirus B19 (2), adenovirus (2), and coxsackie B5 virus, enterovirus, and parainfluenza virus type 2 in one case each. Six (21%) patients had no pathogen detected but imaging and other laboratory test results were compatible with myocarditis. Age 0-2 years was associated with RSV, influenza A/B, coronavirus, and enteroviruses (P < .001). Twenty-one patients (72%) experienced full clinical recovery. Three patients (10%) required venoarterial extracorporeal membrane oxygenation (VA-ECMO), and all 3 recovered. Three others (10%) required and underwent successful cardiac transplantation without complications. Two patients (7%) died 9-10 days after hospitalization (1 had RSV and 1 had influenza A/B). Two other patients presented with complete atrioventricular block; 1 case (rhinovirus) resolved spontaneously, and 1 (coronavirus) resolved after support with VA-ECMO. Age <2 years, female sex, lower ejection fraction at admission, and greater initial and peak levels of brain natriuretic peptide were significant predictors of critical outcomes (use of VA-ECMO, listing for cardiac transplantation, and death). CONCLUSIONS: Viral nucleic acid-based testing revealed a wider spectrum of viruses that could be associated with myocarditis in children than previously reported and traditionally anticipated. A predilection of certain pathogens in the very young patients was observed. Whether the observed range of viral agents reflects an undercurrent of change in viral etiology or viral detection methods is unclear, but the wider spectrum of viral pathogens found underscores the usefulness of polymerase chain reaction testing to explore possible viral etiologies of myocarditis in children. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Aljohani, Othman A AU - Aljohani OA AD - Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, CA; Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, CA. Electronic address: Dr.othman.aljohani@gmail.com. FAU - Mackie, Duncan AU - Mackie D AD - University of California San Diego School of Medicine, San Diego, CA. FAU - Bratincsak, Andras AU - Bratincsak A AD - Kapiolani Medical Specialists, Hawaii Pacific Health, Honolulu, HI. FAU - Bradley, John S AU - Bradley JS AD - Division of Infectious Diseases, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, CA. FAU - Perry, James C AU - Perry JC AD - Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, CA. LA - eng GR - TL1 TR001443/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20211111 PL - United States TA - J Pediatr JT - The Journal of pediatrics JID - 0375410 SB - IM MH - Adolescent MH - California/epidemiology MH - Child MH - Child, Preschool MH - Female MH - Hospitals, Pediatric MH - Humans MH - Infant MH - Male MH - Myocarditis/diagnosis/*etiology/therapy/*virology MH - Polymerase Chain Reaction MH - Retrospective Studies MH - Virus Diseases/*complications MH - Viruses/*pathogenicity OTO - NOTNLM OT - ECMO OT - children OT - extracorporeal membrane oxygenation OT - fulminant myocarditis OT - viral myocarditis EDAT- 2021/11/15 06:00 MHDA- 2022/03/12 06:00 CRDT- 2021/11/14 20:44 PHST- 2021/05/21 00:00 [received] PHST- 2021/11/02 00:00 [revised] PHST- 2021/11/04 00:00 [accepted] PHST- 2021/11/15 06:00 [pubmed] PHST- 2022/03/12 06:00 [medline] PHST- 2021/11/14 20:44 [entrez] AID - S0022-3476(21)01076-3 [pii] AID - 10.1016/j.jpeds.2021.11.011 [doi] PST - ppublish SO - J Pediatr. 2022 Mar;242:18-24. doi: 10.1016/j.jpeds.2021.11.011. Epub 2021 Nov 11.