ASSOCIATION OF PARVOVIRUS B19 GENOME IN CHILDREN WITH MYOCARDITIS ANDCARDIAC ALLOGRAFT-REJECTION - DIAGNOSIS USING THE POLYMERASE CHAIN-REACTION

Background Inflammatory diseases of the heart, including myocarditis a nd cardiac transplant rejection, are important causes of morbidity and mortality in children. Although viral infection may be suspected in e ither of these clinical conditions, the definitive etiology is often d ifficult to ascertain. Furthermore, the histology is identical for bot h disorders. Coxsackievirus has long been considered the most common c ause of viral myocarditis; however, we previously demonstrated by poly merase chain reaction (PCR) analysis that many different, and sometime s unexpected, viruses may be responsible for myocarditis and cardiac r ejection. In this study, we describe the association of parvovirus gen ome identified through PCR analysis of cardiac tissue in the clinical setting of myocarditis and cardiac allograft rejection. Methods and Re sults Myocardial tissue from endomyocardial biopsy, explant, or autops y was analyzed for parvovirus B19 using primers designed to amplify a 699-base pair PCR product from the VP1 gene region. Samples tested inc luded those obtained from patients with suspected myocarditis (n = 360 ) or transplant rejection (n = 200) or control subjects (n = 250). Par voviral genome was identified through PCR in 9 patients (3 myocarditis ; 6 transplant) and no control patients. Of the 3 patients with myocar ditis, 1 presented with cardiac arrest leading to death, 1 developed d ilated cardiomyopathy, and the other gradually improved. Four of the 6 transplant patients had evidence of significant rejection on the basi s of endomyocardial biopsy histology. All transplant patients survived the infection. Conclusions Parvovirus is associated with myocarditis in a small percentage of children and may be a potential contributor t o cardiac transplant rejection. PCR may provide a rapid and sensitive method of diagnosis.