Enteroviral infection causing fatal myocarditis and subclinical myopathy

Enteroviral RNA detection in myocarditis and dilated cardiomyopathy is rare . Enteroviral particles and RNA have recently been identified in patient's skeletal muscle, suggesting that skeletal more than heart muscle hosts the virus in chronic infection. Enteroviral RNA and virus-like particles were f ound in the myocardium and in the skeletal muscle of two patients with fata l myocarditis: a 39 year old man who died five days after the onset of febr ile flu; and a 49 year old woman, assisted for 50 days with a left ventricu lar assist device, who then died from cerebral haemorrhage. Automated seque ncing, alignment, and sequence comparison confirmed the enteroviral origin of polymerase chain reaction products and excluded contamination. These fin dings agree with prior observations of enteroviral localisation in the skel etal muscle of patients with dilated cardiomyopathy, and further support th e hypothesis that skeletal rather than heart muscle may host the virus and serve as a reservoir in cardiomyopathies related to chronic infection.