Diagnosis of viral myocarditis in children by multiplex real-time PCR in Vali-Asr Hospital, Birjand, eastern Iran

Background and Objective: Viral myocarditis (VMC) is one of the common heart diseases to endanger human health in different age groups, especially children. The aim of this study was to diagnose VMC in children with clinical suspicion of myocarditis (MCI) using multiplex real-time PCR in Birjand Vali-Asr Hospital. Methods: This cross-sectional study was conducted on 19 patients with clinical suspicion of MCI, who had evidence of infections in the recent weeks. Routine electrocardiogram and dynamic electrocardiogram (ECG) examinations, auxiliary laboratory testing and echocardiographic evaluation were performed. Multiplex real-time PCR was used for detection of viral agents in blood or pericardial fluid samples. Findings: The results indicated that 4 out of 19 (21.05%) MCI patients were virus-positive. The spectrum of viral agents included human herpesvirus 6, 7 (HHV), parvovirus B-19 (PVB19), Epstein–Barr virus (EBV), varicella zoster virus (VZV) and adenoviruses. A co-infection of HHV-6, 7 and PVB19 was found in one patient. The ECG findings such as sinus tachycardia with ST-T changes, premature ventricular contraction and complete heart block were observed in VMC patients. The predominant echocardiographic features in VMC patients were low ejection fraction, mitral regurgitation and severe pericardial effusion with hypotension. Aspartate aminotransferase (AST) and lactic dehydrogenase (LDH) had abnormal increase in some patients. Conclusion: Our findings highlight the importance of identification of VMC in children with clinical suspicion of MCI. The present study emphasizes the importance of PCR-based assays for detection of viral agents in MCI patients with symptoms of virus infection.