THÔNG TIN TÀI LIỆU
Myocarditis Myocarditis is defined as an inflammatory disease of the myocardium The etiology of myocarditis includes infectious pathogens, toxins, and immunemediated reactions (Table 63.1) Viruses are the most frequent cause of myocarditis in children when a cause can be established In many patients, however, the precise etiology cannot be determined In children, the two main classes of nonrheumatic myocarditis are infectious and generalized autoimmune variants Table 63.1 Causes of Myocarditis INFECTIOUS Bacterial Viral Fungal Protozoal Parasitic Rikettsial Staphylococcus, Streptococcus, Pneumococcus, Meningococcus, Gonococcus, Salmonella, Corynebacterium diphtheriae, Haemophilus influenzae, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Brucella Adenoviruses, coxsackieviruses A and B, parvovirus B19, cytomegalovirus, human herpes virus-6, Epstein-Barr virus, varicella zoster virus, herpes simplex virus, echoviruses, polioviruses, influenza A and B viruses, respiratory syncytial virus, mumps virus, measles virus, rubella virus, hepatitis C virus, dengue virus, yellow fever virus, Chikungunya virus, human immunodeficiency virus-1 Aspergillus, Actinomyces, Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, Mucormycoses, Nocardia, Sporothrix Trypanosoma cruzi, Toxoplasma gondii, Entamoeba, Leishmania Trichinella spiralis, Echinococcus granulosus, Taenia solium Coxiella burnetii (Q fever), Rickettsia rickettsii (Rocky Mountain spotted fever), Rickettsia tsutsugamushi TOXINS Drugs Amphetamines, anthracyclines, cocaine, cyclophosphamide, ethanol, fluorouracil, lithium, catecholamines, interleukin-2, trastuzumab, clozapine Heavy metals Copper, iron, lead IMMUNE-MEDIATED Autoimmune, Systemic lupus erythematosus, rheumatoid arthritis, Churg-Strauss syndrome, Kawasaki autoinflammatory disease, inflammatory bowel disease, scleroderma, polymyositis, myasthenia gravis, insulindependent diabetes mellitus, thyrotoxicosis, sarcoidosis, Wegener granulomatosis Allergens Penicillin, cefaclor, colchicine, furosemide, isoniazid, lidocaine, tetracycline, sulfonamides, phenytoin, phenylbutazone, methyldopa, thiazide diuretics, amitriptyline, tetanus toxoid, vaccines, serum sickness MISCELLANEOUS Scorpion sting, snake and spider bites, bee and wasp stings, carbon monoxide, inhalants, phosphorus, arsenic, sodium azide, radiation, electric shock The clinical consequences of myocarditis are largely determined by the degree and extent of myocardial injury Sudden death may occur before the diagnosis is made, but most patients will present with heart failure, dysrhythmias, or chest pain Some may not have overt cardiac symptoms and are diagnosed serendipitously or as part of screening for associated disease Infectious Myocarditis Infectious myocarditis can occur as a complication of almost any infectious disease Viral infections are the most frequent causes in developed countries; in other parts of the world, protozoal infections may rank highest Other infectious etiologies include tuberculosis, Lyme disease, and hemolytic uremic syndrome.1–4 Infectious myocarditis may also be a complication of opportunistic infections in patients with immune deficiencies Precise estimates of the prevalence of myocarditis are not well established This is due to the wide variation in causes worldwide, underreporting because of limited resources and owing to subclinical or masked disease Indeed, myocarditis often has a subclinical course and therefore goes undetected In other patients, the presence of infectious myocarditis may be completely masked by signs and symptoms of disease in other affected organs
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