The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts
The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts
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DOI：
10.1007/s12024-014-9570-7
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发表时间：
2014-09-01
影响因子：
1.8
通讯作者：
Banner, Jytte
中科院分区：
文献类型：
--
作者：
Nielsen, Trine Skov;Hansen, Jakob;Banner, Jytte
已在心脏组织中检测到多种病毒，但它们在引起心肌炎中的作用仍存在争议。病毒诊断越来越多地被用于法医学，但对结果的解释有时可能是具有挑战性的。在这项研究中，我们检测了心肌炎相关死亡和非炎症对照心脏的心肌尸检标本中腺病毒、肠道病毒和细小病毒B19(PVB)的流行率，以努力阐明它们在法医材料中作为心肌炎病因的重要性。我们收集了1992-2010年所有诊断为心肌炎的尸检病例。84例心脏形态正常的自杀性死亡作为对照。用聚合酶链式反应检测心肌组织标本中的病毒基因组(腺病毒、肠道病毒和PVB)。通过血清学检测PVB特异性免疫球蛋白M和G.PVB可鉴别急性和持续性PVB感染。112例心肌炎患者中33例(29%)检出PVB，84例对照组中37例(44%)检出PVB。所有样本的腺病毒和肠道病毒的存在均为阴性。由免疫球蛋白M的存在确定的急性PVB感染的血清学证据只在一例中存在。在其余的病例中，PVB被认为是一个旁观者，与心肌炎没有或仅有有限的联系。在这项研究中，腺病毒、肠道病毒和PVB被发现是心肌炎的罕见原因。在心肌尸检标本中检测到PVB很可能代表一种持续性感染，与心肌炎没有或仅有有限的联系。对心肌炎的法医调查需要彻底的检查，包括对非病毒原因的特别关注，并需要多学科的方法。
Multiple viruses have been detected in cardiac tissue, but their role in causing myocarditis remains controversial. Viral diagnostics are increasingly used in forensic medicine, but the interpretation of the results can sometimes be challenging. In this study, we examined the prevalence of adenovirus, enterovirus, and parvovirus B19 (PVB) in myocardial autopsy samples from myocarditis related deaths and in non-inflamed control hearts in an effort to clarify their significance as the causes of myocarditis in a forensic material.We collected all autopsy cases diagnosed with myocarditis from 1992 to 2010. Eighty-four suicidal deaths with morphologically normal hearts served as controls. Polymerase chain reaction was used for the detection of the viral genomes (adenovirus, enterovirus, and PVB) in myocardial tissue specimens. The distinction between acute and persistent PVB infection was made by the serological determination of PVB-specific immunoglobulins M and G.PVB was detected in 33 of 112 (29 %) myocarditis cases and 37 of 84 (44 %) control cases. All of the samples were negative for the presence of adenovirus and enterovirus. Serological evidence of an acute PVB infection, determined by the presence of immunoglobulin M, was only present in one case. In the remaining cases, PVB was considered to be a bystander with no or limited association to myocardial inflammation.In this study, adenovirus, enterovirus, and PVB were found to be rare causes of myocarditis. The detection of PVB in myocardial autopsy samples most likely represents a persistent infection with no or limited association with myocardial inflammation. The forensic investigation of myocardial inflammation demands a thorough examination, including special attention to non-viral causes and requires a multidisciplinary approach.