Viral myocarditis
- 1 July 2016
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Rheumatology
- Vol. 28 (4), 383-389
- https://doi.org/10.1097/bor.0000000000000303
Abstract
Purpose of review The article traces the pathways leading from viral infection of the heart by coxsackievirus B3 to autoimmune myocarditis in its various manifestations. Recent findings Myocarditis can be induced by a number of different infectious agents and represents a significant cause of death especially in young individuals. Following infection, patients may develop lymphocytic, eosinophilic, or giant cell/granulomatous myocardial inflammation. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. Although acute viral myocarditis is frequently subclinical and recovery may be spontaneous, treatment of chronic myocarditis is currently unsatisfactory. Ongoing disease may be because of persistent virus in the heart or to immunopathic attack. Depending on the cause, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining cause and deciding future therapy. A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin. Summary Treatment of myocarditis is still problematic and may depend on etiologic diagnosis to distinguish infectious from immune-mediated disease. Both pathogenic mechanisms may co-occur in individual patients. In the future, treatment may depend upon endomyocardial biopsy, immunohistologic testing, improved imaging, and molecular genetic analysis for providing more precise diagnoses.Keywords
This publication has 33 references indexed in Scilit:
- Fatal Eosinophilic Myocarditis Develops in the Absence of IFN-γ and IL-17APublished by The American Association of Immunologists ,2013
- Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial DiseasesEuropean Heart Journal, 2013
- Innate Signaling Promotes Formation of Regulatory Nitric Oxide–Producing Dendritic Cells Limiting T-Cell Expansion in Experimental Autoimmune MyocarditisCirculation, 2013
- Update on MyocarditisJournal of the American College of Cardiology, 2012
- Critical Cytokine Pathways to Cardiac InflammationJournal of Interferon & Cytokine Research, 2011
- Interleukin-17A Is Dispensable for Myocarditis but Essential for the Progression to Dilated CardiomyopathyCirculation Research, 2010
- Genetic complexity of autoimmune myocarditisAutoimmunity Reviews, 2008
- Experimental Autoimmune Myocarditis in A/J mice Is an Interleukin-4-Dependent Disease with a Th2 PhenotypeThe American Journal of Pathology, 2001
- From Infection to AutoimmunityJournal of Autoimmunity, 2001
- A Clinical Trial of Immunosuppressive Therapy for MyocarditisNew England Journal of Medicine, 1995