natriuretic-peptide--brain and Enterovirus-Infections

A four- and a half-month-old girl with severe dilated cardiomyopathy due to neonatal enterovirus myocarditis, treated with diuretics and milrinone for the past 4 months, was infected with SARS-CoV-2. The disease course was characterised by high fever and gastrointestinal symptoms. Cardiac function, as measured by echocardiography, remained stable. The treatment focused on maintaining a normal heart rate and a stable fluid balance. In children with severe underlying cardiac disease, even a mild SARS-CoV-2 infection can require close monitoring and compound treatment.

Topics: Cardiomyopathy, Dilated; Cardiotonic Agents; COVID-19; Diarrhea; Diuretics; Echocardiography; Enterovirus Infections; Female; Fever; Heart Rate; Heart Transplantation; Humans; Infant; Milrinone; Myocarditis; Natriuretic Peptide, Brain; Peptide Fragments; SARS-CoV-2; Severity of Illness Index; Tachycardia; Tachypnea; Troponin T; Ventricular Dysfunction, Left; Vomiting; Waiting Lists; Water-Electrolyte Balance

Severe enterovirus 71 (EV71) infections in children can result in acute heart failure. B-type natriuretic peptide (BNP) is a good biomarker of myocardial stress. The purpose of this study was to use plasma BNP for the detection of EV71 infection with cardiac involvement.. Patients with severe EV71 infections and healthy control subjects were studied: group 1 (n=30), normal controls; group 2 (n=20), EV71 infection with central nervous system involvement; and group 3 (n=3), EV71 infection with cardiopulmonary failure. The demographic and laboratory data including plasma BNP levels were analyzed statistically.. All group 2 patients recovered completely without neurological sequelae, and all group 3 patients survived without cardiac complications. Group 3 patients had higher troponin I, MB fraction of creatine kinase, and BNP levels than patients of the other groups. The median BNP values were <5 pg/ml in group 1, 9.5 pg/ml in group 2, and 238 pg/ml in group 3. Using a BNP cut-off value of 100 pg/ml to identify cases with severe EV71 infection and acute heart failure, the sensitivity and specificity were both 100%.. Children with severe EV71 infections have varying degrees of myocardial stress. Plasma BNP would be a sensitive and reliable biomarker for the detection of cardiac involvement in children with severe EV71 infections.

Topics: Biomarkers; Child; Child, Preschool; Echocardiography; Enterovirus A, Human; Enterovirus Infections; Female; Heart Diseases; Humans; Infant; Male; Natriuretic Peptide, Brain; Pilot Projects; Severity of Illness Index; Stroke Volume; Ventricular Function, Left