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P4 Clinical features of enteroviral infection in infants at initial presentation and the identification of potential prognostic markers of myocardial involvement
  1. Michaela Blackwell1,
  2. Siske Struik2,
  3. Dirk G Wilson2
  1. 1Cardiff University Medical School, Cardiff, UK
  2. 2Noah’s Ark Children’s Hospital, Cardiff, UK

Abstract

Introduction Enterovirus (EV) infection is common in infants and neonates. The majority of those infected are asymptomatic, or have a minor, self-limiting illness. However, some patients with EV infection can develop serious complications including meningitis and myocarditis. EV myocarditis is rare, but the prognosis is poor, with mortality ranging between 30–83%.

Objectives These were to (1) identify the key clinical features of Enterovirus infection; (2) assess disease burden in patients with myocardial involvement; and (3) identify early clinical markers of myocardial involvement.

Methods A retrospective case note review was conducted of PCR-confirmed EV-positive patients in Southeast Wales between 2013 and 2014. Clinical parameters from initial hospitalisation to discharge were collected, along with laboratory results, additional tests and treatment. Statistical analysis using the Mann-Whitney U test was conducted between those with confirmed EV myocarditis, and the remaining patients.

Results 48 patients with EV infection were identified, of which 35 case notes could be retrieved and reviewed. The common clinical features of EV at initial presentation included fever (91.4%), irritability (71.4%), poor feeding (62.9%), and tachycardia (60%). Myocardial involvement was identified in 2 patients, both with Coxsackie B3 serotype. One patient developed fulminant myocarditis on initial presentation and required ECMO therapy at GOSH, whilst the second, initially diagnosed with viral meningitis, represented 1 week post discharge with signs of dilated cardiomyopathy. Early age of onset, tachycardia persisting beyond 48 h, fever persisting beyond 72 h (p < 0.05 for these parameters, Table 1) and Coxsackie B3 infection were identified as possible markers of myocardial involvement.

Abstract P4 Table 1

Comparison of clinical features in patients with and without known myocardial sequelae following EV infection

Conclusions Clinical features of EV on initial presentation were found to be consistent with previously published data. A larger, prospective study is necessary to assess true disease burden of EV on the cardiovascular system, and to investigate the validity of the clinical markers of EV myocardial involvement identified in this study.

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