1234. Severe Pericarditis in Children Associated with Coxsackie A Virus Infection: An Emerging Disease
Session: Poster Abstract Session: RSV and Other Viral Respiratory Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Severe pericarditis in children requiring pericardiocentesis due to coxsackie A virus infection may be an emerging disease. In October 2010, two deaths were reported in children from New York City due to acute myocarditis associated with coxsackie A9 virus infection. The disease presentations and severity were different in the three children from Upstate New York.

Methods: We report three children with severe pericarditis associated with coxsackie A virus infection.

Results: Three children presented with nonspecific viral syndrome between July-November 2010. All are male patients whose age ranged from 11-19 years. All were previously healthy except Patient C who had valvular pulmonic stenosis status post valvuloplasty. From the initial viral prodrome to progression with pericarditis ranged from 17-42 days. They were evaluated in the emergency room (Patient A) or were admitted in the hospital (Patient B, C) for pericarditis with cardiac tamponade physiology by echocardiogram requiring pericardiocentesis. Blood cultures from all patients were negative. Rectal swab viral culture was negative for Patient A. Pericardial fluid cultures with entrovirus real time PCR were negative for Patient B and C. Coxsackie B IgM (B1-B6) serologies were negative however, the IgG serologies were positive at low titers (1:8 – 1:64) from all patients. Only one patient (Patient B) had positive coxsackie A IgM (A7 - 1:10, A9 - 1:10, and A24 - 1:80) at low titers. All coxsackie A IgG (A7, A9, A16, and A24) had increased titers (1:200 – 1:1600). All improved with ibuprofen (dosage range, 5-10 mg/kg/dose every 8 to 6 hours) for at least 2 weeks (range, 2-8 weeks).

Conclusion: The acute non-specific viral syndrome leading to subacute pericarditis may be a diagnostic challenge to primary care providers. It may be difficult to correlate viral isolation from other body sites to a disease process that has been going on for several weeks and this may be falsely negative. This may be an emerging and under-recognized disease since pericarditis due to non-polio enteroviral infections are not reportable to the Local Health Department.


Subject Category: P. Pediatric and perinatal infections

Roberto Santos, MD, MSc1, Robin Doyle, MD2 and Martha Lepow, MD1, (1)Pediatrics, Albany Medical Center, Albany, NY, (2)Capital District Pediatric Cardiology, Albany, NY

Disclosures:

R. Santos, None

R. Doyle, None

M. Lepow, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.