Myocarditis

Picornavimses are small, nonenveloped RNA vimses. Members of this family include rhino- and enteroviruses, which are responsible for a variety of human diseases (viral respiratory infection, viral meningitis, myocarditis, pericarditis, encephalitis, chronic meningoencephalitis, herpangina, otitis media, neonatal enteroviral disease, and acute exacerbations of asthma). 

Symptoms next include dementia, tremor, and ataxia progressing most often to coma and death survivors show severe chronic meningoencephalitis. The American form of trypanosomiasis (Chagas disease) is a common health problem in Central and Southern America and is transmitted by reduviid bugs. Polymyositis, myocarditis and encephalomyelitis are constant features of the disorder but may be accompanied by more widespread visceral involvement. Infection can be confirmed by complement fixation tests but antibodies do not occur in the blood until about two months after infection. 

In diphtheria, the organism C. diphtheriae eonfmes itself to epithelial surfaces of the nose and throat and produces a powerfiil toxin which affects the elongation factor involved in protein biosynthesis. The heart and peripheral nerves are particularly affected resulhng in myocarditis (inflammation of the myocardium) and neuritis (inflammation of a nerve). Little damage is produeed at the infective site. 

Increased oxygen demand secondary to increased heart rates and blood pressure has been hypothesized to lead to myocardial infarction (especially in patients with fixed coronary disease) and/or ventricular arrhythmias. In patients with no history of cardiac disease, cocaine is thought to induce acute isehemie complications via vasospasm of the coronaries (Ascher et al. 1988). In addition, Virmani et al. (1988) have reported a 20 percent incidence of myocarditis thought to be secondary to accumulated microvascular injuries. 

Diphtheria is a bacterial respiratory infection characterized by membranous pharyngitis. The membrane may cover the pharynx, tonsillar areas, soft palate, and uvula. Diphtheria may also cause anal, cutaneous, vaginal, and conjunctival infections. The impact of diphtheria is not from the causative bacteria, Corynebacterium diphtheriae, but rather from complications attributed to its exotoxin, such as myocarditis and peripheral... 

Myocarditis Inflammation of the muscular wall of the heart. Myoclonus A sudden, involuntary jerking of a muscle or group of... 

Suggested Alternatives for Differential Diagnosis Hepatitis, Legionnaires disease, myocarditis, pericarditis, cardiac tamponade, pneumonia, ehrlichiosis, relapsing fever, Rocky Mountain spotted fever, and tularemia. 

Complications of influenza may include exacerbation of underlying comorbidities, primary viral pneumonia, secondary bacterial pneumonia or other respiratory illnesses (e.g., sinusitis, bronchitis, otitis), encephalopathy, transverse myelitis, myositis, myocarditis, pericarditis, and Reye s syndrome. 

Nonpulmonary manifestations are extremely common and include nausea, vomiting, diarrhea, myalgias, arthralgias, polyarticular arthritis, skin rashes, myocarditis and pericarditis, hemolytic anemia, meningoencephalitis, cranial neuropathies, and ft n i I lain - Bar re syndrome. Systemic symptoms generally clear in 1 to 2 weeks, whereas respiratory symptoms may persist up to 4 weeks. 

Animal models have established that infections can induce autoimmune disease. For example, coxsackievirus B3 infection of susceptible strains of mice results in inflammation in the heart that resembles the myocarditis and dilated cardiomyopathy that occurs in humans.28 44 The same disease can be induced by injecting mice with cardiac myosin mixed with adjuvant, thereby reproducing the disease in the absence of virus infection, indicating that an active viral infection is not necessary for the development of autoimmune disease.9 29 44 Likewise, a number of autoimmune diseases can be... 

Myocarditis, Rheumatic Fever, Chagas disease CVB3, CMV, Chlamydia, Streptococci, Trypanosoma... 

Fairweather, D., Frisancho-Kiss, S., and Rose, N.R., Viruses as adjuvants for autoimmunity Evidence from coxsackievirus-induced myocarditis, Rev. Med. Virol., 15, 17, 2005. 

Guler, M.L. et al., Two autoimmune diabetes loci influencing T cell apoptosis control susceptibility to experimental autoimmune myocarditis, J. Immunol., 174, 2167, 2005. 

Horwitz, M.S. et al., Pancreatic expression of interferon-gamma protects mice from lethal coxsackievirus B3 infection and subsequent myocarditis, Nature Med., 6, 693, 2000. 

Fairweather, D. et al., Wild isolates of murine cytomegalovirus induce myocarditis and antibodies that cross-react with virus and cardiac myosin, Immunology, 94, 263, 1998. 

Fairweather, D. et al., IL-12RP1 and TLR4 increase IL-ip and IL-18-associated myocarditis and coxsackievirus replication, J. Immunol., 170, 4731, 2003. 

Despite the protective effect of NO against various viral infections, workers in several studies have shown a harmful role of NO in many systems. NO seems to play a part in the development of pneumonia caused by influenza virus [128], in the pathogenesis in mice of tick-borne encephalitis flavivirus infection [131], and in worsening the course of the murine myocarditis caused by coxsackievirus B3 [132]. In addition, pneumonia in mice induced by herpes simplex virus type 1 could be suppressed by the inhibitor of iNOS [133]. The issue of whether NO acts as an inhibitor of viral replication or as a harmful agent, therefore, remains unanswered. This issue is particularly evident in HIV-1 infection, since NO seems to act as a double-edged sword in the pathogenesis of HIV-1. 

Nicaud, V., Poirier, O., Behague, I., et al. (1999) Polymorphisms of the endothehn-A and -B receptor genes in relation to blood pressure and myocardial infarction the Etude Cas-Temoins sur ITnfarctus du Myocarde (ECTIM) Study. Am. J. Hypertens. 12, 304-310. 

Selenium is a significant component of the enzymatic system of the glutafion for antioxidant protection. It is included in the composition of 200 enzymes engaged in different biochemical reactions, demonstrates the immune-tropic, antiteratogenic and anticancer properties, betters the functional state of muscles, especially myocarditis, and takes part in hormones synthesis of the thyroid gland. Selenium s deficit in soil is the cause of hearth deficiency in endemic zones. 

Numerous case studies have described death following the accidental ingestion of kerosene by children (usually under the age of 5 but as old 15 years). The deaths are usually attributed to lipoidal pneumonia (Morrison and Sprague 1976 Santhanakrishnan and Chithra 1978 Zucker et al. 1986) that was probably induced by the aspiration of the kerosene. Specific respiratory effects associated with death from kerosene ingestion include pneumothorax (Mahdi 1988 Zucker et al. 1986), emphysema (Mahdi 1988), and pneumonitis (Singh et al. 1981). Cardiac arrhythmia was reported as the cause of death in one child however, it was suspected that myocarditis and pulmonary edema may have been the cause of the rapid deterioration and death of the child (Dudin et al. 1991). 

Do not give a loading dose to patients with myocarditis or other cardiomyopathy closely monitor initial dosage and subsequent adjustments. 

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