Case of heart disease in mixed streptococcal and Epstein - Barr virus infection

Abstract

Cardiac involvement in acute and chronic infectious diseases - an actual pediatric problem. Diagnosis of myocarditis in children for general practitioners is difficult due to the lack of pathognomonic, specific only to this disease complaints, clinical and laboratory features. Symptoms of infection and myocarditis (fever, severe weakness, fatigue, shortness of breath, palpitations, headache, systolic murmur at the apex of the heart) are often the same. Many cases of myocarditis in viral and bacterial diseases remain undiagnosed, resulting in the outcome of a chronic cardiac disease. In order to increase alertness of doctors in relation to cardiac pathology at infectious diseases we have described a clinical example of heart disease when mixed streptococcal and Epstein - Barr virus infection in a 11-year-old girl. The peculiarity of this case is that the main symptom, indicating inflammation of the myocardium, was the ECG negative dynamics - the emergence of AV block of 1 degree in sinus tachycardia, whereas the level of cardiac enzymes (CK-MB, LDH) remained normal. Communication with the previous infection, the presence of one large (the appearance of pathological changes on ECG as AV block 1st degree) and two small (laboratory confirmation of infection - Epstein - Barr virus and streptococcus, tachycardia) diagnostic criteria of myocarditis, lack of valve heart disease and other major diagnostic criteria of acute rheumatic fever has allowed diagnosis of acute infection (viral and bacterial) myocarditis, focal (with a primary lesion of the conduction system of the heart). Thus, the only comprehensive assessment of complaints, clinical, laboratory and instrumental data allows to establish the diagnosis of carditis in infectious disease.