Abstract
Coxsackievirus B (CVB) infection is a common cause of acute viral myocarditis. The clinical presentation of myocarditis caused by this enterovirus is highly variable, ranging from mildly symptoms to complete hemodynamic collapse. These variations in initial symptoms and in the immediate and long term outcomes of this disease have impeded development of effective treatment strategies. Nine cynomolgus monkeys were inoculated with myocarditic strains of CVB. Virological studies performed up to 28 days post-inoculation demonstrated the development of neutralizing antibody in all animals, and the presence of CVB in plasma. High dose intravenous inoculation (n = 2) resulted in severe disseminated disease, while low dose intravenous (n = 6) or oral infection (1 animal) resulted in clinically unapparent infection. Transient, minor, echocardiographic abnormalities were noted in several animals, but no animals displayed signs of significant acute cardiac failure. Although viremia rapidly resolved, signs of myocardial inflammation and injury were observed in all animals at the time of necropsy, and CVB was detected in postmortem myocardial specimens up to 28 days PI. This non-human primate system replicates many features of illness in acute coxsackievirus myocarditis and demonstrates that myocardial involvement may be common in enteroviral infection; it may provide a model system for testing of treatment strategies for enteroviral infections and acute coxsackievirus myocarditis.
Highlights
Viral infections are the most common etiology of acute myocarditis
We initially infected two animals by intravenous injection of 107 pfu of H3, a strain of coxsackievirus B3 (CVB3) known to be myocarditic in mice [22,23]
In this report we describe the clinical and histopathologic characteristics of acute infection of non-human primates with myocarditic strains of Coxsackievirus B (CVB)
Summary
Viral infections are the most common etiology of acute myocarditis. The group B coxsackieviruses (CVB) have historically warranted great attention due to the age-dependent differences in the outcome of acute infection. These viruses often produce life-threatening disease including meningoencephalitis, hepatitis, sepsis and myocarditis [2,3,4]. The circulation of the many serologic types of enteroviruses shows year to year variation [2], a 2007 outbreak of cases of CVB type 1 (CVB1) in newborns and other recent reports [5,6,7,8] demonstrate the ongoing threat posed to newborns by myocarditic coxsackieviruses. Older children and adults with enteroviral myocarditis typically present with less severe initial disease and typically have better long-term outcomes [9]
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