From the Guidelines
Yes, adenovirus can cause both pericarditis and myocarditis, as it is one of the various viruses that can lead to these conditions. Adenovirus is a common viral pathogen that typically causes respiratory and gastrointestinal infections, but it can also affect the heart in some cases. When adenovirus infects the heart tissue, it can trigger inflammation of the pericardium (the sac surrounding the heart) causing pericarditis, or inflammation of the heart muscle itself, causing myocarditis 1. These cardiac complications are more common in immunocompromised individuals but can occur in otherwise healthy people as well. The virus triggers an inflammatory response as the immune system attempts to clear the infection, which can damage heart tissue.
Key Points to Consider
- Symptoms may include chest pain, shortness of breath, fatigue, palpitations, and fever.
- Treatment is typically supportive care, including rest, anti-inflammatory medications like NSAIDs, and in severe cases, corticosteroids or other immunomodulatory therapies, although corticosteroids are generally not indicated in viral pericarditis 1.
- Most cases resolve without long-term complications, but some patients may develop chronic heart issues.
- If you experience chest pain or other cardiac symptoms during or after an adenovirus infection, seek medical attention promptly for proper diagnosis and management.
Diagnosis and Management
The diagnosis of viral pericarditis is not possible without the evaluation of pericardial effusion and/or pericardial/epicardial tissue, preferably by PCR or in-situ hybridisation 1. A four-fold rise in serum antibody levels is suggestive but not diagnostic for viral pericarditis. Treatment of viral pericarditis is directed to resolve symptoms, prevent complications, and eradicate the virus. In patients with chronic or recurrent symptomatic pericardial effusion and confirmed viral infection, specific treatment may be considered, such as immunoglobulin treatment for adenovirus and parvovirus B19 perimyocarditis 1.
Recent Guidelines
According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases, acute viral pericarditis often presents as a self-limiting disease that responds well to a short course of treatment with NSAIDs, with the adjunct of colchicine 1. The identification of specific viral signatures aids in understanding the pathogenetic mechanisms in pericarditis, and might enable an individualized aetiologically driven specific treatment approach to be established.
From the Research
Adenovirus and Pericarditis/Myocarditis
- Adenovirus can cause pericarditis, as reported in a case study where a 2-year-old patient was diagnosed with pericarditis caused by adenovirus infection, with a moderate pericardial effusion 2.
- Adenovirus infection can also cause myocarditis, as evidenced by a study that reported eight children who died in cardiogenic shock due to myocarditis, with adenovirus genome detected in 75% of the cases 3.
- The clinical spectrum of adenovirus infections is broad, and while most cases are self-limited, fatalities can occur, especially in patients with impaired immunity 4.
- Treatment of adenovirus infections, including pericarditis and myocarditis, is controversial, and there is no standardized treatment approach, although cidofovir has been used for severe cases 4.
Diagnosis and Treatment
- Metagenomics next-generation sequencing (mNGS) can be an effective means for diagnosing rare adenovirus myocarditis in children 2.
- Empiric anti-inflammatory therapy, including aspirin, non-steroidal anti-inflammatory drugs (NSAID), and colchicine, is often used to treat pericarditis, including cases caused by adenovirus infection 5, 6.
- Corticosteroids may be used as a second-line treatment for pericarditis, especially in cases with systemic autoimmune diseases or postpericardiotomy syndrome 5.