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The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts

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Abstract

Purpose

Multiple viruses have been detected in cardiac tissue, but their role in causing myocarditis remains controversial. Viral diagnostics are increasingly used in forensic medicine, but the interpretation of the results can sometimes be challenging. In this study, we examined the prevalence of adenovirus, enterovirus, and parvovirus B19 (PVB) in myocardial autopsy samples from myocarditis related deaths and in non-inflamed control hearts in an effort to clarify their significance as the causes of myocarditis in a forensic material.

Methods

We collected all autopsy cases diagnosed with myocarditis from 1992 to 2010. Eighty-four suicidal deaths with morphologically normal hearts served as controls. Polymerase chain reaction was used for the detection of the viral genomes (adenovirus, enterovirus, and PVB) in myocardial tissue specimens. The distinction between acute and persistent PVB infection was made by the serological determination of PVB-specific immunoglobulins M and G.

Results

PVB was detected in 33 of 112 (29 %) myocarditis cases and 37 of 84 (44 %) control cases. All of the samples were negative for the presence of adenovirus and enterovirus. Serological evidence of an acute PVB infection, determined by the presence of immunoglobulin M, was only present in one case. In the remaining cases, PVB was considered to be a bystander with no or limited association to myocardial inflammation.

Conclusion

In this study, adenovirus, enterovirus, and PVB were found to be rare causes of myocarditis. The detection of PVB in myocardial autopsy samples most likely represents a persistent infection with no or limited association with myocardial inflammation. The forensic investigation of myocardial inflammation demands a thorough examination, including special attention to non-viral causes and requires a multidisciplinary approach.

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Acknowledgments

This work was supported by the Beckett Foundation, Kong Christian den Tiendes Foundation, Kirsten Anthonius Foundation (Mindelegat), Aalborg University, and Aarhus University.

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Authors and Affiliations

  1. Department of Clinical Medicine, Centre for Clinical Research, Vendsyssel Hospital, Aalborg University, Bispensgade 37, 9800, Hjørring, Denmark

    Trine Skov Nielsen & Ulrik Thorngren Baandrup

  2. Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark

    Trine Skov Nielsen, Jakob Hansen & Jytte Banner

  3. Department of Forensic Medicine, Copenhagen University, Frederik V’s Vej 11, 2100, Copenhagen Ø, Denmark

    Jytte Banner

  4. Department of Virology/Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark

    Lars Peter Nielsen

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  1. Trine Skov Nielsen
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Correspondence to Trine Skov Nielsen.

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Nielsen, T.S., Hansen, J., Nielsen, L.P. et al. The presence of enterovirus, adenovirus, and parvovirus B19 in myocardial tissue samples from autopsies: an evaluation of their frequencies in deceased individuals with myocarditis and in non-inflamed control hearts. Forensic Sci Med Pathol 10, 344–350 (2014). https://doi.org/10.1007/s12024-014-9570-7

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