Viral infection has been clearly associated with acute episodes of myocarditis in which a patient often presents with cardiomyopathy and heart failure. Many different infectious agents have been considered as the cause of viral myocarditis, including enteroviruses, adenovirus, cytomegalovirus,3'4 hepatitis C virus,5 and others. Among the most commonly identified infectious agents are the CVBs, members of the enterovirus genus of the picornavirus family. Reports of isolation of coxsackievirus from the heart or pericardial fluid of patients with acute myocarditis date back as far as 1965,6J with numerous reports since of virus isolated from the heart or pericardial fluid or demonstrating the presence of viral antigens in diseased heart tissue.7-14 According to World Health Organization surveys from many different countries, 34.6 per 1,000 of all CVB infections are associated with cardiovascular disease.15
In addition to the clear association between enteroviral infection and acute myocarditis, it has been shown that chronic, dilated cardiomyopathy can also be a sequela of viral myocarditis.16 Attempts to isolate virus from the myocardium of patients with dilated cardiomyopathy have so far been unsuccessful. However, serologic evidence and the presence of enteroviral genomes in the heart tissue of patients with dilated cardiomyopathy have been demonstrated by molecular biologic techniques such as slot blot, in situ hybridization, and reverse transcription polymerase chain reaction. Identification of enteroviral RNA and antigen in myocardial tissue provides evidence that enteroviruses are associated with dilated cardiomyopathy. The average enterovirus detection rates from published studies that used different strategies are 10% to 30%. These studies indicate that enteroviral infection is associated with acute viral myocarditis and that it is likely to contribute to a subset of cases of chronic dilated cardiomyopathies.
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