52. Cardiac injury in infants with acute gastroenteritis: Is it ischemia or rota associated carditis

Abstract

Reports suggested that rotavirus could be found in extra-intestinal tissues including the heart following infection and fatal rotavirus myocarditis has been recently reported in 2 children. We hypothesized that rotavirus may have a direct injurious effect on the myocardium of infants and this injury can be detected by the presence of cardiac troponin I (TnI). Methods: Over 8 weeks period, 50 of 150 infants(5–18 months) with acute gastroenteritis were found to have human rotavirus (HRV) gastroenteritis with rotavirus antigenemia. Sera of 150 infants were analyzed for TnI. If TnI value was above the screening limit (0.05 ng/ml), electrocardiogram (ECG) and cardiac ultrasound were performed. Infants with primary conditions associated with elevated TnI were excluded. Results: Thirty four infants (22.6%) had elevated TnI (0.06–2.5 ng/ml), 16 (47%) of them had HRV-GE (p = 0.054). However, none of them had any sign of myocarditis or ischemia in their ECG or cardiac ultrasound scan and their TnI levels normalized within 24–72 h after correction of dehydration. Infants less than 1 year ,and those with dehydration, anemia or acidosis were more prone to have elevated cTnI (p = 0.008, 0.009, 0.006, 0.001, respectively). Multivariate logistic regression analysis, showed that severe dehydration and acidosis are still significantly associated with elevated TnI levels (adjusted OR, 95% CI = 22.9, 2.19–239 and 20.76, 6.15–70, respectively. Conclusion: Our study is the first pediatric study to show that myocardial injury occurs in infants with gastroenteritis and this injury was precipitated by transient ischemia which may go unnoticed on the ECG. However, we could not document rotavirus myocarditis