Features of Septic Shock and Hepatitis in Parechovirus MyocarditisEisenhut, Michael MDThe Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p 913 doi: 10.1097/INF.0000000000000761 Letters to the Editor Free Author InformationAuthors Article OutlineOutline Article MetricsMetrics Luton & Dunstable University Hospital, NHS Foundation Trust, Luton, United Kingdom The authors have no funding or conflicts of interest to disclose. Address for correspondence: Michael Eisenhut, MD; E-mail: email@example.com. To the Editors: REFERENCES Back to Top | Article Outline To the Editors: A recent report summarized clinical and laboratory features of human parechovirus (HPeV) genotype 3 infection in infants. The authors noted rapid onset of sepsis-like features with mottled skin appearance and in 2 infants hypovolemic shock.1 The fact that creatinine values were normal in the patients studied and the rapid appearance without diarrhea or vomiting reported makes it unlikely that the cardiovascular compromise of the infants was caused by dehydration as stated by the authors. The patient with the highest alanine aminotransferase (ALT)- levels also had shock. The authors did not take into account that the origin of ALT might be the myocardium. Direct evidence for myocarditis caused by HPeV infection is provided by 3 case reports such as a recent one documenting cardiovascular failure and dilated cardiomyopathy associated with HPeV infection.2 Another described a 14-month-old child who died of myocarditis with HPeV cultured from the myocardium and pericardial fluid3 and a 6-week-old boy with clinical and electrocardiographic evidence of myocarditis and HPeV isolated from stool cultures.4 The elevation of ALT might have been myocardial in origin. It is important to recognize myocarditis because of its risk of fatal arrhythmias and the opportunity to provide supportive treatment with inotropes, such as milrinone, dobutamine and diuretics.3 An aid to recognition of myocarditis could be a three-tiered classification: increase in troponin concentration in the absence of another cause and electrocardiographic changes suggestive of acute myocardial injury or abnormal function on echocardiogram or cardiac magnetic resonance imaging.2 Michael Eisenhut, MD Luton & Dunstable University Hospital NHS Foundation Trust Luton, United KingdomBack to Top | Article Outline REFERENCES 1. Skram MK, Skanke LH, Krokstad S, et al. Severe parechovirus infection in Norwegian infants. Pediatr Infect Dis J. 2014;33:1222–1225 Cited Here... | View Full Text | PubMed | CrossRef 2. Wildenbeest JG, Wolthers KC, Straver B, et al. Successful IVIG treatment of human parechovirus-associated dilated cardiomyopathy in an infant. Pediatrics. 2013;132:e243–e247 Cited Here... | PubMed | CrossRef 3. Maller HM, Powars DF, Horowitz RE, et al. Fatal myocarditis associated with ECHO virus, type 22, infection in a child with apparent immunological deficiency. J Pediatr. 1967;71:204–210 Cited Here... | PubMed | CrossRef 4. Russell SJ, Bell EJ.. Echoviruses and carditis. Lancet. 1970;1:784–785 Cited Here... Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.