Cardiac troponin I

A reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection

Yung Feng Huang, P. C. Chiu, C. C. Chen, Y. Y. Chen, K. S. Hsieh, Y. C. Liu, P. H. Lai, H. W. Chang

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count (P=0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II (P=0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.

Original languageEnglish
Pages (from-to)238-243
Number of pages6
JournalJournal of Infection
Volume46
Issue number4
DOIs
Publication statusPublished - May 2003
Externally publishedYes

Fingerprint

Enterovirus Infections
Meningoencephalitis
Troponin I
Enterovirus
Central Nervous System Infections
Central Nervous System
Herpangina
Hand, Foot and Mouth Disease
Veterans Hospitals
Intravenous Immunoglobulins
Brain Diseases
Platelet Count
Cardiomyopathies
Taiwan
Burns
General Hospitals
Hypotension
Muscle Cells
Brain Stem
Disease Outbreaks

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

Cardiac troponin I : A reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection. / Huang, Yung Feng; Chiu, P. C.; Chen, C. C.; Chen, Y. Y.; Hsieh, K. S.; Liu, Y. C.; Lai, P. H.; Chang, H. W.

In: Journal of Infection, Vol. 46, No. 4, 05.2003, p. 238-243.

Research output: Contribution to journalArticle

Huang, Yung Feng ; Chiu, P. C. ; Chen, C. C. ; Chen, Y. Y. ; Hsieh, K. S. ; Liu, Y. C. ; Lai, P. H. ; Chang, H. W. / Cardiac troponin I : A reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection. In: Journal of Infection. 2003 ; Vol. 46, No. 4. pp. 238-243.
@article{c433cee1a5084d5eb70f06604fbd0196,
title = "Cardiac troponin I: A reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection",
abstract = "Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count (P=0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II (P=0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.",
author = "Huang, {Yung Feng} and Chiu, {P. C.} and Chen, {C. C.} and Chen, {Y. Y.} and Hsieh, {K. S.} and Liu, {Y. C.} and Lai, {P. H.} and Chang, {H. W.}",
year = "2003",
month = "5",
doi = "10.1053/jinf.2002.1117",
language = "English",
volume = "46",
pages = "238--243",
journal = "Journal of Infection",
issn = "0163-4453",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Cardiac troponin I

T2 - A reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection

AU - Huang, Yung Feng

AU - Chiu, P. C.

AU - Chen, C. C.

AU - Chen, Y. Y.

AU - Hsieh, K. S.

AU - Liu, Y. C.

AU - Lai, P. H.

AU - Chang, H. W.

PY - 2003/5

Y1 - 2003/5

N2 - Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count (P=0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II (P=0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.

AB - Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count (P=0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II (P=0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.

UR - http://www.scopus.com/inward/record.url?scp=0037869584&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037869584&partnerID=8YFLogxK

U2 - 10.1053/jinf.2002.1117

DO - 10.1053/jinf.2002.1117

M3 - Article

VL - 46

SP - 238

EP - 243

JO - Journal of Infection

JF - Journal of Infection

SN - 0163-4453

IS - 4

ER -