Published Date: 1998-03-18 23:50:00
Subject: PRO> Viral myocarditis - Malaysia
Archive Number: 19980318.0516

VIRAL MYOCARDITIS - MALAYSIA
****************************
A ProMED-mail post

See Also

Viral myocarditis - Malaysia (Sarawak)(02) 970602120701
Viral myocarditis - Malaysia (Sarawak)(03) 970606150424
Viral myocarditis - Malaysia (Sarawak)(04) 970607230200
Viral myocarditis - Malaysia (Sarawak)(05) 970609134209
Viral myocarditis - Malaysia (Sarawak)(06) 970609160000
Viral myocarditis - Malaysia (Sarawak)(07) 970610125021
Viral myocarditis - Malaysia (Sarawak)(08) 970611150601
Viral myocarditis - Malaysia (Sarawak)(09) 970612130247
Viral myocarditis - Malaysia (Sarawak)(10) 970614210138
Viral myocarditis - Malaysia (Sarawak)(11) 970615093300
Viral myocarditis - Malaysia (Sarawak)(12) 970623174531
Viral myocarditis - Malaysia (Sarawak)(13) 970624154415
Viral myocarditis - Malaysia (Sarawak)(14) 970625130912
Viral myocarditis - Malaysia (Sarawak)(15) 970629145143,
970629150340
Viral myocarditis - Malaysia (Sarawak)(17) 970702081031
Viral myocarditis - Malaysia (Sarawak)(18) 970702084122
Viral myocarditis - Malaysia (Sarawak)(19) 970708133727
Viral myocarditis - Malaysia (Sarawak), end 970808140442
Viral myocarditis - Malaysia (Sarawak), end (02)970813122745
Viral myocarditis - Malaysia (Sarawak), end (03)970813152947
Viral myocarditis/HFM - Malaysia (Sarawak)(04)970703132426
Viral myocarditis/HFM - Malaysia (Sarawak)(05)970725170100
Viral myocarditis/HFM disease - Malaysia 970618154459
Viral myocarditis/HFM disease - Malaysia (02) 970619120243
Viral myocarditis/HFM disease - Malaysia (03) 970625165037
Viral myocarditis/HFM disease - Malaysia (05) 970709112948
and
Viral myocarditis, research - Malaysia 980316225204
Date: Wed, 18 Mar 1998 16:24:16 GMT-3
From: "John Woodall" <WOODALL@SERVER.BIOQMED.UFRJ.BR>

Readers who were with us last year will remember the confusing mixed
outbreak of hand, foot and mouth disease (HFMD) and a syndrome including
encephalitis, flaccid paralysis, heart problems and pulmonary edema
(leakage of fluid into the lungs) that claimed the lives of a number of
children in Sarawak a year ago.
To put the facts in perspective, it is necessary to know that HFMD occurs
annually in Sarawak -- and in many other countries -- principally in
children under 10, and is seasonal. The season in Sarawak begins shortly.
The infection produces vesicles (blisters) on the hands and feet and ulcers
in the mouth. It is very rarely fatal. It is transmitted by direct contact
with nose and throat secretions and feces of infected individuals, and by
aerosol. It is caused by Human coxsackieviruses A4, B5, B9, B10, and
particularly B16; by Human coxsackieviruses B2 and B5; and by Human
enterovirus 71 (EV71). EV71 was isolated from a number of cases of HFMD
during the Malaysian outbreak.
Japanese encephalitis (JE), a mosquito-borne disease, affects all ages, and
is often fatal. It attacks the brain, and is caused by a flavivirus, a
virus of a different family (Flaviviridae) from the Coxsackieviruses and
enteroviruses (family Picornaviridae). Mosquitoes acquire JE virus from
wildlife or pigs and transmit it to humans. No isolations of JE virus were
made during the Malaysian outbreak, so it is unlikely that any of the
encephalitic symptoms seen were due to JE virus.
Viral carditis, or viral myocarditis, may be caused by a variety of Human
coxsackieviruses of both groups A and B, including Human coxsackievirus B5
(CB5). The symptoms are heart failure due to inflammation of the heart
muscle. Laboratory tests on cases in Sarawak were reported to have shown
antibodies to CB5. However, some fatal cases showed no inflammation of the
cardiac muscle.
It appears that most of the fatal cases were not due to EV71 or
CB5 alone, and that none was due to JE virus. We understand that several
isolates of a possibly new virus of yet another virus family were made from
fatal cases by CDC and others. It would be a public service to release
details of this agent.
--
Jack Woodall
Director, ProMED-mail
[The epidemiologic evidence for etiologic attribution in these cases is
scant. Withholding information and absence of full discussions of
laboratory results will, in the long run, prove to be counterproductive. -
Mod.CHC
......................................chc/es
--
*##########################################################*
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################