Aim: The investigation of three fatal cases during a nationwide cluster
of cases of an upper respiratory tract infection (URTI) associated with
myocarditis and/or pericarditis in Greece in 2002.
Methods: In the three women who died, necropsies were performed and
tissue sections were taken for histological examination, antigen
detection by immunohistochemistry and indirect immunofluorescence assay
(IFA), amplification of viral genomes by nested reverse transcription
polymerase chain reaction (RTPCR), and sequence analysis.
Results: All samples showed histological signs of active myocarditis.
Immunohistochemistry revealed the presence of the enterovirus VP1 family
of proteins and IFA revealed the presence of coxsackievirus B3 antigen.
Nested RT-PCR amplified enteroviral alleles of the 5’-untranslated
region which were identical to each other and to the coxsackievirus B3
sequences.
Conclusions: This study provides pathological evidence of enteroviral
infection among fatal myocarditis cases in a nationwide URTI cluster of
cases associated with myocarditis and/or pericarditis
