Enterovirus sequences resembling coxsackievirus A2 detected in stool and spleen from a girl with fatal myocarditis

Abstract

A 10-year-old girl who died suddenly was found at post mortem to have myocarditis. Virus could not be cultured from post-mortem stool, spleen or heart but enterovirus RNA was detected in stool and spleen by PCR, and the stool caused flaccid paralysis in newborn suckling mice. A 654 base pair (bp) sequence from the capsid-coding region of the viral genome was amplified from an affected mouse and sequenced. Using this sequence, strain-specific nested primers were designed and used to amplify viral sequences directly from stool and spleen. These sequences were identical to each other and to that obtained from the infected mouse, and most closely resembled Coxsackievirus A2, an uncommon serotype rarely associated with myocarditis. Testing spleen tissue may be useful in etiological investigation of suspected viral myocarditis. PCR proved more sensitive than suckling mouse inoculation in detecting this Coxsackievirus, but a combination of both methods was required for genotypic characterization.