Community-acquired pneumonia (CAP) kills more under-five (U-5) children in Sub-Saharan Africa than in any other part of the world. Co-existing myocarditis and congestive cardiac failure (CCF) in the setting of CAP could play a crucial role in determining the disease outcome. The aim of the study was to evaluate myocarditis in U-5 children with CAP in the emergency room setting using cardiac troponin-T (cTnT) and electrocardiography (ECG). A hospital based cross-sectional study involving 76 children with CAP aged between 2 - 59 months, and their age- and sex-matched controls. Serum cTnT was measured using Roche Cobas® h232 POC system and standard electrocardiographic (ECG) tracings were obtained from participants using the APS Three Channel ECG-3B (Model- EKG-903A3) machine to evaluate for myocarditis. The mean age of subjects in this study was 19.8 ± 12.2 months. The prevalence of ECG features of myocarditis was 45%. The ECG features of myocarditis detected in the study include prolonged PR interval, reduced QRS voltages in limb leads, right axis deviation and prolonged QTc. Presence of elevated cTnT (≥50 ng/L) suggestive of myocarditis was detected in about 10% of subjects with CAP, particularly in those with CCF. The presence of elevated cTnT was a better predictor of mortality than the ECG features of myocarditis (p = 0.029). The prevalence of myocardial involvement in U-5 children with CAP is high and an elevated serum cTnT predicts mortality better than ECG changes in children with CAP.
Cite this paper
Alao, S. , Uzodimma, C. and Olowu, A. (2023). Myocarditis in Under-Five Children with Community-Acquired Pneumonia Using Serum Cardiac Troponin-T and Electrocardiography. Open Access Library Journal, 10, e894. doi: http://dx.doi.org/10.4236/oalib.1110894.
Ylten, F., Tenocak, F., Zorlu, P. and Teziç, T. (2003) Cardiovascular Changes in Children with Pneumonia. The Turkish Journal of Pediatrics, 45, 306-310.
Seedat, M., Feldman, C., Skoularigis, J., Promnitz, D., Smith, C. and Zwi, S. (1993) A Study of Community-Acquired Pneumonia, Including Details of Cardiac Changes. Quarterly Journal of Medicine, 86, 669-675.
https://doi.org/10.1093/qjmed/86.10.669
Cangemi, R., Casciaro, M., Rossi, E., Calvieri, C., Calabrese, C.M., Taliani, G., et al. (2014) Platelet Activation Is Associated with Myocardial Infarction in Patients with Pneumonia. Journal of the American College of Cardiology, 64, 1917-1925.
https://doi.org/10.1016/j.jacc.2014.07.985
Koçak, G., Tabel, Y., Karakurt, C. and Demirdag, Y.Y. (2009) Electrocardiographic Abnormalities of Acute Pneumonia and Bronchiolitis in Children. Inönü Üniversitesi T?p Fakültesi Dergisi, 16, 69-73.
Hegazy, L.A.G., Mossad, H.N., Wahba, N.S. and Ishak, S.R. (2020) Troponin T Level in Children with Acute Chest Diseases and Respiratory Distress Troponin T Level in Children with Acute Chest Diseases and Respiratory Distress. The Egyptian Journal of Chest Diseases and Tuberculosis, 69, 585-589.
https://doi.org/10.4103/ejcdt.ejcdt_191_19
Han, F., Gao, J. and Gai, J. (2018) Detection of Myocardial Enzymes, Cardiac Troponin T and Hepatic and Renal Function in the Diagnosis and Treatment of Severe Pneumonia in Children. Pakistan Journal of Medical Sciences, 34, 1257-1261.
https://doi.org/10.12669/pjms.345.15397
Wells, S.M. and Sleeper, M. (2008) Cardiac Troponins. Journal of Veterinary Emergency and Critical Care, 18, 235-245.
https://doi.org/10.1111/j.1476-4431.2008.00307.x
World Health Organization (2014) Revised WHO Classification and Treatment of Pneumonia in Children at Health Facilities: Evidence Summaries.
http://www.ncbi.nlm.nih.gov/books/NBK264162
Kelly, M.S. and Sandora, T.J. (2020) Community-Acquired Pneumonia. In: Berman, R.E., Kliegman, M.R., St Geme, J.W., Blum, N.J., Shah, S.S., Tasker, R.C., et al., Eds., Nelson Textbook of Pediatrics, 21st Edition, Elsevier Inc., Philadelphia, 2266-2274.
Cherian, T., Mulholland, E., Carlin, J. and Ostensen, H. (2004) Standardized Interpretation of Paediatric Chest Radiographs for the Diagnosis of Pneumonia in Epidemiological Studies. Bulletin of the World Health Organization, 83, 353-359.
Fernandes Jr., C.J., Akamine, N. and Knobel, E. (1999) Cardiac Troponin: A New Serum Marker of Myocardial Injury in Sepsis. Intensive Care Medicine, 25, 1165-1168. https://doi.org/10.1007/s001340051030
Spies, C., Haude, V., Overbeck, M., Schaffartzik, W., Schr?der, K., Fitzner, R., et al. (1998) Serum Cardiac Troponin T as a Prognostic Marker in Early Sepsis. CHEST Journal, 113, 1055-1063. https://doi.org/10.1378/chest.113.4.1055
Moynihan, J.A., Brown, L., Sehra, R. and Checchia, P.A. (2003) Cardiac Troponin I as a Predictor of Respiratory Failure in Children Hospitalized with Respiratory Syncytial Virus (RSV) Infections: A Pilot Study. The American Journal of Emergency Medicine, 21, 479-482. https://doi.org/10.1016/S0735-6757(03)00163-3
Bruce, N., Pope, D. and Stanistreet, D. (2008) Quantitative Methods for Health Research. John Wiley & Sons, West Sussex. https://doi.org/10.1002/9780470725337
Fleiss, J., Levin, B. and Cho Paik, M. (2003) Statistical Methods for Rates and Proportions. 3rd Edition, John Wiley, New York. https://doi.org/10.1002/0471445428
Zhang, Y., Xiao, Y. and Li, X. (2015) Applied Research of Pediatric Pneumonia Serum CK, CTnT Levels and ECG Change Characteristics in Diagnosis and Treatment of Disease and Prognostic Evaluation. Journal of Hainan Medical University, No. 8, 104-107.
Sadoh, W.E., Olubor, O.O., Osueni, G.O. and Daniel, Q. (2018) Management and Outcome of Children with Supraventricular Tachycardia Presenting to the Emergency Room of a Tertiary Centre in Nigeria. Sri Lanka Journal of Child Health, 47, 228-232. https://doi.org/10.4038/sljch.v47i3.8544
Corrales-Medina, V.F., Musher, D.M., Shachkina, S. and Chirinos, J.A. (2013) Acute Pneumonia and the Cardiovascular System. The Lancet, 381, 496-505.
https://doi.org/10.1016/S0140-6736(12)61266-5
Dutt, T.S., Tousheed, S.Z. and Mohan, B.V. (2014) Community Acquired Pneumonia and Cardiac Diseases: A Fatal Association. The Indian Journal of Chest Diseases and Allied Sciences, 56, 153-156. https://doi.org/10.5005/ijcdas-56-3-153
Frencken, J., van Baal, L., Kappen, T., Donke, D., Horn, J., van der Poll, T., et al. (2019) Myocardial Injury in Critically Ill Patients with Community-Acquired Pneumonia: A Cohort Study. Annals of the American Thoracic Society, 16, 606-612.
Trushinskii, Z., Striuk, R. and Krasnopol’skaia, S. (1984) Prognostic Significance of ECG Changes in Acute Pneumonia. Terapevticheskii Arkhiv, 56, 74-78.
Petrilli, C.M. and Giacherio, D.A. (2018) Annals for Hospitalists Inpatient Notes-Clinical Pearls—A Middle-Aged Man with Pneumonia and Elevated High-Sensitivity Troponin Levels. Annals of Internal Medicine, 169, HO2-HO3.
https://doi.org/10.7326/M18-2296