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Correspondence

Indian Pediatr 2014;51: 837-838

Pericardial Effusion Associated with Rhinovirus Infection in an Immunocompetent Infant


Saliha Kanik-Yuksek and Hasan Tezer

Ankara Hematology Oncology Children’s Training and Research Hospital, Pediatric Infectious Diseases Department, Altindag, Ankara, Turkey.
Email: [email protected]

 
 


Human rhinovirus (HRV) is one of the most frequent causes of respiratory tract infections (RTIs) [1]. Most HRV infections are self-limited, but sometimes are associated with complications such as severe lower RTIs, bacterial sinusitis and otitis media [2]. Two 4-month-old twin girls, were hospitalized with us in view of hypoxia due to bronchiolitis. On examination, temperature was 37.7ºC, oxygen saturation was 90%, heart and respiratory rates were 128 bpm and 60 per min, respectively. Respiratory system examination revealed rhonchi and chest retraction; cardiac examination was normal. White blood cell and platelet counts were normal; hemoglobin was 9.8 g/dL with hypochromic microcytic anemia. C-reactive protein and blood biochemistry were normal. On chest radiography, bilateral hyperinflation was present without evidence of consolidation. Multiplex viral PCR (Fast Track Diagnostics/ Respiratuar Pathogen 21, Luxemburg) test from nasopharyngeal aspirate was positive for rhinovirus in both the patient and her twin. On fifth day, detailed cardiac examination was planned because of insufficient improvement in hypoxia despite symptomatic treatment. On echocardiography, 9 mm pericardial effusion (PE) was detected on rear wall of interventricular septum with normal cardiac function and anatomy. On repeated echocardiographies, complete disappearance of PE was observed. Hypoxia and bronchospasm improved within ten days, and patient was discharged after normal test results for immune deficiencies. Recurrence was not detected on follow-ups.

In this child, PE could not be attributed to any another cause, and was attributed to HRV infection. To the best of our knowledge, HRV is not reported as a cause of PE. Few cases of pericarditis associated with HRV-C besides most common causes include Coxsackie virus, infectious mononucleosis, Adenovirus, Echo virus, hepatitis viruses and HIV [3,4]. The limitation of diagnosis in our patient was that we could not directly test HRV in pericardial fluid.

References

1. Jacobs SE, Lamson DM, George KS, Walsh TJ. Human rhinoviruses. Clin Microbiol Rev. 2013;26:135-62.

2. Mandell GL, Bennett JE, Dolin R. Rhinovirus. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone; 2010. p.2389-98.

3. Henquell C, Mirand A, Deusebis AL, Regagnon C, Archimbaud C, Chambon M, et al. Prospective genotyping of human rhinoviruses in children and adults during the winter of 2009-2010. J Clin Virol. 2012;53:280-4.

4. Spodick DW. Pericardial diseases. In: Braunwald E, Zipes D, Libby P, editors. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: WB Saunders; 2001.p.1823-76.

 

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