Acute Myocarditis in a young infant: a case reflection

Introduction: In Malaysia, a course of vaccination DTaP/IPV/Hib was introduced in 2008, replacing the 2006 DwPT-HBV/Hib+OPV vaccines. Severe systemic adverse reactions after diphtheria, tetanus and pertussis vaccination are uncommon. Cardiac complications are rarely reported and is most probably im...

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Main Authors:	Anuar, Muhamad Azamin, Abu Bakar, Asrar, Abdul Rahman, Amir Hamzah, Hasan, Taufiq Hidayat, Mohamed, Mossad Abdelhak Shaban
Format:	Conference or Workshop Item
Language:	English English
Published:	2019
Subjects:	RA Public aspects of medicine RA0421 Public health. Hygiene. Preventive Medicine RJ Pediatrics RJ101 Child Health. Child health services
Online Access:	http://irep.iium.edu.my/75194/ http://irep.iium.edu.my/75194/7/Muhamad%20Azamin%20Anuar%20-%20PP109.pdf http://irep.iium.edu.my/75194/13/MPA%202019%20myocarditis%20poster%20-%2075194.pdf

id	iium-75194
recordtype	eprints
spelling	iium-751942020-02-26T07:11:22Z http://irep.iium.edu.my/75194/ Acute Myocarditis in a young infant: a case reflection Anuar, Muhamad Azamin Abu Bakar, Asrar Abdul Rahman, Amir Hamzah Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban RA Public aspects of medicine RA0421 Public health. Hygiene. Preventive Medicine RJ Pediatrics RJ101 Child Health. Child health services Introduction: In Malaysia, a course of vaccination DTaP/IPV/Hib was introduced in 2008, replacing the 2006 DwPT-HBV/Hib+OPV vaccines. Severe systemic adverse reactions after diphtheria, tetanus and pertussis vaccination are uncommon. Cardiac complications are rarely reported and is most probably implicated to the pertussis component. We describe a rare case of acute myocarditis that developed 60 hours after DTaP/IPV/Hib vaccination. Case Summary: A 2-month old infant presented to emergency department 60 hours after her first diphtheria, tetanus and pertussis vaccination due to severe respiratory distress and cyanosis. The infant has uneventful antenatal, perinatal and postnatal periods. She had her BCG and two Hepatitis B vaccinations previously with no major side effects. Parents reported that she was feverish for 48 hours post DTaP/IPV/Hib vaccination with no other associated symptoms. Two hours prior to presentation, she was febrile and mother did tepid sponging on her. At this point she went floppy and was immediately brought to hospital. On arrival, she was tachypnoeic and cyanotic with hypoperfusion and hypotensive. She was also noted to have hepatomegaly. She was grunting and her level of consciousness deteriorated. She was immediately intubated and her first blood gas showed profound metabolic acidosis with pH 6.6, base excess -24mmol/L, lactate 14mmol/L and bicarbonate 4mmol/L. She required 40mls/kg of fluid boluses and dobutamine infusion was commenced. She also received antibiotics and sodium bicarbonate to correct her acidosis. Her echocardiography showed global hypokinesia with structurally normal heart, CK was 3018 and positive Troponin I. She was treated with immunoglobulin for myocarditis and was on high frequency oscillation for 4 days before being extubated on day 11 of admission. All her viral serology and cultures came back negative. Conclusion: Cardiac complications and specifically myocardial injury after diphtheria, tetanus and pertussis and other vaccinations are exceptionally uncommon. This patient developed sudden onset cardiogenic deterioration after an expected fever-like illness post vaccination. Given her viral screening and cultures were negative, this make acute myocarditis post vaccination a remote possibility. We concur that evaluation of cardiac state should be considered in recently vaccinated infants who manifest with cyanosis, hypoperfusion and drowsiness. 2019 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/75194/7/Muhamad%20Azamin%20Anuar%20-%20PP109.pdf application/pdf en http://irep.iium.edu.my/75194/13/MPA%202019%20myocarditis%20poster%20-%2075194.pdf Anuar, Muhamad Azamin and Abu Bakar, Asrar and Abdul Rahman, Amir Hamzah and Hasan, Taufiq Hidayat and Mohamed, Mossad Abdelhak Shaban (2019) Acute Myocarditis in a young infant: a case reflection. In: 15th Asian Oceanian Congress of Child Neurology in conjunction with the 41st Malaysian Paediatric Association Annual Congress 2019 “Synergy to Challenge Boundaries in Child Neurology”, 19th-22nd September 2019, Kuala Lumpur. (Unpublished)
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	RA Public aspects of medicine RA0421 Public health. Hygiene. Preventive Medicine RJ Pediatrics RJ101 Child Health. Child health services
spellingShingle	RA Public aspects of medicine RA0421 Public health. Hygiene. Preventive Medicine RJ Pediatrics RJ101 Child Health. Child health services Anuar, Muhamad Azamin Abu Bakar, Asrar Abdul Rahman, Amir Hamzah Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban Acute Myocarditis in a young infant: a case reflection
description	Introduction: In Malaysia, a course of vaccination DTaP/IPV/Hib was introduced in 2008, replacing the 2006 DwPT-HBV/Hib+OPV vaccines. Severe systemic adverse reactions after diphtheria, tetanus and pertussis vaccination are uncommon. Cardiac complications are rarely reported and is most probably implicated to the pertussis component. We describe a rare case of acute myocarditis that developed 60 hours after DTaP/IPV/Hib vaccination. Case Summary: A 2-month old infant presented to emergency department 60 hours after her first diphtheria, tetanus and pertussis vaccination due to severe respiratory distress and cyanosis. The infant has uneventful antenatal, perinatal and postnatal periods. She had her BCG and two Hepatitis B vaccinations previously with no major side effects. Parents reported that she was feverish for 48 hours post DTaP/IPV/Hib vaccination with no other associated symptoms. Two hours prior to presentation, she was febrile and mother did tepid sponging on her. At this point she went floppy and was immediately brought to hospital. On arrival, she was tachypnoeic and cyanotic with hypoperfusion and hypotensive. She was also noted to have hepatomegaly. She was grunting and her level of consciousness deteriorated. She was immediately intubated and her first blood gas showed profound metabolic acidosis with pH 6.6, base excess -24mmol/L, lactate 14mmol/L and bicarbonate 4mmol/L. She required 40mls/kg of fluid boluses and dobutamine infusion was commenced. She also received antibiotics and sodium bicarbonate to correct her acidosis. Her echocardiography showed global hypokinesia with structurally normal heart, CK was 3018 and positive Troponin I. She was treated with immunoglobulin for myocarditis and was on high frequency oscillation for 4 days before being extubated on day 11 of admission. All her viral serology and cultures came back negative. Conclusion: Cardiac complications and specifically myocardial injury after diphtheria, tetanus and pertussis and other vaccinations are exceptionally uncommon. This patient developed sudden onset cardiogenic deterioration after an expected fever-like illness post vaccination. Given her viral screening and cultures were negative, this make acute myocarditis post vaccination a remote possibility. We concur that evaluation of cardiac state should be considered in recently vaccinated infants who manifest with cyanosis, hypoperfusion and drowsiness.
format	Conference or Workshop Item
author	Anuar, Muhamad Azamin Abu Bakar, Asrar Abdul Rahman, Amir Hamzah Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban
author_facet	Anuar, Muhamad Azamin Abu Bakar, Asrar Abdul Rahman, Amir Hamzah Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban
author_sort	Anuar, Muhamad Azamin
title	Acute Myocarditis in a young infant: a case reflection
title_short	Acute Myocarditis in a young infant: a case reflection
title_full	Acute Myocarditis in a young infant: a case reflection
title_fullStr	Acute Myocarditis in a young infant: a case reflection
title_full_unstemmed	Acute Myocarditis in a young infant: a case reflection
title_sort	acute myocarditis in a young infant: a case reflection
publishDate	2019
url	http://irep.iium.edu.my/75194/ http://irep.iium.edu.my/75194/7/Muhamad%20Azamin%20Anuar%20-%20PP109.pdf http://irep.iium.edu.my/75194/13/MPA%202019%20myocarditis%20poster%20-%2075194.pdf
first_indexed	2023-09-18T21:46:23Z
last_indexed	2023-09-18T21:46:23Z
_version_	1777413478227640320

Acute Myocarditis in a young infant: a case reflection

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