Cover Image

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...

Full description

Saved in:
Bibliographic Details
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/75194/7/Muhamad%20Azamin%20Anuar%20-%20PP109.pdf
http://irep.iium.edu.my/75194/13/MPA%202019%20myocarditis%20poster%20-%2075194.pdf
http://irep.iium.edu.my/75194/
Tags: Add Tag
No Tags, Be the first to tag this record!
id my.iium.irep.75194
record_format dspace
spelling my.iium.irep.751942020-11-09T02:14:43Z 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)
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
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/75194/7/Muhamad%20Azamin%20Anuar%20-%20PP109.pdf
http://irep.iium.edu.my/75194/13/MPA%202019%20myocarditis%20poster%20-%2075194.pdf
http://irep.iium.edu.my/75194/
_version_ 1683230338532245504
score 13.211869

Similar Items