Molecular detection and serotypic analysis of enterovirus RNA in archival specimens from patients with acute myocarditis.

OBJECTIVE To determine whether enterovirus RNA can be demonstrated in archival necropsy material in acute myocarditis. DESIGN Analysis of paraffin embedded myocardial tissue from cases of acute myocarditis. SETTING University virology department. METHODS Extraction of RNA from tissue followed by polymerase chain reaction (PCR) and DNA sequence analysis. PATIENTS Six patients with histologically proven myocarditis and eight controls. RESULTS Enterovirus RNA was identified in 5 of 6 patients with myocarditis and in none of the controls. The nucleotide sequences of the PCR products showed greatest similarity to group B coxsackieviruses, particularly coxsackievirus B3. CONCLUSION This study indicates that archival tissue samples, even histologically stained tissue sections, can be used to study the role of enteroviruses in myocardial disease using molecular detection techniques. If a predominant role for coxsackievirus B3 in myocarditis is confirmed by further study, this may have implications for the development of a specific vaccine.