Viral link?

[JAMESFETT]

Double tragedy: baby developed hydrocephalus at 17 weeks gestation, survived only a few minutes following delivery at 33 weeks; mother diagnosed with PPCM one week later. Mom (recovering) tested positive during pregnancy for both cytomegalovirus and parvovirus B19, both of which could potentially cause neurological complications in fetus and/or cardiomyopathy in mother. So sorry for the tragedies and hopeful we can learn more through these sorrows. Did any of our PPCM readers experience an infection with one of these viruses during pregnancy?

JD

[LovinLife]

was that in the US? I believe you already have the info on the bloodwork I had done a few weeks after dx.

[JAMESFETT]

Yes, hopefully, by and by she will join us.

JD

[ShannonA]

What kind of symptoms would these viruses cause?

[JAMESFETT]

Exactly the same as for heart failure in PPCM from any other cause.

JD

[mikki]

I'm wondering about myself here... I have no idea if I had these viruses but was very sick at 1 month (given zpack at ER) and had horrible itchy rashes during my pregnancy...
my son was also dx with autism at age 4 (which is neurological)
My son had jaundice when he was born also... and has had those patchy red rashes before also.

would my blood still carry these? I am 7.5 years after dx.

[JAMESFETT]

The best time to test for viruses is at the time of diagnosis of PPCM.

At that time one can test the blood for IgG and IgM antibodies against adenovirus, parvovirus B19, coxsackievirus, human herpesvirus 6, E-B virus, and cytomegalovirus.

If IgM is positive, indicating recent infection with that virus, blood can be further tested by PCR testing for virus particles, indicating current viremia, and hence acute infection going on.

Parvovirus B19 can be tested for various antibodies, the presence of some indicating only partial immunity. If you are currently recovered, there would be no value to do the testing this late after diagnosis. Many adults carry IgG antibodies against these common viruses, and that just means exposure and infection some time in the past. It is very possible you had a viral infection during pregnancy. Could that have caused your son's autism? I don't know, but I worry about that.

During pregnancy one hopes a woman is not exposed to these viruses for the first time. Parvovirus B19 is becoming increasingly a factor, and it is common for women during pregnancy to be exposed to kids with this infection, particularly in daycare and school. Best wishes,

JD

[lisamavs]

My sisters 5 year old had this and his symptoms showed up 3 days after I was exposed to him so he was contagious but I was tested and showed antibodies and was told I was immuned. Even if I was immuned could it be something like that could caused my PPCM or should I look further. Also, what kind of treatment do you get for this type of induced ppcm?

[JAMESFETT]

Some antibodies in PVB19 infection actually indicate previous exposure but incomplete immunity--the non-specific protein IgG antibodies. These are the ones who can flare with later complications. So PVB 19 requires very specific testing. And of course the IgM antibodies are seen early, in the stage of viremia, and may shown positivity on peripheral blood polymerase chain reaction (PCR) testing, meaning active virus in the circulation. Your exposure to PVB19 during pregnancy would be an important medical history item.

If your PPCM was initiated by PVB19 exposure, recent or remote, the treatment so far is still the diuretics, ACE-I, and BB combination. Persistence of virus in non-recovered inflammatory cardiomyopathy is being evaluated with anti-viral treatment, including IV beta-interferon. There are other anti-viral medications in the pipeline, various stages of clinical trials, so the final word is not out yet on this. One treatment that may possibly be helpful is IVIG.

JD

[lisamavs]

I was wondering how much IVIG one would need and for how long? I may qualify for IVIG therapy from hypogammaglobuliemia which I actually posted in another thread question so you may have already answered this :) I use to get treatments 20 mg once a month for it but stopped in 2002 to try to avoid insurance issues of not being able to get coverage for pre-exisiting conditions. ( I wanted to start my own business) The condition is still there so I may be able to get treatment again. Is there any contraindications for Immunaglobulin treatment with PPCM that you have run across over the years and how effective was it in recovery of PPCM due to immune response? Thank you!

[JAMESFETT]

IVIG treatment is very expensive. When used, the dosage has been 2 Gm per kilo, so very large in comparison with what you are taking in replacement therapy. Used once only, over a matter of short time period.

When used for PPCM, it is used in a situation of deteriorating function, sort of a "last measure" and usually in an acute situation. I don't think your situation would apply for consideration of use. But good to review with your cardiologist, so you can vet your thoughts.

JD