Parvovirus B19

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Abstract
We would like to add some information to Young and Brown's review (Feb. 5 issue)1 of parvovirus B19 infection and myocarditis. We studied myocardial tissue from five patients with fulminant parvovirus B19–associated myocarditis by in situ hybridization and showed that parvovirus B19 is present exclusively in endothelial cells of the smaller intramyocardial vessels ( Figure 1A ), not in cardiac myocytes.2 Additional immunohistochemical investigation revealed marked expression of E-selectin by endothelial cells of parvovirus B19–infected hearts, a finding indicative of endothelial dysfunction, and massive margination and adhesion of T lymphocytes in the venular compartment ( Figure 1B ). These processes may lead to disturbances in the coronary microcirculation, followed by an increase in coronary resistance with secondary myofibrillar degeneration ( Figure 1B ) and myocyte necrosis — lesions that are similar to the morphologic lesions seen in ischemic heart disease.3,4 These findings would explain the observation that many patients with parvovirus B19–associated myocarditis present with the clinical signs that are typical of ischemic heart disease.5