Frequency and Clinical Profile of Myocarditis in Children Under 5 Years with Measles: a Cross-Sectional Study at Hayatabad Medical Complex, Peshawar

Abstract

Background: Measles remains a significant public health challenge in developing nations, with resurgence episodes often complicated by severe systemic manifestations. Cardiac involvement, particularly acute myocarditis, is a life-threatening complication that significantly increases morbidity and mortality in pediatric populations, especially in children under five years of age.

Objective: To determine the frequency, clinical presentation, and associated outcomes of acute myocarditis among children under 5 years hospitalized with acute measles at the Pediatric Department, Hayatabad Medical Complex, Peshawar.

Methods: This cross-sectional observational study was conducted over a 12-month period in the Pediatric Department at Hayatabad Medical Complex, Peshawar. A total of 154 confirmed measles patients aged 1 to 59 months admitted to the pediatric ward/PICU were consecutively enrolled. Diagnosis of myocarditis was established using clinical criteria (tachycardia disproportionate to fever, gallop rhythm, muffled heart sounds, heart failure), elevated cardiac biomarkers (Troponin I and CK-MB), and electrocardiographic (ECG) / echocardiographic abnormalities (reduced ejection fraction, wall motion abnormalities). Data were analyzed using SPSS version 26.

Results: Results: Out of 154 evaluated children, acute myocarditis was diagnosed in 24 patients, establishing a frequency of 15.6%. The mean age of children with myocarditis was 28.4 ± 11.2 months, with a male predominance (58.3%). The most common presenting symptoms among myocarditis cases included persistent lethargy/irritability (91.7%), tachypnea (83.3%), and severe tachycardia disproportionate to fever (79.2%). Electrocardiographic changes revealed sinus tachycardia (75.0%), ST-T wave abnormalities (54.2%), and low voltage complexes (33.3%). Echocardiography demonstrated left ventricular dysfunction (ejection fraction < 55%) in 70.8% of cases. Elevated cardiac biomarkers were universally observed. Mortality among myocarditis cases was 16.7% (4/24), significantly higher than uncomplicated measles cases.

Conclusion: Acute myocarditis is a frequent and critical complication in young children hospitalized with measles at our center, accounting for substantial morbidity and mortality. Early clinical vigilance, serial cardiac enzyme evaluation, and prompt echocardiography are essential for timely diagnosis and management.