Made available in DSpace on 2014-06-12T18:32:26Z (GMT). No. of bitstreams: 2 arquivo8111_1.pdf: 2471883 bytes, checksum: c0fb13a5284ed20837a6628a9217346f (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2006 / O diagnóstico das doenças exantemáticas virais apresenta muitas falhas quando baseado apenas em critérios clínicos, principalmente nos países onde os casos de sarampo e rubéola são raros. Estudos realizados em diversos países apontam outras viroses determinantes de doenças exantemáticas confundidas com sarampo e rubéola. Para verificar a freqüência de sarampo, rubéola, dengue e eritema infeccioso dos casos suspeitos de sarampo e rubéola no estado de Pernambuco, no período de 2001 a 2004, foram analisadas 1.161 amostras de soro encaminhadas ao Laboratório Central de Saúde Pública de Pernambuco. Ensaios imunoenzimáticos (ELISA), para detecção de anticorpos IgM específicos para os respectivos vírus foram utilizados. O diagnóstico laboratorial foi confirmado em 23,8% (276/1161) dos casos investigados. Destes, foram identificados como dengue, 16,9% (196/1161), parvovírus B19, 3,3% (38/1161), rubéola, 2,8% (32/1161) e sarampo, 0,9% (10/1161). Todos os exames positivos para sarampo e 44% dos positivos para rubéola foram decorrentes, provavelmente, de reação vacinal. Este é o primeiro estudo que evidencia a circulação de parvovírus B19 em Pernambuco, tendo sido observado que 92,1% dos casos positivos para esse agravo e 90,8% dos casos positivos para dengue, tiveram como hipótese diagnóstica a rubéola, devido à semelhança dos seus sintomas. O alto percentual de doenças exantemáticas sem a etiologia definida (76,2%), indica a necessidade de implementar o diagnóstico diferencial para que outros agravos possam ser melhor investigados. Essa conduta é importante para nortear o sistema de vigilância epidemiológica que deverá ser implantado após a erradicação do sarampo, além de dar maior credibilidade à qualidade e eficácia da vacina dupla ou tríplice viral

Background: Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia. Materials and Methods: A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716). Results: Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%-76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%-18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%-15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%-41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses. Conclusion: The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.

Parvovirus B19 is a common human pathogen that typically infects erythroid progenitors and causes hematological problems such as anemia and aplastic crises. The clinical presentation depends mainly on the immunological status of the patient. PVB19 can cause serious clinical disorders in immunocompromised patients after transplantation. More than 1500 samples from 90 patients who passed the HSCT in 2015 were tested for the presence of PVB19 in this work. This work describes the incidence of the virus and two typical periods of onset of infection in patients after the transplantation. Although several sources report the negative effect of PVB19 infection on the survival of allogeneic graft patients, this work did not confirm this assertion. Also, the results of this work suggest that allogenic grafts are not the main source for transmission, but that it is likely to be reactivated after long-term persistent or latent PVB19 infections. PVB19 is divided into 3 genotypes. Genotype 1 is the most widespread, genotype 2 is very rare in Europe for the last 10 years, and genotype 3 occurs mainly in tropical localities. This work as the first describes the distribution of genotypes in the Czech Republic. More than 130 samples from 125 PVB19 positive patients, stored in the Motol University Hospital from 2004...

O Programa Nacional de Controle e Erradicação de Brucelose e Tuberculose (PNCEBT) proposto pelo MAPA (Ministério da Agricultura Pecuária e Abastecimento) adotou como medida central à vacinação com a B19 de todas as fêmeas das espécies bovina e bubalina, entre três e oito meses de idade. Embora a B19 seja capaz de conferir 65 a 70 % de proteção contra a maioria dos níveis de exposição de fêmeas bovinas, se utilizada na dose correta e na idade recomendada, o período de excreção e seu efeito sobre animais comunicantes e suscetíveis, incluindo o homem ainda são pouco conhecidos e por se tratar de uma vacina viva e virulenta deve-se atentar para o papel zoonótico no manejo dos animais excretores. O presente estudo avaliou a excreção da estirpe B19 pelo leite e urina, de 14 fêmeas bovinas de diferentes faixas etárias, que foram imunizadas dos três aos oito meses de idade, provenientes de um rebanho de exploração leiteira, empregando-se o diagnóstico bacteriológico e PCR, correlacionando-os com as fases hormonais de um ciclo reprodutivo completo. Todas as amostras positivas na PCR para Brucella spp. foram confirmadas como sendo da estirpe vacinal B19, sendo sua excreção predominantemente no momento do cio aos 150 dias de gestação e no pós-parto imediato (30 dias), ou seja, independentemente da fase hormonal. A persistência e excreção de B19 foi observada em fêmeas bovinas de até nove anos de idade. / The National Program of Brucellosis and Tuberculosis Control and Eradication (PNCEBT) designed by MAPA (Ministério da Agricultura Pecuária e Abastecimento) adapted as the central of vaccination by law with B19 the of all females of bovine and bubaline species, between three and eight months of age. However the B19 should be capable of verifying 65 - 70% of protection against a large number of levels of exposition of bovines if utilized in the correct dose and age recommended the period of excretion and your effect about communicant animals and bound to included men but are still not well known and for the subject of biovaccines of a high infectious should be watchful for the role of zoonotic in the handling of animals that?s eliminate these vaccines. This studies evaluated the excretion of B19 strain in milk and urine of 14 bovine females the different ages that was immunized at three and eight months of age originated from heads of milky exploration, based on the bacteriologic tests and polymerize chain reaction (PCR) diagnoses correlated with hormonal fases of complete reproductive cycle. All of positive samples in PCR for Brucella spp. was confirmed for B19 strain being its excretion predominantly at moment of cio about 150 pregnant days and the pos parturition (30 days) or else independently the hormonal fase. The persistence and excretion of B19 was observed in bovine females until nine years old.

Erythrovirus B19 infects erythrocytic progenitor cells, leading to a transient interruption of erythropoiesis. It is the causal agent of several clinical syndromes, including erythema infectiosum and its associated (or isolated) joint symptoms; transitory aplastic crisis of individuals with hemolytic anemias; non-immune hydrops fetalis; and the chronic anemias of immunosuppressed patients, including those with AIDS. In this latter setting, erythrovirus B19 assumes certain importance, as it is, among the innumerable causes of anemia in AIDS, a treatable one. Aiming at to look for evidences of erythrovirus B19 infection, bone marrow stored material from 42 autopsies (49 paraffin blocks) and 36 biopsies (48 paraffin blocks from 31 patients)underwent histopathological examinations and immunohistochemical and in situ hybridization tests. As a whole, 97 paraffin blocks, from autopsies and necropsies done from 1988 to 2002, were examined. Eighty-five sections were stained with hematoxylin-eosin (HE) and examined under optical microscopy. In 20 out of these blocks intra-nuclear inclusion bodies displacing the chromatin to the periphery (lantern cells), suggestive of erythrovirus B19 infection, were noticed. Eighty-seven sections were also subjected to immunohistochemistry, in which ten were deemed positive. The immunohistochemistry was repeated in these ten sections and seven were again considered positive (two from necropsy material, plus five biopsies from four patients). Nine out of the 10 originally mmunohistochemistry positive sections were also subjected to in situ hybridization, with three positives, one of them strongly. Nine other sections, taken among those that were positive under HE, were also subjected to in situ hybridization, where four were considered positive. Among the techniques used in this study, the most easy-to-do was microscopy of HE-stained sections, the lantern cells being, as described in the literature, easily seen. Most bone marrow sections were normocellular or hypocellular, and many had myelodysplastic changes, plasma cell infiltrates, histiocytosis, and hyperplasia of megacaryocytes, with immature and dysmorphic forms. In spite of the tests being done blindly, there was a regular agreement between HE and immunohistochemistry results, as the percentage of HE positive sections were far greater among the immunohistochemistry positive ones. Among the 15 sections subjected to the three techniques used in the study, only one gave unequivocal positive results with all three. The use of immunohistochemistry and in situ hybridization in the diagnosis of erythrovirus B19 infections in paraffin-stored bone marrow material deserves further study. The frequency of erythrovirus B19 infection in the examined material can be deemed low. / O eritrovírus B19 infecta precursores eritrocíticos, determinando a interrupção temporária da eritropoese. É o agente causal de várias síndromes clínicas, entre as quais: o eritema infeccioso e os quadros articulares que o acompanham (ou que surgem isoladamente); a crise aplástica transitória dos indivíduos com anemias hemolíticas; a hidropisia fetal não imune; e as anemias crônicas dos pacientes imunossuprimidos, incluindo aqueles com AIDS. Nesse último contexto a infecção pelo eritrovírus B19 reveste-se de certa importância, por tratar-se, dentre as inúmeras causas de anemia em pacientes com AIDS, de uma infecção passível de tratamento. Com o intuito de investigar as evidências de infecção pelo eritrovírus B19, o material estocado das medulas ósseas de 42 necropsias (49 blocos de parafina) e 36 biópsias (48 blocos de parafina, de 31 pacientes) foi submetido a exame histopatológico, imunoistoquímica e hibridização in situ. No total, foram estudados 97 blocos de parafina, provenientes de biópsias e necropsias realizadas entre 1988 e 2002. Oitenta e cinco cortes foram corados pela hematoxilina-eosina (HE) e examinados à microscopia óptica. Em vinte desses blocos foi observada a presença de corpúsculos de inclusão intranucleares eosinofílicos, deslocando a cromatina para a periferia, sugestivos de infecção por eritrovírus B19 (células em lanterna). Oitenta e sete cortes foram também submetidos a imunoistoquímica, sendo que dez cortes foram considerados positivos. A imunoistoquímica foi repetida nesses dez cortes, e sete foram novamente positivos (dois de material de necropsia, mais cinco biópsias de quatro pacientes). Nove dos dez cortes inicialmente positivos à imunoistoquímica foram também submetidos a hibridização in situ sendo três deles positivos, um deles fortemente. Nove outros cortes, escolhidos por terem sido positivos à HE, foram também submetidos a hibridização in situ, sendo quatro considerados positivos. Das técnicas empregadas no presente estudo, a de mais fácil realização foi o exame microscópico dos cortes corados à HE, sendo as células em lanterna de fácil visualização, conforme padrão descrito na literatura. A maior parte das medulas era normo ou hipocelular e muitas continham alterações mielodisplásicas, plasmocitose, histiocitose e hiperplasia dos megacariócitos, com formas imaturas e dismórficas. Apesar de os exames terem sido conduzidos de modo cego, houve regular concordância entre os resultados da HE e os da imunoistoquímica, uma vez que o percentual de lâminas positivas à HE foi bem maior entre as lâminas positivas à imunoistoquímica. Dos 15 cortes submetidos às três técnicas empregadas no estudo, apenas um corte mostrou resultados positivos inequívocos em todas elas. O emprego de imunoistoquímica e da hibridização in situ no diagnóstico da infecção pelo eritrovírus B19 em material de medula óssea estocado em parafina merece estudos adicionais. A freqüência de infecção por eritrovírus B19 pode ser considerada baixa no material examinado.

O Programa Nacional de Controle e Erradicação de Brucelose e Tuberculose (PNCEBT) proposto pelo MAPA (Ministério da Agricultura Pecuária e Abastecimento) adotou como medida central à vacinação com a B19 de todas as fêmeas das espécies bovina e bubalina, entre três e oito meses de idade. Embora a B19 seja capaz de conferir 65 a 70 % de proteção contra a maioria dos níveis de exposição de fêmeas bovinas, se utilizada na dose correta e na idade recomendada, o período de excreção e seu efeito sobre animais comunicantes e suscetíveis, incluindo o homem ainda são pouco conhecidos e por se tratar de uma vacina viva e virulenta deve-se atentar para o papel zoonótico no manejo dos animais excretores. O presente estudo avaliou a excreção da estirpe B19 pelo leite e urina, de 14 fêmeas bovinas de diferentes faixas etárias, que foram imunizadas dos três aos oito meses de idade, provenientes de um rebanho de exploração leiteira, empregando-se o diagnóstico bacteriológico e PCR, correlacionando-os com as fases hormonais de um ciclo reprodutivo completo. Todas as amostras positivas na PCR para Brucella spp. foram confirmadas como sendo da estirpe vacinal B19, sendo sua excreção predominantemente no momento do cio aos 150 dias de gestação e no pós-parto imediato (30 dias), ou seja, independentemente da fase hormonal. A persistência e excreção de B19 foi observada em fêmeas bovinas de até nove anos de idade. / The National Program of Brucellosis and Tuberculosis Control and Eradication (PNCEBT) designed by MAPA (Ministério da Agricultura Pecuária e Abastecimento) adapted as the central of vaccination by law with B19 the of all females of bovine and bubaline species, between three and eight months of age. However the B19 should be capable of verifying 65 - 70% of protection against a large number of levels of exposition of bovines if utilized in the correct dose and age recommended the period of excretion and your effect about communicant animals and bound to included men but are still not well known and for the subject of biovaccines of a high infectious should be watchful for the role of zoonotic in the handling of animals that?s eliminate these vaccines. This studies evaluated the excretion of B19 strain in milk and urine of 14 bovine females the different ages that was immunized at three and eight months of age originated from heads of milky exploration, based on the bacteriologic tests and polymerize chain reaction (PCR) diagnoses correlated with hormonal fases of complete reproductive cycle. All of positive samples in PCR for Brucella spp. was confirmed for B19 strain being its excretion predominantly at moment of cio about 150 pregnant days and the pos parturition (30 days) or else independently the hormonal fase. The persistence and excretion of B19 was observed in bovine females until nine years old.

Para avaliar a circulação e freqüência dos genótipos de eritrovírus na região amazônica, foi analisado um total de 487 amostras de soros/plasmas colhidas de pacientes apresentando sintomas e sinais clínicos sugestivos de infecção pelos eritrovírus. O ensaio imunoenzimático foi utilizado para detecção de anticorpos específicos para B19, das classes IgM/IgG, e a reação em cadeia da polimerase/semi-nested PCR para detecção do DNA. Das 487 amostras examinadas, 117 (24%) mostraram a presença do DNA dos eritrovírus, sendo todas as 117 foram posteriormente seqüenciadas e genotipadas. A maioria dos isolamentos foi classificada como genótipo 1 (91% das amostras) e 3b (9% ). Também observamos três diferentes grupos dentro do genótipo 1 (A1, A2, B). Conseqüentemente, estas linhagens de B19 introduzidas em Belém apresentaram uma elevada taxa de mudanças dos aminoácidos, decorrência da pressão seletiva, gerando reinfecções consecutivas em uma pequena rede de transmissão, metaforicamente comparada a uma \"panela de pressão evolutiva\". / To assess the circulation and relative frequency of erythrovirus genotypes in clinical samples from patients living in the Amazon region we screened a total of 487 samples from patients suffering from different clinical manifestations suggestive of erythrovirus infections. Enzyme-linked immunosorbent assay was used to detect B19-specific IgM/IgG antibodies and polymerase chain reaction/ semi-nested PCR for viral DNA detection. Of the 487 samples 117 (24%) were positive for the erythrovirus DNA and all 117 isolates were sequenced and genotyped analyzing a fragment of 476 bp of VP1 and VP2 gene sequences of the erythrovirus. The majority of isolates was classified as genotype 1 (91% of the samples) and 3b (9% of the samples). We also reported three different clusters (A1, A2, B) within genotype 1. Our analysis revealed a strikingly different pattern of evolutionary change for those viral lineages introduced in Belém, which exhibited a higher rate of nonsynonymous substitutions compared to those viruses sampled from other locations.

Para avaliar a circulação e freqüência dos genótipos de eritrovírus na região amazônica, foi analisado um total de 487 amostras de soros/plasmas colhidas de pacientes apresentando sintomas e sinais clínicos sugestivos de infecção pelos eritrovírus. O ensaio imunoenzimático foi utilizado para detecção de anticorpos específicos para B19, das classes IgM/IgG, e a reação em cadeia da polimerase/semi-nested PCR para detecção do DNA. Das 487 amostras examinadas, 117 (24%) mostraram a presença do DNA dos eritrovírus, sendo todas as 117 foram posteriormente seqüenciadas e genotipadas. A maioria dos isolamentos foi classificada como genótipo 1 (91% das amostras) e 3b (9% ). Também observamos três diferentes grupos dentro do genótipo 1 (A1, A2, B). Conseqüentemente, estas linhagens de B19 introduzidas em Belém apresentaram uma elevada taxa de mudanças dos aminoácidos, decorrência da pressão seletiva, gerando reinfecções consecutivas em uma pequena rede de transmissão, metaforicamente comparada a uma \"panela de pressão evolutiva\". / To assess the circulation and relative frequency of erythrovirus genotypes in clinical samples from patients living in the Amazon region we screened a total of 487 samples from patients suffering from different clinical manifestations suggestive of erythrovirus infections. Enzyme-linked immunosorbent assay was used to detect B19-specific IgM/IgG antibodies and polymerase chain reaction/ semi-nested PCR for viral DNA detection. Of the 487 samples 117 (24%) were positive for the erythrovirus DNA and all 117 isolates were sequenced and genotyped analyzing a fragment of 476 bp of VP1 and VP2 gene sequences of the erythrovirus. The majority of isolates was classified as genotype 1 (91% of the samples) and 3b (9% of the samples). We also reported three different clusters (A1, A2, B) within genotype 1. Our analysis revealed a strikingly different pattern of evolutionary change for those viral lineages introduced in Belém, which exhibited a higher rate of nonsynonymous substitutions compared to those viruses sampled from other locations.

Background: Although infectious diseases are less common in high-income countries compared to low-income countries, they should still be seriously considered as a relevant public health issue. Some professions, such as healthcare workers, laboratory workers, and care providers may be at a particularly high risk of acquiring infections. In Germany, work-related infectious diseases are after skin diseases, the most common cause of occupational diseases reported to the Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW). An occupational disease, as defined by the WHO, is “any disease contracted primarily as a result of an exposure to risk factors arising from work activity”, although this definition varies between countries. In order for infections to be recognized as an occupational disease, either the identification of an index case is needed or it must be shown that the likelihood in which a particular case of illness was attributable to the occupation: the probability of causation must be greater than 50% (the “more-likely-than-not” rule). A general “rule-of-thumb” is to equate the probability of causation of 50% with a relative risk of disease equal to two (the “doubling of the risk”). This principle is used by many countries for the recognition of an occupational disease. Few studies have concentrated on the risk of infectious disease in daycare workers, who may be at higher risk than the general population due to their frequent and close contact to young children. Research questions: The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk for infections not preventable by vaccines. Furthermore, research gaps were to be identified. Finally, the implications for practice and health policy based on the evidence were to be described. Methods: For the systematic reviews with meta-analysis, the Medline and Embase databases were searched using search strings defined according to the Population, Exposure, Comparison, and Outcomes (PECO) applicable to the research questions in order to find studies on vaccine non-preventable infections in daycare workers published since 2000. The search hits were evaluated using predefined inclusion and exclusion criteria by two independent reviewers. A separate manual search was performed by reviewing the reference lists of key articles and systematic reviews. The “citation tracking factor” by Google scholar was used to find additional relevant studies. The resulting studies were extracted and were assessed in eight risk of bias domains for the judgement of study quality. With a meta-analysis, the pooled risk of infections for daycare workers compared to the general or a reference population was calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: After evaluating the 6879 records, ten methodologically adequate studies were identified regarding parvovirus B19 infection (four studies) and cytomegalovirus (CMV) infection (six studies). No adequate studies on other infections were found. For parvovirus B19 infection, three cross-sectional studies and one retrospective cohort study were identified. The pooled parvovirus B19 seroprevalence in daycare workers was 70.3% (95% CI 59.5-80.4). Of three studies investigating the relative risk (RR) of parvovirus B19 infection on daycare workers, only one study evaluated seroconversion rates. There was an indication for an increased risk of parvovirus B19 infection for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98–1.27) using prevalence estimators. Furthermore, daycare workers had a higher parvovirus B19 seroconversion rate compared to the unexposed population (RR = 2.63, 95% CI 1.27–5.45) in the low risk of bias study. For CMV infection, five cross-sectional studies and one cohort study were included. The pooled CMV seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, RR=1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers. Conclusions: The findings suggest higher parvovirus B19 and cytomegalovirus seroprevalence for daycare workers compared to the general population. There is a need for longitudinal and higher-quality studies regarding infections not preventable by vaccines in daycare workers, as well as a need to study other infections for which daycare workers may be at higher risk. Nonetheless, when the actual occupational seroconversion risk is considered by taking into account the pre-occupational seroprevalences, the pooled relative risks for both parvovirus B19 and CMV infection are compatible with a doubled seroconversion risk corresponding to a probability of causation due to the occupation of at least 50%. Preventative efforts in the workplace are needed based on the legally required risk assessment at the workplace. Moreover, it is important to raise awareness of the potential risk of infection in women trying to conceive or during pregnancy. Recommendations to prevent infections in the day care center include using gloves and frequent handwashing after exposure to young children’s bodily fluids, cleaning surfaces, and avoiding intimate contact with young children if pregnant, although these measures alone may not completely protect the daycare worker from infection. Currently, in Germany, an employment ban for pregnant daycare workers depends on the federal state. To avoid occupational risks for pregnant daycare workers, scientific-based guidelines should be developed and applied consistently.

Die entzündliche Kardiomyopathie ist eine heterogene Erkrankung. Die häufigste Ursache ist eine Virusinfektion, wobei Parvovirus B19 (B19V) der bedeutendste Erreger ist. In dieser Arbeit wurden potenzielle Therapie für die speziellen klinischen Verläufe und deren Phänotypen untersucht. In vitro konnte gezeigt werden, dass Telbivudin in B19V-infizierten/B19V-non-structural protein-1-stimulierten humanen mikrovaskulären Endothelzellen (HMEC-1) endothelial-protektiv wirkt. In einem klinischen Versuch wurden dann 4 Patienten, bei denen eine aktive Transkription des B19V nachgewiesen wurde, für 6 Monate mit Telbivudin behandelt. Alle Patienten verbesserten sich. Ein anderes klinisches Szenario stellt die schwere Entzündung des Myokards dar, welche gewöhnlich mit einer inaktiven/persistierenden Infektion des B19V verbunden ist. Eine Behandlung mit Immunsuppressiva ist hier umstritten, da eine Reaktivierung des Virus befürchtet wird. Um diesen Aspekt weiter zu untersuchen, würde eine Therapie mit Prednisolon in Kombination mit Azathioprin bei 51 B19V-positiven und 17 B19V-negativen Patienten angewandt. Beide Gruppen profitierten in ähnlichem Maße von der Kombinationstherapie, wobei sich die Virusmenge nicht signifikant veränderte. Bei B19V-negativen Patienten konnte über die Persistenz von CD20+ B-Lymphozyten in den EMBs die Untergruppe der „Steroide non-responder“ klassifiziert werden. Im weiteren Verlauf wurden 6 Patienten mit Rituximab, einem monoklonalen Antikörper, der spezifisch gegen CD20+ B-Lymphozyten gerichtet ist, behandelt. Hiervon zeigten 5 Patienten eine ausgezeichnete klinische Verbesserung. Ein Patient mit Myokarditis-induzierten kardiogenen Schock zeigt, dass die Entlastung des linken Ventrikels mittels eines Mikroaxialpumpensystems zu einer rapiden Abnahme der Entzündungszellen führt. Zusammenfassend liefert diese Arbeit Belege für die Wirksamkeit und die Notwendigkeit einer phänotypbasierten Behandlung bei der entzündlichen Kardiomyopathie. / Inflammatory cardiomyopathy is a heterogenous disease. Viral etiologies are the most common, with parvovirus B19 (B19V) being the most prominent culprit. Currently, no specific treatment for inflammatory cardiomyopathy exists. In this study, tailored treatment strategies were investigated as potential therapies for specific clinical scenarios. The antiviral drug telbivudine was investigated in the setting of EMB-proven B19V-associated inflammatory cardiomyopathy. In cell culture, telbivudine exhibited endothelial-protective effects on B19V-infected/B19V-non-structural protein-1-stimulated human microvascular endothelial cells (HMEC-1). Clinically, four B19V-positive patients improved following six-month telbivudine regimen in a single-patient use approach. The results were translated to the “PreTOPIC” clinical study, for further evaluation in a randomized placebo-controlled setting. In a different clinical scenario, severe myocardial inflammation is usually associated with inactive/persistent B19V. Here, the use of immunosuppression is controversial, fearing viral flare-up. We investigated combined prednisolone/azathioprine therapy in 51 B19V-positive and 17 B19V negative patients in a single-center observational study. Both groups gained similar benefit, while viral loads did not significantly vary. Among virus-negative phenotypes, EMB-proven CD20+ B lymphocyte persistence characterized a subgroup of steroid non-responders. In this cohort, six patients were treated with rituximab, a monoclonal antibody selectively targeting CD20+ B lymphocytes. Five patients showed outstanding clinical improvement parallel to CD20+ B lymphocyte depletion. Lastly, in a single case of myocarditis-induced cardiogenic shock, mechanical left ventricular unloading via axial flow pump proved to exert disease-modifying effects. In conclusion, this thesis provides evidence for the efficacy and need for phenotype-based inflammatory cardiomyopathy treatment.