Frequency of Different Deranged Cardiac Enzymes in Children Presenting with Measles and Manifesting Clinical Signs of Myocarditis

Abstract

Background: Myocarditis is an inflammatory condition of the myocardium that can complicate measles infection, leading to significant morbidity and mortality in children. Early detection is critical but challenging due to nonspecific clinical presentations and limited access to definitive diagnostic tools in resource-constrained settings. Objective: To determine the frequency of elevated cardiac enzymes, particularly Troponin I, among children with measles and clinical signs of myocarditis, and to analyze demographic, socioeconomic, and clinical factors associated with enzyme elevation. Methods: A cross-sectional study was conducted at the Children’s Ward, Lady Reading Hospital, Peshawar, from January to June 2025, enrolling 125 children aged 6 months to 12 years diagnosed with measles and presenting with clinical signs of myocarditis. Demographic, socioeconomic, and clinical data were collected using structured interviews and physical examinations. Blood samples were analyzed for Troponin I, CK, and CK-MB levels. Associations were assessed using chi-square tests, t-tests, and odds ratios with 95% confidence intervals; significance was set at p≤0.05. Results: Elevated Troponin I was found in 70.7% of children, with significant associations observed for chest pain (80.0%, p=0.008), fatigue (77.5%, p=0.035), arrhythmia (78.0%, p=0.016), shortness of breath (81.0%, p=0.004), fever (76.0%, p=0.039), and lower socioeconomic status (75.0%, p=0.027). Elevated CK and CK-MB levels correlated strongly with elevated Troponin I (p<0.001). Conclusion: Elevated Troponin I is common in children with measles and myocarditis and is significantly associated with key clinical signs and lower socioeconomic status, underscoring the importance of routine cardiac evaluation in this population and the need for equitable public health interventions.