Non-rheumatic streptococcal myocarditis - warm hands, warm heart

Area of Science:

• Cardiology
• Infectious Diseases
• Microbiology

Background:

• Acute myopericarditis in developed nations is typically attributed to viral infections like enteroviruses and adenoviruses.
• These viral causes are often not routinely tested for due to the generally self-limiting nature and good prognosis of myopericarditis.
• The established viral etiology often overshadows other potential causes of this cardiac inflammation.

Observation:

• Two cases of acute myopericarditis were observed in patients with concurrent Streptococcus pyogenes (group A Streptococcus, GAS) pharyngotonsillitis.
• The decision to investigate a microbiological cause was driven by the severity of the upper respiratory tract infection and systemic symptoms.
• This clinical presentation prompted a review of GAS as a potential, albeit under-recognized, etiological agent for myopericarditis.

Findings:

• The study presents two cases linking Streptococcus pyogenes (GAS) pharyngitis to acute myopericarditis.
• Literature review suggests this association may be under-recognized in clinical practice.
• In the absence of rheumatic fever indicators, a toxin-mediated mechanism is hypothesized for GAS-induced myopericarditis.

Implications:

• The findings suggest that Streptococcus pyogenes (GAS) pharyngitis should be considered as a potential cause of acute myopericarditis.
• Testing for GAS in patients presenting with myopericarditis, especially with concurrent pharyngitis, may be warranted.
• This could lead to earlier diagnosis and potentially different management strategies for specific patient cohorts.