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Early onset, non-rheumatic, group A streptococcal-associated myocarditis
Oded Shamriz1, Yuval Tal1, Ronen Durst2
1Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Clinical and Experimental Rheumatology
|January 9, 2019
Summary
Group A streptococcal (GAS) tonsillitis can cause non-rheumatic fever (non-RF) myocarditis, often affecting young men. Prompt antibiotic treatment leads to good recovery, though misdiagnosis is possible.
Area of Science:
- Cardiology
- Infectious Diseases
- Rheumatology
Background:
- Group A streptococcal (GAS) tonsillitis is an infrequent cause of acute non-rheumatic fever (non-RF) myocarditis.
- Understanding the characteristics of non-RF GAS-myocarditis is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the occurrence, diagnosis, management, and prognosis of non-RF GAS-myocarditis.
- To delineate the clinical presentation and outcomes of patients with this condition.
Main Methods:
- Retrospective analysis of medical records from 1998-2016 for patients diagnosed with acute rheumatic fever or non-RF streptococcal myocarditis.
- Literature review of relevant studies published between 1973-2016.
Main Results:
- Eight cases of non-RF GAS-myocarditis were identified, predominantly affecting young males (7/8).
- Patients presented with symptoms like sore throat followed by chest pain, ECG abnormalities, and some required coronary catheterization due to suspected myocardial infarction.
- Three patients experienced heart failure, but all recovered with antibiotic treatment and NSAIDs, with one recurrence.
Conclusions:
- Non-RF GAS-myocarditis typically affects healthy young males and accounts for approximately 3% of hospitalized myocarditis cases.
- Misdiagnosis as acute rheumatic fever or myocardial infarction is a concern.
- Prognosis is generally favorable with antibiotic therapy and potentially NSAIDs.
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