Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis

Abstract

We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis. Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis. Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively). In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.

Zonulina e Presepsina Poderiam ser Biomarcadores e Alvos Terapêuticos para Miocardite Aguda?

“…Além disso, embora observado com menor frequência do que os agentes virais, o desenvolvimento de miocardite após gastroenterite de bactérias enteropatogênicas indica que a permeabilidade intestinal prejudicada pode estar associada ao desenvolvimento de miocardite. 36 …”

An unusual complication of bacterial prostatitis

“…Documented cases of E.coli -related myocarditis in the context of urosepsis have been associated with poor cardiac outcomes and morbidity. 2 Myocarditis is thought to be predominantly attributable to viral, pharmacological or autoimmune causes. The prevalence of acute bacterial myocarditis is not well defined, and there are no established diagnostic criteria.…”

“… 3 The definitive diagnosis of myocarditis ultimately requires invasive sampling with endomyocardial biopsy; in practice, this may be unfeasible except in postmortem. 2 Due to these factors, acute bacterial infection is not typically considered a significant differential in the clinical evaluation of chest pain.…”

Multimodality imaging in acute myocarditis

“…Viral myocarditis is characterized by the presence of subepicardial or mid‐wall enhancement often on the lateral wall or septum 90 while in bacterial myocarditis the LGE can be subepicardial or intramural on the lateral wall 91,92 . In some noninfective etiologies, LGE can show an ischemic pattern mixed with a nonischemic pattern such as in the case of giant cell myocarditis 93 or systemic lupus erythematous 94,95 …”