From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

Schmutzler, Lukas; Mirna, Moritz; Hoppe, Uta C.; Lichtenauer, Michael

doi:10.3390/jcdd9060170

Cited by 6 publications

(7 citation statements)

References 39 publications

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“…On the other hand, numerous examples suggest that myocarditis can develop shortly after the streptococcal infection and is confirmed by a rapid antigen test or culture with concomitant exclusion of the ARF criteria and normal coronaries on angio-coronary CT, favoring the diagnosis of SPAM. [7] This condition has been referred to as non-rheumatic myocarditis since Gore and Saphir were the first to describe it in 1947. It occurs mainly in young patients, primarily men, and typically presents with nonpleuritic chest discomfort, sporadic fever, and this type of myocarditis [9].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The symptoms of SPAM usually appear within five days of the original streptococcal illness. On the other hand, myocarditis in rheumatic fever caused by group A streptococcal (GAS) infection typically appears after a two- to three-week interval of latent infection [ 7 ]. It is worth noting that acute rheumatic fever (ARF) affects the entire heart (i.e., pericardium, epicardium, myocardium, and endocardium) and causes mostly valvular disease.…”

Section: Introductionmentioning

confidence: 99%

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Non-rheumatic Streptococcal Acute Myocarditis: The First Documented Sibling Case

Mcheik,

Ayach,

El Koubayati

et al. 2024

Cureus

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Myocarditis is an inflammatory disease of the cardiac muscle that manifests as chest pain, dyspnea, and other signs of heart failure. ST segment changes with elevated cardiac biomarkers mimic acute coronary syndromes. It is most commonly caused by viruses like the Epstein-Barr virus (EBV) and Coxsackie B virus, but it can also be due to cardiotoxic drugs like cyclophosphamide and cocaine or caused by a systemic infiltrative process like sarcoidosis or collagen vascular diseases. One relatively common bacterial cause of myocarditis is beta-hemolytic Group A Streptococcus, which is well known to lead, two to three weeks later, to rheumatic fever and pancarditis. Less commonly, it can cause non-rheumatic myocarditis, which occurs faster, with the pathogenesis not very well understood.We will be reporting a case series of two brothers suffering at the same time from non-rheumatic streptococcal A-isolated myocarditis, questioning the possibility of bacterial toxin-mediated myocarditis or inter-linked genetic predisposition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-rheumatic Streptococcal Acute Myocarditis: The First Documented Sibling Case

Mcheik,

Ayach,

El Koubayati

et al. 2024

Cureus

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“…У закордонних рекомендаціях доволі часто вживають термін «pharyngitis» («фарингіт»), коли йдеться про запальний процес у ротоглотці, зокрема спричинений БГСА [17,20,23]. Тонзиліт у цьому аспекті розглядають як частину спектра фарингіту, який охоплює патологію від локалізованої тонзилярної інфекції до генералізованої інфекції глотки [2].…”

Section: вступunclassified

Diagnosis and treatment of scarlet fever: awareness of Ukrainian doctors

Mateiko,

Horbal,

Matvisiv

et al. 2024

MPU

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In recent years, the incidence of scarlet fever has been increasing in Ukraine and in the world. Timely diagnosis is important to reduce the transmission of the pathogen, while timely and rational treatment reduces the frequency of the complications. Aim - to assess the knowledge of doctors regarding the diagnosis and treatment of scarlet fever, and to identify problems that arise in the management of patients with scarlet fever, in particular, when providing medical care at the primary level. Materials and methods. A sociological study was conducted by anonymously surveying doctors using Google Form in April-September 2023. We studied the awareness of Ukrainian doctors about the diagnosis and treatment of scarlet fever in children. The survey involved 100 doctors with different experiences and specializations. Results. 83% of doctors who participated in the survey work at the primary level of medical care. It was estimated that 48% of doctors consulted patients with scarlet fever rarely and only 4% of them dealt with such patients 2-3 times a week. Therefore, only one-third of the physicians, who took part in the survey, feel confident about the diagnosis of scarlet fever. A rapid test for qualitative detection of Group A Streptococcus antigen was used by 42% of doctors in their practice, whereas 50% of physicians did not have the ability to perform this test. 56% of doctors feel confident while prescribing treatment. More than half of the surveyed physicians (60%) prescribe the first choice antibiotics (amoxicillin or penicillin). Regarding the terms of isolation of patients with scarlet fever, the answers were different, only 24% of doctors answered correctly. Complications were observed by 22% of doctors. It was found that 34% of the respondents used the invalid order of the Ministry of Health of Ukraine No 354 from 2009 in their practice, whilst the minority relied on clinical Duodecim protocols and UpToDate (7% and 11% respectively). Conclusions. After analyzing the survey results, several problems, that need to be solved, have been identified: insufficient awareness of doctors with scarlet fever and its diagnosis due to the infrequent patient visits; and unavailability of rapid tests for qualitative detection of Group A Streptococcus antigen. A significant percentage of doctors (62%) do not use updated valid guidelines regarding treatment and, as a result, the physicians do not always prescribe antibiotic therapy adequately and conduct anti-epidemic measures appropriately enough. All these identified problems point to the need for constant updating of knowledge in everyday medical practice. No conflict of interests was declared by the authors.

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“…A systematic review by Schmutzler et al highlighted the specific electrocardiogram changes, laboratory parameters, and symptoms associated with myocarditis subsequent to group A streptococcal pharyngitis and tonsillitis [ 8 ]; approximately 50% of the cases demonstrated ST-elevations, with fewer cases revealing T wave inversions and biphasic T waves [ 8 ]. The limited documentation of such cases underscores the significant gap in knowledge, calling for further research to effectively clarify this relationship and guide clinical interventions.…”

Section: Introductionmentioning

confidence: 99%

Sinus Node Dysfunction Triggered by Tonsillar Abscess: Effects of Vagal Nerve Compression

Yu,

Zaveri,

Schaible

et al. 2024

Am J Case Rep

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Unusual clinical course Background:Compression of the vagus nerve by a pharyngeal mass is a well-documented condition that can result in sinus node dysfunction (SND). However, there is scarce literature on extrinsic vagal nerve compression from a tonsillar abscess. Case Report:A 59-year-old woman with a history of asthma and chronic throat discomfort presented to the Emergency Department with bradycardia, palpitations, and voice changes. Following a shellfish allergy hospitalization, an otolaryngology evaluation revealed an enlarged right tonsil, recommending tonsillectomy, but scheduling challenges persisted. The patient reported mild throat pain, dysphagia, hoarseness, rhinorrhea, and exertional dyspnea and was admitted for the evaluation of peritonsillar mass. She was found to be bradycardic with a heart rate of 47, with an electrocardiogram revealing SND. Albuterol and ipratropium nebulizers, as well as dexamethasone and pantoprazole, were initiated. With this treatment, the patient symptomatically improved with a new heart rate of 68. She was discharged with outpatient appointments, but was unfortunately lost to follow-up. Conclusions:This case reveals sinus node dysfunction resulting from extrinsic vagal nerve compression by a tonsillar abscess. Pressure on the vagus nerve can trigger bradycardia and low blood pressure, possibly due to compensatory overfiring of afferent vagal nerve signals from local mass effect. Early recognition and antibiotic treatment are essential to prevent cardiac complications. Clinicians must remain vigilant for such extrinsic causes, particularly in patients with chronic sore throat and cardiac symptoms. Further research and case reports are needed to deepen our understanding of this rare yet significant association.

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From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review

Cited by 6 publications

References 39 publications

Non-rheumatic Streptococcal Acute Myocarditis: The First Documented Sibling Case

Non-rheumatic Streptococcal Acute Myocarditis: The First Documented Sibling Case

Diagnosis and treatment of scarlet fever: awareness of Ukrainian doctors

Sinus Node Dysfunction Triggered by Tonsillar Abscess: Effects of Vagal Nerve Compression

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