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Yao Z, Liang M, Zhu S. Infectious factors in myocarditis: a comprehensive review of common and rare pathogens. Egypt Heart J 2024; 76:64. [PMID: 38789885 PMCID: PMC11126555 DOI: 10.1186/s43044-024-00493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Myocarditis is a significant health threat today, with infectious agents being the most common cause. Accurate diagnosis of the etiology of infectious myocarditis is crucial for effective treatment. MAIN BODY Infectious myocarditis can be caused by viruses, prokaryotes, parasites, and fungi. Viral infections are typically the primary cause. However, some rare opportunistic pathogens can also damage heart muscle cells in patients with immunodeficiencies, neoplasms and those who have undergone heart surgery. CONCLUSIONS This article reviews research on common and rare pathogens of infectious myocarditis, emphasizing the complexity of its etiology, with the aim of helping clinicians make an accurate diagnosis of infectious myocarditis.
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Affiliation(s)
- Zongjie Yao
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qindao, China.
| | - Mingjun Liang
- Department of Intensive Care Medicine, Shanghai Six People's Hospital Affilicated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Zhu
- Wuhan Third Hospital-Tongren Hospital of Wuhan University, Wuhan, China
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2
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Karnik AA, Awtry EH. Management of Inflammatory Cardiac Masses. Cardiol Res 2018; 9:400-406. [PMID: 30627294 PMCID: PMC6306126 DOI: 10.14740/cr801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022] Open
Abstract
Systemic rheumatologic and inflammatory disorders can affect almost any organ system, including the heart. The cardiac valves, conduction system, myocardium, endocardium, pericardium, and coronary arteries may be affected. Intracardiac masses may develop as part of the disease process or a consequence of their therapy, such as methotrexate-associated nodulosis. Optimal therapy in these cases is not known, since many patients are asymptomatic and the potential benefit of surgical excision must be weighed against its associated morbidity and mortality. Importantly, these inflammatory masses must be differentiated from thrombus, infection, and primary and metastatic tumors. We present three cases of inflammatory cardiac masses associated with rheumatoid arthritis and Wegener’s granulomatosis, which were successfully treated conservatively, and propose a management algorithm. The benefits of such an approach must be individualized and weighed against the risks of systemic embolization, stroke and obstruction.
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Affiliation(s)
- Ankur A Karnik
- Section of Cardiology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
| | - Eric H Awtry
- Section of Cardiology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
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3
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Pang R, Merritt NH, Shkrum MJ, Tijssen JA. Febrile Illness in an Infant With an Intracardiac Inflammatory Myofibroblastic Tumor. Pediatrics 2016; 137:e20143544. [PMID: 26798044 DOI: 10.1542/peds.2014-3544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 12/12/2022] Open
Abstract
We report a case of a child with a right ventricular inflammatory myofibroblastic tumor (IMT) who presented with fever, viral symptoms, and abdominal discomfort. Including this case, 49 intracardiac tumors have been previously reported in all age groups. The majority of intracardiac IMTs occur in pediatric patients, with approximately half presenting in children aged <12 months. Intracardiac IMTs are generally described as benign tumors; however, depending on their location, the initial presentation may involve heart failure or sudden death.(1) In addition to cardiac signs and symptoms, the clinical presentation of IMTs may also include constitutional signs such as fever, anemia, and elevated inflammatory markers. This case report reviews the diagnosis and management of IMTs, as well as the histopathologic features of this rare tumor type. Clinicians should be aware of their clinical presentation because early diagnosis and treatment can significantly reduce morbidity and mortality.
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Affiliation(s)
- Renée Pang
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; and University of Western Ontario, London, Ontario, Canada
| | - Neil H Merritt
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; and University of Western Ontario, London, Ontario, Canada
| | - Michael J Shkrum
- University of Western Ontario, London, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada; and
| | - Janice A Tijssen
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; and University of Western Ontario, London, Ontario, Canada
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4
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Maybrook RJ, Afzal MR, Parashar S, Deibert B, Chivington M, Walker JY, Dawn B, Parashara D. Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature. Echocardiography 2015; 33:117-32. [DOI: 10.1111/echo.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ryan J. Maybrook
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Muhammad R. Afzal
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Sonya Parashar
- University of Kansas School of Medicine; Kansas City Kansas
| | - Brent Deibert
- University of Kansas School of Medicine; Kansas City Kansas
| | - Mary Chivington
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Jacquelyn Y. Walker
- Division of Cardiology; VA Eastern Kansas Health Care System; Leavenworth Kansas
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Deepak Parashara
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
- Division of Cardiology; Kansas City VA Medical Center; Kansas City Missouri
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5
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Ladani AP, Biswas A, Vaghasia N, Generalovich T. Unusual presentation of listerial myocarditis and the diagnostic value of cardiac magnetic resonance. Tex Heart Inst J 2015; 42:255-8. [PMID: 26175642 DOI: 10.14503/thij-14-4204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias. We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis. In addition to reporting our patient's case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.
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6
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McMullen PD, Freitag NE. Assessing bacterial invasion of cardiac cells in culture and heart colonization in infected mice using Listeria monocytogenes. J Vis Exp 2015:e52497. [PMID: 26065439 DOI: 10.3791/52497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Listeria monocytogenes is a Gram-positive facultative intracellular pathogen that is capable of causing serious invasive infections in immunocompromised patients, the elderly, and pregnant women. The most common manifestations of listeriosis in humans include meningitis, encephalitis, and fetal abortion. A significant but much less documented sequelae of invasive L. monocytogenes infection involves the heart. The death rate from cardiac illness can be up to 35% despite treatment, however very little is known regarding L. monocytogenes colonization of cardiac tissue and its resultant pathologies. In addition, it has recently become apparent that subpopulations of L. monocytogenes have an enhanced capacity to invade and grow within cardiac tissue. This protocol describes in detail in vitro and in vivo methods that can be used for assessing cardiotropism of L. monocytogenes isolates. Methods are presented for the infection of H9c2 rat cardiac myoblasts in tissue culture as well as for the determination of bacterial colonization of the hearts of infected mice. These methods are useful not only for identifying strains with the potential to colonize cardiac tissue in infected animals, but may also facilitate the identification of bacterial gene products that serve to enhance cardiac cell invasion and/or drive changes in heart pathology. These methods also provide for the direct comparison of cardiotropism between multiple L. monocytogenes strains.
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Affiliation(s)
- P David McMullen
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago
| | - Nancy E Freitag
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago;
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7
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Eilers AL, Nazarullah AN, Shipper ES, Jagirdar JS, Calhoon JH, Husain SA. Cardiac Inflammatory Myofibroblastic Tumor. World J Pediatr Congenit Heart Surg 2014; 5:556-64. [DOI: 10.1177/2150135114546203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although inflammatory myofibroblastic tumors (IMTs) can be found in virtually every major organ, cardiac origin is rare. After recently providing care to a child who presented with a significant myocardial infarction, interest in this rare tumor was piqued. We describe a comprehensive review of cardiac IMT, including information on nomenclature, epidemiology, clinical features, pathogenesis, gross/histological features, immunohistochemical profile, diagnosis, treatment, and prognosis. Fifty-seven cases were identified in the literature. Interestingly, our case represents the seventh case of coronary artery involvement reported. Moreover, it was found that an initial presentation of sudden death most commonly involves the coronary arteries.
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Affiliation(s)
- Amanda L. Eilers
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alia N. Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edward S. Shipper
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jaishree S. Jagirdar
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John H. Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S. Adil Husain
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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8
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Xu B, Fraser RS, Renaud C, Youssef S, Gottesman RD, Bernard C. Inflammatory myofibroblastic tumor of the aortic valves causing sudden cardiac death: a case report and review of the literature. Pediatr Dev Pathol 2014; 17:231-9. [PMID: 24649800 DOI: 10.2350/13-12-1414-cr.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity affecting predominantly infants, children, and young adults. Although most tumors have a benign clinical course after complete surgical resection, some have significant clinical effects. We report the case of a 9-year-old girl who had sudden cardiac death as a result of occlusion of the left circumflex coronary artery. A review of 57 cases of cardiac IMTs reported in the literature in terms of epidemiology, clinical presentation, histologic and immunohistologic features, and outcome is presented. Recognition of this rare abnormality is important in order to initiate prompt surgical intervention.
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Affiliation(s)
- Bin Xu
- 1 Department of Pathology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H3H 1P3, Canada
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10
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Berthelot E, Berthelot-Garcias E, Voicu S, de Menthon M, Logeart D, Mahr A, Nataf P, Fabre A, Sirol M, Cohen-Solal A. Unusual pseudotumoral right atrial involvement in Listeria monocytogenes septicemia. Circulation 2012; 126:e66-8. [PMID: 22869861 DOI: 10.1161/circulationaha.112.096347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Berthelot
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
| | - E Berthelot-Garcias
- Hôpital Lariboisière, Service de Cardiologie, 10, rue Ambroise Paré, 75010 Paris, France.
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11
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Nasopharyngeal inflammatory pseudotumor showing abducens nerve palsy. Auris Nasus Larynx 2011; 38:543-6. [DOI: 10.1016/j.anl.2010.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 01/22/2023]
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12
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Puntambekar P, Santhakumar S, Kupsky WJ, Tselis A, Mittal S. Primary intracranial plasma cell granulomas presenting as malignant neoplasms. J Neurooncol 2011; 106:327-37. [PMID: 21786175 DOI: 10.1007/s11060-011-0667-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 07/07/2011] [Indexed: 12/22/2022]
Abstract
Plasma cell granuloma (PCG) is an uncommon non-neoplastic mass lesion of unknown etiology. It is characterized by a polyclonal proliferation of chronic inflammatory cells, mostly mature plasma and other mononuclear cells. PCGs arising in the central nervous system are particularly rare. We report two additional cases of intracranial PCG exclusively involving the brain parenchyma. A 47 year-old woman, presenting with partial motor seizures and fluent aphasia, underwent complete excision of a well-demarcated, enhancing left parietal mass. The second patient was a 56 year-old man presenting with headaches and right-sided weakness who underwent stereotactic biopsy of an ill-defined, heterogeneously enhancing lesion in the left basal ganglia. Immunohistochemical analysis of surgical specimens showed polyclonal plasma cells and mature lymphocytes but no etiological agent. A histopathologic diagnosis of intracranial PCG was made in both cases. PCG should be part of the differential diagnosis of enhancing mass lesions of the brain. The etiology and natural history of these tumor-like lesions is not fully understood. Complete surgical excision appears to be curative. Lesions where total resection is not possible may benefit from adjuvant treatment including corticosteroids and possibly radiation therapy.
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Affiliation(s)
- Preeti Puntambekar
- Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
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13
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Alonzo F, Xayarath B, Whisstock JC, Freitag NE. Functional analysis of the Listeria monocytogenes secretion chaperone PrsA2 and its multiple contributions to bacterial virulence. Mol Microbiol 2011; 80:1530-48. [PMID: 21545417 DOI: 10.1111/j.1365-2958.2011.07665.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
As an organism that has evolved to live in environments ranging from soil to the cytosol of mammalian cells, Listeria monocytogenes must regulate the secretion and activity of protein products that promote survival within these habitats. The post-translocation chaperone PrsA2 has been adapted to assist in the folding and activity of L. monocytogenes secreted proteins required for bacterial replication within host cells. Here we present the first structure/function investigation of the contributions of PrsA2 to protein secretion and activity as well as to bacterial virulence. Domain swap experiments with the closely related L. monocytogenes PrsA1 protein combined with targeted mutagenesis indicate distinct functional roles for the PrsA2 peptidyl-prolyl isomerase (PPIase) and the N- and C-terminal domains in pathogenesis. In contrast to other PrsA-like proteins described thus far in the literature, an absolute in vivo requirement for PrsA2 PPIase activity is evident in mouse infection models. This work illustrates the diversity of function associated with L. monocytogenes PrsA2 that serves to promote bacterial life within the infected host.
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Affiliation(s)
- Francis Alonzo
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
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14
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Alonzo F, Bobo LD, Skiest DJ, Freitag NE. Evidence for subpopulations of Listeria monocytogenes with enhanced invasion of cardiac cells. J Med Microbiol 2011; 60:423-434. [PMID: 21266727 DOI: 10.1099/jmm.0.027185-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cardiac infections caused by the foodborne bacterium Listeria monocytogenes represent a significant but poorly studied facet of disease. It is not known whether L. monocytogenes cardiac infections stem solely from host susceptibility, or whether bacterial isolates exist that exhibit a tropism for cardiac tissue. Here we examine the cardio-invasive capacity of a recent L. monocytogenes cardiac case strain (07PF0776) as well as nine additional outbreak and clinical isolates. Mice infected with the cardiac isolate 07PF0776 had 10-fold more bacteria recovered from heart tissue than those infected with L. monocytogenes strain 10403S, a well-characterized clinical isolate originally obtained from a human skin lesion. Additional L. monocytogenes isolates exhibited varied capacities to colonize the hearts of mice; however, those with the highest efficiency of mouse cardiac invasion also demonstrated the highest levels of bacterial invasion in cultured myoblast cells. Our findings strongly suggest that subpopulations of L. monocytogenes strains have acquired an enhanced ability to target and invade the myocardium.
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Affiliation(s)
- Francis Alonzo
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
| | - Linda D Bobo
- Adult Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel J Skiest
- Division of Infectious Diseases, Baystate Medical Center - Tufts University School of Medicine, Springfield, MA, USA
| | - Nancy E Freitag
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA
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Obikane H, Ariizumi K, Yutani C, Mitsumata M. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) of the mitral valve of the heart. Pathol Int 2010; 60:533-7. [DOI: 10.1111/j.1440-1827.2010.02556.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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