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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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Chinen K. Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis. AUTOPSY AND CASE REPORTS 2020; 10:e2020185. [PMID: 33344302 PMCID: PMC7703123 DOI: 10.4322/acr.2020.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An 80-year-old Japanese woman with diabetes mellitus was admitted with gastrointestinal symptoms and pyrexia. At presentation, liver abscesses and severe hemolytic anemia were noted. Before detailed diagnostic evaluation and adequate treatment, she suddenly died 2.5 hours after admission. The autopsy and bacteriological examinations revealed liver abscesses and massive intravascular hemolysis caused by Clostridium perfringens as well as other miscellaneous critical pathological findings, including acute renal tubular necrosis, lung edema, and pulmonary fat embolism. In this article, the detailed autopsy results are described and clinicopathologic characteristics on Clostridium perfringens-related sudden death are discussed with a review of the literature.
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Affiliation(s)
- Katsuya Chinen
- Nerima General Hospital, Department of Pathology. Nerima, Tokyo, Japan
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Nagahama M, Takehara M, Rood JI. Histotoxic Clostridial Infections. Microbiol Spectr 2019; 7:10.1128/microbiolspec.gpp3-0024-2018. [PMID: 31350831 PMCID: PMC10957196 DOI: 10.1128/microbiolspec.gpp3-0024-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 01/01/2023] Open
Abstract
The pathogenesis of clostridial myonecrosis or gas gangrene involves an interruption to the blood supply to the infected tissues, often via a traumatic wound, anaerobic growth of the infecting clostridial cells, the production of extracellular toxins, and toxin-mediated cell and tissue damage. This review focuses on host-pathogen interactions in Clostridium perfringens-mediated and Clostridium septicum-mediated myonecrosis. The major toxins involved are C. perfringens α-toxin, which has phospholipase C and sphingomyelinase activity, and C. septicum α-toxin, a β-pore-forming toxin that belongs to the aerolysin family. Although these toxins are cytotoxic, their effects on host cells are quite complex, with a range of intracellular cell signaling pathways induced by their action on host cell membranes.
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Affiliation(s)
- Masahiro Nagahama
- Department of Microbiology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Yamashiro-cho, Tokushima 770-8514, Japan
| | - Masaya Takehara
- Department of Microbiology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Yamashiro-cho, Tokushima 770-8514, Japan
| | - Julian I Rood
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
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Mallozzi M, Viswanathan VK, Vedantam G. Spore-forming Bacilli and Clostridia in human disease. Future Microbiol 2010; 5:1109-23. [DOI: 10.2217/fmb.10.60] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Many Gram-positive spore-forming bacteria in the Firmicute phylum are important members of the human commensal microbiota, which, in rare cases, cause opportunistic infections. Other spore-formers, however, have evolved to become dedicated pathogens that can cause a striking variety of diseases. Despite variations in disease presentation, the etiologic agent is often the spore, with bacterially produced toxins playing a central role in the pathophysiology of infection. This review will focus on the specific diseases caused by spores of the Clostridia and Bacilli.
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Affiliation(s)
- Michael Mallozzi
- Department of Veterinary Science and Microbiology, University of Arizona, 1117, East Lowell St., Building 90, Room 303, Tucson, AZ 85721, USA
| | - VK Viswanathan
- Department of Veterinary Science and Microbiology, University of Arizona, 1117, East Lowell St., Building 90, Room 303, Tucson, AZ 85721, USA
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Yeom JH, Son SI, Min HK, Shim JH, Cho SY, Shin WJ, Kim KH, Jeon WJ. Spontaneous, Fulminant Gas Gangrene Caused by Klebsiella Pneumoniae: An Unrecognized Small Air Bubbles in the Left Femoral, External and Common Iliac Vein, and Inferior Vena Cava - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.1.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jong Hoon Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Sung Il Son
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung Ki Min
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Sang Yoon Cho
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Woo Jong Shin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Kyoung Hun Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
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Lanting B, Athwal GS, Naudie DDR. Spontaneous Clostridium perfringens myonecrosis of the shoulder: a case report. Clin Orthop Relat Res 2007; 461:20-4. [PMID: 17483728 DOI: 10.1097/blo.0b013e318073c273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Clostridium perfringens is a rare, life-threatening infection. We present an atypical evolution of spontaneous Clostridium perfringens myonecrosis in a monitored healthy patient. After a head injury, the hemodynamically stable patient became febrile and grew cultures of Clostridium perfringens with no identifiable focus. Antibiotics were initiated. Seventy-two hours after culture results, the patient complained of shoulder pain and imaging revealed periscapular subcutaneous emphysema. Multiple surgical débridements of the necrotic supraspinatus muscle were required to eradicate the infection. The unique features of this patient include the opportunity to (1) follow the progression of clostridial myonecrosis in a healthy patient in a monitored setting and (2) study the extended period of time between positive cultures and the onset of clinical myonecrosis, a feature at odds with the classic rapid progression.
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Affiliation(s)
- Brent Lanting
- Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
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Affiliation(s)
- Olivier N Pages
- Pediatric Surgery Department, American Memorial Hospital, Reims, France.
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Ma M, Boyd JT, Trinh HT, Coombs JW, Fermann GJ. Fatal myocarditis due to Clostridium novyi type B in a previously healthy woman: case report and literature review. ACTA ACUST UNITED AC 2007; 39:77-80. [PMID: 17366019 DOI: 10.1080/00365540600786531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clostridium novyi is a Gram-positive anaerobe, which is commonly a pathogen of domestic and wild animals. Disease in humans typically presents as myonecrosis. C. novyi has not previously been reported as a cause of myocarditis. We report a fatal case with infection of the myocardium by C. novyi type B.
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Affiliation(s)
- Marek Ma
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Tsokos M, Schalinski S, Paulsen F, Sperhake JP, Püschel K, Sobottka I. Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases. Int J Legal Med 2007; 122:35-41. [PMID: 17370083 DOI: 10.1007/s00414-007-0163-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.
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Affiliation(s)
- Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559, Berlin, Germany.
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Morris J, Harrison LM, Partridge SM. Practical and theoretical aspects of postmortem bacteriology. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2006.07.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yildiz T, Gündeş S, Willke A, Solak M, Toker K. Spontaneous, nontraumatic gas gangrene due to Clostridium perfringens. Int J Infect Dis 2005; 10:83-5. [PMID: 16310394 DOI: 10.1016/j.ijid.2005.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 02/11/2005] [Accepted: 02/22/2005] [Indexed: 11/29/2022] Open
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