Diagnosis
Inflammation of the heart (PubMed). There are, of course, non-infectious causes.
Epidemiologic Risks
It depends on the organism.
Microbiology
An enormous number of organisms can involve the heart. NEJM review (PubMed).
A list, not inclusive, but of the important ones to consider, include:
- Viral: Adenovirus, Coxsackie A, Coxsackie B, Cytomegalovirus, Echovirus, Epstein-Barr, Hepatitis B, Hepatitis C, Herpes simplex, Human immunodeficiency virus, Influenza A and B, Lymphocytic choriomeningitis, Mumps, Nonpolio enterovirus, Parvovirus B19, Polio, Respiratory Syncytial Virus, Rubella, Rubeola, Varicella-zoster.
-Bacteria and rickettsiae: Borrelia burgdorferi, Brucella, Chlamydia pneumoniae, Chlamydia psittaci, Clostridium perfringens, Corynebacterium diphtheriae, Coxiella burnetti, Ehrlichia, Legionella pneumophila, Listeria monocytogenes, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Neisseria meningitidis, Orientia tsutsugamushi, Rickettsia prowazekii, Rickettsia rickettsii, Salmonella, Staphylococcus aureus, Streptococcus pyogenes, Treponema pallidum, Tropheryma whippeli.
- "Acute non-rheumatic streptococcal myocarditis is an under-recognized and treatable cause of ST-segment elevation and chest pain in young adults with a history of recent pharyngitis (PubMed).
- Fungi: Aspergillus, Blastomyces, Candida species, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum.
-Parasites: Toxocara canis, Toxoplasma gondii, Trichinella spiralis, Trypanosoma cruzi (common in the US South), Trypanosoma gambiense, Trypanosoma rhodesiense.
Empiric Therapy
It depends on the presumed etiology. Bed rest is important, do not stress that heart.
Pearls
Fortunately, the heart is hard to infect with bacteria. Usually, acute disease of most of the bacterial organisms listed above leads to death. For the viral causes, usually get the diagnosis after the disease had come and gone and we have to deal with the resultant 'idiopathic' cardiomyopathy. It is rare indeed to get a positive and treatable acute etiology from a cardiac biopsy.
Chagas is under-recognized in the US where it is endemic in the Southern half.
Curious Cases
Relevant links to my Medscape blog
Last Update: 11/10/18.