Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2010 May;122(9-10):315-9. doi: 10.1007/s00508-010-1381-6.
Infectious myocarditis is a life-threatening condition because it can lead to arrhythmia, dilated cardiomyopathy and congestive heart failure. A large number of different infectious causes have been identified as leading to myocarditis, with enteroviral infections being the most common reasons.
We present a rare Austrian case of bacterial-induced myocarditis in a 19-year-old immunocompetent male without any cardiac risk factors. Four days prior to the onset of severe left thoracic pain the patient developed acute gastroenteritis. The initial electrocardiogram showed sinus tachycardia, strain on the right side of the heart and signs of myocardial injury. Cardiac enzyme markers creatine kinase and troponin T were elevated to maximum values of 627 U/l and 0.52 ng/ml. Stool cultures revealed the presence of Campylobacter jejuni as the only source of infection. The clinical diagnosis of bacterial-induced myocarditis was confirmed by specific radiological findings of inflammation using cardiac magnetic resonance imaging.
In recent years, instead of performing endomyocardial biopsies, the clinical diagnosis of bacterial-induced myocarditis can be confirmed by specific radiological findings in combination with positive stool cultures for Enterobacteriaceae. Due to the increasing numbers of Campylobacter infections, myocarditis should be considered as a rare but relevant extraintestinal complication also in immunocompetent patients with Campylobacter jejuni gastroenteritis.
感染性心肌炎是一种危及生命的疾病,因为它可能导致心律失常、扩张型心肌病和充血性心力衰竭。大量不同的感染原因已被确定为导致心肌炎的原因,其中肠道病毒感染最为常见。
我们报告了一例罕见的奥地利细菌性心肌炎病例,发生在一名 19 岁免疫功能正常的男性,无任何心脏危险因素。在出现严重左胸疼痛的前四天,患者出现急性肠胃炎。初始心电图显示窦性心动过速、右心劳损和心肌损伤迹象。心肌酶标志物肌酸激酶和肌钙蛋白 T 升高至最高值 627 U/L 和 0.52ng/ml。粪便培养显示仅存在空肠弯曲菌为感染源。心脏磁共振成像显示炎症的特定放射学发现,临床诊断为细菌性心肌炎。
近年来,细菌性心肌炎的临床诊断可以通过特定的放射学发现结合阳性的肠杆菌科粪便培养来确认,而不是进行心内膜心肌活检。由于空肠弯曲菌感染的数量增加,应将心肌炎视为免疫功能正常的空肠弯曲菌性肠胃炎患者的一种罕见但相关的肠道外并发症。