Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2015; 7(12): 931-937
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.931
Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis
Pedro Villablanca, Divyanshu Mohananey, Garnet Meier, John E Yap, Sonam Chouksey, Ayokunle T Abegunde
Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States
Divyanshu Mohananey, Garnet Meier, John E Yap, Sonam Chouksey, Department of Internal Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, IL 60612, United States
Ayokunle T Abegunde, Section of Digestive Diseases and Nutrition, Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, United States
Author contributions: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S and Abegunde AT contributed equally to the work; Villablanca P, Mohananey D and Abegunde AT conceptualized and designed the review; Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S and Abegunde AT contributed to search of literature and data extraction; Villablanca P, Mohananey D and Abegunde AT carried out the analysis and drafted the manuscript; all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: None of the authors of this systematic review have any conflicts of interest.
Data sharing statement: There is no additional data aside from that which is presented in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Divyanshu Mohananey, MD, MSc, Department of Internal Medicine, John H Stroger, Jr Hospital of Cook County, 1900 W. Polk St. 9th Floor, Chicago, IL 60612, United States. divyanshu26@hotmail.com
Telephone: +1-786-3979971
Received: February 1, 2015
Peer-review started: February 2, 2015
First decision: June 3, 2015
Revised: July 14, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: December 26, 2015
Processing time: 326 Days and 8.3 Hours
Abstract

AIM: To study trends in the epidemiology, clinical presentation, microbiology and prognosis of non-typhoid Salmonella (NTS) myocarditis.

METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation, electrocardiogram (ECG) changes, transthoracic echocardiographic findings, cardiac magnetic resonance findings, microbiology cultures, Salmonella species, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases (defined as < 18 years old) and adult cases (defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics (Windows, Version 20.0. Armonk, NY: IBM Corp.) for demographic characteristics, presenting symptoms, microbiology, diagnostic methods, treatment modalities and outcome.

RESULTS: From the selected articles, we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years (range 1 mo-67 years), 16% of cases were children aged < 18 years. Most patients presented with chest pain, fever, and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia (40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group (100% vs 63.1%). Eighty-three percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.

CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.

Keywords: Diarrhea, Myocarditis, Salmonella, Non-typhoid

Core tip: Myocarditis is a rare extra-intestinal manifestation of non-typhoid Salmonella infection. In our review, the most common presenting symptoms were fever, abdominal pain, and chest pain and the most frequent electrocardiogram finding was ST segment elevation. Around 70% of patients had positive cardiac biomarkers (creatine kinase and/or troponin). Salmonella Enteritidis was the most common pathogen identified. Mortality appears to be high as is seen with all bacterial myocarditis, and intensive care unit admission is warranted in a large number of cases.