Bacterial cardiomyopathy: A review of clinical status and meta-analysis of diagnosis and clinical management

Abstract

Primary bacterial infection of the myocardium without associated endocarditis is a rare cause of cardiomyopathy (BCM). Staphylococcus aureus is the most common aetiological agent of BCM although infections with a broad range of other bacterial pathogens may also cause the disease. BCM is a major long-term sequela of myocarditis, which usually develops in the setting of overwhelming bacteraemia and sepsis. It has a wide spectrum of clinical manifestations ranging from a subclinical self-limiting flu-like illness to life-threatening arrhythmias, heart failure and even death. Its typical pathophysiological features include multifocal studding of the myocardium with tiny abscesses and the involvement of the left ventricle. The disease may lead to cardiac dysfunction, rhythm disturbances and myocardial rapture with or without secondary purulent pericarditis. Due to a very low incidence in modern clinical practice, there are no large-scale clinical trials on BCM. Almost all information about BCM originates from autopsy studies performed during the pre-antibiotic era with a few recent case reports and observational studies. The lack of clinical trials has undermined a specific understanding of BCM. This paper reviews published literature on aetiology, pathophysiology, diagnosis and clinical management of BCM as well as highlights implications for clinical practice and future research. Introduction