{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:51:59Z","timestamp":1791363119483,"version":"4.3.1"},"reference-count":44,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed\/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis\/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and\/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient.<\/jats:p>","DOI":"10.3390\/jcdd9060170","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T08:50:22Z","timestamp":1653555022000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["From Streptococcal Pharyngitis\/Tonsillitis to Myocarditis: A Systematic Review"],"prefix":"10.3390","volume":"9","author":[{"given":"Lukas","family":"Schmutzler","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5679-4872","authenticated-orcid":false,"given":"Moritz","family":"Mirna","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lichtenauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,25]]},"reference":[{"key":"ref_1","unstructured":"Efstratiou, A., and Lamagni, T. (2022, February 03). Epidemiology of Streptococcus pyogenes, Streptococcus pyogenes Basic Biology to Clinical Manifestations, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK343616\/."},{"key":"ref_2","unstructured":"Anderson, J., and Paterek, E. (2022, February 03). Tonsillitis, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK544342\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1136\/heartjnl-2012-301686","article-title":"Pathogenesis and Diagnosis of Myocarditis","volume":"98","author":"Elamm","year":"2012","journal-title":"Heart"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1056\/NEJMra0800028","article-title":"Myocarditis","volume":"360","author":"Cooper","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/0002-8703(47)90148-8","article-title":"Myocarditis Associated with Acute Nasopharyngitis and Acute Tonsillitis","volume":"34","author":"Gore","year":"1947","journal-title":"Am. Heart J."},{"key":"ref_6","unstructured":"Sika-Paotonu, D., Beaton, A., Raghu, A., Steer, A., and Carapetis, J. (2022, February 04). Acute Rheumatic Fever and Rheumatic Heart Disease, Streptococcus pyogenes: Basic Biology to Clinical Manifestations, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425394\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11936-017-0513-y","article-title":"Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations","volume":"19","author":"Beaton","year":"2017","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1177\/000348940811700409","article-title":"Acute Myopericarditis Complicating Acute Tonsillitis: Beware the Young Male Patient with Tonsillitis Complaining of Chest Pain","volume":"117","author":"Talmon","year":"2008","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1378\/chest.95.2.359","article-title":"Streptococcal Tonsillitis and Acute Nonrheumatic Myopericarditis","volume":"95","author":"Karjalainen","year":"1989","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1177\/000348941212100907","article-title":"Streptococcal Tonsillitis and Acute Streptococcal Myocarditis: An Unusual Combination Assessed by Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsy","volume":"121","author":"Mavrogeni","year":"2012","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/10935266211007262","article-title":"Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group","volume":"24","author":"Neagu","year":"2021","journal-title":"Pediatric Dev. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1080\/00015385.2020.1854985","article-title":"Streptococcal Pharyngitis Associated Myocarditis (SPAM): The Perfect ST-Segment Elevation Myocardial Infarction (STEMI) Mimic in Young Individuals. A Case Series","volume":"76","author":"Kalpakos","year":"2021","journal-title":"Acta Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4674875","DOI":"10.1155\/2019\/4674875","article-title":"Separating Acute Rheumatic Fever from Nonrheumatic Streptococcal Myocarditis","volume":"2019","author":"Derbas","year":"2019","journal-title":"Case Rep. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1055\/a-0480-8005","article-title":"31-J\u00e4hriger Mann Mit Fieber, Thoraxschmerz Und Angina Tonsillaris","volume":"144","year":"2019","journal-title":"DMW Dtsch. Med. Wochenschr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1017\/S1047951117001524","article-title":"Non-Rheumatic Streptococcal Myocarditis Mimicking Acute Myocardial Infarction in an Adolescent Male","volume":"28","author":"Coulson","year":"2018","journal-title":"Cardiol. Young"},{"key":"ref_17","first-page":"000987","article-title":"Acute Non-Rheumatic Myopericarditis: A Rare Complication of Pharyngitis","volume":"5","author":"Silva","year":"2018","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"806.e1","DOI":"10.1016\/j.ajem.2016.12.004","article-title":"Nonrheumatic Myopericarditis Post Acute Streptococcal Pharyngitis: An Uncommon Cause of Sore Throat with ST Segment Elevation","volume":"35","author":"Pourmand","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"K15","DOI":"10.1530\/ERP-16-0013","article-title":"Acute Myocarditis with Normal Wall Motion Detected with 2D Speckle Tracking Echocardiography","volume":"3","author":"Sturmberger","year":"2016","journal-title":"Echo Res. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1080\/08998280.2015.11929224","article-title":"Acute Nonrheumatic Streptococcal Myocarditis Resembling St-Elevation Acute Myocardial Infarction in a Young Patient","volume":"28","author":"Aguirre","year":"2015","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_21","first-page":"964038","article-title":"Recurrent Acute Nonrheumatic Streptococcal Myocarditis Mimicking STEMI in a Young Adult","volume":"2014","author":"Chikly","year":"2014","journal-title":"Case Rep. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1099\/jmm.0.049569-0","article-title":"Non-Rheumatic Streptococcal Myocarditis\u2014Warm Hands, Warm Heart","volume":"62","author":"Chaudhuri","year":"2013","journal-title":"J. Med. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.amjmed.2012.06.016","article-title":"Acute Nonrheumatic Streptococcal Myocarditis: STEMI Mimic in Young Adults","volume":"125","author":"Upadhyay","year":"2012","journal-title":"Am. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ejim.2010.05.008","article-title":"Perimyocarditis Following Streptococcal Group A Infection: From Clinical Cases to Bioinformatics Analysis","volume":"21","author":"Malnick","year":"2010","journal-title":"Eur. J. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/j.jcmg.2010.05.012","article-title":"Streptococcal Pharyngitis-Associated Myocarditis Mimicking Acute STEMI","volume":"3","author":"Mokabberi","year":"2010","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1177\/000348940911800804","article-title":"Acute Myopericarditis Complicating Acute Tonsillitis: A Prospective Study","volume":"118","author":"Talmon","year":"2009","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"638.e1","DOI":"10.1016\/j.ajem.2007.10.030","article-title":"Acute Streptococcal Myopericarditis Mimicking Myocardial Infarction","volume":"26","author":"Khavandi","year":"2008","journal-title":"Am. J. Emerg. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S0828-282X(08)70195-8","article-title":"Unusual Echocardiographic Features Seen in a Case of Giant Cell Myocarditis","volume":"24","author":"Kochar","year":"2008","journal-title":"Can. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0300-2977(98)00100-4","article-title":"Acute Nonrheumatic Myopericarditis Associated with Group A Hemolytic Streptococcal Tonsillitis in a Male ICU-Nurse","volume":"53","author":"Said","year":"1998","journal-title":"Neth. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0147-9563(05)80065-2","article-title":"Nonrheumatic Poststreptococcal Myocarditis","volume":"24","author":"Gill","year":"1995","journal-title":"Heart Lung"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000174780","article-title":"Acute Nonrheumatic Perimyocarditis Complicating Streptococcal Tonsillitis","volume":"78","author":"Putterman","year":"1991","journal-title":"Cardiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1136\/hrt.59.3.389","article-title":"Atrioventricular Block Complicating Acute Streptococcal Tonsillitis","volume":"59","author":"Caraco","year":"1988","journal-title":"Heart"},{"key":"ref_33","unstructured":"(2022, April 12). Acute Myocarditis-StatPearls-NCBI Bookshelf, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441847\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s000590050021","article-title":"The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID)","volume":"25","author":"Hufnagel","year":"2000","journal-title":"Herz"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.jacc.2012.01.007","article-title":"Long-Term Follow-Up of Biopsy-Proven Viral Myocarditis","volume":"59","author":"Schumm","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e12726","DOI":"10.1111\/anec.12726","article-title":"Diagnostic and Prognostic Role of Electrocardiogram in Acute Myocarditis: A Comprehensive Review","volume":"25","author":"Zappia","year":"2020","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3949\/ccjm.78a.10077","article-title":"ST-Segment Depression and T-Wave Inversion: Classification, Differential Diagnosis, and Caveats","volume":"78","author":"Hanna","year":"2011","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_38","first-page":"180","article-title":"Acute Viral Myocarditis: Current Concepts in Diagnosis and Treatment","volume":"15","author":"Shauer","year":"2013","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1161\/01.CIR.95.1.163","article-title":"Elevations of Cardiac Troponin I Associated with Myocarditis. Experimental and Clinical Correlates","volume":"95","author":"Smith","year":"1997","journal-title":"Circulation"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1136\/heart.84.3.245","article-title":"Myocarditis Mimicking Acute Myocardial Infarction: Role of Endomyocardial Biopsy in the Differential Diagnosis","volume":"84","author":"Angelini","year":"2000","journal-title":"Heart"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e210252","DOI":"10.1148\/ryct.210252","article-title":"Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination","volume":"3","author":"Thavendiranathan","year":"2021","journal-title":"Radiol. Cardiothorac. Imaging"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12968-015-0185-2","article-title":"Cardiovascular Magnetic Resonance Predictors of Clinical Outcome in Patients with Suspected Acute Myocarditis","volume":"17","author":"Sanguineti","year":"2015","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hiraiwa, H., Morimoto, R., Ando, R., Ito, R., Araki, T., Mizutani, T., Kazama, S., Kimura, Y., Oishi, H., and Kuwayama, T. (J. Cardiol. Cases, 2022). Recurrent Fulminant Non-Rheumatic Streptococcal Myocarditis Proven by Endomyocardial Biopsy and Autopsy, J. Cardiol. Cases, in press.","DOI":"10.1016\/j.jccase.2022.02.004"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1038\/nrcardio.2012.197","article-title":"Revisiting the Pathogenesis of Rheumatic Fever and Carditis","volume":"10","author":"Tandon","year":"2013","journal-title":"Nat. Rev. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/6\/170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:18:46Z","timestamp":1760138326000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/6\/170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,25]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcdd9060170"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9060170","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,25]]}}}