title: Perimyocarditis following streptococcal group A infection: from clinical cases to bioinformatics analysis.
abstract: BACKGROUND
  Streptococcal infection is known to be associated with non-suppurative complications, including rheumatic fever. A less well recognized complication is perimyocarditis.
  
  
  METHODS
  We report 4 cases of myocarditis in young males associated with acute streptoccal infection. Following this clinical observation we employed bioinformatic techniques to identify common epitopes between Streptococcus group A and human muscle proteins. We used Blast to search all the proteome (1697 proteins) of the Streptococcus pyogenes M1 GAS against the human proteome of 34,180 proteins.
  
  
  RESULTS
  4 patients with streptococcal A related myocarditis were treated and made a complete recovery. One cardiac protein, ATP2A2 (NP_733765.1)), a cardiac Ca2+ ATPase, shared an epitope with Streptococcus group A and a high probability of being presented on a MHC Class II molecule.
  
  
  CONCLUSIONS
  Streptococcal myocarditis may be a commoner entity than previously appreciated. Bioinformatic techniques have identified a suspected common epitope between the streptococcal proteins and a cardiac Ca2+ ATPase.
authors.affiliation: Department of Internal Medicine C, Kaplan Medical Center, Rehovot, Israel (affiliated to the Hebrew University-Hadassah, Jerusalem, Israel). stephen@malnick.net
authors.forename: Stephen D H
authors.initials: SD
authors.lastname: Malnick
authors.forename: Ayellet
authors.initials: A
authors.lastname: Bar-Ilan
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Marina
authors.initials: M
authors.lastname: Somin
authors.forename: Tirza
authors.initials: T
authors.lastname: Doniger
authors.forename: Alon
authors.initials: A
authors.lastname: Basevitz
authors.forename: Ron
authors.initials: R
authors.lastname: Unger
mesh_terms: D000328:Adult; D000252:Calcium-Transporting ATPases / Q000235:genetics; D000939:Epitopes / Q000235:genetics / Q000276:immunology; D005802:Genes, MHC Class II / Q000235:genetics; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D040901:Proteomics / Q000379:methods*; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases / Q000235:genetics / Q000276:immunology; D013290:Streptococcal Infections / Q000150:complications* / Q000276:immunology / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000235:genetics / Q000276:immunology
chemical_list: D000939:Epitopes; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases; C506946:ATP2A2 protein, human; D000252:Calcium-Transporting ATPases