title: Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Pedro
authors.initials: P
authors.lastname: Villablanca
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Mohananey
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Garnet
authors.initials: G
authors.lastname: Meier
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: John E
authors.initials: JE
authors.lastname: Yap
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Sonam
authors.initials: S
authors.lastname: Chouksey
authors.affiliation: Pedro Villablanca, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, United States.
authors.forename: Ayokunle T
authors.initials: AT
authors.lastname: Abegunde
keywords: Diarrhea; Myocarditis; Non-typhoid; Salmonella