Causes of Myocarditis 
1. Infectious Myocarditis
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Causes of Myocarditis 

1. Infectious Myocarditis

 • Bacterial - Staphylococcus, Streptococcus, Pneumococcus, Meningococcus, Gonococcus, Salmonella, Corynebacterium diphtheriae, Haemophilus influenzae, Myobacterium (tuberculosis), Mycoplasma pneumoniae, Brucella

 • Spirochaetal - Borrelia (Lyme disease), Leptospira (Weil disease)

 • Fungal - Aspergillus, Actinomyces, Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, Mucormycoses, Nocardia, Sporothrix

 • Protozoal - Trypanosoma cruzi, Toxoplasma gondii, Entamoeba, Leishmania

 • Parasitic - Trichinella spiralis, Echinococcus granulosus, Taenia solium

 • Rickettsial - Coxiella bumetti (Q fever), R. rickettsia (Rocky Mountain Spotted fever), R. tsutsugamuschi

 • Viral - RNA viruses: Cox sackie viruses A and B, echo viruses, polio viruses, influenza A and B viruses, respiratory syncytial virus, mumps virus, measles virus, rubella virus, hepatitis C virus, dengue virus, yellow fever virus, Chikungunya virus, Junin virus, Lassa fever virus, rabies virus, human immunodeficiency virus-1 DNA viruses: Adenoviruses, parvovirus B 19, cytomegalovirus, human herpes virus-6, Epstein-Barr virus, varicella-zoster virus, herpes simplex virus, variola virus, vaccinia virus

2. Immune-mediated myocarditis

 • Allergens - Tetanus toxoid, vaccines, serum sickness. Drugs: Penicillin, cefaclor, colchicine, furosemide, isoniazid, lidocaine, tetracycline, sulfonamides, phenytoin, phenylbutazone, methyldopa, thiazide diuretics, amitriptyline

 • Alloantigens - Heart transplant rejection

 • Autoantigens - Infection-negative lymphocytic, infection-negative giant cell. Associated with autoimmune or immune-oriented disorders: Systemic lupus erythematosus, rheumatoid arthritis, Churg-Strauss syndrome, Kawasaki's disease, inflammatory bowel disease, scleroderma, polymyositis, myasthenia gravis, insulin-dependent diabetes mellitus, thyrotoxicosis, sarcoidosis, Wegener's granulomatosis, rheumatic heart disease (rheumatic fever)

3. Toxic myocarditis

 • Drugs - Amphetamines, anthracyclines, cocaine, cyclophosphamide, ethanol, fluorouracil, lithium, catecholamines, hemetine, interleukin-2, trastuzumab, clozapine

 • Heavy metals - Copper, iron, lead (rare, more commonly cause intramyocyte accumulation)

 • Miscellaneous - Scorpion sting, snake and spider bites, bee and wasp stings, carbon monoxide, inhalants, phosphorus, arsenic, sodium azide

 • Hormones - Phaeochromocytoma, vitamins: beri-beri

 • Physical agents - Radiation, Electric Shock



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