Cardiotoxicity during invasive pneumococcal disease

Armand O. Brown, Elizabeth R.C. Millett, Jennifer K. Quint, Carlos J. Orihuela

Research output: Contribution to journalReview articlepeer-review

53 Scopus citations


Streptococcus pneumoniae is the leading cause of community-acquired pneumonia and sepsis, with adult hospitalization linked to approximately 19% incidence of an adverse cardiac event (e.g., heart failure, arrhythmia, infarction). Herein, we review the specific host-pathogen interactions that contribute to cardiac dysfunction during invasive pneumococcal disease: (1) cell wall-mediated inhibition of cardiomyocyte contractility; (2) the new observation that S. pneumoniae is capable of translocation into the myocardium and within the heart, forming discrete, nonpurulent, microscopic lesions that are filled with pneumococci; and (3) the bacterial virulence determinants, pneumolysin and hydrogen peroxide, that are most likely responsible for cardiomyocyte cell death. Pneumococcal invasion of heart tissue is dependent on the bacterial adhesin choline-binding protein A that binds to laminin receptor on vascular endothelial cells and binding of phosphorylcholine residues on pneumococcal cell wall to platelet-activating factor receptor. These are the same interactions responsible for pneumococcal translocation across the blood-brain barrier during the development of meningitis. We discuss these interactions and how their neutralization, either with antibody or therapeutic agents that modulate platelet-activating factor receptor expression, may confer protection against cardiac damage and meningitis. Considerable collagen deposition was observed in hearts of mice that had recovered from invasive pneumococcal disease. We discuss the possibility that cardiac scar formation after severe pneumococcal infection may explain why individuals who are hospitalized for pneumonia are at greater risk for sudden death up to 1 year after infection.

Original languageEnglish (US)
Pages (from-to)739-745
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number7
StatePublished - Apr 1 2015
Externally publishedYes


  • Heart failure
  • Invasion
  • Invasive pneumococcal disease
  • Pathogenesis
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Cardiotoxicity during invasive pneumococcal disease'. Together they form a unique fingerprint.

Cite this