What is it about?
Sepsis can weaken the heart muscle, a condition called septic cardiomyopathy, and this is usually attributed to the body excessive inflammatory response and to endotoxin from Gram-negative bacteria. In this letter, commenting on a review in Critical Care Medicine, we draw attention to another cause: exotoxins, toxic proteins released by common bacteria. Pneumolysin from Streptococcus pneumoniae punches holes in heart cells and disrupts calcium balance, which may explain why heart complications are especially common in pneumococcal pneumonia. Staphylococcus aureus alpha-toxin and Pseudomonas aeruginosa exotoxin A also depress heart function, and Clostridioides difficile toxin B has been shown to damage heart cells in experimental models.
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Why is it important?
Recognizing that some bacteria can injure the heart directly through their toxins broadens our understanding of septic cardiomyopathy. This perspective may help explain why certain infections are more often complicated by cardiac events and points to research on anti-toxin strategies, such as antibodies or toxin-suppressing antibiotics, as potential adjunctive treatments.
Perspectives
Bacterial toxins are a recurring theme in my research, from Clostridioides difficile to Staphylococcus aureus alpha-hemolysin. With Jacopo Monticelli, we wanted to remind intensivists that in sepsis the pathogen is not a passive trigger: some bacteria actively attack organs such as the heart.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Septic Cardiomyopathy and Bacterial Exotoxins, Critical Care Medicine, September 2018, Wolters Kluwer Health,
DOI: 10.1097/ccm.0000000000003217.
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