Mozart and Sore Throats

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mozartIn 1791, arguably the world’s most gifted composer, Wolfgang Amadeus Mozart, died at the very young age of 35. His death was rumored incorrectly to have been caused by poisoning by Antonio Salieri, a court composer in Austria who was jealous of Mozart’s great talent and success. Twenty-two years after Mozart’s death, Salieri, who was then in a mental institution, claimed that he poisoned Mozart, but several years later on his deathbed, he strongly denied having killed Mozart. Today, no serious researchers believe that Mozart was poisoned because his medical history and his symptoms during the week before his death match those of a classic disease that can now be cured.

Symptoms and Diagnosis
At age 35, on Nov. 20, 1791, Mozart developed a high fever, a headache, a rash, and pain and swelling in his arms and legs. He was alert and lucid, but in the second week of his illness, he began vomiting and had diarrhea. His body became swollen with fluid, causing his clothes to squeeze his body. He was too weak to sit up in bed without help, and he complained of severe shortness of breath. Then he died.

He had a fever, headache and sore throat, which tells us that he was most likely to have had an infection. The red rash was probably caused by the erythrotoxin produced by a beta strep group A bacteria, that causes a sore throat and then rheumatic fever, an inflammatory reaction that can damage the heart and other organs. Most adults who die from rheumatic fever have a long history of recurrent attacks because each time they are infected with strep, they develop the same symptoms — fever, sore throat, headache and rash — and they suffer increasing amounts of heart and kidney damage.

Mozart’s Long History of Rheumatic Fever
According to his father, Leopold, Mozart had suffered three attacks of serious upper respiratory infections in childhood. At age six, he developed rheumatic fever, which was most likely a result of his strep infections. Two years later, at age eight, Mozart suffered a sore throat that made him so sick that he stayed in bed for several months. That attack was likely to have been caused by another strep infection called tonsillitis. He suffered a third bout of rheumatic fever at age ten, in 1766.

At ages 28 and 31, he suffered his fourth and fifth severe prolonged attacks. Each successive infection with beta strep group A bacteria further weakened his heart and kidneys, and the last serious strep infection, at age 35, was more than his body could stand.

A Beta Strep Epidemic in Vienna
In 2008, a group of medical scholars from Amsterdam, Vienna, and London pored through recorded deaths of people in the same age group in Vienna at the time of Mozart’s death, between December 1791 and January 1792, and compared the deaths to those that occurred in the next few winters (Annals of Internal Medicine, 2009, 151:274-278). There had been a marked increase in deaths in people in their 30s in that December and January, the same time that Mozart died. Furthermore, many of the people who died in the same period as Mozart also had severe edema. The researchers concluded that this pointed to a minor epidemic of a rheumatic-fever type of glomerulonephritis, kidney damage from a streptococcal bacterial infection.

How Beta Strep Bacteria Can Cause Rheumatic Fever
When you are infected with a beta strep, group A bacteria in your throat or skin, your body makes cells and proteins called antibodies to attack and kill that bacteria. Most people do not develop rheumatic fever, but if the sore throat becomes chronic and is not treated with antibiotics, up to three percent can go on to suffer rheumatic fever in which these same antibodies attack the host: the joints, heart, kidneys, lymph nodes, skin, and so forth. This happens most commonly in children, but can occur at any age and even in older adults. Untreated strep infections can cause permanent damage to heart valves and heart failure.

Rheumatic fever usually starts two to four weeks after a strep throat infection. Symptoms can include fatigue, fever, chest pain, heart murmur, irregular heartbeats, uncontrollable body movements, unusual behavior such as crying or inappropriate laughing, painful, red, swollen and tender joints, shortness of breath, and painless bumps beneath the skin.

Today’s Treatment of Sore Throats
If possible, anyone who has a persistent sore throat that lasts more than a few days should get at least a throat culture to look for beta strep bacteria. Sometimes when a culture is not available for children, doctors may prescribe antibiotics, but this is very controversial. Doctors often keep children with rheumatic fever on antibiotics continuously until age 18 because every subsequent infection with beta strep can cause further damage to the heart and kidneys.

Wolfgang Amadeus Mozart
January 27, 1756 – December 5, 1791