What killed Mozart?

For more than two centuries, the music of Wolfgang Amadeus Mozart has endured — as has the speculation about what led to his sudden death at age 35 on Dec. 5, 1791.

Was the wunderkind composer poisoned by a jealous rival? Did he have an intestinal parasite from an undercooked pork chop? Could he have accidentally poisoned himself with mercury used to treat a bout of syphilis?

A report in Tuesday's Annals of Internal Medicine suggests the exalted Austrian composer might have succumbed to something far more commonplace: a streptococcal infection — possibly strep throat — that led to kidney failure.

The researchers looked at death records in Vienna during the months surrounding Mozart's death — November and December 1791 and January 1792, and compared causes of death with the previous and following years.

"We saw that at the time of Mozart's death there was a minor epidemic in deaths involving edema (swelling), which also happened to be the hallmark of Mozart's final disease," said Dr. Richard Zegers of the University of Amsterdam, one of the study's authors.

There was a spike in swelling-related deaths among younger men in Vienna at the time of Mozart's death compared to the other years studied, suggesting a minor epidemic of streptococcal disease, Zegers said.

The cause of death recorded in Vienna's official death register was "fever and rash," though even in Mozart's time those were recognized to be merely symptoms and not an actual disease.

His surviving letters and creative output suggest that he was feeling well in the months before his death and was not suffering from any chronic ailment. Many accounts note that he fell ill not long before he died — suffering from swelling so severe, his sister-in-law recalled three decades later, that the composer was unable to turn in bed.

Others who reported to have been witnesses to Mozart's final days also described swelling, as well as back pain, malaise and rash — all symptoms that indicate Mozart may have died of kidney disease brought on by a strep infection.

"It's not definitive, but it's certainly food for thought," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center who was not involved in the study.

He said it was not unreasonable to presume that Mozart died from strep complications, based on the information presented, but he pointed out that the authors had scant data to go on.

"Serious streptococcal infections were much more common than they are now and, indeed, they had very serious complications," he said. "This is sure to set off many discussions going forward."