An ostrich egg painted with a portrait of Wolfgang Amadeus Mozart is pictured in a gift shop in Salzburg January 27, 2006. REUTERS/Herwig Prammer

NEW YORK (Reuters) - The death of composer Wolfgang Amadeus Mozart at the age of 35 may have been caused by complications stemming from strep throat, according to a Dutch study published on Monday. Since the composer’s death in 1791, there have been various theories about the cause of his untimely end, from intentional poisoning, to rheumatic fever, to trichinosis, a parasitic disease caused by eating raw or undercooked pork.

On his death certificate it was officially recorded that the cause of death was hitziges Frieselfieber, or “heated miliary fever,” referring to a rash that looks like millet seeds.

But researchers from the University of Amsterdam in the Netherlands said studies on his death have generally been based on less-than-reliable evidence, like accounts from people who witnessed Mozart’s final days, written decades after his death.

Their new study, reported in the Annals of Internal Medicine, was based on information from official death registers for Vienna in the winter of 1791 that places Mozart’s death in a wider context. He died in Vienna.

“Our findings suggest that Mozart fell victim to an epidemic of strep throat infection that was contracted by many Viennese people in Mozart’s month of death, and that Mozart was one of several persons in that epidemic that developed a deadly kidney complication,” researcher Richard Zegers, of the University of Amsterdam in the Netherlands, told Reuters Health.

Zegers and his colleagues said this “minor epidemic” of step throat, or streptococcal pharyngitis, may have begun in the city’s military hospital.

According to witness accounts, Mozart fell ill with an “inflammatory fever,” which is consistent with strep throat, Zegers and his colleagues wrote in their report.

The composer, who wrote more than 600 works during his life, eventually developed severe swelling, “malaise,” back pain and a rash, consistent with a strep infection leading to kidney inflammation known as glomerulonephritis.

Zegers said it was also possible that Mozart had scarlet fever, which, like strep throat, can be caused by infection with streptococcal bacteria, but this was less likely because witnesses said Mozart developed a rash near the end of his illness and with scarlet fever, the rash appears early on.