201
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Russo C, Mikulska M, Bassetti M. Re: 'time to blood culture positivity in Staphylococcus aureus bacteraemia to determine risk of infective endocarditis' by Kahn et al. Clin Microbiol Infect 2022; 28:745-746. [PMID: 35031488 DOI: 10.1016/j.cmi.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy.
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
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202
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SaiKiran KVP, Biswal D, Agrawal SK, Batra P, Sagar T, Choudhary SK, Verma N, Chaudhry R. Anaerobes in cardiac infections: A decade experience from the tertiary care center. Indian J Med Microbiol 2022; 40:274-278. [PMID: 35031155 DOI: 10.1016/j.ijmmb.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Anaerobic infections are common yet life-threatening. They are being recovered from all sites of the body, including the cardiovascular system. This study was aimed to determine the retrospective analysis on the isolation of anaerobes in cardiovascular samples received for a decade-long duration. It helps in knowing the frequency of isolation of anaerobic causes of cardiovascular infection. METHODS All cardiovascular samples from the department of Cardio-thoracic vascular surgery from January 2010 to December 2020 were studied. RESULTS Of 601 samples received, predominant samples were vegetations and valvular tissues of 258, followed by 98 samples of pericardial tissues, 92 samples of embolus, 90 samples of blood and post-operative collections, and 63 excised aneurysms and vascular grafts. Of the total, 15 samples grew anaerobes where Clostridium species were the predominant isolates. Clostridioides difficile was isolated in 2 samples. CONCLUSIONS Anaerobes in cardiovascular samples are uncommon yet form a significant cause of morbidity and mortality. Most infections are from the contiguous spread, penetrating trauma, and hematogenous causing endocarditis or valvular infections. These conditions and samples form the seat of infectious focus and clinical suspicion towards the anaerobic cause of these conditions, especially in conventional routine culture-negative samples. Timely diagnosis of anaerobic infections plays a vital role in the good prognostic outcome of patients undergoing cardiothoracic and vascular surgery.
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Affiliation(s)
| | | | | | - Priyam Batra
- Department of Microbiology, AIIMS, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, AIIMS, New Delhi, India
| | - S K Choudhary
- Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi, India
| | | | - Rama Chaudhry
- Department of Microbiology, AIIMS, New Delhi, India.
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203
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Bourget M, Pasquie M, Charbonneau H, Bonnet E. Comparable clinical course between coagulase-negative staphylococcal and Staphylococcus aureus endocarditis. Infection 2022; 50:483-490. [PMID: 35006535 DOI: 10.1007/s15010-021-01738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Staphylococcus aureus (SA) is involved in almost one-third of endocarditis events (known as E-SA) and is frequently associated with unfavorable outcomes compared to infectious endocarditis (IE) caused by other pathogens including coagulase-negative staphylococci (CNS). The aim of this study was to compare the morbidity and mortality of patients with E-SA and endocarditis due to CNS (known as E-CNS). METHODS A monocentric retrospective cohort analysis was conducted including all patients admitted with IE from January 2010 to December 2017. Lengths of stay, complications, in-hospital and 1-year mortality were described from medical records and compared between E-SA and E-CNS. RESULTS Among the 428 patients included, 102 had staphylococcus (50 E-SA and 52 E-CNS). Half of the IE events due to staphylococcus occurred in the year following a cardiac procedure [p = 0.029]. A septic embolism occurred in 41% and 48% of patients with E-CNS and E-SA, respectively [p = 0.439]. Cardiac surgery was indicated in 50% of E-SA and 48% of E-CNS cases [p = 0.846]. The intra-hospital and 1-year mortality rates were 25% and 31% for E-CNS and 34% and 45% for E-SA [p = 0.699, p = 0.234]. CONCLUSION Embolic complications, surgical management rate and mortality rates of E-SA and E-CNS were comparable, which may suggest a similar morbidity and mortality irrespective of the pathogen involved in IE.
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Affiliation(s)
- Marie Bourget
- Infectiology Unit, Clinique Pasteur, Toulouse, France. .,CHU Hotel Dieu, Nantes, France.
| | - Marie Pasquie
- Research Department, Clinique Pasteur, Toulouse, France
| | - Hélène Charbonneau
- Anesthesiology and Critical Care Unit, Clinique Pasteur, Toulouse, France
| | - Eric Bonnet
- Infectiology Unit, Clinique Pasteur, Toulouse, France
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204
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Pérez-Caballero R, Pardo CA, Marques Correia P, Ballesteros F. Recurrent infective stenosis of Fontan conduit. Eur J Cardiothorac Surg 2022; 62:6501294. [PMID: 35018407 DOI: 10.1093/ejcts/ezab562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/17/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ramón Pérez-Caballero
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Andrés Pardo
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Marques Correia
- Department of Cardiothoracic Surgery, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Fernando Ballesteros
- Department of Paediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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205
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Abstract
The opioid overdose epidemic is one of the leading causes of death in adults. Its devastating effects have included not only a burgeoning overdose crisis but also multiple converging infectious diseases epidemics. The use of both opioids and other substances through intravenous (IV) administration places individuals at increased risks of infectious diseases ranging from invasive bacterial and fungal infections to human immunodeficiency virus (HIV) and viral hepatitis. In 2012, there were 530,000 opioid use disorder (OUD)-related hospitalizations in the United States (US), with $700 million in costs associated with OUD-related infections. The scale of the crisis has continued to increase since that time, with hospitalizations for injection drug use-related infective endocarditis (IDU-IE) increasing by as much as 12-fold from 2010 to 2015. Deaths from IDU-IE alone are estimated to result in over 7,260,000 years of potential life lost over the next 10 years. There have been high-profile injection-related HIV outbreaks, and injection drug use (IDU) is now the most common risk factor for hepatitis C virus (HCV). As this epidemic continues to grow, clinicians in all aspects of medical care are increasingly confronted with infectious complications of IDU. This review will describe the pathogenesis, clinical syndromes, epidemiology, and models of treatment for common infectious complications among persons who inject drugs (PWIDs).
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Affiliation(s)
- Laura R Marks
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA.
| | - Nathanial S Nolan
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA; Division of Emergency Medicine, Washington University in St. Louis School of Medicine
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA
| | - Melissa B Weimer
- Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, E.S. Harkness Memorial Building A, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
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206
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Fujiwara Y, Tobita H, Mochizuki N, Inomata T, Asano T, Ohishi H, Kanamitsu H, Kubonishi S, Mohri M, Hiramatsu Y. [Cunninghamella bertholletiae-infective endocarditis complicated by tricuspid valve giant vegetation in a patient with aplastic anemia]. Rinsho Ketsueki 2022; 63:740-745. [PMID: 35922941 DOI: 10.11406/rinketsu.63.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 62-year-old female was presented to the hospital of the current study for pancytopenia and was diagnosed with severe aplastic anemia. She was treated with a combination therapy of antithymocyte globulin, cyclosporine A, and eltrombopag. The patient also presented with febrile neutropenia after commencement of the treatment and did not respond to the various antibiotics and antifungal agents. Echocardiography showed a giant vegetation attached to the tricuspid valve on Day 78 of the immunosuppressive therapy, and the tricuspid valve replacement was performed. The vegetation was formed by Cunninghamella bertholletiae, a mucor type, and was treated with high-dose liposomal amphotericin B (L-AMB), which was terminated after six weeks due to decreased renal function. In addition, mucormycosis was controlled by posttreatment with posaconazole (PSCZ). This is a rare case of mucormycosis that developed into a giant vegetation during the immunosuppressive therapy for aplastic anemia. It was believed to be a valuable case to consider in future mucormycosis treatment, including the success of the treatment by switching from L-AMB to PSCZ.
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Affiliation(s)
- Yuki Fujiwara
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Haruna Tobita
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Naoya Mochizuki
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Tomoko Inomata
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Takeru Asano
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Hirokazu Ohishi
- Department of Inspection Technology, Japanese Red Cross Society Himeji Hospital
| | - Hitoshi Kanamitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Society Himeji Hospital
| | - Shiro Kubonishi
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
| | - Makoto Mohri
- Department of Cardiovascular Surgery, Japanese Red Cross Society Himeji Hospital
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital
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207
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Davtyan A, Guyon PW, El-Sabrout HR, Ponder R, Ramchandar N, Weber R, Zayed W, Ratnayaka K, Nigro JJ, Moore JW, Bauser-Heaton H, Alshawabkeh L, Reeves RR, Levi D, Aboulhosn J, Justino H, Bradley J, El-Said HG. Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience. Pediatr Cardiol 2022; 43:894-902. [PMID: 34894280 DOI: 10.1007/s00246-021-02801-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 12/22/2022]
Abstract
Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1-9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.
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208
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Béraud G, Maupetit JC, Darras A, Vimont A, Blachier M. Dalbavancin in Real Life: Economic Impact of Prescription Timing in French Hospitals. Infect Dis Ther 2021; 11:435-449. [PMID: 34913137 PMCID: PMC8847654 DOI: 10.1007/s40121-021-00577-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin, but no real-life assessment has been conducted to date. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals. METHODS A multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization. RESULTS A total of 179 patients were identified in the registry, and 154 were included in our study. Dalbavancin was mostly used for bone and joint infections (56.0%), infective endocarditis (19.0%) and acute bacterial skin and skin structure infections (6.0%). When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin (up to a reduction of 13 days). The budget impact for dalbavancin was heterogeneous but frequently generated savings (up to 2257.0 €). Early switching (within less than 11 days) was associated with savings (or lesser costs), with even greater benefits within 7 days of hospitalization. Patients who required a deep venous catheter as well as the most severe patients benefited the most from dalbavancin. CONCLUSION Our study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch.
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Affiliation(s)
- Guillaume Béraud
- Department of Internal Medicine and Infectious Diseases, University Hospital of Poitiers, Poitiers, France.
| | | | - Audric Darras
- UNIHA Tender, Hospital Pharmacy, University Hospital of Toulouse, Toulouse, France
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209
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Momtazmanesh S, Saeedi Moghaddam S, Malakan Rad E, Azadnajafabad S, Ebrahimi N, Mohammadi E, Rouhifard M, Rezaei N, Masinaei M, Rezaei N, Keykhaei M, Aminorroaya A, Ghamari A, Larijani B, Farzadfar F. Global, regional, and national burden and quality of care index of endocarditis: the global burden of disease study 1990-2019. Eur J Prev Cardiol 2021; 29:1287-1297. [PMID: 34897404 DOI: 10.1093/eurjpc/zwab211] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/17/2021] [Indexed: 02/06/2023]
Abstract
AIMS Endocarditis accounts for significant morbidity and mortality. Timely diagnosis and prompt treatment are of paramount importance for optimal patient outcome. However, only few studies have assessed quality of care (QoC) in endocarditis. We aimed to describe QoC and changes in epidemiological features of endocarditis from 1990 to 2019. METHODS AND RESULTS Using primary indices of mortality, incidence, years of life lost, years lived with disability, and disability-adjusted life year, obtained from the Global Burden of Disease Study 2019, we calculated four secondary measures. Principal component analysis was performed to calculate QoC index (QCI), scored on a scale of 0-100 with higher values indicating better QoC, for different locations, age groups, and genders from 1990 to 2019. The all-ages incidence rate of endocarditis was estimated to increase significantly from 1990 to 2019, while mortality rate did not change. The age-standardized QCI was 73.6% globally, with higher values in high-income countries than in low-income countries. High-income North America (82.0%) and Asia Pacific (81.1%) had the highest QCI, whereas Eastern Europe (43.3%) had the lowest. Globally, the 30-49 and 95+ age groups had the highest (91.3%) and the lowest (71.7%) QCI, respectively. In most countries, particularly those with lower socio-demographic index, women had better QCI. CONCLUSION This is the first global assessment of QCI, shedding light on the current trends and highlighting the necessity of improving the endocarditis QoC, mainly by timely case detection, adherence to antibiotic prophylaxis guidelines, utilizing targeted antibiotics and advanced treatments, in the African region and resolving gender inequality in selected countries.
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Affiliation(s)
- Sara Momtazmanesh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, No.62, Dr. Gharib's street, End of Keshavarz Boulevard, Tehran 1419733151, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Mahtab Rouhifard
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No.10, Jalal Al-e-Ahmad Highway, Tehran 1411713139, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Azin Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No.10, Jalal Al-e-Ahmad Highway, Tehran 1411713139, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second floor, No. 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran 1411713137, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No.10, Jalal Al-e-Ahmad Highway, Tehran 1411713139, Iran
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210
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Arora N, Panda PK, Cr P, Uppal L, Saroch A, Angrup A, Sharma N, Sharma YP, Vijayvergiya R, Rohit MK, Gupta A, Sihag BK, Gupta H, Dahiya N, Bahl A, Singh P, Mehrotra S, Barwad P, Pannu AK. Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India. Indian Heart J 2021; 73:711-717. [PMID: 34861981 PMCID: PMC8642647 DOI: 10.1016/j.ihj.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design A retrospective analysis of patients with in north India between 2010 and 2020. Methods The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.
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Affiliation(s)
- Navneet Arora
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Prashant Kumar Panda
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pruthvi Cr
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Lipi Uppal
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Atul Saroch
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Yash Paul Sharma
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ankur Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhupinder Kumar Sihag
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Himanshu Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neelam Dahiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parminder Singh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Saurabh Mehrotra
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parag Barwad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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211
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Haddad S, Saade Y, Ramlawi B, Kreidieh B, Gilbert B, Rao S. Native valve endocarditis complicated by abscess formation caused by Rothia mucilaginosa. IDCases 2021; 26:e01348. [PMID: 34849341 DOI: 10.1016/j.idcr.2021.e01348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
Rothia mucilaginosa is increasingly recognized as an emerging pathogen associated with endocarditis. It has mostly been reported a causative agent for prosthetic valve endocarditis. The previously reported cases of native valve endocarditis caused by this organism only required medical treatment with no surgical intervention. We report a case of R. mucilaginosa native valve endocarditis complicated by abscess formation requiring surgical intervention and review the literature of native valve endocarditis caused by this organism.
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212
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Grillo S, Cuervo G, Laporte-Amargós J, Tuells M, Grau I, Berbel D, Gudiol C, Pujol M, Carratalà J. Bloodstream Infection and Endocarditis Caused by Staphylococcus aureus in Patients with Cancer: A Multicenter Cohort Study. Infect Dis Ther 2021. [PMID: 34855164 DOI: 10.1007/s40121-021-00575-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/24/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION In a large cohort of patients with Staphylococcus aureus bloodstream infection (SABSI), we aimed to analyze the incidence and risk factors for infective endocarditis (IE) among patients with active cancer (PAC) in comparison with those without cancer (PWC). METHODS Multicenter cohort study of patients with SABSI admitted to two tertiary care hospitals, from 2011 to 2019. PAC were defined as those with an active solid organ cancer or hematological malignancies. SABSI and S. aureus IE were compared between PAC and PWC. RESULTS Among 978 episodes of SABSI, 217 (22.2%) occurred in PAC. PAC were younger, had fewer comorbidities, carried cardiac devices less often, and had less community-acquired SABSI than PWC. Compared to PWC, PAC more frequently had catheter-related SABSI, less IE (2.8% vs 10.9%, p < 0.001) and osteoarticular infection (2.3% vs 14.3%, p < 0.001). Independent risk factors for IE were cardiopathy (aOR 4.392, 95% CI 2.719-7.094) and persistent bacteremia (aOR 3.545, 95% CI 2.159-5.820). Thirty-day mortality was high, and similar between groups (24.2% vs 25.5%, p = 0.282). CONCLUSIONS PAC with SABSI developed IE less frequently than PWC did. This finding seems related to the differences in baseline characteristics and may have significant clinical implications, such as transesophageal echocardiography in PAC without cardiopathy or persistent bacteremia.
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Durante-Mangoni E, Giuffrè G, Ursi MP, Iossa D, Bertolino L, Senese A, Pafundi PC, D'Amico F, Albisinni R, Zampino R. Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients. Eur J Intern Med 2021; 94:27-33. [PMID: 34474958 DOI: 10.1016/j.ejim.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Very limited data are available on the long-term outcome of infective endocarditis (IE) and its determinants. The aim of this study was to identify the predictors of long-term mortality in patients affected by left sided IE (LSIE). METHODS This was an historical retrospective observational study on prospectively collected data from patients with LSIE hospitalized in our Unit (January 2000-December 2017). Multiple variables relevant to history, physical examination, laboratory tests, echocardiography, comorbidities, complications and outcome were analysed by Cox regression to identify predictors of long-term mortality. RESULTS 414 patients were included, and followed up for a median of 39 months [IQR 11-74]. Median age was 59 years [range 3-89], and most patients were male. Over 50% showed at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors of 1-year mortality. At multivariate analysis, peripheral arterial disease (p= 0.017), hyperglycemia on admission (p=0.013) and a higher BMI (p=0.009) were independent predictors of long-term mortality in 1-year survivors. At multivariable Cox proportional hazard regression, peripheral arterial disease (p=0.002), hyperglycemia (p=0.041) and CKD on hemodialysis (p=0.025) confirmed to be independently associated with an increased risk of long-term mortality in the overall 414 patient cohort. CONCLUSIONS Cardiovascular and metabolic risk signals, specifically peripheral arterial disease and hyperglicemia, affect long-term mortality of LSIE. An active and long-term follow up seems warranted in IE survivors showing these conditions at outset.
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Affiliation(s)
- Emanuele Durante-Mangoni
- Departments of Precision Medicine, Univeristy of Perugia; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy.
| | | | | | - Domenico Iossa
- Departments of Precision Medicine, Univeristy of Perugia
| | | | | | | | | | - Rosina Albisinni
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Rosa Zampino
- Advanced Medical and Surgical Sciences, University of Campania 'L. Vanvitelli'; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
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Serota DP, Tookes HE, Hervera B, Gayle BM, Roeck CR, Suarez E, Forrest DW, Kolber MA, Bartholomew TS, Rodriguez AE, Doblecki-Lewis S. Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team. Ann Med 2021; 53:1960-1968. [PMID: 34726095 PMCID: PMC8567885 DOI: 10.1080/07853890.2021.1993326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections (SSTI) are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality. The purpose of this study was to describe the development of an integrated "SIRI Team" and its initial barriers and facilitators to success. MATERIALS AND METHODS The Jackson SIRI Team was developed to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, a 1550-bed public hospital in Miami, Florida, United States. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder (MOUD), and utilizes a variety of infection and addiction treatment modalities to suit each individual patient. RESULTS Over the initial 8-months of the SIRI Team, 21 patients were treated with 20 surviving until discharge. Infections included osteomyelitis, endocarditis, bacteraemia/fungemia, SSTIs, and septic arthritis. All patients had OUD and 95% used stimulants. All patients were discharged on MOUD and 95% completed their prescribed antibiotic course. At 90-days post-discharge, 25% had been readmitted and 70% reported taking MOUD. CONCLUSIONS A model of integrated infectious disease and SUD care for the treatment of SIRIs has the potential to improve infection and addiction outcomes. Providing attentive, patient-centered care, using a harm reduction approach can facilitate engagement of this marginalized population with the healthcare system.KEY MESSAGESIntegrated infectious disease and addiction treatment is a novel approach to treating severe injection-related infections.Harm reduction should be applied to treating patients with severe injection-related infections with a goal of facilitating antibiotic completion, remission from substance use disorder, and reducing hospital readmissions.
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Affiliation(s)
- David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Belén Hervera
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Babley M. Gayle
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Cara R. Roeck
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Edward Suarez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W. Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A. Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E. Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Gutiérrez-Villanueva A, Muñoz P, Delgado-Montero A, Olmedo-Samperio M, de Alarcón A, Gutiérrez-Carretero E, Zarauza J, García I Pares D, Goenaga MÁ, Ojeda-Burgos G, Goikoetxea-Agirre AJ, Reguera-Iglesias JM, Ramos A, Fernández-Cruz A. Mural Endocarditis: The GAMES Registry Series and Review of the Literature. Infect Dis Ther 2021; 10:2749-2764. [PMID: 34312819 PMCID: PMC8572950 DOI: 10.1007/s40121-021-00490-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis. METHODS Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series. RESULTS Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar. CONCLUSION MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.
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Affiliation(s)
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María Olmedo-Samperio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Department, CIBERCV, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Jesús Zarauza
- Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Delia García I Pares
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Internal Medicine Service, Clinica Sagrada Familia, Barcelona, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Department, Hospital Universitario Donosti, ISS Biodonostia, San Sebastián, Spain
| | - Guillermo Ojeda-Burgos
- Infectious Diseases Clinical Unit, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | | | | | - Antonio Ramos
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
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216
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Douin C, Marchetta S, Dulgheru R, Bruyère PJ, Moonen M, Lancellotti P. Case report: aortic bioprosthesis marantic endocarditis. Acta Cardiol 2021; 76:1143-1144. [PMID: 33047667 DOI: 10.1080/00015385.2020.1813995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Clara Douin
- GIGA Cardiovascular Sciences, Department of Cardiology and Radiology, University of Liège Hospital, CHU Sart-Tilman, Liège, Belgium
| | - Stella Marchetta
- Department of Cardiology, CHC MontLegia Hospital, Liège, Belgium
| | - Raluca Dulgheru
- GIGA Cardiovascular Sciences, Department of Cardiology and Radiology, University of Liège Hospital, CHU Sart-Tilman, Liège, Belgium
| | - Pierre-Julien Bruyère
- GIGA Cardiovascular Sciences, Department of Cardiology and Radiology, University of Liège Hospital, CHU Sart-Tilman, Liège, Belgium
| | - Marie Moonen
- GIGA Cardiovascular Sciences, Department of Cardiology and Radiology, University of Liège Hospital, CHU Sart-Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology and Radiology, University of Liège Hospital, CHU Sart-Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
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217
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Oral H, Sönmezer MÇ, Yıldız AE, Hazırolan G, Metan G, İnkaya AÇ. Disseminated Brucella melitensis infection following canakinumab treatment. Travel Med Infect Dis 2021; 45:102227. [PMID: 34856407 DOI: 10.1016/j.tmaid.2021.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hakan Oral
- Hacettepe University, Department of Internal Medicine, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - Gülşen Hazırolan
- Hacettepe University, Department of Microbiology, Ankara, Turkey
| | - Gökhan Metan
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
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218
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Mirna M, Topf A, Schmutzler L, Hoppe UC, Lichtenauer M. Time to abandon ampicillin plus gentamicin in favour of ampicillin plus ceftriaxone in Enterococcus faecalis infective endocarditis? A meta-analysis of comparative trials. Clin Res Cardiol 2021; 111:1077-1086. [PMID: 34751788 PMCID: PMC9525249 DOI: 10.1007/s00392-021-01971-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/03/2021] [Indexed: 01/11/2023]
Abstract
Background Current guidelines recommend either ampicillin plus ceftriaxone (AC) or amoxicillin/ampicillin plus gentamicin (AG) with an equivalent class IB recommendation in Enterococcus faecalis endocarditis. However, previous observational studies suggest that AC might be favourable in terms of adverse events. Objectives To investigate whether AC is non-inferior to AG, and if it is associated with less adverse events. Methods In June 2021, a systematic literature search using the databases PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS was conducted by two independent reviewers. Studies were considered eligible if (P) patients included were ≥ 18 years of age and had IE with E. faecalis, (I) treatment with AC was compared to (C) treatment with AG and (O) outcomes on in-hospital mortality, nephrotoxicity and adverse events requiring drug withdrawal were reported. Odds ratios and 95% confidence intervals were calculated using random-effects models with the Mantel–Haenszel method, the Sidik–Jonkman estimator for τ2 and the Hartung–Knapp adjustment. Results Treatment with AC was non-inferior to AG, as depicted by no significant differences in-hospital mortality, 3-month mortality, relapses or treatment failure. Furthermore, AC was associated with a lower prevalence of nephrotoxicity (OR 0.45 [0.26–0.77], p = 0.0182) and drug withdrawal due to adverse events (OR 0.11 [0.03–0.46], p = 0.0160) than AG. Conclusions Treatment with AC was non-inferior to treatment with AG, and it was associated with a reduced prevalence of nephrotoxicity and drug withdrawal due to adverse events. Thus, combination therapy with AC appears favourable over AG in patients with E. faecalis IE. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01971-3.
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Affiliation(s)
- Moritz Mirna
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Albert Topf
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas Schmutzler
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Uta C Hoppe
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Lichtenauer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Jordan AM, Tatum R, Ahmad D, Patel SV, Maynes EJ, Weber MP, Moss S, Royer TL, Tchantchaleishvili V, Massey HT, Rame JE, Zurlo JJ, Aburjania N. Infective endocarditis following heart transplantation: A systematic review. Transplant Rev (Orlando) 2021; 36:100672. [PMID: 34826752 DOI: 10.1016/j.trre.2021.100672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Infective endocarditis (IE) is a rare but potentially fatal complication following heart transplantation (HTx). There is a lack of literature regarding the patterns and clinical course of IE development following HTx. We sought to pool the existing data in regards to defining characteristics, management options, and outcomes of IE following HTx. METHODS An electronic search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, and the Scopus databases were performed to identify all articles in the English literature that report IE following HTx in adult patients. Patient-level data were extracted and analyzed. RESULTS Systematic search yielded 57 patients from 32 articles. Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8] months. IE of the mitral valve was observed in 36.8% (21/57) of patients, followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1% (12/57). The most common organisms were Staphylococcus aureus in 26.3% (15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in 12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57) patients. Overall case fatality was 44.6% (25/56). Fungal IE was associated with a significantly higher case fatality 75.0% (9/12) than that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of post-HTx IE was observed in 35.1% (20/57) of patients. This included valve surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14), aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of patients. CONCLUSION In addition to bacterial organisms, fungi also represent a frequent cause of IE in post-HTx patients. Overall HTx patient survival in the setting of IE is poor and may be worse if caused by A. fumigatus.
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220
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Ohno T, Saito S, Iwata E, Ushida S, Otsuka R, Miyahara K, Matsuura A. Blood culture-negative endocarditis caused by Bartonella henselae: a case report. Indian J Thorac Cardiovasc Surg 2021; 38:187-190. [PMID: 34754148 PMCID: PMC8568566 DOI: 10.1007/s12055-021-01266-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
Bartonella henselae is well known as a causative organism of cat scratch disease. Although this bacterium infrequently involves the heart, the diagnosis is difficult to confirm. A 75-year-old woman who had a pet cat presented with pancytopenia, hepatosplenomegaly, and low-grade fever. Echocardiography depicted sessile nodules on the aortic valve. C-reactive protein concentration was low, and leukocytosis was not seen. Two sets of blood culture turned out negative. However, elevated B. henselae immunoglobulin G titer led us to the diagnosis of infective endocarditis. Minocycline was administered orally in combination with intravenous administration of gentamicin as an antimicrobial treatment. The patient underwent aortic valve replacement 2 months after her initial visit. Warthin-Starry silver staining did not show any bacterial bodies. The culture of the vegetation tissue was negative. Polymerase chain reaction testing of the excised valve tissue detected the deoxyribonucleic acid of the organism. The postoperative course was uneventful, and the patient was discharged home.
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Affiliation(s)
- Tsukasa Ohno
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Shunei Saito
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Eri Iwata
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Sen Ushida
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Ryohei Otsuka
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Ken Miyahara
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Akio Matsuura
- Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
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Al-Mashdali AF, Alamin MA, Kanaan AM, Alkhulaifi A, Al Kindi DI. Fatal native aortic valve fungal endocarditis caused by Aspergillus flavus: A case report. IDCases 2021; 26:e01310. [PMID: 34729358 PMCID: PMC8546413 DOI: 10.1016/j.idcr.2021.e01310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Fungal endocarditis is a rare condition, specifically in immunocompetent patients. Aspergillus species are the etiology in less than 30% of the cases. Moreover, Aspergillus flavus endocarditis is extremely rare and reported in only 7% of the total Aspergillus endocarditis cases. The most common predisposing factors are immunocompromised state, prosthetic valve, and previous cardiac surgery. In most cases, the diagnosis is delayed and occasionally missed. Prompt medical management combined with early surgical intervention is recommended once the diagnosis is established since the mortality rate is nearly 100% without surgical intervention. We report a rare and fatal case of native aortic valve endocarditis in a 49 years old diabetic patient who presented with fever and abdominal pain, complicated by multiple septic embolizations (splenic infarction, cerebral emboli, and limbs ischemia), and in which A. flavus was confirmed post mortem.
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Affiliation(s)
| | - Mohammed A Alamin
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ammar M Kanaan
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz Alkhulaifi
- Department of Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dawoud I Al Kindi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Santhanam H, Nguyen MHN, Muthukumarasamy N, Mehta A, Francisco MT, Fountain RR, Helmstetter NJ. Bartonella endocarditis in patients with right ventricle-to-pulmonary artery conduit: 2 case reports and literature review. IDCases 2021; 26:e01306. [PMID: 34722156 PMCID: PMC8536538 DOI: 10.1016/j.idcr.2021.e01306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022] Open
Abstract
Bartonella species are Gram-negative bacilli and fastidious bacteria that can cause a number of clinical syndromes, including blood culture-negative infective endocarditis (IE). The two most commonly isolated species in humans are Bartonella quintana, the agent of trench fever, and Bartonella henselae, mostly known for causing cat scratch disease (Edouard et al., 2015 [1]; Edouard and Raoult, 2010 [2]). Both species also cause bacillary angiomatosis, primarily in immunocompromised patients (Edouard et al., 2015 [1]; Fournier et al., 2001 [3]). The risk of B. henselae IE is increased in patients with cardiac valvular disease and congenital heart disease (CHD) (Edouard and Raoult, 2010 [2]; Das et al., 2009 [4]; Abandeh et al., 2012 [5]; Ouellette et al., 2016 [6]; Hoffman et al., 2007 [7]; Georgievskaya et al., 2014 [8]). In this article, we detail two cases of Bartonella IE in patients with right ventricle-to-pulmonary artery (RV-PA) conduits who presented to our institution. We also perform a literature review on Bartonella IE in patients with a history of RV-PA conduit or pulmonary valve replacement.
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Affiliation(s)
- Haripriya Santhanam
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Minh H N Nguyen
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Nirmal Muthukumarasamy
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Aditya Mehta
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Michael T Francisco
- Department of Hematology/Oncology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Robin R Fountain
- Bronson Methodist Hospital, Pediatric Cardiology, 601 John St, Kalamazoo, MI 49007, USA
| | - Nicholas J Helmstetter
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
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223
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Wutawunashe CV, Ma R, Chang GDW, Goyal R, Morrow Z, Ilyas N. A rare case of a novel coagulase negative Staphylococcus native valve endocarditis in a 28-year-old male. IDCases 2021; 26:e01262. [PMID: 34692414 PMCID: PMC8517830 DOI: 10.1016/j.idcr.2021.e01262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
Coagulase negative staphylococci (CoNS) are an emerging cause of native valve endocarditis in community and healthcare settings. We describe a case of a 28-year-old man with no significant risk factors who presented with Staphylococcus pettenkoferi native valve endocarditis. During our patient’s initial hospitalization, he was treated for CoNS bacteraemia and subsequently discharged after a protracted hospital course with a transthoracic echocardiogram (TTE) showing no valvular vegetations. However, during the course of his second hospitalization, speciation identified S. pettenkoferi and transoesophageal echocardiogram (TEE) showed aortic valve perforations with new regurgitation raising concern for left sided endocarditis. We postulate that our patient may have been infected with the same CoNS species causing aortic valve endocarditis during his initial hospitalization. This case highlights the importance of recognizing CoNS as a possible causative bacterium in NVE, as well as the importance of obtaining a TEE when evaluating a patient for suspected endocarditis.
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Affiliation(s)
- Caleb V. Wutawunashe
- Correspondence to: Lenox Hill Hospital/Northwell Health, 130 East 77th Street, New York, NY 10075, USA.
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224
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Velders BJJ, Tomšič A, Klautz RJM, Palmen M. Patch repair in infective native mitral valve endocarditis. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34767703 DOI: 10.1510/mmcts.2021.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infective native mitral valve endocarditis occurs rarely. Mitral valve repair, although surgically challenging, is favored over replacement in the latest European and American guidelines. In this video tutorial, patch repair of the posterior mitral valve leaflet is performed in a 61-year-old patient with endocarditis caused by Streptococcus agalactiae.
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Affiliation(s)
- Bart J J Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton Tomšič
- Department of Cardiothoracic Surgery Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden Netherlands
| | - Robert J M Klautz
- Heart Lung Center Department of Cardiothoracic Surgery Leiden University Medical Center Leiden Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery Leiden University Medical Center Albinusdreef 2, 2333 ZA Leiden Netherlands
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225
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Saia F, Orzalkiewicz M. How to reduce uncommon but severe transcatheter aortic valve implantation complications: stroke, thrombosis, endocarditis, cognitive decline? Eur Heart J Suppl 2021; 23:E142-E146. [PMID: 34650374 PMCID: PMC8503386 DOI: 10.1093/eurheartj/suab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transcatheter aortic valve implantation has become a valid alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis, regardless of baseline surgical risk. The incidence of periprocedural complications has steadily declined over the years, thanks to technical advancement of transcatheter heart valves, delivery systems, and increased operators' experience. Beyond the most common periprocedural complications, there are a few uncommon but potentially severe complications that more often occur during follow-up, although they may also arise in the periprocedural phase. Stroke, infective endocarditis, valve thrombosis, and cognitive decline are among them. In this brief review, we describe the incidence, predictive factors, and potential preventive measures for those events.
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Affiliation(s)
- Francesco Saia
- Cardiac Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola (Pav. 23), Via Massarenti, 9, 40138 Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiac Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola (Pav. 23), Via Massarenti, 9, 40138 Bologna, Italy
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226
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Terry NLJ, Manapragada P, Aziz MU, Singh SP. Cardiac mass evaluation with cardiac computed tomography: A review. J Med Imaging Radiat Sci 2021; 52:S78-S87. [PMID: 34645578 DOI: 10.1016/j.jmir.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Cardiac masses are rare and include both benign and malignant neoplasms as well as pseudo-tumors. The goal of imaging in patients with suspected cardiac mass is to: (1) confirm presence of a mass; (2) determine the mass' location in the heart; (3) characterize the mass to determine if it is benign or malignant; and (4) evaluate its relationship and effect on adjacent structures. Echocardiography is often the first to detect and assess cardiac structures as it is widely available, non-invasive, and can be done bedside. Echo can also determine if the myocardium or pericardium is involved. Cardiac Magnetic Resonance Imaging (MRI) is often the second modality of choice to evaluate a cardiac mass. Cardiac Computed Tomography (CCT) is an excellent alternative modality with high spatial and temporal resolution, which is widely available, fast, and can be performed in patients with cardiac hardware. We will discuss the role of computed tomography (CT) in the evaluation of various cardiac masses.
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Affiliation(s)
- Nina L J Terry
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA.
| | - Padma Manapragada
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA
| | - Muhammad Usman Aziz
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA
| | - Satinder P Singh
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA
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227
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Vitali P, Savoldi F, Segati F, Melazzini L, Zanardo M, Fedeli MP, Benedek A, Di Leo G, Menicanti L, Sardanelli F. MRI versus CT in the detection of brain lesions in patients with infective endocarditis before or after cardiac surgery. Neuroradiology 2021; 64:905-913. [PMID: 34647143 PMCID: PMC9005423 DOI: 10.1007/s00234-021-02810-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
Purpose Imaging of brain involvement in infective endocarditis can drive the clinical management of this serious condition. MRI is very sensitive, but CT is more readily available. In this retrospective study, we compared the detection rates of CT and MRI. Methods After Ethics Committee approval, we retrospectively reviewed a series of 20 patients (13 males, median age 64 years) who underwent both CT and MRI either before or after cardiac surgery for definite infective endocarditis. Plain CT and MRI were evaluated for acute ischemic lesions, both punctuate and large, intraparenchymal hemorrhages, cerebral microbleeds, subarachnoid hemorrhages, abscesses, microabscesses, and meningitis. Qualitative assessment and McNemar test were performed. The value of contrast-enhanced scans (MRI, n = 14; CT, n = 9) and cognitive status were also assessed. Results A total of 166 lesions were identified on either technique: 137 (83%) on MRI only, 4 (2%) on CT only, and 25 (15%) on both techniques (p < 0.001). For these last 25 lesions, concordance on lesion type was only 16/25 (64%). MRI detected more microbleeds and ischemic lesions, while the 4 CT-only findings were false positives. Contrast-enhanced scans identified 68 enhancing lesions, mainly abscesses and microabscesses, and allowed a better characterization for 61/117 lesions (52%) with MRI, and for 11/81 (14%) with CT. Follow-up identified mild cognitive impairment in 6/13 and dementia in 3/13 patients. Conclusion While CT rapidly excludes large hemorrhages in patients with infective endocarditis, MRI accurately distinguishes the whole spectrum of brain lesions, including small ischemic lesions, microbleeds, and microabscesses.
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Affiliation(s)
- Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Filippo Savoldi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Flavia Segati
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milan, Italy
| | - Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Maria Paola Fedeli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Adrienn Benedek
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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228
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Chiocchi M, D'Errico F, De Stasio V, Di Tosto F, Pugliese L, Di Donna C, Spiritigliozzi L, Benelli L, Masala S, Caterino L, Vanni G, Pasqualetto M, Cerimele C, Sbordone F, Grimaldi F, Cesareni M, Luciano A, Laudazi M, Rellini C, Cerocchi M, Leomanni P, Floris R, Garaci F. Pseudoaneurysm of the aortic root following aortic valve endocarditis - a case with 2 rare life - threatening complications. Radiol Case Rep 2021; 16:3703-3707. [PMID: 34630805 PMCID: PMC8493506 DOI: 10.1016/j.radcr.2021.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
Infective endocarditis can have peri-annular spread and involve the valvular annulus and adjacent cardiac structures, leading to tissue necrosis and peri-annular abscess. This process may cause pseudoaneurysm formation and other rare and potentially life-threatening complications, so their identification and correct diagnosis are crucial. We describe a case of an 81-year-old woman, with a history of aortic valve replacement and worsening of symptoms, that presents at the imaging a pseudoaneurysm of the aortic root complicated at the same time by 2 life-threatening conditions: fistulization in the Right Ventricular Outflow Tract (RVOT) and the compression of Right Coronary Artery (RCA). This case underlines the importance of imaging, especially Coronary Computed Tomography Angiography (CCTA), in the diagnosis and follow-up of infective endocarditis and its complications, especially in a patient not eligible for surgery.
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Affiliation(s)
- Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Francesca D'Errico
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Federica Di Tosto
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Luca Pugliese
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Carlo Di Donna
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Luigi Spiritigliozzi
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Leonardo Benelli
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Salvatore Masala
- Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Lucrezia Caterino
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy.,Policlinico Agostino Gemelli, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Monia Pasqualetto
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Cecilia Cerimele
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Francesco Sbordone
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Francesco Grimaldi
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Matteo Cesareni
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Alessandra Luciano
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Carlotta Rellini
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Martina Cerocchi
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Paola Leomanni
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Francesco Garaci
- Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
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229
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Sadeghpour A, Maleki M, Boodagh S, Behjati M, Rezvani L, Ghadrdoost B, Noohi F, Bakhshandeh H, Moradnejad P, Kamali M, Alizadehasl A, Alireza Ghavidel A, Hosseini S, Pasha H. Impact of the Iranian Registry of Infective Endocarditis (IRIE) and multidisciplinary team approach on patient management. Acta Cardiol 2021; 76:838-841. [PMID: 32589112 DOI: 10.1080/00015385.2020.1781423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUNDS The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside. METHODS In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this. RESULTS Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics (p = 0.04) and higher rate of positive blood culture (p = 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT (p = 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT (p < 0.001) and consequently in-hospital mortality reduced significantly (p = 0.05). CONCLUSION Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.
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Affiliation(s)
- A. Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M. Maleki
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sh Boodagh
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M. Behjati
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - L. Rezvani
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - B. Ghadrdoost
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - F. Noohi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - H. Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - P. Moradnejad
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M. Kamali
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A. Alizadehasl
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A. Alireza Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - S. Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - H. Pasha
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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230
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Serrano R, Rello J. New insights in endocarditis caused by Gram negative bacilli not included in the HACEK group. Eur J Intern Med 2021; 92:36-37. [PMID: 34503887 DOI: 10.1016/j.ejim.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Ricardo Serrano
- Critical Care Department, Hospital de Hellín, Gerencia Atención Integrada de Hellín, Albacete, Spain.
| | - Jordi Rello
- Vall d'Hebron Institute of Research, Barcelona, Spain; Clinical Research, CHRU Nîmes, France
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231
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Suzuki T, Ishikawa K, Matsuo T, Kijima Y, Aoyagi H, Kawai F, Komiyama N, Mori N. Pacemaker infection and endocarditis due to Parvimonas micra: A case report and systematic review. Anaerobe 2021; 72:102459. [PMID: 34555513 DOI: 10.1016/j.anaerobe.2021.102459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/12/2021] [Accepted: 09/19/2021] [Indexed: 12/13/2022]
Abstract
Infective endocarditis caused by Parvimonas micra is rare. Its clinical features are presented in this systematic review. We also describe the case of an 82-year-old man with infective endocarditis and pacemaker infection due to P. micra. There are some reports of recurrence during antimicrobial therapy; hence, careful follow-up is necessary.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan.
| | - Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Yasufumi Kijima
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Hideshi Aoyagi
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Fujimi Kawai
- St. Luke's International University Library, 10-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-0044, Japan
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232
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Andrade NL, da Cruz Campos AC, Cabral AM, Damasco PH, Lo-Ten-Foe J, Rosa ACP, Damasco PV. Infective endocarditis caused by Enterobacteriaceae: phenotypic and molecular characterization of Escherichia coli and Klebsiella pneumoniae in Rio de Janeiro, Brazil. Braz J Microbiol 2021; 52:1887-1896. [PMID: 34549374 PMCID: PMC8578509 DOI: 10.1007/s42770-021-00528-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
The etiological agent for infective endocarditis (IE), a life-threatening disease, is usually gram-positive bacteria. However, gram-negative bacteria can rarely cause IE and 4% of cases are associated with morbidity and mortality. This study aimed to characterize Escherichia coli and Klebsiella pneumoniae isolates from the blood of patients with IE. The characteristics of blood isolates were compared with those of urinary isolates from patients with urinary tract infections (UTIs). The results of this study revealed that K. pneumoniae isolates from patients with IE were phylogenetically related to those from patients with UTI. Additionally, the resistance phenotype, resistance gene, virulence gene, and plasmid profiles were similar between the blood and urinary isolates. The isolates belonging to the sequence types (STs) 76, 36, 101 (K. pneumoniae), and 69 (E. coli) are reported to be associated with drug resistance. The Enterobacteriaceae isolates from patients with IE did not produce extended-spectrum β-lactamase or carbapenemase. Additionally, this study investigated the virulence phenotype, biofilm formation ability, and the ability to adhere to the epithelial cells in vitro of the isolates. The isolates from patients with IE exhibited weaker biofilm formation ability than the urinary isolates. All isolates from patients with IE could adhere to the renal epithelial cells. However, three isolates from patients with UTIs could not adhere to the epithelial cells. The closely related K. pneumoniae isolates (648, KP1, KP2, KP3, and KP4) could not form biofilms or adhere to the epithelial cells. In summary, the molecular analysis revealed that the genetic characteristics of IE-causing K. pneumoniae and E. coli were similar to those of UTI-causing isolates. These isolates belonged to the STs that are considered treatable. Genetically similar isolates did not exhibit the same virulence phenotype. Thus, these non-hypervirulent clones must be monitored as they can cause complex infections in susceptible hosts.
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Affiliation(s)
- Nathália L Andrade
- Department of Microbiology, Immunology and Parasitology, Biomedical Center, Rio de Janeiro State University, Blv 28 de Setembro, 87, 3th floor, Vila Isabel, Rio de Janeiro, Brazil
| | - Ana Carolina da Cruz Campos
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, EB80 Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Andrea Maria Cabral
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Vila Isabel, Rio de Janeiro, Brazil
| | | | - Jerome Lo-Ten-Foe
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, EB80 Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Ana Cláudia P Rosa
- Department of Microbiology, Immunology and Parasitology, Biomedical Center, Rio de Janeiro State University, Blv 28 de Setembro, 87, 3th floor, Vila Isabel, Rio de Janeiro, Brazil
| | - Paulo V Damasco
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Vila Isabel, Rio de Janeiro, Brazil.,Department of Infectious and Parasitic Diseases, Graffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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233
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Ahmad S, Song D, Reyes JVM, Whiting A, Almas T, Lieber JJ. Hakuna mycotic aneurysm, Streptococcus salivarius does not always mean "no worries". Ann Med Surg (Lond) 2021; 69:102798. [PMID: 34522379 PMCID: PMC8424443 DOI: 10.1016/j.amsu.2021.102798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Streptococcus salivarius, an easily missed and commonly disregarded Viridians strep species, is usually written off as a culture contaminant, but has been implicated as a rare cause of bacterial endocarditis with serious complications. It is a normal commensal microorganism of the mouth and gut, S. salivarius is usually harmless and even demonstrates anti-inflammatory properties. However, the literature about the complications of a S. salivarius bacteremia remains unclear. This case highlights a patient with mycotic aneurysms due to infective endocarditis in the setting of S. salivarius bacteremia. Streptococcus salivarius is easily missed and usually a culture contaminant, but it is also a rare cause of bacterial endocarditis with serious complications. Infective endocarditis is diagnosed based on the modified Duke's criteria and commonly presents with a low-grade fever, a new onset heart murmur, petechiae, subungual hemorrhages, Janeway lesions, Osler nodes, or Roth spots. It is critical to recognize S. salivarius's role in bacterial endocarditis and its serious complications; therefore, rapid identification and treatment with antibiotics are imperative to avoid complications.
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Affiliation(s)
- Saad Ahmad
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital (Elmhurst Hospital Center) NY, USA
| | - David Song
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital (Elmhurst Hospital Center) NY, USA
| | - Jonathan Vincent M Reyes
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital (Elmhurst Hospital Center) NY, USA
| | - Adrian Whiting
- Department of Internal Medicine, NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph J Lieber
- Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital (Elmhurst Hospital Center) NY, USA
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234
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Shah S, Bremmer DN, Kline EG, Nicolau DP, Shields RK. Ceftolozane/tazobactam for refractory P. aeruginosa endocarditis: A case report and pharmacokinetic analysis. J Infect Chemother 2021:S1341-321X(21)00231-2. [PMID: 34535403 DOI: 10.1016/j.jiac.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
We describe a case of a 48 years old male with left sided endocarditis and septic emboli secondary to a Pseudomonas aeruginosa strain that developed resistance to other β-lactam antibiotics during therapy resulting in prolonged bacteremia. Blood cultures sterilized within 1 day of initiating ceftolozane/tazobactam 3 g every 8 hours in combination with ciprofloxacin. Steady state free ceftolozane plasma Cmax and Cmin concentrations were calculated to be 122.2μg/mL and 24.3μg/mL, respectively. The multidrug-resistant strain harbored chromosomal β-lactamases OXA-486 and PDC-3, mutations in ampD and dacB predicted to lead to ampC over-expression, and mutations in OprD predicted to decrease outer membrane permeability. Following completion of a 42 day course and aortic valve replacement, the patient was deemed clinically cured without recurrence of infection at follow up 2 years later. To our knowledge, this is the first reported case to measure ceftolozane concentrations during the treatment of endocarditis which supports dose optimization approaches of severe endovascular disease due to multidrug resistant pathogens.
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235
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van Ramshorst J, Duffels M, de Boer SPM, Bos-Schaap A, Drexhage O, Walburg S, de Beij J, van der Stoop D, Umans VAWM. Connected care for endocarditis and heart failure patients: a hospital-at-home programme. Neth Heart J 2021; 30:319-327. [PMID: 34524621 PMCID: PMC9123121 DOI: 10.1007/s12471-021-01614-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.
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Affiliation(s)
- J van Ramshorst
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Duffels
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - S P M de Boer
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - A Bos-Schaap
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - O Drexhage
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | | | | | - D van der Stoop
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - V A W M Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
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236
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Van Hemelrijck M, Frank M, Zinkernagel AS, Buechel R, Sromicki J, Wilhelm MJ, Klein H, Hasse B, Mestres CA. Sternectomy for Candida albicans sternal osteomyelitis after left ventricular assist device implantation. Indian J Thorac Cardiovasc Surg 2021; 37:573-576. [PMID: 34511767 PMCID: PMC8387541 DOI: 10.1007/s12055-021-01144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Fungal osteomyelitis is an uncommon complication after cardiac surgery and associated with high mortality. A case of Candida albicans and Staphylococcus epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a 60-year-old male patient is presented here. After clinical identification and confirmation with microbiological examinations and fluorodeoxyglucose positron emission tomography (FDG-PET) scan, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin, and negative pressure wound therapy were initiated, but failed to achieve healing. Total sternectomy and pectoralis flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.
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Affiliation(s)
- Mathias Van Hemelrijck
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Michelle Frank
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Ronny Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Juri Sromicki
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Markus J. Wilhelm
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Holger Klein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carlos A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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237
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Viezens L, Dreimann M, Strahl A, Heuer A, Koepke LG, Bay B, Waldeyer C, Stangenberg M. Spontaneous spondylodiscitis and endocarditis: interdisciplinary experience from a tertiary institutional case series and proposal of a treatment algorithm. Neurosurg Rev 2021; 45:1335-1342. [PMID: 34510310 PMCID: PMC8976816 DOI: 10.1007/s10143-021-01640-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/01/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022]
Abstract
Previously, the simultaneous presence of endocarditis (IE) has been reported in 3–30% of spondylodiscitis cases. The specific implications on therapy and outcome of a simultaneous presence of both diseases are not yet fully evaluated. Therefore, the aim of this study was to investigate the influence of a simultaneously present endocarditis on the course of therapy and outcome of spondylodiscitis. A prospective database analysis of 328 patients diagnosed with spontaneous spondylodiscitis (S) using statistical analysis with propensity score matching was conducted. Thirty-six patients (11.0%) were diagnosed with concurrent endocarditis (SIE) by means of transoesophageal echocardiography. In our cohort, the average age was 65.82 ± 4.12 years and 64.9% of patients were male. The incidence of prior cardiac or renal disease was significantly higher in the SIE group (coronary heart disease SIE n = 13/36 vs. S n = 57/292, p < 0.05 and chronic heart failure n = 11/36 vs. S n = 41/292, p < 0.05, chronic renal failure SIE n = 14/36 vs. S n = 55/292, p < 0.05). Complex interdisciplinary coordination and diagnostics lead to a significant delay in surgical intervention (S = 4.5 ± 4.5 days vs. SIE = 8.9 ± 9.5 days, p < 0.05). Mortality did not show statistically significant differences: S (13.4%) and SIE (19.1%). Time to diagnosis and treatment is a key to efficient treatment and patient safety. In order to counteract delayed therapy, we developed a novel therapy algorithm based on the analysis of treatment processes of the SIE group. We propose a clear therapy pathway to avoid frequently observed pitfalls and delays in diagnosis to improve patient care and outcome.
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Affiliation(s)
- Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany.
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - André Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Heuer
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Leon-Gordian Koepke
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Benjamin Bay
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Waldeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
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238
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Miyagi Y, Sakamoto SI, Kawase Y, Oomori H, Watanabe Y, Kurita J, Maruyama Y, Sasaki T, Ishii Y. Temporal and Microbiological Analysis of Cardiac Implantable Electrical Device Infections - A Retrospective Study. Circ Rep 2021; 3:488-496. [PMID: 34568627 PMCID: PMC8423618 DOI: 10.1253/circrep.cr-21-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background:
Although the causative pathogens in cardiac implantable electronic device (CIED) infections are well known, the relationship between time after implantation and infection patterns has not been sufficiently investigated. This study investigated the microbiology and onset of CIED infections according to infection patterns. Methods and Results:
This retrospective study included 97 patients who underwent CIED removal due to device-related infections between April 2009 and December 2018. After device implantation, infections peaked in the first year and declined gradually over 10 years. Most infections (>60%) occurred within 5 years. Staphylococcal infections, the predominant form of CIED infections, occurred throughout the study period. CIED infections were categorized as systemic (SI; n=26) or local (LI; n=71) infections according to clinical presentation, and as CIED pocket-related (PR; n=85) and non-pocket-related (non-PR; n=12) infections according to the pathogenic pathway. The main causative pathogen in SI was
Staphylococcus aureus, whereas coagulase-negative staphylococci were mainly related to LI. Both SI and LI peaked in the first year after implantation and then decreased gradually. There was no significant microbiological difference between PR and non-PR infections. PR infections showed the same temporal distribution as the overall cohort. However, non-PR infections exhibited a uniform temporal distribution after the first year. Conclusions:
The severity of CIED infections depends on the causative pathogen, whereas their temporal distribution is affected by the microbiological intrusion pathway.
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Affiliation(s)
- Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | | | - Yasuhiro Kawase
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | - Hiroya Oomori
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | | | - Jiro Kurita
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | - Yuji Maruyama
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School Tokyo Japan
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239
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Farandzha D, Shikerova P, Lazarova G, Hazarbasanov D. Normal procalcitonin, C-reactive protein, and negative blood cultures in infective endocarditis with a massive residual vegetation: a case report. Eur Heart J Case Rep 2021; 5:ytab312. [PMID: 34622133 PMCID: PMC8491057 DOI: 10.1093/ehjcr/ytab312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/27/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a serious infection with high morbidity and mortality that involves the endocardial lining of the heart. Most cases of IE are due to bacteria although other atypical micro-organisms can also be involved. Procalcitonin (PCT) is a biomarker that is used in the diagnosis of bacterial infections. CASE SUMMARY We present the case of a 54-year-old patient with bacterial endocarditis who has been regularly visiting his cardiologist for follow-up on a mitral valve prolapse and moderate mitral regurgitation (MR) for the last 11 years. During his last visit, transthoracic echocardiography (TTE) showed a previously non-existent structure on the posterior mitral valve leaflet with severe MR. Blood cultures were positive for Streptococcus viridans. On admission, he had elevated levels of PCT and C-reactive protein which returned to normal values after 4 weeks of intravenous antibiotic therapy. His follow-up blood cultures, taken after normalization of PCT, did not show bacterial growth; however, on TTE he had severe mitral regurgitation and a persistent vegetation which had slightly increased in size after completion of the full antibiotic course. He was referred for mitral valve replacement surgery. DISCUSSION Normalization of procalcitonin levels may correlate with negative blood cultures in cases of IE with residual vegetations. The optimal time for surgery in such patients is difficult to define but even in circumstances with less infective organisms such as S. viridans and late in the course of the disease residual vegetations remain a serious risk factor for embolic events. Randomized controlled clinical trials are needed in order to have better recommendations with solid evidence regarding prophylaxis and treatment in IE.
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Affiliation(s)
- Dzhem Farandzha
- Department of Cardiology, University Hospital Lozenetz, Kozyak 1, Sofia, 1407, Bulgaria
| | - Petranka Shikerova
- Department of Cardiology, University Hospital Lozenetz, Kozyak 1, Sofia, 1407, Bulgaria
| | - Gergana Lazarova
- Department of Cardiology, University Hospital Lozenetz, Kozyak 1, Sofia, 1407, Bulgaria
| | - Dobri Hazarbasanov
- Department of Cardiology, University Hospital Lozenetz, Kozyak 1, Sofia, 1407, Bulgaria
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240
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Schiller M, Lorenz HM, Kick W. [Chronic inflammatory demyelinating polyneuropathy as differential diagnosis to polymyalgia rheumatica]. Z Rheumatol 2021; 81:140-142. [PMID: 34468809 DOI: 10.1007/s00393-021-01068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disease affecting the peripheral nerves. The disease causes symmetric weakness of certain muscle groups, mainly affecting the hips and shoulders. In some patients a loss of sensitivity occurs. We report a case of symmetric and proximal weakness of the legs, which was found together with an elevation of inflammatory markers. The first tentative diagnosis was polymyalgia rheumatica; however, an interdisciplinary work-up of the case finally led to the diagnosis of CIDP in combination with infectious endocarditis.
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Affiliation(s)
- Martin Schiller
- Innere Medizin, Kliniken Hochfranken Münchberg, Hofer Str. 40, 95213, Münchberg, Deutschland.
| | - Hanns-Martin Lorenz
- Innere Medizin, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, 69120, Deutschland
| | - Wolfgang Kick
- Innere Medizin, Kliniken Hochfranken Münchberg, Hofer Str. 40, 95213, Münchberg, Deutschland
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241
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Hahn DW, Atkinson CE, Le M. Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report. BMC Pediatr 2021; 21:372. [PMID: 34465285 PMCID: PMC8406827 DOI: 10.1186/s12887-021-02845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although M. pneumoniae (M. pneumoniae) infections have been associated with various extrapulmonary manifestations, there have been very few documented cases of thrombotic events in pediatrics, and none to our knowledge with such extensive involvement as the patient described here. We aim to contribute to the urgency of discovering the mechanism of the coagulopathy associated with M. pneumoniae infections. Case presentation This 10-year-old boy was admitted after 2 weeks of fever, sore throat, worsening cough, and progressive neck and back pain. During hospitalization, he developed clots in several different organs: bilateral pulmonary emboli, cardiac vegetations, multiple splenic infarcts, and deep venous thromboses in three of four extremities. He was treated with long-term antibiotics and anticoagulation, and fully recovered. Conclusions This is the first case known to us of a child with an extensive number of thrombotic events in multiple anatomic sites associated with M. pneumoniae infection. The mechanism by which M. pneumoniae infection is related to thrombotic events is not fully understood, but there is evidence that the interplay between the coagulation pathways and the complement cascade may be significant. This patient underwent extensive investigation, and was found to have significant coagulopathy, but minimal complement abnormalities. By better understanding the mechanisms involved in complications of M. pneumoniae infection, the clinician can more effectively investigate the progression of this disease saving time, money, morbidity, and mortality.
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Affiliation(s)
- Devon W Hahn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, A1 Room 12305, Oklahoma City, Oklahoma, 73104, USA.
| | - Claire E Atkinson
- Department of Pediatrics, University of North Carolina, 030 MacNider Hall, CB 7231, Chapel Hill, North Carolina, 27599-7231, USA
| | - Matthew Le
- Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, A1 Room 12305, Oklahoma City, Oklahoma, 73104, USA
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242
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Shah I, Sheikh AB, Sagheer S, Javed N, Shekhar R. Pneumococcal endocarditis involving the pulmonic valve in a patient with HIV. Proc AMIA Symp 2021; 34:627-628. [PMID: 34456495 DOI: 10.1080/08998280.2021.1930926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Infective endocarditis in drug users commonly targets the tricuspid valves, whereas pulmonic valve endocarditis is a rare occurrence. Staphylococcus aureus rather than Streptococcus species is the culprit organism. Streptococcal pneumonia is also not commonly seen as an etiological agent for endocarditis. Here we present a case of a 57-year-old man with a history of HIV infection on antiretroviral therapy who was admitted for sepsis and found to have pneumococcal bacteremia with vegetation on a pulmonic valve. He had been vaccinated with both pneumococcal conjugate vaccine 13 and pneumococcal polysaccharide vaccine 23 at the time of his HIV diagnosis. Pulmonic valve endocarditis is unusual in the setting of pneumococcal bacteremia in HIV patients previously vaccinated for pneumococcal disease.
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Affiliation(s)
- Ishan Shah
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Shazib Sagheer
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Nismat Javed
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Rahul Shekhar
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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243
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Taamallah K, Hammami F, Gharsallah H, Koubaa M, Ben Jemaa M, Fehri W. Brucella Prosthetic Valve Endocarditis: A Systematic Review. J Saudi Heart Assoc 2021; 33:198-212. [PMID: 34447668 PMCID: PMC8366765 DOI: 10.37616/2212-5043.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Brucella prosthetic valve endocarditis is a rare but a life-threatening complication of brucellosis. It remains a diagnostic challenge. Optimal treatment of Brucella prosthetic valve endocarditis is debated. Available data is limited to case reports or small case series. The purpose of this study was to systematically review all published cases of Brucella prosthetic valve endocarditis in the literature. Method A systematic review of PubMed database, Google, Google Scholar, and Scopus (From January 1974 to the present) for studies providing epidemiological, clinical and microbiological data as well as data on treatment and outcomes of Brucella prosthetic valve endocarditis was performed. Results A total of 51 reported cases were reviewed. Brucella melitensis (45%) and Brucella abortus (11.7%) were the most frequently isolated species. Most common type of prosthesis valve was mechanical prothesis (84.3%) and ten patients had double valve prosthesis (19.6%). Fever and dyspnea were present in 100% and 37.2% of the cases, respectively. The diagnosis was set with echocardiographic finding in 30 cases (93.7%), which revealed vegetation in 27 cases (84.3%). Most used antibiotics were rifampicin, doxycycline and aminoglycoside or cotrimoxazole. No deaths were noted in patients treated by combined medical and surgical treatment, but mortality was noted in 27.7% of the cases treated by antibiotics alone (p = 0.006). Conclusion This systematic review highlights diagnostic challenges and demonstrates that surgery improved outcome by reducing mortality in patients treated with the combined surgical and medical treatment option. Brucellosis should be considered in the differential diagnosis of prosthetic valve endocarditis in patients residing in or traveling to areas of endemicity.
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Affiliation(s)
- Karima Taamallah
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Fatma Hammami
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hédi Gharsallah
- Intensive Care Unit Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Makram Koubaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Wafa Fehri
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
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Beaufrère M, Pressat-Laffouilhère T, Marcelli C, Michon J, Lequerré T, Prum-Delépine C, Fiaux E, Rasoldier V, Etienne M, Savouré A, Dormoy L, Dargère S, Verdon R, Vittecoq O, Avenel G. Valvular and infection-associated risk factors as criteria to guide the use of echocardiography in patients with native joint infections. Semin Arthritis Rheum 2021; 51:1274-1281. [PMID: 34465446 DOI: 10.1016/j.semarthrit.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Native joint and bone infections (NJBI) are associated with infective endocarditis (IE) in 15% of cases. There are no studies analyzing the use of cardiac imaging in cases of NJBI. The objective of this study was to identify factors associated with echocardiography suggestive of IE in patients with NJBI. METHODS This medical records review was conducted in patients hospitalized for NJBI between 2007 and 2017 in Rheumatology and Infectious Diseases departments of 2 university hospitals. Patients included had a microbiologically proven NJBI during their hospitalization. RESULTS In this cohort of 546 patients, median age 66 years, echocardiography was suggestive of IE in 66 (12%). In multivariate analysis, factors associated with echocardiography suggestive of IE were 2 or more positive blood cultures (OR 11.55 (CI95% 3.24-74.20)), cardiac conditions with a high risk of IE (OR 7.34 (CI95% 2.95-18.61)), unknown heart murmur (OR 4.59 (CI95% 1.79-11.74)), multifocal infection (OR 2.26 (CI95% 1.21-4.23)) and an infection due to S. bovis (OR 3.52 (CI95% 1.26-9.79)). The factor associated with the absence of an echocardiography evocative of IE was infection due to unconventional bacteria for IE (OR 0.13 (CI95% 0.01-0.76)). According to the factors associated with echocardiography evocative of IE, we propose the Normandy score based on three kinds of data: cardiac condition, bacterial strain and NJBI mechanism. Echocardiography should be realized when this score, whose negative predictive value is 100% CI95% (98-100%) for prescription of echocardiography, is more than zero. CONCLUSIONS A score based on valvular condition, bacterial strain and NJBI mechanism could guide clinicians in prescribing echocardiography during NJBI with an excellent negative predictive value.
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Affiliation(s)
- Marie Beaufrère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France.
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France
| | - Jocelyn Michon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Thierry Lequerré
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Camille Prum-Delépine
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Elise Fiaux
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Véro Rasoldier
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Manuel Etienne
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Arnaud Savouré
- CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Laurent Dormoy
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Cardiology, 14000 Caen, France
| | - Sylvie Dargère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Renaud Verdon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Olivier Vittecoq
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Gilles Avenel
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
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245
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Enwezor C, Russ-Friedman CL, Gruss ZP, Murphy A, Palavecino EL, Jakharia N. A case report of Nocardia spp. infective endocarditis in an injection drug user. BMC Infect Dis 2021; 21:832. [PMID: 34412578 PMCID: PMC8375157 DOI: 10.1186/s12879-021-06541-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals. Case presentation A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice. Conclusions This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.
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Affiliation(s)
- Chukwunyelu Enwezor
- Department of Internal Medicine, Section of Infectious Diseases, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Courtney L Russ-Friedman
- Department of Internal Medicine, Section of Infectious Diseases, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Zachary P Gruss
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Adam Murphy
- Department of Internal Medicine, Section of Infectious Diseases, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | | | - Niyati Jakharia
- Department of Internal Medicine, Division of Infectious Diseases, Stanford University Hospital, Palo Alto, CA, USA
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246
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Schmiegelow MDS, Elming H, Sibilitz KL, Bruun NE, Carranza CL, Dahl JS, Fosbøl E, Køber L, Torp-Pedersen C, Schmiegelow SS. Reintervention rates following bioprosthetic surgical aortic valve replacement-a Danish Nationwide Cohort Study. Eur J Cardiothorac Surg 2021; 61:614-622. [PMID: 34411227 DOI: 10.1093/ejcts/ezab365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/01/2021] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Updated European guidelines recommend annual echocardiographic evaluation after bioprosthetic surgical aortic valve replacement (bio-SAVR). Given the increased demand on health care resources, only clinically relevant controls can be prioritized. We therefore aimed to explore reintervention rates following bio-SAVR. METHODS From the nationwide Danish Register of Surgical Procedures, we identified all patients ≥40 years with isolated bio-SAVR ± concomitant coronary artery bypass graft surgery (CABG) during 2000-2016. In 90-day reintervention-free survivors, we assessed aortic valve reintervention rates (primary outcome) and all-cause mortality rates (secondary outcome) at 1, 3 and 5 years with total follow-up until 31 December 2017 and further estimated annual theoretical echocardiographic control visits. RESULTS In 10 518 patients with bio-SAVR (+CABG 39.7%), we observed low reintervention rates at 1, 3 and 5 years, but with high rates of all-cause mortality; i.e. 5-year reintervention rate of 3.7/1000 person-years (≤1.5%) and 5-year mortality rate of 21.7/1000 person-years. Accounting for the competing risk of death, 5-year rates were inversely related to age group and remained relatively low across all age categories but increased gradually in the long term. A significant proportion of reinterventions were presumed due to infectious endocarditis (48% at 3 years, 37% at 5 years). With annual transthoracic echocardiography, the theoretical ratio of echocardiographies per reintervention in the first 5 years was 248, and 425 when endocarditis events were excluded. CONCLUSION Reintervention rates within the first 5 years following bio-SAVR were relatively rare, and with a substantial number due to endocarditis.
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Affiliation(s)
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Kirstine L Sibilitz
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,Clinical Institute, Copenhagen University, Copenhagen, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Christian L Carranza
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, University of Southern Denmark, Odense, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
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247
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Kolben Y, Ishay Y, Azmanov H, Rokney A, Baum M, Amit S, Nir-Paz R. Right-sided endocarditis caused by polyclonal Staphylococcus aureus infection. Eur J Med Res 2021; 26:91. [PMID: 34380556 PMCID: PMC8356449 DOI: 10.1186/s40001-021-00549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case of bacterial endocarditis with both methicillin-sensitive and methicillin-resistant Staphylococcus aureus, which based on typing, originated from two distinct clones. Such a case may be misinterpreted by microbiology lab automation to be a monoclonal multi-drug resistant Staphylococcus aureus, while simple microbiology techniques will instantly reveal distinct clonality.
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Affiliation(s)
- Yotam Kolben
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Yuval Ishay
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Henny Azmanov
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Rokney
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Moti Baum
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Sharon Amit
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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248
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Abstract
Enterobacter species are Gram-negative, non-spore-forming, facultative anaerobes typically motile due to the presence of peritrichous flagella. E. cloacae, the species responsible for the majority of Enterobacter infections in humans, is part of the intestinal microbiota and may cause infection in patients that have previously received antimicrobial therapy or who have been admitted to the Intensive Care Unit. E. cloacae may cause several infections, such as pneumonia, urinary tract, skin and soft tissue and intravascular infections. Infective Endocarditis (IE) is a rare disease with notable morbidity and mortality. Even though IE is rarely caused by E. cloacae, these infections can be problematic due to the relative lack of experience in their management. The purpose of this study was to systematically review all published cases of IE by E. cloacae in the literature. A systematic review of PubMed, Scopus and Cochrane library (through 14th November 2020) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE by E. cloacae was performed. A total of 20 studies, containing data of 20 patients, were included. A prosthetic valve was present in 27.8%. Mitral valve was the commonest infected site, followed by aortic valve. Diagnosis was facilitated by transthoracic and transesophageal echocardiography in 38.5% each, while the diagnosis was set at autopsy in 10%. Fever, sepsis, shock and immunologic phenomena were the most common clinical presentations, followed by heart failure. Aminoglycosides, cephalosporins and carbapenems were the most common antimicrobials used. Clinical cure was noted in 75%, while overall mortality was 30%. Development of shock and treatment with the combination of piperacillin with tazobactam were associated with overall mortality.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Rodanthi Vamvoukaki
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
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249
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Abstract
Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.
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Affiliation(s)
- D Ten Hove
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. .,Department of Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - B Sinha
- Department of Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - R P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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250
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Lakkas L, Serim BD, Fotopoulos A, Iakovou I, Doumas A, Korkmaz U, Michalis LK, Sioka C. Infection of cardiac prosthetic valves and implantable electronic devices: early diagnosis and treatment. Acta Cardiol 2021; 76:569-575. [PMID: 32406333 DOI: 10.1080/00015385.2020.1761594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There has been a recent rise in the use of implantable cardiac devices, mostly valves but also electronic ones, such as pacemakers, and implantable defibrillators. The increasing use of these devices had as a consequence the raised incidence of endocarditis, an infrequent but morbid complication of these procedures. Thus, early diagnosis of the implantable cardiac devices related infection and endocarditis became pivotal for appropriate management. For diagnostic purposes, the modified Duke criteria are widely used, which are based on clinical and imaging findings, in addition to serological analyses and blood cultures. 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently employed method in order to improve the early diagnosis of endocarditis as well as infection of the implantable device. It is likely, that combining the modified Duke criteria with the FDG PET/CT, will increase the sensitivity and specificity of diagnosis and will guide the treating physician to an early and appropriate management.
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Affiliation(s)
- Lampros Lakkas
- 2nd Department of Cardiology, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Burcu Dirlik Serim
- Department of Nuclear Medicine, Institution of Cardiology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Andreas Fotopoulos
- Department of Nuclear Medicine, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Iakovou
- 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Argyrios Doumas
- 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Ulku Korkmaz
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Lampros K. Michalis
- 2nd Department of Cardiology, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, Medical school, University Hospital of Ioannina, Ioannina, Greece
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