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Zacarías Mendoza NV, Gamarra Valverde NN, Robles Velarde VJ. Challenges and Insights in Aggregatibacter aphrophilus endocarditis: a review of literature. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:102-108. [PMID: 38046225 PMCID: PMC10688407 DOI: 10.47487/apcyccv.v4i3.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/18/2023] [Indexed: 12/05/2023]
Abstract
Infective endocarditis is a serious disease associated with high mortality despite recent advances in diagnosis and treatment. Aggregatibacter aphrophilus is a fastidious Gram-negative member of the HACEK organisms (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). A. aphrophilus is associated with dental infections but has also been implicated in cases of infective endocarditis. We highlight the importance of a high index of suspicion in symptomatic patients with an initial negative blood culture, particularly in high-risk groups such as patients with congenital valve disease and prosthetic valve. The knowledge of this rare entity may lead to early diagnosis and appropriate management. We review the main characteristics of Aggregatibacter aphrophilus endocarditis reported in the medical literature.
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Affiliation(s)
- Nathalie Victoria Zacarías Mendoza
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaFacultad de Medicina Alberto HurtadoUniversidad Peruana Cayetano HerediaLimaPeru
| | - Norma Nicole Gamarra Valverde
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaFacultad de Medicina Alberto HurtadoUniversidad Peruana Cayetano HerediaLimaPeru
| | - Víctor Justo Robles Velarde
- Servicio de Cirugía Cardiovascular, Instituto Nacional de Cardiología. Lima, Perú.Servicio de Cirugía CardiovascularInstituto Nacional de CardiologíaLimaPerú
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Stahl-Rommel S, Jain M, Nguyen HN, Arnold RR, Aunon-Chancellor SM, Sharp GM, Castro CL, John KK, Juul S, Turner DJ, Stoddart D, Paten B, Akeson M, Burton AS, Castro-Wallace SL. Real-Time Culture-Independent Microbial Profiling Onboard the International Space Station Using Nanopore Sequencing. Genes (Basel) 2021; 12:genes12010106. [PMID: 33467183 PMCID: PMC7830261 DOI: 10.3390/genes12010106] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/23/2022] Open
Abstract
For the past two decades, microbial monitoring of the International Space Station (ISS) has relied on culture-dependent methods that require return to Earth for analysis. This has a number of limitations, with the most significant being bias towards the detection of culturable organisms and the inherent delay between sample collection and ground-based analysis. In recent years, portable and easy-to-use molecular-based tools, such as Oxford Nanopore Technologies’ MinION™ sequencer and miniPCR bio’s miniPCR™ thermal cycler, have been validated onboard the ISS. Here, we report on the development, validation, and implementation of a swab-to-sequencer method that provides a culture-independent solution to real-time microbial profiling onboard the ISS. Method development focused on analysis of swabs collected in a low-biomass environment with limited facility resources and stringent controls on allowed processes and reagents. ISS-optimized procedures included enzymatic DNA extraction from a swab tip, bead-based purifications, altered buffers, and the use of miniPCR and the MinION. Validation was conducted through extensive ground-based assessments comparing current standard culture-dependent and newly developed culture-independent methods. Similar microbial distributions were observed between the two methods; however, as expected, the culture-independent data revealed microbial profiles with greater diversity. Protocol optimization and verification was established during NASA Extreme Environment Mission Operations (NEEMO) analog missions 21 and 22, respectively. Unique microbial profiles obtained from analog testing validated the swab-to-sequencer method in an extreme environment. Finally, four independent swab-to-sequencer experiments were conducted onboard the ISS by two crewmembers. Microorganisms identified from ISS swabs were consistent with historical culture-based data, and primarily consisted of commonly observed human-associated microbes. This simplified method has been streamlined for high ease-of-use for a non-trained crew to complete in an extreme environment, thereby enabling environmental and human health diagnostics in real-time as future missions take us beyond low-Earth orbit.
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Affiliation(s)
| | - Miten Jain
- UCSC Genomics Institute, University of California, Santa Cruz, CA 95064, USA; (M.J.); (B.P.); (M.A.)
| | - Hang N. Nguyen
- JES Tech, Houston, TX 77058, USA; (S.S.-R.); (H.N.N.); (C.L.C.)
| | - Richard R. Arnold
- Astronaut Office, NASA Johnson Space Center, Houston, TX 77058, USA; (R.R.A.); (S.M.A.-C.)
| | | | | | | | - Kristen K. John
- Project Management and Systems Engineering Division, NASA Johnson Space Center, Houston, TX 77058, USA;
| | - Sissel Juul
- Oxford Nanopore Technologies, New York, NY 10013, USA;
| | - Daniel J. Turner
- Oxford Nanopore Technologies, Oxford Science Park, Oxford OX4 4DQ, UK; (D.J.T.); (D.S.)
| | - David Stoddart
- Oxford Nanopore Technologies, Oxford Science Park, Oxford OX4 4DQ, UK; (D.J.T.); (D.S.)
| | - Benedict Paten
- UCSC Genomics Institute, University of California, Santa Cruz, CA 95064, USA; (M.J.); (B.P.); (M.A.)
| | - Mark Akeson
- UCSC Genomics Institute, University of California, Santa Cruz, CA 95064, USA; (M.J.); (B.P.); (M.A.)
| | - Aaron S. Burton
- Astromaterials Research and Exploration Science Division, NASA Johnson Space Center, Houston, TX 77058, USA;
| | - Sarah L. Castro-Wallace
- Biomedical Research and Environmental Sciences Division, NASA Johnson Space Center, Houston, TX 77058, USA
- Correspondence: ; Tel.: +1-281-483-7254
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Daoud H, Abugroun A, Olanipekun O, Garrison D. Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus. IDCases 2019; 17:e00561. [PMID: 31193507 PMCID: PMC6535683 DOI: 10.1016/j.idcr.2019.e00561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
Aggregatibacter aphrophilus is a rare cause of infective endocarditis that was first described in 1940 by Khairat et al. and is now classified under the HACEK group of bacteria (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). There is limited literature describing the extracardiac complications of infective endocarditis caused by this organism. We report a case of a 53-year-old male with no significant past medical history who developed acute infective endocarditis complicated by a brain abscess caused by A. aphrophilus. The patient underwent aspiration of the abscess and treated with a long course of intravenous antimicrobials. This case represents a rare complication of infective endocarditis caused by A. aphrophilus and to the best of our knowledge, is the second reported case in the literature describing such a complication in a previously healthy patient. Although neurological sequela is associated with higher mortality and may be the presenting symptom of infective endocarditis, it may also be clinically silent - only detected upon imaging.
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Menegueti MG, Machado-Viana J, Gaspar GG, Nicolini EA, Basile-Filho A, Auxiliadora-Martins M. Ischemic Stroke and Septic Shock After Subacute Endocarditis Caused by Haemophilus parainfluenzae: Case Report. J Clin Med Res 2016; 9:71-73. [PMID: 27924179 PMCID: PMC5127219 DOI: 10.14740/jocmr2703w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/17/2022] Open
Abstract
Haemophilus parainfluenzae, which belongs to the HACEK (Haemophilus ssp, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) group, is a rare cause of subacute endocarditis and may lead to ischemic stroke. A 65-year-old female patient previously diagnosed with rheumatic valve disease was submitted to surgical mitral valve repair in 1996. Physical examination did not reveal any murmurs; physical examination of the lungs and abdomen was normal. The patient was admitted to hospital with progressive dyspnea, dry cough, and fever. Transesophageal echocardiogram revealed an approximately 8-mm filamentous image with chaotic motion in the ventricular face of the anterior mitral valve leaflet compatible with vegetation. Treatment with ceftriaxone and gentamicin was initiated. Haemophilus parainfluenzae grew in five blood culture samples. Along the hospital stay, the patient’s level of consciousness decreased, and she was diagnosed with ischemic stroke of cardioembolic etiology. The patient developed septic shock refractory to the prescribed treatment and died 12 days after admission. Even though the patient started being treated for endocarditis before the infectious agent was identified, the prompt use of antimicrobials hindered the growth of Haemophilus parainfluenzae and made its isolation difficult.
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Affiliation(s)
- Mayra Goncalves Menegueti
- Committee for Hospital Infection Control, Department of Medical Clinics, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jaciara Machado-Viana
- Intensive Therapy Division, Department of Surgery and Anatomy, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Gilberto Gambero Gaspar
- Committee for Hospital Infection Control, Department of Medical Clinics, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Edson Antonio Nicolini
- Intensive Therapy Division, Department of Surgery and Anatomy, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Anibal Basile-Filho
- Intensive Therapy Division, Department of Surgery and Anatomy, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Maria Auxiliadora-Martins
- Intensive Therapy Division, Department of Surgery and Anatomy, University Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Abstract
INTRODUCTION The HACEK group, referring to Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae, is a rare cause of infective endocarditis (IE). It causes the majority of Gram-negative endocarditis cases and has an excellent prognosis and simple management if properly identified. However, delay in diagnosis and associated complications can render the infection fatal. AREAS COVERED Over the past few decades, there have been tremendous advancements in understanding the manifestations and progression of HACEK endocarditis (HE). This review tackles the epidemiology of HE, the microbiological characteristics of each organism in the HACEK group, the methods used to diagnose HE, the clinical manifestations, complications, and mortality of patients with HE, as well as the recommended treatment and preventive methods. Expert Commentary: The lack of robust randomized controlled trials in diagnosis and treatment of HE makes it difficult to determine the optimal management of such infections. Nevertheless, advancements in culturing methods have shown progress in isolating and identifying these fastidious organisms. Positive blood cultures for any of the HACEK organisms in the setting of no definite focus of infection is highly suggestive of HE. In such cases, treatment with ceftriaxone or a fluoroquinolone, even without obtaining antibiotic susceptibilities, should be initiated. Moreover, the decision to proceed with surgical intervention should be individualized. As is the case for other IE, HE requires the collaboration of a multidisciplinary team consisting of the infectious disease specialist, cardiologist, cardiothoracic surgeon, and the microbiologist.
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Affiliation(s)
- Sima L Sharara
- a School of Medicine, American University of Beirut , Beirut , Lebanon
| | - Ralph Tayyar
- b Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Zeina A Kanafani
- b Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Souha S Kanj
- b Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
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