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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 114] [Impact Index Per Article: 114.0] [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] [Indexed: 08/26/2023] Open
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Pernow G, Shannon O, Öberg J, Nilson B, Rasmussen M. Platelet Activation and Aggregation Induced by Streptococcus bovis /Streptococcus equinus Complex. Microbiol Spectr 2022; 10:e0186122. [PMID: 36374116 PMCID: PMC9769897 DOI: 10.1128/spectrum.01861-22] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus bovis/Streptococcus equinus complex (SBSEC) is a common cause of infective endocarditis (IE). For IE-pathogens, the capacity to activate and aggregate platelets is believed to be an important virulence mechanism. While the interactions between bacteria and platelets have been described in detail for many Gram-positive pathogens, little research has been carried out with SBSEC in this respect. Twenty-six isolates of the four most common species and subspecies of SBSEC identified in bacteremia were collected, and interactions with platelets were investigated in platelet rich plasma (PRP) from three donors. Aggregation was studied using light-transmission aggregometry and platelet activation using flow cytometry detecting surface upregulation of CD62P. Platelets and serum were treated with different inhibitors to determine mechanisms involved in platelet aggregation and activation. Twenty-two of 26 isolates induced aggregation in at least one donor, and four isolates induced aggregation in all three donors. In PRP from donor 1, isolate SL1 induced a rapid aggregation with a median time of 70 s to reach 50% aggregation. Blockade of the platelet Fc-receptor or enzymatic cleavage of IgG abolished platelet activation and aggregation. The capacity for bacteria-induced platelet aggregation was also shown to be transferable between donors through serum. SBSEC mediates platelet aggregation in an IgG and IgG-Fc-receptor dependent manner. Bacterial activation of platelets through this pathway is common for many bacteria causing IE and could be a potential therapeutic target for the prevention and treatment of this infection. IMPORTANCE The capacity of bacteria to activate and aggregate platelets is believed to contribute to the pathogenesis of IE. The Streptococcus bovis/Streptococcus equinus complex (SBSEC) contains known IE-pathogens, but there is limited research on the different subspecies ability to interact with platelets and what signaling pathways are involved. This study reports that 22 of 26 tested isolates of different subspecies within SBSEC can induce aggregation, and that aggregation is host dependent. The Fc-IgG-receptor pathway was shown essential for platelet activation and aggregation. To the best of our knowledge, this is the first study that reports on platelet interactions of SBSEC-isolates other than Streptococcus gallolyticus subspecies gallolyticus as well as the first study to report of mechanisms of platelet interaction of SBSEC-isolates. It adds SBSEC to a group of bacteria that activate and aggregate platelets via the platelet Fc-receptor. This could be a potential therapeutic target for prevention of IE.
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Affiliation(s)
- Gustav Pernow
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Helsingborg Hospital, Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Öberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Helsingborg Hospital, Lund, Sweden
| | - Bo Nilson
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
- Division of Medical Microbiology, Department of Laboratory Medicine Lund, Medical Faculty, Lund University, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Chamat-Hedemand S, Dahl A, Hassager C, Arpi M, Østergaard L, Bundgaard H, Lauridsen TK, Oestergaard LB, Gislason G, Fosbøl E, Bruun NE. Streptococcal infective endocarditis: clinical features and outcomes according to species. Infection 2022. [PMID: 36152224 DOI: 10.1007/s15010-022-01929-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Infective endocarditis (IE) is frequently caused by streptococcal species, yet clinical features and mortality are poorly investigated. Our aim was to examine patients with streptococcal IE to describe clinical features and outcomes according to streptococcal species. METHODS From 2002 to 2012, we investigated patients with IE admitted to two tertiary Danish heart centres. Adult patients with left-sided streptococcal IE were included. Adjusted multivariable logistic regression analyses were performed, to assess the association between streptococcal species and heart valve surgery or 1-year mortality. RESULTS Among 915 patients with IE, 284 (31%) patients with streptococcal IE were included [mean age 63.5 years (SD 14.1), 69% men]. The most frequent species were S. mitis/oralis (21%) and S. gallolyticus (17%). Fever (86%) and heart murmur (81%) were common symptoms, while dyspnoea was observed in 46%. Further, 18% of all cases were complicated by a cardiac abscess/pseudoaneurysm and 25% by an embolic event. Heart valve surgery during admission was performed in 55% of all patients, and S. gallolyticus (OR 0.28 [95% CI 0.11-0.69]) was associated with less surgery compared with S. mitis/oralis. In-hospital mortality was 7% and 1-year mortality 15%, without any difference between species. CONCLUSION S. mitis/oralis and S. gallolyticus were the most frequent streptococcal species causing IE. Further, S. gallolyticus IE was associated with less heart valve surgery during admission compared with S. mitis/oralis IE. Being aware of specific symptoms, clinical findings, and complications related to different streptococcal species, may help the clinicians in expecting different outcomes.
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Oh YZ, Huang W, Tan JJ. Stretococcus gallolyticus infective endocarditis, a different presentation-a case report. Cardiology Plus 2022; 7:144-147. [DOI: 10.1097/cp9.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sasi S, Abid FB, Wilson GJ, Zaqout A, Nair AP, Chitrambika P. Intrauterine infection and postpartum bacteremia due to Streptococcus gallolyticus subsp gallolyticus: An emerging concern. IDCases 2022; 29:e01562. [PMID: 35815109 PMCID: PMC9263517 DOI: 10.1016/j.idcr.2022.e01562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
Streptococcus gallolyticus is a gram-positive coccus belonging to the family Streptococcus bovis/Streptococcus equinus complex (SBSEC). Most cases of SBSEC bacteremia are reported in elderly males with underlying hepatobiliary disease and associated with infective endocarditis (IE) or colonic malignancy. The gastrointestinal tract is the most common portal of entry, followed by the urinary tract and hepatobiliary tree. We present 5 cases of intrapartum bacteremia caused by S. gallolyticus subsp gallolyticus reported from the labor unit of our hospital from 2019 to 2021. There was histopathological or microbiological evidence of chorioamnionitis in each case. All the mothers were below the age of 35 years, and none of them had underlying hepatobiliary or colonic disease. All maternal antenatal screenings for group B streptococci (GBS) were negative. All the isolates were susceptible to penicillins, ceftriaxone, carbapenems, and vancomycin. Three of them were treated with ceftriaxone and two with aminopenicillins. Duration of treatment varied from 8 days to 14 days. None of the babies were low birth weight or pre-term. All but one baby had clinical sepsis requiring neonatal intensive care unit (NICU) stay, with one having evidence of meningitis and three respiratory distress syndromes (RDS). None of the babies had S. gallolyticus bacteremia. All mothers and babies made a complete recovery without any complications. These cases suggest that S. gallolyticus subsp gallolyticus can be a rare but emerging cause of intrauterine infection complicated by post-partum bacteremia. There is possibility of colonization of maternal genital tract with S. gallolyticus causing neonatal infection.
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Shapira R, Weiss T, Goldberg E, Cohen E, Krause I, Sharony R, Goldberg I. Streptococcus gallolyticus endocarditis on a prosthetic tricuspid valve: a case report and review of the literature. J Med Case Rep 2021; 15:528. [PMID: 34702343 PMCID: PMC8549216 DOI: 10.1186/s13256-021-03125-5] [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: 12/10/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Streptococcus gallolyticus subspecies gallolyticus is a known pathogen that causes infective endocarditis, and most cases involve the left heart valves. We present the first reported case of prosthetic tricuspid valve endocarditis caused by this microorganism. Relevant literature is reviewed. Case presentation A 67-year-old Jewish female with a history of a prosthetic tricuspid valve replacement was admitted to the emergency department because of nonspecific complaints including effort dyspnea, fatigue, and a single episode of transient visual loss and fever. No significant physical findings were observed. Laboratory examinations revealed microangiopathic hemolytic anemia and a few nonspecific abnormalities. Transesophageal echocardiogram demonstrated a vegetation attached to the prosthetic tricuspid valve. The involved tricuspid valve was replaced by a new tissue valve, and Streptococcus gallolyticus subspecies gallolyticus was grown from its culture. Prolonged antibiotic treatment was initiated. Conclusions Based on this report and the reviewed literature, Streptococcus gallolyticus should be considered as a rare but potential causative microorganism in prosthetic right-sided valves endocarditis. The patient’s atypical presentation emphasizes the need for a high index of suspicion for the diagnosis of infective endocarditis.
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Affiliation(s)
- Raz Shapira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Department of Medicine F - Recanati, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Eytan Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Department of Medicine F - Recanati, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Ilan Krause
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Department of Medicine F - Recanati, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Ram Sharony
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Idan Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.
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Vinciguerra M, Santamaria V, Romiti S, D'Abramo M, Toto G, De Bellis A, Taliani G, Sangiorgi G, Greco E. Case Report: Streptococcus alactolyticus as a Rare Pathogen of Mitral Endocarditis. Front Cardiovasc Med 2021; 8:648213. [PMID: 33996945 PMCID: PMC8116484 DOI: 10.3389/fcvm.2021.648213] [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: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Streptococcus bovis/Streptococcus equinus complex (SBSEC) is a group of non-enterococcal group D Streptococci that colonizes both humans and animals. Due to gastrointestinal disease, they can switch in opportunistic pathogens passing through intestinal mucosal barrier and may cause bacteremia and distant organs damage. Despite infective endocarditis (IE), extra-cardiac manifestations of organs damage include osteoarticular infections, meningitis, and biliary infections among others; moreover, the association with colonic pathological lesions has been largely described. Streptococcus alactolyticus as a species included in SBSEC may share pathophysiological similarities, although it represents an extremely rare cause of distant organ infections, being reported in literature as causative agent of IE in only two other cases. We describe a case of 69-year-old male admitted to our institution due to mild-moderate dyspnea and fever, affected by cervico-brachialgia for 3 weeks. Streptococcus alactolyticus was identified as causative agent of IE on the mitral valve, causing severe regurgitation.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Valeria Santamaria
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Romiti
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianmarco Toto
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio De Bellis
- Department of Cardiology and Cardiac Surgery, Casa di Cura "S. Michele", Maddaloni, Italy
| | - Gloria Taliani
- Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sangiorgi
- Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Abstract
BACKGROUND Infective endocarditis (IE) continues to be associated with great challenges. Embolic events (EE) are frequent and life-threatening complications in IE patients. It remains challenging to predict and assess the embolic risk in individual patients with IE accurately. HYPOTHESIS Accurate prediction of embolization is critical in the early identification and treatment of risky and potentially embolic lesions in patients with IE. METHODS We searched the PubMed, Web of Science, and Google Scholar databases using a range of related search terms, and reviewed the literatures about the pathogenesis and embolic predictors of IE. RESULTS The development of IE and its complications is widely accepted as the result of complex interactions between microorganisms, valve endothelium, and host immune responses. The predictive value of echocardiographic characteristics is the most powerful for EE. In addition, both easily obtained blood biomarkers such as C-reactive protein, mean platelet volume, neutrophil-to-lymphocyte ratio, anti-β2-glycoprotein I antibodies, D-Dimer, troponin I, matrix metalloproteinases, and several microbiological or clinical characteristics might be promising as potential predictors of EE. CONCLUSION Our review provides a synthesis of current knowledge regarding the pathogenesis and predictors of embolism in IE along with a review of potentially emerging biomarkers.
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Affiliation(s)
- Wangling Hu
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Xindi Wang
- Department of HematologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Guanhua Su
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
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9
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Gboko KDT, Traoré SG, Sanhoun AR, Kirioua J, Otaru N, Kurt F, Jaeger FN, Isenring J, Kaindi DWM, Kreikemeyer B, Renault P, Hattendorf J, Meile L, Jans C, Nguetta R, Bonfoh B. Risk factors for the carriage of Streptococcus infantarius subspecies infantarius isolated from African fermented dairy products. PLoS One 2019; 14:e0225452. [PMID: 31774832 PMCID: PMC6881063 DOI: 10.1371/journal.pone.0225452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
Streptococcus infantarius subsp. infantarius (Sii) has been identified as predominant lactic acid bacteria in spontaneously fermented dairy products (FDPs) in sub-Saharan Africa including Côte d'Ivoire. However, Sii belongs to the Streptococcus bovis/Streptococcus equinus complex (SBSEC). Most SBSEC members are assumed to be involved as opportunistic pathogens in serious diseases in both humans and animals. A population-based cross-sectional survey, including 385 participants was conducted in Korhogo, northern Côte d'Ivoire, to identify risk factors for Sii fecal carriage, including consumption of local FDPs. A structured questionnaire was used to gather participant's socio-demographic and economic characteristics, their relation to livestock and dietary habits. In addition, fresh stool and milk samples were collected. The identification of Sii was done using a SBSEC-specific PCR assay targeting 16S rRNA and groEL genes. The overall prevalence of SBSEC and Sii carriage was 23.2% (confidence interval CI 95% = 18.9-27.5) and 12.0% (CI 95% = 8.4-15.5) for stool, respectively. Prevalence of Sii was significantly higher in consumers of artisanal butter compared with non-consumers (57.1% vs 10.1%, odds ratio OR: 11.9, 95% CI: 3.9-36.6), as well as in persons handling livestock (OR = 3.9; 95% CI = 1.6-9.3) and livestock primary products (OR = 5.7; 95% CI = 2.3-14.3). The closer contact with livestock was a risk factor for Sii fecal carriage. Sii strains were isolated from fresh and fermented milk products with a prevalence of 30.4% and 45.4%, respectively. Analysis of Sii population structure through the SBSEC multi locus sequence typing assay revealed a close relationship across human and dairy isolates, possibly linked to a Kenyan human isolate. All these outcomes underline the interest of in-depth investigations on the ecology, potential reservoirs and pathways of contamination by Sii at the human-animal-environment interface in comparison to yet to be collected data from Europe, Asia and the Americas to further elucidate the various roles of Sii.
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Affiliation(s)
- Kossia D T Gboko
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire
| | - Sylvain G Traoré
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,University of Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Aimé R Sanhoun
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Jérôme Kirioua
- University of Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Nize Otaru
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Fabienne Kurt
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Fabienne N Jaeger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Julia Isenring
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Dasel W M Kaindi
- Department of Food Science, Nutrition and Technology, University of Nairobi, Nairobi, Kenya
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Medical Centre Rostock, Germany
| | - Pierre Renault
- Institut National de la Recherche Agronomique, UMR 1319 MICALIS, Jouy-en-Josas, France
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Christoph Jans
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Roland Nguetta
- Institut de cardiologie d'Abidjan (ICA), Abidjan, Côte d'Ivoire.,Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Valenzuela I, Hunter MD, Sundheim K, Klein B, Dunn L, Sorabella R, Han SM, Willey J, George I, Gutierrez J. Clinical risk factors for acute ischaemic and haemorrhagic stroke in patients with infective endocarditis. Intern Med J 2019; 48:1072-1080. [PMID: 29740951 DOI: 10.1111/imj.13958] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/31/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stroke as a complication of infective endocarditis portends a poor prognosis, yet risk factors for stroke subtypes have not been well defined. AIM To identify risk factors associated with ischaemic and haemorrhagic strokes. METHODS A retrospective patient chart review was performed at a single US academic centre to identify risk factors and imaging for patients who were 18 years or older with infectious endocarditis (IE) and stroke diagnoses. Differences in patient characteristics by stroke status were assessed using univariate analysis, χ2 or student's t-test as well as logistic regression models for multivariable analyses and correlation matrices to identify possible collinearity between variables and to obtain odds ratios (OR) and their 95% confidence intervals. RESULTS A final sample of 1157 participants was used for this analysis. The total number of non-surgical strokes was 178, with a prevalence of 15.4% (78% ischaemic, 10% parenchymal haemorrhages, 8% subarachnoid haemorrhages and 4% mixed ischaemic/haemorrhagic). Multivariate risk factors for ischaemic stroke included prior stroke (OR 2.0, 1.3-3.1), Staphylococcus infection (OR 2.0, 1.3-3.0), mitral vegetations (OR 2.2, 1.4-3.3) and valvular abscess (OR 2.7, 1.7-4.3). Risk factors for haemorrhagic stroke included fungal infection (OR 6.4, 1.2-34.0), male gender (OR 3.5, 1.4-8.3) and rheumatic heart disease (OR 3.3, 1.1-10.4). CONCLUSION Among patients with IE, there exist characteristics that relate differentially to ischaemic and haemorrhagic stroke risk.
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Affiliation(s)
- Ives Valenzuela
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Madeleine D Hunter
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kathryn Sundheim
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Bradley Klein
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Lauren Dunn
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Robert Sorabella
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Sang M Han
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Joshua Willey
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
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11
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Schirone L, Iaccarino A, Saade W, D'Abramo M, De Bellis A, Frati G, Sciarretta S, Mestres CA, Greco E. Cerebrovascular Complications and Infective Endocarditis: Impact of Available Evidence on Clinical Outcome. Biomed Res Int 2018; 2018:4109358. [PMID: 30687742 DOI: 10.1155/2018/4109358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
Background. Infective endocarditis (IE) is a life-threatening disease. Its epidemiological profile has substantially changed in recent years although 1-year mortality is still high. Despite advances in medical therapy and surgical technique, there is still uncertainty on the best management and on the timing of surgical intervention. The objective of this review is to produce further insight into the short- and long-term outcomes of patients with IE, with a focus on those presenting cerebrovascular complications.
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12
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Sara JD, Prasad M, Kapa S. 79-Year-Old Man With Shortness of Breath and Fevers. Mayo Clin Proc 2018; 93:e125-e129. [PMID: 30414730 DOI: 10.1016/j.mayocp.2018.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Jaskanwal D Sara
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Megha Prasad
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Suraj Kapa
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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13
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Masrour-Roudsari J, Ebrahimpour S. Causal role of infectious agents in cancer: An overview. Caspian J Intern Med 2017; 8:153-158. [PMID: 28932365 PMCID: PMC5596184 DOI: 10.22088/cjim.8.3.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 05/29/2017] [Accepted: 06/12/2017] [Indexed: 12/13/2022]
Abstract
Cancer is a complex group of diseases with multiple eventual causes. The underlying causes are not fully known. Thus, learning more about the known causes of cancer is an important issue. Moreover, among these factors, infection and its association to cancers is controversial. Although, it seems that the genome instability of the cells can initiate cancer development. The purpose of this review was to present the role of infection in the development of cancer. Infectious agents, such as hepatitis B (HBV) and C viruses (HCV), Epstein-Barr virus (EBV), human papillomavirus (HPV), human immunodeficiency virus type 1 (HIV-1), Helicobacter pylori (H. pylori) and Streptococcus bovis (S. bovis) contribute to the pathogenesis of different cancers. These cancers include hepatocellular carcinoma, Burkitt's lymphoma, nasopharyngeal carcinoma, cervical cancers, non-Hodgkin lymphoma, Kaposi sarcoma, adenocarcinoma and lymphoma. Screenings of infectious diseases in cancer patients may open up areas of research in the identification of optimizing cancer control strategies.
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Affiliation(s)
- Jila Masrour-Roudsari
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Delahaye F. [Which patients with infective endocarditis require emergency surgery?]. Presse Med 2016; 45:926-932. [PMID: 27687628 DOI: 10.1016/j.lpm.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
Half of patients with infectious endocarditis have surgery during the active phase of infective endocarditis (before the end of antibiotic therapy). The American Heart Association and the European Society of Cardiology, independently from each other, have published guidelines in September 2015. As regards surgical indications, these guidelines are similar. The surgical indication must be a common decision of a multidisciplinary team of experts in cardiology, cardiac surgery, imaging and infectious diseases. The main indications are heart failure, non-infectious process control and prevention of embolisms.
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Affiliation(s)
- François Delahaye
- Hospices civils de Lyon, université Claude Bernard Lyon 1, EA 7425 : qualité sécurité performance en santé, 69000 Lyon, France.
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15
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García-País MJ, Rabuñal R, Armesto V, López-Reboiro M, García-Garrote F, Coira A, Pita J, Rodríguez-Macías AIB, López-Álvarez MJ, Alonso MP, Corredoira J. Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review. Semin Arthritis Rheum 2016; 45:738-46. [PMID: 26992635 DOI: 10.1016/j.semarthrit.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Received: 11/10/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.
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Affiliation(s)
| | - Ramón Rabuñal
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Victor Armesto
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - Amparo Coira
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Julia Pita
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - María Pilar Alonso
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Corredoira
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
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16
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Olmos C, Vilacosta I, Sarriá C, López J, Ferrera C, Sáez C, Vivas D, Hernández M, Sánchez-Enrique C, García-Granja PE, Pérez-Cecilia E, Maroto L, San Román JA. Streptococcus bovis endocarditis: Update from a multicenter registry. Am Heart J 2016; 171:7-13. [PMID: 26699595 DOI: 10.1016/j.ahj.2015.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Infective endocarditis (IE) due to Streptococcus bovis has been classically associated with elderly patients, frequently involving >1 valve, with large vegetations and high embolic risk, which make it a high-risk group. Our aim is to analyze the current clinical profile and prognosis of S bovis IE episodes, in comparison to those episodes caused by viridans group streptococci and enterococci. METHODS We analyzed 1242 consecutive episodes of IE prospectively recruited on an ongoing multipurpose database, of which 294 were streptococcal left-sided IE and comprised our study group. They were classified into 3 groups: group I (n = 47), episodes of IE due to S bovis; group II (n = 134), episodes due to viridans group streptococci; and group III (n = 113), those episodes due to enterococci. RESULTS The incidence of enterococci IE has significantly increased in the last 2 decades (6.4% [1996-2004] vs 11.1% [2005-2013]; P = .005), whereas the incidence of IE due to S bovis and viridans streptococci have remained stable (4% and 10%, respectively). Gender distribution was similar in the 3 groups. Patients with S bovis and enterococci IE were older than those from group II. Nosocomial acquisition was more frequent in group III. Concerning comorbidity, diabetes mellitus (36.7% vs 9.2% vs 26.8%; P < .001) was more common in groups I and III. Chronic renal failure was more prevalent in patients from group III (4.2% vs 1.5% vs 19%; P < .001). Prosthetic valve IE was more frequent in enterococcal IE. Infection upon normal native valves was more frequent in S bovis IE. Colorectal tumors were found in 69% of patients from this group. Vegetation detection was similar in the 3 groups. However, vegetation size was smaller in S bovis IE. During hospitalization, in-hospital complications and in-hospital mortality were higher in enterococci episodes. CONCLUSIONS S bovis IE accounts for 3.8% of all IE episodes in our cohort; it is associated with a high prevalence of colonic tumors, with predominance of benign lesions, and affects patients without preexisting valve disease. It is related to small vegetations and a low rate of in-hospital complications, including systemic embolisms. In-hospital mortality is similar to that of viridans group streptococci.
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Affiliation(s)
| | | | - María Pilar Alonso
- Department of Clinical Microbiology, Hospital Universitario Lucus Augusti, Lugo, Spain
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18
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3034] [Impact Index Per Article: 337.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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19
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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20
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Corredoira J, García-país MJ, Coira A, Rabuñal R, García-garrote F, Pita J, Rodríguez-macías A, Blanco M, Lopez-roses L, López-álvarez M, Alonso-garcía MP. Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer. Eur J Clin Microbiol Infect Dis 2015; 34:1657-65. [DOI: 10.1007/s10096-015-2402-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/03/2015] [Indexed: 12/24/2022]
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Mello R, da Silva Santos M, Golebiosvki W, Weksler C, Lamas C. Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014. Braz J Infect Dis 2015; 19:209-12. [PMID: 25636194 PMCID: PMC9425377 DOI: 10.1016/j.bjid.2014.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 10/10/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. Objectives To describe aspects of S. bovis endocarditis. Methods This is a case series of patients admitted to a cardiac surgery referral center, during the years 2005–2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. Results Nine patients with S. bovis endocarditis were included; all cases fulfilled the modified Duke criteria. Incidence was 8/220 (4%) in years 2006–2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal findings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. Conclusions S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.
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Affiliation(s)
| | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Cristiane Lamas
- Unigranrio, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.
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22
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Abstract
AIM A meta-analysis was conducted to determine the risk associated with Streptococcus bovis infection and the occurrence of colorectal neoplasia (CRN). The level of risk remains unknown. METHOD We conducted a search of MEDLINE, PubMed and EMBASE up to January 2014. We used a random-effects model to analyse the data. RESULTS We identified 48 studies concerning three main topics: S. bovis septicaemia, S. bovis endocarditis and S. bovis faecal carriage. The total sample sizes were 1729, 807 and 1145, respectively; the 48 studies included 9 case-control studies and 39 case series. Overall, the presence of S. bovis infection was found to be significantly associated with the presence of CRN. Streptococcus bovis endocarditis showed the strongest association in analyses of case-control studies and case series (OR 14.54, 95% CI 5.66-37.35, test for heterogeneity I2 = 43.53; event rate of 0.53, 95% CI 0.45-0.61, test for heterogeneity I2 = 53.50). Similarly, S. bovis septicaemia was also associated with a high level of concurrence with CRN (OR 7.48, 95% CI 3.10-18.06, test for heterogeneity I(2) = 43.32; event rate 0.49, 95% CI 0.42-0.56, test for heterogeneity I2 = 69.97). Patients with CRN were found to have a higher incidence of S. bovis in faeces upon stool culture (OR 2.52, 95% CI 1.14-5.58, test for heterogeneity I2 = 69.17). CONCLUSION The meta-analysis showed a statistically significant association between the presence of S. bovis endocarditis or S. bovis septicaemia and CRN. Furthermore, there is a statistically significant increase in likelihood of finding S. bovis in the stool of individuals with CRN.
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Affiliation(s)
- S Krishnan
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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23
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Olmos C, Vilacosta I, Fernández C, Sarriá C, López J, Del Trigo M, Ferrera C, Vivas D, Maroto L, Hernández M, Rodríguez E, San Román JA. Comparison of clinical features of left-sided infective endocarditis involving previously normal versus previously abnormal valves. Am J Cardiol 2014; 114:278-83. [PMID: 24878130 DOI: 10.1016/j.amjcard.2014.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/17/2022]
Abstract
Native valve infective endocarditis (IE) in patients with normal valves has increased in the last decades. Whether patients with normal valves present a similar prognosis to those with pathologic valves is unresolved. Our aim is to describe epidemiologic and clinical differences between patients with left-sided IE and normal valves and those with native pathologic valves. We analyzed 945 consecutive episodes of IE, 435 of which involved left-sided nonprosthetic IE. They were classified into 2 groups: episodes in normal valves (normal group, n=173) and episodes in pathologic valves (abnormal group, n=262). Patients in the normal group were younger, Staphylococcus aureus and Streptococcus bovis were more frequently isolated, and vegetations were more frequently found. Heart failure, septic shock, and the need for surgery or death were more common. Multivariate analysis identified the following as factors independently associated with normal valve IE: age<65 years, S bovis, S aureus, heart failure, and vegetation detection. Factors independently associated with in-hospital events included S aureus, periannular complications, heart failure, and septic shock development. In conclusion, compared with patients with abnormal valve IE, patients with IE on normal valves were younger, had a more virulent microbiological profile, developed heart failure and septic shock more frequently, needed more surgical procedures, and had worse prognosis.
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Affiliation(s)
- Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Cristina Sarriá
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain
| | - María Del Trigo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Hernández
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Enrique Rodríguez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - José Alberto San Román
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
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Rizzi M, Ravasio V, Carobbio A, Mattucci I, Crapis M, Stellini R, Pasticci MB, Chinello P, Falcone M, Grossi P, Barbaro F, Pan A, Viale P, Durante-Mangoni E. Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI). BMC Infect Dis 2014; 14:230. [PMID: 24779617 PMCID: PMC4101861 DOI: 10.1186/1471-2334-14-230] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/24/2014] [Indexed: 12/28/2022] Open
Abstract
Background Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. Methods We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). Results There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Conclusions Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery.
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Affiliation(s)
- Marco Rizzi
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, piazza OMS 1, Bergamo, BG 24127, Italia.
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Sheng WH, Chuang YC, Teng LJ, Hsueh PR. Bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus is associated with digestive tract malignancies and resistance to macrolides and clindamycin. J Infect 2014; 69:145-53. [PMID: 24637236 DOI: 10.1016/j.jinf.2014.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 07/17/2013] [Revised: 02/24/2014] [Accepted: 03/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was intended to delineate the association between digestive tract malignancies and bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus. METHODS We reviewed the medical records and microbiological results of patients with bacteraemia due to Streptococcus bovis during the period 2000-2012. Species and subspecies identification of isolates originally classified as S. bovis was confirmed by 16S rRNA sequencing and PCR restriction fragment length polymorphism (PCR-RFLP) assays. Minimum inhibitory concentrations of antimicrobial agents were determined by the broth microdilution method. RESULTS Of the 172 S. bovis complex isolates obtained from 172 patients (age range, <1-94 years, median age, 66) with bacteraemia, 31 isolates were identified to be S. gallolyticus subspecies gallolyticus, 126 were S. gallolyticus subspecies pasteurianus, and 15 were shown to be Streptococcus infantarius. The majority (n = 104, 60%) of patients were male and had underlying malignancies (n = 87, 51%). Bacteraemia due to S. gallolyticus subspecies gallolyticus was significantly associated with endocarditis while S. gallolyticus subspecies pasteurianus was more likely to be associated with malignancies of the digestive tract, including gastric, pancreatic, hepatobiliary and colorectal cancers. Septic shock at presentation was the only factor associated with mortality among patients with bacteraemia due to either subspecies of S. bovis. Isolates of S. gallolyticus subspecies pasteurianus had higher rates of resistance to macrolides and clindamycin than isolates of S. gallolyticus subspecies gallolyticus. CONCLUSION Extensive diagnostic work-up for digestive tract malignancies and trans-esophageal echocardiogram should be investigated in patients with bacteraemia caused by S. gallolyticus.
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Affiliation(s)
- Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lee-Jene Teng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Kovalchuk O, Walz P, Kovalchuk I. Does bacterial infection cause genome instability and cancer in the host cell? Mutat Res 2014; 761:1-14. [PMID: 24472301 DOI: 10.1016/j.mrfmmm.2014.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 09/16/2013] [Revised: 12/08/2013] [Accepted: 01/16/2014] [Indexed: 06/03/2023]
Abstract
Research of the past several decades suggests that bacterial infection can lead to genome instability of the host cell often resulting in cancer development. However, there is still a substantial lack of knowledge regarding possible mechanisms involved in the development of genomic instability. Several questions remain unanswered, namely: Why has the causative relationship between the bacterial infection and cancer been established only for a small number of cancers? What is the mechanism responsible for the induction of genome instability and cancer? Is the infection process required to cause genome instability and cancer? In this review, we present a hypothesis that the bacterial infection, exposure to heat-killed bacteria or even some bacterial determinants may trigger genome instability of exposed and distal cells, and thus may cause cancer. We will discuss the mechanisms of host responses to the bacterial infection and present the possible pathways leading to genome instability and cancer through exposure to bacteria.
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Affiliation(s)
- Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge T1K 3M4, Alberta, Canada.
| | - Paul Walz
- Department of Biological Sciences, University of Lethbridge, Lethbridge T1K 3M4, Alberta, Canada.
| | - Igor Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge T1K 3M4, Alberta, Canada.
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Abstract
An 87-year-old woman was admitted to our Cardiology Department with symptoms and signs of acute congestive heart failure and fever. She had a long history of hypertension and chronic atrial fibrillation. Transthoracic echocardiography showed a large (>10 mm) and mobile mitral valve vegetation, prolapsing into the left ventricular inflow tract, with severe mitral regurgitation due to a perforation in the posterior leaflet, in a mitral valve with fibro-calcific degeneration. Mitral regurgitation was hemodynamically significant and a moderate-to-severe pulmonary hypertension was observed. Tissue Doppler Imaging recorded at the level of the vegetation detected its incoherent motion and measured the peak antegrade velocity, which was found to be almost four times higher than that sampled at the lateral mitral annulus. Blood cultures were negative for both aerobic and anaerobic microbes. During hospitalization, the patient developed a sudden onset of left-side hemiplegia. Diffusion-weighted magnetic resonance imaging demonstrated multiple hyperintense lesions involving both hemispheres, suggestive of a cardioembolism. Diagnosis of fungal endocarditis was made and a treatment with fluconazole was started. Successive echocardiograms showed a decrease in the size and mobility of the mitral vegetation, and an increase in its echo intensity. However, in view of the systemic conditions severely affected, the patient was treated conservatively and died 3 months later. In our patient echocardiography played a key role for a better definition of the clinical course. In this context, Tissue Doppler Imaging might provide an adjunctive parameter for the prediction of embolic risk from endocardial vegetations: the peak antegrade velocity recorded at the level of the vegetation. However, before being adopted in clinical setting, this parameter should be validated by adequately powered prospective studies.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe-Multimedica, Via San Vittore 12, 20123 Milan, Italy
| | - Elisabetta Rigamonti
- Department of Cardiac Rehabilitation, Ospedale San Giuseppe-Multimedica, Via San Vittore 12, 20123 Milan, Italy
| | - Graziana Trotta
- Department of Cardiology, Ospedale San Giuseppe-Multimedica, Via San Vittore 12, 20123 Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe-Multimedica, Via San Vittore 12, 20123 Milan, Italy
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Hurtado-hernández Z, Segura-domínguez A. Déficit neurológico agudo, dolor torácico pleurítico y bloqueo trifascicular: a propósito de un caso de endocarditis infecciosa con presentación atípica. Semergen 2014; 40:47-49. [DOI: 10.1016/j.semerg.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/14/2013] [Indexed: 11/19/2022]
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Abstract
Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
| | - Ana Catarina Fonseca
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
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Werdan K, Dietz S, Löffler B, Niemann S, Bushnaq H, Silber RE, Peters G, Müller-Werdan U. Mechanisms of infective endocarditis: pathogen–host interaction and risk states. Nat Rev Cardiol 2013; 11:35-50. [DOI: 10.1038/nrcardio.2013.174] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Almuzara M, Bonofiglio L, Cittadini R, Vera Ocampo C, Montilla A, Del Castillo M, Ramirez MS, Mollerach M, Vay C. First case of Streptococcus lutetiensis bacteremia involving a clindamycin-resistant isolate carrying the lnuB gene. J Clin Microbiol 2013; 51:4259-61. [PMID: 24048528 DOI: 10.1128/JCM.01774-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Here, we describe the first case of a Streptococcus lutetiensis isolate harboring the lnuB gene.
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Fitzmaurice GJ, McKenna AJ, Murphy J, McMullan R, O'Donnell ME. Streptococcus bovis bacteraemia: an evaluation of the long-term effect on cardiac outcomes. Gen Thorac Cardiovasc Surg 2013; 62:142-8. [PMID: 24022385 DOI: 10.1007/s11748-013-0316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality. METHODS A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality. RESULTS Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3 % of total patients); four patients (9.3 %) had native valve involvement while three (7.0 %) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4 %). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100 % recurrence rate amongst the valve replacement patients (n = 2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1 % alive vs. 50 % of non-endocarditis patients, p = 0.73). CONCLUSION Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted.
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Affiliation(s)
- Gerard J Fitzmaurice
- Department of Cardiothoracic Surgery, The Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK,
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Sharara AI, Abou Hamdan T, Malli A, El-Halabi MM, Hashash JG, Ghaith OA, Kanj SS. Association of Streptococcus bovis endocarditis and advanced colorectal neoplasia: a case-control study. J Dig Dis 2013; 14:382-7. [PMID: 23551389 DOI: 10.1111/1751-2980.12059] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the association between Streptococcus bovis (S. bovis) endocarditis and advanced colorectal neoplasia. METHODS This was a case-control study of patients with S. bovis endocarditis undergoing colonoscopic evaluation. Patients were matched 1:20 with controls by gender and age (±2 years) from a large screening colonoscopy database. The baseline, colonoscopic and clinicopathological characteristics of patients with S. bovis endocarditis were analyzed. RESULTS From 1996 to 2010, 18 adult patients with S. bovis bacteremia were identified, of whom 10 with infective endocarditis (IE) underwent colonoscopic evaluation. Endocarditis involved a native or prosthetic valve in six and four of those patients, respectively. All 10 patients recovered without recurrence of IE (mean follow-up duration 49.6 months). None had a concurrent or preceding history of colon disease and only one had subclinical chronic liver disease. Advanced neoplasia, defined as the presence of polyps ≥1 cm (n = 6), villous histology (n = 3), high-grade focal dysplasia (n = 1) or cancer (n = 1), was found under colonoscopy in 6 of the 10 cases (60.0%) compared with 13/200 (6.5%) matched controls (OR 21.6, 95% CI 5.4-86.1, P < 0.0001). CONCLUSIONS S. bovis endocarditis is strongly associated with the presence of advanced colorectal neoplasia. In the absence of any contraindication, colonoscopic examination is strongly recommended in patients with endocarditis. The exact pathophysiological mechanisms underlying this association and the predilection for S. bovis bacteremia in patients with advanced colonic neoplasia remain unclear.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Arcopinto M, Russo T, Ruvolo A, Cittadini A, Saccà L, Napoli R. A Giant Pseudoaneurysm of the Forearm as Unusual Complication of Bacterial Endocarditis. Case Rep Vasc Med 2013; 2013:1-4. [PMID: 24191229 PMCID: PMC3794644 DOI: 10.1155/2013/549529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/19/2013] [Indexed: 11/20/2022] Open
Abstract
A 59-year-old man with fever was diagnosed with endocarditis due to Streptococcus bovis. Two weeks after antibiotic therapy was started, he presented with red and painful swelling of the forearm without any sign of systemic inflammation. A giant hematoma connected to the radial artery was detected with ultrasound. Surgical intervention with the removal of multiple, sterile clots from the hematoma was performed, and the multiple lacerations of the artery detected were corrected. This is the first case reporting rupture of the radial artery as a complication of infective endocarditis.
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Kutikhin AG, Yuzhalin AE, Brusina EB. The Role of Bacteria in Cancer Development. Infect Agent Cancer 2013. [DOI: 10.1007/978-94-007-5955-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Malhotra A, Prendergast BD. Evaluating treatment options for patients with infective endocarditis: when is it the right time for surgery? Future Cardiol 2012; 8:847-61. [DOI: 10.2217/fca.12.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infective endocarditis remains a life-threatening condition with an unchanging incidence and mortality of nearly 30% at 1 year. Surgery is required in 25–50% of acute infections and 20–40% of patients during convalescence. Operative procedures are often technically challenging and high-risk, often due to coexistent multisystem disease. However, international guidelines provide clear indications for surgical intervention, which are applicable for the majority of patients. These are not, however, supported by particularly robust clinical evidence and decision-making often needs to be tailored to the advancing age of the overall patient cohort, the presence of multisystem disease, comorbidities, prior antibiotic therapy of varying duration and the availability of surgical expertise. Native valve endocarditis will be the initial focus of this article, along with subgroups including prosthetic valve endocarditis. We present the treatment options for patients with infective endocarditis, evaluate the evidence-base that supports current clinical practice and attempt to provide an insight and subsequent recommendations for the timing of surgery.
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Affiliation(s)
- Aneil Malhotra
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Bernard D Prendergast
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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Corredoira-Sánchez J, García-Garrote F, Rabuñal R, López-Roses L, García-País MJ, Castro E, González-Soler R, Coira A, Pita J, López-Álvarez MJ, Alonso MP, Varela J. Association between bacteremia due to Streptococcus gallolyticus subsp. gallolyticus (Streptococcus bovis I) and colorectal neoplasia: a case-control study. Clin Infect Dis 2012; 55:491-6. [PMID: 22563018 DOI: 10.1093/cid/cis434] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The association between bacteremia by Streptococcus gallolyticus subsp. gallolyticus (SGG) and colorectal neoplasia (CRN) is well established but the frequency of the association varies widely in different studies. We conducted a case-control study to assess the association between SGG bacteremia and CRN. METHODS An analysis of all SGG bacteremias was performed during the period 1988-2011. The frequency of CRN in patients with SGG bacteremia was compared with the frequency of CRN in a symptomatic control group of patients matched at a 1:2 ratio for gender and age (±3 years) without S. bovis bacteremia and personal history of CRN and with increased risk of CRN (by the presence of symptoms, signs, or test suspicious of colonic pathology or by family history of CRN). RESULTS One hundred nine cases of SGG bacteremia were detected (mean age, 66 years; 87% male). Colonoscopy was performed in 98 cases, diagnosing 69 cases of CRN: 57 adenomas (39 advanced adenomas) and 12 invasive carcinomas. Only 4 cases had suspected CRN before the blood culture. The prevalence of CRN was higher in patients with SGG bacteremia than in the 196 control patients (70% vs 32%; odds ratio [OR], 5.1; 95% confidence interval [CI], 3.0-8.6). This difference was not significant when comparing nonadvanced adenomas (19% vs 12%), but we found significant differences in advanced adenomas (40% vs 16%; OR, 3.5; 95% CI, 2.0-6.1) and invasive carcinomas (12% vs 5%; OR, 2.9; 95% CI, 1.2-6.9). CONCLUSIONS The frequency of CRN among SGG infected patients is significantly increased compared with symptomatic age-matched controls, indicating that SGG infection is a strong indicator for underlying occult malignancy.
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Boleij A, van Gelder MMHJ, Swinkels DW, Tjalsma H. Clinical Importance of Streptococcus gallolyticus infection among colorectal cancer patients: systematic review and meta-analysis. Clin Infect Dis 2011; 53:870-8. [PMID: 21960713 DOI: 10.1093/cid/cir609] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Streptococcus bovis has long been associated with colorectal cancer (CRC). However, not all genospecies are as closely related to CRC. With this systematic review, we aim to increase the awareness of the association between S. bovis biotype I (Streptococcus gallolyticus) and CRC and urge for uniform molecular microbiological classification. METHODS In January 2011, the PubMed database was searched for all studies that investigated the association between S. bovis, infective endocarditis (IE), and CRC. A total of 191 studies were screened for eligibility and yielded 52 case reports and 31 case series, of which 11 were used for meta-analysis on the association between S. bovis biotype, IE, and adenomas/carcinomas (CRC). RESULTS Among the S. bovis-infected patients who underwent colonic evaluation, the median percentage of patients who had concomitant adenomas/carcinomas was 60% (interquartile range, 22%), which largely exceeds the disease rate reported in the general asymptomatic population. Meta-analysis showed that patients with S. bovis biotype I infection had a strongly increased risk of having CRC (pooled odds ratio [OR], 7.26; 95% confidence interval [CI], 3.94-13.36) and IE (pooled OR, 16.61; 95% CI, 8.85-31.16), compared with S. bovis biotype II-infected patients. Notably, CRC occurred more often among patients with S. bovis IE than among patients with S. bovis infection at other sites (pooled OR, 3.72; 95% CI, 2.03-6.81). CONCLUSIONS Our meta-analysis clearly indicates that S. bovis should no longer be regarded as a single species in clinical practice, because S. gallolyticus (S. bovis biotype I) infection, in particular, has an unambiguous association with CRC.
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Affiliation(s)
- Annemarie Boleij
- Department of Laboratory Medicine/830, Nijmegen Institute for Infection, Inflammation and Immunity (N4i), The Netherlands.
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Selton-Suty C, Doco-Lecompte T, Bernard Y, Duval X, Letranchant L, Delahaye F, Célard M, Alla F, Carteaux JP, Hoen B. Clinical and microbiologic features of multivalvular endocarditis. Curr Infect Dis Rep 2011; 12:237-43. [PMID: 21308537 DOI: 10.1007/s11908-010-0112-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Multivalvular endocarditis accounts for 15% of all endocarditis. The mechanisms of spread of the infection differs whether endocarditis is only left-sided (involving both the mitral and aortic valves) or bilateral. In left-sided bivalvular endocarditis, it is often a secondary mitral lesion following a primary aortic endocarditis. Multivalvular endocarditis often results in severe and extensive cardiac lesions, well described at echocardiography and frequently responsible for severe heart failure. Patients often need surgery, which consists of radical debridement of all the infected tissue with reconstruction using different types of prostheses; therefore, the surgery may be very complex. The goal should be an early diagnosis of endocarditis to avoid spread of the infection to more than one valve, to improve the prognosis for those patients.
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Abstract
Colorectal cancer is a major cause of cancer-related morbidity and mortality in the United States and many other regions of the world. Our understanding of the pathogenesis of colorectal cancer, from the precursor adenomatous polyp to adenocarcinoma, has evolved rapidly. Colorectal carcinogenesis is a sequential process characterized by the accumulation of multiple genetic and molecular alterations in colonic epithelial cells. However, the development of colorectal cancer involves more then just a genetic predisposition. External or environmental factors presumably play a significant role, and inflammatory bowel diseases, obesity, alcohol consumption, and a diet high in fat and low in fiber have all been implicated as risk factors for the development of either colonic adenomas or carcinomas. We are becoming increasingly aware of microbes as causes of malignancies. This article reviews the various microbes that have been associated with the development of colorectal carcinomas.
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Affiliation(s)
- Nazia Hasan
- Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
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Abadía F, García I, Ojeda E, Goenaga MÁ. Endocarditis por Streptococcus bovis en las 4 válvulas nativas. A propósito de un caso. Enferm Infecc Microbiol Clin 2010; 28:330-1. [DOI: 10.1016/j.eimc.2009.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/20/2009] [Accepted: 04/29/2009] [Indexed: 10/20/2022]
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Abstract
AIM An association between colonic carcinoma and Streptococcus bovis endocarditis/bacteraemia was first suggested in 1951. This knowledge has great clinical implications, yet we found scant awareness amongst general surgical trainees. The aim of this article was to review the evidence available in the literature and explore the pathophysiology behind this association. METHOD The literature was reviewed, between 1950 and 2008, using Pubmed, Embase and Ovid database searches. We utilized different combinations of the keywords: Streptococcus bovis, endocarditis, septicaemia and colon cancer/carcinoma. Quality assessment was determined using the Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001). Studies were selected based on their relevance to the aims to be addressed. RESULTS We included nine case reports and found 24 studies demonstrating an association between S. bovis bacteraemia/endocarditis and colon cancer; the reported incidence in studies was variable (6-67%). The majority of studies (20) were retrospective analysis of data; only four studies were prospective. A total of 12 of 24 studies also reported an association with extra-colonic malignancy (1-22%) and 12 with liver disease (3-57%). Eight studies relevant to the pathophysiology of this association were identified. CONCLUSION Streptococcus bovis endocarditis and/or bacteraemia is an early clue to the likely presence of colorectal cancer. Whilst further studies are required to determine the precise pathophysiology, clinicians should be aware of this association. It is advisable to investigate rigorously for colon cancer in all patients presenting with S. bovis endocarditis/bacteraemia; such patients may also present with liver disease or, occasionally, extra-colonic malignancy.
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lourenço S, Caeiro F, Ramos A, Pacheco M, Malhado JA. Aortic and tricuspid endocarditis due to Streptococcus gallolyticus in an immunocompetent patient with a normal heart. J Cardiol Cases 2009; 1:e95-e97. [PMID: 30615735 DOI: 10.1016/j.jccase.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 03/27/2009] [Revised: 08/23/2009] [Accepted: 09/08/2009] [Indexed: 11/18/2022] Open
Abstract
Endocarditis due to Streptococcus gallolyticus, an agent previously included in the Streptococcus bovis denomination is a serious disease, often associated with lesions of the colon mucosa. Aortic valve is more often affected and tricuspid involvement is quite rare. We present a case of a 56-year-old man who was admitted with a 2-month history of fever. Echocardiogram revealed vegetations on the aortic and tricuspid valve and blood cultures grew S. gallolyticus. Thoracic X-ray and computed tomography were consistent with septic pulmonary embolism. Despite optimal antibiotic therapy he developed an ischemic stroke and acute aortic regurgitation, which led to emergent surgery. Colonoscopy found a benign adenoma which was excised, and the patient had a full recovery.
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Affiliation(s)
- Sofia Lourenço
- Service of Internal Medicine 1, Curry Cabral Hospital, Lisbon, Portugal
| | - Fernando Caeiro
- Service of Internal Medicine 1, Curry Cabral Hospital, Lisbon, Portugal
| | - Alexandra Ramos
- Service of Internal Medicine 1, Curry Cabral Hospital, Lisbon, Portugal
| | - MªHelena Pacheco
- Service of Internal Medicine 1, Curry Cabral Hospital, Lisbon, Portugal
| | - José A Malhado
- Service of Internal Medicine 1, Curry Cabral Hospital, Lisbon, Portugal
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Derex L, Bonnefoy E, Delahaye F. Impact of stroke on therapeutic decision making in infective endocarditis. J Neurol 2010; 257:315-21. [DOI: 10.1007/s00415-009-5364-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 10/09/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1213] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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Casalta J, Gouriet F, Thuny F, Bothelo E, Lepidi H, Fournier P, Habib G, Guidon C, Collard F, Raoult D. Standardisation et prise en charge multidisciplinaire des endocardites. Stratégie du CHU de Marseille. ACTA ACUST UNITED AC 2009; 11:81-9. [DOI: 10.1016/j.antib.2009.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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