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Damasco PV, Ramos JN, Correal JCD, Potsch MV, Vieira VV, Camello TCF, Pereira MP, Marques VD, Santos KRN, Marques EA, Castier MB, Hirata R, Mattos-Guaraldi AL, Fortes CQ. Infective endocarditis in Rio de Janeiro, Brazil: a 5-year experience at two teaching hospitals. Infection 2014; 42:835-42. [PMID: 24934541 DOI: 10.1007/s15010-014-0640-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/19/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Despite the recent advances in diagnosis and treatment, mortality rates due to infective endocarditis (IE) remain high if not aggressively treated with antibiotics, whether or not associated with surgery. Data on the prevalence, epidemiology and etiology of IE from developing countries remain scarce. The aim of this observational, prospective cohort study was to report a 5-year experience of IE at two teaching hospitals in Rio de Janeiro, Brazil. MATERIAL AND METHODS Demographical, anamnestic and microbiological characteristics of 71 IE patients were evaluated during the period of January 2009 to March 2013. RESULTS The mean age of the IE patients was 49.8 ± 2.4 years, of which 41 (57.7%) were males. The median time between the onset of symptoms and diagnosis of IE was 35.8 ± 4.8 days. A total of 31 (43.6%) cases of community-acquired infective endocarditis (CAIE) and 40 (56.3%) cases of healthcare-acquired infective endocarditis (HAIE) were observed. Staphylococcus aureus (30%) was the predominant cause of IE. Streptococcus spp. (45.1 %) was the predominant cause of the CAIE while S. aureus (32.5%) and Enterococcus spp. (27.2 %) were the main etiological agents of HAIE. For 64 (90.1 %) patients with native valve endocarditis, the mitral valve was the most commonly affected (48.3%). The main source of IE in this cohort was intravascular catheter. The tricuspid valve and renal chronic insufficiency were more frequent in patients with HAIE than CAIE (p = 0.001). The risk factors associated with in-hospital mortality rate (46.4%) in IE patients were: age over 45 (OR 3.4; 95% CI 1.03-11.24; p = 0.04) and chronic renal insufficiency (OR 38.3; 95% CI 3.2-449.4; p = 0.004). CONCLUSIONS At two main teaching hospitals in Brazil, Streptococcus spp. was the principal pathogen of CAIE while S. aureus and Enterococcus spp. were the most frequent causes of HAIE. IE remains a serious disease associated with high in-hospital mortality rate (46.6%); especially, in individuals over 45 years of age and with renal failure. Data suggest that early surgery may improve the outcome of IE patients.
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Affiliation(s)
- P V Damasco
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brazil
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Ramos JN, dos Santos LS, Vidal LMR, Pereira PMA, Salgado AA, Fortes CQ, Vieira VV, Mattos-Guaraldi AL, Júnior RH, Damasco PV. A case report and literature overview: Abiotrophia defectiva aortic valve endocarditis in developing countries. Infection 2014; 42:579-84. [PMID: 24510585 DOI: 10.1007/s15010-014-0595-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Abstract
A fatal case of aortic valve endocarditis due to Abiotrophia defectiva was reported in Brazil. An overview of cases of endocarditis and other human infections related to A. defectiva in developing countries was also accomplished.
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Affiliation(s)
- J N Ramos
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (FCM/UERJ), Rio de Janeiro, RJ, Brazil
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Damasco PV, Cavalcante FS, Chamon RC, Ferreira DC, Rioja SS, Potsch MV, Pastura MP, Marques VD, Castier MB, Marques EA, Santos KRN. The first case report of non-nosocomial healthcare-associated infective endocarditis due to methicillin-resistant Staphylococcus aureus USA400 in Rio de Janeiro, Brazil. Infection 2013; 41:851-4. [PMID: 23456477 DOI: 10.1007/s15010-013-0430-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have distinct origins, namely, community, nosocomial, or non-nosocomial healthcare-associated (NNHCA). We report the first case of NNHCA-IE caused by methicillin-resistant S. aureus strain USA400/SCCmec IV in which the combination therapy of rifampin and vancomycin had a favorable outcome for the patient.
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Affiliation(s)
- P V Damasco
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Mattos-Guaraldi AL, Damasco PV, Gomes DLR, Melendez MG, Santos LS, Marinelli RS, Napoleão F, Sabbadini PS, Santos CS, Moreira LO, Hirata R. Concurrent diphtheria and infectious mononucleosis: difficulties for management, investigation and control of diphtheria in developing countries. J Med Microbiol 2011; 60:1685-1688. [DOI: 10.1099/jmm.0.027870-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- A. L. Mattos-Guaraldi
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - P. V. Damasco
- Disciplina de Doenças Infecciosas e Parasitárias, Universidade do Rio de Janeiro, Rio de Janeiro, Brazil
- Disciplina de Doenças Infecciosas e Parasitárias, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - D. L. R. Gomes
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. G. Melendez
- Disciplina de Doenças Infecciosas e Parasitárias, Universidade do Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. S. Santos
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. S. Marinelli
- Laboratório Central Noel Nutels, LACEN-SESDEC (Laboratório Central de Saúde Publica – Secretaria de Estado de Saúde e Defesa Civil), Rio de Janeiro, Brazil
| | - F. Napoleão
- Laboratório Central Noel Nutels, LACEN-SESDEC (Laboratório Central de Saúde Publica – Secretaria de Estado de Saúde e Defesa Civil), Rio de Janeiro, Brazil
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - P. S. Sabbadini
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C. S. Santos
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. O. Moreira
- Disciplina de Patologia Geral, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. Hirata
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Hirata R, Pereira GA, Filardy AA, Gomes DLR, Damasco PV, Rosa ACP, Nagao PE, Pimenta FP, Mattos-Guaraldi AL. Potential pathogenic role of aggregative-adhering Corynebacterium diphtheriae of different clonal groups in endocarditis. Braz J Med Biol Res 2009; 41:986-91. [PMID: 19099151 DOI: 10.1590/s0100-879x2008001100007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 10/30/2008] [Indexed: 11/22/2022] Open
Abstract
Invasive diseases caused by Corynebacterium diphtheriae have been described increasingly. Several reports indicate the destructive feature of endocarditis attributable to nontoxigenic strains. However, few reports have dealt with the pathogenicity of invasive strains. The present investigation demonstrates a phenotypic trait that may be used to identify potentially invasive strains. The study also draws attention to clinical and microbiological aspects observed in 5 cases of endocarditis due to C. diphtheriae that occurred outside Europe. Four cases occurred in female school-age children (7-14 years) treated at different hospitals in Rio de Janeiro, Brazil. All patients developed other complications including septicemia, renal failure and/or arthritis. Surgical treatment was performed on 2 patients for valve replacement. Lethality was observed in 40% of the cases. Microorganisms isolated from 5 blood samples and identified as C. diphtheriae subsp mitis (N = 4) and C. diphtheriae subsp gravis (N = 1) displayed an aggregative adherence pattern to HEp-2 cells and identical one-dimensional SDS-PAGE protein profiles. Aggregative-adhering invasive strains of C. diphtheriae showed 5 distinct RAPD profiles. Despite the clonal diversity, all 5 C. diphtheriae invasive isolates seemed to display special bacterial adhesive properties that may favor blood-barrier disruption and systemic dissemination of bacteria. In conclusion, blood isolates from patients with endocarditis exhibited a unique adhering pattern, suggesting a pathogenic role of aggregative-adhering C. diphtheriae of different clones in endocarditis. Accordingly, the aggregative-adherence pattern may be used as an indication of some invasive potential of C. diphtheriae strains.
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Affiliation(s)
- R Hirata
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro
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Mattos-Guaraldi AL, Sampaio JLM, Santos CS, Pimenta FP, Pereira GA, Pacheco LGC, Miyoshi A, Azevedo V, Moreira LO, Gutierrez FL, Costa JLF, Costa-Filho R, Damasco PV, Camello TCF, Hirata Jr R. First detection of Corynebacterium ulcerans producing a diphtheria-like toxin in a case of human with pulmonary infection in the Rio de Janeiro metropolitan area, Brazil. Mem Inst Oswaldo Cruz 2008; 103:396-400. [DOI: 10.1590/s0074-02762008000400014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 06/05/2008] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - JLM Sampaio
- Fleury Centro de Medicina Diagnóstica, Brasil
| | - CS Santos
- Universidade do Estado do Rio de Janeiro, Brasil; Universidade Federal do Rio de Janeiro, Brasil
| | - FP Pimenta
- Universidade do Estado do Rio de Janeiro, Brasil
| | - GA Pereira
- Universidade do Estado do Rio de Janeiro, Brasil
| | - LGC Pacheco
- Universidade Federal de Minas Gerais, Brasil
| | - A Miyoshi
- Universidade Federal de Minas Gerais, Brasil
| | - V Azevedo
- Universidade Federal de Minas Gerais, Brasil
| | - LO Moreira
- Universidade do Estado do Rio de Janeiro, Brasil
| | | | | | | | - PV Damasco
- Universidade do Estado do Rio de Janeiro, Brasil; Universidade Federal do Estado do Rio de Janeiro, Brasil
| | - TCF Camello
- Universidade do Estado do Rio de Janeiro, Brasil
| | - R Hirata Jr
- Universidade do Estado do Rio de Janeiro, Brasil
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Damasco PV, Pimenta FP, Filardy AA, Brito SM, Andrade AFB, Lopes GS, Hirata R, Mattos-Guaraldi AL. Prevalence of IgG diphtheria antitoxin in blood donors in Rio de Janeiro. Epidemiol Infect 2005; 133:911-4. [PMID: 16181513 PMCID: PMC2870324 DOI: 10.1017/s0950268805003997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2005] [Indexed: 11/06/2022] Open
Abstract
The lack of information on the immunity of adults in Brazil against diphtheria prompted us to analyse sera from 234 blood donors aged 18-61 years (30.3% females and 69.7% males). IgG diphtheria antitoxin levels determined by means of an ELISA, validated by toxin neutralization test in Vero cells, showed that 30.7% (95% CI 25.0-37.1) of the population was fully protected (>or=1 IU/ml). The highest percentage of subjects fully protected was in the 31-40 years age group. Most of the subjects with uncertain or no protection (<1 IU/ml) were found in the 18-30 years age group (43.8%, OR 2.18, P=0.01). Antitoxin levels were not influenced by the increase in age. Males were more protected than females (80.5%, OR 0.44, P=0.01). The prevalence of 30% of individuals fully protected against diphtheria in blood donors in Rio de Janeiro supports the fact that immunity to diphtheria among healthy Brazilian adults is inadequate. To avoid diphtheria epidemics in the future the immunity among adults should be raised in the coming years.
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Affiliation(s)
- P V Damasco
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Vila Isabel, RJ, Brasil
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