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Chen P, An Q, Huang Y, Zhang M, Mao S. Prevention of endotoxin-induced cardiomyopathy using sodium tanshinone IIA sulfonate: Involvement of augmented autophagy and NLRP3 inflammasome suppression. Eur J Pharmacol 2021; 909:174438. [PMID: 34437885 DOI: 10.1016/j.ejphar.2021.174438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/17/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022]
Abstract
Increasing evidence indicates that patients or experimental animals exposure to endotoxin (lipopolysaccharides, LPS) exert deleterious cardiac functions that greatly contribute to morbidity and mortality. The pathophysiologic processes, including NLRP3 inflammasome overactivation and cardiac inflammatory injury, are complicated. Sodium tanshinone IIA sulfonate (STS), a water-soluble derivative of tanshinone IIA, is a naturally occurring compound extracted from Salvia miltiorrhiza and has anti-inflammatory and cardioprotective properties. In this study we examined the effect of STS on endotoxin-induced cardiomyopathy and investigated the underlying mechanisms. An endotoxemic mouse model was established by injecting LPS (10 mg/kg). Different doses of STS were administered intraperitoneally (5, 10, or 50 mg/kg) at different time points (2/12 h, 4/12 h, and 8/12 h) after LPS challenge to assess its effect on survival of mice with endotoxemia. In parallel, cardiac function, myocardial inflammatory cytokines, cardiomyocyte pyroptosis and autophagy were evaluated to determine the extent of myocardial damage due to sepsis in the presence and absence of STS at the optimal dose (10 mg/kg) and time-point (2/12 h). The results demonstrated that STS increased the survival rates, improved the compromised cardiac function and reduced myocardial inflammatory injury associated with enhanced autophagy and mitigated NLRP3 inflammasome activation. Moreover, inhibiting of autophagy or blocking the AMPK pathway reversed STS-elicited prevention of cardiomyopathy and activated the NLRP3 inflammasome in endotoxemic mice. Collectively, our study demonstrates that STS attenuates endotoxemia-induced mortality and cardiomyopathy, which may be associated with promotion of autophagy and inhibition of NLRP3 inflammasome overactivation.
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Affiliation(s)
- Peipei Chen
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Qiyuan An
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China; Southern Medical University, Guangzhou, 510515, China
| | - Yuxin Huang
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Minzhou Zhang
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Shuai Mao
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China; Guangdong Provincial Branch of National Clinical Research Centre for Chinese Medicine Cardiology, Guangzhou, 510120, China.
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Barriales D, Martín-Ruiz I, Carreras-González A, Montesinos-Robledo M, Azkargorta M, Iloro I, Escobés I, Martín-Mateos T, Atondo E, Palacios A, Gonzalez-Lopez M, Bárcena L, Cortázar AR, Cabrera D, Peña-Cearra A, van Liempd SM, Falcón-Pérez JM, Pascual-Itoiz MA, Flores JM, Abecia L, Pellon A, Martínez-Chantar ML, Aransay AM, Pascual A, Elortza F, Berra E, Lavín JL, Rodríguez H, Anguita J. Borrelia burgdorferi infection induces long-term memory-like responses in macrophages with tissue-wide consequences in the heart. PLoS Biol 2021; 19:e3001062. [PMID: 33395408 PMCID: PMC7808612 DOI: 10.1371/journal.pbio.3001062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/14/2021] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
Lyme carditis is an extracutaneous manifestation of Lyme disease characterized by episodes of atrioventricular block of varying degrees and additional, less reported cardiomyopathies. The molecular changes associated with the response to Borrelia burgdorferi over the course of infection are poorly understood. Here, we identify broad transcriptomic and proteomic changes in the heart during infection that reveal a profound down-regulation of mitochondrial components. We also describe the long-term functional modulation of macrophages exposed to live bacteria, characterized by an augmented glycolytic output, increased spirochetal binding and internalization, and reduced inflammatory responses. In vitro, glycolysis inhibition reduces the production of tumor necrosis factor (TNF) by memory macrophages, whereas in vivo, it produces the reversion of the memory phenotype, the recovery of tissue mitochondrial components, and decreased inflammation and spirochetal burdens. These results show that B. burgdorferi induces long-term, memory-like responses in macrophages with tissue-wide consequences that are amenable to be manipulated in vivo. Lyme carditis is a manifestation of Lyme disease characterized by episodes of atrioventricular block and additional cardiomyopathies. This study describes the proteomic and transcriptomic changes in the heart upon infection with Borrelia burgdorferi, and identifies innate immune memory hallmarks specific to the response to the spirochete that are amenable to therapeutic manipulation.
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Affiliation(s)
- Diego Barriales
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Itziar Martín-Ruiz
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Ana Carreras-González
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Marta Montesinos-Robledo
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Mikel Azkargorta
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Ibon Iloro
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Iraide Escobés
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Teresa Martín-Mateos
- Physiopathology of the Hypoxia-Signaling Pathway Laboratory, CIC bioGUNE-BRTA, Derio, Spain
| | - Estibaliz Atondo
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Ainhoa Palacios
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Laura Bárcena
- Genomic Analysis Platform, CIC bioGUNE-BRTA, Derio, Spain
| | | | - Diana Cabrera
- Metabolomics Platform, CIC bioGUNE-BRTA, Derio, Spain
| | - Ainize Peña-Cearra
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Juan M. Falcón-Pérez
- Metabolomics Platform, CIC bioGUNE-BRTA, Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Miguel A. Pascual-Itoiz
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Juana María Flores
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Leticia Abecia
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Aize Pellon
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Ana M. Aransay
- Genomic Analysis Platform, CIC bioGUNE-BRTA, Derio, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Pascual
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Felix Elortza
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Edurne Berra
- Physiopathology of the Hypoxia-Signaling Pathway Laboratory, CIC bioGUNE-BRTA, Derio, Spain
| | | | - Héctor Rodríguez
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Juan Anguita
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- * E-mail:
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Shang X, Li J, Yu R, Zhu P, Zhang Y, Xu J, Chen K, Li M. Sepsis-related myocardial injury is associated with Mst1 upregulation, mitochondrial dysfunction and the Drp1/F-actin signaling pathway. J Mol Histol 2019; 50:91-103. [PMID: 30604255 DOI: 10.1007/s10735-018-09809-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022]
Abstract
LPS-induced septic cardiomyopathy has been found to be connected with mitochondrial stress through unknown mechanisms. Mitochondrial fission is an early event in mitochondrial dysfunction. The aim of our study was to determine the role and regulatory mechanism of mitochondrial fission in the progression of LPS-induced septic cardiomyopathy, with a particular focus on Mst1 and F-actin. Our data demonstrated that Mst1 expression was rapidly upregulated in LPS-treated hearts and that increased Mst1 promoted cardiomyocyte death by inducing mitochondrial stress. Mechanistically, elevated expression of Mst1 upregulated Drp1, and the latter initiated mitochondrial fission. Excessive mitochondrial fission caused mitochondrial oxidative injury, mitochondrial membrane potential reduction, mitochondrial proapoptotic element translocation into the cytoplasm/nucleus, mitochondrial energy dysfunction and mitochondrial apoptosis activation. Inhibition of mitochondrial fission sustained mitochondrial function and favored cardiomyocyte survival. Furthermore, we identified F-actin degradation as an apparent downstream event of mitochondrial fission activation in the context of LPS-induced septic cardiomyopathy. Stabilization of F-actin attenuated fission-mediated cardiomyocyte death. Altogether, our results define the Mst1/Drp1/mitochondrial fission/F-actin axis as a new signaling pathway that mediates LPS-related septic cardiomyopathy by inducing mitochondrial stress and cardiomyocyte death. Therefore, Mst1 expression, mitochondrial fission modification and F-actin stabilization may serve as potential therapeutic targets for sepsis-related myocardial injury.
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Affiliation(s)
- Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Jun Li
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Rongguo Yu
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Yingrui Zhang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Jingqing Xu
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Kaihua Chen
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Min Li
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
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Abstract
RATIONALE Takotsubo syndrome (TTS) most commonly occurs in postmenopausal women who have been exposed to a triggering event such as acute physical or emotional distress. Sepsis-induced TTS in young premenopausal women were rarely reported. In particular, the relationship between sepsis-induced TTS and sepsis-induced cardiomyopathy (SIC) remains to be illuminated. PATIENT CONCERNS Two young premenopausal women were admitted to the hospital with sepsis and myocardial involvement. DIAGNOSIS Both patients fully met the Mayo Clinic criteria for TTS. INTERVENTIONS Both patients received anti-infection and fluid infusion treatment. OUTCOMES Both patients were discharged without complications and the follow-up ultrasonic echocardiography showed normal results. LESSONS In this report, we describe 2 young premenopausal women with sepsis-induced TTS. There is an overlap between sepsis-induced TTS and SIC, and SIC could be a special type of TTS, which occurs under the stress of sepsis.
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Shenoy AT, Beno SM, Brissac T, Bell JW, Novak L, Orihuela CJ. Severity and properties of cardiac damage caused by Streptococcus pneumoniae are strain dependent. PLoS One 2018; 13:e0204032. [PMID: 30216364 PMCID: PMC6138390 DOI: 10.1371/journal.pone.0204032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/31/2018] [Indexed: 01/15/2023] Open
Abstract
Streptococcus pneumoniae is an opportunistic Gram-positive pathogen that can cause invasive disease. Recent studies have shown that S. pneumoniae is able to invade the myocardium and kill cardiomyocytes, with one-in-five adults hospitalized for pneumococcal pneumonia having a pneumonia-associated adverse cardiac event. Furthermore, clinical reports have shown up to a 10-year increased risk of adverse cardiac events in patients formerly hospitalized for pneumococcal bacteremia. In this study, we investigated the ability of nine S. pneumoniae clinical isolates, representing eight unique serotypes, to cause cardiac damage in a mouse model of invasive disease. Following intraperitoneal challenge of C57BL/6 mice, four of these strains (D39, WU2, TIGR4, and 6A-10) caused high-grade bacteremia, while CDC7F:2617-97 and AMQ16 caused mid- and low-grade bacteremia, respectively. Three strains did not cause any discernible disease. Of note, only the strains capable of high-grade bacteremia caused cardiac damage, as inferred by serum levels of cardiac troponin-I. This link between bacteremia and heart damage was further corroborated by Hematoxylin & Eosin and Trichrome staining which showed cardiac cytotoxicity only in D39, WU2, TIGR4, and 6A-10 infected mice. Finally, hearts infected with these strains showed varying histopathological characteristics, such as differential lesion formation and myocytolysis, suggesting that the mechanism of heart damage varied between strains.
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Affiliation(s)
- Anukul T. Shenoy
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sarah M. Beno
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Terry Brissac
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeremiah W. Bell
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lea Novak
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Carlos J. Orihuela
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Asakawa N, Uchida K, Sakakibara M, Omote K, Noguchi K, Tokuda Y, Kamiya K, Hatanaka KC, Matsuno Y, Yamada S, Asakawa K, Fukasawa Y, Nagai T, Anzai T, Ikeda Y, Ishibashi-Ueda H, Hirota M, Orii M, Akasaka T, Uto K, Shingu Y, Matsui Y, Morimoto SI, Tsutsui H, Eishi Y. Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients. PLoS One 2017; 12:e0179980. [PMID: 28686683 PMCID: PMC5501515 DOI: 10.1371/journal.pone.0179980] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/07/2017] [Indexed: 12/28/2022] Open
Abstract
Background Although rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients. Methods and results We examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (≥14 inflammatory cells) and minimal (<14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CM-group samples. Conclusions Frequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.
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Affiliation(s)
- Naoya Asakawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Keisuke Uchida
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
- * E-mail:
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Keiji Noguchi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Yusuke Tokuda
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Kanako C. Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Shiro Yamada
- Department of Cardiovascular Medicine, Otaru-kyokai Hospital, Hokkaido, Japan
| | - Kyoko Asakawa
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Hokkaido, Japan
| | - Yuichiro Fukasawa
- Department of Pathology, Sapporo City General Hospital, Hokkaido, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masanori Hirota
- Department of Cardiovascular Surgery, Machida Municipal Hospital, Tokyo, Japan
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shin-ichiro Morimoto
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyusyu University, Fukuoka, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Elbadawi A, Saad M, Elgendy IY, Zafar A, Chow MY. Multiple myocardial abscesses secondary to late stent infection. Cardiovasc Pathol 2017; 28:1-2. [PMID: 28213312 DOI: 10.1016/j.carpath.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/17/2022] Open
Abstract
A 53-year-old woman presented to our hospital with dizziness and low-grade fever. She underwent percutaneous coronary intervention to the obtuse marginal artery with a drug-eluting stent 20 months prior to this presentation. Physical examination was remarkable for bradycardia. Electrocardiogram showed a junctional rhythm with heart rate of 35 bpm. Blood and urine cultures were negative. Despite successful urgent pacemaker placement, she had cardiac arrest the following day with unsuccessful cardiopulmonary resuscitation attempt. Cardiac autopsy report revealed multiple abscesses involving the obtuse marginal and left anterior descending arteries as well as the adjacent myocardial regions.
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Affiliation(s)
- Ayman Elbadawi
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Marwan Saad
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Aneeqa Zafar
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Ming-Yan Chow
- Department of Pulmonary and Critical care Medicine, Rochester General Hospital, Rochester, NY
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8
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Affiliation(s)
- Pierre Braquet
- Centre Balmes-Geriatrics, CHU Montpellier, 39, Avenue Charles Flahaut, F-34295 Montpellier Cedex 5, France
| | - Gregory Baptista
- Department of Geriatrics, CHU Montpellier, Montpellier 34000, France
| | | | - François Roubille
- Department of Cardiology and Cardiovascular Medicine, CHU Montpellier, Montpellier, France
| | - Vincent Le Moing
- Department of Infectious Diseases and Tropical Medicine, CHU Montpellier, Montpellier, France
| | - Claude Jeandel
- Department of Geriatrics, University Hospital of Montpellier, Montpellier, France
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9
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Lobzin IV, Volzhanin VM, Finogeev IP, Semena AV. [Clinical and electrocardiographic characteristics of myocardial dystrophy in patients with infectious diseases]. Voen Med Zh 2009; 330:34-38. [PMID: 19530456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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10
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Syed FF, Aje A, Ntsekhe M, Mayosi BM, Moosa S, Tshifularo M, Smedema JP. Resolution of nodular myocardial tuberculosis demonstrated by contrast-enhanced magnetic resonance imaging. Cardiovasc J Afr 2008; 19:198-199. [PMID: 18776963] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
In sub-Saharan Africa, pericardial tuberculosis is frequently diagnosed in HIV sero-positive patients. Myocardial involvement has only rarely been reported. We present an HIV sero-positive patient in whom both pericardial and myocardial tuberculosis were diagnosed, and highlight the value of cardiac magnetic resonance imaging in the diagnosis and management of this condition.
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Affiliation(s)
- F F Syed
- Department of Internal Medicine, Groote Schuur Hospital and University of Cape Town, Observatory
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11
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Vistarini N, d'Alessandro C, Aubert S, Jault F, Acar C, Pavie A, Gandjbakhch I. Surgery for infective endocarditis on mitral annulus calcification. J Heart Valve Dis 2007; 16:611-616. [PMID: 18095509] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to assess the characteristics of bacterial endocarditis complicating mitral annulus calcification, and to evaluate the surgical results. METHODS Twenty-four patients (mean age 64 years) underwent surgery for mitral insufficiency secondary to mitral endocarditis with annulus calcification (acute, n = 18; healed, n = 6). Surgery was performed as an emergency in seven cases for septic (n = 3) or cardiogenic (n = 4) shock. An aortic prosthesis had previously been placed in three cases. Comorbidities noted included chronic renal insufficiency/dialysis (n = 8), cancer (n = 6), coronary disease (n = 6), and obstructive cardiomyopathy (n = 1). Nine patients suffered an embolic complication, such as stroke (n = 7, of which three had coma), splenic (n = 3), or lower limb (n = 1). The microorganism present was identified as Staphylococcus aureus (n = 9), Streptococcus/ Enterococcus sp. (n = 12), or others (n = 3). The left atrial diameter was 48 mm, the ejection fraction 63%, and the septal thickness 13 mm. RESULTS The mean severity score of annulus calcifications (range: 1 to 5) was 1.9. The anatomical lesions included: vegetations (n = 16, of which eight were > 10 mm), leaflet perforation (n = 9), chordae rupture (n = 9), aortic abscess (n = 2) and mitral annular abscess (n = 9), and one fistulation into the pericardium. The valve was repaired in 15 cases, and replaced in nine (seven bioprostheses, two mechanical). Associated procedures included aortic valve replacement (n = 7) and coronary artery bypass (n = 3). The in-hospital mortality was 29% (n = 7); all patients who died were operated on during the acute phase. All patients who presented with septic shock or coma died. After a mean follow up of 46 months, six patients had died (overall survival was 46% at 33 months), and 11 were in NYHA class I/II. One recurrence of endocarditis was treated medically. CONCLUSION Bacterial endocarditis complicating mitral annulus calcification has a poor prognosis due to the frequent comorbidity and severity of the infectious complications. Patients in septic shock or coma do not appear to be suitable candidates for surgery. Valve repair was possible in two-thirds of the present patients; otherwise, a bioprosthetic replacement was the option of choice.
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Affiliation(s)
- Nicola Vistarini
- Département de Chirurgie Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié Salpétrière, Paris, France
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12
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Charles P, Hot A, Ou P, Carbonnelle E, Sidi D, Nassif X, Lortholary O. Propionibacterium acnes endocarditis in an adolescent boy suffering from a congenital cardiopathy. Pediatr Infect Dis J 2007; 26:856-8. [PMID: 17721389 DOI: 10.1097/inf.0b013e3180616733] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Propionibacterium acnes endocarditis is an uncommon infection in pediatrics. We describe a case of P. acnes endocarditis in a 16-year-old boy that occurred 6 months after recurrent surgery for a congenital cardiopathy. Molecular identification of P. acnes was obtained. He recovered from this infection after a surgical treatment and with a prolonged antibiotic regimen including ceftriaxone.
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Affiliation(s)
- Pierre Charles
- Faculté de Médecine Paris V, Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris cedex 15, France
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13
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Begon E. [Lyme arthritis, Lyme carditis and other presentations potentially associated to Lyme disease]. Med Mal Infect 2007; 37:422-34. [PMID: 17698309 DOI: 10.1016/j.medmal.2006.01.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 10/23/2022]
Abstract
Lyme disease or Lyme borreliosis is the most common tick-transmitted disease in the Northern hemisphere and is caused by Borrelia burgdorferi spirochetes. Lyme disease commonly begins with a characteristic skin lesion, erythema migrans. Weeks or months later, the patients may have neurologic, joint, or cardiac abnormalities. Some patients may still present persistent deep fatigue and various unspecific symptoms after standard courses of antibiotic treatment for Lyme disease. This constellation of symptoms has been variously referred to as "chronic Lyme disease", or "post-Lyme disease syndrome". The first French National Consensus Conference on Lyme Disease was the reason to review all aspects of articular and cardiac manifestations of Lyme disease after a synthesis of recent literature. The involvement of Borrelia species in chronic Lyme disease and other pathologies is discussed.
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Affiliation(s)
- E Begon
- Service de dermatologie, centre hospitalier général René-Dubos, 6, avenue de l'Ile-de-France, BP 79, 95303 Cergy-Pontoise cedex, France.
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Affiliation(s)
- Maysaa Alzetani
- Hammersmith Hospital NHS Trust, Imperial College, London, UK.
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15
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Cattaneo P, Marchetti P, Morandi F, Salerno-Uriarte JA. Left ventricular apical ballooning in mitral endocarditis. Int J Cardiol 2007; 119:261-3. [PMID: 17056141 DOI: 10.1016/j.ijcard.2006.07.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 07/19/2006] [Accepted: 07/29/2006] [Indexed: 11/22/2022]
Abstract
Tako-tsubo cardiomyopathy is an enigmatic syndrome characterized by chest pain, transient left ventricular dysfunction and specific electrocardiographic changes induced by physical or emotional stress. We describe the first case of this syndrome associated with acute mitral regurgitation due to bacterial endocarditis: the reversible ventricular dysfunction might have been induced by altered catecholamine dynamics due to the pulmonary edema.
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Carlson D, Maass DL, White DJ, Tan J, Horton JW. Antioxidant vitamin therapy alters sepsis-related apoptotic myocardial activity and inflammatory responses. Am J Physiol Heart Circ Physiol 2006; 291:H2779-89. [PMID: 16844910 DOI: 10.1152/ajpheart.01258.2005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the effects of antioxidant vitamins on several aspects of sepsis-related myocardial signaling cascades. Sprague-Dawley rats were divided into four groups: group 1, vehicle-treated shams; group 2, sham-operated rats given antioxidant vitamins (vitamin C, 24 mg/kg; vitamin E, 20 U/kg; vitamin A, 417 U/kg; and zinc, 3.7 ng/kg) by oral gavage in 0.5 ml water twice daily for 3 days and no septic challenge (vitamin-treated, sham-operated rats); group 3, intratracheal delivery of Streptococcus pneumoniae, 4 × 106 colony forming units in a volume of 0.3 ml phosphate buffer solution; group 4, S. pneumonia challenge as described for group 3 plus antioxidant vitamins (as described for group 2). Hearts collected 24 h after septic challenge were used to examine several aspects of cell signaling and ventricular function. As a result, when compared with sham-operated rats, sepsis in the absence of antioxidant therapy promoted NF-κB activation, increased mitochondrial cytochrome c release, increased myocyte cytokine secretion, increased caspase activation, and impaired left ventricular function. Antioxidant vitamin therapy plus septic challenge prevented NF-κB activation, reduced mitochondrial cytochrome c release, decreased caspase activity, abrogated cardiomyocyte secretion of inflammatory cytokines, and improved myocardial contractile function. In conclusion, antioxidant vitamin therapy abrogated myocardial inflammatory cytokine signaling and attenuated sepsis-related contractile dysfunction, suggesting that antioxidant vitamin therapy may be a potential approach to treat injury and disease states characterized by myocardial dysfunction.
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Affiliation(s)
- Deborah Carlson
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9160, USA
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Turgeman Y, Levahar P, Lavi I, Shneor A, Colodner R, Samra Z, Bloch L, Rosenfeld T. Adult calcific aortic stenosis and Chlamydia pneumoniae: the role of Chlamydia infection in valvular calcification. Isr Med Assoc J 2006; 8:464-8. [PMID: 16889160] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Adult calcific aortic stenosis is a well-known clinical entity but its pathophysiology and cellular mechanism have yet to be defined. OBJECTIVES To determine whether there is an association between the presence and severity of adult calcific aortic stenosis and Chlamydia pneumoniae seropositivity. METHODS Forty adult patients (23 women, 17 men) were divided into three groups according to echocardiographic aortic valve area: Group A - 7 symptomatic subjects (age 67 +/- 7 years) with normal aortic valve and normal coronary angiogram, Group B - 16 patients (age 73 +/- 6) with moderate ACAS (AVA > 0.8 < or = 1.5 cm2), and Group C - 17 patients (age 76 +/- 7) with severe ACAS (AVA +/- 0.8 cm2). We tested for immunoglobulins M, G and A as retrospective evidence of C. pneumoniae infection using the micro-immunofluorescence method. Past C. pneumoniae infection was defined by IgG titer > 16 < or = 512. RESULTS No patients in group A showed positive Ig for C. pneumoniae. IgM was not detected in any of the patients with ACAS (groups B and C) while 2 of 17 patients (12%) in group C showed IgA for the pathogen. High titers of IgG were found in 14 of 33 (42%) of the patients with moderate or severe ACAS: 5 of 16 (31%) in group B and 9 of 17 (53%) in group C (P = 0.2). Both groups had the same prevalence of coronary artery disease (66%). AVA was lower in IgG-seropositive patients than in the seronegative group (0.88 +/- 0.3 cm2 vs. 1.22 +/- 0.4 cm2, respectively, P = 0.02). CONCLUSIONS Past C. pneumoniae infection may be associated with a higher prevalence and greater severity of ACAS.
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Affiliation(s)
- Yoav Turgeman
- Department of Cardiology, HaEmek Medical Center, Afula, Israel.
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19
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Abstract
Mucormycosis is an uncommon, severe, life-threatening fungal infection in the immunocompromised host. Mucormycosis with aplastic anemia is seen rarely. Only a few cases of cardiac mucormycosis with aplastic anemia have been reported in the literature. The authors present a case with severe aplastic anemia that did not respond to classic and immunosuppressive treatment for disease and developing invasive cardiac mucormycosis despite empiric treatment for febrile neutropenia.
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Affiliation(s)
- Ilgen Saşmaz
- Department of Pediatric Hematology, Cukurova University, Faculty of Medicine, Adana, Turkey
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20
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Affiliation(s)
- A Scherrer
- Imagerie Médicale, Hôpital Foch, Suresnes
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21
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Carvalho G, Bestetti RB, Godoy M, Cury P, Leme Neto AC. [Aorta-right ventricle fistula. An unexpected complication of bacterial endocarditis]. Arq Bras Cardiol 2005; 85:346-7. [PMID: 16358153 DOI: 10.1590/s0066-782x2005001800010] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gustavo Carvalho
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP.
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22
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Abstract
Infection is a common problem in dialysis patients and ranks second behind cardiovascular disease as a major cause of death. The major causes of infections, mainly bloodstream infections, often are related to dialysis access. Metastatic infectious complications have been reported frequently in the course of such bacteremias. We report the case of a 79-year-old dialysis patient who was admitted with recurrent catheter-related bacteremia caused by methicillin-resistant Staphylococcus aureus. Echocardiography and a computed tomographic scan of her chest showed multiple coronary artery bypass graft mycotic aneurysms. Despite prompt dialysis catheter removal and antibiotic treatment, she had progressive deterioration of her hemodynamic and mental status and eventually died of profound sepsis. An autopsy confirmed computed tomographic findings, plus extensive suppuration involving the left atrial and ventricular myocardium and upper lobe of the left lung. To our knowledge, this is the first report of coronary artery graft aneurysms complicating infective endocarditis in a dialysis patient.
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MESH Headings
- Abscess/etiology
- Abscess/microbiology
- Aged
- Aneurysm, Infected/etiology
- Aneurysm, Infected/microbiology
- Anti-Bacterial Agents/therapeutic use
- Bacteremia/etiology
- Bacteremia/microbiology
- Cardiomyopathies/etiology
- Cardiomyopathies/microbiology
- Catheters, Indwelling/adverse effects
- Coronary Aneurysm/etiology
- Coronary Aneurysm/microbiology
- Coronary Artery Bypass
- Drug Resistance, Multiple, Bacterial
- Endocarditis, Bacterial/etiology
- Endocarditis, Bacterial/microbiology
- Fatal Outcome
- Female
- Humans
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Methicillin Resistance
- Postoperative Complications/microbiology
- Recurrence
- Renal Dialysis
- Sepsis/etiology
- Staphylococcal Infections/complications
- Tomography, X-Ray Computed
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Affiliation(s)
- Ayman A Geneidy
- South Carolina Nephrology and Hypertension Center, Orangeburg, SC 29115, USA.
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23
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Elzi L, Laifer G, Bremerich J, Vosbeck J, Mayr M. Invasive apergillosis with myocardial involvement after kidney transplantation. Nephrol Dial Transplant 2005; 20:631-4. [PMID: 15735245 DOI: 10.1093/ndt/gfh625] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luigia Elzi
- Division of Infectious Diseases, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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24
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Abstract
The exposure to Aspergillus organisms/spores is likely common, but disease caused by tissue invasion with these fungi is uncommon and occurs primarily in the setting of immunosuppression. We report a case of rapidly advancing invasive endomyocardial aspergillosis secondary to prolonged usage of multiple broad-spectrum antibiotics in a nonimmunocompromised host. A 36-year-old cotton textile worker presented to our institution with a 3-month history of weight loss and fatigue. He reported receiving prolonged use of multiple broad-spectrum antibiotic treatment. The echocardiogram demonstrated multiple endomyocardial vegetations and a mass in the left atrium. Myocardial biopsy specimen revealed an invasive endomyocardial aspergillosis. The patient was investigated for immune deficiency including HIV, and this workup was negative. Treatment was started with amphotericin B and heparin for presumed left atrial thrombus. The patient died because of a rupture of mycotic aneurysm that resulted in cerebral hemorrhage. This case illustrates the risk of an invasive fungal infection in a nonimmunocompromised host who is a prolonged user of antibiotics in the setting of environmental exposure of opportunistic invasive fungal infections.
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Affiliation(s)
- Vedat Davutoglu
- Departments of Cardiology and Pathology, Gaziantep University School of Medicine, Sahinbey Medical Center, TR-27310 Sahinbey/Gaziantep, Turkey.
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25
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Klausz G, Tiszai A, Lénárt Z, Gyulai Z, Tiszlavicz L, Hogye M, Csanády M, Lonovics J, Mándi Y. Helicobacter pylori-induced immunological responses in patients with duodenal ulcer and in patients with cardiomyopathies. Acta Microbiol Immunol Hung 2005; 51:311-20. [PMID: 15571071 DOI: 10.1556/amicr.51.2004.3.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The interaction between the bacteria and the host is a key factor determining the clinical consequences of H. pylori infection. The immune system plays an important role in either promoting or preventing the disease. The mucosal production of TNF-alpha, IL-6, IL-8 and IL-10 and the CagA status were investigated in H. pylori-positive patients with duodenal ulcer (DU). The concentrations of these cytokines in gastric antral mucosal specimens from patients infected with H. pylori (n = 40) were determined by ELISA and compared with data on mucosal specimens from H. pylori-negative patients (n = 12). The local TNF-alpha, IL-6 and IL-8 concentrations in the antral biopsy samples were significantly higher (p < 0.001) in the patients infected with H. pylori than in the samples from the H. pylori-negative subjects. CagA positivity was demonstrated in 39 (97.5%) of the 40 patients with DU, and in 41 (70.7%) of H. pylori-positive (58 of 100) healthy blood donors. In complementary studies focusing on extragastric disease, it was found that 57% of patients with ischaemic heart disease were seropositive as concerns H. pylori, and 91% of them had antibodies against human heat shock protein 60, too. This study suggests that, besides the bacterial virulence factor, the host response of an increased mucosal production of inflammatory cytokines can be relevant to the gastric pathophysiology in H. pylori-induced DU. At the same time, in ischaemic heart diseases the role of autoimmune processes induced by H. pylori cannot be excluded.
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Affiliation(s)
- G Klausz
- Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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26
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Abstract
Certain strains of Escherichia coli have been shown to cause gas accumulation in--for example, emphysematous pyelonephritis. This paper describes a patient with intramyocardial air collections resulting from an intramyocardial infection with gas forming E coli.
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Affiliation(s)
- H J J van der Vliet
- Department of Internal Medicine, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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27
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Tsai WC, Chang LK, Lin TC. Streptococcus constellatus causing myocardial abscess complicated by cerebritis. J Microbiol Immunol Infect 2004; 37:63-6. [PMID: 15060690] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Streptococcus constellatus infection is a rare cause of myocardial abscess. The complication of cerebritis is also rare. We report a case of S. constellatus bacteremia in a 21-year-old woman who developed fever and watery diarrhea 7 days prior to admission. Computed tomography of the brain showed severe effacement of the cerebral sulci, narrowing of the ventricular system, and severe brain swelling. Echocardiography showed a cystic lesion of about 2 cm(2) over the left atrium. Mannitol and dexamethasone were administered. Hyperventilation was performed. Intravenous penicillin G and ceftazidime were administered but without response. The increased intracranial pressure persisted despite medical treatment. She died 3 days after admission. Culture of cerebrospinal fluid grew S. constellatus and 3 sets of blood cultures grew S. constellatus. This case emphasizes the potential pathogenic role of S. constellatus in myocardial abscess.
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Affiliation(s)
- Wen-Cheng Tsai
- Section of Infectious Disease, Armed Forces Tsoying Hospital, Kaohsiung, Taiwan, ROC.
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Stöllberger C, Preiser J, Finsterer J. Histological detection of intramyocardial abscesses in Candida sepsis mimicking left ventricular non-compaction/hypertrabeculation on echocardiography. Fallbericht. Histologischer Nachweis myokardialer Abszesse bei Candida-Sepsis, die echokardiographisch linksventrikulare Hypertrabekulierung/Noncompaction vortauschten. Mycoses 2004; 47:72-5. [PMID: 14998404 DOI: 10.1046/j.1439-0507.2003.00948.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Left ventricular non-compaction/hypertrabeculation (LVHT) is a rare cardiac abnormality characterized by more than three trabeculations protruding from the left ventricular wall, apically to the papillary muscles, visible in one echocardiographic image plane and intertrabecular spaces, perfused from the ventricular cavity. LVHT is frequently associated with neuromuscular disorders. Differential diagnoses of LVHT are intraventricular thrombi, false tendons, aberrant bands, intramyocardial hematoma, cardiac metastases and the apical type of hypertrophic cardiomyopathy. Intramyocardial abscesses have not been reported as a differential diagnosis of left ventricular non-compaction. In the presented case, cardiac microabscesses as a result of Candida sepsis mimicked left ventricular non-compaction in a 55-year-old man with hypopharyngeal carcinoma who died 20 days after chemotherapy. These microabscesses were not visible on echocardiography but were detected only at histologic examination of the myocardium. This case shows that intramyocardial abscesses as a result of Candida sepsis are a rare differential diagnosis of LVHT.
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Affiliation(s)
- C Stöllberger
- 2nd Medical Department, Krankenanstalt Rudolfstiftung, Wien, Austria.
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29
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Abstract
We report a case of infected intracardiac hydatid cyst in a patient who had complaints of chest pain, exertional dyspnea, palpitation, evening fever and fatigue. Echocardiography demonstrated a left ventricular apical cystic mass in 7 cm diameter. Magnetic resonance imaging and hemagglutination test confirmed the diagnosis. Single capsulated cyst full of pus was surgically removed by using cardio-pulmonary bypass. Histopathological examination revealed an infected hydatid cyst. Postoperative recovery was uneventful and the patient remains free of symptoms after one year of follow-up.
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Affiliation(s)
- V Kutay
- Department of Cardiovascular Surgery, Yuzuncu Yil University School of Medicine, Van, Turkey.
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30
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Ayres JG, Wildman M, Groves J, Ment J, Smith EG, Beattie JM. Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue. QJM 2002; 95:539-46. [PMID: 12145393 DOI: 10.1093/qjmed/95.8.539] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 1989, an outbreak of Q fever (C. burnetii infection) with 147 confirmed cases occurred in Solihull, West Midlands. Three patients developed cardiomyopathy in the subsequent 10 years. The cohort has been followed up with respect to the development of fatigue and, in this instance, cardiac effects after the original infection. AIM To determine whether persisting fatigue after Q fever represented sub-clinical cardiomyopathy. DESIGN Prospective follow-up study. METHODS All traceable subjects from the original outbreak, and community age-, sex- and smoking-matched controls, were studied. Questionnaires for idiopathic fatigue, 12-lead ECG, echocardiography, spirometry and shuttle walk distance were undertaken, and a subset with CDC-defined chronic fatigue syndrome had gated cardiac scans. RESULTS Of the original cohort, 19 had died, three had emigrated and 10 were untraceable. Of the remaining 115, 108 responded to a mailed questionnaire and 87 were investigated further, of whom 85 provided complete data. Two developed aortic valve vegetations, one of whom died. Chronic fatigue syndrome was found in 20% of cases and 5.3% of controls (including those with co-morbidities), falling to 8.2% and 0 when excluding those with co-morbidities. There were no significant differences in ECG and echocardiographic investigations or shuttle-walk distance between those with fatigue and those without. Six of the seven patients with CFS had gated cardiac scans: all were within normal limits. CONCLUSIONS These findings do not support the existence of a sub-clinical cardiomyopathy in the patients in this cohort who suffer from fatigue after acute Q fever, although endocarditis can occur after acute infection.
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Affiliation(s)
- J G Ayres
- Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
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31
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32
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Abstract
Lyme disease is a vector-borne illness that can affect numerous organ systems during the early disseminated phase, including the heart. The clinical course of Lyme carditis is usually benign with most patients recovering completely. In rare instances, death from Lyme carditis has been reported. The cardinal manifestation of Lyme carditis is conduction system disease, which generally is self-limited. Heart block occurs usually at the level of the atrioventricular node but often is unresponsive to atropine sulfate. Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement can occur but generally is mild and self-limited. Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, EM, or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea. Serologic studies and endomyocardial biopsy can support the diagnosis in the correct clinical setting, and MR imaging, echocardiography, and gallium scanning have utility in selected circumstances. No treatment has been shown clearly to attenuate or prevent the development of Lyme carditis, but mild carditis generally is treated with oral antibiotics and severe carditis with intravenous antibiotics in an effort to eradicate the infection and prevent late complications of Lyme disease. There is conflicting evidence regarding the role that B. burgdorferi plays in the development and progression of chronic congestive heart failure. Because of the significant false-positive ELISA rate in this population and the unclear benefit of antibiotic therapy, confirmatory Western blot analysis is recommended. Routine therapy and screening of patients with idiopathic dilated cardiomyopathy is of limited utility and should be reserved for patients with clear history of antecedent Lyme disease or tick bite.
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Affiliation(s)
- Duane S Pinto
- Harvard Medical School, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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34
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Hjelm E, Wesslén L, Gnarpe H, Gnarpe J, Nyström-Rosander C, Rolf C, Friman G. Antibodies to Chlamydia pneumoniae in young Swedish orienteers. Scand J Infect Dis 2002; 33:589-92. [PMID: 11525352 DOI: 10.1080/00365540110026674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
During 1992-93 sera from 1790 Swedish elite orienteers were tested for antibodies to Chlamydia pneumoniae. The reason for this was that a cluster of 16 cases of sudden unexpected cardiac death had occurred among Swedish orienteers and DNA from C. pneumoniae had been found in the myocarditic heart and in the lung in 1 of 2 deceased athletes in whom testing was feasible; in addition, C. pneumoniae IgG was found in all 5 cases where serum was available. Among the orienteers, the prevalence rates of IgG antibodies in males and females were 54% (n = 1194) and 50% (n = 596), respectively. The corresponding figures for 319 male and female blood donors were 60% (n = 169) and 53% (n = 150), respectively. These differences are not statistically significant. Male orienteers had a lower prevalence of IgA antibodies than male blood donors (19% and 26%, respectively; p < 0.05), while no such difference was found in females (16% and 18%). The prevalence of IgM antibodies was < 1% in all groups. Neither the performance level of the orienteers nor the place of residence affected the antibody prevalence. In conclusion, Swedish orienteers do not show a higher prevalence of antibodies to C. pneumoniae than healthy blood donors.
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Affiliation(s)
- E Hjelm
- Department of Medical Sciences, Uppsala University Hospital, Sweden
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35
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Tomsová M. [Mycotic diseases of the heart]. Cesk Patol 2001; 37:172-6. [PMID: 11813636] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
There has been an increasing frequency of deep mycotic infections over the last years complicating mostly disease states with immunosuppression. During the last 30 years, 54 cases of mycotic infection of the heart were identified at the Fingerland Department of Pathology in Hradec Králové, with 32 cases during the last 10 years alone (prevalence 0.2% of 28 199 autopsies). A review of the sex, age, etiology, source of infection, principal disease and morphological cardiac findings is presented. There was male predominance (74%). The mean age of the patients was 48 years (ranging from 15 days to 87 years). Yeasts of genus Candida dominated, followed in incidence by genus Aspergillus. The postmortem haemocultivation was positive in only 25% of all cases, while cultivation from a vegetation or a myocardial abscess was positive in 61%. The probable source of infection was detected in 28 patients; very often it was bronchopneumonia or an infected central venous catheter. Endocarditis was found in 28 cases, including six cases on a prosthetic valve and four cases on mural endocardium. Isolated myocarditis was found in 25 patients. There was also one case of isolated mycotic pericarditis. In more than half of all patients there was a state of immunosuppression, usually caused by a haematologic malignancy.
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Affiliation(s)
- M Tomsová
- Fingerlandův ústav patologie LF UK a FN, Hradec Králové
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36
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Reynier C, Garcier J, Legault B, Motreff P, Ponsonnaille J, Ravel A, De Riberolles C, Boyer L. [Cross-sectional imaging of post endocarditis paravalvular myocardial abscesses of native mitral valves: 4 cases]. J Radiol 2001; 82:665-9. [PMID: 11449169] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Four cases of submitral myocardial abscess imaged by CT or MRI following endocarditis are described. All cases occurred in fragile patients (diabetes mellitus, dialysis, severe cardiovascular diseases). An iatrogenic source was noted in one patient. Staphylococcus aureus was responsible in 2 patients. If subvalvular aortic abscesses are usually described, submitral myocardial abscesses are infrequent. In addition to transesophageal echocardiography, a technique superior to transthoracic echocardiography, CT and MRI may incidentally suggest the correct diagnosis. Both techniques provide useful morphological evaluation, information that can be used to optimize the timing for surgical repair.
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Affiliation(s)
- C Reynier
- Service de Radiologie, CHU Montpied BP 69, 63003 Clermont-Ferrand Cedex
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37
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Abstract
We report on a 66-year-old man with severe hemoptysis following coronary artery bypass grafting and repair of a left ventricular septal defect after acute myocardial infarction. Initial diagnosis was delayed by misleading clinical symptoms and radiologic studies. Due to subfebrile temperature and sputum culture positive for Pseudomonas aeruginosa, he had been treated with antibiotics before reoperation. At reoperation, replacement of all foreign material and reconstruction of the ventricular repair with bovine pericardium resulted in reinfection with the same organism despite prolonged antibiotic therapy after 6 months. Removal of the pericardial tissue with direct suture closure of the ventricles and interposition of omentum led to complete healing of the infection without reoccurrence after 2 years.
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Affiliation(s)
- T Kofidis
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
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38
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Abstract
In this paper we report a case of 34-year-old man with a severe septic shock. Because of profound hypotension he was given massive amounts of catecholamines for 10 days. After a short recovery the function of his heart started to deteriorate again and clear calcification around the left ventricle was disclosed by computer tomography. Catecholamines are known to induce myocardial injury resulting in a special form of cardiomyopathy with eventual calcification, but there are no previous reports of myocardial calcification to this extent.
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39
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Affiliation(s)
- S M Lau
- Department of Internal Medicine, China Medical College Hospital, Taichung, Taiwan, Republic of China.
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40
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Thomas D, Choussat R, Isnard R, Michel PL, Lung B, Hanania G, Mathieu P, du Roy de Chaumaray T, de Gevigney G, Le Breton H, Logeais Y, Pierre-Justin E, de Riberolles C, Morvan Y, Bischoff N. [Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology]. Arch Mal Coeur Vaiss 1998; 91:745-52. [PMID: 9749191] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.
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Affiliation(s)
- D Thomas
- Service de cardiologie, hôpital Tenon, Paris
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41
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Segura Porta F, Fernández MM. [Treatment of borreliosis]. Enferm Infecc Microbiol Clin 1998; 16:239-44. [PMID: 9666589] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- F Segura Porta
- Programa Asistencial de Enfermedades Infecciosas, Corporació Sanitària Parc Taulí, Sabadell, Barcelona
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42
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Romero-Menor C, Español I, Alcaide F, Peña C, Casanovas T. Myocardial abscess at a distant zone from the active valvular infection. J Cardiovasc Surg (Torino) 1998; 39:227-8. [PMID: 9639010] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A case of an infective endocarditis with myocardial abscess due to Streptococcus anginosus at a distant location from the active valvular infection is reported. We conclude that local cardiac suppurative complications can appear in the evolution of endocarditis caused by this virulent organism.
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Affiliation(s)
- C Romero-Menor
- Service of Cardiology, Ciutat Sanitaria I Universitaria de Bellvitge, L'Hospitalet de LLobregat, Barcelona, Spain
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43
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Pagano L, Ricci P, Tonso A, Nosari A, Cudillo L, Montillo M, Cenacchi A, Pacilli L, Fabbiano F, Del Favero A. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). Br J Haematol 1997; 99:331-6. [PMID: 9375750 DOI: 10.1046/j.1365-2141.1997.3983214.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A retrospective study of 37 patients with haematological malignancy (21 acute myeloid leukaemia, 11 acute lymphoid leukaemia, two lymphoma, two hairy cell leukaemia, one Hodgkin's disease) and histologically documented mucormycosis was conducted to evaluate the clinical characteristics and ascertain the factors which influenced the outcome from mycotic infection. Patients were admitted to 18 haematology divisions in tertiary care or university hospitals in Italy between 1987 and 1995. Fever, thoracic pain, dyspnoea and cough were the most frequent presenting symptoms. At the onset, 89% patients were neutropenic (neutrophil counts < 0.5 x 10(9)/l) with a median duration of previous neutropenia of 14 d (range 6-60). The most frequent sites of infection were lungs (81%), CNS (27%), sinus (16%), liver (16%) and orbital space (10%). Only three patients were asymptomatic. A correct in vivo diagnosis was made in only 13 (35%) patients. When performed, thoracic and cranial CT scan were the most useful diagnostic investigations. Despite the fact that 26 febrile patients were treated with empirical antifungal treatment, 28 of the 37 patients (76%) died from fungal infection at a median time of 17 d from the onset of clinical symptoms. Nine patients were cured by antifungal therapy plus, in five cases, radical surgery procedures. An analysis of factors influencing outcome demonstrated that the resolution of chemotherapy-induced neutropenia and prolonged treatment with amphotericin B and, if feasible, radical surgical debridement treatment, were significantly correlated with recovery from infection. Mucormycosis, a rare filamentous fungal infection that occurs most frequently in neutropenic acute leukaemia patients, is characterized by a high mortality rate. Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients.
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44
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Bashour TT, Gord C, Baladi N, Mason DT. Intracardiac actinomyocosis. Am Heart J 1997; 133:467-468. [PMID: 9124172 DOI: 10.1016/s0002-8703(97)70192-3] [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] [Indexed: 05/22/2023]
Affiliation(s)
- T T Bashour
- The Western Heart Institute, St. Mary's Medical Center at Golden Gate Park, San Francisco, CA 94117, USA
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45
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Abstract
A myocardial abscess is a life threatening complication of infective endocarditis that necessitates early diagnosis in order to identify the need for emergent surgical intervention and improved prognosis. This review discusses the relevant historical aspects, clinical features suggestive of the diagnosis, associated conditions and various appropriate imaging modalities--in particular, trans-thoracic and trans-esophageal echocardiography, Indium-111 radionucleide scintigraphy, and computerized tomographic scanning. Specific clinical and echocardiographic criteria for identifying a myocardial abscess are discussed and comparative data presented from published studies in the literature.
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Affiliation(s)
- J Chakrabarti
- Department of Medicine, Tufts University School of Medicine, Springfield, MA 01199, USA
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46
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Leititis JU. [Diphtheria--an old new infectious disease]. Kinderkrankenschwester 1995; 14:506, 511. [PMID: 8602967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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47
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Abstract
A 63-year-old woman admitted with 2:1 infranodal atrioventricular block subsequently developed ventricular dysfunction incident to septic syndrome. Concomitant changes included an abnormally prolonged QTc interval (600 ms) and the occurrence of torsade de pointes. Restoration of a normal QTc interval and cessation of torsade de pointes was coincident with return of normal ventricular function and remission of sepsis. This report supports the view that sepsis-induced cardiomyopathy is another cause of the long QT syndrome.
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Affiliation(s)
- P Varriale
- Cabrini Medical Center, New York, NY 10003, USA
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48
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Sproule MW, Briggs MJ. Salmonellosis complicated by myocardial abscess and cerebral mycotic aneurysms. Br J Clin Pract 1995; 49:273-274. [PMID: 7492470] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- M W Sproule
- Department of Medicine, Royal Shrewsbury Hospital, Shropshire
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49
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Abstract
Myocardial abscess may occur rarely as a complication of myocardial infarction. This case report is the first demonstration of a myocardial abscess at the site of acute myocardial infarction in a 38-year-old man diagnosed by transesophageal echocardiography and color-flow imaging. Transesophageal echocardiography was crucial in the timing of surgery. Three months later the patient was well. Our patient is the first reported survivor of this uncommon complication of myocardial infarction.
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Affiliation(s)
- R Behnam
- Department of Internal Medicine, Greenbrier Valley Medical Center, Ronceverte, WV 24970, USA
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50
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Ashorobi RB, Kpohraror BO. Effects of calcium ions and atropine on endotoxin-induced contractility deficit in rat atrial muscle. East Afr Med J 1995; 72:263-6. [PMID: 7621764] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Isolated atrial muscle preparations obtained from rats injected (ip) with 3.7 x 10(9) per kg/body weight heat killed pure E. coli (endotoxin) were used to investigate the severity of induced mycocardial inotropic dysfunction and the effects of some autonotic agents and calcium. Both atrial strips were removed from endotoxin-shock rats at 48 and 72 hours post treatment. The control groups were given (ip) 0.2ml of isotonic saline and sacrificed at the same period as the treated groups. Maximum developed contractile force (amplitude) were significantly depressed in atrial strips of shock rats (p < 0.05). Maximum deficit in atrial contractility was characterised by altered responsiveness to low extra cellular Ca2+ (0.12mM) concentration. Increasing Ca2+ concentration by 1-3 mM in a normal Ca2+ medium significantly enhanced the contractile force by an increase of 88 +/- 5.9% (p < 0.005). Atropine (5 x 10(-7) - 1.5 x 10(-6)M) produced positive intropic effect with a maximum increase of 80 +/- 7.1% (p < 0.05) in the shock atrial strips. Noradrenaline (1 x 10(-7)-10(-6)) on the other hand, did not produce any significant inotropic effect. Concomitant administration of noradrenaline (1 x 10(-6)M) and atropine (1.5 x 10(-5)M) produced positive inotropic effect which is not greater in magnitude compared with atropine (5 x 10(-7)M). This study suggests that Ca2+ and atropine may provide beneficial effects in endotoxin-induced shock state. It also confirms the involvement of myocardium in the pathogenesis of this condition.
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Affiliation(s)
- R B Ashorobi
- Department of Pharmacology, College of medicine, University of Lagos, Nigeria
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