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Aydın C, Demirkıran A, Aykaç H, Uslu N, Alpsoy Ş. Can the Glasgow prognostic score predict ischemic stroke in patients with infective endocarditis? Rev Assoc Med Bras (1992) 2024; 70:e20231299. [PMID: 38656008 DOI: 10.1590/1806-9282.20231299] [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] [Received: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The Glasgow prognosis score is a simple parameter calculated using serum levels of albumin and C-reactive protein. The aim of this study was to examine whether this parameter may predict ischemic stroke in patients with infective endocarditis. METHODS A total of 80 patients who were diagnosed with definitive infective endocarditis according to Duke criteria between 2016 and 2023 were included in the study. Glasgow prognosis score was based on serum levels of albumin and C-reactive protein. In imaging methods, patients were divided into two groups according to whether they had a stroke or not. These two groups were compared in terms of biochemical parameters, and infective endocarditis findings on echocardiography and Glasgow prognosis score. RESULTS We found that the results were statistically similar except for serum C-reactive protein (Group 1: 54.9±71.1 and Group 2: 39±70.7; p=0.03), neutrophil (Group 1: 19.8±10.8*109/L and Group 2: 13.3±7.3*109/L; p=0.014), albumin (Group 1: 2.3±0.6 and Group 2: 2.8±0.5; p=0.03), and Glasgow prognosis score (Group 1: median 2, min.-max. (1-2) and Group 2: median 1, min.-max. (0-1); p=0.004). In the receiver operating characteristics analysis, Glasgow prognosis score had 82.4% sensitivity and 58.3% specificity in predicting ischemic stroke if the Glasgow prognosis score cutoff was ≥1. In multivariate logistic regression analysis, chronic renal failure [odds ratio (OR): 1.098; 95% confidence interval: 1.054-1.964; p=0.044], age (OR: 1.050; 95%CI 1.006-1.096; p=0.024), and Glasgow prognosis score (OR: 0.695; 95%CI 0.411-0.949; p=0.035) were independent variables in predicting ischemic stroke. CONCLUSION High Glasgow prognosis score is an independent predictor of ischemic stroke in patients with infective endocarditis. Glasgow prognosis score, determined using albumin and C-reactive protein levels, is a simple and practical index for predicting the prognosis of patients hospitalized with infective endocarditis.
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Affiliation(s)
- Cihan Aydın
- Namık Kemal University, Faculty of Medicine, Department of Cardiology - Tekirdağ, Turkey
| | - Aykut Demirkıran
- Namık Kemal University, Faculty of Medicine, Department of Cardiology - Tekirdağ, Turkey
| | - Hüseyin Aykaç
- Namık Kemal University, Faculty of Medicine, Department of Cardiology - Tekirdağ, Turkey
| | - Nurullah Uslu
- Namık Kemal University, Faculty of Medicine, Department of Cardiology - Tekirdağ, Turkey
| | - Şeref Alpsoy
- Namık Kemal University, Faculty of Medicine, Department of Cardiology - Tekirdağ, Turkey
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Lin YW, Jiang M, Wei XB, Huang JL, Su Z, Wang Y, Chen JY, Yu DQ. Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study. BMC Cardiovasc Disord 2021; 21:279. [PMID: 34090346 PMCID: PMC8180106 DOI: 10.1186/s12872-021-02078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). METHODS 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. RESULTS In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03-1.19, P = 0.005). In addition, the Kaplan-Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05-1.18, P < 0.001). CONCLUSIONS D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.
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Affiliation(s)
- Ying-Wen Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, China
| | - Mei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xue-Biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Department of Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zedazhong Su
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yu Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Wei X, Fu B, Chen X, Chen W, Wang Z, Yu D, Jiang G, Chen J. U-Shaped Association Between Serum Uric Acid and Short-Term Mortality in Patients With Infective Endocarditis. Front Endocrinol (Lausanne) 2021; 12:750818. [PMID: 34795640 PMCID: PMC8593231 DOI: 10.3389/fendo.2021.750818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Increased uric acid (UA) levels have been reported to be associated with poor clinical outcomes in several conditions. However, the prognostic value of UA in patients with infective endocarditis (IE) is yet unknown. METHODS A total of 1,117 patients with IE were included and divided into two groups according to the current definition of hyperuricemia (UA>420 μmol/L in men and >360 μmol/L in women): hyperuricemia group (n=336) and normouricemia group (n=781). The association between the UA level and short-term outcomes were examined. RESULTS The in-hospital mortality was 6.2% (69/1117). Patients with hyperuricemia carried a higher risk of in-hospital death (9.8% vs. 4.6%, p=0.001). Hyperuricemia was not an independent risk factor for in-hospital death (adjusted odds ratio [aOR]=1.92, 95% confidence interval [CI]: 0.92-4.02, p=0.084). A U-shaped relationship was found between the UA level and in-hospital death (p<0.001). The in-hospital mortality was lower in patients with UA in the range 250-400 μmol/L. The aOR of in-hospital death in patients with UA>400 and <250 μmol/L was 3.48 (95% CI: 1.38-8.80, p=0.008) and 3.28 (95%CI: 1.27-8.51, p=0.015), respectively. Furthermore, UA>400 μmol/L (adjusted hazard ratio [aHR]=3.54, 95%CI: 1.77-7.07, p<0.001) and <250 μmol/L (aHR=2.23, 95%CI: 1.03-4.80, p=0.041) were independent risk factors for the 6-month mortality. CONCLUSION The previous definition of hyperuricemia was not suitable for risk assessment in patients with IE because of the U-shaped relationship between UA levels and in-hospital death. Low and high levels of UA were predictive of increased short-term mortality in IE patients.
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Affiliation(s)
- Xuebiao Wei
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bingqi Fu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaolan Chen
- Division of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - WeiTao Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhenqian Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Jiyan Chen, ; Danqing Yu, ; Guozhi Jiang,
| | - Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- *Correspondence: Jiyan Chen, ; Danqing Yu, ; Guozhi Jiang,
| | - Jiyan Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Jiyan Chen, ; Danqing Yu, ; Guozhi Jiang,
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Nishiguchi S, Nishino K, Kitagawa I, Tokuda Y. Factors associated with delayed diagnosis of infective endocarditis: A retrospective cohort study in a teaching hospital in Japan. Medicine (Baltimore) 2020; 99:e21418. [PMID: 32791760 PMCID: PMC7386977 DOI: 10.1097/md.0000000000021418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with infective endocarditis (IE), have high mortality and morbidity, however, its early diagnosis is difficult. Few studies have examined the delayed diagnosis of IE. We aimed to investigate the factors associated with the diagnostic delay of IE.A retrospective cohort study was conducted for consecutive patients diagnosed with IE in an acute care teaching hospital in Japan from April 2006 to March 2018. Time-to-diagnosis was analyzed using a multivariate Cox hazard model for determining factors associated with days required for IE diagnosis. Factors analyzed in the model included age, gender, activities of daily living, Charlson comorbidity index, presence of internal device, chief complaint, inappropriate antibiotics use, shaking chill, fever >38°C, hypoxemia, serum C-reactive protein (CRP) < 10 mg/dL, Staphylococcus aureus as causative pathogen, findings on first echocardiography, resident as a first contact physician, primary care physician as a first contact doctor, and transport measures to the clinic/hospital.There were 145 IE patients with a mean age of 70 years and 90 were male (62.1%). The median time to the diagnosis of definite IE was 13 days and median time to consider the diagnosis of IE from first clinic/hospital visit was 6 days. The time to consider IE diagnosis was significantly delayed in patients who had inappropriate prior antibiotic use (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.01 to 2.57; P = .045), in patients without fever >38°C (HR, 1.80; 95% CI, 1.11 to 2.90; P = .016), in patients with serum CRP level < 10 mg/dL (HR, 1.53; 95% CI, 1.01 to 2.33; P = .046), and in patients who did not use an ambulance for hospital arrival (HR, 3.18; 95% CI, 1.72 to 5.85; P < .001).Delay in considering IE diagnosis is associated with inappropriate prior antibiotics use, absence of high fever, absence of high CRP level, and use of a hospital arrival vehicle other than an ambulance. For earlier IE diagnosis, inappropriate use of antibiotics should be avoided and IE should not be excluded by relatively low level of temperature or serum CRP.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital
- Department of Internal Medicine, Hayama Heart Center
- Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Kanagawa
| | - Koichi Nishino
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo
| | | | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Japan
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Zhou Z, Ye J, Teng J, Liu H, Cheng X, Sun Y, Su Y, Chi H, Wang F, Yang C, Jin W. Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai. BMJ Open 2020; 10:e031512. [PMID: 32051300 PMCID: PMC7044959 DOI: 10.1136/bmjopen-2019-031512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to characterise rheumatic manifestations and autoantibodies in 432 patients diagnosed with infective endocarditis (IE) in Shanghai. DESIGN, SETTING AND PARTICIPANTS A retrospective study was conducted in Ruijin Hospital from 1997 to 2017. The clinical and laboratory characteristics of a total of 432 patients were analysed. In addition, the differences between patients with positive and negative antineutrophil cytoplasmic antibodies (ANCA) and antiphospholipid (aPL) antibodies as well as the survival rates of these patients were compared. RESULTS A total of 432 patients, including 278 male patients and 154 female patients, were included. The mean age of the patients was 46±16 years. A total of 346 patients (80%) had cardiac surgery, and 55 patients (13%) died in the hospital. Among the IE patients, 104 were tested for either ANCA or aPL and were analysed in different groups. Twenty-one (24%) positive ANCA patients were proteinase 3-ANCA positive. Compared with the ANCA-negative group, patients with positive ANCA had higher IgM (p=0.048), lower haemoglobin (p=0.001) and a higher likelihood of arthritis (p=0.003). Twenty-one (40%) aPL-positive patients had a higher erythrocyte sedimentation rate than was found in the aPL-negative group (p=0.003). In addition, the survival rate of the ANCA-positive IE patients was lower (p=0.032) than that of the ANCA-negative group, while there was no difference between patients with or without aPL antibodies (p=0.728). CONCLUSION This study supports the claim that rheumatic manifestations and autoantibodies are frequently present in patients with IE and might lead to early misdiagnosis. Physicians should pay more attention to the measurement of autoantibodies in these patients.
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Affiliation(s)
- Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chmielewski T, Kuśmierczyk M, Fiecek B, Roguska U, Lewandowska G, Parulski A, Cielecka-Kuszyk J, Tylewska-Wierzbanowska S. Tick-borne pathogens Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii and Rickettsia spp. may trigger endocarditis. ADV CLIN EXP MED 2019; 28:937-943. [PMID: 31374162 DOI: 10.17219/acem/94159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infections caused by tick-borne pathogens such as Bartonella spp., Borrelia burgdorferi s.l., Coxiella burnetii, and Rickettsia spp. are capable of causing serious lesions of the mitral and aortic valves, leading to a need for valve replacement. OBJECTIVES The aim of the study was to determine whether such cases are sporadic or frequent. An additional goal was to establish effective diagnostic methods to detect these infections. MATERIAL AND METHODS The study involved 148 patients undergoing valve replacement. Blood samples were drawn for serological testing. Samples of the removed mitral and aortic valves were tested with polymerase chain reaction and immunohistochemical staining. RESULTS Specific antibodies to Bartonella spp. were detected in 47 patients (31.7%) and in 1 of the healthy controls (1%) (p < 0.05). Antibodies to B. burgdorferi spirochetes were found in 18 of the patients (12.2%) and in 6 blood donors from the control group (5.8%) (p < 0.1). Antibodies to Rickettsia spp. were detected in 12 (8.1%) and to C. burnetii phase I and II antigens in the serum of 1 patient. All the participants in the control group were seronegative to C. burnetii and Rickettsia spp. antigens. Polymerase chain reaction (PCR) tests for detection of Bartonella spp., B. burgdorferi s.l., C. burnetii and Rickettsia spp. DNA in the valve samples were all negative. Inflammation foci with mononuclear lymphoid cells in the aortic and mitral valves were seen in sections stained with hematoxiline and eozine. In sections dyed using the indirect immunofluorescence method with hyperimmune sera, Bartonella spp. and Rickettsia spp. were found. CONCLUSIONS The results obtained indicate that laboratory diagnostics for patients with heart disorders should be expanded to include tests detecting tick-borne zoonoses such as bartonelloses, Lyme borreliosis, rickettsioses and Q fever.
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Affiliation(s)
- Tomasz Chmielewski
- Laboratory of Rickettsiae, Chlamydiae and Spirichetes, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
| | - Mariusz Kuśmierczyk
- Department of Surgery and Transplantology of the National Institute of Cardiology, Warszawa, Poland
| | - Beata Fiecek
- Laboratory of Rickettsiae, Chlamydiae and Spirichetes, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
| | - Urszula Roguska
- Laboratory of Rickettsiae, Chlamydiae and Spirichetes, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
| | - Grażyna Lewandowska
- Laboratory of Rickettsiae, Chlamydiae and Spirichetes, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
| | - Adam Parulski
- Department of Surgery and Transplantology of the National Institute of Cardiology, Warszawa, Poland
| | - Joanna Cielecka-Kuszyk
- Department of Virology, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
| | - Stanisława Tylewska-Wierzbanowska
- Laboratory of Rickettsiae, Chlamydiae and Spirichetes, National Institute of Public Health - National Institute of Hygiene, Warszawa, Poland
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Małecka BA, Ząbek A, Dębski M, Szot W, Holcman K, Boczar K, Ulman M, Lelakowski J, Kostkiewicz M. The usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing lead-dependent infective endocarditis. ADV CLIN EXP MED 2019; 28:113-119. [PMID: 30411545 DOI: 10.17219/acem/92315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lead-dependent infective endocarditis (LDIE) is a life-threatening complication of permanent transvenous cardiac pacing. According to the 2015 European Society of Cardiology (ECS) guidelines, the diagnosis of LDIE is based on the modified Duke criteria (MDC), while single-photon emission computed tomography with conventional computed tomography (SPECT-CT) with radioisotope-labeled leukocytes serves as an additional tool in difficult cases. The major challenge is to differentiate between true vegetation and a thrombus. OBJECTIVES The aim of the study was to evaluate the usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing LDIE in patients with intracardiac masses (ICMs). MATERIAL AND METHODS The prospective registry included 40 consecutive patients admitted with an ICM on the lead and suspicion of LDIE. The confirmation or rejection of the LDIE diagnosis was made according to an algorithm based on the MDC. The cohort was divided into 2 groups: patients with definite and possible LDIE diagnoses based on the MDC (the LDIE-positive group), and patients with negative LDIE diagnoses according to the MDC (the LDIE-negative group). All patients underwent SPECT-CT with radioisotope-labeled leukocytes. The diagnostic ability of SPECT-CT was compared to the gold standard MDC. RESULTS The LDIE-positive group with diagnosis based on the MDC consisted of 19 patients (LDIE definite - 11; LDIE possible - 8). The LDIE diagnosis was rejected on the basis of the MDC in 21 patients. The SPECT-CT results were compared with the MDC results and showed 73.7% sensitivity, 81.0% specificity, 77.5% accuracy, 77.8% positive predictive value (PPV), 77.3% negative predictive value (NPV), likelihood ratio positive (LR+) 3.868, likelihood ratio negative (LR-) 0.325, and moderate agreement (κ = 0.548, p < 0.001). After the exclusion of 5 patients treated with antibiotics at the time of the SPECT-CT, LR+ and LRimproved to 5.250 and 0, respectively, and inter-test agreement amounted to almost perfect concordance (κ = 0.773, p < 0.001). CONCLUSIONS Single-photon emission computed tomography with conventional CT with radioisotopelabeled leukocytes is a useful, efficient, single-step test for diagnosing LDIE.
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Affiliation(s)
- Barbara A Małecka
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
| | - Maciej Dębski
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
| | - Wojciech Szot
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
- Nuclear Medicine Department, John Paul II Hospital, Kraków, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
| | - Mateusz Ulman
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Kostkiewicz
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland
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Erba PA, Lancellotti P, Vilacosta I, Gaemperli O, Rouzet F, Hacker M, Signore A, Slart RHJA, Habib G. Recommendations on nuclear and multimodality imaging in IE and CIED infections. Eur J Nucl Med Mol Imaging 2018; 45:1795-1815. [PMID: 29799067 DOI: 10.1007/s00259-018-4025-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/18/2022]
Abstract
In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [18F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [18F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when interpreting images, and the most important results from the literature, and also provide recommendations on the appropriate use of multimodality imaging.
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Affiliation(s)
- Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, GIGA-Cardiovascular Sciences, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Isidre Vilacosta
- Department of Cardiology, Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain
| | - Oliver Gaemperli
- Interventional Cardiology and Cardiac Imaging, University Heart Center Zurich, Zurich, Switzerland
| | - Francois Rouzet
- Department of Nuclear Medicine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Inserm, UMR-S 1148, Paris, France
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, AKH, Vienna, Austria
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Gilbert Habib
- Aix-Marseille University, URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095- IHU - Méditerranée Infection, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
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9
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Wei XB, Chen XJ, Li YL, Huang JL, Chen XL, Yu DQ, Tan N, Liu YH, Chen JY, He PC. Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis. J Clin Lipidol 2017; 12:498-505. [PMID: 29339066 DOI: 10.1016/j.jacl.2017.12.005] [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] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE). OBJECTIVE The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients. METHODS Patients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes. RESULTS Of the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; P = .006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; P < .001). ApoA-I (area under the curve, 0.671; P < .001) and HDL-C (area under the curve, 0.672; P < .001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I <0.90 g/L and HDL-C <0.78 mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1 g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P = .023) and HDL-C (increments of 1 mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P = .015) were independently associated with long-term mortality. CONCLUSIONS ApoA-I and HDL-C were inversely associated with adverse IE prognosis.
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Affiliation(s)
- Xue-Biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Xiao-Jin Chen
- Department of Internal Medicine, Longnan Medicine Hospital, Ganzhou, China
| | - Yuan-Ling Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Xiao-Lan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China; Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan, China.
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10
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Slim J, Saling C, Szabela M, Brown M, Johnson T, Goldfarb I. (1→3)-β-D-Glucan Assay in Monitoring Response to Anti-Fungal Therapy in Fungal Endocarditis. J Heart Valve Dis 2017; 26:208-210. [PMID: 28820552] [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: 06/07/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY A case is reported of Candida glabrata infective endocarditis (IE) treated without surgical intervention. The study aim was to: (i) briefly discuss the outcomes of other documented cases of fungal IE managed medically with fluconazole; (ii) discuss the (1→3)-β-D-glucan assay and its previously studied role in the diagnosis of invasive fungal infections; and (iii) examine a possible application of the (1→3)-β-D-glucan assay to monitor response to antifungal treatment in patients with Candida endocarditis. METHODS The serum Fungitell assay was used to trend (1→3)-β-D-glucan in a patient with Candida endocarditis to determine treatment effectiveness with fluconazole, to provide an appropriate end date for antifungal therapy, and to survey infection suppression while off treatment. RESULTS The (1→03)-β-D-glucan assay began trending downwards at 197 days into treatment with oral fluconazole. After 16 months of therapy, fluconazole was stopped due to transaminitis. (1→3)-β-Dglucan levels were checked six weeks after the discontinuation of treatment and were negative. The patient has now been off therapy for 21 weeks with no signs of clinical disease, and values remain negative. CONCLUSIONS The present case indicates that a trending (1→3)-β-D-glucan assay may have valuable application in monitoring treatment response and infection suppression for Candida endocarditis.
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Affiliation(s)
- Jihad Slim
- Department of Infectious Disease, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Christopher Saling
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA. Electronic correspondence:
| | - Maria Szabela
- Department of Infectious Disease, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Melinda Brown
- Department of Infectious Disease, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Tamara Johnson
- Department of Infectious Disease, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Irvin Goldfarb
- Department of Cardiology, Saint Michael's Medical Center, Newark, NY, USA
- New York Medical College, Valhalla, NY, USA
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11
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Kaziród-Wolski K, Sielski J, Ciuraszkiewicz K. [Infective endocarditis in intensive cardiac care unit - clinical and biochemical differences of blood-culture negative infective endocarditis]. Pol Merkur Lekarski 2017; 42:21-25. [PMID: 28134227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Diagnosis and treatment of infective endocarditis (IE) is still a challenge for physicians. Group of patients with the worst prognosis is treated in Intensive Cardiac Care Unit (ICCU). Etiologic agent can not be identified in a substantial number of patients. AIM The aim of study is to find differences between patients with blood culture negative infective endocarditis (BCNIE) and blood culture positive infective endocarditis (BCPIE) treated in ICCU by comparing their clinical course and laboratory parameters. MATERIALS AND METHODS Retrospective analysis of 30 patients with IE hospitalized in ICCU Swietokrzyskie Cardiac Centre between 2010 and 2016. This group consist of 26 men (86,67%) and 4 women (13,3%). Mean age was 58 years ±13. Most of the cases were new disease, recurrence of the disease was observed in 2 cases (6,7%). 8 patients (26,7%) required artificial ventilation, 11 (36,7%) received inotropes and 6 (20%) vasopresors. In 14 (46,7%) cases blood cultures was negative (BCNIE), the rest of patients (16, 53,3%) was blood cultures - positive infective endocarditis (BCIE). RESULTS Both of the groups were clinically similar. There were no statistically significant differences in incidence of cardiac implants, localization of bacterial vegetations, administered catecholamines, antibiotic therapy, artificial ventilation, surgical treatment, complication and in-hospital mortality. Incidence of cardiac complications in all of BCNIE cases and in 81,3% cases of BCPIE draws attention, but it is not statistically significant difference (p=0,08). There was statistically significant difference in mean BNP blood concentration (3005,17 ng/ml ±2045,2 vs 1013,42 ng/ml ±1087,6; p=0,01), but there were no statistically significant differences in rest of laboratory parameters. CONCLUSIONS BCNIE group has got higher mean BNP blood concentration than BCPIE group. There were no statistically significant differences between these groups in others laboratory parameters, clinical course and administered antibiotic therapy. In our endemic region major cause of BCNIE seems to be early antibiotic therapy prior to collection of blood samples, but further studies are necessary.
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Affiliation(s)
| | - Janusz Sielski
- Intensive Cardiac Care Unit, Swietokrzyskie Cardiac Centre in Kielce, Poland; The Jan Kochanowski University, Kielce, Poland
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12
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Iossa D, Molaro R, Andini R, Parrella A, Ursi MP, Mattucci I, De Vincentiis L, Dialetto G, Utili R, Durante-Mangoni E. Clinical significance of hyperhomocysteinemia in infective endocarditis: A case-control study. Medicine (Baltimore) 2016; 95:e4972. [PMID: 27684846 PMCID: PMC5265939 DOI: 10.1097/md.0000000000004972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Blood coagulation plays a key role in the pathogenesis of infective endocarditis (IE). Conditions associated with thrombophilia could enhance IE vegetation formation and promote embolic complications.In this study, we assessed prevalence, correlates, and clinical consequences of hyper-homocysteinemia (h-Hcy) in IE.Homocysteine (Hcy) plasma levels were studied in 246 IE patients and 258 valvular heart disease (VHD) patients, as well as in 106 healthy controls.IE patients showed Hcy levels comparable to VHD patients (14.9 [3-81] vs 16 [5-50] μmol/L, respectively; P = 0.08). H-Hcy was observed in 48.8% of IE patients and 55.8% of VHD (P = 0.13). Vegetation size and major embolic complications were not related to Hcy levels. IE patients with h-Hcy had a higher prevalence of chronic kidney disease and a higher 1-year mortality (19.6% vs 9.9% in those without h-Hcy; OR 2.21 [1.00-4.89], P = 0.05). However, at logistic regression analysis, h-Hcy was not an independent predictor of 1-year mortality (OR 1.87 [95% CI 0.8-4.2]; P = 0.13).Our data suggest h-Hcy in IE is common, is related to a worse renal function, and may be a marker of cardiac dysfunction rather than infection. H-Hcy does not appear to favor IE vegetation formation or its symptomatic embolic complications.
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Affiliation(s)
- Domenico Iossa
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | - Rosa Molaro
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | - Roberto Andini
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | - Antonio Parrella
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | - Maria Paola Ursi
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | - Irene Mattucci
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
| | | | - Giovanni Dialetto
- Unit of Cardiac Surgery A.O.R.N. dei Colli – Ospedale Monaldi, Napoli, Italy
| | - Riccardo Utili
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
- Unit of Infectious & Transplant Medicine
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N
- Unit of Infectious & Transplant Medicine
- Correspondence: Emanuele Durante-Mangoni, Ospedale Monaldi, Piazzale Ettore Ruggieri, Napoli, Italy (e-mail: )
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13
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Fedorova TA, Tazina SY, Kaktursky LV, Kanareitseva TD, Stefanenko NI, Burtsev VI, Semenenko NA. [INFLAMMATION AND CARDIAC INSUFFICIENCY ASSOCIATED WITH INFECTIOUS ENDOCARDITIS]. Klin Med (Mosk) 2016; 94:23-27. [PMID: 27172717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.PBotkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measurements of the levels of C-reactive protein, tumour necrosis factor and highly sensitive troponin-1 for the evaluation of activity of the infectious/toxic process, severity of the disease, and detection of complications. The study revealed the relationship of the enhanced level of troponin-1 with changes of inflammation markers, morphofunctional characteristics of myocardium, and circulatory failure. Morphologicl study demonstrated inflammatory and dystrophic changes in myocardium, focal and diffuse cardiofibrosis suggesting development of non-coronarogenic myocardial lesions that play an important role in the progress of cardiac failure associated with infectious endocarditis.
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14
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Langlois V, Lesourd A, Girszyn N, Ménard JF, Levesque H, Caron F, Marie I. Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis. Medicine (Baltimore) 2016; 95:e2564. [PMID: 26817911 PMCID: PMC4998285 DOI: 10.1097/md.0000000000002564] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/17/2015] [Accepted: 12/28/2015] [Indexed: 12/23/2022] Open
Abstract
To determine the prevalence of antineutrophil cytoplasmic antibodies (ANCA) in patients with infective endocarditis (IE) in internal medicine; and to compare clinical and biochemical features and outcome between patients exhibiting IE with and without ANCA.Fifty consecutive patients with IE underwent ANCA testing. The medical records of these patients were reviewed.Of the 50 patients with IE, 12 exhibited ANCA (24%). ANCA-positive patients with IE exhibited: longer duration between the onset of first symptoms and IE diagnosis (P = 0.02); and more frequently: weight loss (P = 0.017) and renal impairment (P = 0.08), lower levels of C-reactive protein (P = 0.0009) and serum albumin (P = 0.0032), involvement of both aortic and mitral valves (P = 0.009), and longer hospital stay (P = 0.016). Under multivariate analysis, significant factors for ANCA-associated IE were: longer hospital stay (P = 0.004), lower level of serum albumin (P = 0.02), and multiple valve involvement (P = 0.04). Mortality rate was 25% in ANCA patients; death was because of IE complications in all these patients.Our study identifies a high prevalence of ANCA in unselected patients with IE in internal medicine (24%). Our findings further underscore that ANCA may be associated with a subacute form of IE leading to multiple valve involvement and more frequent renal impairment. Because death was due to IE complications in all patients, our data suggest that aggressive therapy may be required to improve such patients' outcome.
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Affiliation(s)
- Vincent Langlois
- From the Department of Internal Medicine, Institute for Biochemical Research, IFRMP, University of Rouen (VL, AL, NG, HL, IM); Department of Infectious diseases (FC); and Department of Biostatistics (J-F M), CHU Rouen, France
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15
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Araújo IR, Ferrari TCA, Teixeira-Carvalho A, Campi-Azevedo AC, Rodrigues LV, Guimarães Júnior MH, Barros TLS, Gelape CL, Sousa GR, Nunes MCP. Cytokine Signature in Infective Endocarditis. PLoS One 2015. [PMID: 26225421 PMCID: PMC4520569 DOI: 10.1371/journal.pone.0133631] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Infective endocarditis (IE) is a severe disease with high mortality rate. Cytokines participate in its pathogenesis and may contribute to early diagnosis improving the outcome. This study aimed to evaluate the cytokine profile in IE. Serum concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12 and tumor necrosis factor (TNF)-α were measured by cytometric bead array (CBA) at diagnosis in 81 IE patients, and compared with 34 healthy subjects and 30 patients with non-IE infections, matched to the IE patients by age and gender. Mean age of the IE patients was 47±17 years (range, 15–80 years), and 40 (50%) were male. The IE patients had significantly higher serum concentrations of IL-1β, IL-6, IL-8, IL-10 and TNF-α as compared to the healthy individuals. The median levels of IL-1β, TNF-α and IL-12 were higher in the IE than in the non-IE infections group. TNF-α and IL-12 levels were higher in staphylococcal IE than in the non-staphylococcal IE subgroup. There was a higher proportion of both low IL-10 producers and high producers of IL-1β, TNF-α and IL-12 in the staphylococcal IE than in the non-staphylococcal IE subgroup. This study reinforces a relationship between the expression of proinflammatory cytokines, especially IL-1β, IL-12 and TNF-α, and the pathogenesis of IE. A lower production of IL-10 and impairment in cytokine network may reflect the severity of IE and may be useful for risk stratification.
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Affiliation(s)
- Izabella Rodrigues Araújo
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Teresa Cristina Abreu Ferrari
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andréa Teixeira-Carvalho
- Fundação Oswaldo Cruz, Centro de Pesquisas René Rachou, Laboratório de Biomarcadores de Diagnóstico e Monitoração, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Carolina Campi-Azevedo
- Fundação Oswaldo Cruz, Centro de Pesquisas René Rachou, Laboratório de Biomarcadores de Diagnóstico e Monitoração, Belo Horizonte, Minas Gerais, Brazil
| | - Luan Vieira Rodrigues
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milton Henriques Guimarães Júnior
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thais Lins Souza Barros
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cláudio Léo Gelape
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giovane Rodrigo Sousa
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Carmo Pereira Nunes
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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16
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Ferrera C, Vilacosta I, Fernández C, López J, Sarriá C, Olmos C, Vivas D, Sáez C, Sánchez-Enrique C, Ortiz C, San Román JA. Usefulness of thrombocytopenia at admission as a prognostic marker in native valve left-sided infective endocarditis. Am J Cardiol 2015; 115:950-5. [PMID: 25708863 DOI: 10.1016/j.amjcard.2015.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Received: 10/22/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 11/18/2022]
Abstract
In-hospital mortality of patients with infective endocarditis (IE) remains exceedingly high. Quick recognition of parameters accurately identifying high-risk patients is of paramount importance. The objective of this study was to analyze the incidence and severity of thrombocytopenia at presentation and its prognostic impact in patients with native valve left-sided IE. We studied a cohort of 533 consecutive episodes of native valve left-sided IE prospectively recruited. We distinguished 2 groups: group I (n = 175), episodes who had thrombocytopenia at admission, and group II (n = 358) gathered all the episodes who did not. Thrombocytopenia at admission was defined as a platelet count of <150,000/μl. No differences were found in the need for surgery, but in-hospital mortality was significantly higher in patients with thrombocytopenia (p <0.001). Mortality rate was associated with the degree of thrombocytopenia (p <0.001). In the multivariable analysis, thrombocytopenia at admission was an independent predictor of higher mortality (p = 0.002). A synergistic interaction between thrombocytopenia and Staphylococcus aureus on mortality risk was also observed (p = 0.04). In conclusion, thrombocytopenia at admission is an early risk marker of increased mortality in patients with native valve left-sided IE. Mortality rates increased with increasing severity of thrombocytopenia. Thrombocytopenia at admission should be used as an early marker for risk stratification in patients with native valve IE to identify those at risk of complicated in-hospital evolution and increased mortality.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Carlos Ortiz
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain
| | - José Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain
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Canpolat U, Turak O, Özcan F, Özeke Ö, Aras D. Clinical outcomes and inflammatory markers should be kept in mind when assessing the mean platelet volume in patients with infective endocarditis. Med Princ Pract 2014; 23:391-2. [PMID: 24504258 PMCID: PMC5586890 DOI: 10.1159/000358252] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Uğur Canpolat
- *Uğur Canpolat, Cardiology Clinic, Türkiye Yüksek Ýhtisas Training and Research Hospital, TR-06100 Sýhhiye, Ankara (Turkey), E-Mail
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Balta S, Demirkol S, Unlu M, Kucuk U, Arslan Z. Current opinion: mean platelet volume is one of the most important parameters at the first glance. Med Princ Pract 2014; 23:189-90. [PMID: 23988523 PMCID: PMC5586841 DOI: 10.1159/000354738] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/11/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sevket Balta
- *Dr. Sevket Balta, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., TR-06018 Etlik-Ankara (Turkey), E-Mail
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Affiliation(s)
- Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
| | - Christiane Oddoze
- Clinical Laboratory, Laboratoire de Biochimie Endocrinienne, CHU Timone, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Université de la Méditerranée, Faculté de Médecine, Marseille, France
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Tilley DO, Arman M, Smolenski A, Cox D, O'Donnell JS, Douglas CWI, Watson SP, Kerrigan SW. Glycoprotein Ibα and FcγRIIa play key roles in platelet activation by the colonizing bacterium, Streptococcus oralis. J Thromb Haemost 2013; 11:941-50. [PMID: 23413961 DOI: 10.1111/jth.12175] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/11/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by thrombus formation on a cardiac valve. The oral bacterium, Streptococcus oralis, is recognized for its ability to colonize damaged heart valves and is frequently isolated from patients with IE. Platelet interaction with S. oralis leads to the development of a thrombotic vegetation on heart valves, which results in valvular incompetence and congestive heart failure. OBJECTIVE To investigate the mechanism through which platelets become activated upon binding S. oralis. PATIENTS AND METHODS Platelet interactions with immobilized bacteria under shear conditions were assessed using a parallel flow chamber. S. oralis-inducible platelet reactivity was determined using light transmission aggregometry. Dense granule secretion was measured by luminometry using a luciferin/luciferase assay. RESULTS Using shear rates that mimic physiological conditions, we demonstrated that S. oralis was able to support platelet adhesion under venous (50-200 s(-1) ) and arterial shear conditions (800 s(-1) ). Platelets rolled along immobilized S. oralis through an interaction with GPIbα. Following rolling, platelet microaggregate formation was observed on immobilized S. oralis. Aggregate formation was dependent on S. oralis binding IgG, which cross-links to platelet FcγRIIa. This interaction led to phosphorylation of the ITAM domain on FcγRIIa, resulting in dense granule secretion, amplification through the ADP receptor and activation of RAP1, culminating in platelet microaggregate formation. CONCLUSIONS These results suggest a model of interaction between S. oralis and platelets that leads to the formation of a stable septic vegetation on damaged heart valves.
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Affiliation(s)
- D O Tilley
- Cardiovascular Infection Group, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Icli A, Tayyar S, Varol E, Aksoy F, Arslan A, Ersoy I, Akcay S. Mean platelet volume is increased in infective endocarditis and decreases after treatment. Med Princ Pract 2013; 22:270-3. [PMID: 23221003 PMCID: PMC5586739 DOI: 10.1159/000345393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 10/24/2012] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with infective endocarditis. SUBJECTS AND METHODS Twenty-nine patients with infective endocarditis and 29 healthy subjects were studied. Plasma MPV values in patients and control subjects were measured on admission and after 2 weeks of specific treatment of infective endocarditis. RESULTS The MPV was significantly higher among patients with infective endocarditis when compared with the control group (9.86 ± 1.1 vs. 8.0 ± 1.0 fl, respectively; p < 0.01). The MPV values of patients with infective endocarditis decreased significantly after treatment from 9.86 ± 1.1 to 7.86 ± 1.0 fl (p < 0.01). Total platelet counts increased significantly after treatment from 193.4 ± 96.5 × 10(9) to 243.7 ± 92.4 × 10(9) (p = 0.04). CONCLUSION MPV values were higher in patients with infective endocarditis and decreased significantly after treatment. Elevated MPV values indicate that patients with infective endocarditis have increased platelet activation and infective endocarditis treatment decreases this platelet activation by decreasing MPV.
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Affiliation(s)
- Atilla Icli
- Department of Cardiology, Ahi Evran University Education and Research Hospital, Kirsehir, Turkey
| | - Senol Tayyar
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ercan Varol
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Fatih Aksoy
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
- *Fatih Aksoy, Suleyman Demirel Univesitesi Tıp Fakultesi, Cardiology Department, TR-32200 Isparta (Turkey), E-Mail
| | - Akif Arslan
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ibrahim Ersoy
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Selahaddin Akcay
- Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Hanf W, Serre JE, Salmon JH, Fabien N, Ginon I, Dijoud F, Trolliet P. Glomérulonéphrite rapidement progressive à ANCA révélant une endocardite infectieuse subaiguë. Rev Med Interne 2011; 32:e116-8. [PMID: 21277658 DOI: 10.1016/j.revmed.2010.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/19/2022]
Affiliation(s)
- W Hanf
- Service de néphrologie-dialyse et transplantation, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, Pierre-Bénite cedex, France.
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Durante-Mangoni E, Iossa D, Nappi F, Utili R. Inherited hyper-homocysteinemia as a cause of nonbacterial thrombotic endocarditis. J Heart Valve Dis 2011; 20:232-233. [PMID: 21560828] [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: 05/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Despite high rates of valve disease, non-bacterial thrombotic endocarditis remains an uncommon condition, the individual susceptibility to which might be influenced by an inherited thrombophilic state. METHODS A comprehensive hemostasis study was conducted in a 17-year-old patient with definite nonbacterial thrombotic endocarditis, including a genetic screening for all major inherited thrombophilias. RESULTS Non-bacterial thrombotic endocarditis was detected on a bicuspid aortic valve. A hemostasis work-up showed that the patient had severe hyperhomocysteinemia, and was homozygous for the C677T mutation of the methylenetetrahydrofolate reductase gene. CONCLUSION Based on the present clinical case, a novel hypothesis was proposed that the pathophysiology of non-bacterial thrombotic endocarditis might be affected by a genetic predisposition, such as an inherited thrombophilic state.
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Affiliation(s)
- Emanuele Durante-Mangoni
- Department of Cardiothoracic Sciences, University of Naples S.U.N. and Unit of Infectious and Transplant Medicine, A.O.R.N. 'V. Monaldi', Naples, Italy.
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Knudsen JB, Fuursted K, Petersen E, Wierup P, Mølgaard H, Poulsen SH, Egeblad H. Procalcitonin in 759 patients clinically suspected of infective endocarditis. Am J Med 2010; 123:1121-7. [PMID: 20870199 DOI: 10.1016/j.amjmed.2010.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND diagnostic delay contributes to high morbidity and mortality in infective endocarditis. A readily available diagnostic marker of infective endocarditis is desirable. S-procalcitonin has been proposed as a candidate, but data on its yield are conflicting. We tested its diagnostic value in a large population of patients seen in a tertiary center. METHODS this prospective study included 759 consecutive patients referred for echocardiographic examination on clinical suspicion of infective endocarditis. Transthoracic echocardiography was followed by immediate transesophageal examination, and a blood sample was obtained for procalcitonin analysis. Infective endocarditis was diagnosed by an interdisciplinary team and confirmed according to the Duke criteria. The team was unaware of the results of procalcitonin analyses. RESULTS infective endocarditis was present in 147 patients (19%). Procalcitonin was higher in these patients than in those in whom infective endocarditis was rejected (median, 0.21 ng/mL vs. 0.13 ng/mL; P <.0005). Multivariate analysis identified significant independent determinants of high procalcitonin: blood culture with endocarditis-typical microorganisms (odds ratio [OR], 2.81), temperature ≥ 38°C (OR, 2.61), symptoms ≤ 5 days (OR, 2.39), immunocompromised status (OR, 1.74), and male gender (OR, 1.61). Tests at various procalcitonin thresholds yielded an acceptable sensitivity of 95% at 0.04 ng/mL, but specificity was only 14%. Only 12% had procalcitonin below this threshold, which might justify postponement of further examinations for infective endocarditis. CONCLUSIONS procalcitonin was significantly higher in patients with infective endocarditis than in patients without infective endocarditis and bacteremia with endocarditis-typical organisms was the strongest independent determinant of high procalcitonin. The clinical importance of this is questionable, because a suitable procalcitonin threshold for diagnosing or excluding infective endocarditis was not established.
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Affiliation(s)
- Jane B Knudsen
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Shiue AB, Stancoven AB, Purcell JB, Pinkston K, Wang A, Khera A, de Lemos JA, Peterson GE. Relation of level of B-type natriuretic peptide with outcomes in patients with infective endocarditis. Am J Cardiol 2010; 106:1011-5. [PMID: 20854966 DOI: 10.1016/j.amjcard.2010.05.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 11/29/2022]
Abstract
Elevated B-type natriuretic peptide (BNP) is a marker of poor outcomes in heart failure, acute coronary syndromes, and sepsis. Elevated cardiac troponin I (cTnI) is associated with adverse outcomes in infective endocarditis. It was hypothesized that elevated BNP would be associated with increased rates of morbidity and mortality in patients with infective endocarditis, particularly when combined with elevated cTnI. Consecutively enrolled patients in the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) were evaluated at a single center. The association between elevated BNP and a composite outcome of death, intracardiac abscess, and central nervous system event and the individual components of the composite was determined. Similar analyses were performed in patients who had BNP and cTnI measured. Of 103 patients, 45 had BNP measured for clinical indications. The median BNP level was higher in patients with the composite outcome (1,498 vs 433 pg/ml, p = 0.03) and in those who died (2,150 vs 628 pg/ml, p = 0.04). Elevated BNP was significantly associated with the composite outcome (p <0.01) and intracardiac abscess (p = 0.02). Patients with elevation of BNP and cTnI had a significantly higher probability of the composite outcome (69%) than patients with either BNP or cTnI elevated (29%) or neither BNP nor troponin elevated (0%) (p for trend <0.01). In conclusion, these data demonstrate a significant association between elevated BNP alone and in combination with cTnI for serious outcomes in infective endocarditis and warrant prospective evaluation.
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Affiliation(s)
- Angela B Shiue
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Yasumura R, Kobayashi Y, Aoyama Y, Takayama W, Takao R, Yoshikawa T. [Hybrisep, a new method for the diagnosis of blood culture-negative infective endocarditis: a case report]. Masui 2010; 59:491-494. [PMID: 20420142] [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: 05/29/2023]
Abstract
Blood cultures were considered as the gold standard for the diagnosis of infective endocarditis (IE) but were frequently negative. This report describes an IE patient who successfully underwent aortic valve replacement; it discusses a new diagnostic method of blood culture-negative IE. Recently, Hybrisep (FUSO Pharmaceutical Industries, Japan), a rapid diagnostic method for bacteremia was developed using in situ hybridization, which is superior in sensitivity to conventional blood cultures. In this case, echocardiography confirmed severe aortic regurgitation and aortic valve vegetations, while serial blood cultures could not reveal any pathogenic organisms. A preoperative serum sample was found to be positive for Enterococcus faecalis by Hybrisep. Gram stain examination of the excised valves showed gram-positive cocci and therefore correlated with the finding by Hybrisep. After surgery, the patient was successfully treated with appropriate antibiotics according to these results. In summary, Hybrisep will have a promising positive impact on IE patient care.
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Affiliation(s)
- Rie Yasumura
- Department of Anesthesia, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902
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Tanaka H, Ito M, Yoshida K, Asakura T, Taniguchi H. Nonbacterial thrombotic endocarditis complicated with stage Ia ovarian cancer. Int J Clin Oncol 2009; 14:369-71. [PMID: 19705251 DOI: 10.1007/s10147-008-0852-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
Abstract
Nonbacterial thrombotic endocarditis (NBTE) commonly occurs in advanced malignancies associated with a cancer-related hypercoagulable state, but the prevalence of NBTE in patients with less advanced malignancies is unknown. A 46-year-old woman had multiple thromboembolic events and disseminated intravascular coagulation on admission. Transthoracic echocardiography showed several growths on the mitral valve. Pelvic magnetic resonance imaging revealed a rapidly enlarging large tumor. In spite of anticoagulation therapy, she died 1.5 months after admission. At autopsy, NBTE with stage Ia ovarian cancer was diagnosed. In cases of higher-growth rate tumors with abundant necrosis, NBTE may occur in early-stage (even in stage Ia) ovarian cancer. In the majority of stage Ia ovarian cancers, curative surgical resection can be done. Prognostic improvement may be gained by such positive intervention, although this depends on the patient's general condition when NBTE occurs. With tumor resection, there is a possibility that the patient will recover from the hypercoagulable state and a poor outcome will be avoided.
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Affiliation(s)
- Hirohiko Tanaka
- Department of Obstetrics and Gynecology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie, Japan.
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28
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Selivanenko VT, Shatokhina SN, Dudakov VA, Martakov MA. [Morphological changes in blood plasma of patients with infectious endocarditis]. Vestn Ross Akad Med Nauk 2009:37-41. [PMID: 19253689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of the study was to examine the morphological picture of sera obtained from 34 patients with infectious endocarditis (IE) pre-, intra- and postoperatively after their cuneiform dehydration. The method allowed integral homeostasis to be assessed including detection of markers of various pathological processes (onset of generalization of Candida infection and development of polyorgan dysfunction). Results of surgical treatment of IE for the period of 2002-2007 are presented.
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Kraśnicka-Sokół B, Kochmański M, Filczak K. [Prognostic useful of the new risk index for infective endocarditis]. Pol Merkur Lekarski 2008; 24:484-486. [PMID: 18702326] [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: 05/26/2023]
Abstract
UNLABELLED The aim of study was the separation of the group of patients with the high risk of death based on the risk index (I(R)) calculated with use of C-reactive protein and hemoglobin concentrations measured on the admission. MATERIAL AND METHODS The initial group consisted 41 patients (16 women and 25 men) hospitalized between 1999 and 2005 with the recognition of the infective endocarditis based on the Duke University criteria. The IR was calculated according to the formula: I(R) = [(CRP[mg/l])/(Hgb[g/dl]-beta)] x 10, and the coefficient beta = 6 g/dl. RESULTS The I(R) was significantly higher among deceased patients than among patients with good early prognosis (376,6 vs 79,9; p < 0,001). The risk index exceeding 100 is strongly associated with high death risk among patients with infective endocarditis. CONCLUSION This index may also be very useful in reaching the diagnosis and the efficacy prognosing of treatment.
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Affiliation(s)
- Beata Kraśnicka-Sokół
- Centralny Szpital Kliniczny Ministerstwa Spraw Wewnetrznych i Administracji w Warszawie, Klinika Kardiologii Zachowawczej.
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Kahveci G, Bayrak F, Mutlu B, Gurel YE, Karaahmet T, Tigen K, Basaran Y. Clinical significance of high-density lipoprotein cholesterol in left-sided infective endocarditis. Am J Cardiol 2008; 101:1170-3. [PMID: 18394453 DOI: 10.1016/j.amjcard.2007.11.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/18/2022]
Abstract
Decreased serum levels of high-density lipoprotein (HDL) cholesterol have been shown to be of prognostic significance in patients with severe infectious diseases. Serum HDL cholesterol levels were therefore investigated as a possible parameter for the prediction of clinical outcomes in patients with left-sided infective endocarditis (IE). Fifty-four patients with IE with available admission serum HDL cholesterol levels were included in the study. A clinical outcome was defined as a complicated course during hospitalization. Forty-two patients had complicated courses during their in-hospital stays. The median serum HDL cholesterol level was significantly lower in patients with IE (n = 54) than healthy controls (n = 26) (26 vs 47 mg/dl, p <0.0001). In the 42 patients with complicated courses, the median serum HDL cholesterol level was lower compared with that in 12 patients with uneventful courses (24 vs 36 mg/dl, p = 0.011). A cut point of serum HDL cholesterol level of 25 mg/dl had sensitivity of 62%, specificity of 75%, and a positive predictive value of 90% for predicting clinical outcomes. In conclusion, serum HDL cholesterol levels measured at admission were markedly reduced in patients with left-sided IE. Furthermore, low serum HDL cholesterol levels predicted complicated clinical courses in these patients.
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Affiliation(s)
- Gokhan Kahveci
- Department of Cardiology, Rize State Hospital, Rize, Turkey.
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Al'-Ganadi AA, Gritsenko VV, Zueva EE, Kadinskaia MI, Galkina OV, Chefu SG. [The significance of investigation of the endothelium function in diagnosis and assessment of effectiveness of treatment of infective endocarditis]. Vestn Khir Im I I Grek 2008; 167:21-25. [PMID: 18942430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The complex state of the endothelium function was studied in 25 patients with infective endocarditis in the preoperative and early terms after surgery. A reliable elevation of all indices of endothelium dysfunction independent of the localization of the formed heart disease was detected. Against the background of operative treatment reliable changes demonstrating an improved functional state of the endothelium were noted in the early postoperative period.
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Demin AA, Chapaeva NN, Trifonova MA. [Pseudoinfectious endocarditis in antiphospholipid syndrome]. Klin Med (Mosk) 2008; 86:14-18. [PMID: 18756740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The antiphospholipid syndrome (APhS) is autoimmune non-inflammatory trombotic vasculopathy, associated with damage of vessels of any caliber and localization that determines the diversity of clinical manifestations of this syndrome. One of possible localizations of thrombosis in AphS is pseudoinfective endocarditis (PsIE). We have performed analysis of clinical and laboratory features of APhS, associated with PsIE. 28 APhS patients with PsIE, average age--44+/-13 years, were included in the study. Among them 21 patients had primary form of APhS, 7 cases had secondary form of APhS. For statistical treatment of the results the logistic regression (SPSS for Windows. Release 11.5.0.) was used, the confidence level of differences between groups was determined with the use of Student's test. Heart valve abnormalities occurred in 100% of patients and included valvular thickening, induration and sclerosis, the presence of valve vegetations, focip of calcinosis and different grade of valve dysfunction. Mitral and aortal valve vegetations occurred with the same incidence (64%), both valves were been involved in 29% of cases. Positive associations with presence/development of PsIE in APhS from multivariant model data included mitral valve lesion (OR: 0.029), focal cardiofibrosis (OR: 0.084), prior valve lesion (OR: 0.087), negative associations--hemicrania (OR: 8.627) and secondary form of APhS (OR: 6.425). Moderately high titer of lupous anticoagulant (multivariant model) (OR: 3.753) seemed to be prognostic marker of PsIE. In half of patients with APhS and PsIE systemic embolisms appeared, embolic cerebrovascular complications were the most frequent (32%). The possibility of development of hemodynamically significant valve dysfunction that needs valve replacement and nececcity of making of differential diagnosis with infective endocarditis are related to other aspects, important for clinical practice.
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Pemán J, Ortiz R, Osseyran F, Pérez-Bellés C, Crespo M, Chirivella M, Frasquet J, Quesada A, Cantón E, Gobernado M. Endocarditis por Aspergillus fumigatus en válvula nativa con hemocultivo positivo y galactomanano negativo. Descripción de un caso y revisión de la literatura. Rev Iberoam Micol 2007; 24:157-60. [PMID: 17604438 DOI: 10.1016/s1130-1406(07)70034-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 10/20/2022] Open
Abstract
Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.
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Affiliation(s)
- Javier Pemán
- Servicio de Microbiología, Hospital Universitario La Fe, Avenida de Campanar 21, 46009 Valencia, Spain.
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Hetyey CS, Manczur F, Dudás-Györki Z, Reiczigel J, Ribiczey P, Vajdovich P, Vörös K. Plasma antioxidant capacity in dogs with naturally occurring heart diseases. ACTA ACUST UNITED AC 2007; 54:36-9. [PMID: 17359453 DOI: 10.1111/j.1439-0442.2007.00911.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 11/27/2022]
Abstract
The aim of the study was to compare the plasma levels of antioxidants by measuring total antioxidant activity (TAS) and ferric reducing ability of the plasma (FRAP) in healthy dogs and in those that are suffering from dilated cardiomyopathy (DCM) or from mitral endocardiosis (ME). Dogs with echocardiographically diagnosed ME (10 dogs) as well as DCM (23 dogs) were sampled. Of dogs with DCM, eight having DCM with sinus rhythm (SR) were included in the DCM-SR group and 15 having DCM with atrial fibrillation (AF) in the DCM-AF group. Total antioxidant levels measured by TAS assay differed neither significantly between the cardiac patients and the control group nor between the heart disease groups. Ferric reducing ability of the plasma in animals with cardiac disease was significantly higher than in the control animals, and the difference was also significant in between the two DCM groups. However, the differences between the antioxidant levels of the DCM and ME groups did not reach significance in none of the antioxidant (TAS and FRAP) tests. Summarizing the results of this study it can be concluded that there is an increased antioxidant reactivity detected by the FRAP, but not by the TAS assay in the blood of dogs with naturally occurring cardiac disorders. The magnitude of this increase seems to be more affected rather by the severity of the cardiac insufficiency and/or by the heart rate or rhythm disorder than by the underlying heart disease itself.
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Affiliation(s)
- C S Hetyey
- Department and Clinic of Internal Medicine, Faculty of Veterinary Science, Szent István University, H-1078 Budapest, István u. 2., Hungary.
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Letaief A, Boughzala E, Kaabia N, Ernez S, Abid F, Ben Chaabane T, Ben Jemaa M, Boujnah R, Chakroun M, Daoud M, Gaha R, Kafsi N, Khalfallah A, Slimane L, Zaouali M. Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study. Int J Infect Dis 2007; 11:430-3. [PMID: 17331773 DOI: 10.1016/j.ijid.2006.10.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 10/25/2006] [Accepted: 10/27/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since the first description of infective endocarditis, the profile of the disease has evolved continuously with stable incidence. However, epidemiological features are different in developing countries compared with western countries. OBJECTIVE To describe epidemiological, microbiological and outcome characteristics of infective endocarditis in Tunisia. PATIENTS AND METHODS This was a descriptive multicenter retrospective study of inpatients treated for infective endocarditis from 1991 to 2000. Charts of patients with possible or definite infective endocarditis according to the Duke criteria were included in the study. RESULTS Four hundred and forty episodes of infective endocarditis among 435 patients (242 males, 193 females; mean (SD) age=32.4 (16.8) years, range 1-78 years) were reviewed. The most common predisposing heart disease was rheumatic valvular disease (45.2%). Infective endocarditis occurred on prosthetic valves in 17.3% of cases. Causative microorganisms were identified in 50.2% of cases: streptococci (17.3%), enterococci (3.9%), staphylococci (17.9%), and other pathogens (11.1%). Blood cultures were negative in 53.6% and no microorganism was identified in 49.8%. Early valve surgery was performed in 51.2% of patients. The in-hospital mortality was 20.6%. CONCLUSION Infective endocarditis is still frequently associated with rheumatic disease among young adults in Tunisia, with a high frequency of negative blood cultures and high in-hospital mortality, given that the population affected is relatively young.
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Affiliation(s)
- Amel Letaief
- Infectious Diseases Department, Farhat Hached University Hospital, Avenue Ibn El Jazzar, Sousse 4000, Tunisia.
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Gouriet F, Bothelo-Nevers E, Coulibaly B, Raoult D, Casalta JP. Evaluation of sedimentation rate, rheumatoid factor, C-reactive protein, and tumor necrosis factor for the diagnosis of infective endocarditis. Clin Vaccine Immunol 2006; 13:301. [PMID: 16467342 PMCID: PMC1391938 DOI: 10.1128/cvi.13.2.301.2006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Wälli F, Chuard C, Regamey C. [Blood culture negative endocarditis: a diagnostic challenge]. Rev Med Suisse 2005; 1:2346-50. [PMID: 16281446] [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: 05/05/2023]
Abstract
Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling. Other common causes include slow growing and non cultivable organisms. Identification of the etiologic agent is critical in the management of BCNE and molecular tools such as broad range 16SrRNA PCR technique followed by direct automated sequencing and microorganism-specific PCR are promising. Some authors have proposed to include these techniques among major Duke's criteria for the diagnosis of BCNE.
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Affiliation(s)
- F Wälli
- Clinique de Médicine, Hôpital Cantonal, Fribourg.
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40
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Omezzine-Letaïef A, Alaoui FZ, Bahri F, Mahdhaoui A, Boughzela E, Jemni L. [Infectious endocarditis with negative blood cultures]. Arch Mal Coeur Vaiss 2004; 97:120-4. [PMID: 15032411] [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
Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.
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41
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Mukhopadhyay S, Mukhopadhyay AK. Non-haematological functions of platelets. Natl Med J India 2002; 15:78-83. [PMID: 12044121] [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: 02/25/2023]
Affiliation(s)
- S Mukhopadhyay
- Department of Laboratory Medicine, All India Institute of Medical Sciences, Ansari Negar, New Delhi.
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42
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Hryniewiecki T, Tylewska-Wierzbanowska S, Rawczyńska-Englert I. [Attempt of estimation of Q fever endocarditis frequency in Poland]. Przegl Lek 2002; 58:759-61. [PMID: 11769382] [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
Up to now no Q fever endocarditis (caused by rickettsia Coxiella burnetii) has been diagnosed in Poland. Potential endocarditis caused by Coxiella burnetii strains can be related to a group of strains present in Poland or sensitivity of Polish Population. The aim of the study was to estimate frequency of Q fever endocarditis is patients of National Institute of Cardiology and to characterize Coxiella burnetii strains and correlation between frequency of Q fever endocarditis and the group of strains. In all patients infective endocarditis and valvular heart disease were diagnosed. In all cases vegetations on TTE or TEE and negative blood cultures were confirmed. No fungal antigens or elevated anti-Candida and anti-Aspergillus antibodies were found. Serological investigations as far as it concerns C. burnetii antibodies were negative in all cases. No Coxiella burnetii infection were found in patients with infective endocarditis and negative blood cultures in the National Institute of Cardiology. However due to high probability of occurrence of such an infection in Poland further investigations in other centers would be useful.
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Korkmaz S, Ileri M, Hisar I, Yetkin E, Kosar F. Increased levels of soluble adhesion molecules, E-selectin and P-selectin, in patients with infective endocarditis and embolic events. Eur Heart J 2001; 22:874-8. [PMID: 11350097 DOI: 10.1053/euhj.2000.2401] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Inflammation-induced procoagulant changes and endothelial cell activation appear to play an important role in thromboembolic complications of infective endocarditis. Hence, the aim of this study was to compare the plasma levels of soluble adhesion molecules E- and P-selectin in infective endocarditis patients with and without embolic events, and healthy subjects. METHODS AND RESULTS The study group consisted of 76 consecutive patients (mean age=26 years old, range from 8 to 64 years) with definite infective endocarditis according to the Duke criteria. Thirteen of the patients (17.1%) had embolic events. Transoesophageal echocardiographic examinations were performed on all patients within 3 days of initiation of antimicrobial therapy. Although there was a trend towards a higher rate of vegetations detected in those with embolic events than in those without, this did not reach statistical significance (84.6% vs 80.9%, P>0.05). Significantly larger vegetations were observed in patients with embolic events as compared to those without embolic events (1.4 cm vs 1.0 cm, P=0.03). The mean plasma concentrations of P-selectin were elevated in patients with embolic events as compared to both patients without embolic events and control subjects (58.69+/-7.49 ng x ml(-1)vs 29.65+/-5.69 ng x ml(-1), P=<0.001 and 58.69+/- 7.49 ng x ml(-1) vs 25.82+/-5.38 ng x ml(-1), P<0.001). Similarly, the patients with embolic events had increased plasma levels of E-selectin compared to those without embolic events and the control group (73.15+/-11.47 ng x ml(-1) vs 42.84+/-8.77 ng x ml(-1), P<0.001 and 73.15+/- 11.47 ng x ml(-1) vs 34.23+/-5.92 ng x ml(-1), P<0.001). CONCLUSION Determination of these membrane activation molecules may provide useful markers with which to identify patients at high thromboembolic risk from infective endocarditis.
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Affiliation(s)
- S Korkmaz
- Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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Rodríguez-Hernández MJ, Cuberos L, Pichardo C, Caballero FJ, Moreno I, Jiménez-Mejías ME, García-Curiel A, Pachón J. Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains. J Antimicrob Chemother 2001; 47:479-82. [PMID: 11266426 DOI: 10.1093/jac/47.4.479] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [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: 11/13/2022] Open
Abstract
Sulbactam and imipenem were compared in an experimental pneumonia model in immunocompetent mice, using a susceptible strain of Acinetobacter baumannii, and in an experimental endocarditis model in rabbits, using an intermediately susceptible strain. In the former, sulbactam was as efficacious as imipenem in terms of survival, sterility of lungs and in the bacterial clearance from lungs and blood, provided that the t > MIC for sulbactam (1.84 h) was similar to that for imipenem (2.01 h). In the endocarditis model, imipenem (t > MIC, 2.12 h) was more efficacious than sulbactam (t > MIC, 1.17 h) in bacterial clearance from vegetations. These results show the efficacy of sulbactam in infections caused by susceptible strains of A. baumannii, with an MIC up to 4 mg/L, provided that doses reach a t > MIC similar to that of imipenem. The activity of sulbactam was time dependent.
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Affiliation(s)
- M J Rodríguez-Hernández
- Service of Infectious Diseases, University Hospital Virgen del Rocio, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain.
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Abstract
Infective endocarditis is characterized by the colonization of endocardium by microorganisms. Except for Staphylococcus aureus, microorganisms are not able to adhere to and grow on endocardial cells; prior damage, e.g., by shear stress or other mechanical factors, is necessary. But other causes may well have a share. This study was, therefore, designed to identify immunological factors, especially antibodies against endothelial cells, which could contribute to the initiation of endocardial injury. Sera of patients with infective endocarditis and healthy controls were investigated for the presence of antibodies against endothelial antigen. As the antigen source human umbilical vein endothelial cells were used. Antibodies against endothelial cells were detected by indirect immunofluorescence, ELISA, immunoblotting, antibody dependent cellular cytotoxicity, and antibody mediated cytotoxicity. Antibodies against endothelial cells were found in seven out of fifteen patients. These antibodies were directed against cytoplasmic structures and only appeared in the course of the disease. A correlation between the presence of these antibodies and disease activity or the outcome of disease was not observed. These antibodies may develop as a consequence of damage to endocardial cells (thereby exposing intracellular antigen to the immune system) and do not seem to play a role in the pathogenesis of infective endocarditis.
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Affiliation(s)
- I Portig
- Klinikum der Philipps--Universität SP Kardiologie, Marburg, Germany.
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Söderquist B, Sundqvist KG, Vikerfors T. Adhesion molecules (E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)) in sera from patients with Staphylococcus aureus bacteraemia with or without endocarditis. Clin Exp Immunol 1999; 118:408-11. [PMID: 10594559 PMCID: PMC1905434 DOI: 10.1046/j.1365-2249.1999.01081.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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] [Indexed: 11/20/2022] Open
Abstract
The aim of this prospective study was to evaluate if patients with endocarditis display a more extensive endothelial activation than those with bacteraemia but without endocarditis. Sixty-five patients with blood culture-verified Staphylococcus aureus bacteraemia were included and serum samples collected on admission were analysed by enzyme immunoassays. Elevated serum concentrations of adhesion molecules were found in most of the patients with S. aureus bacteraemia. Patients with endocarditis (n = 15) showed significantly higher serum E-selectin (median 156 ng/ml) and VCAM-1 (median 1745 ng/ml) concentrations compared with those with S. aureus bacteraemia but without endocarditis (80 ng/ml and 1172 ng/ml, respectively; P = 0.01 and P = 0.003). No significant difference was found between the groups concerning ICAM-1 (median 451 ng/ml versus 522 ng/ml). In addition, serum tumour necrosis factor-alpha (TNF-alpha) concentrations were significantly correlated (P < 0.002) to serum levels of E-selectin, ICAM-1 and VCAM-1.
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Affiliation(s)
- B Söderquist
- Department of Infectious Diseases, Orebro Medical Centre Hospital, Orebro, Sweden.
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47
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Manzar S. Endocarditis after blood transfusion? J R Soc Med 1999; 92:325. [PMID: 10472294 PMCID: PMC1297225 DOI: 10.1177/014107689909200625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kraśnik L, Ochotny R, Hryniewiecki T, Paluszak J, Cieśliński A, Paradowski S. [The level of erythropoietin in serum of patients with anemia during infective endocarditis]. Pol Arch Med Wewn 1999; 101:113-5. [PMID: 10723224] [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: 02/15/2023]
Abstract
The infective endocarditis is a septic syndrome caused by an infection in endocardium or in heart valves. The majority of patients with infective endocarditis develop normocytic anemia. The metabolic studies in septic shock syndromes documented an intensive proteolysis of muscles, visceral organs and blood proteins, and probably of erythropoietin as a glycoprotein as well. The aim of the study was to assess the erythropoietin level in patients with infective endocarditis severe anemia and preserved renal function. Erythropoietin concentration was measured in blood serum in 12 patients (11 men and 1 woman), mean age 48 +/- 8 years, with infective endocarditis. The patients had clinical symptoms of endocarditis, positive blood bacteriological cultures and echocardiography features. All patients had serious normocytic anemia with mean hemoglobin concentration 5.40 +/- 0.48 mmol/L. The control group consisted of 7 healthy persons (5 men and 2 women), mean age 50 +/- 7 years, with hemoglobin concentration 8.70 +/- 0.60 mmol/L. The concentration of erythropoietin at the patients with bacterial endocarditis was 144.04 +/- 17.80 mIU/mL versus 67.28 +/- 6.29 mIU/mL in the control group (p = 0.0002). We conclude that in patients with infective endocarditis and serious normocytic anemia without renal insufficiency the concentration of erythropoietin is increased.
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Affiliation(s)
- L Kraśnik
- Katedra i Zakład Fizjologii AM, Karola Marcinkowskiego w Poznaniu
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Neumayer U, Schmidt HK, Mellwig KP, Kleikamp G. Moraxella catarrhalis endocarditis: report of a case and literature review. J Heart Valve Dis 1999; 8:114-7. [PMID: 10096493] [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: 02/11/2023]
Abstract
A 53-year-old man developed severe acute systemic illness three weeks after an upper respiratory tract infection. Serial blood cultures grew Moraxella catarrhalis. During antibiotic treatment, fever and infectious parameters disappeared, but severe aortic regurgitation developed. Aortic valve replacement was performed, during which extensive destruction of the aortic valve was noted. Endocarditis due to M. catarrhalis is very rare with, to our knowledge, only six cases having been reported to date. M. catarrhalis is a normal commensal of the upper respiratory tract, but in unpredictable circumstances can become an important pathogen. Bacteremia due to this organism therefore requires prompt treatment, as serious organ complications, including endocarditis, can occur.
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Affiliation(s)
- U Neumayer
- Department of Cardiology, Ruhr-University Bochum, Heart Center NRW, Bad Oeynhausen, Germany
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Shevchenko VS. [The manifestations of the immediate bioincompatibility reaction in patients undergoing restorative heart operations]. Fiziol Zh (1994) 1998; 44:10-4. [PMID: 9669169] [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 generation in plasma the anodic autoprecipitating protein, or autoprecipitin (AAP), as the bioincompatibility reaction under influence of a number of alien components during cardiac operations with using cardiopulmonary bypass, heterotopic vascular autotransplants and artificial valve implants was studied in 257 patients. Selective formation of the AAPs in result of their inductors effect was discovered by the methods of immunodiffusion and immunoelectrophoresis in blood of patients within operation periods and early postoperation hours. Repeated and reiterated generation of the AAPs due to bioincompatibility in patients with coronarosclerosis and endocarditis, undergoing prosthetic cardiac operations may favour developing reaction of immediate hypersensitivity with complications and has prognostic value.
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Affiliation(s)
- V S Shevchenko
- Institute of Cardiovascular Surgery, Academy of Medical Sciense, Ukraine
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