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Kankotia RJ, Kwon RS, Philips GM, Regenbogen SE, Zacur GM, Wamsteker EJ, Schulman AR, Machicado JD. Comparison of lumen-apposing metal stents versus endoscopic balloon dilation for the management of benign colorectal anastomotic strictures. Gastrointest Endosc 2024; 100:136-139.e3. [PMID: 38462058 DOI: 10.1016/j.gie.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Limited data exist evaluating lumen-apposing metal stents (LAMSs) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures (BCASs). This study compares outcomes of both interventions. METHODS Patients with left-sided BCAS treated with LAMSs versus EBD were identified retrospectively. The primary outcome was a composite of crossover to another intervention to achieve clinical success or recurrence requiring reintervention. RESULTS Twenty-nine patients (11 LAMS and 18 EBD) were identified with longer follow-up in the EBD group (734 vs 142 days; P = .003). No significant differences were found in the composite outcome, technical success, clinical success, or components of composite outcome. With LAMS, there was a nonsignificant trend toward fewer procedures (2.4 vs 3.3; P = .06) and adverse events (0% vs 16.7%; P = .26). CONCLUSIONS LAMS appears to be as effective as EBD for the treatment of BCAS but may require fewer procedures and may be safer than EBD.
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Affiliation(s)
- Ravi J Kankotia
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard S Kwon
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - George M Philips
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott E Regenbogen
- Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - George M Zacur
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erik-Jan Wamsteker
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
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Giri S, Vaidya A, Kale A, Jearth V, Sundaram S. Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis. Ann Gastroenterol 2023; 36:524-532. [PMID: 37664226 PMCID: PMC10433256 DOI: 10.20524/aog.2023.0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Lumen-apposing metal stents (LAMS) are an evolving option for the management of benign gastrointestinal (GI) strictures. Multiple studies have reported on the efficacy and safety of LAMS for benign GI strictures, but were limited by their small sample size. Hence, we conducted this meta-analysis to assess the critical role of LAMS for the management of benign GI strictures. Methods A literature search of various databases from inception until October 2022 was conducted for studies evaluating the outcome of LAMS in patients with benign GI strictures. The outcomes assessed included technical and clinical success, adverse events including stent migration, and reintervention. Pooled event rates across studies were expressed with summative statistics. Results A total of 18 studies (527 patients) were included in the present analysis. The pooled event rates for technical, short-term and long-term clinical success were 99.9% (95% confidence interval [CI] 99.1-100.0), 93.9% (95%CI 90.7-100.0), and 72.8% (95%CI 55.7-90.0), respectively. The pooled incidence of adverse events and stent migration with LAMS for benign GI strictures was 13.5% (95%CI 8.6-18.5) and 10.6% (95%CI 6.0-15.2), respectively. The pooled event rate for reintervention with LAMS for GI strictures was 23.0% (95%CI 15.7-30.3). In a subgroup analysis focusing only on anastomotic strictures there was no significant difference in the pooled event rates for various outcomes. Conclusions LAMS have a high technical and short-term clinical success rate, with an acceptable safety profile for the management of benign GI strictures. Further studies are needed to determine the appropriate duration of stent therapy and long-term outcomes.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad (Suprabhat Giri)
| | - Arun Vaidya
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai (Arun Vaidya, Aditya Kale)
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai (Arun Vaidya, Aditya Kale)
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh (Vaneet Jearth)
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai (Sridhar Sundaram), India
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Mahmoud T, Beran A, Bazerbachi F, Matar R, Jaruvongvanich V, Razzak FA, Abboud DM, Vargas EJ, Martin JA, Kellogg TA, Ghanem OM, Petersen BT, Levy MJ, Law RJ, Chandrasekhara V, Storm AC, Wong Kee Song LM, Buttar NS, Abu Dayyeh BK. Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm. Surg Endosc 2023; 37:2133-2142. [PMID: 36316581 DOI: 10.1007/s00464-022-09715-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/11/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumen-apposing metal stents (LAMS) are an alternative therapeutic option for benign gastrointestinal (GI) tract strictures. Our study aimed to evaluate the safety and efficacy of LAMS for the management of benign GI strictures. METHODS Consecutive patients who underwent a LAMS placement for benign luminal GI strictures at a tertiary care center between January 2014 and July 2021 were reviewed. Primary outcomes included technical success, early clinical success, and adverse events (AEs). Other outcomes included rates of stent migration and re-intervention after LAMS removal. RESULTS One hundred and nine patients who underwent 128 LAMS placements (67.9% female, mean age of 54.3 ± 14.2 years) were included, and 70.6% of the patients had failed prior endoscopic treatments. The majority of strictures (83.5%) were anastomotic, and the most common stricture site was the gastrojejunal anastomosis (65.9%). Technical success was achieved in 100% of procedures, while early clinical success was achieved in 98.4%. The overall stent-related AE rate was 25%. The migration rate was 27.3% (35/128). Of these, five stents were successfully repositioned endoscopically. The median stent dwell time was 119 days [interquartile range (IQR) 68-189 days], and the median follow-up duration was 668.5 days [IQR: 285.5-1441.5 days]. The re-intervention rate after LAMS removal was 58.3%. CONCLUSIONS LAMS is an effective therapeutic option for benign GI strictures, offering high technical and early clinical success. However, the re-intervention rate after LAMS removal was high. In select cases, using LAMS placement as destination therapy with close surveillance is a reasonable option.
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Affiliation(s)
- Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Fateh Bazerbachi
- Interventional Endoscopy Program, CentraCare Digestive Center, St. Cloud Hospital, St. Cloud, MN, USA
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Veeravich Jaruvongvanich
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Farah Abdul Razzak
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Donna Maria Abboud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Navtej S Buttar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Kasapidis P, Mavrogenis G, Mandrekas D, Bazerbachi F. Short benign ileocolonic anastomotic strictures - management with bi-flanged metal stents: Six case reports and review of literature. World J Clin Cases 2022; 10:10162-10171. [PMID: 36246813 PMCID: PMC9561585 DOI: 10.12998/wjcc.v10.i28.10162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The endoscopic management of benign short post-anastomotic ileocolonic stricture (PAICS) that is refractory to primary and secondary treatment modalities remains challenging. The lumen-apposing metal stent (LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy. LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents (FCSEMSs).
CASE SUMMARY This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature. We report a life-saving technique not previously documented and the use of technology to improve patient outcomes. The six patients (median age, 75 years) suffered from vomiting, constipation and recurrent abdominal pain, with symptoms starting 23-25 wk post-surgery. The median stricture length was 1.83 cm. All six patients underwent successful and uneventful bi-flanged metal stent (BFMS)-LAMS placement for benign PAICS. All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal. According to the literature, the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding. Conversely, FCSEMS has a high migration rate (15%-50%).
CONCLUSION The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options, allowing them to avoid more invasive surgical interventions. The BFMS (NAGI stent) is longer and larger than the prototype AXIOS-LAMS, which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.
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Affiliation(s)
- Panagiotis Kasapidis
- Department of Gastroenterology and Endoscopy Unit, Central Clinic of Athens, Athens 10680, Greece
| | - Georgios Mavrogenis
- Department of Gastroenterology, Mediterraneo Hospital, Glyfada, Athens 16685, Greece
| | - Dimitrios Mandrekas
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
- Department of Surgery, Attendant of Central Clinic of Athens, Athens 10680, Greece
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN 56301, United States
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KHENG M, ALEXIS JF, WALTER G, MOSNIER É, MALMONTET T, PIERRE DEMAR M, TAUCH V, VESIN G, ABBOUD P, ROQUES F, DJOSSOU F, EPELBOIN L. [Sacroiliitis with Erysipelothrix Rhusiopathiae revealing tricuspid endocarditis, the first case reported on the Guiana Shield: clinical case and review of the literature]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2022; 2:mtsi.v2i3.2022.256. [PMID: 36284553 PMCID: PMC9557821 DOI: 10.48327/mtsi.v2i3.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
We report here an atypical case of acute sacroiliitis caused by Erysipelothrix rhusiopathiae revealing tricuspid endocarditis in a 53-year-old woman without medical history. She was admitted to Cayenne hospital because of intense right hip and thigh pain, associated with fever. A right sacroiliitis was visible on the computed tomography (CT) scan, confirmed on MRI. Transesophageal echocardiography revealed a large mobile tricuspid vegetation. Blood cultures were positive for E. rhusiopathiae. CT scan showed pulmonary alveolar opacities, consistent with septic emboli. Clinical improvement was obtained under ceftriaxone followed by ciprofloxacin for 6 weeks of treatment. We present a review of bone and joint infections caused by E. rhusiopathiae. So far, not a single case has been reported in Latin America.
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Affiliation(s)
- Mathilde KHENG
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Jean Francky ALEXIS
- Service de cardiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Gaëlle WALTER
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Émilie MOSNIER
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Thomas MALMONTET
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Magalie PIERRE DEMAR
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Vilyn TAUCH
- Service de radiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Guillaume VESIN
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Philippe ABBOUD
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - François ROQUES
- Service de chirurgie thoracique, Centre hospitalier universitaire de Martinique, Fort-de-France, Martinique, France
| | - Félix DJOSSOU
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Loïc EPELBOIN
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
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6
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Daoud ND, Ghoz H, Mzaik O, Zaver HB, McKinney M, Brahmbhatt B, Woodward T. Endoscopic Management of Luminal Strictures: Beyond Dilation. Dig Dis Sci 2022; 67:1480-1499. [PMID: 35212884 DOI: 10.1007/s10620-022-07396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/19/2022]
Abstract
Luminal strictures can occur as part of many different gastrointestinal (GI) disorders anywhere along the GI tract and affect all age groups. The end goal of managing any stricture is to re-establish an adequate and durable luminal patency that is sufficient to resolve the presenting clinical symptoms. Treatment options can be generally categorized into medical, endoscopic, and surgical. However, within each of these categories, multiple different options are available. Therefore, choosing the best treatment modality is often challenging and depends on multiple factors including the type, location, and complexity of the stricture, as well as the preference of the treating physician. In this article, we will review the most current literature regarding foregut strictures, particularly esophageal and gastric, beyond dilation.
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Affiliation(s)
- Nader D Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Micah McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Timothy Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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7
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Rostamian M, Rahmati D, Akya A. Clinical manifestations, associated diseases, diagnosis, and treatment of human infections caused by Erysipelothrix rhusiopathiae: a systematic review. Germs 2022; 12:16-31. [PMID: 35601944 PMCID: PMC9113682 DOI: 10.18683/germs.2022.1303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/05/2021] [Accepted: 01/07/2022] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Erysipelothrix rhusiopathiae is a bacillus that can cause cutaneous and systemic diseases in humans. Studies on the infection caused by this bacterium have been mostly done as case reports. This study aimed to systematically review E. rhusiopathiae infection cases published over the last 20 years. METHODS Science Direct, PubMed, Scopus, Google Scholar, and Web of Science were searched using appropriate keywords to find relevant studies. After assessment of the studies, 57 case reports which surveyed 62 patients were included and their data were collected and analyzed. RESULTS The majority of cases were adult men living in high-income countries with an animal-related job and/or a history of animal contacts. The number of cases has increased in recent years. The main underlying diseases that were associated with E. rhusiopathiae infections include hypertension, diabetes, and alcoholism. The most frequent presentations were fever, pain, local skin lesions, and heart failure/endocarditis. Two patients died, while 60 patients were recovered following antibiotic therapy, mainly with penicillin and ceftriaxone. CONCLUSIONS Altogether, the results indicated that E. rhusiopathiae usually infects people who come into contact with animals and causes mild to severe local or systemic infections, especially in those who have underlying diseases. Therefore, accurate and early diagnosis of E. rhusiopathiae infections by setting up appropriate laboratory tests is required.
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Affiliation(s)
- Mosayeb Rostamian
- PhD, Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Reza Hospital, Parastar Blvd, Kermanshah, postal code 6714415333, Iran
| | - Donya Rahmati
- MD, Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Shahid Shiroudi Blvd, Kermanshah, postal code 6714869914, Iran
| | - Alisha Akya
- PhD, Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Reza Hospital, Parastar Blvd, Kermanshah, postal code 6714415333, Iran
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Law RJ, Chandrasekhara V, Bhatt A, Bucobo JC, Copland AP, Krishnan K, Kumta NA, Pannala R, Parsi MA, Rahimi EF, Saumoy M, Trikudanathan G, Trindade AJ, Yang J, Lichtenstein DR. Lumen-apposing metal stents (with videos). Gastrointest Endosc 2021; 94:457-470. [PMID: 34311975 DOI: 10.1016/j.gie.2021.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lumen-apposing metal stents (LAMSs) are a novel class of devices that have expanded the spectrum of endoscopic GI interventions. LAMSs with their dumbbell configuration, short saddle length, and large inner luminal diameter provide favorable stent characteristics to facilitate anastomosis formation between the gut lumen and adjacent structures. METHODS The MEDLINE database was searched through April 2021 for articles related to LAMSs by using additional relevant keywords such as "walled-off pancreatic necrosis," "pseudocysts," "pancreatic fluid collection," "cholecystitis," "gastroenterostomy," in addition to "endoscopic treatment" and "endoscopic management," among others. RESULTS This technology review describes the full spectrum of LAMS designs and delivery systems, techniques for deployment, procedural outcomes, safety, training issues, and financial considerations. CONCLUSIONS Although LAMSs were initially introduced for drainage of pancreatic pseudocysts and walled-off necrosis, the versatility of these devices has led to a variety of off-label uses including gallbladder drainage, enteric bypass with the creation of gastroenterostomies, and treatment of luminal GI strictures.
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Affiliation(s)
| | - Ryan J Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Carlos Bucobo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Andrew P Copland
- Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Erik F Rahimi
- Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas, USA
| | - Monica Saumoy
- Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Julie Yang
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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9
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Boregowda U, Goyal H, Mann R, Gajendran M, Patel S, Echavarria J, Sayana H, Saligram S. Endoscopic management of benign recalcitrant esophageal strictures. Ann Gastroenterol 2021; 34:287-299. [PMID: 33948052 PMCID: PMC8079876 DOI: 10.20524/aog.2021.0585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.
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Affiliation(s)
- Umesha Boregowda
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY (Umesha Boregowda)
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduation Medical Center, Scranton, PA (Hemant Goyal)
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, Fresno, CA (Rupinder Mann)
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX (Mahesh Gajendran)
| | - Sandeep Patel
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Juan Echavarria
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Hari Sayana
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
| | - Shreyas Saligram
- Division of Gastroenterology, University of Texas Health, San Antonio, TX (Sandeep Patel, Juan Echavarria, Hari Sayana, Shreyas Saligram), USA
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10
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Mizrahi M, Fahmawi Y, Merritt L, Kumar M, Tharian B, Khan SA, Inamdar S, Sharma N, Uppal D, Shami VM, Kashif MS, Gabr M, Pleskow D, Berzin TM, James TW, Croglio M, Baron TH, Adler DG. Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes. Ann Gastroenterol 2021; 34:33-38. [PMID: 33414619 PMCID: PMC7774669 DOI: 10.20524/aog.2020.0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures. Methods A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events. Results A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal. Conclusions Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.
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Affiliation(s)
- Meir Mizrahi
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Yazan Fahmawi
- Department of Internal Medicine, University of South Alabama, Mobile, AL (Yazan Fahmawi)
| | - Lindsey Merritt
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Manoj Kumar
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Benjamin Tharian
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Salman Ali Khan
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Neil Sharma
- Department of Gastroenterology and Hepatology, Parkview Health, Fort Wayne, IN (Neil Sharma)
| | - Dushant Uppal
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Vanessa M Shami
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Mahmood Syed Kashif
- Department of Gastroenterology and Hepatology, Orange Regional Medical Center, Middletown, NY (Mahmood Syed Kashif)
| | - Moamen Gabr
- Department of Gastroenterology and Hepatology, University of Kentucky College of Medicine, Lexington, KY (Moamen Gabr)
| | - Douglas Pleskow
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Tyler M Berzin
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Ted W James
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Michael Croglio
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT (Douglas G. Adler), USA
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12
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Lumen-apposing Metal Stents, Fully Covered Self-expanding Metal Stents, and Biodegradable Stents in the Management of Benign of GI Strictures: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2019; 53:560-573. [PMID: 31149932 DOI: 10.1097/mcg.0000000000001228] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Refractory benign gastrointestinal (GI) strictures are difficult to treat and placement of a stent is a commonly sought resort. Stents used for this purpose are fully covered self-expanding metal stent (FCSEMS), a biodegradable stent (BDS) and recently, a lumen-apposing metal stent (LAMS). There is no data comparing these stents to this end. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through October 2018) to identify studies that reported on the performance of FCSEMS, BDS, and LAMS in the treatment of refractory benign GI strictures. Our goals were to evaluate the pooled rate of technical success, clinical success, and adverse events with these stents and compare the outcomes between them. RESULTS A total of 31 studies were analyzed. In total, 14 (342 patients), 11 (226 patients), and 8 studies (192 patients) reported the use of FCSEMS, BDS, and LAMS, respectively. The pooled rate of technical success was 96.5% [95% confidence interval (CI): 93.5-98.1], 91.9% (95% CI: 85.6-95.6), and 97.6% (95% CI: 94.0-99.0) with FCSEMS, BDS, and LAMS respectively. No statistical significance to the difference was noted. The pooled rate of clinical success was 48.4% (95% CI: 37.1-59.8), 34.9% (95% CI: 23.6-48.1), and 78.8% (95% CI: 65.8-87.8) with FCSEMS, BDS, and LAMS, respectively. Statistical significance was noted in LAMS versus FCSEMS (P=0.001) and LAMS versus BDS (P=0.001). LAMS demonstrated statistically better outcomes in regards to stent migration and postprocedure pain when compared with FCSEMS and BDS. CONCLUSION Our study demonstrates that LAMS gives better clinical outcomes in the treatment of refractory benign GI strictures when compared with FCSEMS and BDS. Variability in the site, as well as the length of stricture, indirect comparison, and heterogeneity, were the limitations of our study.
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Zhang TT, Liu MZ, Yin RH, Yao LQ, Liu BS, Chen ZL. Rapid and simple detection of Glaesserella parasuis in synovial fluid by recombinase polymerase amplification and lateral flow strip. BMC Vet Res 2019; 15:294. [PMID: 31412870 PMCID: PMC6694577 DOI: 10.1186/s12917-019-2039-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Glaesserella parasuis (G. parasuis) is an influential pathogen of the pig, which induces high morbidity and mortality in naive pig populations in the pig industry. Accurate and rapid detection of the agent is important for disease control. In this study, a simple recombinase polymerase amplification (RPA) with a Lateral flow (LF) strip (RPA-LF-GPS) was developed to detect G. parasuis. Results The RPA-LF-GPS can specifically detect G. parasuis a limit of 100 CFU from other common related pathogens causing arthritis in the pig. The RPA-LF-GPS assay can use boiled synovial fluid samples as a template with the same sensitivity as other DNA extraction methods. In the detection of clinic positive synovial fluid sample, RPA-LF-GPS is equally sensitive (98.1%) compared with that of PCR (90.4%) (P > 0.05). The whole procedure of the RPA-LF-GPS assay could be finished in 1 hour without professional equipment. Conclusions RPA-LF-GPS assay is a rapid and simple method for point-of-care diagnostic testing for G. parasuis infection.
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Affiliation(s)
- Ting-Ting Zhang
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China
| | - Meng-Zhi Liu
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China
| | - Rong-Huan Yin
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China
| | - Long-Quan Yao
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China
| | - Bao-Shan Liu
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China.
| | - Ze-Liang Chen
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, No. 120 Dongling road, Shenyang, 110866, China.
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Marshall KR, Walton SA, Boyd M, Bishop B, Wellehan J, Craft W, Santoro D. Erysipeloid lesions caused by Erysipelothrix rhusiopathiae in a dog: clinical and histopathological findings, molecular diagnosis and treatment. Vet Dermatol 2019; 30:434-e134. [PMID: 31364229 DOI: 10.1111/vde.12773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Erysipelothrix rhusiopathiae is a widespread Gram-positive, nonsporulating rod bacterium predominantly associated with skin disease in swine and cetaceans. Cutaneous lesions have yet to be described in dogs. OBJECTIVE To describe the clinical presentation, molecular and histopathological diagnosis, and treatment of a case of erysipeloid caused by E. rhusiopathiae in a dog. ANIMALS A 6-month-old spayed female standard poodle dog presented with lethargy, fever, vomiting and diarrhoea. Skin lesions appeared 20 days post first examination. METHODS AND MATERIALS Complete blood count, serum chemistry profile, urinalysis, urine culture, blood culture, computed topography, forelimb radiography, joint and cerebrospinal fluid aspiration were performed; samples were collected for skin cytological evaluation, culture and histopathological analysis. RESULTS Blood cultures yielded Gram-positive, catalase-negative bacilli. Histopathological evaluation of skin biopsies revealed lymphoplasmacytic, neutrophilic and histiocytic perivascular and periadnexal dermatitis, and vasculitis. Cutaneous and blood PCR and sequencing of 16S rRNA identified the bacteria as E. rhusiopathiae. Clinical resolution was observed following the use of of amoxicillin/clavulanic acid and ciprofloxacin therapies. CONCLUSIONS AND CLINICAL IMPORTANCE To the best of the authors' knowledge, this is the first confirmed case of erysipeloid caused by E. rhusiopathiae in a dog. Clinical resolution was attained with the extended use of antibiotics. After 13 months, no clinical signs had returned.
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Affiliation(s)
- Kalie R Marshall
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - Stuart A Walton
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - Megan Boyd
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - Bradley Bishop
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - James Wellehan
- Department of Comparative, Diagnostic and Population Medicine College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - William Craft
- Department of Comparative, Diagnostic and Population Medicine College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32611, USA
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Tan S, Zhong C, Huang S, Luo X, Xu J, Fu X, Peng Y, Tang X. Clinical outcomes of lumen-apposing metal stent in the management of benign gastrointestinal strictures: a systematic review and meta-analysis. Scand J Gastroenterol 2019; 54:811-821. [PMID: 31290352 DOI: 10.1080/00365521.2019.1638447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims: Lumen-apposing metal stent (LAMS) have been considered as a viable alternative to treat benign gastrointestinal (GI) strictures. We aimed to determine the efficacy and safety of LAMS for benign GI strictures. Methods: Medline, Embase, Cochrane, and PubMed databases were searched using the keywords 'benign stricture', 'gastrointestinal stricture', 'lumen-apposing metal stent' and related terms on December 2018. Articles were selected for review by two authors independently according to predefined inclusion criteria and exclusion criteria. A meta-analysis using a random effects model was performed. Results: Six studies with a total of 144 patients were included in the final analysis (60 males, 41.7%). Overall, the pooled technical success rate was 98.3% [95% confidence interval (CI): 0.962-1.004], clinical success rate was 73.8% (95% CI: 0.563-0.912) and adverse events rate was 30.6% (95% CI: 0.187-0.425). The most common complication associated with LAMS for benign GI strictures was migration, and the pooled events rate was 10.9% (95% CI: 0.058-0.160). According to locations of stricture, subgroup analysis was performed in terms of clinical success [Esophagogastric: 63.9% (95% CI: 0.365-0.914); Gastroduodenal: 67.4% (95% CI: 0.421-0.927); Gastrojejunal: 78% (95% CI: 0.638-0.922); Pylorus: 77.6% (95% CI: 0.551-1.002); Colonic: 85.3% (95% CI: 0.515-1.191)]. Conclusions: Although the safety of LAMS placement in benign GI strictures is not very satisfactory, it is associated with a low migration rate. LAMS can achieve clinical symptom improvement or resolution in most patients with benign GI strictures, and it might be an alluring prospect for treating patients with this difficult condition.
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Affiliation(s)
- Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Shu Huang
- Department of Gastroenterology, The People's Hospital of Lianshui , Huaian , China
| | - Xujuan Luo
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Jin Xu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Xiangsheng Fu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College , Nanchong , China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
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Angulo López I, Fernández Torres M, Baldeón Conde C, Alonso Buznego L. Lesiones máculo-papulosas diseminadas en paciente en contacto con ganado. Enferm Infecc Microbiol Clin 2017; 35:603-604. [DOI: 10.1016/j.eimc.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
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Tan EM, Marcelin JR, Adeel N, Lewis RJ, Enzler MJ, Tosh PK. Erysipelothrix rhusiopathiae bloodstream infection - A 22-year experience at Mayo Clinic, Minnesota. Zoonoses Public Health 2017; 64:e65-e72. [PMID: 28206705 DOI: 10.1111/zph.12348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Indexed: 11/28/2022]
Abstract
Erysipelothrix rhusiopathiae is a facultatively anaerobic Gram-positive bacillus found mostly in swine, fish and sheep. E. rhusiopathiae classically causes cutaneous eruptions in butchers, fish handlers and veterinarians. Based solely on case reports, 90% of E. rhusiopathiae bloodstream infections (BSI) have been associated with infective endocarditis (IE). To assess the true frequency of IE in E. rhusiopathiae BSI as well as other clinical associations, we performed a retrospective cohort analysis of E. rhusiopathiae BSI at Mayo Clinic. This is a single-centre, retrospective study conducted between 1/1/1994 and 20/6/2016 at Mayo Clinic in Rochester, MN. Medical records were reviewed for demographics, E. rhusiopathiae BSI, anti-microbial susceptibilities, incidence of IE, patient comorbidities, intensive care unit (ICU) admission and duration of antibiotics. Five cases of E. rhusiopathiae BSI were identified. Risk factors included animal exposures, immunosuppression, diabetes and kidney disease. All cases involved penicillin-sensitive strains and high-grade BSI. Four cases showed no signs of IE on transesophageal echocardiogram. All patients recovered fully with intravenous antibiotics. Our retrospective review illustrates that E. rhusiopathiae can cause invasive BSI in the absence of IE and that the previously reported 90% association between BSI and IE may be overestimated due to reporting bias. E. rhusiopathiae should be suspected in any patient with Gram-positive bacilli in blood cultures and the aforementioned risk factors. A limitation of our study was the low sample size, and future studies may involve multicentre collaborations and the use of polymerase chain reaction (PCR) or serologic testing to increase the number of diagnoses..
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Affiliation(s)
- E M Tan
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - J R Marcelin
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - N Adeel
- Department of Internal Medicine, UnityPoint Health, University of Iowa - Des Moines, Des Moines, IA, USA
| | - R J Lewis
- Department of Internal Medicine, UnityPoint Health, University of Iowa - Des Moines, Des Moines, IA, USA
| | - M J Enzler
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - P K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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Asimaki E, Nolte O, Overesch G, Strahm C. A dangerous hobby? Erysipelothrix rhusiopathiae bacteremia most probably acquired from freshwater aquarium fish handling. Infection 2016; 45:557-562. [PMID: 27873166 DOI: 10.1007/s15010-016-0966-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Erysipelothrix rhusiopathiae is a facultative anaerobic Gram-positive rod that occurs widely in nature and is best known in veterinary medicine for causing swine erysipelas. In humans, infections are rare and mainly considered as occupationally acquired zoonosis. A case of E. rhusiopathiae bacteremia most likely associated with home freshwater aquarium handling is reported. The route of transmission was probably a cut with the dorsal fin of a dead pet fish. A short review of clinical presentations, therapeutic considerations and pitfalls of E. rhusiopathiae infections in humans is presented.
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Affiliation(s)
- E Asimaki
- Department of Internal Medicine, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland.
| | - O Nolte
- Center of Laboratory Medicine, Frohbergstrasse 3, 9001, St. Gallen, Switzerland
| | - G Overesch
- Vetsuisse Faculty, Institute of Veterinary Bacteriology, University of Bern, Länggassstrasse 120, 3012, Bern, Switzerland
| | - C Strahm
- Department of Infectious Diseases, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland
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Principe L, Bracco S, Mauri C, Tonolo S, Pini B, Luzzaro F. Erysipelothrix Rhusiopathiae Bacteremia without Endocarditis: Rapid Identification from Positive Blood Culture by MALDI-TOF Mass Spectrometry. A Case Report and Literature Review. Infect Dis Rep 2016; 8:6368. [PMID: 27103974 PMCID: PMC4815943 DOI: 10.4081/idr.2016.6368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022] Open
Abstract
Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74-year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i) no correlation with animal source; ii) correlation between bacteremia and erysipeloid lesion; iii) absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity) of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen.
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Affiliation(s)
- Luigi Principe
- Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy
| | - Silvia Bracco
- Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy
| | - Carola Mauri
- Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy
| | - Silvia Tonolo
- Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy
| | - Beatrice Pini
- Microbiology and Virology Unit, A. Manzoni Hospital , Lecco, Italy
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