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Gizaw AW, Tadesse A, Alemu H, Worku A, Chanie SD, Muluken G. Isolated Pulmonic Valve Endocarditis: A Rare Clinical Entity. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241277329. [PMID: 39193425 PMCID: PMC11348358 DOI: 10.1177/11795476241277329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/04/2024] [Indexed: 08/29/2024]
Abstract
Background Isolated pulmonic valve endocarditis is a rare heart valve infection, and constitutes about 1% to 2% of all infective endocarditis cases. Modified Duke's criteria were used to diagnose culture negative pulmonic valve endocarditis. Case presentation A 52-year-old male patient presented with generalized body swelling of 1 month duration associated with prolonged fever, malaise, fatigue, and lassitude. He had productive cough, dyspnea on mild exertion, and reddish discoloration of urine. Upon physical examination, blood pressure (BP) = 140/90 mmHg, pulse rate (PR) = 104 beats per minute, respiratory rate (RR) = 26 breaths per minute, temperature (T0) = 38.3°C, and Sp02 = 90% at ambient air. He had signs of bilateral pleural effusion. Cardiovascular examination revealed tachycardia, raised jugular venous pressure, murmurs of pulmonic regurgitation, and tricuspid regurgitation. There was grade 2 ascites and bilateral leg edema. On laboratory investigation, there were normochromic, normocytic anemia; raised ESR; positive Rheumatoid factor, elevated serum creatinine; and active urinary sediments on urinalysis. Two sets of blood culture were negative on days 1, 5, and 7. Chest-X-ray showed cardiomegaly with bilateral pleural effusion. ECG revealed sinus tachycardia with regular P-waves and QRS complexes. 2D Transthoracic echo showed vegetation on pulmonic valves, pulmonary valve lesions, dilated right atrium and right ventricle, and elevated right ventricular systolic pressure. Abdominal ultrasound revealed enlarged and echogenic kidneys, and ascites. Definitive diagnosis of PVE was made using modified Duke's criteria which was evidenced by 1 major (echo-proven vegetation on pulmonic valve), and 3 minors (suspected congenital pulmonic stenosis, fever, and immunologic phenomena [acute glomerulonephritis, positive rheumatoid factor]). The patient's clinical condition markedly improved after 2 weeks of intravenous antibiotics and loop diuretics, and discharged home after completing 6 weeks of parenteral antibiotics. Conclusion Modified Duke's criteria could play a major role in the management decision about diagnosis and empiric treatment of infective endocarditis in the absence of positive bacterial cultures.
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Affiliation(s)
- Abera Wondie Gizaw
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemaryam Alemu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samuel Dereje Chanie
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Muluken
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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2
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Gupta S, Kashiv P, Malde S, Dubey S, Sejpal KN, Pasari AS, Balwani M. Infection-Related Glomerulonephritis Due to Subacute Bacterial Endocarditis in the Aortic Valve: A Case Report. Cureus 2024; 16:e62670. [PMID: 39036169 PMCID: PMC11258590 DOI: 10.7759/cureus.62670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
Infection-related glomerulonephritis (IRGN) is a rare but severe complication of bacterial infections, including subacute bacterial endocarditis (SBE). We present a case of a 15-year-old male with bilateral lower limb swelling, facial puffiness, frothy urine, and dyspnea. Laboratory investigations revealed abnormal kidney function tests and imaging studies confirmed infective endocarditis. Blood cultures isolated Burkholderia cepacia and methicillin-resistant coagulase-negative Staphylococcus. Kidney biopsy confirmed immune complex-mediated glomerulonephritis. The patient received multidisciplinary care, including respiratory support, hemodialysis, antibiotics, and blood transfusion. This case highlights the importance of recognizing and promptly managing IRGN secondary to SBE to prevent irreversible renal damage and systemic complications.
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Affiliation(s)
- Sushrut Gupta
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranjal Kashiv
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunny Malde
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Dubey
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kapil N Sejpal
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit S Pasari
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manish Balwani
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Arshad K, Ali F, Alamro Y, Latif R, Egbe Bessong Tabot A. The Shadows of Normal Flora on Minor Wounds: A Case Report of an Uncommon Pathogen With Potentially Lethal Consequences. Cureus 2024; 16:e59648. [PMID: 38832147 PMCID: PMC11147491 DOI: 10.7759/cureus.59648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
Staphylococcus lugdunensis is a gram-positive, coagulase-negative organism, typically found in the normal skin flora, predominantly colonizing the perineal region. It has gained recognition as an opportunistic pathogen capable of causing severe infections. This manuscript presents a case study of a 75-year-old female with multiple comorbidities, including hypertension, hyperlipidemia, atrial fibrillation on Xarelto, type 2 diabetes mellitus, hypothyroidism, and a bioprosthetic aortic valve. The patient exhibited symptoms of fever, chills, and lethargy following a dog scratch that resulted in wounds on the left lower extremity. Despite initial negative findings in the drug screen and unremarkable workup for other infectious etiologies, the patient's clinical course revealed the presence of S. lugdunensis in the blood cultures. Timely intervention with broad-spectrum intravenous antibiotics and a six-week course of cefazolin led to significant improvement without recurrence. Staphylococcus lugdunensis, previously considered a relatively benign microorganism, has become a significant player in infectious diseases, particularly causing skin and soft tissue infections and infective endocarditis (IE). It is considered an aggressive pathogen, especially in chronic immunocompromised personnel, with a high potential for morbidity and mortality. S. lugdunensis was found to be the fourth most common cause of IE. The manuscript discusses the epidemiology, clinical presentation, and management of S. lugdunensis infections, emphasizing the importance of early recognition and treatment to prevent potentially fatal outcomes.
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Affiliation(s)
- Khurram Arshad
- Internal Medicine, Corewell Health East Dearborn, Dearborn, USA
| | - Farman Ali
- Medicine, St. John Hospital and Medical Center, Detroit, USA
| | - Yazan Alamro
- Internal Medicine, Beumont Hospital Dearborn, Dearborn, USA
| | - Rabia Latif
- Internal Medicine, McLaren Hospital, Flint, USA
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4
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Hutt E, Canosa FJM, Unai S, Jaber WA. Manifestations of Prosthetic Valve Endocarditis: Lessons From Multimodality Imaging and Pathological Correlation. Circ Cardiovasc Imaging 2024; 17:e016435. [PMID: 38626096 DOI: 10.1161/circimaging.123.016435] [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] [Received: 12/05/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024]
Abstract
Heart valve replacement has steadily increased over the past decades due to improved surgical mortality, an aging population, and the increasing use of transcatheter valve technology. With these developments, prosthetic valve complications, including prosthetic valve endocarditis, are increasingly encountered. In this review, we aim to characterize the manifestations of prosthetic valve endocarditis using representative case studies from our institution to highlight the advances and contributions of modern multimodality imaging techniques.
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Affiliation(s)
- Erika Hutt
- Departments of Cardiovascular Imaging (E.H., W.A.J.), Cleveland Clinic Foundation, OH
| | | | - Shinya Unai
- Cardiothoracic Surgery (S.U.), Cleveland Clinic Foundation, OH
| | - Wael A Jaber
- Departments of Cardiovascular Imaging (E.H., W.A.J.), Cleveland Clinic Foundation, OH
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5
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Awlad Thani S, Al Jamei SM, Al Azri KN, Al Alawi K, Al Shabibi S. Native Aortic Valve Infective Endocarditis Secondary to Community-Acquired Methicillin-Resistant Staphylococcus aureus: A Case Report and Literature Review. Cureus 2024; 16:e55341. [PMID: 38559539 PMCID: PMC10981920 DOI: 10.7759/cureus.55341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infective endocarditis (IE) refers to a microbial infection affecting either a heart valve or endocardium, resulting in tissue damage and the formation of vegetation. Native aortic valve endocarditis in children is rare and is associated with serious complications related to valvular insufficiency and systemic embolizations. As reports about community-acquired methicillin-resistant Staphylococcus aureus (MRSA) native aortic valve endocarditis in children are very scarce, we report this case along with a literature review about its complications and management. Here, we report the case of a seven-month-old infant who was previously healthy and presented with signs and symptoms of shock and systemic embolizations secondary to native aortic valve IE. His blood culture showed MRSA. He developed aortic valve insufficiency heart failure and multiorgan septic emboli that progressed to fatal refractory multiorgan failure. The management of complicated aortic valve endocarditis in children is challenging and needs a multidisciplinary team approach and prompt intervention.
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6
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Judd D, Oldham J, Lish J. Septic Embolic Encephalitis Following Cardiac Valve Replacement. Cureus 2024; 16:e51628. [PMID: 38313955 PMCID: PMC10837647 DOI: 10.7759/cureus.51628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
This paper presents a detailed case study of a 48-year-old male who underwent ascending aortic aneurysm repair with a bioprosthetic valve five years prior and subsequently developed septic embolic encephalitis, an infrequent yet critical complication following cardiac valve replacement. The patient exhibited an array of initial symptoms, including generalized weakness, fatigue, fevers, chills, diarrhea, and altered mentation. Microbiological analysis of blood cultures revealed the presence of Enterococcus, and echocardiogram examination demonstrated vegetation on the prosthetic valve. To assess disease progression, diagnostic imaging, including CT scans and MRIs, was conducted at various time points. The imaging results unveiled several abnormalities, including subarachnoid and parenchymal bleeding, cortical infarcts, cerebritis, and meningitis. Additionally, splenic and renal infarcts were observed through an abdominal CT scan. This case report accentuates the paramount role of diagnostic imaging in corroborating suspected septic embolic encephalitis while underscoring the significance of appropriate management of patients with a history of cardiac valve replacement, thereby emphasizing the urgency of timely intervention.
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Affiliation(s)
- Dallin Judd
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Jake Oldham
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - James Lish
- Neuroradiology, Chandler Radiology Associates, Chandler, USA
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7
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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8
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Freling S, Wald-Dickler N, Banerjee J, Canamar CP, Tangpraphaphorn S, Bruce D, Davar K, Dominguez F, Norwitz D, Krishnamurthi G, Fung L, Guanzon A, Minejima E, Spellberg M, Spellberg C, Baden R, Holtom P, Spellberg B. Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study. Clin Infect Dis 2023; 77:672-679. [PMID: 36881940 DOI: 10.1093/cid/ciad119] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND We sought to compare the outcomes of patients treated with intravenous (IV)-only vs oral transitional antimicrobial therapy for infective endocarditis (IE) after implementing a new expected practice within the Los Angeles County Department of Health Services (LAC DHS). METHODS We conducted a multicentered, retrospective cohort study of adults with definite or possible IE treated with IV-only vs oral therapy at the 3 acute care public hospitals in the LAC DHS system between December 2018 and June 2022. The primary outcome was clinical success at 90 days, defined as being alive and without recurrence of bacteremia or treatment-emergent infectious complications. RESULTS We identified 257 patients with IE treated with IV-only (n = 211) or oral transitional (n = 46) therapy who met study inclusion criteria. Study arms were similar for many demographics; however, the IV cohort was older, had more aortic valve involvement, were hemodialysis patients, and had central venous catheters present. In contrast, the oral cohort had a higher percentage of IE caused by methicillin-resistant Staphylococcus aureus. There was no significant difference between the groups in clinical success at 90 days or last follow-up. There was no difference in recurrence of bacteremia or readmission rates. However, patients treated with oral therapy had significantly fewer adverse events. Multivariable regression adjustments did not find significant associations between any selected variables and clinical success across treatment groups. CONCLUSIONS These results demonstrate similar outcomes of real-world use of oral vs IV-only therapy for IE, in accord with prior randomized, controlled trials and meta-analyses.
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Affiliation(s)
- Sarah Freling
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Noah Wald-Dickler
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Josh Banerjee
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Catherine P Canamar
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Soodtida Tangpraphaphorn
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Dara Bruce
- Department of Integrative Anatomical Sciences, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Kusha Davar
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Fernando Dominguez
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Daniel Norwitz
- Department of Integrative Anatomical Sciences, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Ganesh Krishnamurthi
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Lilian Fung
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Ashley Guanzon
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Pharmacy, University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, USA
| | - Emi Minejima
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Pharmacy, University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, USA
| | - Michael Spellberg
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Catherine Spellberg
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Rachel Baden
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
| | - Paul Holtom
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine-University of Southern California, Los Angeles, California, USA
| | - Brad Spellberg
- Department of Medicine and Infectious Diseases, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA
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Poyser TA, Dilibe A, Shaw C, Hicks CM, Munzinger E, Martin DE. From Obscurity To Spotlight: Staphylococcus lugdunensis-Induced Infective Endocarditis, a Profound Case Unraveling. Cureus 2023; 15:e44685. [PMID: 37809210 PMCID: PMC10551056 DOI: 10.7759/cureus.44685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Infective endocarditis (IE) represents a grave infection characterized by endocardial inflammation and valve impairment due to diverse pathogens. Staphylococcus lugdunensis, a coagulase-negative organism, has garnered increasing recognition as a significant etiological agent of IE. This bacterium is renowned for its aggressive tissue infections encompassing bone and joint, bloodstream, and IE sites. Particularly noteworthy is the rapid devastation and abscess formation it induces on heart valves, resulting in elevated mortality rates. The pathogen's affinity for von Willebrand factor facilitates its attachment to cardiac valves and blood vessels, thereby exacerbating its virulence. This abstract provides a comprehensive overview of S. lugdunensis-triggered IE. We present a compelling case involving a 66-year-old female afflicted by IE attributed to this microorganism, illuminating the clinical manifestations and challenges linked to the ailment. Moreover, we scrutinize previously reported instances of S. lugdunensis-related IE spanning from 1993 to 2022, accentuating the escalating importance of this pathogen in disease causality. The deleterious consequences of S. lugdunensis-induced IE emanate from its distinctive clinical attributes, necessitating tailored diagnostic strategies and treatment considerations. Given the gravity and swift progression of the infection, healthcare professionals play a pivotal role in administering timely and efficacious management for afflicted patients. Further research is imperative to enhance diagnostic modalities and explore therapeutic approaches aimed at effectively combating this formidable and life-threatening infection.
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Affiliation(s)
- Tracy-Ann Poyser
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | - Arthur Dilibe
- Internal Medicine, East Carolina University Health, Greenville, USA
| | - Collie Shaw
- Internal Medicine, Unity Health - White County Medical Center, Searcy, USA
| | - Courtney M Hicks
- Infectious Diseases, Unity Health - White County Medical Center, Searcy, USA
| | - Ethan Munzinger
- Interventional Cardiology, Unity Health - White County Medical Center, Searcy, USA
| | - David E Martin
- Graduate Medical Education, Unity Health - White County Medical Center, Searcy, USA
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10
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Rösch RM, Brendel L, Buschmann K, Vahl CF, Treede H, Dohle DS. Surgery for Infective Endocarditis after Primary Transcatheter Aortic-Valve Replacement-A Retrospective Single-Center Analysis. J Clin Med 2023; 12:5177. [PMID: 37629220 PMCID: PMC10456027 DOI: 10.3390/jcm12165177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Transcatheter aortic-valve replacement (TAVR) is increasingly being used for the treatment of aortic-valve stenosis. Therefore, the total number of patients with an aortic-valve prosthesis is increasing, causing the incidence of prosthetic-valve endocarditis to increase. METHODS Between March 2016 and July 2019, ten patients underwent surgery due to prosthetic-valve endocarditis after TAVR. They were identified in our institutional database and analyzed. RESULTS Infective endocarditis was diagnosed 17 ± 16 month after TAVR. Mean age was 79 ± 4.4 years. Microbiological detection showed 6/10 positive blood cultures for enterococcus faecalis. Median EuroScore II was 24.64%. The mean size of the surgically replaced aortic prosthesis was 23.6 ± 1.3 and that of the TAVR was 28.4 ± 2.3 mm. The surgically implanted aortic valves had a mean gradient of 8.5 ± 2.2 mmHg. One patient died in hospital due to septic multiorgan failure. After discharge, all patients survived with a mean follow-up of 9 ± 8 month. CONCLUSIONS With a rising number of patients after TAVR, prosthetic-valve endocarditis will increasingly occur in patients who were previously considered high or intermediate risk. Our results show that patients with TAVR infective endocarditis can be operated on with good results. Surgical therapy should not be withheld from TAVR patients with infective endocarditis.
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Affiliation(s)
- Romina Maria Rösch
- Department of Thoracic Surgery, Thoraxklinik Heidelberg, Heidelberg University Hospital, 69126 Heidelberg, Germany;
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
| | - Lena Brendel
- Department of Thoracic Surgery, Thoraxklinik Heidelberg, Heidelberg University Hospital, 69126 Heidelberg, Germany;
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
| | - Katja Buschmann
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
| | - Christian-Friedrich Vahl
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
| | - Hendrik Treede
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
| | - Daniel-Sebastian Dohle
- University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.B.); (H.T.); (D.-S.D.)
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11
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Mousa A, Ghazy A, Kakhktsyan T, Chepenko K, Young K. Staphylococcus lugdunensis Infective Endocarditis With Mitral Valve Vegetations in a Hemodialysis Patient With Recurrent Arteriovenous Fistula Cannulation: A Case Report. Cureus 2023; 15:e39853. [PMID: 37404404 PMCID: PMC10314977 DOI: 10.7759/cureus.39853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Infective endocarditis is a severe medical condition that occurs when the endocardium of the heart gets infected by different microorganisms, including coagulase-negative staphylococci such as Staphylococcus lugdunensis. The source of infection is often related to procedures done in the groin area, such as femoral catheterization for cardiac catheterization, vasectomy, or central line placement in an already infected mitral or aortic valve. Herein, we are discussing a case of a 55-year-old female with a past medical history of end-stage renal disease on hemodialysis with a history of recurrent cannulation of her arteriovenous (AV) fistula. She presented with fever, myalgia, and generalized weakness, and was later found to have Staphylococcus lugdunensis bacteremia and infective endocarditis with mitral valve vegetations, for which the patient was transferred to the mitral valve specialized center for mitral valve replacement. This case acts as a reminder to consider recurrent cannulation of the AV fistula as one of the potential ports of entry of Staphylococcus lugdunensis to the body.
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Affiliation(s)
- Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Ahmed Ghazy
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Tigran Kakhktsyan
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Kateryna Chepenko
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Kristopher Young
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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12
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Casey B, Bahekar A, Patel D, Walker E, Ilaiwy A. Fungal Endocarditis Secondary to Transdermal Fentanyl Patch. Cureus 2023; 15:e38706. [PMID: 37292538 PMCID: PMC10246510 DOI: 10.7759/cureus.38706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
Fungal endocarditis is an uncommon and dangerous disorder of the heart. The two most frequent etiologic fungi discovered to be responsible for fungal endocarditis are Aspergillus and Candida species. It is difficult to make a diagnosis of fungal endocarditis; a comprehensive assessment must be carried out, and specific diagnostic requirements must be completed. One of the main causes of endocarditis that physicians deal with in the hospital is intravenous drug abuse, but we never hear about transdermal drug abuse causing endocarditis. Here we present an interesting case of a 33-year-old male patient that presents to the hospital with non-specific complaints, and he was found to have fungemia. It was found out that the patient was using a kitchen appliance to cause dermal abrasion on his skin to increase the absorption rate of his fentanyl patch. Patient also suffers from trypanophobia, so he declined any surgical intervention and wanted lifelong oral medication therapy.
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Affiliation(s)
- Bradley Casey
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Amol Bahekar
- Cardiology, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Divyang Patel
- Cardiology, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Eric Walker
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Amro Ilaiwy
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
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13
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Mir T, Uddin MM, Shanah L, Hussain T, Parajuli T, Shafi O, Ullah W, Rab T, Sheikh M, Eltahawy E. Outcomes of Cardiac Arrest with Valve Surgery Among Infective Endocarditis Patients: A United States National Cohort Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:49-53. [PMID: 36460570 DOI: 10.1016/j.carrev.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Cardiac arrest can complicate infective endocarditis (IE) and is associated with significant in-hospital complications and mortality rates. We report the characteristics, outcomes, and readmission rates for IE patients with cardiac arrest in the United States. METHODS We surveyed the Nationwide Readmission Database (NRD), a database designed to support national level readmission analyses, for patients admitted with IE and who had cardiac arrest during index admission between 2016 and 2019. Baseline demographics, comorbidities, surgical procedures, and outcomes were identified using their respective International Classification of Diseases (ICD) codes. RESULTS There were 663 index admissions (mean age 55.87 ± 17.21 years;34.2 % females) for IE with cardiac arrest in the study period, with an overall mortality rate of 55.3 %. Of these, 270 (40.7 %) had surgical procedures performed during the hospitalization encounter. In patients who had a surgical procedure, 72 (26.8 %) patients had in-hospital mortality while 293 (74.9 %) patients without surgical procedures had in-hospital mortality (p < 0.001). After coarsened matching for baseline characteristics, surgical valve procedures were less likely to be associated with mortality (OR = 0.09, 95%CI 0.04-0.24; p < 0.001). Among the 295 alive discharges associated with cardiac arrest, 76 (38.57 %) were readmitted within 30-days, with a mortality rate of 22 % noted for readmissions. CONCLUSION Among IE patients who had cardiac arrest, surgical procedures subgroup had low mortality despite having higher complication rates. However, due to chances of bias more randomized trials are needed evaluate the hypothesis.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University. Detroit, MI, USA; Internal Medicine, Baptist Health System. Montgomery, AL, USA.
| | | | - Layla Shanah
- Internal Medicine, Wayne State University. Detroit, MI, USA
| | - Tanveer Hussain
- Internal Medicine, Wayne State University. Detroit, MI, USA; Critical Care Medicine, Summa Health System, Akron, OH, USA
| | | | - Obeid Shafi
- Clinical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Waqas Ullah
- Division of Cardiology, Thomas Jefferson Hospital, PA, USA
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica Toledo Hospital, OH, USA
| | - Ehab Eltahawy
- Division of Cardiology, University of Toledo College of Medicine, and Life Sciences, OH, USA
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14
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Patel J, Murin P, Sharif N, Animalu C. Disseminated Streptococcus gallinaceus infection. A new breed of zoonotic Streptococcus. J Natl Med Assoc 2023:S0027-9684(23)00035-4. [PMID: 36948955 DOI: 10.1016/j.jnma.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
Streptococcus gallinaceus is a new species of Streptococcus that was first isolated in 2004 in chickens. Infections in humans are associated with chicken exposure. There are very few case reports of human infections with this organism and none with disseminated infection. We report a case of Streptococcus gallinaceus bacteremia complicated by aortic valve endocarditis and lumbar osteomyelitis and paraspinal abscess in a patient with chicken exposure. The patient presented with progressive lower back pain and malaise. Blood culture was positive for Streptococcus gallinaceus. Magnetic resonance imaging (MRI) of the spine showed L2-L3 osteomyelitis with a compression fracture and paraspinal abscess. Transthoracic echocardiography revealed severe aortic insufficiency, 1-cm aortic valve echo density suspected to be a vegetation, and perforation of the right coronary cusp. He subsequently underwent anaortic valve repair. Pathology confirmed acute endocarditis with associated vegetations and granulation tissues. He was successfully treated with a six-week course of ceftriaxone.
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Affiliation(s)
- Jay Patel
- Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peyton Murin
- Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Navila Sharif
- Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chinelo Animalu
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA.
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15
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Jacobwitz M, Favilla E, Patel A, Giglia TM, Taing K, Ravishankar C, Gaynor JW, Licht DJ, McGuire JL, Beslow LA. Neurologic complications of infective endocarditis in children. Cardiol Young 2023; 33:463-472. [PMID: 35546418 PMCID: PMC9652479 DOI: 10.1017/s1047951122001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To define the frequency and characteristics of acute neurologic complications in children hospitalised with infective endocarditis and to identify risk factors for neurologic complications. STUDY DESIGN Retrospective cohort study of children aged 0-18 years hospitalised at a tertiary children's hospital from 1 January, 2008 to 31 December, 2017 with infective endocarditis. RESULTS Sixty-eight children met Duke criteria for infective endocarditis (43 definite and 25 possible). Twenty-three (34%) had identified neurologic complications, including intracranial haemorrhage (25%, 17/68) and ischaemic stroke (25%, 17/68). Neurologic symptoms began a median of 4.5 days after infective endocarditis symptom onset (interquartile range 1, 25 days), though five children were asymptomatic and diagnosed on screening neuroimaging only. Overall, only 56% (38/68) underwent neuroimaging during acute hospitalisation, so additional asymptomatic neurologic complications may have been missed. Children with identified neurologic complications compared to those without were older (48 versus 22% ≥ 13 years old, p = 0.031), more often had definite rather than possible infective endocarditis (96 versus 47%, p < 0.001), mobile vegetations >10mm (30 versus 11%, p = 0.048), and vegetations with the potential for systemic embolisation (65 versus 29%, p = 0.004). Six children died (9%), all of whom had neurologic complications. CONCLUSIONS Neurologic complications of infective endocarditis were common (34%) and associated with mortality. The true frequency of neurologic complications was likely higher because asymptomatic cases may have been missed without screening neuroimaging. Moving forward, we advocate that all children with infective endocarditis have neurologic consultation, examination, and screening neuroimaging. Additional prospective studies are needed to determine whether early identification of neurologic abnormalities may direct management and ultimately reduce neurologic morbidity and overall mortality.
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Affiliation(s)
- Marin Jacobwitz
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emmanuelle Favilla
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amisha Patel
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Therese M Giglia
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Taing
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Licht
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer L McGuire
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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16
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Konnai M, Yamamoto M, Ito K, Yamabe H, Kishimoto TE, Aoki H, Machida Y, Michishita M, Haritani M, Yoshimura H. Infective endocarditis with systemic bacterial embolism caused by Staphylococcus aureus in a free-ranging Amami rabbit (Pentalagus furnessi). J Comp Pathol 2023; 201:23-27. [PMID: 36652791 DOI: 10.1016/j.jcpa.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/16/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023]
Abstract
The Amami rabbit (Pentalagus furnessi) is found only on the two islands of Amami-Ōshima and Tokunoshima in southwest Japan. It has a primitive appearance and ecology, is an evolutionarily valuable animal and has been assigned to the International Union for Conservation of Nature Red List of Threatened Species. We describe a case with mild purulent wounds on the distal digital skin of both forelimbs and multiple nodular lesions in various organs, including the heart and kidney. Microscopically, the heart lesions were characterized by disruption of the mitral valve and multifocal myocardial necrosis and abscesses due to infection with gram-positive cocci. Similar bacterial infarctions were also found in other organs, including the kidneys. The bacteria were identified as Staphylococcus aureus by immunohistochemical and molecular biological examinations. This first report of infective endocarditis and systemic infarctions caused by S. aureus in an Amami rabbit indicates the importance of monitoring purulent injuries, even if mild, to prevent secondary infections in this species.
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Affiliation(s)
- Masaki Konnai
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Masami Yamamoto
- Laboratory of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Keiko Ito
- Amami Dog & Cat Animal Hospital, Oshima-gun, Kagoshima, Japan
| | - Hanae Yamabe
- Laboratory of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Takuya E Kishimoto
- Laboratory of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan; FUJIFILM VET Systems Ltd, Tokyo, Japan
| | - Hiroshi Aoki
- Department of Basic Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yukino Machida
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Masaki Michishita
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan; Center for Animal Life Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Makoto Haritani
- Laboratory of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan; Environmental Science for Sustainable Development, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Hisashi Yoshimura
- Laboratory of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo, Japan; Center for Animal Life Science, Nippon Veterinary and Life Science University, Tokyo, Japan.
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17
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Vinod VC, Farhana U, Waring S, Mlawa G. A Rare and Interesting Presentation of Diabetic Ketoacidosis Caused by Native Aortic Valve Endocarditis Complicated by Aortic Root Abscess Resulting in Multiple Septic Emboli Causing Bowel Ischemia and Splenic Infarction. Cureus 2022; 14:e29254. [PMID: 36262944 PMCID: PMC9575144 DOI: 10.7759/cureus.29254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 01/18/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is a serious life-threatening complication of diabetes, often precipitated by infection. Infective endocarditis (IE) is a serious precipitating factor for DKA, especially in patients with a previous cardiac surgery or valvular pathology. IE can be further complicated by life-threatening embolic events, which could be fatal if not detected and managed early and effectively. Our patient is a 54-year-old diabetic who presented with DKA precipitated by native aortic valve endocarditis complicated by an aortic root abscess, which was further complicated by septic emboli to the splenic artery and superior mesenteric artery leading to splenic infarction and bowel ischemia, respectively. To our knowledge and as per the literature reviewed, no case has been reported in a single patient who presented with DKA precipitated by IE complicated by aortic root abscess and multiple septic emboli resulting in bowel ischemia and splenic infarction.
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18
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Kamde SP, Anjankar A. Pathogenesis, Diagnosis, Antimicrobial Therapy, and Management of Infective Endocarditis, and Its Complications. Cureus 2022; 14:e29182. [PMID: 36258995 PMCID: PMC9572932 DOI: 10.7759/cureus.29182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Infective endocarditis in the adult is life-threatening. Bacterial endocarditis is an inner infection lining the heart muscle (endocardium). The scientific study of the causes of diseases is known as etiology. The agents that cause disease fall into five groups: bacteria, viruses, protozoa, fungi, and helminths (worms). Risk factors are past heart defects, damaged or abnormal heart valves, new valves after surgery, chronic hemodialysis, and immunosuppressed state (chemotherapy, HIV, etc.). Infective endocarditis is categorized into two clinical forms: bacterial acute and subacute endocarditis. Acute bacterial endocarditis is usually caused by staphylococci (staph) and streptococci (strep). And occasionally by listeria and brucella bacterial strains. Invasive medical technology has increased the responsibility of healthcare-associated infective endocarditis (HAIE). Microscopy of the disease is the chronic aggressive cells in the deeper zone of nonspecific, composed of fibrin and platelets covering colonies of bacteria. Tuberculous valvular endocarditis due to mycobacterium tuberculosis is a rare clinical entity. Syphilitic endocarditis is pathologically the cutaneous lesions of secondary syphilis. It is caused by infection with the microorganismTreponema pallidum. Fungal endocarditis is a rare and fatal condition. They are infected with fungi such as Candida albicans, Histoplasma capsulatum, and Aspergillus species. Fatal endocarditis associated with Q fever (query fever). Q fever is a chronic or prolonged disease caused by the rickettsial-like bacillus Coxiella burnetii, a rare form of rickettsia in the endocarditis. Varicella-zoster virus (VZV) infection causes chronic and repeated febrile illness. They are followed by pharyngitis, malaise, and a vesicular rash. Chronic Q fever usually manifests as endocarditis or hepatitis. The therapy given to simplify the complications is antimicrobial therapy. The medicines prescribed are ampicillin, cefazolin, ceftazidime, gentamicin, vancomycin, metronidazole, and tobramycin. High medicinal antibiotics are used to control the spread of infective endocarditis.
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19
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Chiba Y, Takahashi K, Makino R, Yoshida M, Oe Y, Nagasawa T, Sato H, Miyazaki M, Okamoto K. Glomerulonephritis Associated with Infective Endocarditis Showing Serological Positivity for PR3-anti-neutrophil Cytoplasmic Antibody and Anti-glomerular Basement Membrane Antibody. Intern Med 2022; 61:2179-2185. [PMID: 34980793 PMCID: PMC9381337 DOI: 10.2169/internalmedicine.8385-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein report a case of crescentic glomerulonephritis (GN) associated with infective endocarditis (IE). A 61-year-old-woman presented with a fever and renal dysfunction and was diagnosed with IE. The patient was positive for proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) and anti-glomerular basement membrane (GBM) antibodies. Renal biopsy findings showed crescentic GN with isolated deposition of C3c, a serum conversion product of complement C3. Given these clinical findings, the patient was diagnosed with infective endocardis (IE)-associated GN. Antibiotic therapy was continued without immunosuppressive agents. After the initiation of the antibiotics, the fever resolved, and the renal function gradually recovered. This case highlights the notion that laboratory findings should be carefully evaluated with reference to other findings.
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Affiliation(s)
- Yuki Chiba
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kei Takahashi
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Rui Makino
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Mai Yoshida
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Yuji Oe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Tasuku Nagasawa
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | | | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koji Okamoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
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20
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Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z, Elmadi J, Satish Kumar L. Malignancy and Endocarditis: Divulging Into the Intertwined Association. Cureus 2022; 14:e24089. [PMID: 35573527 PMCID: PMC9098766 DOI: 10.7759/cureus.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Cancer is an immunosuppressive disorder with characteristic features of unchecked cell growth, invasion, and sometimes thromboembolism leading to multiple systemic sequelae, including infective endocarditis. This article has compiled some of the crucial mechanisms by which infective endocarditis occurs in cancer patients, its risk factors, and the existing treatment interventions. It has focused on the necessity of being aware that these multiple pathogeneses are involved in the development of infective endocarditis (IE) in cancer patients, which would help delineate the risk factors associated with the condition and help physicians screen better for specific red flags. Identifying these risk factors and patient-oriented therapy, targeting the necessary elements such as causative organism, patient immune status, type of cancer, choosing evidence-based treatment modalities, and to improve the outcome of the disease in an already exasperating condition called cancer.
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21
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Ojha U, Ayathamattam J, Ahmad S. Catastrophic case of suppurative, embolic and fistulating infective endocarditis causing complete heart block. Future Cardiol 2022; 18:385-391. [PMID: 35403433 DOI: 10.2217/fca-2021-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Complete heart block, aortic root abscess and aortic valve regurgitation are well-recognized complications of infective endocarditis of the aortic valve. Splenic abscess and aorto-cavitary fistula are rarer phenomena and are indicative of calamitous infection. The authors present the case of an otherwise healthy 61-year-old man presenting with a 2-month history of non-specific symptoms, who developed suppurative endocarditis with a fistulating aortic root abscess, combined with severe sepsis, splenic embolization and complete heart block. Staphylococcus lugdunensis was the causative bacterium identified. The combination of these sequelae in the same patient is sparsely reported, is exceedingly rare and carries a significant risk of mortality.
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Affiliation(s)
- Utkarsh Ojha
- Royal Brompton & Harefield Hospitals, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | | | - Saad Ahmad
- Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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22
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Yousef Khan F, Elmudathir A, Abu Bakir M, Alsawaf B. Splenic Abscess in Qatar: A Single-Center Experience. Qatar Med J 2022; 2022:16. [PMID: 35321120 PMCID: PMC8928606 DOI: 10.5339/qmj.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND & OBJECTIVES Splenic abscess (SA) is a rare clinical entity. There is a lack of information on SA in most Arab and Gulf countries, including Qatar. This study describes the demographics, clinical features, microbiologic etiologies, treatments, and outcomes of patients with SA at the largest tertiary medical center in Qatar over the previous six years. METHODS This retrospective observational study was conducted at Hamad general hospital. It involved all patients of 18 years old or above who were admitted with the diagnosis of SA for the period between January 1, 2015, and December 31, 2020. RESULTS We recruited 25 patients, of which 14 (56%) were males, and 11 (44%) were females. The mean age ( ± SD) of them was 48.64 ± 19.08 years. The mean illness duration was 22.88 ± 11.88 days. Fever was the most common presenting symptom and was found in 21 (84%) cases, whereas bacteremia was the most predisposing factor found in 15 (60%) patients. The etiology of SA was bacterial in 16 cases (64%), mixed (fungal and bacterial) in one (4%), and tuberculous in one (4%), whereas the etiological agent was unidentified in seven (28%) cases. Intravenous antimicrobial therapy was administered empirically in all patients. However, seven patients (28%) received intravenous antibiotics as the only treatment modality for SA, 15 patients (60%) underwent percutaneous drainage with a pigtail catheter, and two patients underwent splenectomy. The inhospital mortality was three (12%). CONCLUSIONS This study showed that SA could be caused by various organisms that should be isolated to guide the choice of antimicrobial agents. An abdominal computed tomography is a good diagnostic modality, whereas computed tomography- and ultrasonography-guided percutaneous drainage were efficient therapeutic options that reduce the need for surgery.
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Affiliation(s)
| | - Ahmed Elmudathir
- Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail:
| | | | - Bisher Alsawaf
- Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail:
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23
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Khan A, Ehtesham M, Asif H, Riasat M, Alsheikhly K. Successful Debulking of Tricuspid Valve Vegetation Using Suction Filtration and Veno-Venous Bypass. Cureus 2022; 14:e22741. [PMID: 35386476 PMCID: PMC8970320 DOI: 10.7759/cureus.22741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.
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24
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Giri S, Shrestha B, Gajurel BP, Sapkota D, Gautam N, Shrestha A. Staphylococcal endocarditis with meningitis and basal ganglia infarcts mimicking meningococcemia. Clin Case Rep 2022; 10:e05548. [PMID: 35261776 PMCID: PMC8888920 DOI: 10.1002/ccr3.5548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Staphylococcus aureus is one of the common causes of infective endocarditis (IE). IE can present with various neurological complications such as stroke, brain abscess, and meningitis, the mortality rate can be very high in such cases.
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Affiliation(s)
- Subarna Giri
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Bhushan Shrestha
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | | | - Dharmendra Sapkota
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Institute of MedicineKathmanduNepal
| | - Ashish Shrestha
- Department of NeurologyTribhuvan University Institute of MedicineKathmanduNepal
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Ki YJ, Woo JS, Kim W. Acute Left Main Coronary Artery Occlusion by Embolization of Vegetation in Patient With Infective Endocarditis. Korean Circ J 2022; 52:906-907. [DOI: 10.4070/kcj.2022.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- You-Jeong Ki
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Jong Shin Woo
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
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Gamma camera imaging of infectious endocarditis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Sampson B, Hammers J, Stram M. Forensic aspects of cardiovascular pathology. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Keerty D, Yacoub AT, Nguyen TC, Haynes E, Greene J. First Case of Infective Endocarditis With Streptococcus equinus in an Immunocompetent Patient in North America: A Case Report and Review of Literature. Cureus 2021; 13:e19473. [PMID: 34912614 PMCID: PMC8664352 DOI: 10.7759/cureus.19473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
Infective endocarditis (IE) can be caused by bacterial or fungal infections invading the endocardial surface of the heart, such as its valves and chambers. Staphylococcus and Streptococcus species are mainly responsible for IE. Streptococcus equinus (S. equinus) has been rarely noted to cause IE. We present a case of a 69-year-old white male with a past medical history of severe aortic regurgitation, who during an elective aortic heart valve replacement surgery was noted to have multiple plaque-like vegetations at the base of the mitral valve that were positive for S. equinus. To date, there are only four cases of S. equinus endocarditis reported worldwide, with a high possibility of our case being the first reported in North America.
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Affiliation(s)
- Dinesh Keerty
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
| | | | | | | | - John Greene
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
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Kiriyama S, Imai H, Matsuhashi N, Murase K, Yoshida K, Suzui N. Atraumatic splenic rupture and infection-related glomerulonephritis in a patient with infected aortic aneurysm: A case report. Int J Surg Case Rep 2021; 88:106556. [PMID: 34741862 PMCID: PMC8581505 DOI: 10.1016/j.ijscr.2021.106556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Atraumatic splenic rupture is very rare and the case is often difficult to determine. We report a case of atraumatic splenic rupture in a patient with an infected aortic aneurysm. Case presentation A 40-year-old man under evaluation and treatment for renal dysfunction presented with the sudden onset of epigastric pain. The patient had a previous history of aortic arch replacement for Stanford type B aortic dissection. Contrast-enhanced computed tomography revealed intraabdominal hemorrhaging around the spleen and intrasplenic extravasation of contrast medium, and atraumatic splenic rupture was diagnosed. The patient slipped into hemorrhagic shock, and emergency splenectomy was scheduled. The histopathological diagnosis was splenic rupture with splenic infarction. The patient became febrile on postoperative day 10. Repeat contrast-enhanced computed tomography revealed enlargement of a cystic aortic aneurysm that was present prior to splenectomy. Infected aortic aneurysm was suspected, which was confirmed following thoracic endovascular aortic repair performed on postoperative day 12. Discussion We consider that splenic rupture occurred following infected of the kidney and spleen by an infected aortic aneurysm. Conclusion Infection should be considered as a cause in patients with atraumatic splenic rupture. Atraumatic splenic rupture was related to infection in only 27.3% of cases. Atraumatic splenic rupture in patients with infected aortic aneurysm is not well-documented. Infection-related splenic rupture should be considered in patients with acute abdominal pain.
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Affiliation(s)
- Shunya Kiriyama
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Hisashi Imai
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Katsutoshi Murase
- Department of General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
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Akhtar F, Khan AU. Antimicrobial photodynamic therapy (aPDT) against vancomycin resistant Staphylococcus aureus (VRSA) biofilm disruption: A putative role of phagocytosis in infection control. Photodiagnosis Photodyn Ther 2021; 36:102552. [PMID: 34597830 DOI: 10.1016/j.pdpdt.2021.102552] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Biofilm mediated infections have major clinical impact. Staphylococcus aureus is a pathogen that frequently causes biofilm forming infections, such as those associated with medical devices and persistent wounds. Microorganisms embedded in biofilm are impervious to antibiotics and other antimicrobial agents, thus they are difficult to eliminate. The upsurge of multi-drug resistant strains makes treating such illnesses even more difficult. Therefore, new strategies are required to combat such type of infections. In this work, we have proposed an alternative therapeutic option to eradicate preformed biofilm of vancomycin resistant Staphylococcus aureus (VRSA) and enhanced phagocytosis by neutrophils in fresh human blood using curcumin mediated antimicrobial photodynamic therapy (aPDT).At sub-MIC of curcumin, different anti-biofilm assays and microscopic examinations were performed, followed by 20 J/cm2 of blue laser light irradiation which corresponds to 52 s only. The result showed significant disruption of VRSA biofilm. Moreover, when curcumin-aPDT treated VRSA biofilm was exposed to whole blood from healthy donors, it was nearly completely eradicated. The present study suggests that curcumin-aPDT enhanced phagocytosis may be a useful strategy for inactivating VRSA biofilms adhering to medical implant surfaces.
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Affiliation(s)
- Farheen Akhtar
- Medical Microbiology and Molecular Biology Lab., Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Asad U Khan
- Medical Microbiology and Molecular Biology Lab., Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India.
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Cardiovascular Diseases and Pharmacomicrobiomics: A Perspective on Possible Treatment Relevance. Biomedicines 2021; 9:biomedicines9101338. [PMID: 34680455 PMCID: PMC8533057 DOI: 10.3390/biomedicines9101338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular diseases (CVDs), the most common cause of mortality in rich countries, include a wide variety of pathologies of the heart muscle and vascular system that compromise the proper functioning of the heart. Most of the risk factors for cardiovascular diseases are well-known: lipid disorders, high serum LDL cholesterol, hypertension, smoking, obesity, diabetes, male sex and physical inactivity. Currently, much evidence shows that: (i) the human microbiota plays a crucial role in maintaining the organism’s healthy status; and (ii) a link exists between microbiota and cardiovascular function that, if dysregulated, could potentially correlate with CVDs. This scenario led the scientific community to carefully analyze the role of the microbiota in response to drugs, considering this the right path to improve the effectiveness of disease treatment. In this review, we examine heart diseases and highlight how the microbiota actually plays a preponderant role in their development. Finally, we investigate pharmacomicrobiomics—a new interesting field—and the microbiota’s role in modulating the response to drugs, to improve their effectiveness by making their action targeted, focusing particular attention on cardiovascular diseases and on innovative potential treatments.
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Eid MM. Infective endocarditis with embolic renal infarct presenting as acute abdomen. Clin Exp Emerg Med 2021; 8:145-148. [PMID: 34237820 PMCID: PMC8273678 DOI: 10.15441/ceem.20.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Infective endocarditis (IE) is a disease that is rare but potentially fatal and challenging to diagnose. A 28-year-old man with sickle cell trait and a history of intravenous drug use presented with abdominal pain and hematuria mimicking a surgical abdomen. The preliminary diagnosis was cholecystitis or perforated viscus. The chest radiograph was indicative of pulmonary septic emboli. Computed tomography was initially thought to show pyelonephritis, but further review of images revealed renal infarct. The patient was found to have endocarditis which resulted in an embolic renal infarct. The patient recovered remarkably well after 60 days of intravenous antibiotics. This case demonstrates that a surgical abdomen may also be a sign of endocarditis, and multiple imaging studies may be required to confirm the diagnosis. In patients such as intravenous drug users with an increased risk of IE, unexplained flank pain should raise a suspicion of acute renal infarction.
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Optimal Timing of Surgery for Patients with Active Infective Endocarditis. Cardiol Clin 2021; 39:197-209. [PMID: 33894934 DOI: 10.1016/j.ccl.2021.01.002] [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] [Indexed: 11/21/2022]
Abstract
Infective endocarditis (IE) is a rare but serious condition with a dismal prognosis. One of the keys to improving outcomes is the prompt identification of high-risk patients who have intracardiac and extracardiac (systemic and neurologic) complications. However, as cardiac and extracardiac complications indicating surgery add to the surgical risk for active IE, controversies surround the optimal indication and timing for surgery, especially in patients presenting neurologic complications. This article reviews the necessary evaluation for patients with suspected IE and proposes a state-of-the-art patient flow chart for evaluation of suspected IE.
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34
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Mohamed M, Scholle T. Bilateral Central Retinal Artery Occlusion in Infective Endocarditis. JOURNAL OF VITREORETINAL DISEASES 2021; 5:261-265. [PMID: 37006508 PMCID: PMC9979040 DOI: 10.1177/2474126420960903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This report describes a patient with bilateral, sequential central retinal artery occlusions (CRAOs) due to infective endocarditis (IE). Methods: A case report is presented. Results: A 35-year-old man with IE who recently completed a course of intravenous antibiotic therapy presented with sudden right-eye vision loss. Examination revealed hand motion vision, a cherry-red spot in the macula in the right eye, and an embolus in the inferotemporal arcade of the left eye. The diagnosis of right-eye CRAO secondary to IE was made, with the presumed source being his dental caries. The patient was admitted with plans for aortic valve replacement and dental extraction. During his hospitalization, the patient suffered from a CRAO in his left eye, resulting in bilateral loss of vision. Conclusions: IE can have severe embolic complications; prompt diagnosis and treatment medically and surgically are necessary to reduce further morbidity and mortality.
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Affiliation(s)
- Mohamed Mohamed
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Tahira Scholle
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
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Culture-Negative Mycotic Aortic Aneurysms Probably Have a Less Severe Clinical Nature Than Culture-Positive Counterparts. Ann Vasc Surg 2021; 75:150-161. [PMID: 33831517 DOI: 10.1016/j.avsg.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mycotic aortic aneurysm constitutes a potentially devastating disease that necessitates prompt suspicion and diagnosis. There is no exact consensus for treatment, but removal of infected tissues and prolonged use of antimicrobials based on the identified causative microorganisms seem widely acceptable and have been similarly practiced worldwide. However, some patients still show no identified microorganisms. In this study, we sought to determine whether there are any clinical significance or differences of note in culture-negative mycotic aortic aneurysms. METHODS Between October 2003 and August 2018, 71 patients were identified as treated for mycotic aortic aneurysms at a single tertiary institution. Review of medical records and imaging studies were completed to collect the following information: demographics, previous medical/surgical history regarding potential infection sources, laboratory and radiologic findings, clinical presentations, treatment method, and morbidity and mortality rates. For analysis, patients were categorized into two groups: the blood and/or tissue culture-positive (CP) group and the blood and/or tissue culture-negative (CN) group. The latter was further divided as CN with identified microorganism by molecular biologic methods [CN(+)] and CN with no identified microorganism [CN(-)]. RESULTS More patients in the CP group were symptomatic than were in the CN(+) group (100% vs. 80%; P = 0.034). However, identification of causative microorganisms did not result in a difference in symptom status upon comparing the [CP + CN(+)] and [CN(-)] groups. Inflammatory markers were the most elevated in the CP group and least elevated in the CN(-) group. The aneurysm growth rate seemed slower in the CN(-) group than in the CN(+) and CP groups (1.3 vs. 3.4 vs. 9 mm/month respectively). Aneurysm rupture at initial presentation was more prevalent in the CP group (33.3%). 18F-Fluorodeoxyglucose-positron emission tomography showed increased uptake regardless of whether or not the microorganisms were identified. Early mortality and disease-specific mortality rates during the follow-up period were higher in the CP group but without statistical significance. CONCLUSIONS Compared with the CP group, the CN groups appeared clinically less severe, and also exhibited a relatively less devastating course as exhibited by the slower aneurysm expansion rate and smaller number of ruptured aneurysms at the initial presentation.
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Akhtar F, Khan AU, Misba L, Akhtar K, Ali A. Antimicrobial and antibiofilm photodynamic therapy against vancomycin resistant Staphylococcus aureus (VRSA) induced infection in vitro and in vivo. Eur J Pharm Biopharm 2021; 160:65-76. [PMID: 33508436 DOI: 10.1016/j.ejpb.2021.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
Biofilm mediated infection caused by multi-drug resistant bacteria are difficult to treat since it protects the microorganisms by host defense system, making them resistant to antibiotics and other antimicrobial agents. Combating such type of nosocomial infection, especially in immunocompromised patients, is an urgent need and foremost challenge faced by clinicians. Therefore, antimicrobial photodynamic therapy (aPDT) has been intensely pursued as an alternative therapy for bacterial infections. aPDT leads to the generation of reactive oxygen species (ROS) that destroy bacterial cells in the presence of a photosensitizer, visible light and oxygen. Here, we elucidated a possibility of its clinical application by reducing the treatment time and exposing curcumin to 20 J/cm2 of blue laser light, which corresponds to only 52 s to counteract vancomycin resistant Staphylococcus aureus (VRSA) both in vitro and in vivo. To understand the mechanism of action, the generation of total reactive oxygen species (ROS) was quantified by 2'-7'-dichlorofluorescein diacetate (DCFH-DA) and the type of phototoxicity was confirmed by fluorescence spectroscopic analysis. The data showed more production of singlet oxygen, indicating type-II phototoxicity. Different anti-biofilm assays (crystal violet and congo red assays) and microscopic studies were performed at sub-MIC concentration of curcumin followed by treatment with laser light against preformed biofilm of VRSA. The result showed significant reduction in the preformed biofilm formation. Finally, its therapeutic potential was validated in skin abrasion wistar rat model. The result showed significant inhibition of bacterial growth. Furthermore, immunomodulatory analysis with rat serum was performed. A significant reduction in expression of proinflammatory cytokines TNF-α and IL-6 were observed. Hence, we conclude that curcumin mediated aPDT with 20 J/cm2 of blue laser treatment (for 52 s) could be used against multi-drug resistant bacterial infections and preformed biofilm formation as a potential therapeutic approach.
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Affiliation(s)
- Farheen Akhtar
- Medical Microbiology and Molecular Biology Lab., Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Asad U Khan
- Medical Microbiology and Molecular Biology Lab., Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India.
| | - Lama Misba
- Medical Microbiology and Molecular Biology Lab., Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Kafil Akhtar
- Department of Pathology, JNMC, A.M.U., Aligarh, India
| | - Asif Ali
- Department of Biochemistry, F/o Medicine, JNMC A.M.U., Aligarh, India
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de Santis A, Siciliano RF, Sampaio RO, Akamine M, Veronese ET, de Almeida Magalhaes FM, Araújo MRE, Rossi F, Magri MMC, Nastri AC, Accorsi TAD, Rosa VEE, Titinger DP, Spina GS, Tarasoutchi F. Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report. BMC Infect Dis 2020; 20:907. [PMID: 33256617 PMCID: PMC7708205 DOI: 10.1186/s12879-020-05652-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional “endocarditis team” is essential to achieve favorable clinical outcomes in such defiant scenarios.
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Affiliation(s)
- Antonio de Santis
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil. .,Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Rinaldo Focaccia Siciliano
- Infection Control Team, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Masahiko Akamine
- General Surgery Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Elinthon T Veronese
- Cardiac Surgery Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Maria Rita Elmor Araújo
- Clinical Microbiology Laboratory, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Flavia Rossi
- Clinical Microbiology Laboratory, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcelo M C Magri
- Department of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ana Catharina Nastri
- Department of Infectious Diseases, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tarso A D Accorsi
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Vitor E E Rosa
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - David Provenzale Titinger
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Guilherme S Spina
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Flavio Tarasoutchi
- Heart Valve Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
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Abe T, De Allie G, Eyituoyo HO, Abe T, Tobun T, Asotibe JC, Hayes D, Mather P. CHA2DS2-VASc Is Associated With In-Hospital Mortality in Patients With Infective Endocarditis: A Cross-Sectional Cohort Study. Cureus 2020; 12:e11620. [PMID: 33364135 PMCID: PMC7752800 DOI: 10.7759/cureus.11620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 12/26/2022] Open
Abstract
Background and objective The CHA2DS2-VASc score is a stroke risk stratification tool that is used in patients with atrial fibrillation (AF). Most of its clinical variables have been associated with poor outcomes in patients with infective endocarditis (IE). In this study, we aimed to determine its utility in predicting outcomes in IE patients. Methods We included 35,570 patients with IE from the National Inpatient Sample (NIS), 2009-2012. The CHA2DS2-VASc score was calculated for each patient. Hierarchical logistic regression was used to estimate the adjusted odds ratio for in-hospital mortality for CHA2DS2-VASc scores from 1 to 9, using a score of 0 as the reference score. All clinical characteristics were defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Results The mean age of the sample was 57.81 ±14 years. Higher CHA2DS2-VASc scores were associated with increased mortality, and the scores among the sample ranged from 0 for 8.1% to 8 for 21.7%. In the hierarchical logistic regression, after adjusting for age, sex, and relevant comorbidities, as the score increased, so did the odds for overall mortality. Conclusion In patients with IE, the CHA2DS2-VASc score may serve as a risk assessment tool with which to predict outcomes. Further studies are needed to replicate these findings.
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Affiliation(s)
- Temidayo Abe
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | | | - Harry O Eyituoyo
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Tolulope Abe
- Internal Medicine, All Saints University School of Medicine, Roseau, DMA
| | - Temitope Tobun
- Internal Medicine, All Saints University School of Medicine, Roseau, DMA
| | | | - Dolphurs Hayes
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
- Department of Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Paul Mather
- Department of Cardiovascular Disease, Perelman School of Medicine, Philadelphia, USA
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Phogat D, Bajpai M, Ganguli P, Upreti V. Post-mortem findings in Staphylococcus aureus acute infective endocarditis. AUTOPSY AND CASE REPORTS 2020; 10:e2020212. [PMID: 33344326 PMCID: PMC7703179 DOI: 10.4322/acr.2020.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-year-old male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism.
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Affiliation(s)
- Deepika Phogat
- 151 Base Hospital, Department of Pathology, Guwahati, Assam, India
| | - Mukul Bajpai
- 151 Base Hospital, Department of Pathology, Guwahati, Assam, India
| | - Prosenjit Ganguli
- Command Hospital Eastern Command, Department of Pathology, Kolkata, West Bengal, India
| | - Vimal Upreti
- 151 Base Hospital, Department of Internal Medicine, Guwahati, Assam, India
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40
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Wang J, Monga N, Mopala P, Husnain M. Development of Nonbacterial Thrombotic Endocarditis While on Systemic Anticoagulation in Pancreatic Cancer: A Case Report. Cureus 2020; 12:e10967. [PMID: 33209525 PMCID: PMC7667603 DOI: 10.7759/cureus.10967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nonbacterial thromboembolic endocarditis (NBTE), or marantic endocarditis, is a rare complication associated with advanced cancer. Enoxaparin or unfractionated heparin is considered the standard treatment for NBTE. In this case report, we describe a 59-year-old female with metastatic pancreatic cancer who presented with embolic stroke and was found to have new NBTE of the mitral valve while she was receiving the therapeutic dose of enoxaparin. Of note, her recent echocardiogram one week ago was negative for mitral valve vegetations. Our case emphasized that for patients with advanced cancer presenting with stroke, the diagnosis of NBTE should be entertained even for those on systemic anticoagulation.
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Affiliation(s)
- Jiasheng Wang
- Department of Internal Medicine, MetroHealth Medical Center, Cleveland, USA
| | - Natasha Monga
- Department of Radiology, MetroHealth Medical Center, Cleveland, USA
| | - Prashanth Mopala
- Department of Cardiology, MetroHealth Medical Center, Cleveland, USA
| | - Muhammad Husnain
- Department of Medicine, MetroHealth Medical Center, Cleveland, USA
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Abstract
This article presents updates and an overview of pediatric infective endocarditis. It includes a discussion of presentation of illness, diagnosis of this disorder, differential diagnosis, treatment recommendation, and associated morbidity and mortality.
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Affiliation(s)
- Daniel A Cox
- University of Utah School of Medicine, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Lloyd Y Tani
- University of Utah School of Medicine, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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42
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Kadam M, Birns J, Bhalla A. The management of infective endocarditis complicated by stroke. Int J Clin Pract 2020; 74:e13469. [PMID: 31877574 DOI: 10.1111/ijcp.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mustafa Kadam
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Jonathan Birns
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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43
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Zhao S, Zhu L, Tinzin L, Huang F, Ma L, Zhou Y. Acute myocardial infarction in a young woman: Unexpected findings of a coronary occlusion. Leg Med (Tokyo) 2019; 42:101662. [PMID: 31896072 DOI: 10.1016/j.legalmed.2019.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
In clinical and forensic practice, the cause of death is often attributed to acute myocardial infarction, among which the coronary atherosclerosis being the Captain of the Men of Death. However, other reasons such as coronary septic embolization with neutrophilic granulocyte myocarditis although rare, can also cause sudden unexpected death. This paper reports a case with this rare cause-a 21-year-old woman diagnosed with "acute gastroenteritis" who died 4 days later. A forensic autopsy revealed an inflammatory polypous embolic located at 1.0 cm from the left anterior descending branch (LAD) with serve neutrophilic granulocyte myocarditis, which resulted in embolic at the opening of the left main coronary artery, acute myocardial infarction and eventually leading to her death. Histopathological examination showed large amounts of neutrophilic granulocyte infiltration in the arterial layer forming the septic embolic and eventually resulting in coronary occlusion. To find the real cause of septic embolic, myocarditis, bacterial, fungal, protozoan and virus detection was performed through RT-PCR, with negative findings. Septic embolic leading coronary occlusion in left main coronary artery and LAD is rarely reported in forensic practice, we hope this report can pave the way on understanding this rare disease to make correct diagnosis in medical practice.
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Affiliation(s)
- Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longlong Zhu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Lopsong Tinzin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longda Ma
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China.
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44
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Hsieh FC, Huang CY, Lin SF, Sun JT, Yen TH, Chang CC. Short-term exposure to particulate matters is associated with septic emboli in infective endocarditis. Medicine (Baltimore) 2019; 98:e17899. [PMID: 31702666 PMCID: PMC6855621 DOI: 10.1097/md.0000000000017899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This survey was to investigate the short-term effect of particulate matters (PMs) exposure on clinical and microbiological variables, especially septic emboli, in infective endocarditis (IE). The study analyzed 138 IE patients in Far Eastern Memorial Hospital from 2005 to 2015 and clinical variables were retrospectively requested. The data of air quality were recorded and collected by a network of 26 monitoring stations spreading in Northern part of Taiwan. We found that IE patients with septic emboli were found to be exposed to a significantly higher level of PM2.5 (32.01 ± 15.89 vs. 21.70 ± 13.05 μg/m, P < .001) and PM10 (54.57 ± 24.43 vs 40.98 ± 24.81 μg/m, P = .002) on lag 0 day when compared to those without. Furthermore, multivariate regression analysis revealed that that ambient exposure to PM2.5 (odds ratio: 3.87, 95% confidence interval: 1.31-8.31; P = .001) and PM10 (odds ratio: 4.58, 95% confidence interval: 2.03-10.32; P < .001) significantly increased risk of septic emboli in IE patients. To our knowledge, this is the first study demonstrating that short-term exposure to PMs was associated with septic emboli in IE.
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Affiliation(s)
- Fu-Chien Hsieh
- Division of Cardiovascular Surgery, Cardiovascular Center
| | | | - Sheng-Feng Lin
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei
| | | | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University
- Kidney Research Center
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei
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45
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O'Connor CT, O'Rourke S, Buckley A, Murphy R, Crean P, Foley B, Maree A, Ryan R, Tolan M, Young V, O'Connell B, Daly C. Infective endocarditis: a retrospective cohort study. QJM 2019; 112:663-667. [PMID: 31147713 DOI: 10.1093/qjmed/hcz134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a potentially life-threatening infection of the heart's endocardial surface. Despite advances in the diagnosis and management of IE, morbidity and mortality remain high. AIM To characterize the demographics, bacteriology and outcomes of IE cases presenting to an Irish tertiary referral centre. DESIGN Retrospective cohort study. METHODS Patients were identified using Hospital Inpatient Enquiry and Clinical Microbiology inpatient consult data, from January 2005 to January 2014. Patients were diagnosed with IE using Modified Duke Criteria. Standard Bayesian statistics were employed for analysis and cases were compared to contemporary international registries. RESULTS Two hundred and two patients were diagnosed with IE during this period. Mean age 54 years. Of these, 136 (67%) were native valve endocarditis (NVE), 50 (25%) were prosthetic valve endocarditis (PVE) and 22 (11%) were cardiovascular implantable electronic device-associated endocarditis. Culprit organism was identified in 176 (87.1%) cases and Staphylococcal species were the most common (57.5%). Fifty-nine per cent of NVE required surgery compared to 66% of PVE. Mean mortality rate was 17.3%, with NVE being the lowest (12.5%) and PVE the highest (32%). Increasing age was also associated with increased mortality. Fifty-three (26.2%) patients had embolic complications. CONCLUSIONS This Irish cohort exhibited first-world demographic patterns comparable to those published in contemporary international literature. PVE required surgery more often and was associated with higher rates of mortality than NVE. Embolic complications were relatively common and represent important sequelae, especially in the intravenous drug user population. It is also pertinent to aggressively treat older cohorts as they were associated with increased mortality.
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Affiliation(s)
- C T O'Connor
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - S O'Rourke
- Department of Microbiology, St. James's Hospital, James's Street, Dublin D08 K0Y5
| | - A Buckley
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - R Murphy
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - P Crean
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - B Foley
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - A Maree
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
| | - R Ryan
- Department of Cardiothoracic Surgery, St. James's Hospital, James's Street, Dublin D08 FD2W, Ireland
| | - M Tolan
- Department of Cardiothoracic Surgery, St. James's Hospital, James's Street, Dublin D08 FD2W, Ireland
| | - V Young
- Department of Cardiothoracic Surgery, St. James's Hospital, James's Street, Dublin D08 FD2W, Ireland
| | - B O'Connell
- Department of Microbiology, St. James's Hospital, James's Street, Dublin D08 K0Y5
| | - C Daly
- Department of Cardiology, St. James's Hospital, James's Street, Dublin D08 FD2W
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46
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Damasco PV, Correal JCD, Cruz-Campos ACD, Wajsbrot BR, Cunha RGD, Fonseca AGD, Castier MB, Fortes CQ, Jazbick JC, Lemos ERSD, Rossen JW, Leão RDS, Hirata Junior R, Guaraldi ALDM. Epidemiological and clinical profile of infective endocarditis at a Brazilian tertiary care center: an eight-year prospective study. Rev Soc Bras Med Trop 2019; 52:e2018375. [PMID: 31188916 DOI: 10.1590/0037-8682-0375-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/16/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is a systemic infectious disease requiring a multidisciplinary team for treatment. This study presents the epidemiological and clinical data of 73 cases of IE in Rio de Janeiro, Brazil. METHODS This observational prospective cohort study of endocarditis patients during an eight-year study period described 73 episodes of IE in 70 patients (three had IE twice). Community-associated (CAIE) and healthcare-acquired infective endocarditis (HAIE) were diagnosed according to the modified Duke criteria. The collected data included demographic, epidemiologic, and clinical characteristics, including results of blood cultures, echocardiographic findings, surgical interventions, and outcome. RESULTS Analysis of data from the eight-year study period and 73 cases (70 patients) of IE showed a mean age of 46 years (SD=2.5 years; 1-84 years) and that 65.7% were male patients. The prevalence of CAIE and HAIE was 32.9% and 67.1%, respectively. Staphylococcus aureus (30.1%), Enterococcus spp. (19.1%), and Streptococcus spp. (15.0%) were the prevalent microorganisms. The relevant signals and symptoms were fever (97.2%; mean 38.6 + 0.05°C) and heart murmur (87.6%). Vegetations were observed in the mitral (41.1%) and aortic (27.4%) valves. The mortality rate of the cases was 47.9%. CONCLUSIONS In multivariate analysis, chronic renal failure (relative risk [RR]= 1.60; 95% confidence interval [CI] 1.01-2.55), septic shock (RR= 2.19; 95% CI 1.499-3.22), and age over 60 years (RR= 2.28; 95% CI 1.44-3.59) were indirectly associated with in-hospital mortality. The best prognosis was related to the performance of cardiovascular surgery (hazard ratio [HR]= 0.51; 95% CI 0.26-0.99).
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Affiliation(s)
- Paulo Vieira Damasco
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Julio Cesar Delgado Correal
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ana Carolina Da Cruz-Campos
- Programa de Pós-Graduação em Microbiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Bruno Reznik Wajsbrot
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Guimarães da Cunha
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Márcia Bueno Castier
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Claudio Querido Fortes
- Departamento de Medicina Preventiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - João Carlos Jazbick
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Robson de Souza Leão
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Microbiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Raphael Hirata Junior
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Microbiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ana Luíza de Mattos Guaraldi
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Microbiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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47
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Duperril M, Rapin S, Vuillard C, Rayet I, Patural H. Case report: Staphylococcus aureus endocarditis in 2 premature newborns. Medicine (Baltimore) 2019; 98:e13549. [PMID: 30608383 PMCID: PMC6344129 DOI: 10.1097/md.0000000000013549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Neonatal infectious endocarditis (IE) in a healthy heart is rare. The infectious agents most frequently found in newborns are Staphylococcus aureus and fungi. Infection at the site of central intravenous catheter is generally thought to be the cause of this pathology. PATIENT CONCERNS We present 2 cases of premature newborns whose condition is evolving positively. They presented S aureus endocarditis during their first week of life. DIAGNOSIS Modified Duke diagnostic criteria-from clinical, echocardiogram and microbiological findings-based on those used for adults, can be used for children and newborns, but the very low prevalence of neonatal IE often delays diagnosis. Diagnosis on the basis of transthoracic heart ultrasound requires an extension report, given the very high embolic risk. INTERVENTION In the large majority of cases, long-term antibiotic therapy efficaciously treats the infection, although sometimes surgery is necessary. These 2 newborns needed only antibiotic therapy. OUTCOME Despite the various complications, especially embolic, these 2 children are followed and are doing well. LESSONS Long-term pediatric heart monitoring combined with prophylactic antibiotics are essential, according to the European Society of Cardiology guidelines.
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Affiliation(s)
- Marie Duperril
- Neonatal Intensive Care Unit, Department of Pediatric Medicine, CHU de Saint-Etienne
| | - Stéphanie Rapin
- Neonatal Intensive Care Unit, Department of Pediatric Medicine, CHU de Saint-Etienne
| | - Cécilia Vuillard
- Neonatal Intensive Care Unit, Department of Pediatric Medicine, CHU de Saint-Etienne
| | - Isabelle Rayet
- Neonatal Intensive Care Unit, Department of Pediatric Medicine, CHU de Saint-Etienne
| | - hugues Patural
- Neonatal Intensive Care Unit, Department of Pediatric Medicine, CHU de Saint-Etienne
- EA SNA-EPIS Research Laboratory, Jean Monnet University of Saint-Etienne, Saint-Etienne, France
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48
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Abstract
Endocarditis has been reported in patients with valvular heart disease who have undergone acupuncture treatment, although most have been associated with the use of semi-permanent needles. This has led reviewers to suggest that acupuncture may not only be contraindicated in such patients but that prophylactic antibiotics should be given. This study investigated the use of acupuncture treatment in patients with proven valvular heart disease and observed whether endocarditis developed in such patients. All patients in a single-handed GP practice with proven valvular heart disease, including those with prosthetic valves, were identified over a ten-year period. Those who had undergone acupuncture treatment underwent a clinical examination and diagnostic tests, which focused on the signs, symptoms and laboratory criteria for the diagnosis of endocarditis and included a transthoracic echocardiogram. Autopsy findings were reviewed in any patient who died. Based on these clinical and laboratory data, using the modified Duke's criteria for the diagnosis of endocarditis, patients were identified as having definite or possible endocarditis, or the diagnosis was rejected. All patients underwent brief acupuncture with no skin disinfectant and no prophylactic antibiotics were given. Semi-permanent needles were avoided. Thirty-six patients with valvular heart disease underwent a total of 479 acupuncture treatments over a ten-year period. The median number of treatments was 9 (range 1 – 72), with a follow-up after treatment of 5.75 years (range 0.5 – 10 years). Definite endocarditis was not found in any patient, but two patients had possible endocarditis, eventually discounted by both negative blood cultures and echocardiography. In conclusion, brief acupuncture was safe in this small cohort of valvular heart disease patients and no case of endocarditis was detected over a ten-year period.
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49
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Alnasser SA, Mindru C, Preventza O, Rosengart T, Cornwell L. Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis. Ann Thorac Surg 2018; 107:e235-e237. [PMID: 30326233 DOI: 10.1016/j.athoracsur.2018.08.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
The spleen is the most common abdominal site for systemic septic emboli that often complicate infective endocarditis. Management of an embolic splenic abscess usually involves surgical splenectomy or image-guided drainage, but the natural history of splenic abscess without drainage is unknown. We describe the successful conservative treatment of a large complex splenic abscess with antibiotics alone in a patient with aortic valve infective endocarditis who required an emergent valve replacement surgical procedure. Previous complex abdominal wall operation with the presence of a synthetic mesh made abdominal surgical intervention unfavorable. The splenic abscess resolved completely with no recurrence of infection at the 3-year follow-up.
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Affiliation(s)
- Saleh A Alnasser
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Cezarina Mindru
- Department of Internal Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Todd Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Lorraine Cornwell
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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50
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Parra JA, Hernández L, Muñoz P, Blanco G, Rodríguez-Álvarez R, Vilar DR, de Alarcón A, Goenaga MA, Moreno M, Fariñas MC. Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis. Medicine (Baltimore) 2018; 97:e11952. [PMID: 30113500 PMCID: PMC6112969 DOI: 10.1097/md.0000000000011952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4-9.1), liver disease (OR = 8.3, 95% CI = 2.1-31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3-11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them.
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Affiliation(s)
- José A. Parra
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Cantabria
| | - Luis Hernández
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid
| | - Gerardo Blanco
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria
| | | | | | - Arístides de Alarcón
- Infectious Diseases Service, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva Grupo de Investigacion en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)/CSIC/, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - Mar Moreno
- Department of Cardiology, Hospital Universitario La Paz, Madrid
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
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