1
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Kim MGJ, Payne S, Post J. A subacute presentation of Mycoplasma hominis prosthetic valve endocarditis. BMJ Case Rep 2022; 15:e252972. [PMID: 36319037 PMCID: PMC9628652 DOI: 10.1136/bcr-2022-252972] [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] [Indexed: 11/07/2022] Open
Abstract
Mycoplasma hominis is a rare but important cause of prosthetic valve endocarditis. It is usually associated with acute progression of symptoms and can be difficult to diagnose as it does not grow in standard culture media. We report a case of an immunocompetent man in his 70s who presented with 14-month subacute decline with shortness of breath and evidence of a splenic infarct. Following a redo aortic valve replacement and diagnosis of M. hominis through 16S ribosomal ribonucleic acid PCR, he improved clinically with oral doxycycline therapy. He remained well at follow-up 2 years post-cessation of antibiotics. We present a literature review highlighting the role of PCR testing in the microbiological identification of M. hominis.
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Affiliation(s)
- Myong Gyu Joshua Kim
- Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Susannah Payne
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Jeffrey Post
- Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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2
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Bustos-Merlo A, Rosales-Castillo A, Cobo F, Hidalgo-Tenorio C. Blood Culture-Negative Infective Endocarditis by Mycoplasma hominis: Case Report and Literature Review. J Clin Med 2022; 11:jcm11133841. [PMID: 35807126 PMCID: PMC9267468 DOI: 10.3390/jcm11133841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
Mycoplasma hominis is a habitual colonizing microorganism of the lower genital tract but can exceptionally be the causal agent of blood culture-negative infective endocarditis (IE). Only 11 cases of this entity have been published to date. The study objectives were to describe the first case diagnosed in our center of IE by M. hominis on pacemaker lead and to carry out a narrative review. Among published cases of IE by this microorganism, 72.7% were male, with a mean age of 45 years and a history of valve surgery; the diagnosis was by culture (54.5%) or molecular technique (45.5%), and the prognosis was favorable in 72.7% of cases. The most frequently prescribed antibiotics were doxycycline, quinolones, and clindamycin.
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Affiliation(s)
- Antonio Bustos-Merlo
- Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (A.B.-M.); (A.R.-C.)
| | - Antonio Rosales-Castillo
- Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (A.B.-M.); (A.R.-C.)
| | - Fernando Cobo
- Department of Microbiology, Virgen de las Nieves University Hospital, 18012 Granada, Spain;
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-627-010-441
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3
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Dawood H, Nasir S, Khair RM, Dawood M. Infective Endocarditis Secondary to Mycoplasma pneumoniae. Cureus 2021; 13:e17461. [PMID: 34603862 PMCID: PMC8475736 DOI: 10.7759/cureus.17461] [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: 08/26/2021] [Indexed: 11/05/2022] Open
Abstract
Mycoplasma pneumoniae (MP) is a gram-positive bacterium most commonly associated with community-acquired pneumonia in adults. It can also involve other systems of the body. Cardiovascular complications include pericarditis, myocarditis, congestive cardiac failure, and, rarely, infective endocarditis. We report a case of infective endocarditis secondary to MP infection in an adult. We treated our patient with doxycycline, which showed significant improvement.
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Affiliation(s)
| | - Saad Nasir
- Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Reem M Khair
- Internal Medicine, Beaumont Hospital, Dublin, IRL
| | - Mustafa Dawood
- Nephrology, Emory University School of Medicine, Atlanta, USA
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4
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Givone F, Peghin M, Vendramin I, Carletti S, Tursi V, Pasciuta R, Livi U, Bassetti M. Salvage heart transplantation for Mycoplasma hominis prosthetic valve endocarditis: A case report and review of the literature. Transpl Infect Dis 2020; 22:e13249. [PMID: 31977151 DOI: 10.1111/tid.13249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/11/2019] [Accepted: 01/12/2020] [Indexed: 12/19/2022]
Abstract
Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a "last resort" procedure. Orthotropic HT with bicaval technique was performed in a man with culture-negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.
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Affiliation(s)
- Filippo Givone
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Maddalena Peghin
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Silvia Carletti
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Tursi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Renée Pasciuta
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Matteo Bassetti
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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5
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Korytny A, Nasser R, Geffen Y, Friedman T, Paul M, Ghanem-Zoubi N. Ureaplasma parvum causing life-threatening disease in a susceptible patient. BMJ Case Rep 2017; 2017:bcr-2017-220383. [PMID: 28814589 DOI: 10.1136/bcr-2017-220383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A 56-year-old man with lymphoma developed orchitis followed by septic arthritis of his right glenohumeral joint. Synovial fluid cultures were negative but PCR amplification test was positive forUreaplasmaparvum. The patient was treated with doxycycline. Two and a half years later, the patient presented with shortness of breath and grade III/IV diastolic murmur on auscultation. Echocardiography revealed severely dilated left heart chambers, severe aortic regurgitation and several mobile masses on the aortic valve cusps suspected to be vegetations. He underwent valve replacement; valve tissue culture was negative but the 16S rRNA gene amplification test was positive for U. parvumHe was treated again with doxycycline. In an outpatient follow-up 1 year and 3 months later, the patient was doing well. Repeated echocardiography showed normal aortic prosthesis function.
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Affiliation(s)
- Alexander Korytny
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Roni Nasser
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Geffen
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Tom Friedman
- Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
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6
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Affiliation(s)
- Søren A Ladefoged
- Department of Medical Microbiology and Immunology University of Aarhus, Denmark.,Department of Clinical Biochemistry University Hospital of Aarhus, Denmark
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7
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Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis. J Clin Microbiol 2015; 53:3068-71. [PMID: 26135868 DOI: 10.1128/jcm.00827-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma spp. are rarely recognized agents of infective endocarditis. We report a case of Mycoplasma hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA (rDNA) PCR and culture of valves in a 74-year-old man. We reviewed the literature and found only 8 other cases reported.
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8
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Mycoplasma hominis prosthetic valve endocarditis: The value of molecular sequencing in cardiac surgery. J Thorac Cardiovasc Surg 2013; 146:e7-9. [DOI: 10.1016/j.jtcvs.2013.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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Jamil HA, Sandoe JAT, Gascoyne-Binzi D, Chalker VJ, Simms AD, Munsch CM, Baig MW. Late-onset prosthetic valve endocarditis caused by Mycoplasma hominis, diagnosed using broad-range bacterial PCR. J Med Microbiol 2011; 61:300-301. [PMID: 21997872 DOI: 10.1099/jmm.0.030635-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report what is believed to be the first case of late-onset prosthetic valve endocarditis caused by Mycoplasma hominis in a case of blood culture-negative endocarditis. The objective of this report is to emphasize the use of a broad-range PCR technique for bacterial 16S rRNA genes in identifying the causative pathogen, thus enabling targeted antimicrobial treatment.
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Affiliation(s)
- H A Jamil
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - J A T Sandoe
- Department of Microbiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - D Gascoyne-Binzi
- Department of Microbiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - V J Chalker
- Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK
| | - A D Simms
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - C M Munsch
- Department of Cardiac Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - M W Baig
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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10
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Scapini JP, Flynn LP, Sciacaluga S, Morales L, Cadario ME. Confirmed Mycoplasma pneumoniae endocarditis. Emerg Infect Dis 2008; 14:1664-5. [PMID: 18826843 PMCID: PMC2609863 DOI: 10.3201/eid1410.080157] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Hidalgo-Tenorio C, Pasquau J, López-Checa S, López-Ruz MA. [Endocarditis due to Mycoplasma hominis]. Enferm Infecc Microbiol Clin 2006; 24:470-1. [PMID: 16956540 DOI: 10.1157/13091789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Dominguez SR, Littlehorn C, Nyquist AC. Mycoplasma hominis endocarditis in a child with a complex congenital heart defect. Pediatr Infect Dis J 2006; 25:851-2. [PMID: 16940850 DOI: 10.1097/01.inf.0000232639.81762.d4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of a 4-year-old girl with a complex congenital heart defect who developed Mycoplasma endocarditis after surgical repair. This is the first reported case of Mycoplasma endocarditis in a child and suggests consideration of this organism as a cause of culture-negative endocarditis.
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13
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Krijnen MR, Hekker T, Algra J, Wuisman PIJM, Van Royen BJ. Mycoplasma hominis deep wound infection after neuromuscular scoliosis surgery: the use of real-time polymerase chain reaction (PCR). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15 Suppl 5:599-603. [PMID: 16429284 PMCID: PMC1602191 DOI: 10.1007/s00586-005-0055-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 11/07/2005] [Accepted: 12/23/2005] [Indexed: 11/05/2022]
Abstract
Mycoplasma hominis is a commensal of the genitourinary tract. It mostly causes infections to associated structures of this system; however, occasionally it is a pathogen in nongenitourinary tract infections. Since, M. hominis strains require special growth conditions and cannot be Gram stained, they may be missed or delay diagnosis. This report describes a deep wound infection caused by M. hominis after neuromuscular scoliosis surgery; M. hominis was recovered by real-time polymerase chain reaction (PCR). An awareness of the role of M. hominis as an extragenital pathogen in musculoskeletal infections, especially in neuromuscular scoliosis, being a high-risk group for postoperative wound infection, it is necessary to identify this pathogen. Real-time PCR for postoperative deep wound infection, in patients with a history of genitourinary infections, decreases the delay in diagnosis and treatment. In these cases rapid real-time PCR on deep cultures should be considered.
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Affiliation(s)
- Matthijs R. Krijnen
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Thecla Hekker
- Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Johan Algra
- Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul I. J. M. Wuisman
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Barend J. Van Royen
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands
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Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005; 84:162-173. [PMID: 15879906 DOI: 10.1097/01.md.0000165658.82869.17] [Citation(s) in RCA: 285] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To identify the current etiologies of blood culture-negative infective endocarditis and to describe the epidemiologic, clinical, laboratory, and echocardiographic characteristics associated with each etiology, as well as with unexplained cases, we tested samples from 348 patients suspected of having blood culture-negative infective endocarditis in our diagnostic center, the French National Reference Center for Rickettsial Diseases, between 1983 and 2001. Serology tests for Coxiella burnettii, Bartonella species, Chlamydia species, Legionella species, and Aspergillus species; blood culture on shell vial; and, when available, analysis of valve specimens through culture, microscopic examination, and direct PCR amplification were performed. Physicians were asked to complete a questionnaire, which was computerized. Only cases of definite infective endocarditis, as defined by the modified Duke criteria, were included. A total of 348 cases were recorded-to our knowledge, the largest series reported to date. Of those, 167 cases (48%) were associated with C. burnetii, 99 (28%) with Bartonella species, and 5 (1%) with rare, fastidious bacterial agents of endocarditis (Tropheryma whipplei, Abiotrophia elegans, Mycoplasma hominis, Legionella pneumophila). Among 73 cases without etiology, 58 received antibiotic drugs before the blood cultures. Six cases were right-sided endocarditis and 4 occurred in patients who had a permanent pacemaker. Finally, no explanatory factor was found for 5 remaining cases (1%), despite all investigations.Q fever endocarditis affected males in 75% of cases, between 40 and 70 years of age. Ninety-one percent of patients had a previous valvulopathy, 32% were immunocompromised, and 70% had been exposed to animals. Our study confirms the improved clinical presentation and prognosis of the disease observed during the last decades. Such an evolution could be related to earlier diagnosis due to better physician awareness and more sensitive diagnostic techniques. As for Bartonella species, B. quintana was recorded more frequently than B. henselae (53 vs 17 cases). For 18 patients with Bartonella endocarditis, the responsible species was not identified. Species determination was achieved through culture and/or PCR in 49 cases and through Western immunoblotting in 22. Comparison of B. quintana and B. henselae endocarditis revealed distinct epidemiologic patterns. The 2 cases due to T. whipplei reflect the emerging role of this agent as a cause of infective endocarditis. Because identification of the bacterium was possible only through analysis of excised valves by histologic examination, PCR, and culture on shell vial, the prevalence of the disease might be underestimated. Among patients who received antibiotic drugs before blood cultures, 4 cases (7%) were found to be associated with Streptococcus species (2 S. bovis and 2 S. mutans) through 16S rDNA gene amplification directly from the valve, which shows the usefulness of this technique in overcoming the limitations of previous antibiotic treatment. Right-sided endocarditis occurred classically in young patients (mean age, 36 yr), intravenous drug users in 50% of cases, and suffering more often from embolic complications. Finally, 5 cases without etiology or explaining factors were all immunocompetent male patients with previous aortic valvular lesions, and 3 of the 5 presented with an aortic abscess. Further investigations should be focused on this group to identify new agents of infective endocarditis.
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Affiliation(s)
- Pierre Houpikian
- From Unitué des Rickettsies, Université de la Méditerraneé, Faculté de médecine, CNRS UPRES A 6020, 27 Boulevard Jean Moulin 13385 Marseille Cedex 05, France
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15
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Calza L, Manfredi R, Chiodo F. Infective endocarditis: a review of the best treatment options. Expert Opin Pharmacother 2005; 5:1899-916. [PMID: 15330728 DOI: 10.1517/14656566.5.9.1899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite significant advances in antimicrobial therapy and an enhanced ability to diagnose and treat complications, infective endocarditis is still associated with substantial morbidity and mortality today, and its incidence has not decreased over the past decades. This apparent paradox may be explained by a progressive change in risk factors, leading to an evolution in its epidemiological and clinical features. In fact, new risk factors for endocarditis have emerged, such as intravenous drug abuse, diffusion of heart surgery procedures and prosthetic valve implantation, atherosclerotic valve disease in elderly patients, and nosocomial disease. Recently identified microorganisms (including Bartonella spp., Abiotrophia defectiva, and the HACEK group of bacteria [including Haemophilus spp., Actinobacillus spp., Cardiobacterium hominis, Eikenella corrodens and Kingella kingae]) are sometimes the cause of culture-negative endocarditis, and emerging resistant bacteria (such as methicillin- or vancomycin-resistant Staphylococci and vancomycin-resistant Enterococci) are becoming a new challenge for conventional antibiotic therapy. New therapeutic approaches need to be developed for the treatment of infective endocarditis caused by drug-resistant Gram-positive cocci, and some antimicrobial compounds recently introduced in clinical practice (such as streptogramins and oxazolidinones) may be an effective alternative, but further clinical studies are needed in order to confirm their effectiveness and safety. This review should help redefine the best therapeutic and preventive strategies against infective endocarditis.
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Affiliation(s)
- Leonardo Calza
- Department of Clinical and Experimental Medicine, Division of Infectious Diseases, Alma Mater Studiorum University of Bologna, S. Orsola Hospital, via G. Massarenti 11, I-40138 Bologna, Italy.
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16
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Fenollar F, Gauduchon V, Casalta JP, Lepidi H, Vandenesch F, Raoult D. Mycoplasma Endocarditis: Two Case Reports and a Review. Clin Infect Dis 2004; 38:e21-4. [PMID: 14727231 DOI: 10.1086/380839] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Accepted: 09/09/2003] [Indexed: 11/03/2022] Open
Abstract
We describe 2 patients with endocarditis for whom blood cultures and cardiac valve cultures were repeatedly sterile. Broad-range eubacterial polymerase chain reaction (PCR) amplification performed on cardiac valve specimens from these 2 patients detected DNA of Mycoplasma hominis, for one patient, and of Ureaplasma parvum, for the other patient. Three other cases of infective endocarditis caused by mycoplasmas were identified in the literature. It is important to rule out a diagnosis of mycoplasma endocarditis because the evolution of the disease may be fatal and it requires an adequate and specific antibiotic therapy.
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Affiliation(s)
- Florence Fenollar
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, and Fédération de Bactériologie, Virologie et Hygiène hospitalière, Hôpital de la Timone, Marseille, France
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17
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Abstract
The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.
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Affiliation(s)
- P Brouqui
- Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 13385 Marseille Cedex 5, France.
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18
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Mattila PS, Carlson P, Sivonen A, Savola J, Luosto R, Salo J, Valtonen M. Life-threatening Mycoplasma hominis mediastinitis. Clin Infect Dis 1999; 29:1529-37. [PMID: 10585808 DOI: 10.1086/313529] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycoplasma hominis infections are easily missed because conventional methods for bacterial detection may fail. Here, 8 cases of septic mediastinitis due to M. hominis are reported and reviewed in the context of previously reported cases of mediastinitis, sternum wound infection, pleuritis, or pericarditis caused by M. hominis. All 8 patients had a predisposing initial condition related to poor cardiorespiratory function, aspiration, or complications related to coronary artery surgery or other thoracic surgeries. Mediastinitis was associated with purulent pleural effusion and acute septic symptoms requiring inotropic medication and ventilatory support. Later, the patients had a tendency for indolent chronic courses with pleuritis, pericarditis, or open sternal wounds that lasted for several months. M. hominis infections may also present as mild sternum wound infection or as chronic local pericarditis or pleuritis without septic mediastinitis. Treatment includes surgical drainage and debridement. Antibiotics effective against M. hominis should be considered when treating mediastinitis of unknown etiology.
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Affiliation(s)
- P S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.
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19
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Frangogiannis NG, Cate TR. Endocarditis and Ureaplasma urealyticum osteomyelitis in a hypogammaglobulinemic patient. A case report and review of the literature. J Infect 1998; 37:181-4. [PMID: 9821094 DOI: 10.1016/s0163-4453(98)80174-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a hypogammaglobulinemic patient who developed chronic polyarthritis and osteomyelitis due to Ureaplasma urealyticum. He also had mitral valve endocarditis of uncertain origin. Patients with primary antibody deficiency show increased susceptibility to mycoplasma infections. Early diagnosis and treatment is very important in order to prevent potentially debilitating complications.
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Affiliation(s)
- N G Frangogiannis
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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20
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Affiliation(s)
- P D Barnes
- Academic Unit of Infectious Disease and Microbiology, John Radcliffe Hospital, Oxford, UK
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21
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Berbari EF, Cockerill FR, Steckelberg JM. Infective endocarditis due to unusual or fastidious microorganisms. Mayo Clin Proc 1997; 72:532-42. [PMID: 9179137 DOI: 10.4065/72.6.532] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infective endocarditis due to fastidious microorganisms is commonly encountered in clinical practice. Some organisms such as fungi account for up to 15% of cases of prosthetic valve infective endocarditis, whereas organisms of the HACEK group (Haemophilus parainfluenzae, H. aphrophilus, and H. paraphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) cause 3% of community-acquired cases of infective endocarditis. Special techniques are necessary to identify these microorganisms. A history of contact with mammals or birds may suggest infection caused by Coxiella burnetii (Q fever), Brucella species, or Chlamydia psittaci. A nosocomial cluster of postsurgical infective endocarditis may be caused by Legionella species or Mycobacterium species. If risk factors that are commonly associated with fungal infections (cardiac surgical treatment, prolonged hospitalization, indwelling central venous catheters, and long-term antibiotic use) are present, fungal endocarditis is possible. Patients with endocarditis and a history of periodontal disease or dental work in whom routine blood cultures are negative might have infection due to nutritionally variant streptococci or bacteria of the HACEK group. Communication between the microbiologist and the clinician is of crucial importance for identification of these microorganisms early during the course of the infection before complications such as embolization or valvular failure occur. In this article, we review the microbiologic and clinical features of these organisms and provide recommendations for diagnosis and treatment.
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Affiliation(s)
- E F Berbari
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 2-1997. A 38-year-old man with digital clubbing, low-grade fever, and a murmur. N Engl J Med 1997; 336:205-10. [PMID: 8988901 DOI: 10.1056/nejm199701163360308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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23
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Levi N, Prag J, Skov Jensen J, Just S, Schroeder TV, Lorentzen JE. Aortic graft infection with mycoplasma (Ureaplasma urealyticum). Eur J Vasc Endovasc Surg 1995; 10:374-5. [PMID: 7552544 DOI: 10.1016/s1078-5884(05)80062-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N Levi
- Department of Vascular Surgery, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Pigrau C, Almirante B, Gasser I, Pahissa A. Sternotomy infection due to Mycoplasma hominis and Ureaplasma urealyticum. Eur J Clin Microbiol Infect Dis 1995; 14:597-8. [PMID: 7588844 DOI: 10.1007/bf01690731] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mycoplasma hominis infections outside the urogenital tract are uncommon. An unusual case of sternal infection caused by both Mycoplasma hominis and Ureaplasma urealyticum is described. This is the first report found in the literature of mixed infection due to these microorganisms at this site. The outcome was favourable after drainage of the surgical wound and antibiotic therapy with clindamycin, gentamicin and doxycycline.
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Affiliation(s)
- C Pigrau
- Infectious Diseases Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Spain
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25
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Martres P, Testart F, Blanchard G, Boulet E, Trouillet G, Thibault M. Mycoplasma hominis et médiastinites : à propos de deux cas. Med Mal Infect 1995. [DOI: 10.1016/s0399-077x(05)81341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Abstract
A 59-yr-old male alcoholic with bilateral nephrocalcinosis and upper urinary tract stones presented with fever, acute abdominal signs and ascites. Laparotomy revealed the presence of 1.5 litres of ascitic fluid and confirmed right-sided acute pyelonephritis. Culture of urine from the renal pelvis obtained during surgery was positive for Mycoplasma hominis. Initial therapy with cefuroxime failed and doxycycline was later initiated when culture was positive for Mycoplasma hominis, with definite clinical improvement. This is an unusual case of acute pyelonephritis with peritoneal signs and ascites due to Mycoplasma hominis in an elderly male who had no recent history of urinary tract instrumentation.
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Affiliation(s)
- S S Wong
- Department of Microbiology, University of Hong Kong, Queen Mary Hospital
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27
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Testart F, Boulet E, Blanchard G, Richecoeur J, Blanc P, Trouillet G, Thibault M. A propos d'un nouveau cas de médiastinite à Mycoplasma hominis. Med Mal Infect 1994. [DOI: 10.1016/s0399-077x(05)80506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ginsburg KS, Kundsin RB, Walter CW, Schur PH. Ureaplasma urealyticum and Mycoplasma hominis in women with systemic lupus erythematosus. ARTHRITIS AND RHEUMATISM 1992; 35:429-33. [PMID: 1567492 DOI: 10.1002/art.1780350412] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the prevalence of genitourinary mycoplasma infection in women with systemic lupus erythematosus (SLE). METHODS Urine specimens from 49 patients with SLE and 22 patients with chronic fatigue syndrome (CFS) were cultured for mycoplasma. Patient records were reviewed for medical history and SLE disease activity. RESULTS Sixty-three percent of the SLE patients were culture positive, compared with 4.5% of the CFS patients (P less than 0.001). Neither corticosteroid treatment, SLE activity, nor age accounted for this difference. CONCLUSION Genitourinary mycoplasma colonization occurs significantly more frequently in SLE than in CFS.
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Affiliation(s)
- K S Ginsburg
- Department of Rheumatology and Immunology, Brigham and Women's Hospital, Boston, MA 02115
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Sacher HL, Miller WC, Landau SW, Sacher ML, Dixon WA, Dietrich KA. Relapsing native-valve enterococcal endocarditis: a unique cure with oral ciprofloxacin combination drug therapy. J Clin Pharmacol 1991; 31:719-21. [PMID: 1908863 DOI: 10.1002/j.1552-4604.1991.tb03766.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Enterococcal endocarditis is the third most common presentation in native valves, and it is the most refractory. Unique among the streptococci, enterococci are relatively resistant to beta-lactam antibiotics requiring a combination aminoglycoside regimen for cure. Relapse is common even after apparently adequate therapy and may be seen in up to 25% of cases that involve streptomycin-resistant strains. This problem is magnified by the recent appearance of beta-lactamase-producing strains of S. faecalis resistant to both ampicillin and gentamicin. Ciprofloxacin is being investigated with a number of antimicrobials in the attempt to identify superior protocols against troublesome pathogens. However, little published data is available concerning the clinical efficacy of this drug in enterococcal endocarditis. In vitro studies and preliminary trials with animal models have generally been disappointing with broth macrodilution time-kill or agar dilution proving the most reliable in vitro methods for predicting in vivo outcomes. The urgent need to identify new combination drug regimens is underscored not only by the development of new resistance patterns, but by the well-documented toxicities of conventional therapies. The authors present a case of relapsing enterococcal endocarditis caused by a non-beta-lactamase-producing strain of S. faecalis, which demonstrated high-level resistance to streptomycin but not to gentamicin. Relapses occurred despite favorable laboratory data and aggressive beta-lactam-gentamicin therapies. Cure was achieved using oral ciprofloxacin in a combination drug regimen, which is reported here for the first time.
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Affiliation(s)
- H L Sacher
- Department of Internal Medicine, Massapequa General Hospital, Seaford, Long Island, New York 11783
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Abstract
PURPOSE To heighten awareness of the role of Mycoplasma hominis as an extragenital pathogen in adults. PATIENTS AND METHODS AND RESULTS Patients ranged in age from 14 to 76 years. Thirteen patients were immunosuppressed, including nine organ transplant recipients; three were receiving steroids, and two had an underlying malignancy. The remainder were immunocompetent. Thirteen patients had prior surgery at or near the site of infection. M. hominis was isolated from normally sterile sites such as blood or cerebrospinal, pleural, abdominal and joint fluids, and bone. Non-sterile sites of isolation included surgical wounds and pulmonary secretions. The organism was detected in anaerobic cultures of clinical specimens sent to the laboratory for routine bacteriologic culture. Gram stains of fluids or wound drainage revealed neutrophils but no bacteria. Anti-mycoplasmal therapy was effective in eradicating the organism in 13 of 15 patients who were treated. Of those in whom treatment failed, one patient had an antibiotic-resistant isolate and the other had M. hominis isolated from the lung at postmortem after just 2 days of therapy. CONCLUSION Our experience suggests that significant infections due to M. hominis, although uncommon, are not rare, and methods to isolate and identify this organism should be available for general adult medical and surgical populations.
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Affiliation(s)
- D K McMahon
- Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
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