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Greer ME, Ghuman N, Johnson PT, Zimmerman SL, Fishman EK, Facciola J, Azadi JR. Tip of the iceberg: extracardiac CT findings in infective endocarditis. Emerg Radiol 2024:10.1007/s10140-024-02257-7. [PMID: 38941027 DOI: 10.1007/s10140-024-02257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.
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Affiliation(s)
- M E Greer
- School of Medicine, Georgetown University, Washington, DC, USA
| | - N Ghuman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - P T Johnson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - S L Zimmerman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - E K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - J Facciola
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - Javad R Azadi
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA.
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2
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Koike M, Doi T, Morishita K, Uruno K, Kawasaki-Nabuchi M, Komuro K, Iwano H, Naraoka S, Nagahara D, Yuda S. Impact of Hemoglobin Level, White Blood Cell Count, Renal Dysfunction, and Staphylococcus as the Causative Organism on Prediction of In-Hospital Mortality from Infective Endocarditis. Int Heart J 2024; 65:199-210. [PMID: 38556331 DOI: 10.1536/ihj.23-360] [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] [Indexed: 04/02/2024]
Abstract
Infective endocarditis (IE) is a highly fatal disease in cases of delayed diagnosis and treatment, although its incidence is low. However, there have been few single-center studies in which the risk of in-hospital death from IE was stratified according to laboratory findings on admission and the organism responsible for IE. In this study, a total of 162 patients who were admitted to our hospital during the period from 2009 to 2021, who were suspected of having IE according to the modified Duke classification, and for whom IE was confirmed by transesophageal echocardiography were retrospectively analyzed. Patients were observed for a mean-period of 43.7 days with the primary endpoint being in-hospital death. The in-hospital death group had a lower level of hemoglobin (Hb), higher white blood cell (WBC) count, lower level of estimated glomerular filtration rate (eGFR), and higher frequency of Staphylococcus being the causative agent than those in the non-in-hospital death group. In overall multivariate analysis, Hb, WBC count, eGFR, and Staphylococcus as the causative agent were identified to be significant prognostic determinants. IE patients with Hb < 10.6 g/dL, WBC count > 1.4 × 104/μL, eGFR < 28.1 mL/minute/1.7 m2, and Staphylococcus as the causative agent had significantly and synergistically increased in-hospital death rates compared to those in other IE patients. Low level of Hb, high WBC count, low eGFR, and Staphylococcus as the causative agent of IE were independent predictors of in-hospital mortality, suggesting that these 4 parameters may be combined to additively stratify the risk of in-hospital mortality.
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Affiliation(s)
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kosuke Uruno
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kaoru Komuro
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital
| | | | - Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital
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3
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Moscatelli S, Leo I, Bianco F, Surkova E, Pezel T, Donald NA, Triumbari EKA, Bassareo PP, Pradhan A, Cimini A, Perrone MA. The Role of Multimodality Imaging in Patients with Congenital Heart Disease and Infective Endocarditis. Diagnostics (Basel) 2023; 13:3638. [PMID: 38132222 PMCID: PMC10742664 DOI: 10.3390/diagnostics13243638] [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: 11/05/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Infective endocarditis (IE) represents an important medical challenge, particularly in patients with congenital heart diseases (CHD). Its early and accurate diagnosis is crucial for effective management to improve patient outcomes. Multimodality imaging is emerging as a powerful tool in the diagnosis and management of IE in CHD patients, offering a comprehensive and integrated approach that enhances diagnostic accuracy and guides therapeutic strategies. This review illustrates the utilities of each single multimodality imaging, including transthoracic and transoesophageal echocardiography, cardiac computed tomography (CCT), cardiovascular magnetic resonance imaging (CMR), and nuclear imaging modalities, in the diagnosis of IE in CHD patients. These imaging techniques provide crucial information about valvular and intracardiac structures, vegetation size and location, abscess formation, and associated complications, helping clinicians make timely and informed decisions. However, each one does have limitations that influence its applicability.
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Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Children NHS Foundation Trust, London WC1N 3JH, UK; (S.M.); (N.A.D.)
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guys’ and St Thomas’ NHS Trust, London SW3 5NP, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 5NP, UK;
| | - Théo Pezel
- Département de Cardiologie, Université Paris-Cité, Hôpital Universitaire de Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Inserm UMRS 942, 75010 Paris, France;
| | - Natasha Alexandra Donald
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Children NHS Foundation Trust, London WC1N 3JH, UK; (S.M.); (N.A.D.)
| | | | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital, Children’s Health Ireland Crumlin, D07 R2WY Dublin, Ireland;
| | - Akshyaya Pradhan
- Department of Cardiology, King George’s Medical University, Lucknow 226003, India;
| | - Andrea Cimini
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy
| | - Marco Alfonso Perrone
- Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
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4
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Sami S, Ali F, Pasha K. Native Tricuspid Valve Infective Endocarditis After Breast Skin Abscess. Cureus 2023; 15:e46607. [PMID: 37937025 PMCID: PMC10626000 DOI: 10.7759/cureus.46607] [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: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Tricuspid valve infective endocarditis is a rare disease in non-intravenous drug users. It can occur with congenital heart disease, foreign bodies such as central venous catheters and intracardiac devices, and in immunocompromised patients. In the present case, there was a left-sided breast abscess associated with tricuspid valve endocarditis in a patient without any apparent underlying causative factors. We present a case of a young female in her early 20s who arrived at the emergency department with complaints of fever, epistaxis, and vomiting. On clinical examination, she was found to have a fading 2 cm pinkish left breast skin lesion, which had formed on her breast 10 days ago. Blood cultures identified methicillin-resistant Staphylococcus aureus in the blood. A CT scan of the chest, abdomen, and pelvis revealed splenomegaly and an infective focus in the spleen. Subsequent echocardiography confirmed the diagnosis of infective endocarditis of the native tricuspid valve, which was treated with intravenous vancomycin. There was no history of intravenous drug abuse, congenital heart disease, placement of an intracardiac device, central venous catheter, or an immunocompromised state in this patient. Therefore, the diagnosis of infective endocarditis, characterized by a native tricuspid valve vegetation identified as a consequence of a left breast skin abscess, was made. A high index of suspicion is required for a non-specific presentation of tricuspid valve infective endocarditis and in the absence of any prior history of risk factors for right-sided infective endocarditis. Timely initiation of antibiotics depends on a preliminary clinical diagnosis.
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Affiliation(s)
- Sumayya Sami
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Faisal Ali
- Department of Gastroenterology and Hepatology, Shifa International Hospital Islamabad, Multan, PAK
| | - Kamran Pasha
- Department of Acute Medicine, Royal Surrey County Hospital, Guildford Surrey, GBR
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Mathé P, Göpel S, Hornuss D, Tobys D, Käding N, Eisenbeis S, Kohlmorgen B, Trauth J, Gölz H, Walker SV, Mischnik A, Peter S, Hölzl F, Rohde AM, Behnke M, Fritzenwanker M, Häcker G, Steffens B, Vehreschild M, Kramme E, Falgenhauer J, Peyerl-Hoffmann G, Seifert H, Rupp J, Gastmeier P, Imirzalioglu C, Tacconelli E, Kern W, Rieg S. Increasing numbers and complexity of Staphylococcus aureus bloodstream infection-14 years of prospective evaluation at a German tertiary care centre with multi-centre validation of findings. Clin Microbiol Infect 2023; 29:1197.e9-1197.e15. [PMID: 37277092 DOI: 10.1016/j.cmi.2023.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Staphylococcus aureus bloodstream infection (SAB) is a common and severe infection. This study aims to describe temporal trends in numbers, epidemiological characteristics, clinical manifestations, and outcomes of SAB. METHODS We performed a post-hoc analysis of three prospective SAB cohorts at the University Medical Centre Freiburg between 2006 and 2019. We validated our findings in a large German multi-centre cohort of five tertiary care centres (R-Net consortium, 2017-2019). Time-dependent trends were estimated using Poisson or beta regression models. RESULTS We included 1797 patients in the mono-centric and 2336 patients in the multi-centric analysis. Overall, we observed an increasing number of SAB cases over 14 years (6.4%/year and 1000 patient days, 95% CI: 5.1% to 7.7%), paralleled by an increase in the proportion of community-acquired SAB (4.9%/year [95% CI: 2.1% to 7.8%]) and a decrease in the rate of methicillin-resistant-SAB (-8.5%/year [95% CI: -11.2% to -5.6%]). All of these findings were confirmed in the multi-centre validation cohort (6.2% cases per 1000 patient cases/year [95% CI: -0.6% to 12.6%], community-acquired-SAB 8.7% [95% CI: -1.2% to 19.6%], methicillin-resistant S. aureus-SAB -18.6% [95% CI: -30.6 to -5.8%]). Moreover, we found an increasing proportion of patients with multiple risk factors for complicated/difficult-to-treat SAB (8.5%/year, 95% CI: 3.6% to 13.5%, p < 0.001), alongside an overall higher level of comorbidities (Charlson comorbidity score 0.23 points/year, 95% CI: 0.09 to 0.37, p 0.005). At the same time, the rate of deep-seated foci such as osteomyelitis or deep-seated abscesses significantly increased (6.7%, 95% CI: 3.9% to 9.6%, p < 0.001). A reduction of in-hospital mortality by 0.6% per year (95% CI: 0.08% to 1%) was observed in the subgroup of patients with infectious diseases consultations. DISCUSSION We found an increasing number of SAB combined with a significant increase in comorbidities and complicating factors in tertiary care centres. The resulting challenges in securing adequate SAB management in the face of high patient turnover will become an important task for physicians.
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Affiliation(s)
- Philipp Mathé
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Siri Göpel
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Hornuss
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - David Tobys
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadja Käding
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Simone Eisenbeis
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Britta Kohlmorgen
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Janina Trauth
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Internal Medicine (Infectious Diseases), Uniklinikum Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hanna Gölz
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Sarah V Walker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute for Clinical Microbiology and Hospital Hygiene, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Alexander Mischnik
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Silke Peter
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Florian Hölzl
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Anna M Rohde
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Michael Behnke
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Moritz Fritzenwanker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Georg Häcker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Benedict Steffens
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria Vehreschild
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Evelyn Kramme
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jane Falgenhauer
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Harald Seifert
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rupp
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Petra Gastmeier
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Can Imirzalioglu
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Evelina Tacconelli
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany.
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Muacevic A, Adler JR. Fungal Endocarditis: A Rare Case of Multiple Arterial Embolization. Cureus 2023; 15:e33312. [PMID: 36741648 PMCID: PMC9894501 DOI: 10.7759/cureus.33312] [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: 12/31/2022] [Indexed: 02/07/2023] Open
Abstract
Fungal endocarditis is a rare and fatal condition, with a mortality of up to 75%, affecting immunocompromised hosts with a predisposing condition, namely, a history of previous cardiac or noncardiac surgery. Embolization is frequent, accounting for 44% of cases, and as the most common site is the brain, it can cause leptomeningitis, parenchymal granulomas, or abscesses. This case report describes a man with aortic valve replacement one year ago and a recent carotid endarterectomy who was admitted with fever and neurological deficits. The workup permitted a diagnosis of fungal endocarditis, and the patient underwent a combined and aggressive treatment approach with antifungal therapy and surgery, with a successful replacement of the aortic valve. During hospitalization, the patient's neurological status deteriorated, and a cerebral abscess was discovered on the left frontal lobe. Despite the poor prognosis, the patient recovered slowly and was discharged from the hospital three months later. The present case highlights the high index of suspicion needed for the diagnosis and the need for a multidisciplinary team to approach these patients to achieve a positive outcome.
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7
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Li J, Ruegamer T, Brochhausen C, Menhart K, Hiergeist A, Kraemer L, Hellwig D, Maier LS, Schmid C, Jantsch J, Schach C. Infective Endocarditis: Predictive Factors for Diagnosis and Mortality in Surgically Treated Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120467. [PMID: 36547464 PMCID: PMC9788195 DOI: 10.3390/jcdd9120467] [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: 10/18/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Diagnosis of infective endocarditis (IE) often is challenging, and mortality is high in such patients. Our goal was to characterize common diagnostic tools to enable a rapid and accurate diagnosis and to correlate these tools with mortality outcomes. Methods: Because of the possibility of including perioperative diagnostics, only surgically treated patients with suspected left-sided IE were included in this retrospective, monocentric study. A clinical committee confirmed the diagnosis of IE. Results: 201 consecutive patients (age 64 ± 13 years, 74% male) were finally diagnosed with IE, and 14 patients turned out IE-negative. Preoperative tests with the highest sensitivity for IE were positive blood cultures (89.0%) and transesophageal echocardiography (87.5%). In receiver operating characteristics, vegetation size revealed high predictive power for IE (AUC 0.800, p < 0.001) with an optimal cut-off value of 11.5 mm. Systemic embolism was associated with mortality, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) had predictive power for mortality. Conclusion: If diagnostic standard tools remain inconclusive, we suggest employing novel cut-off values to increase diagnostic accuracy and accelerate diagnosis. Patients with embolism or elevated NT-proBNP deserve a closer follow-up.
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Affiliation(s)
- Jing Li
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Tamara Ruegamer
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Department for Pathology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Karin Menhart
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lukas Kraemer
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Dirk Hellwig
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lars S. Maier
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christof Schmid
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Köln, Germany
| | - Christian Schach
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-7210; Fax: +49-941-944-7235
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8
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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9
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Takizawa K, Ozasa K, Matsumoto K, Nakata J, Noma N. Infective Endocarditis With Secondary Headache: A Case Report. Cureus 2022; 14:e26791. [PMID: 35967166 PMCID: PMC9366033 DOI: 10.7759/cureus.26791] [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: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Secondary headache is a symptom of an underlying disease. Infective endocarditis (IE) is a serious infection of the heart tissue. Herein, we present a rare case of IE, with a secondary headache. The patient presented with persistent headache, fever of 39°C, myalgia, and painful erythema of the plantar surface of the foot. The headache progressively worsened over a few weeks. She was diagnosed with secondary headache, and sepsis was suspected. Blood culture revealed the presence of Streptococcus viridans, leading to a diagnosis of IE. Postoperatively, the patient recuperated without any complications. Headaches can be secondary to other conditions. Therefore, comprehensive assessment and accurate diagnosis are essential. Dentists must be aware that headache is a concomitant symptom of IE.
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10
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Pecoraro AJK, Herbst PG, Pienaar C, Taljaard J, Prozesky H, Janson J, Doubell AF. Modified Duke/European Society of Cardiology 2015 clinical criteria for infective endocarditis: time for an update? Open Heart 2022; 9:openhrt-2021-001856. [PMID: 35534094 PMCID: PMC9086646 DOI: 10.1136/openhrt-2021-001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background The diagnosis of infective endocarditis (IE) is based on the modified Duke/European Society of Cardiology (ESC) 2015 clinical criteria. The sensitivity of the criteria is unknown in South Africa, but high rates of blood culture negative endocarditis (BCNIE), coupled with a change in the clinical features of IE, may limit the sensitivity. Methods The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and June 2021. A standardised protocol for organism detection, with management of patients by an Endocarditis Team, was employed. Patients with definite IE by pathological criteria were analysed to determine the sensitivity of the current clinical criteria. Results Eighty consecutive patients with IE were included of which 45 (56.3%) had definite IE by pathological criteria. In patients with definite IE by pathological criteria, 26/45 (57.8%) of patients were classified as definite IE by clinical criteria. BCNIE was present in 25/45 (55.6%) of patients and less than three minor clinical criteria were present in 32/45 (75.6%) of patients. The elevation of Bartonella serology to a major microbiological criterion of the modified Duke/ESC 2015 clinical criteria would increase the sensitivity (57.8% vs 77.8%; p=0.07). Conclusion The sensitivity of the modified Duke/ESC 2015 clinical criteria is lower than expected in patients with IE in South Africa, primarily due to the high rates of Bartonella-associated BCNIE. The elevation of Bartonella serology to a major microbiological criterion, similar to the status of Coxiella burnetii in the current criteria, would increase the sensitivity. The majority of patients with definite IE by pathological criteria had less than three minor criteria present.
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Affiliation(s)
- Alfonso Jan Kemp Pecoraro
- Division of Cardiology, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Philipus George Herbst
- Division of Cardiology, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Colette Pienaar
- Division of Medical Microbiology, Department of Pathology, Stellenbusch University Faculty of Medicine and Health Sceinces, Cape Town, Western Cape, South Africa.,National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Hans Prozesky
- Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgery, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Anton Frans Doubell
- Division of Cardiology, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
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Simos PA, Holland DJ, Stewart A, Isler B, Hughes I, Price N, Henderson A, Alcorn K. Clinical prediction scores and the utility of time to blood culture positivity in stratifying the risk of infective endocarditis in Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2022; 77:2003-2010. [DOI: 10.1093/jac/dkac129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/31/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) complicates up to a quarter of Staphylococcus aureus bacteraemia (SAB) cases. Risk scores predict IE complicating SAB but have undergone limited external validation, especially in community-acquired infections and those who use IV drugs. Addition of the time to positive culture (TTP) may provide incremental risk prognostication.
Objectives
To externally validate risk scores for predicting IE in SAB and assess the incremental value of TTP.
Methods
The modified Duke score was calculated for adults hospitalized with SAB at a major tertiary institution. All patients underwent echocardiography. Sensitivity and specificity of the risk scores for predicting IE were calculated, and the incremental value of TTP was assessed.
Results
One hundred and six cases were analysed and 18 (17%) met definite IE criteria. The optimal TTP to predict IE was 11.5 h (sensitivity 88.9%; specificity 71.6%). The sensitivity of VIRSTA and PREDICT (Predicting risk of endocarditis using a clinical tool) were similar (94.4% for both) and higher than POSITIVE (Prediction Of Staphylococcus aureus Infective endocarditis Time to positivity, IV drug use, Vascular phenomena, pre-Existing heart condition; 77.8%). The receiver-operator characteristic AUCs were VIRSTA 0.83, PREDICT 0.75, POSITIVE 0.89 and TTP 0.85. Adding TTP to VIRSTA (i.e. VIRSTA+) resulted in the highest AUC (0.90), sensitivity (100%) and negative predictive value (100%), albeit with a low specificity (33%).
Conclusions
The VIRSTA and POSITIVE scores were the strongest predictors for IE complicating SAB. The addition of TTP to VIRSTA (VIRSTA+) significantly improved discriminatory value and may be safely used to rationalize echocardiography strategies.
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Affiliation(s)
- Peter A. Simos
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Infectious Disease Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David J. Holland
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - Adam Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
- Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Burcu Isler
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Price
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Henderson
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kylie Alcorn
- Infectious Disease Department, Gold Coast University Hospital, Southport, Queensland, Australia
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Urina-Jassir M, Jaimes-Reyes MA, Martinez-Vernaza S, Quiroga-Vergara C, Urina-Triana M. Clinical, Microbiological, and Imaging Characteristics of Infective Endocarditis in Latin America: A Systematic Review. Int J Infect Dis 2022; 117:312-321. [PMID: 35181535 DOI: 10.1016/j.ijid.2022.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We aimed to describe the clinical, microbiological, and imaging characteristics of patients with infective endocarditis (IE) in studies from Latin America (LATAM). METHODS A systematic search through PubMed, EMBASE, LILACS, and SciELO from inception until February 2021 was conducted. We included observational studies that assessed adults with IE from LATAM and reported data on clinical, microbiological, or imaging characteristics. Data were independently extracted by 2 authors and the risk of bias was evaluated by study design with its respective tool. Findings were summarized using descriptive statistics. RESULTS Forty-four studies were included. Most cases were male (68.5%), had a predisposing condition including valve disease (24.3%), or had a prosthetic valve (23.4%). Clinical manifestations included fever (83.9%), malaise (63.2%), or heart murmur (57.7%). A total of 36.4% and 27.1% developed heart failure or embolism, respectively. Blood cultures were negative in 23.9% and S. aureus (18.6%) and the viridans group streptococci (17.8%) were the most common isolates. Most cases were native valve IE (67.3%) affecting mainly left-sided valves. Echocardiographic findings included vegetations (84.3%) and regurgitation (75.9%). In-hospital mortality was 25.1%. CONCLUSIONS This is the first systematic review that evaluated the characteristics of IE in LATAM patients. A lack of multicenter studies reflects the need for these studies in LATAM.
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Affiliation(s)
- Manuel Urina-Jassir
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Maria Alejandra Jaimes-Reyes
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
| | - Samuel Martinez-Vernaza
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Camilo Quiroga-Vergara
- Unidad de Infectología, Hospital Universitario San Ignacio, Bogotá D.C., Colombia. Full postal address: Calle 41 #13-06 Piso 2, Bogotá D.C., Colombia.
| | - Miguel Urina-Triana
- Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia; Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia. Full postal address: Carrera 59 # 59 - 65, Barranquilla, Atlántico, Colombia.
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13
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Wang W, Patel R, Beavis JH, Harky A. Viral endomyocarditis: a mystery or a missed diagnosis? Future Virol 2021. [DOI: 10.2217/fvl-2021-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- William Wang
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ruhi Patel
- Imperial College School of Medicine, Imperial College of Science, Technology and Medicine, London, UK
| | - James Huxley Beavis
- Aberdeen School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
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