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Lin KP, Yeh TK, Chuang YC, Wang LA, Fu YC, Liu PY. Blood Culture Negative Endocarditis: A Review of Laboratory Diagnostic Approaches. Int J Gen Med 2023; 16:317-327. [PMID: 36718144 PMCID: PMC9884005 DOI: 10.2147/ijgm.s393329] [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: 10/18/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Infective endocarditis is a potentially fatal condition, and identifying the pathogen is crucial to optimizing antibiotic treatment. While a blood culture takes time and may yield negative results, it remains the gold standard for diagnosis, blood culture-negative endocarditis, which accounts for up to 20% of infective endocarditis cases, poses a clinical challenge with increasing mortality. To better understand the etiology of blood culture-negative infective endocarditis, we reviewed non-culture-based strategies and compared the results. Serology tests work best in limited pathogens, such as Coxiella burnetii and Bartonella infections. Most of the pathogens identified by broad-range PCR tests are Streptococcus spp, Staphylococcus spp and Propionibacterium spp. adding specific real-time PCR assays to the systematic PCR testing of patients with blood culture-negative endocarditis will increase the efficiency of diagnosis. Recently, metagenomic next-generation sequencing has also shown promising results.
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Affiliation(s)
- Kuan-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Kuang Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chuan Chuang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-An Wang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Ching Fu
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Correspondence: Yun-Ching Fu; Po-Yu Liu, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Blvd, Xitun District, Taichung City, 40705, Taiwan, Tel +886-4-2359-2525 ext.3110, Fax +886-4-2359-5046, Email ;
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Melenotte C, Epelboin L, Million M, Hubert S, Monsec T, Djossou F, Mège JL, Habib G, Raoult D. Acute Q Fever Endocarditis: A Paradigm Shift Following the Systematic Use of Transthoracic Echocardiography During Acute Q Fever. Clin Infect Dis 2020; 69:1987-1995. [PMID: 30785186 DOI: 10.1093/cid/ciz120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 02/04/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND As Q fever, caused by Coxiella burnetii, is a major health challenge due to its cardiovascular complications, we aimed to detect acute Q fever valvular injury to improve therapeutic management. METHODS In the French national reference center for Q fever, we prospectively collected data from patients with acute Q fever and valvular injury. We identified a new clinical entity, acute Q fever endocarditis, defined as valvular lesion potentially caused by C. burnetii: vegetation, valvular nodular thickening, rupture of chorda tendinae, and valve or chorda tendinae thickness. To determine whether or not the disease was superimposed on an underlying valvulopathy, patients' physicians were contacted. Aortic bicuspidy, valvular stenosis, and insufficiency were considered as underlying valvulopathies. RESULTS Of the 2434 patients treated in our center, 1797 had acute Q fever and 48 had acute Q fever endocarditis. In 35 cases (72%), transthoracic echocardiography (TTE) identified a valvular lesion of acute Q fever endocarditis without underlying valvulopathy. Positive anticardiolipin antibodies (>22 immunoglobulin G-type phospholipid units [GPLU]) were independently associated with acute Q fever endocarditis (odds ratio [OR], 2.7 [95% confidence interval {CI}, 1.3-5.5]; P = .004). Acute Q fever endocarditis (OR, 5.2 [95% CI, 2.6-10.5]; P < .001) and age (OR, 1.7 [95% CI, 1.1-1.9]; P = .02) were independent predictors of progression toward persistent C. burnetii endocarditis. CONCLUSIONS Systematic TTE in acute Q fever patients offers a unique opportunity for early diagnosis of acute Q fever endocarditis and for the prevention of persistent endocarditis. Transesophageal echocardiography should be proposed in men, aged >40 years, with anticardiolipin antibodies >60 GPLU when TTE is inconclusive or negative.
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Affiliation(s)
- Cléa Melenotte
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections, Institut Hospitalo Universitaire-Méditerranée Infection, Cayenne
| | - Loïc Epelboin
- Unité de Maladies infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne
| | - Matthieu Million
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections, Institut Hospitalo Universitaire-Méditerranée Infection, Cayenne
| | - Sandrine Hubert
- Department of Cardiology, Aix-Marseille Université, Marseille
| | - Thierry Monsec
- Department of Cardiologie, Centre Hospitalier de Valence, France
| | - Félix Djossou
- Unité de Maladies infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne
| | - Jean-Louis Mège
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections, Institut Hospitalo Universitaire-Méditerranée Infection, Cayenne
| | - Gilbert Habib
- Unité de Maladies infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne
| | - Didier Raoult
- Aix-Marseille Université, Institut de Recherche pour le Développement, Assistance publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections, Institut Hospitalo Universitaire-Méditerranée Infection, Cayenne
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Tak T, Dhawan S, Reynolds C, Shukla SK. Current diagnosis and treatment of infective endocarditis. Expert Rev Anti Infect Ther 2014; 1:639-54. [PMID: 15482161 DOI: 10.1586/14787210.1.4.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of infective endocarditis continues to rise with a yearly incidence of around 15,000 to 20,000 new cases in the USA. As a result, rapid diagnosis, effective treatment and prompt recognition of complications are essential to desirable clinical outcomes. Recent guidelines such as the Duke criteria have incorporated echocardiography for diagnosis of infective endocarditis, making this diagnostic test mandatory for patients with suspected infective endocarditis. The diversity of pathogens that can cause infective endocarditis, some of which cannot be cultured easily, makes diagnosis even more difficult. Coagulase-negative staphylococci and viridans streptococci groups continue to be the major causative microorganisms of infective endocarditis. In the case of culture-negative endocarditis or infective endocarditis caused by fastidious microorganisms, the polymerase chain reaction and probe-based diagnostic methods are available to clinical reference laboratories.
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Affiliation(s)
- Tahir Tak
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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4
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PCR-electrospray ionization mass spectrometry for direct detection of pathogens and antimicrobial resistance from heart valves in patients with infective endocarditis. J Clin Microbiol 2013; 51:2040-6. [PMID: 23596241 DOI: 10.1128/jcm.00304-13] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Microbiological diagnosis is pivotal to the appropriate management and treatment of infective endocarditis. We evaluated PCR-electrospray ionization mass spectrometry (PCR/ESI-MS) for bacterial and candidal detection using 83 formalin-fixed paraffin-embedded heart valves from subjects with endocarditis who had positive valve and/or blood cultures, 63 of whom had positive valvular Gram stains. PCR/ESI-MS yielded 55% positivity with concordant microbiology at the genus/species or organism group level (e.g., viridans group streptococci), 11% positivity with discordant microbiology, and 34% with no detection. PCR/ESI-MS detected all antimicrobial resistance encoded by mecA or vanA/B and identified a case of Tropheryma whipplei endocarditis not previously recognized.
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Casalta JP, Thuny F, Fournier PE, Lepidi H, Habib G, Grisoli D, Raoult D. DNA persistence and relapses questions on the treatment strategies of Enterococcus infections of prosthetic valves. PLoS One 2012; 7:e53335. [PMID: 23300913 PMCID: PMC3534059 DOI: 10.1371/journal.pone.0053335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 11/30/2012] [Indexed: 12/14/2022] Open
Abstract
We used amplification of the 16S rRNA gene followed by sequencing to evaluate the persistence of bacterial DNA in explanted heart valve tissue as part of the routine work of a clinical microbiology laboratory, and we analyzed the role of this persistence in the relapses observed in our center. We enrolled 286 patients treated for infective endocarditis (IE) who had valve replacement surgery and were diagnosed according to the modified Duke's criteria described by Li et al. from a total of 579 IE cases treated in our center. The patients were grouped based on the infecting bacteria, and we considered the 4 most common bacterial genus associated with IE separately (144 were caused by Streptococcus spp., 52 by Enterococcus spp., 58 by Staphylococcus aureus and 32 by coagulase-negative Staphylococcus). Based on our cohort, the risk of relapse in patients with enterococcal prosthetic valve infections treated with antibiotics alone was 11%. Bacterial DNA is cleared over time, but this might be a very slow process, especially with Enterococcus spp. Based on a comprehensive review of the literature performed on Medline, most reports still advise combined treatment with penicillin and an aminoglycoside for as long as 4-6 weeks, but there has been no consensus for the treatment of enterococcal infection of prostheses in IE patients.
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Affiliation(s)
- Jean-Paul Casalta
- URMITE, Aix Marseille Université, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Franck Thuny
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Pierre-Edouard Fournier
- URMITE, Aix Marseille Université, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Hubert Lepidi
- URMITE, Aix Marseille Université, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Gilbert Habib
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Dominique Grisoli
- Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
- * E-mail:
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6
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Abstract
Q fever is an ubiquitous zoonosis caused by Coxiella burneti, an intracellular bacterium that can produce acute or chronic infections in humans. These forms are characterized by different evolution, serological profile and treatment that must be very long to achieve a cure in chronic forms. However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. In this article, we describe in a comprehensive manner the different clinical presentations of the disease, making a critical overview of the evidence for serological predictions. We also take a broad view of new available diagnostic techniques and finally, we give recommendations for treatment.
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Affiliation(s)
- Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Manuel Siurot s/n, Sevilla, 41013, Spain,
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7
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Q Fever Presenting As Recurrent, Culture-negative Endocarditis with Aortic Prosthetic Valve Failure: A Case Report and Review of the Literature. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 17:341-4. [PMID: 18382649 DOI: 10.1155/2006/152624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 06/27/2006] [Indexed: 11/17/2022]
Abstract
The present report describes a case of recurrent, culture-negative endocarditis presenting with aortic prosthetic valve dysfunction in a 62-year-old man who required four valve replacement surgeries. On each occasion, he presented with valve failure. Fever was only documented during his first presentation. Furthermore, no vegetations were detectable on his aortic valve at transesophageal echocardiography. On the occasion of his most recent presentation, a detailed history of animal exposure - including hunting and skinning deer, moose and other large animals with his bare hands - was the only clue to his diagnosis. Serum antibodies against Coxiella burnetii were strongly positive, and C burnetii DNA was detected by polymerase chain reaction from his resected aortic valve tissue. Q fever is a worldwide zoonotic infection with diverse reservoirs. This diagnosis should be considered when evaluating unexplained prosthetic valve dysfunction, particularly in the setting of animal exposure.
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8
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Malou N, Raoult D. Immuno-PCR: a promising ultrasensitive diagnostic method to detect antigens and antibodies. Trends Microbiol 2011; 19:295-302. [DOI: 10.1016/j.tim.2011.03.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/09/2011] [Accepted: 03/08/2011] [Indexed: 11/30/2022]
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10
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Voldstedlund M, Pedersen LN, Fuursted K, Nielsen LP. Different Polymerase Chain Reaction-based Analyses for Culture-negative Endocarditis Caused by Streptococcus pneumoniae. ACTA ACUST UNITED AC 2010; 35:757-9. [PMID: 14606617 DOI: 10.1080/00365540310015971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Two cases of culture-negative infective endocarditis caused by Streptococcus pneumoniae are presented. Conventional bacteriological methods were compared with 2 different polymerase chain reaction (PCR)-based analyses: PCR amplification with primers specific for S. pneumoniae, and broad-range PCR followed by sequencing. PCR-based analyses can be a valuable supplement to traditional bacteriological analyses.
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Affiliation(s)
- Marianne Voldstedlund
- Department of Clinical Microbiology, Skejby Hospital, Brendstrupgaardsvej, Aarhus, Denmark.
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11
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Riedel S, Carroll KC. Blood cultures: key elements for best practices and future directions. J Infect Chemother 2010; 16:301-16. [PMID: 20490596 DOI: 10.1007/s10156-010-0069-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Indexed: 01/09/2023]
Abstract
Bloodstream infections (BSI) cause significant morbidity and mortality among populations worldwide. Blood cultures (BCs) are regarded as the "gold standard" for diagnosis of bacteremia and are among the most important functions of the clinical microbiology laboratory. Significant changes in the methods and techniques of obtaining BCs have occurred since the first inception of BCs into clinical practice. Aside from significant improvements of established, conventional technology, new assays for diagnosis of bacteremia and fungemia, particularly those involving molecular techniques, are now available. BCs must be collected under sterile conditions and guidelines for appropriate collection, processing, and results reporting of BCs have been established. This review provides comprehensive information on optimal BC practices for laboratories, utilizing traditional approaches and emerging technology. As laboratories and clinicians must appreciate the key factors affecting the use of these techniques, improved communication between laboratory personnel and clinicians regarding such elements as duration of incubation, workup of contaminants and critical action value reporting will greatly improve the diagnostic approach to BSI.
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Affiliation(s)
- Stefan Riedel
- Division of Microbiology, Department of Pathology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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12
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Calabrese F, Carturan E, Thiene G. Cardiac infections: focus on molecular diagnosis. Cardiovasc Pathol 2010; 19:171-82. [DOI: 10.1016/j.carpath.2009.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 01/09/2023] Open
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13
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Salmi D, Bhat A, Corman L, Raff G, Satake N. Diagnostic Challenges in Native Valve Fungal Endocarditis Producing a Massive Septic Pulmonary Embolus. ACTA ACUST UNITED AC 2010; 51:207-10. [DOI: 10.3314/jjmm.51.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Billeter SA, Diniz PPVP, Battisti JM, Munderloh UG, Breitschwerdt EB, Levy MG. Infection and replication of Bartonella species within a tick cell line. EXPERIMENTAL & APPLIED ACAROLOGY 2009; 49:193-208. [PMID: 19242658 PMCID: PMC4465226 DOI: 10.1007/s10493-009-9255-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 02/11/2009] [Indexed: 05/27/2023]
Abstract
Bartonella species are fastidious, gram negative bacteria, some of which are transmitted by arthropod vectors, including fleas, sandflies, and lice. There is very little information regarding the interaction and/or transmission capabilities of Bartonella species by ticks. In the present study, we demonstrate successful infection of the Amblyomma americanum cell line, AAE12, by seven Bartonella isolates and three Candidatus Bartonella species by electron or light microscopy. With the exception of Bartonella bovis, infection with all other examined Bartonella species induced cytopathic effects characterized by heavy cellular vacuolization and eventually cell lysis. Furthermore, using quantitative real time PCR (qPCR), we demonstrated significant amplification of two B. henselae genotype I isolates in the A. americanum cell line over a 5 days period. Ultimately, tick-cell derived Bartonella antigens may prove useful for the development of more sensitive diagnostic reagents and may assist in the development of an effective vaccine to prevent the further spread of disease caused by these organisms.
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Affiliation(s)
- Sarah A. Billeter
- Center for Comparative Medicine and Translational Research, Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, 4700 Hillsborough Street, Room 456, Raleigh, NC 27606, USA
| | - Pedro Paulo V. P. Diniz
- Center for Comparative Medicine and Translational Research, Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, 4700 Hillsborough Street, Room 456, Raleigh, NC 27606, USA
| | - James M. Battisti
- Division of Biological Sciences, University of Montana, Missoula, MT, USA
| | | | - Edward B. Breitschwerdt
- Center for Comparative Medicine and Translational Research, Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, 4700 Hillsborough Street, Room 456, Raleigh, NC 27606, USA
| | - Michael G. Levy
- Center for Comparative Medicine and Translational Research, Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, 4700 Hillsborough Street, Room 456, Raleigh, NC 27606, USA
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García-Lechuz Moya JM. [Infectious agents in the etiopathogenesis of rheumatic diseases]. ACTA ACUST UNITED AC 2008; 4 Suppl 2:29-34. [PMID: 21794561 DOI: 10.1016/s1699-258x(08)76165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is an author's view of how to face the knowledge about infectious agents and their pathogenic role in the starting immune mechanisms, trying to clarify its role in the origin of some rheumatic diseases. From the basic immune responds, recent evidence and newly molecular mechanisms are dissected as well as diagnostic and therapeutic implications.
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Affiliation(s)
- Juan M García-Lechuz Moya
- Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna. Hospital General Universitario Miguel Servet. Zaragoza. España
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López-Dupla M, Hernández S, Olona M, Mercé J, Lorenzo A, Tapiol J, Gómez F, Santamaría J, García R, Auguet T, Richart C, Castells E, Bardají A, Vidal F. Características clínicas y evolución de la endocarditis infecciosa en una población general no seleccionada, atendida en un hospital docente que no dispone de cirugía cardiaca. Estudio de 120 casos. Rev Esp Cardiol 2006. [DOI: 10.1157/13095782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Siciliano RF, Strabelli TM, Zeigler R, Rodrigues C, Castelli JB, Grinberg M, Colombo S, da Silva LJ, Mendes do Nascimento EM, Pereira dos Santos FC, Uip DE. Infective Endocarditis due to Bartonella spp. and Coxiella burnetii: Experience at a Cardiology Hospital in Sao Paulo, Brazil. Ann N Y Acad Sci 2006; 1078:215-22. [PMID: 17114712 DOI: 10.1196/annals.1374.123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis.
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Loa CC, Mordechai E, Tilton RC, Adelson ME. Production of recombinant Bartonella henselae 17-kDa protein for antibody-capture enzyme-linked immunosorbent assay. Diagn Microbiol Infect Dis 2006; 55:1-7. [PMID: 16490335 DOI: 10.1016/j.diagmicrobio.2005.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 10/19/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
The Bartonella henselae 17-kDa protein was expressed in a prokaryotic expression system as a histidine-tagged fusion protein and was purified. The target gene was cloned into a recombinant expression construct, pTri-17kd. The expressed protein was purified to near homogeneity by a nickel-agarose column chromatography. Protein recovery was estimated to be 2.9 mg from 100 mL of bacterial culture. The purified 17-kDa protein was recognized by serum from patients infected with B. henselae and Bartonella quintana, suggesting antigenic integrity. The sensitivity and specificity of the IgG enzyme-linked immunosorbent assay (ELISA) relative to immunofluorescent antibody assay testing were 71.1% and 93.0%, respectively. According to the receiver operating characteristic curve analysis, the area under the curve was 0.823. These results indicate that the expressed 17-kDa protein is a suitable source of antigen for development of an antibody-capture ELISA for the detection of antibodies to B. henselae.
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Affiliation(s)
- Chien Chang Loa
- Department of Research and Development, Medical Diagnostic Laboratories, L.L.C., Hamilton, NJ 08690, USA
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19
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Rosamel P, Cervantes M, Tristan A, Thivolet-Béjui F, Bastien O, Obadia JF, Lehot JJ. Active infectious endocarditis: postoperative outcome. J Cardiothorac Vasc Anesth 2005; 19:435-9. [PMID: 16085246 DOI: 10.1053/j.jvca.2005.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Many changes have occurred in the natural history and the management of active infectious endocarditis (AIE) in recent years. Therefore, the records of patients admitted in a tertiary care specialized hospital presenting with the Duke criteria were reviewed. METHODS Adults operated on to treat AIE were included during a 3-year period. Patients presenting with AIE associated with a pacemaker were not included. Bacteriologic investigations included blood cultures, intraoperative samplings (including polymerase chain reaction), and serologies. Clinical and bacteriologic factors associated with hospital mortality were studied by univariate regression analysis (p < 0.05). RESULTS Ninety-eight of 164 patients (60%) admitted with the diagnosis of AIE underwent valvular surgery. The duration between the beginning of AIE and surgery was 23 +/- 16 (mean +/- standard deviation) days. Only 45 patients had a previous history of valvular disease. Seventy-two patients presented with aortic and 41 with mitral valve AIE. Fifty suffered from embolic events. Streptococcus species were responsible in 64 cases (23 were Streptococcus bovis) and Staphylococcus species in 24 cases. Death occurred postoperatively in 19 patients. The factors associated with fatal outcome were preoperative hemodynamic instability, age, Parsonnet and Simplified Acute Physiology Score II scores, diabetes mellitus, preexisting valvulopathy, antiarrhythmic treatment, hypoalbuminemia, renal dysfunction, duration of extracorporeal circulation, and red cell allogeneic transfusions. The type of bacteria did not influence mortality. The mean intensive care unit and hospital stays were 10 and 39 days, respectively. Eleven patients suffered from neurologic sequelae; 2 years later, 2 of them presented with severe deficit and 1 had died. CONCLUSIONS AIE necessitating cardiac surgery should be considered as a severe and resource-consuming disease.
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Affiliation(s)
- Pascal Rosamel
- Department of Anesthesia and Intensive Care, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon Montchat, 69394 Lyon Cedex 03, France
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Greub G, Lepidi H, Rovery C, Casalta JP, Habib G, Collard F, Fournier PE, Raoult D. Diagnosis of infectious endocarditis in patients undergoing valve surgery. Am J Med 2005; 118:230-8. [PMID: 15745720 DOI: 10.1016/j.amjmed.2004.12.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Histologic examination of valve samples is considered as the gold standard for the diagnosis of infectious endocarditis. Molecular tools are also very promising for patients with negative-culture endocarditis. Thus, we studied the contribution of valvular histology, culture, and 16S rRNA PCR amplification plus sequencing to the diagnosis of infectious endocarditis in patients undergoing valve surgery. SUBJECTS AND METHODS We performed culture, histological examination, and broad-range PCR amplification plus sequencing on valve samples taken from 127 patients with infectious endocarditis and from 118 patients without endocarditis. The sensitivity and specificity of these tests for the diagnosis of endocarditis in patients undergoing valve surgery were studied. RESULTS The sensitivity of PCR was of 61% (64/105) whereas that of histological examination was of 63% (62/98) and that of valve culture was of only 13% (14/105). All 68 positive PCR results considered reliable according to an interpretation scheme were from patients with infectious endocarditis, resulting in a 100% (118/118) specificity of the interpreted molecular approach. The specificity of histology was also of 100% (118/118) when using stringent criteria (ie, presence of vegetation, microorganisms, and/or valvular inflammation with mainly polymorphonuclear cells). PCR identified an etiological agent in 38% (5/13) of definite blood culture-negative infectious endocarditis. CONCLUSION We show that valvular histology with stringent criteria is the gold standard for the diagnosis of infectious endocarditis. Broad-range amplification of 16S rRNA gene is indicated for infectious endocarditis of unknown etiology, whereas valve culture is of limited sensitivity.
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Affiliation(s)
- Gilbert Greub
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Rovery C, Greub G, Lepidi H, Casalta JP, Habib G, Collart F, Raoult D. PCR detection of bacteria on cardiac valves of patients with treated bacterial endocarditis. J Clin Microbiol 2005; 43:163-7. [PMID: 15634966 PMCID: PMC540121 DOI: 10.1128/jcm.43.1.163-167.2005] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We used broad-range PCR amplification and sequencing to detect and identify bacterial DNA in 156 valves of patients treated for infective endocarditis (IE). Bacterial DNA was found more frequently in patients who underwent valve replacement while on antibiotic treatment for IE (60%) than in patients who had completed antibiotic treatment for IE (37%; P = 0.02). We found specific bacterial DNA in valves removed from 11 of 30 patients who had completed antibiotic treatment for IE. Six had no histological evidence of IE. The presence of DNA was significantly correlated with the presence of histologic lesions (P = 0.001) and with the presence of bacteria detected by Gram staining (P < 0.001). Bartonella and streptococci were detected for much longer after antibiotic treatment by PCR than other species (P = 0.047 and 0.04, respectively), and coagulase-negative staphylococci were detected for much shorter periods (P = 0.02). The finding that bacterial DNA was more likely to be detected in valves of patients with active IE than in patients who had completed antibiotic treatment for IE shows that bacterial DNA is cleared slowly. There was no significant correlation between the duration of antibiotic therapy and the presence of bacterial DNA in valves. Since the persistence of bacterial DNA in valves does not necessarily indicate the persistence of viable bacteria, the detection of bacterial DNA in valves from IE patients should be interpreted with caution, in particular in those patients with a past history of treated IE.
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Affiliation(s)
- Clarisse Rovery
- Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Hôpital dde la Timone, Marseille, France
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OH YK, Hong SI, Song MJ, Kim YS, Chang KW, Chae HS, Lee H, Cho SG. A Case of Infective Endocarditis associated with Microcytic Hypochromic Anemia. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- You-Kyong OH
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-In Hong
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myoung-Joon Song
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon-Seong Kim
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Wook Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Suk Chae
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyegung Lee
- Department of Clinical Laboratories, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Goo Cho
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Albrich WC, Kraft C, Fisk T, Albrecht H. A mechanic with a bad valve: blood-culture-negative endocarditis. THE LANCET. INFECTIOUS DISEASES 2004; 4:777-84. [PMID: 15567127 DOI: 10.1016/s1473-3099(04)01226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 33-year-old man with a known bicuspid aortic valve presented with fever, chills, progressive fatigue, anorexia, and night sweats. Echocardiography confirmed aortic-valve endocarditis, but blood cultures remained negative. Bartonella henselae endocarditis was ultimately confirmed by serology as well as by immunohistochemistry and PCR testing of the excised valve. The patient recovered with appropriate antibiotic therapy. B henselae is a common cause of culture-negative endocarditis. It predominantly affects men with underlying valvular disease, and has a predilection for aortic valves. Diagnosis is usually made serologically and with either tissue culture, immunohistochemistry, or PCR. Treatment of this destructive endocarditis consists of a combination of long-term antibiotic therapy and surgical valve repair. This case is used to discuss the approach towards the treatment of patients with endocarditis that is blood-culture negative.
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Affiliation(s)
- Werner C Albrich
- Division of Infectious Diseases, Emory University Medical School, Altlanta, GA, USA.
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Anguita-Alonso P, Patel R. Molecular Methods in the Diagnosis of Endocarditis. Curr Infect Dis Rep 2004; 6:270-275. [PMID: 15265454 DOI: 10.1007/s11908-004-0047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Advances in molecular microbiologic diagnostics have yielded new tools to diagnose infective endocarditis. These tools can detect microorganisms that are difficult to grow or are uncultivable, because of prior antimicrobial therapy or because of innate characteristics of the microorganisms. This paper reviews molecular microbiologic diagnostic techniques and their role in the diagnosis of infective endocarditis.
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Affiliation(s)
- Paloma Anguita-Alonso
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Prendergast BD. Diagnostic criteria and problems in infective endocarditis. BRITISH HEART JOURNAL 2004; 90:611-3. [PMID: 15145855 PMCID: PMC1768277 DOI: 10.1136/hrt.2003.029850] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- B D Prendergast
- North-West Regional Cardiothoracic Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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Abstract
Infections due to Coxiella burnetii, the causative organism of Q fever, are extremely rare in North America. Endocarditis due to the organism has an unusual presentation and poses echocardiographic and laboratory challenges in establishing a diagnosis. We describe the presentation and clinical course of a 40-year-old American man with Q fever endocarditis and briefly discuss the salient issues regarding this entity.
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Affiliation(s)
- Apoor S Gami
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Abstract
Despite improvements in health care, the incidence of infective endocarditis has not decreased over the past decades. This apparent paradox is explained by a progressive evolution in risk factors; while classic predisposing conditions such as rheumatic heart disease have been all but eradicated, new risk factors for infective endocarditis have emerged. These include intravenous drug use, sclerotic valve disease in elderly patients, use of prosthetic valves, and nosocomial disease. Newly identified pathogens, which are difficult to cultivate--eg, Bartonella spp and Tropheryma whipplei--are present in selected individuals, and resistant organisms are challenging conventional antimicrobial therapy. Keeping up with these changes depends on a comprehensive approach, allying understanding of the pathogenesis of disease with the development of new drugs for infective endocarditis. Infection by staphylococci and streptococci is being dissected at the molecular level. New ideas for antimicrobial agents are being developed. These novel insights should help redefine preventive and therapeutic strategies against infective endocarditis.
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Affiliation(s)
- Philippe Moreillon
- Institute of Fundamental Microbiology, Centre Hospitalier Universitaire, University of Lausanne, Switzerland.
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