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Canetta PA. Right Heart, Wronged Kidneys. Clin J Am Soc Nephrol 2023; 18:813-815. [PMID: 36988331 PMCID: PMC10278778 DOI: 10.2215/cjn.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Pietro A Canetta
- Nephrology Division, Columbia University Irving Medical Center, New York, New York
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2
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Shahzad MA, Aziz KT, Korbet S. Bartonella henselae Infective Endocarditis: A Rare Cause of Pauci-Immune Necrotizing Glomerulonephritis-A Case Report. Can J Kidney Health Dis 2023; 10:20543581221150554. [PMID: 36700055 PMCID: PMC9869233 DOI: 10.1177/20543581221150554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
Rationale Bartonella sp. are the most common causes of culture-negative infective endocarditis (IE) cases in the United States. Although, infection-related glomerulonephritis can frequently mimic primary vasculitis due to pauci-immune pattern, majority of previously reported cases of Bartonella henselae-associated glomerulonephritis have immune-complex deposits on immunofluorescence. We present a rare case of B henselae IE-related pauci-immune necrotizing glomerulonephritis. Timely recognition of this atypical presentation led to appropriately directed medical therapy. Presenting concerns of the patient A 33-year-old Caucasian male with a history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART), alcohol abuse, previous subarachnoid hemorrhage (SAH), and recent wisdom tooth extraction (on amoxicillin) was transferred from an outside hospital for further evaluation of severe headache. He was diagnosed with an SAH and right anterior cerebral artery mycotic aneurysm. The serum creatinine at the outside hospital was 292 umol/L (3.3 mg/dL) with a previously normal baseline around 2 years ago. The serum creatinine at our institution was 256 umol/L (3.0 mg/dL). The urinalysis demonstrated +100 protein, +3 blood and 29 red blood cells/high power field. The urine protein creatinine ratio (UPC) was 1.7 g/g. Serologic evaluation was positive for a low C4 10.2 mg/dL, elevated rheumatoid factor 40 IU/mL and an elevated proteinase 3 (PR-3) antineutrophilic cytoplasmic antibodies (ANCA Ab) 4.0 U/mL. A transesophageal echocardiogram (TEE) showed echo densities on both mitral and aortic valve. Blood cultures were negative. Further serologic evaluation was positive for B henselae IgG titer of 1:2560 (normal <1:320) with a negative IgM titer. Diagnoses A percutaneous kidney biopsy revealed pauci-immune necrotizing glomerulonephritis, with 14/16 glomeruli globally sclerotic, and 2 glomeruli with active segmental necrotizing lesions. There was no evidence of immune-complex deposition on immunofluorescence or electron microscopy. Clinical findings were consistent with B henselae IE associated mycotic aneurysm and necrotizing glomerulonephritis. Intervention Empiric treatment for an active glomerulonephritis with immunosuppressive agents was deferred on admission, given concern for an underlying infectious process and mycotic aneurysms in an HIV-positive patient. He received antibiotic treatment with doxycycline and ceftriaxone with gentamicin for synergy. Despite this, the mitral and aortic valve regurgitation worsened, and he developed congestive heart failure requiring aortic valve replacement and mitral valve repair. The explanted aortic valve was positive for B henselae by polymerase chain reaction (PCR) confirming the diagnosis of B henselae IE. Outcomes Immunosuppression was deferred due to timely identification of an atypical presentation of B henselae-associated ANCA antibodies-positive, pauci-immune necrotizing glomerulonephritis. A course of antibiotic treatment resulted in improved renal functions along with undetectable B henselae and PR3 Ab titers. The serum creatinine decreased to 176 umol/L (2 mg/dL) and remained stable 12 months after discharge. Teaching points B henselae IE should be suspected in patients with pauci-immune necrotizing glomerulonephritis and culture-negative IE. This is imperative for optimal decision making in the management of such patients. Having high clinical suspicion can avoid unnecessary and potentially deleterious use of immunosuppressive agents.
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Affiliation(s)
- Muhammad Asim Shahzad
- Division of Nephrology, RUSH University Medical Center, Chicago, IL, USA,Muhammad Asim Shahzad, Division of Nephrology, RUSH University Medical Center, 1620W. Harrison St., Chicago, IL 60612-3833, USA.
| | | | - Stephen Korbet
- Division of Nephrology, RUSH University Medical Center, Chicago, IL, USA
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3
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Ai S, Liu J, Ma G, Ye W, Hu R, Zhang S, Fan X, Liu B, Miao Q, Qin Y, Li X. Endocarditis-associated rapidly progressive glomerulonephritis mimicking vasculitis: a diagnostic and treatment challenge. Ann Med 2022; 54:754-763. [PMID: 35243934 PMCID: PMC8903796 DOI: 10.1080/07853890.2022.2046288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE)-associated rapidly progressive glomerulonephritis (RPGN) is rarely reported. Sporadic case reports have noted the diagnostic and therapeutic challenge in IE-associated glomerulonephritis because it may masquerade as idiopathic vasculitis. METHODS Patients with clinical diagnosis of IE-related RPGN in a tertiary hospital in China between January 2004 and May 2021 were identified and retrospectively reviewed. RESULTS Twenty-four patients with IE-associated RPGN were identified. All patients presented with fever and multiorgan system involvement on top of heart and kidneys, spleen (79%, 19/24), skin (63%, 15/24), lung (33%, 8/24) and nervous system (17%, 4/24). Six of the 24 patients (25%) were initially suspected to have ANCA-associated or IgA vasculitis. Forty-five percent of patients are seropositive for ANCA. Renal histology showed mesangial and/or endocapillary hypercellularity with extensive crescents in most patients. C3-dominant deposition was the predominant pattern on immunofluorescence and pauci-immune necrotising crescentic glomerulonephritis was observed in one case. All patients received antibiotics with or without surgery. Six patients received immunosuppressive therapy before antibiotics due to misdiagnosis and seven patients received immunosuppressive therapy after antibiotics due to persistence of renal failure. Three of the 24 patients died due to severe infection. All the surviving patients had partial or complete recovery of renal function. CONCLUSION IE-associated RPGN is rare and the differential diagnosis from idiopathic vasculitis can be challenging due to overlaps in clinical manifestations, ANCA positivity and absence of typical presentations of IE. The prognosis is generally good if antibiotics and surgery are not delayed. The decision on introducing immunoruppressive treatment should be made carefully on a case by case basis when kidney function does not improve appropriately after proper anti-infective therapy.Key messagesInfective endocarditis associated RPGN is rare and differentiating it from idiopathic vasculitis can be challenging due to overlap in clinical manifestations, ANCA positivity and occasional absence of typical manifestations of infective endocarditis.Kidney function usually responds to antibiotic therapy alone.Immunosuppressive therapy may be beneficial in carefully selected patients whose kidney function does not improve with antibiotics alone.
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Affiliation(s)
- Sanxi Ai
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenling Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rongrong Hu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohong Fan
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bingyan Liu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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4
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Lim P, Le Maistre M, Campanini LB, De Roux Q, Mongardon N, Landon V, Bouguerra H, Aouate D, Woerther PL, Vincent F, Galy A, Tacher V, Galien S, Ennezat PV, Fiore A, Folliguet T, Huguet R, Mekontso-Dessap A, Iung B, Lepeule R. Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. J Clin Med 2022; 11:jcm11195523. [PMID: 36233404 PMCID: PMC9573652 DOI: 10.3390/jcm11195523] [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: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose: Post-operative vasoplegic syndrome is a dreaded complication in infective endocarditis (IE). Methods and Results: This retrospective study included 166 consecutive patients referred to cardiac surgery for non-shocked IE. Post-operative vasoplegic syndrome was defined as a persistent hypotension (mean blood pressure < 65 mmHg) refractory to fluid loading and cardiac output restoration. Cardiac surgery was performed 7 (5−12) days after the beginning of antibiotic treatment, 4 (1−9) days after negative blood culture and in 72.3% patients with adapted anti-biotherapy. Timing of cardiac surgery was based on ESC guidelines and operating room availability. Most patients required valve replacement (80%) and cardiopulmonary bypass (CPB) duration was 106 (95−184) min. Multivalvular surgery was performed in 43 patients, 32 had tricuspid valve surgery. Post-operative vasoplegic syndrome was reported in 53/166 patients (31.9%, 95% confidence interval of 24.8−39.0%) of the whole population; only 15.1% (n = 8) of vasoplegic patients had a post-operative documented infection (6 positive blood cultures) and no difference was reported between vasoplegic and non-vasoplegic patients for valve culture and the timing of cardiac surgery. Of the 23 (13.8%) in hospital-deaths, 87.0% (n = 20) occurred in the vasoplegic group and the main causes of death were multiorgan failure (n = 17) and neurological complications (n = 3). Variables independently associated with vasoplegic syndrome were CPB duration (1.82 (1.16−2.88) per tertile) and NTproBNP level (2.11 (1.35−3.30) per tertile). Conclusions: Post-operative vasoplegic syndrome is frequent and is the main cause of death after IE cardiac surgery. Our data suggested that the mechanism of vasoplegic syndrome was more related to inflammatory cardiovascular injury rather than the consequence of ongoing bacteremia.
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Affiliation(s)
- Pascal Lim
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
- Correspondence:
| | - Margaux Le Maistre
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Lucas Benoudiba Campanini
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Quentin De Roux
- Service d’anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Nicolas Mongardon
- Service d’anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Valentin Landon
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Hassina Bouguerra
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - David Aouate
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Paul-Louis Woerther
- Laboratoire de Bactériologie et Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Fihman Vincent
- Laboratoire de Bactériologie et Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Adrien Galy
- Unité Transversale de Traitement des Infections, DMU PDTI, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Vania Tacher
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Sébastien Galien
- Service de Maladies Infectieuses et Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Pierre-Vladimir Ennezat
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Antonio Fiore
- Service de Chirurgie Cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Thierry Folliguet
- Service de Chirurgie Cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Raphaelle Huguet
- Service de Cardiologie, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, DMU Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
| | - Bernard Iung
- Service de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Bichat et Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75018 Paris, France
| | - Raphael Lepeule
- Unité Transversale de Traitement des Infections, DMU PDTI, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, F-94010 Créteil, France
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Kobayashi S, Kakeshita K, Imamura T, Fujioka H, Yamazaki H, Koike T, Kinugawa K. Clinical Implications of Steroid Therapy for Crescentic Glomerulonephritis and Gemella morbillorum-associated Infective Endocarditis. Intern Med 2021; 60:299-303. [PMID: 32921686 PMCID: PMC7872803 DOI: 10.2169/internalmedicine.5319-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 54-year-old man was admitted to our institute with a diagnosis of infective endocarditis (IE) with vegetation on the mitral valve and severe regurgitation due to Gemella morbillorum infection together with renal dysfunction, which was eventually diagnosed as infection-related pauci-immune necrotizing crescentic glomerulonephritis. Given the refractoriness to antibiotics, the persistent activity of nephritis, and repeated cerebral hemorrhaging, we prioritized steroid therapy over early surgical mitral valve replacement. Following steroid therapy, the glomerulonephritis completely improved. Although the administration of steroid therapy in the active phase of IE remains controversial, it might be indicated if comorbid glomerulonephritis is critical.
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Affiliation(s)
- Shiori Kobayashi
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Japan
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Brunet A, Julien G, Cros A, Beaudoux O, Hittinger-Roux A, Bani-Sadr F, Servettaz A, N'Guyen Y. Vasculitides and glomerulonephritis associated with Staphylocococcus aureus infective endocarditis: cases reports and mini-review of the literature. Ann Med 2020; 52:265-274. [PMID: 32588668 PMCID: PMC7877925 DOI: 10.1080/07853890.2020.1778778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We reported two cases of Staphylococcus aureus Infective Endocarditis associated with vasculitides and glomerulonephritis respectively, before conducting an online search of previously published similar cases reports. Twenty five references were selected: 15 cases of glomerulonephritis; 2 cases of vasculitis and 8 cases involving both glomerulonephritis and vasculitis. Vasculitides and glomerulonephritis associated with Staphylococcus aureus definite Infective Endocarditis have been reported since 1976. All cases except one described clinical symptoms occurring before or during initial antibiotics treatment. Except kidney, organs that were more frequently affected by vasculitis process were skin, gastrointestinal tract and peripheral nerve and the vessels involved were small to medium size vessels. When antineutrophil cytoplasmic antibodies were evidenced (6 out of the 25 cases (24%)), kidney was the most frequently affected organ. The most commonly observed pattern in Kidney biopsy was membranoproliferative glomerulonephritis with endocapillary proliferation sometimes associated with extra capillary crescents, whether or not antineutrophil cytoplasmic antibodies were evidenced. Right-sided Infective Endocarditis (especially in intravenous drug users) were overrepresented (14 of the 25 cases (56.0%)) in this review. Besides antibiotics, corticosteroids were the most frequently prescribed immunosuppressive treatment both for vasculitides or glomerulonephritis. KEY MESSAGES Vasculitides and glomerulonephritis associated with Staphylococcus aureus definite Infective Endocarditis have been reported since 1976. Except kidney, organs that were more frequently affected (by small to medium size vessel vasculitis) were skin, gastrointestinal tract and peripheral nerve. The most commonly observed pattern in Kidney biopsy was membranoproliferative glomerulonephritis with endocapillary proliferation and right-sided Infective Endocarditis (especially in intravenous drug users) were overrepresented in this review.
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Affiliation(s)
- Aurélie Brunet
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Gautier Julien
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Amandine Cros
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Olivia Beaudoux
- Laboratoire d'Anatomie pathologique, Hôpital Robert Debré, Reims, France
| | | | | | - Amélie Servettaz
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
| | - Yohan N'Guyen
- Service de Médecine Interne, Hôpital Robert Debré, Reims, France
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7
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Shaik A, Roeuth D, Azmeen A, Thanikonda V, Guevara-Pineda D, Alamnajam M, Yamase H, Haider L. Granulicatella Causing Infective Endocarditis and Glomerulonephritis. IDCases 2020; 21:e00792. [PMID: 32489865 PMCID: PMC7256654 DOI: 10.1016/j.idcr.2020.e00792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
Granulicatella is a type of nutritionally variant Streptococcus (NVS) that requires special medium for growth. It has shown to cause infective endocarditis which is associated with higher mortality and complications. We present a case of Granulicatella causing endocarditis and glomerulonephritis. There has only been one such prior case report. An adult male with a remote history of gastric bypass presented with shortness of breath with exertion, lower extremity swelling of 1-month duration. Blood cultures 4/4 bottles grew Granulicatella albicans with infected tooth being the source. Transesophageal echocardiogram revealed a vegetation on the mitral valve. He received intravenous vancomycin. He was found to have acute kidney injury requiring hemodialysis. Kidney biopsy revealed immune complex deposits in the mesangium and along the capillary basement membrane suggestive of post infectious glomerulonephritis. It is crucial to recognize NVS as potential cause for endocarditis in cultures that are slow growing. NVS require a special medium. Though it is rare, NSV can also cause glomerulonephritis. Early recognition is important to help with determining treatment options which may include immunosuppressive therapy along with treatment of underlying infection.
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Affiliation(s)
- Ayesha Shaik
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | - David Roeuth
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | - Ayesha Azmeen
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | | | | | - Mansour Alamnajam
- Department of Cardiology, UConn Health Center, Farmington, CT, United States
| | - Harold Yamase
- Department of Pathology, UConn Health Center, Farmington, CT, United States
| | - Lalarukh Haider
- Department of Nephrology, UConn Health Center, Farmington, CT, United States
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8
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Glomerulonephritis and nephrotic syndrome in a child with DiGeorge syndrome: Answers. Pediatr Nephrol 2019; 34:1735-1736. [PMID: 30963284 DOI: 10.1007/s00467-019-04243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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9
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Asai N, Sakanashi D, Suematsu H, Nishiyama N, Watanabe H, Kato H, Shiota A, Hagihara M, Koizumi Y, Yamagishi Y, Mikamo H. Infective endocarditis caused by Cardiobacterium hominis endocarditis: A case report and review of the literature. J Infect Chemother 2019; 25:626-629. [PMID: 31043327 DOI: 10.1016/j.jiac.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND While it has been increasing cases of C. hominis endocarditis in the past decades due to advances of diagnostic methods, the epidemiology and clinical manifestations of IE caused by C. hominis is still unknown. CASE PRESENTATION A 62-year old man was admitted to our institute with fever, anorexia and general fatigue for the preceding one month. He had a past medical history of both aortic and mitral valves replacement due to cardiac diseases. He was diagnosed as IE caused by C. hominis according to the modified duke criteria. The patient received 2 weeks of combination therapy of intravenous ceftriaxone (CTRX) 2g and gentamycin 180mg daily followed by 4 weeks CTRX 2g daily alone. Oral moxifloxacin 400mg once daily was given for an additional 4 weeks. After the antibiotic therapy was discontinued, disease recurrence was not observed. We reviewed previously reported C. hominis IE cases in 60 publications including ours. Of 73 patients enrolled, 53 were male, the mean age was 52 years. The most common risk factor of IE was past history of cardiac diseases in 44/73 (60%). As for antibiotics initially prescribed, third-generation cephalosporins was most frequently used in 28/69 (41%). While the cure rate was 67/73 (93%), 31/73 patients (43%) received a surgical intervention. Embolic lesions to the central nervous system and vertebrae were seen in 16/72 (22%) and 5/72 (7%). CONCLUSION IE caused by C. hominis has a favorable prognosis, showing the cure rate of 93%. Physicians should recognize the possible occurrence of emboli among IE patients.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Naoya Nishiyama
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroki Watanabe
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Arufumi Shiota
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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10
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Plasmapheresis for treatment of immune complex-mediated glomerulonephritis in infective endocarditis: a case report and literature review. Clin Nephrol Case Stud 2017; 5:26-31. [PMID: 29043144 PMCID: PMC5438014 DOI: 10.5414/cncs109082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 57-year-old man who presented with subacute bacterial endocarditis secondary to Streptococcus mutans complicated by biopsy-proven immune complex-mediated glomerulonephritis (ICGN). Despite initial treatment with antibiotics and a short course of corticosteroids, the kidney function further deteriorated, and plasmapheresis was introduced as third-line therapy to remove circulating immune complexes. Following 7 treatment sessions, the patient recovered kidney function. We discuss the potential merit of plasmapheresis for patients with subacute bacterial endocarditis who develop ICGN.
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Giannitsioti E, Protopapas K, Makris M, Panou F, Avgeropoulou E, Deliolanis I, Giamarellou H. Is there a place for corticosteroids in the therapy of infective endocarditis? Report of a case and review. Hellenic J Cardiol 2017; 58:93-95. [PMID: 28189738 DOI: 10.1016/j.hjc.2017.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Efthymia Giannitsioti
- 4th Department of Internal Medicine, EKPA ATTIKON University General Hospital, University Athens, Greece.
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, EKPA ATTIKON University General Hospital, University Athens, Greece
| | - Michael Makris
- Allergy Unit, Second Department of Dermatology and Venereology, EKPA ATTIKON University General Hospital, Athens, Greece
| | - Fotios Panou
- 2nd Department of Cardiology, ATTIKON University General Hospital, EKPA, Athens, Greece
| | | | - Ioannis Deliolanis
- 4th Department of Internal Medicine, EKPA ATTIKON University General Hospital, University Athens, Greece; Microbiology Laboratory, Laikon General Hospital, Athens, Greece
| | - Helen Giamarellou
- 4th Department of Internal Medicine, EKPA ATTIKON University General Hospital, University Athens, Greece; 6th Department of Internal Medicine, YGEIA General Hospital, Athens, Greece
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Kutiyal AS, Daga MK. Ruptured Sinus of Valsalva with Infective Endocarditis Complicated with Post-Infectious Acute Glomerulonephritis: A Rare Case Presentation. J Clin Diagn Res 2016; 10:OD14-OD15. [PMID: 27891383 DOI: 10.7860/jcdr/2016/21220.8754] [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: 05/14/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022]
Abstract
Ruptured Sinus of Valsalva (RSOV) is a rarely seen disease condition. RSOV can have varied presentations from being asymptomatic with just a cardiac murmur to profound hypotension. There has been simultaneous occurrence of RSOV with Infective Endocarditis (IE) in literature. Glomerulonephritis has also been reported in approximately 20% patients with IE. Large amount of proteinuria or decline in kidney functions is rarely encountered and mostly this finding has been incidental on routine evaluation. The co-existence of all the three conditions in a single patient is rare. This case was diagnosed to have RSOV with IE and was also diagnosed with post-infectious glomerulonephritis on renal biopsy. Patient was advised corrective cardiac surgery, but due to financial constraints, patient could not be operated and he died. Here, we report for the first time an unusual presence of both RSOV and sub-aortic membrane with IE complicated by glomerulonephritis.
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Affiliation(s)
- Aditya Singh Kutiyal
- Senior Resident, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Mradul Kumar Daga
- Director Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
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13
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Raybould JE, Raybould AL, Morales MK, Zaheer M, Lipkowitz MS, Timpone JG, Kumar PN. Bartonella Endocarditis and Pauci-Immune Glomerulonephritis: A Case Report and Review of the Literature. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016; 24:254-260. [PMID: 27885316 PMCID: PMC5098464 DOI: 10.1097/ipc.0000000000000384] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Among culture-negative endocarditis in the United States, Bartonella species are the most common cause, with Bartonella henselae and Bartonella quintana comprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of all Bartonella patients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis-associated glomerulonephritis, it is rarely reported in Bartonella endocarditis. Anti-neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported with Bartonella species. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate between Bartonella endocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positive Bartonella endocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone.
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Affiliation(s)
- Jillian E Raybould
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Alison L Raybould
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Megan K Morales
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Misbah Zaheer
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Michael S Lipkowitz
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Joseph G Timpone
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
| | - Princy N Kumar
- Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC
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14
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Scemla A, Charlier C, Noel LH, Amazzough K, Von Rosen F, Lesavre P, Lortholary O. Pauci-immune crescentic glomerulonephritis without ANCA in a patient presenting with Candida parapsilosis endocarditis. Med Mal Infect 2016; 46:163-5. [DOI: 10.1016/j.medmal.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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15
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Hirai K, Miura N, Yoshino M, Miyamoto K, Nobata H, Nagai T, Suzuki K, Banno S, Imai H. Two Cases of Proteinase 3-Anti-Neutrophil Cytoplasmic Antibody (PR3-ANCA)-related Nephritis in Infectious Endocarditis. Intern Med 2016; 55:3485-3489. [PMID: 27904114 PMCID: PMC5216148 DOI: 10.2169/internalmedicine.55.7331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We herein report two cases of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-related nephritis in infectious endocarditis. In both cases, the patients were middle-aged men with proteinuria and hematuria, hypoalbuminemia, decreased kidney function, anemia, elevated C-reactive protein (CRP) levels, and PR3-ANCA positivity. Each had bacteremia, due to Enterococcus faecium in one and Streptococcus bovis in the other. One patient received aortic valve replacement therapy for aortic regurgitation with vegetation, and the other underwent tricuspid valve replacement therapy and closure of a ventricular septic defect to treat tricuspid regurgitation with vegetation. These patients' urinary abnormalities and PR3-ANCA titers improved at 6 months after surgery following antibiotic treatment without steroid therapy.
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Affiliation(s)
- Kazuya Hirai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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16
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Mantan M, Sethi GR, Batra VV. Post-infectious glomerulonephritis following infective endocarditis: Amenable to immunosuppression. Indian J Nephrol 2013; 23:368-70. [PMID: 24049276 PMCID: PMC3764714 DOI: 10.4103/0971-4065.116321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Glomerulonephritis develops in about 20% patients with infective endocarditis (IE), but is mostly asymptomatic. Heavy proteinuria or derangement of kidney functions is uncommon. We report here a child with IE and proliferative glomerulonephritis who manifested as significant proteinuria that recovered on treatment with immunosupressants.
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Affiliation(s)
- M Mantan
- Department of Pediatrics, G. B. Pant Hospital, Maulana Azad Medical College and Associated Hospitals, University of Delhi, Delhi, India
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17
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Konstantinov KN, Emil SN, Barry M, Kellie S, Tzamaloukas AH. Glomerular disease in patients with infectious processes developing antineutrophil cytoplasmic antibodies. ISRN NEPHROLOGY 2013; 2013:324315. [PMID: 24959541 PMCID: PMC4045435 DOI: 10.5402/2013/324315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Abstract
To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics.
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Affiliation(s)
- Konstantin N. Konstantinov
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Suzanne N. Emil
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Marc Barry
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, BMSB, Room 335, University of New Mexico, Albuquerque, NM 87131, USA
| | - Susan Kellie
- Division of Infectious Diseases, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Antonios H. Tzamaloukas
- Division of Nephrology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, VA Medical Center (111C), 1501 San Pedro, SE, Albuquerque, NM 87131, USA
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18
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Cornér A, Kaartinen K, Aaltonen S, Räisänen-Sokolowski A, Helin H, Honkanen E. Membranoproliferative glomerulonephritis complicating Propionibacterium acnes infection. Clin Kidney J 2012; 6:35-39. [PMID: 27818749 PMCID: PMC5094392 DOI: 10.1093/ckj/sfs165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/25/2012] [Indexed: 11/21/2022] Open
Abstract
Background Propionibacterium acnes (P. acnes) is a common microbe of the skin and mucosal surfaces rarely considered a true pathogen. However, it has been reported to cause serious infections. Subsequent ongoing low-grade antigenaemia may, in turn, lead to an immune-mediated glomerulonephritis with various renal histologies including that of membranoproliferative glomerulonephritis (MPGN). Methods Here, we describe two cases of P. acnes infection-induced MPGN and their treatment. Results Both patients were successfully treated by the eradication of the infection. One patient also received immunosuppressive medication prior to the correct diagnosis. Conclusions A vigorous exclusion of infection is warranted in MPGN type I or immune-complex-mediated MPGN and may sometimes yield a diagnosis of secondary MPGN.
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Affiliation(s)
- Anja Cornér
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Kati Kaartinen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Sari Aaltonen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
| | - Anne Räisänen-Sokolowski
- Transplantation Laboratory, HUSLAB, Department of Pathology , Helsinki University Central Hospital , Helsinki , Finland
| | - Heikki Helin
- Transplantation Laboratory, HUSLAB, Department of Pathology , Helsinki University Central Hospital , Helsinki , Finland
| | - Eero Honkanen
- Department of Nephrology , Helsinki University Central Hospital , Helsinki , Finland
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19
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Abstract
Acute postinfectious glomerulonephritis are defined by an acute nonsuppurative inflammatory insult predominantly glomerular. Its current incidence is uncertain because of the frequency of subclinical forms. The most common infectious agent involved is beta hemolytic streptococcus group A. Acute postinfectious glomerulonephritis is uncommon in adults, and its incidence is progressively declining in developed countries. Humoral immunity plays a key role in the pathogenesis of kidney damage. Complement activation by the alternative pathway is the dominant mechanism, but a third way (lectin pathway) has been recently identified. The classic clinical presentation is sudden onset of acute nephritic syndrome after a free interval from a streptococcal infection. Treatment is essentially symptomatic and prevention is possible through improved hygiene and early treatment of infections.
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20
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Cardiobacterium hominis endocarditis: A case report and review of the literature. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 16:293-7. [PMID: 18159562 DOI: 10.1155/2005/716873] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 02/26/2005] [Indexed: 11/18/2022]
Abstract
The present case report describes the clinical course of a patient who presented with Cardiobacterium hominis endocarditis. A review of the literature follows the case presentation. C hominis, a fastidious Gram-negative bacillus, is a member of the HACEK group of microorganisms (Haemophilus species, Actinobacillus actinomycetemcomitans, C hominis, Eikenella corrodens and Kingella kingae). Endocarditis caused by C hominis is uncommon and generally follows a subacute course. Patients may present with constitutional symptoms, symptoms related to valvular destruction or symptoms secondary to embolic events. Diagnosis requires identification of the pathogen from blood or vegetation by either culture or molecular techniques. Blood cultures may require prolonged incubation, highlighting the importance of incubating blood cultures for at least two to three weeks in patients with suspected endocarditis. In the past, C hominis was generally sensitive to penicillin. However, reports of beta-lactamase-producing C hominis have appeared in the literature over the past decade. The current recommendation for first-line treatment is a third-generation cephalosporin (ceftriaxone) for four weeks (six weeks if a prosthetic valve is in place).
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21
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Skiadas I, Pefanis A, Papalois A, Kyroudi A, Triantafyllidi H, Tsaganos T, Giamarellou H. Dexamethasone as adjuvant therapy to moxifloxacin attenuates valve destruction in experimental aortic valve endocarditis due to Staphylococcus aureus. Antimicrob Agents Chemother 2007; 51:2848-54. [PMID: 17562794 PMCID: PMC1932528 DOI: 10.1128/aac.01376-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the beneficial effects of dexamethasone have frequently been investigated in various serious-infection settings, insufficient data on valve histology and cardiac function for infective endocarditis are available. The efficacy of moxifloxacin for the treatment of experimental aortic valve endocarditis due to methicillin-susceptible Staphylococcus aureus and the long-term effects of dexamethasone were evaluated in the current study. Sixty-eight rabbits were randomly assigned to four groups: A, B, C, and D. Group A consisted of 18 animals and functioned as a control group. Groups B and C consisted of 11 and 23 subjects, respectively, which received moxifloxacin for 5 days in a human-like pharmacokinetic simulation. Group D consisted of 16 animals that were administered moxifloxacin plus dexamethasone (0.25 mg/kg of body weight twice a day intravenously). The group B animals were sacrificed a day after the completion of treatment, and group C and D animals were sacrificed after 12 days in order to monitor any possible relapse and allow microbiological, histopathological, and echocardiographic evaluation of the long-term effects of glucocorticoids. No differences in survival, sterilization rates, or inflammatory infiltration and calcification of valve tissue were observed among the treated groups. However, the degrees of valve damage and collagenization were significantly worse, the fibroblast content was higher, and fractional shortening of the left ventricle fluctuated significantly in group C compared to group D (all groups, P < 0.05). We concluded that dexamethasone treatment for experimental S. aureus endocarditis attenuates valve destruction and preserves overall cardiac function without impeding the efficacy of moxifloxacin.
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Affiliation(s)
- Ioannis Skiadas
- Cardiology Department, Hippocration General Hospital, Athens, Greece.
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22
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Malani AN, Aronoff DM, Bradley SF, Kauffman CA. Cardiobacterium hominis endocarditis: Two cases and a review of the literature. Eur J Clin Microbiol Infect Dis 2006; 25:587-95. [PMID: 16955250 PMCID: PMC2276845 DOI: 10.1007/s10096-006-0189-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiobacterium hominis, a member of the HACEK group (Haemophilus parainfluenzae, Haemophilus aphrophilus, and Haemophilus paraphrophilus, Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella species), is a rare cause of endocarditis. There are 61 reported cases of C. hominis infective endocarditis in the English-language literature, 15 of which involved prosthetic valve endocarditis. There is one reported case of C. hominis after upper endoscopy and none reported after colonoscopy. Presented here are two cases of C. hominis prosthetic valve endocarditis following colonoscopy and a review of the microbiological and clinical features of C. hominis endocarditis. Patients with C. hominis infection have a long duration of symptoms preceding diagnosis (138+/-128 days). The most common symptoms were fever (74%), fatigue/malaise (53%), weight loss/anorexia (40%), night sweats (24%), and arthralgia/myalgia (21%). The most common risk factors were pre-existing cardiac disease (61%), the presence of a prosthetic valve (28%), and history of rheumatic fever (20%). Of the 61 cases reviewed here, the aortic valve was infected in 24 (39%) and the mitral valve in 19 (31%) patients. The average duration of blood culture incubation before growth was detected was 6.3 days (range, 2-21 days). Complications were congestive heart failure (40%), central nervous system (CNS) emboli (21%), arrhythmia (16%), and mycotic aneurysm (9%). C. hominis is almost always susceptible to beta-lactam antibiotics. Ceftriaxone is recommended by the recently published American Heart Association guidelines. The prognosis of C. hominis native valve and prosthetic valve endocarditis is favorable. The cure rate among 60 patients reviewed was 93% (56/60). For prosthetic valve endocarditis, the cure rate was 16/17 (94%). Valve replacement was required in 27 (45%) cases.
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Affiliation(s)
- A N Malani
- Division of Infectious Diseases, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Satoskar AA, Nadasdy G, Plaza JA, Sedmak D, Shidham G, Hebert L, Nadasdy T. StaphylococcusInfection-Associated Glomerulonephritis Mimicking IgA Nephropathy. Clin J Am Soc Nephrol 2006; 1:1179-86. [PMID: 17699345 DOI: 10.2215/cjn.01030306] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The association of methicillin-resistant Staphylococcus aureus (MRSA) infection with glomerulonephritis (GN) has been well documented in Japan but not in North America. Recently, eight renal biopsies with IgA-predominant or -codominant GN from eight patients with underlying staphylococcal infection, but without endocarditis, were observed at a single institution in a 12-mo period. Renal biopsies were worked up by routinely used methodologies. Eight cases of primary IgA nephropathy were used as controls. Five patients had MRSA infection, one had methicillin-resistant S. epidermidis (MRSE) infection, and two had methicillin-sensitive S. aureus infection. Four patients became infected after surgery; two patients were diabetic and had infected leg ulcers. All patients developed acute renal failure, with active urine sediment and severe proteinuria. Most renal biopsies showed only mild glomerular hypercellularity. Two biopsies had prominent mesangial and intracapillary hypercellularity; one of them (the MRSE-associated case) had large glomerular hyalin thrombi. This patient also had a positive cryoglobulin test. Rare glomerular hyalin thrombi were noted in two other cases. Immunofluorescence showed IgA pre- or codominance in all biopsies. Electron microscopy revealed mesangial deposits in all cases. Five biopsies had rare glomerular capillary deposits as well. In the MRSE-associated GN, large subendothelial electron-dense deposits were present. These cases demonstrate that staphylococcal (especially MRSA) infection-associated GN occurs in the US as well, and a rising incidence is possible. It is important to differentiate a Staphylococcus infection-associated GN from primary IgA nephropathy to avoid erroneous treatment with immunosuppressive medications.
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Affiliation(s)
- Anjali A Satoskar
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
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Sadikoglu B, Bilge I, Kilicaslan I, Gokce MG, Emre S, Ertugrul T. Crescentic glomerulonephritis in a child with infective endocarditis. Pediatr Nephrol 2006; 21:867-9. [PMID: 16703379 DOI: 10.1007/s00467-006-0056-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 11/29/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
Renal manifestations associated with infective endocarditis (IE) may present with different clinical patterns, and the most common renal histopathological finding is diffuse proliferative and exudative type of glomerulonephritis, leading to hematuria and/or proteinuria. Renal failure due to crescentic glomerulonephritis (CGN) in children with IE is a very rare condition. We report here a 6-year-old boy, who had a history of cardiac surgery for pulmonary atresia and ventricular septal defect, presenting with the clinical findings of IE and hematuria associated with renal failure due to CGN. He was treated with a combination of intravenous (IV) methylprednisolone pulses and appropriate antibiotics, but also received one dose of IV cyclophosphamide. Complete serological, biochemical, and clinical improvement was achieved after 2 months of follow-up. Antibiotic therapy is the essential part of the treatment of IE-associated glomerulonephritis; however, this case also highlights the importance of aggressive immunosuppressive therapy to suppress the immunological process related with infection in this life-threatening condition leading to renal failure.
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Affiliation(s)
- Banu Sadikoglu
- Istanbul Medical Faculty, Department of Pediatrics, Division of Pediatric Nephrology, Istanbul University, 34390 Capa, Istanbul, Turkey.
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25
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Auzary C, Pinganaud C, Launay O, Joly V, Cremieux AC, Idatte JM, Carbon C. [Prosthetic valve endocarditis due to Coxiella burnetii: six cases]. Rev Med Interne 2001; 22:948-58. [PMID: 11695318 DOI: 10.1016/s0248-8663(01)00453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prosthetic valve endocarditis is a dangerous complication of valvular surgery (3-6%). Among involved pathogens, Coxiella burnetii is an occasional agent, though isolated with increasing frequency. We report our experience with this peculiar endocarditis and lay stress on specific diagnostic and therapeutic difficulties. METHODS Between 1990 and 1995, six patients retrospectively met the diagnosis criteria for definite endocarditis due to Coxiella burnetii. RESULTS Five Algerian men and one French woman presented with prosthetic valve endocarditis with negative blood cultures (on bioprosthesis: four cases, on mechanical valve: two cases). The main clinical and biological feature was febrile congestive heart failure with hepatomegaly, splenomegaly, hepatic and renal abnormalities, inflammatory syndrome, hypergammaglobulinemia, anemia and lymphopenia. Serological testing for Coxiella burnetii provided diagnosis in all cases. Echocardiography displayed vegetations in all cases. Valvular replacement was performed in four patients. With antibiotic therapy including doxycycline or/and hydroxychloroquine, quinolones or rifampicine, all patients experienced complete clinical, biological and echographic remission. CONCLUSION Q fever prosthetic valve endocarditis presents as a systemic disorder occurring in patients with valvular heart disease. From now on, early diagnosis and efficient medical treatment may provide permanent prosthetic sterilization.
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Affiliation(s)
- C Auzary
- Service de médecine interne, centre hospitalier de Moulins-Yzeure, 10, avenue du Général-de-Gaulle, BP 609, 03006 Moulins, France.
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