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Chebolu AP, Wallsh JO, Falk N, Bhatnagar P. CENTRAL RETINAL ARTERY OCCLUSION AS PRESENTATION OF BARTONELLA ENDOCARDITIS. Retin Cases Brief Rep 2023; 17:649-651. [PMID: 37903305 DOI: 10.1097/icb.0000000000001268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND/PURPOSE To describe a rare ocular presentation of a systemic illness and the important lifesaving diagnosis made by a complete eye examination. METHODS The patient was evaluated with a comprehensive ophthalmic examination and followed closely in the outpatient setting with optical coherence tomography, fluorescein angiography, and color fundus photos. RESULTS A 66-year-old man presented with acute vision loss of the left eye. A complete eye examination revealed that he had a central retinal artery occlusion. Systemic workup revealed that he had a mitral valve vegetation and blood cultures grew Bartonella henselae. His kidney biopsy showed membranoproliferative glomerulonephritis, which is often seen with septic emboli. Furthermore, the patient lacked any ocular inflammatory signs. This constellation of findings was diagnostic for a thromboembolic etiology causing his central retinal artery occlusion. At follow-up, the optical coherence tomography demonstrated inner retinal hyperreflectivity and the fluorescein angiogram showed segmented flow and no neovascularization. On follow-up, the patient had a stable examination with light perception vision and completed antibiotic therapy for bartonella endocarditis. CONCLUSION The detection of a fatal systemic illness was made promptly with a thorough ocular examination. We highlight the importance of a multidisciplinary approach in making a lifesaving diagnosis.
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Affiliation(s)
- Apoorv P Chebolu
- Department of Ophthalmology, Lions Eye Institute, Albany, New York
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Tattevin P, Muñoz P, Moreno A, Hékimian G, Delahaye F, Duval X, Castel MÁ, Hasse B, Jaramillo N, Vincelj J, Wray D, Limonta S, Fariñas MC, Mestres CA, Miro JM. Heart transplantation as salvage treatment of intractable infective endocarditis. Infect Dis (Lond) 2023; 55:370-374. [PMID: 36866973 DOI: 10.1080/23744235.2023.2184490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND For infective endocarditis (IE) with extensive perivalvular lesions or end-stage cardiac failure, heart transplantation (HT) may be the last resort. METHODS We retrospectively collected all cases of HT for IE within the International Collaboration on Endocarditis (ICE) network. RESULTS Between 1991 and 2021, 20 patients (5 women, 15 men), median age 50 years [interquartile range, 29-61], underwent HT for IE in Spain (n = 9), France (n = 6), Switzerland (n = 2), Colombia, Croatia, and USA (n = 1). IE affected prosthetic (n = 10), and native valves (n = 10), primarily aortic (n = 11) and mitral (n = 6). The main pathogens were oral streptococci (n = 8), Staphylococcus aureus (n = 5), and Enterococcus faecalis (n = 2). The major complications included heart failure (n = 18), peri-annular abscess (n = 10), and prosthetic valve dehiscence (n = 4). Eighteen patients had previous cardiac surgery for this episode of IE, and four were on circulatory support before HT (left ventricular assist-device and extra-corporeal membrane oxygenation, 2 patients each). The median time interval between first symptoms of IE and HT was 44.5 days [22-91.5]. The main post-HT complication was acute rejection (n = 6). Seven patients died (35%), four during the first month post-HT. Thirteen (81%) of the 16 patients discharged from the hospital survived with a median follow-up of 35.5 months [4-96.5] after HT, and no relapse of IE. CONCLUSIONS IE is not an absolute contraindication for HT: Our case series and the literature review support that HT may be considered as a salvage treatment in highly-selected patients with intractable IE.
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Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Asuncion Moreno
- Infectious Diseases Service. Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillaume Hékimian
- Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive Réanimation, Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | | | - Xavier Duval
- Université Paris-Cité APHP; Inserm CIC, Paris, France
| | - María Ángeles Castel
- Unit for Heart Failure and Heart Transplantation, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Josip Vincelj
- Department of Cardiology, Medikol Polyclinic, Zagreb, Croatia
| | - Dannah Wray
- Medical University of South Carolina, Charleston, SC, USA
| | - Silvia Limonta
- Infectious Diseases, Ospedale San Gerardo, ASST Monza, Italy
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital, Zurich, Switzerland
| | - Jose M Miro
- Infectious Diseases Service. Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Patel R, Koran K, Call M, Schnee A. A case of Bartonella henselae native valve endocarditis presenting with crescentic glomerulonephritis. IDCases 2021; 27:e01366. [PMID: 34984170 PMCID: PMC8692998 DOI: 10.1016/j.idcr.2021.e01366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Bartonella endocarditis is often an elusive diagnosis, usually derived from evaluating multiple laboratory tests and assessment of presenting symptoms. Herein we describe a case of Bartonella henselae native mitral valve endocarditis with an initial presentation of volume overload and renal failure. The Bartonella organism is tedious to isolate from culture medium, causing most diagnoses to be delayed. Due to the destructive nature of B. henselae endocarditis, the need for rapid identification remains prudent. This therefore creates an opportunity for Next Generation Sequencing (NGS) to be used. We further summarize the varied presentations that may be associated with B. henselae endocarditis, and hope that this will heighten the clinicians' awareness of this entity when presented with acute onset renal failure and culture negative vegetations.
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Affiliation(s)
- Roshni Patel
- Prisma Health Infectious Disease Specialists, 890 West Faris Road, Suite 520, Greenville, SC 29605, USA
| | - Kansas Koran
- Prisma Health Infectious Disease Specialists, 890 West Faris Road, Suite 520, Greenville, SC 29605, USA
| | - Mark Call
- Prisma Health Infectious Disease Specialists, 890 West Faris Road, Suite 520, Greenville, SC 29605, USA
| | - Amanda Schnee
- Prisma Health Infectious Disease Specialists, 890 West Faris Road, Suite 520, Greenville, SC 29605, USA
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Givone F, Peghin M, Vendramin I, Carletti S, Tursi V, Pasciuta R, Livi U, Bassetti M. Salvage heart transplantation for Mycoplasma hominis prosthetic valve endocarditis: A case report and review of the literature. Transpl Infect Dis 2020; 22:e13249. [PMID: 31977151 DOI: 10.1111/tid.13249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/11/2019] [Accepted: 01/12/2020] [Indexed: 12/19/2022]
Abstract
Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a "last resort" procedure. Orthotropic HT with bicaval technique was performed in a man with culture-negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.
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Affiliation(s)
- Filippo Givone
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Maddalena Peghin
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Silvia Carletti
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Tursi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Renée Pasciuta
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Matteo Bassetti
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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