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Oldberg K, Rasmussen M. Make Modern Microbiology Matter More in the 2023 European Society of Cardiology Guidelines for the Management of Infective Endocarditis. Clin Infect Dis 2024; 79:336-338. [PMID: 38655671 PMCID: PMC11327790 DOI: 10.1093/cid/ciae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The European Society of Cardiology (ESC) 2023 guidelines for the management of infective endocarditis (IE) stress that a multidisciplinary approach is needed to manage patients with IE. In our view, the guidelines do not include the relevant perspectives from modern microbiology. The diagnostic criteria for IE were changed in the ESC 2023 guidelines, and many IE-causing pathogens are either not clearly defined. Moreover, an improved understanding of the relationship between bacterial species and the risk for IE has not been implemented. The guidelines give detailed and, in our view, incorrect instructions about diagnostic testing in blood culture-negative IE without presenting proper evidence. Other important diagnostic aspects, such as the value of repeated blood cultures and incubation time for blood cultures, are not discussed. We believe that a multidisciplinary collaboration that include microbiologists would have improved these guidelines, and we hope for a future harmonization of diagnostic criteria for IE.
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Affiliation(s)
- Karl Oldberg
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medial Services, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden
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2
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Abu-Ahmad A, Bahouth F, Hershman-Sarafov M, Paz A, Odeh M. Bivalvular Endocarditis Due to Polymicrobial Coinfection with Enterococcus faecalis and Coxiella burnetii: A Case Report and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1122. [PMID: 39064551 PMCID: PMC11279137 DOI: 10.3390/medicina60071122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
Polymicrobial endocarditis is uncommon, and polymicrobial endocarditis in combination with Coxiella burnetii is very rare. We herein describe an extremely rare case of polymicrobial bivalvular endocarditis due to coinfection with Enterococcus faecalis and Coxiella burnetii in a 62-year-old male patient, and extensively review the relevant medical literature. To the best of our knowledge, only three similar cases have been previously reported. Q fever is a worldwide endemic bacterial zoonosis, but it and its most common chronic complication, endocarditis, are still underestimated and underdiagnosed worldwide. This situation reflects the paucity of reported cases of polymicrobial endocarditis in combination with Coxiella burnetii. Clinical presentation of Q fever endocarditis is highly nonspecific, and diagnosis may be delayed or missed, leading to severe and potentially fatal disease. Our case and the previously reported similar cases emphasize the need for further evaluation of infective endocarditis due to Coxiella burnetii, in all cases of culture-negative endocarditis, and in prolonged oligo-symptomatic inflammatory syndrome, particularly in the presence of valvular heart disease. This approach should be applied even when typical pathogens are isolated, especially in endemic areas of Q fever, and with atypical presentation.
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Affiliation(s)
- Asala Abu-Ahmad
- Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel; (A.A.-A.); (M.H.-S.); (A.P.)
| | - Fadel Bahouth
- Department of Cardiology, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel;
| | - Mirit Hershman-Sarafov
- Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel; (A.A.-A.); (M.H.-S.); (A.P.)
| | - Alona Paz
- Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel; (A.A.-A.); (M.H.-S.); (A.P.)
| | - Majed Odeh
- Department of Internal Medicine A, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel
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3
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Iyer I, Sinha R, Kumar P, Schaf B, Berkowitz L. A 'Decrescendo' in a Woman With Ascending Paralysis: A Diagnostic Challenge. Cureus 2024; 16:e59479. [PMID: 38827011 PMCID: PMC11142845 DOI: 10.7759/cureus.59479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Guillain-Barre Syndrome (GBS) is an autoimmune condition that causes muscular weakness and can be potentially life-threatening if not identified early. GBS is diagnosed definitively by cerebrospinal fluid (CSF) analysis and electromyographic (EMG) studies. Identifying illnesses that may have triggered GBS is crucial, as they could affect the course of the disease. Our patient was a 27-year-old woman who developed lower extremity weakness a few days after being treated for a dental abscess. Laboratory and imaging studies ruled out central nervous system (CNS) lesions, myelopathies, and metabolic causes. Diagnosis was difficult due to inconclusive initial investigations, refusal of lumbar puncture, and delayed availability of EMG studies. Additionally, there were no identifiable triggers to support GBS as a diagnosis. During the hospital course, the patient developed tachycardia with new electrocardiogram (EKG) changes. A transthoracic echocardiogram (TTE) showed suspicious vegetation, and a transesophageal echocardiogram (TEE) confirmed severe mitral regurgitation. The new valvular lesions and autonomic dysfunction with worsening lower extremity weakness increased our suspicion of GBS. Intravenous immunoglobulin (IVIG) was administered empirically, but she developed bulbar symptoms, prompting admission to the intensive care unit (ICU). A lumbar puncture performed at this time was negative for albumino-cytological dissociation and CNS infections. Signs of sepsis with valvular lesions raised concerns for infective endocarditis (IE). Due to recent treatment with antibiotics for dental abscess, a negative blood culture was a confounding factor in Duke's criteria, delaying the diagnosis of IE. Infectious disease experts suggested empirical treatment for suspected blood culture-negative infective endocarditis (BCNE) and valvular abscess. She was transferred to a cardiothoracic care facility for valvular surgery evaluation. EMG studies identified the patient's condition as the acute motor sensory axonal neuropathy (AMSAN) variant of GBS. The patient's antibodies tested positive for Campylobacter jejuni (C. Jejuni) immunoglobulin G (IgG). Since this indicates a past infection, it is uncertain whether C. Jejuni triggered the patient's GBS. However, new valvular vegetation and acute-onset lower extremity weakness make us hypothesize that BCNE may have triggered GBS.
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Affiliation(s)
- Ishwari Iyer
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Rishav Sinha
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Pradeep Kumar
- Cardiology, The Brooklyn Hospital Center, Brooklyn, USA
| | - Bryan Schaf
- Pulmonary and Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, USA
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Menon T. Uncommon pathogens causing infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:8-15. [PMID: 38827550 PMCID: PMC11139812 DOI: 10.1007/s12055-023-01627-z] [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: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis is caused by a wide range of aetiological agents. The microbiology, epidemiology, and treatment of this disease have changed considerably in the last two decades. Staphylococci and streptococci are known to be the classical causative agents; however, blood culture-negative endocarditis caused by fastidious and slow-growing organisms is now common. The list of uncommon pathogens causing endocarditis has expanded in recent years. This is a narrative literature review of the aetiological agents of endocarditis that are rarely encountered in clinical practice, their epidemiology, the characteristics of these pathogens, the clinical presentations of the cases, and their management.
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Affiliation(s)
- Thangam Menon
- Department of Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Velappanchavdi, 162 PH Road, Chennai, Tamil Nadu 600077 India
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5
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van der Vaart TW, Bossuyt PMM, Durack DT, Baddour LM, Bayer AS, Durante-Mangoni E, Holland TL, Karchmer AW, Miro JM, Moreillon P, Rasmussen M, Selton-Suty C, Fowler VG, van der Meer JTM. External Validation of the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis. Clin Infect Dis 2024; 78:922-929. [PMID: 38330166 PMCID: PMC11006110 DOI: 10.1093/cid/ciae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE) were introduced to improve classification of IE for research and clinical purposes. External validation studies are required. METHODS We studied consecutive patients with suspected IE referred to the IE team of Amsterdam University Medical Center (from October 2016 to March 2021). An international expert panel independently reviewed case summaries and assigned a final diagnosis of "IE" or "not IE," which served as the reference standard, to which the "definite" Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgical and pathologic data ("clinical" criteria). Finally, we compared the 2023 Duke-ISCVID with the 2000 modified Duke criteria and the 2015 and 2023 European Society of Cardiology (ESC) criteria. RESULTS A total of 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as having IE; 111 (19%) had prosthetic valve IE, and 48 (8%) had a cardiac implantable electronic device IE. The 2023 Duke-ISCVID criteria were more sensitive than either the modified Duke or 2015 ESC criteria (84.2% vs 74.9% and 80%, respectively; P < .001) without significant loss of specificity. The 2023 Duke-ISCVID criteria were similarly sensitive but more specific than the 2023 ESC criteria (94% vs 82%; P < .001). The same pattern was seen for the clinical criteria (excluding surgical/pathologic results). New modifications in the 2023 Duke-ISCVID criteria related to "major microbiological" and "imaging" criteria had the most impact. CONCLUSIONS The 2023 Duke-ISCVID criteria represent a significant advance in the diagnostic classification of patients with suspected IE.
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Affiliation(s)
- Thomas W van der Vaart
- Division of Infectious Diseases, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - David T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine and Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arnold S Bayer
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA, Torrance, California, USA
- Division of Infectious Diseases, The Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Thomas L Holland
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adolf W Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Philippe Moreillon
- Department of Fundamental Microbiology, UNIL—Université de Lausanne, Lausanne, Switzerland
| | - Magnus Rasmussen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Christine Selton-Suty
- Centre Hospitalier Régional Universitaire (CHRU) Nancy, Cardiology Department, CIC-EC, Nancy, France
- Association pour l’Étude et la Prévention de l’Endocardite Infectieuse (AEPEI), France
| | - Vance G Fowler
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jan T M van der Meer
- Division of Infectious Diseases, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
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Lamichhane B, Lamichhane S, Paudel K, Pokhrel NB, Dhital S, Acharya SK. Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report. Ann Med Surg (Lond) 2024; 86:1161-1165. [PMID: 38333264 PMCID: PMC10849347 DOI: 10.1097/ms9.0000000000001638] [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: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5-31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor. Case presentation The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement. Discussion Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality. Conclusion Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.
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Affiliation(s)
| | | | | | - Nishan B. Pokhrel
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Sandhya Dhital
- Internal Medicine, Kern Medical Center/Ross University School of Medicine, Castro Valley, FL
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Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
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Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Barbieri A, Cecchi E, Bursi F, Mantovani F. Is Infectious Endocarditis Evolving into a Time-Dependent Diagnosis in the Contemporary Epidemiological Era? Emphasis on the Role of Echocardiography as a First-Line Diagnostic Approach. Rev Cardiovasc Med 2023; 24:283. [PMID: 39077575 PMCID: PMC11273157 DOI: 10.31083/j.rcm2410283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 07/31/2024] Open
Abstract
Despite significant advances in understanding and outcomes in various domains of cardiology, the prognosis of infective endocarditis (IE) remains dismal. One of the main reasons may rely on an even more intricate diagnosis since epidemiology has shifted towards an aggressive infection, typically in older patients with the involvement of prosthetic valves and cardiovascular implantable electronic devices with earlier clinical presentation. In this novel setting, it is critical to avoid a delay in diagnosis that may delay subsequent adequate treatment, further complications, and ultimately poor clinical outcomes. Accordingly, based on the available data, we will examine the proper use of first-line echocardiography representing the first-line imaging method in patients with clinical suspicion of IE. We will focus on the following three crucial questions: (1) What is the threshold to start the echocardiographic diagnostic workup in stable patients? (2) Has infective endocarditis become a time-dependent diagnosis, even in stable patients? (3) What is the appropriate use of echocardiography in unstable patients? Finally, we propose a new mindset to improve the echocardiographic diagnostic workflow.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, 41122 Modena, Italy
| | - Enrico Cecchi
- Department of Cardiology, Humanitas Cellini, 10100 Turin, Italy
| | - Francesca Bursi
- Division of Cardiology, Dipartimento di Scienze della salute, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, 20142 Milano, Italy
| | - Francesca Mantovani
- Cardiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Kaemmerer AS, Ciotola F, Geißdörfer W, Harig F, Mattner J, Seitz T, Suleiman MN, Weyand M, Heim C. A Dual-Pathogen Mitral Valve Endocarditis Caused by Coxiella burnetii and Streptococcus gordonii-Which Came First? Pathogens 2023; 12:1130. [PMID: 37764938 PMCID: PMC10537458 DOI: 10.3390/pathogens12091130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) is still a life-threatening disease with high morbidity and mortality. While usually caused by a single bacterium, poly-microbial infective endocarditis (IE) is rare. Here, we report a (blood-culture-negative) dual pathogen mitral valve IE caused by Coxiella burnetii and Streptococcus gordonii: A 53-year-old woman was presented to an internal medicine department with abdominal pain for further evaluation. Within the diagnostic work up, transthoracic echocardiography (TTE) revealed an irregularly shaped echogenic mass (5 × 13 mm) adherent to the edge of the posterior mitral valve leaflet and protruding into the left atrium. As infected endocarditis was suspected, blood cultures were initially obtained, but they remained negative. Chronic Q fever infection was diagnosed using serologic testing. After the occurrence of cerebral thromboembolic events, the patient was admitted for mitral valve surgery. Intraoperatively, a massively destructed mitral valve with adhering vegetations was noted. Examination of the mitral valve by broad-range bacterial polymerase chain reaction (PCR) and amplicon sequencing confirmed Coxiella burnetii infection and yielded Streptococcus gordonii as the second pathogen. Based on the detailed diagnosis, appropriate antibiotic therapy of both pathogens was initiated, and the patient could be discharged uneventfully on the 11th postoperative day after a successful minimal-invasive mitral valve replacement.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
| | - Francesco Ciotola
- Department of Cardiology and Pneumonology (Med 1), Klinikum Fürth, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nürnberg, D-90766 Fürth, Germany;
| | - Walter Geißdörfer
- Institute of Microbiology—Clinical Microbiology, Immunology, Hygiene, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (W.G.); (J.M.)
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
| | - Jochen Mattner
- Institute of Microbiology—Clinical Microbiology, Immunology, Hygiene, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (W.G.); (J.M.)
| | - Timo Seitz
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
| | - Mathieu N. Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
| | - Christian Heim
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany; (F.H.); (T.S.); (M.N.S.); (M.W.); (C.H.)
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11
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McHugh J, Saleh OA. Updates in Culture-Negative Endocarditis. Pathogens 2023; 12:1027. [PMID: 37623987 PMCID: PMC10459830 DOI: 10.3390/pathogens12081027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial endocarditis with sterilized blood cultures due to previous antibiotic treatment, endocarditis caused by fastidious microorganisms, and true BCNE caused by intracellular organisms that cannot be cultured using traditional techniques. Non-infectious causes such as nonbacterial thrombotic endocarditis should also be considered. Diagnostic approaches involve thorough patient history; blood and serum testing, including appropriate handling of blood cultures; serological testing; and molecular techniques such as targeted and shotgun metagenomic sequencing. Where available, evaluation of explanted cardiac tissue through histopathology and molecular techniques is crucial. The therapy for BCNE depends on the likely causative agent and the presence of prosthetic material, with surgical intervention often required.
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Affiliation(s)
- Jack McHugh
- Division of Public Health, Infectious Diseases, Occupational Medicine, Mayo Clinic, Rochester, MN 55901, USA;
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12
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Chien SJ, Tseng YJ, Huang YH, Liu HY, Wu YH, Chang LS, Yang YH, Lin YJ. Evaluation of Infective Endocarditis in Children: A 19-Year Retrospective Study in Taiwan. J Clin Med 2023; 12:jcm12062298. [PMID: 36983299 PMCID: PMC10059053 DOI: 10.3390/jcm12062298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Infective endocarditis (IE) is an important cause of morbidity and mortality in pediatric patients with heart disease. Little literature has explored differences in the presentation of endocarditis in children with and without heart disease. This study aimed to compare the clinical outcomes and determine the risk of in-hospital death in the study population. Methods: Data were retrospectively collected from 2001 to 2019 from the Chang Gung Research Database (CGRD), which is the largest collection of multi-institutional electronic medical records in Taiwan. Children aged 0–20 years with IE were enrolled. We extracted and analyzed the demographic and clinical features, complications, microbiological information, and outcomes of each patient. Results: Of the 208 patients with IE, 114 had heart disease and 94 did not. Compared to those without heart disease, more streptococcal infections (19.3% vs. 2.1%, p < 0.001) and cardiac complications (29.8% vs. 6.4%, p < 0.001) were observed in patients with heart disease. Although patients with heart disease underwent valve surgery more frequently (43.9% vs. 8.5%, p < 0.001) and had longer hospital stays (28.5 vs. 12.5, p = 0.021), their mortality was lower than that of those without heart disease (3.5% vs. 10.6%, p = 0.041). Thrombocytopenia was independent risk factor for in-hospital mortality in pediatric patients with IE (OR = 6.56, 95% CI: 1.43–40.37). Conclusion: Among pediatric patients diagnosed with IE, microbiological and clinical features differed between those with and without heart disease. Platelet counts can be used as a risk factor for in-hospital mortality in pediatric patients with IE.
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Affiliation(s)
- Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Early Childhood Care and Education, Cheng Shiu University, Kaohsiung 83347, Taiwan
| | - Yi-Ju Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Ying-Hua Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Hsi-Yun Liu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Yi-Hua Wu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: or ; Tel.: +886-7-731-7123 (ext. 8795); Fax: +886-7-733-8009
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Culture-negative tricuspid valve endocarditis in an intravenous drug abuser masquerading as pulmonary tuberculosis in Nepal: a case report. Ann Med Surg (Lond) 2023; 85:523-527. [PMID: 36923766 PMCID: PMC10010812 DOI: 10.1097/ms9.0000000000000249] [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: 09/09/2022] [Accepted: 12/25/2022] [Indexed: 03/06/2023] Open
Abstract
Infective endocarditis is an infection of the heart valves or endocardium caused by bacterial, viral, or fungal microorganisms. Blood cultures are used to detect the bacteria causing infective endocarditis, and echocardiography is performed to find the damaged heart valves. In blood culture-negative endocarditis, no endocarditis-causing organisms can be found in blood cultures, and blood cultures using usual laboratory methods remain sterile after inoculation of at least three independent blood samples. Case presentation A 24-year-old male with a history of polysubstance abuse presented with complaints of fever, cough, and shortness of breath. He had a past history of pulmonary tuberculosis 4 years ago, for which he was treated with antitubercular therapy. High-resolution computed tomography of the chest revealed multiple cavitary lesions and consolidative areas in the bilateral lungs. Based on these findings, a provisional diagnosis of reactivation of pulmonary tuberculosis was considered, and antitubercular therapy was started. Due to his deteriorating condition, he was readmitted and evaluated. Bronchoalveolar lavage was done and sent for culture and sensitivity testing, which showed the presence of Staphylococcus aureus, and treatment was started accordingly. Despite continuing intravenous antibiotics for 5 days, the patient was not improving. Three sets of samples were withdrawn for blood culture and sensitivity testing, which came out to be negative. Transthoracic echocardiography was done, which revealed vegetation in the tricuspid valve. The patient was diagnosed with culture-negative tricuspid valve endocarditis based on the clinical criteria. Discussion Blood culture-negative endocarditis is difficult to diagnose and presents challenges. When faced with a diagnosis like culture-negative endocarditis in the context of a condition that can appear very similar, like tuberculosis, a broad differential diagnostic approach is important. Conclusion Intravenous drug use is the main cause of right-sided valvular infective endocarditis. Endocarditis should be considered in intravenous drug users even in the absence of positive blood cultures. An appropriate antibiotic regimen and long-term follow-up with a multidisciplinary team are necessary for a good outcome.
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Contemporary Review of Multi-Modality Cardiac Imaging Evaluation of Infective Endocarditis. Life (Basel) 2023; 13:life13030639. [PMID: 36983795 PMCID: PMC10052933 DOI: 10.3390/life13030639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.
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15
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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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16
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CASSIA (cardiology software suite for image analysis): a potential new tool for the evaluation of [ 18F]FDG PET/CT in the setting of infective endocarditis. Int J Comput Assist Radiol Surg 2023; 18:157-169. [PMID: 36053441 PMCID: PMC9883360 DOI: 10.1007/s11548-022-02729-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Due to the high morbidity and mortality of infective endocarditis (IE), medical imaging techniques are combined to ensure a correct diagnosis. [18F]FDG PET/CT has demonstrated the ability to improve diagnostic accuracy compared with the conventional modified Duke criteria in patients with suspected IE, especially those with prosthetic valve infective endocarditis (PVIE). The aim of this study is to provide an adjunctive diagnostic tool to improve the diagnostic accuracy in cardiovascular infections, specifically PVIE. METHODS A segmentation tool to extract quantitative measures of [18F]FDG PET/CT image studies of prosthetic heart valve regions was developed and validated in 20 cases of suspected PVIE, of which 9 were confirmed. For that, Valvular Heterogeneity Index (VHI) and Ring-to-Center Ratio (RCR) were defined. RESULTS Results show an overall increase in the metabolic uptake of the prosthetic valve ring in the studies with confirmed PVIE diagnosis (SUVmax from 1.70 to 3.20; SUVmean from 0.86 to 1.50). The VHI and RCR showed areas under the curve of 0.727 and 0.808 in the receiver operating characteristics curve analyses, respectively, for PVIE diagnosis. Mann-Whitney U tests showed statistically significant differences between groups for RCR (p = 0.02). Visual analyses and clinical reports were concordant with the extracted quantitative metrics. CONCLUSION The proposed new method and presented software solution (CASSIA) provide the capability to assess quantitatively myocardial metabolism along the prosthetic valve region in routine [18F]FDG PET/CT scans for evaluating heart valve infectious processes. VHI and RCR are proposed as new potential adjunctive measures for PVIE diagnosis.
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van der Vaart TW, Heerschop LL, Bouma BJ, Freudenburg W, Bonten MJM, Prins JM, van der Meer JTM. Value of diagnosing immunological phenomena in patients with suspected endocarditis. Infection 2022; 51:705-713. [DOI: 10.1007/s15010-022-01954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Purpose
Immunological phenomena are a minor criteria in the modified Duke Criteria for endocarditis. Given the changes in epidemiology and diagnostics, the added value of determining these phenomena in today’s patients with suspected endocarditis is unknown.
Methods
In a retrospective cohort study of all patients with suspected endocarditis admitted to our hospital and discussed in our endocarditis team, we determined the proportion of patients classified as definite endocarditis because of either positive IgM rheumatoid factor (IgM RF), haematuria, or Roth’s spots on ophthalmology consultation. We also determined diagnostic accuracy of each of these immunological phenomena separately and combined.
Results
Of 285 patients included, 138 (48%) had definite endocarditis and at least one immunological test was performed in 222 patients (78%). Elevated IgM RF was found in 22 of 126 patients tested (17%), haematuria in 78 of 196 tested (40%) and Roth’s spots in six of 120 tested (5%). Eighteen of 138 patients with definite IE (13%) were classified as such because of a positive IgM RF, haematuria or Roth’s spots. Haematuria had the highest sensitivity: 50.5% (95% CI 40.4–60.6) and Roth’s spots the highest specificity: 98.3% (95% CI 90.8–99.9). The diagnostic accuracy results were robust in a sensitivity analysis aimed at avoiding incorporation bias.
Conclusion
Among patients with a clinical suspicion of endocarditis, recommended systematic testing for immunological phenomena helped classify more patients as definite IE and is useful to confirm the diagnosis of endocarditis.
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18
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Milioglou I, Guillombardo C, Forouzandeh F. Bioprosthetic Aortic Valve on the Move. CASE (PHILADELPHIA, PA.) 2022; 6:425-427. [PMID: 36451875 PMCID: PMC9703132 DOI: 10.1016/j.case.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
• Acute bioprosthetic aortic valve regurgitation can present with cardiogenic shock. • Echocardiography is critical in the assessment of bioprosthetic aortic valve function. • In up to 6% of patients with infectious endocarditis, no microbiologic agent is identified. • Surgery is the mainstay of treatment for prosthetic acute aortic regurgitation.
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Affiliation(s)
- Ioannis Milioglou
- Correspondence: Ioannis Milioglou, MD, MS, Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106
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19
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Kelson M, Chaudhry A, Nguyen A, Girgis S. Injection drug induced septic embolism—A growing concern. Radiol Case Rep 2022; 17:4345-4349. [PMID: 36188073 PMCID: PMC9520423 DOI: 10.1016/j.radcr.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Septic pulmonary embolism is an obstruction of the pulmonary vasculature due to embolization of an infected thrombus. In many instances, the etiology is cardiac in origin, given the increased prevalence of intravenous drug users in the United States. This condition usually presents with fever, chest pain, dyspnea, and cough. In order to make the diagnosis, it is helpful to utilize tools like the modified Duke criteria when evaluating for infective endocarditis in the context of pulmonary emboli and septic shock. The gold standard method for establishing the diagnosis of this condition involves imaging modalities, including echocardiogram and computed tomography findings. This case report details a 36-year-old male with a history of drug abuse and hepatitis C, who was found to have an isolated vegetation on the pulmonic valve and septic pulmonary embolism. The patient experienced a rapidly deteriorating clinical course, however improved over the course of 2 weeks with supportive measures and appropriate antibiotic treatment. The purpose of this case report is to highlight the uncommon nature of pulmonary valve involvement in patients with infective endocarditis. Moreover, the goal of this report is to recognize the paralleled increase in septic pulmonary emboli with the rising incidence of patients using injectable opioids in the United States.
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20
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El-Ashry AH, Saad K, Obiedallah AA, Elhoufey A, Dailah HG, Hussein MSA. Molecular and Serological Diagnostic Approach to Define the Microbiological Origin of Blood Culture-Negative Infective Endocarditis. Pathogens 2022; 11:pathogens11111220. [PMID: 36364971 PMCID: PMC9696817 DOI: 10.3390/pathogens11111220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
Blood culture-negative infective endocarditis (BCNIE) poses a significant challenge in determining the best antibiotic regimen for this life-threatening infection, which should be treated with as specific and effective a regimen as feasible. The goal of this study was to determine the prevalence of BCNIE among definite infective endocarditis (IE) cases and to study the impact of a molecular and serological diagnostic approach in defining the microbiological origin of BCNIE. This study included 94 definite IE cases. Serum and blood samples from BCNIE patients were tested using serological, broad-range PCR, and sequencing assays. Valve tissue sections obtained from 42 operated patients were subjected to culture and molecular studies. BCNIE accounted for 63 (67%) of the cases. Of these cases, blood PCR followed by sequencing could diagnose 11 cases. Zoonotic infective endocarditis was detected in 7 (11%) patients by serology and PCR (four Brucella, two Bartonella, and one Coxiella). Sequencing of valve PCR bands revealed 30 positive cases. Therefore, the percentage of BCNIE with unidentified etiology was reduced from 67% to 27.7% through a combination of all diagnostic procedures utilized in our study. Blood and valve PCR and sequencing assays are valuable techniques for the etiological diagnosis of BCNIE, especially in cases with previous antibiotic therapy. However, these tests should be used as part of a larger diagnostic strategy that includes serology, microscopy, and valve culture. The use of an automated blood culture system, and proper blood culture collection before ordering antibiotics, will guide IE etiological diagnosis.
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Affiliation(s)
- Amira H. El-Ashry
- Medical Microbiology & Immunology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut 71111, Egypt
- Correspondence: ; Tel.: +20-882368373
| | - Ahmed A. Obiedallah
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71111, Egypt
| | - Amira Elhoufey
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut 71111, Egypt
- Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan 45142, Saudi Arabia
| | - Hamad Ghaleb Dailah
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
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21
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Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, de-Miguel-Díez J, de-Miguel-Yanes JM, Martinez-Hernandez D, Carabantes-Alarcon D, Zamorano-Leon JJ, Noriega C. Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016-2020. Cardiovasc Diabetol 2022; 21:198. [PMID: 36180922 PMCID: PMC9524731 DOI: 10.1186/s12933-022-01633-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a study to assess sex-differences in incidence (2016-2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status. METHODS Ours was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM. RESULTS From 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74-2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54-3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018). The presence of T2DM was not associated with IHM in men or women. CONCLUSIONS T2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de-Miguel-Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jose M. de-Miguel-Yanes
- Internal Medicine Department, Hospital General, Universitario Gregorio MarañónUniversidad Complutense de MadridInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - David Martinez-Hernandez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Concepción Noriega
- Department of Nursery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
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22
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Mularoni A, Mikulska M, Barbera F, Graziano E, Medaglia AA, Di Carlo D, Monaco F, Bellavia D, Cascio A, Raffa G, Sciacca S, Luca A, Pilato M, Conaldi PG. Molecular Analysis With 16S rRNA PCR/Sanger Sequencing and Molecular Antibiogram Performed on DNA Extracted From Valve Improve Diagnosis and Targeted Therapy of Infective Endocarditis: A Prospective Study. Clin Infect Dis 2022; 76:e1484-e1491. [PMID: 35686318 PMCID: PMC9907470 DOI: 10.1093/cid/ciac452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular analysis (MA) on heart valve (HV) improves the microbiologic diagnosis of infectious endocarditis (IE). The main drawback of MA is the lack of antimicrobial susceptibility information. METHODS We conducted a prospective cohort observational study of consecutive adult patients from April 2012 to May 2021 who underwent valve surgery at our hospital. The performance of MA, blood cultures (BC) and valve cultures (VC), and the diagnostic and therapeutic impact of MA were evaluated. Molecular antibiogram results were compared to culture-based antimicrobial susceptibility testing (AST). RESULTS A total of 137 patients with definite IE and 52 patients with no IE were enrolled in the study. Among IE cases BC, VC, and MA were positive in 75 (55%), 30 (22%), and 120 (88%) of IE cases, respectively. Among 62 cases of BC-negative IE (BCNE), 57 achieved diagnosis with MA. MA led to a change of antimicrobial therapy in 92% of BCNE. MA was negative in 100% of patients with no IE. Molecular antibiogram performed on 17 valve specimens that resulted positive for pathogens potential carrier of genes encoding for multidrug resistant mechanisms showed 100% concordance with AST. CONCLUSIONS MA showed a high specificity and sensitivity in etiological diagnosis of IE. Molecular antibiogram could overcome the major limitation of MA that is the lack of susceptibility testing. We advocate for the inclusion of MA among diagnostic criteria for IE and for a more extensive use of molecular antibiogram when the culture result is negative, and MA is the only positive test.
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Affiliation(s)
- Alessandra Mularoni
- Correspondence: A. Mularoni, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Ernesto Tricomi 5, 90100, Palermo, Italy ()
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL), Genova, Italy,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Floriana Barbera
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- Infectious Diseases Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy,Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
| | | | - Daniele Di Carlo
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesco Monaco
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Sergio Sciacca
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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23
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Comparison of microflora isolated from peripheral blood and valvular structures of the heart in patients with infective endocarditis. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Infective endocarditis (IE) is defined as an infection of a native or prosthetic heart valve, endocardial surface, or permanent cardiac apparatus. Currently, the determination of microorganisms that induce a disease or are involved in the process of pathogenesis by PCR is one of the most modern and rapid tests.The aim. To determine and to compare the spectrum of infectious pathogens in homogenate samples of native heart valves and blood of patients with IE.Materials and methods. Twenty patients with confirmed IE diagnose were examined, admitted for hospitalization at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russia) in 2019. The range of tests used in the study was aimed at detecting such microorganisms as Streptococcus pyogenes, Streptococcus agalactiae, Enterobacter spp., Klebsiella spp., Staphylococcus spp., Streptococcus spp., Bacteroides fragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides ovatus.Results. The study found that 19 samples of heart valves were characterized by the presence of microorganisms from the genus Streptococcus spp., wherein Streptococcus agalactiae was found in two patients. Staphylococcus spp. Were found in 16 samples of valve homogenate. Detection of other pathogens revealed only two cases of Enterobacter spp., Klebsiella spp. When analyzing blood samples from patients with IE, not a single infectious agent was identified. The study revealed a statistically significant difference (p < 0.001) between the incidence of Staphylococcus spp. in samples of valve homogenate and peripheral blood of patients with IE. There was also a statistically significant difference (p < 0.001) for Streptococcus spp. both in samples of valve homogenate and peripheral blood from patients with IE.Conclusion. Molecular genetic research using PCR technologies has low efficiency in detecting the pathogen in the circulating bloodstream, as well as in blood culture. However, the study of homogenized biopsy specimens of the heart valve structures removed during surgery may allow correcting antimicrobial tactics in the early postoperative period of prosthetics.
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Garg P, Chan S, Peeceeyen S, Youssef G, Graves SR, Sullivan R. Culture-negative polymicrobial chronic Q fever prosthetic valve infective endocarditis utilizing 16S ribosomal RNA polymerase chain reaction on explanted valvular tissue. Int J Infect Dis 2022; 121:138-140. [PMID: 35562042 DOI: 10.1016/j.ijid.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Coxiella burnetti is the causative organism of the zoonotic infection Q fever, of which endocarditis is one of the most common manifestations of the chronic form. Polymicrobial endocarditis with Q fever is extremely rare and is yet to be described among an Australasian cohort. SUMMARY: We present the case of a 32-year-old gardener with culture-negative chronic Q fever prosthetic valve endocarditis concomitant with another bacterial pathogen, leading to aortic root abscess formation, requiring a Bentall procedure, extracorporeal membrane oxygenation, and prolonged antimicrobial therapy, with a fatal outcome. Unique to our case, Q fever was identified early, and the second pathogen was only detected on 16S ribosomal RNA (rRNA) polymerase chain reaction of explanted valvular tissue. Given the high risk for morbidity, we recommend that screening for Q fever in endemic areas among patients with infective endocarditis from other etiologies be considered. In addition, this case highlights the role for Q fever vaccination of the at-risk population with underlying valvulopathy. Furthermore, clinicians should be aware of polymicrobial infective endocarditis and suspicious in case of patients with atypical clinical features.
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Affiliation(s)
- Priya Garg
- St George Hospital, Sydney, New South Wales, Australia.
| | | | | | | | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Geelong University Hospital, Barwon Health, Geelong, Victoria, Australia
| | - Richard Sullivan
- St George Hospital, Sydney, New South Wales, Australia; School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health; Menzies School of Health Research, Charles Darwin University
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Villasmil RJ, Sia J, Motie I, Rodriguez L, Kraitman N. Not Your Usual Case of Culture-Negative Endocarditis: A Case Report of Bartonella Endocarditis. Cureus 2022; 14:e24947. [PMID: 35698666 PMCID: PMC9188445 DOI: 10.7759/cureus.24947] [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] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
Advancements in transcatheter interventions have revolutionized the treatment of adult congenital heart disease. We present a case of a 32-year-old male with a history of tetralogy of Fallot with pulmonary atresia diagnosed with Bartonella spp. culture-negative infective endocarditis (IE) of his Melody valve, necessitating Melody valve replacement.
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Affiliation(s)
- Ricardo J Villasmil
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - John Sia
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Ian Motie
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Lisette Rodriguez
- Internal Medicine, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
| | - Natan Kraitman
- Infectious Disease, Sarasota Memorial Hospital, Florida State University College of Medicine, Sarasota, USA
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Sebastian SA, Co EL, Mehendale M, Sudan S, Manchanda K, Khan S. Challenges and Updates in the Diagnosis and Treatment of Infective Endocarditis. Curr Probl Cardiol 2022; 47:101267. [DOI: 10.1016/j.cpcardiol.2022.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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Solanky D, Ahmed AA, Fierer J, Golts E, Jones M, Mehta SR. Utility of Plasma Microbial Cell-Free DNA Decay Kinetics After Aortic Valve Replacement for Bartonella Endocarditis: Case Report. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.842100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundDetection and sequencing of circulating microbial cell-free DNA (mcfDNA) in plasma is an increasingly popular tool for diagnosing many infectious diseases, but could also be used to monitor the progress of infection. However, the decay of this microbial cell-free DNA in blood following treatment has not been previously characterized.Case PresentationA 53 year-old male was diagnosed with Bartonella quintana bioprosthetic aortic valve endocarditis by sequencing of the mcfDNA in the blood (Karius, Redwood City, CA). We then monitored the kinetics of decay of mcfDNA after parenteral antibiotics and valve resection in this individual. We measured plasma mcfDNA (Karius) in serial samples obtained in the operating room to calculate mcfDNA half-life after valve resection. After four weeks of parenteral antibiotics, Bartonella mcfDNA signal decreased by 78%. The signal subsequently rose during operative manipulation of the infected valve but dropped 81-fold over four hours following valve resection. The half-life of mcfDNA between the time shortly following resection of the infected valve and 24 to 48 hours post-operatively was between 35 and 115 minutes. The trend in mcfDNA signal was characterized by rapid and then slower phases of decay within 24 hours, and little change between 24 and 48 hours.ConclusionsThis study is one of the first to characterize decay kinetics of mcfDNA and highlights the potential of monitoring mcfDNA in addressing major challenges in infective endocarditis management, including monitoring the response to therapy, and as an early screen for recurrence.
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Deppe H, Reitberger J, Behr AV, Vitanova K, Lange R, Wantia N, Wagenpfeil S, Sculean A, Ritschl LM. Oral bacteria in infective endocarditis requiring surgery: a retrospective analysis of 134 patients. Clin Oral Investig 2022; 26:4977-4985. [PMID: 35316412 PMCID: PMC9276723 DOI: 10.1007/s00784-022-04465-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/15/2022] [Indexed: 01/02/2023]
Abstract
Objectives It has been reported that bacteria associated with infective endocarditis originate from the oral cavity in 26–45% of cases. However, little is known on the counts and species of periodontal microbiota in infected heart valves. The aim of this study was to identify these aspects of periodontal microbiota in infective endocarditis and to potentially initiate a dental extraction concept for periodontally compromised teeth concerning patients requiring heart valve surgery. Materials and methods The retrospective study group consisted of tissue samples from infected heart valves of 683 patients who had undergone heart valve surgery. Before patients had undergone cardiac surgery, the following laboratory tests confirmed the occurrence of endocarditis in all patients: blood cultures, echocardiography, electrocardiography, chest X-ray, and electrophoresis of the serum proteins. The specimens were aseptically obtained and deep frozen immediately following surgery. Microbiological diagnosis included proof of germs (dichotomous), species of germs, and source of germs (oral versus other). Results Microbiota was detected in 134 (31.2%) out of 430 enrolled patients. Oral cavity was supposed to be the source in 10.4% of cases, whereas microbiota of the skin (57.5%) and gastrointestinal tract (GIT, 24.6%) were detected considerably more frequently. Moreover, periodontal bacteria belonged mostly to the Streptococci species and the yellow complex. None of the detected bacteria belonged to the red complex. Conclusion Most frequently, the skin and GIT represented the site of origin of the microbiota. Nevertheless, the oral cavity represented the source of IE in up to 10%. Consequently, it needs to be emphasized that a good level of oral hygiene is strongly recommended in all patients undergoing heart valve surgery in order to reduce the bacterial load in the oral cavity, thereby minimizing the hematogenous spread of oral microbiota. The prerequisites for conservative dental treatment versus radical tooth extraction must always be based on the patient’s cooperation, and the clinical intraoral status on a sense of proportion in view of the overall clinical situation due to the underlying cardiac disease. Clinical relevance The oral cavity is a source of oral microbiota on infected heart valves. Patients requiring heart valve surgery should always undergo a critical evaluation of dental treatment affecting periodontally compromised teeth, favoring a systematic, conservative-leaning recall.
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Affiliation(s)
- Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Julia Reitberger
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexandra V Behr
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Keti Vitanova
- Department of Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Nina Wantia
- Department of Microbiology, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Kirrbergerstraße Building 86, 66421, Homburg, Saar, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany.
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Abikhzer G, Martineau P, Grégoire J, Finnerty V, Harel F, Pelletier-Galarneau M. [ 18F]FDG-PET CT for the evaluation of native valve endocarditis. J Nucl Cardiol 2022; 29:158-165. [PMID: 32180137 DOI: 10.1007/s12350-020-02092-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND We examined the use of [18F]FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). METHODS PET/CT images in patients with suspected NVE were retrospectively reviewed independently by two experienced physicians blinded to all clinical information. The gold standard consisted of surgical findings, when available, or the modified Duke criteria. RESULTS Fifty four subjects were included, 31 (57%) with a diagnosis of NVE. [18F]FDG-PET/CT correctly identified 21/31 (67.7%) subjects, yielding a sensitivity and specificity of 68% (95% CI 49-83%) and 100% (95% CI 85-100%), respectively. The sensitivity and specificity of the modified Duke criteria were 48% and 74%, respectively. Positive and negative predictive values of PET were 100% (95% CI 84-100%) and 70% (95% CI 51-84%), respectively. Modifying the Duke criteria to include [18F]FDG-PET positivity as a major criterion increased sensitivity to 77% without affecting specificity and led to the correct reclassification of 8/18 (44.4%) subjects from Possible IE to Definite IE. CONCLUSION The addition of a positive [18F]FDG-PET/CT as a major criterion in the modified Duke Criteria improved performance of the criteria for the diagnosis of NVE, particularly in those subjects with Possible IE.
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Affiliation(s)
- Gad Abikhzer
- Department of Radiology and Nuclear Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Patrick Martineau
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jean Grégoire
- Department of Medical Imaging, Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T1C8, Canada
| | - Vincent Finnerty
- Department of Medical Imaging, Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T1C8, Canada
| | - Francois Harel
- Department of Medical Imaging, Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T1C8, Canada
| | - Matthieu Pelletier-Galarneau
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- Department of Medical Imaging, Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T1C8, Canada.
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Sollini M, Bartoli F, Boni R, Zanca R, Colli A, Levantino M, Menichetti F, Ferrari M, Berchiolli R, Lazzeri E, Erba PA. Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure. Front Cardiovasc Med 2021; 8:745556. [PMID: 34926606 PMCID: PMC8671629 DOI: 10.3389/fcvm.2021.745556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT (99mTc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis. Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 99mTc-WBC and 49 [18F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of 99mTc labeled hexamethylpropylene amine oxime-WBC SPECT/CT (99mTc-HMPAO-WBC SPECT/CT) and [18F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. 99mTc-HMPAO-WBC scintigraphy and [18F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria. Results: Sensitivity, specificity, and accuracy of 99mTc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [18F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [18F]FDG PET/CT presented a higher sensitivity than 99mTc-HMPAO-WBC scan. 99mTc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings. Conclusion: Our findings supported the use of 99mTc-HMPAO-WBC SPECT/CT and [18F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Bartoli
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberto Boni
- Unità Operativa Complessa Medicina Nucleare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Zanca
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Colli
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio Levantino
- Division of Cardiovascular Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Paola A Erba
- Department of Translational Research and New Technology in Medicine and Surgery, Regional Center of Nuclear Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, Netherlands
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Houhamdi-Hammou L, Benito Y, Boibieux A, Dupont D, Delahaye F, Thivolet-Bejui F, Wallon M, Vandenesch F, Bouchiat C. Malassezia restricta: An Underdiagnosed Causative Agent of Blood Culture-Negative Infective Endocarditis. Clin Infect Dis 2021; 73:1223-1230. [PMID: 34009270 DOI: 10.1093/cid/ciab377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a severe disease requiring microbial identification to successfully adapt its treatment. Currently, identification of its etiological microorganism remains unresolved in 5.2% of cases. We aimed to improve IE diagnosis using an ultra-sensitive molecular technique on cardiac samples in microbiologically nondocumented (culture and conventional polymerase chain reaction [PCR]) IE (NDIE) cases. METHODS Cardiac samples explanted in a tertiary hospital in Lyon, France, from patients with definite IE over a 5-year period were retrospectively analyzed. NDIE was defined as Duke definite-IE associated with negative explorations including cardiac samples culture, bacterial amplification, and serologies. Ultrasensitive molecular diagnosis was achieved using the Universal Microbe Detection kit (Molzym®). Fungal identification was confirmed using 26S-rDNA and internal transcribed spacer amplifications. Fungal infection was confirmed using Grocott-Gromori staining, auto-immunohistochemistry on cardiac samples, and mannan serologies. RESULTS Among 88 included patients, microbial DNA was detected in all 16 NDIE cases. Bacterial taxa typical of IE etiologies were detected in 13/16 cases and Malassezia restricta in the 3 other cases. In these 3 cases, histological examination confirmed the presence of fungi pathognomonic of Malassezia that reacted with patient sera in an auto-immunohistochemistry assay and cross-reacted with Candida albicans in an indirect immunofluorescent assay. CONCLUSIONS M. restricta appears to be an underestimated causative agent of NDIE. Importantly, serological cross-reaction of M. restricta with C. albicans may lead to its misdiagnosis. This is of major concern since M. restricta is intrinsically resistant to echinocandins; the reference treatment for Candida-fungal IE.
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Affiliation(s)
- Linda Houhamdi-Hammou
- Laboratoire de Bactériologie. Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yvonne Benito
- Laboratoire de Bactériologie. Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - André Boibieux
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Damien Dupont
- Laboratoire de Parasitologie-Mycologie, Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Delahaye
- Service de Cardiologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Françoise Thivolet-Bejui
- Laboratoire d'Anatomie et Cytologie Pathologiques, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Martine Wallon
- Laboratoire de Parasitologie-Mycologie, Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Vandenesch
- Laboratoire de Bactériologie. Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Coralie Bouchiat
- Laboratoire de Bactériologie. Institut des Agents Infectieux. Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Suardi LR, de Alarcón A, García MV, Ciezar AP, Hidalgo Tenorio C, Martinez-Marcos FJ, Concejo-Martínez E, De la Torre Lima J, Vinuesa García D, Luque Márquez R, Ojeda G, Reguera Iglesias JM, Lomas JM, Lopez-Cortes LE. Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study. Infect Dis (Lond) 2021; 53:755-763. [PMID: 34038316 DOI: 10.1080/23744235.2021.1925342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To assess the impact of blood cultures negative infective endocarditis (BCNIE) on in-hospital mortality. METHODS Prospective multicentre study with retrospective analysis of a Spanish cohort including adult patients with definite IE. Cardiac implantable devices infection were excluded. Comparisons between blood cultures positive and BCNIE groups were performed to analyse in-hospital mortality. RESULTS 1001 cases were included of which 83 (8.3%) had BCNIE. Alternative microbiological diagnosis was achieved for 39 (47%) out 83 cases. The most frequent identifications were: Coxiella burnetii (11; 28.2%), Tropheryma whipplei (4; 10.3%), Streptococcus gallolyticus (4;10.3%) and Staphylococcus epidermidis (3; 7.7%). Surgery was performed more frequently in BCNIE group (57.8 vs. 36.9%, p < .001). All-cause in-hospital mortality rate was 26.7% without statistical difference between compared groups. BCNIE was not associated to worse mortality rate in Cox regression model (aHR = 1.37, 95% CI 0.90-2.07, p = .14). Absence of microbiological diagnosis was also not associated to worse in-hospital prognosis (aHR = 1.62, 95% CI 0.99-2.64, p = .06). CONCLUSIONS In our cohort, BCNIE was not associated to greater in-hospital mortality based in multivariate Cox regression models. The variables most frequently associated with mortality were indicated but not performed surgery (aHR = 2.48, 95% CI 1.73-3.56, p < .001), septic shock (aHR = 2.24, 95% CI 1.68-2.99, p < .001), age over 65 years (aHR = 1.88, 95% CI 1.40-2.52, p < .001) and complicated endocarditis (aHR = 1.79, 95% CI 1.36-2.37, p < .001).
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Affiliation(s)
- Lorenzo Roberto Suardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy/Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - María Victoria García
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - Antonio Plata Ciezar
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - Carmen Hidalgo Tenorio
- Staff of Infectious Diseases Unit, University Hospital Virgen de las Nieves/Biomedical Research Institute (IBS), Granada, Spain
| | | | | | | | | | - Rafael Luque Márquez
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Guillermo Ojeda
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - José M Reguera Iglesias
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - José M Lomas
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Luis E Lopez-Cortes
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain
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Change of the Pattern of the Demographic Characteristics of the Patients with Endocarditis: Clinical Case of Infectious Endocarditis in Man with Injectible Drug Dependence, Complicated with Pneumonia and Peripheral Necroses of Feet, Arms, Nose (Own Clinical Observations and Experience of Education in State and English Language). Fam Med 2021. [DOI: 10.30841/2307-5112.2-3.2021.240770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infectious endocarditis is multisystem disease, which is the result of the infection (usually bacterial) of endocardial heart surface. Despite of the latest medical achievements in diagnostics and treatment, infectious endocarditis is still a disease with high mortality rate and severe complications. During last decades in developed countries there are obvious changes of demographic characteristics of the patients with infectious endocarditis, namely increasing of aged patients with degenerative valvular diseases, of patients with anamnesis of invasive manipulations and procedures. Beside with well known risk factors (artificial valves and implanted heart devices), there are increasing roles of injectible drug-dependence, human immunodeficiency virus and wide contact with health protection system as predisposing factors for infectious endocarditis. The article contains literature data of the main populational risk groups of infectious endocarditis.
Clinical case of severe (fatal) infectious endocarditis in patient with injectible drug dependence is submitted. Special features of the case are peripheral dry necroses of feet, arms, nose, which are very close to the description of symmetrical peripheral gangrene. This rare disorder was first described by Hutchinson in 1891 in 37-year old man, who had gangrene of fingers, hands and ears after shock. Symmetrical peripheral gangrene can be induced by different infection and non-inflection causes. The majority of these cases are connected to the treatment of cardiogenic shock with disseminated intravascular coagulation.
Submitted description of the case of symmetrical peripheral gangrene in patient with infectious endocarditis will be useful for different medical care specialists as a reminder of the necessity of constant monitoring of the skin color of the distal parts of the limbs in severe sick patients.
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Zhou Y, Yee Y, Qin Y. Non-bacterial thrombotic endocarditis and metastatic lung adenocarcinoma. BMJ Case Rep 2021; 14:14/7/e242948. [PMID: 34315738 PMCID: PMC8316988 DOI: 10.1136/bcr-2021-242948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 69-year-old Chinese man presented with exertional dyspnoea and subjective left upper limb weakness. Initial clinical impressions were community-acquired pneumonia and cerebrovascular accident. Further imaging studies revealed an incidental mitral valve vegetation and left lung upper lobe nodule likely a lung malignancy with possible lymphangitis carcinomatosis. Appropriate empirical antibiotic treatment for infective endocarditis was instituted early in admission, but multiple blood cultures were negative. The patient progressively developed worsening neurological dysfunction and subconjunctival haemorrhage from recurrent embolic complications despite empirical antimicrobial treatment. Histology finally revealed lung adenocarcinoma after delay in obtaining biopsy due to high procedural risk from recurrent stroke. Unfortunately, before the patient could undergo any systemic oncology treatment, he deteriorated with type I respiratory failure from obstructive pneumonia and eventually demised. Important lessons include the need to consider non-bacterial thrombotic endocarditis as a differential in the appropriate clinical context followed by anticoagulation with systemic treatment as early as possible.
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Affiliation(s)
- Yi Zhou
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Yucai Yee
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Yan Qin
- Department of Internal Medicine, Singapore General Hospital, Singapore
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35
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Godfrey R, Curtis S, Schilling WH, James PR. Blood culture negative endocarditis in the modern era of 16S rRNA sequencing. Clin Med (Lond) 2021; 20:412-416. [PMID: 32675149 DOI: 10.7861/clinmed.2019-0342] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as Coxiella and Bartonella spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. However, these organisms can be difficult to diagnose. We outline a systematic approach to BCNE. Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
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Affiliation(s)
| | - Sally Curtis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Evaluation of Laboratory Predictors for In-Hospital Mortality in Infective Endocarditis and Negative Blood Culture Pattern Characteristics. Pathogens 2021; 10:pathogens10050551. [PMID: 34063295 PMCID: PMC8147437 DOI: 10.3390/pathogens10050551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. Methods: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. Results: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). Conclusion: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.
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Kotova EO, Domonova EA, Kobalava ZD, Karaulova JL, Pisaryuk AS, Balatskiy AV, Akimkin VG. Modern trends in identification of causative agents in infective endocarditis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Advances in the diagnosis and treatment of patients with infectious endocarditis are limited by the high frequency of cases with an unknown etiology and imperfection of microbiological (cultural) methods. To overcome these problems new approaches to the identification of infectious endocarditis pathogens were introduced, which allowed achieving certain positive results. However, it should be noted that despite the wide variety of diagnostic tools currently used, there is no ideal method for etiological laboratory diagnosis of infectious endocarditis. The article discusses the features and place of immunochemical, molecular biological (MALDI-TOF MS, real-time PCR, sequencing, in situ fluorescence hybridization, metagenomic methods, etc.), immunohistochemical methods, and their advantages and limitations.
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Affiliation(s)
| | | | | | | | - A. S. Pisaryuk
- Peoples’ Friendship University of Russia (RUDN);
Moscow City Hospital named after V.V. Vinogradov
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38
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Kyhl F, Rasmussen RV, Lindhardsen J, Smerup M, Fosbøl EL. Rheumatoid arthritis mimicking infective endocarditis with severe aortic regurgitation and aortic root abscess: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa561. [PMID: 33644652 PMCID: PMC7898585 DOI: 10.1093/ehjcr/ytaa561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/08/2020] [Accepted: 12/15/2020] [Indexed: 11/14/2022]
Abstract
Background Rheumatoid arthritis (RA) may involve the cardiovascular system and can cause significant structural cardiac disease. RA mimicking infective endocarditis (IE) is rarely reported. Case summary A 46-year-old man with a medical history of seropositive RA attended a planned outpatient visit for infliximab treatment. The pre-infusion examination revealed a pulse of 41 b.p.m. and the following electrocardiogram showed 3rd degree atrioventricular block. A temporary pacemaker was inserted, and subsequent transthoracic and transoesophageal echocardiograms showed severe aortic valve regurgitation with thickened cusps and thus raised suspicion of infective aortic endocarditis with root abscess. The patient underwent surgery with valve and root replacement the next day. What was thought to be IE, proved to be suppurative and granulomatous inflammation with sporadic necrosis and hyaline fibrosis, compatible with a rheumatoid nodule linked to the patient’s RA diagnosis. Discussion IE is a disease with high mortality and morbidity. In some cases of IE perivalvular cavities develop, most commonly abscesses and/or pseudoaneurysms, which necessitates surgery. Several conditions may mimic IE: for example, malignant and benign tumours, rheumatic diseases, and common age-related valve calcification. In patients with valvular vegetations that are ‘culture-negative’, alternative pathologies should be considered.
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Affiliation(s)
- Frederik Kyhl
- Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Jesper Lindhardsen
- Department of Rheumatic Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,The Heart Valve Unit, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,The Heart Valve Unit, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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39
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Infective endocarditis in intravenous drug users. Trends Cardiovasc Med 2020; 30:491-497. [DOI: 10.1016/j.tcm.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
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40
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Gouriet F, Tissot-Dupont H, Casalta JP, Hubert S, Cammilleri S, Riberi A, Lepidi H, Habib G, Raoult D. FDG-PET/CT Incidental Detection of Cancer in Patients Investigated for Infective Endocarditis. Front Med (Lausanne) 2020; 7:535. [PMID: 33072772 PMCID: PMC7533668 DOI: 10.3389/fmed.2020.00535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is an imaging technique largely used in the management of infective endocarditis and in the detection and staging of cancer. We evaluate our experience of incidental cancer detection by PET/CT during IE investigations and follow-up. Methods and Findings: Between 2009 and 2018, our center, which includes an “endocarditis team,” managed 750 patients with IE in a prospective cohort. PET/CT became available in 2011 and was performed in 451 patients. Incidental diagnosis of cancer by PET/CT was observed in 36 patients and confirmed in 34 of them (7.5%) (colorectal n = 17; lung n = 7; lymphoma n = 2; melanoma n = 2; ovarian n = 2; prostate n = 1; bladder n = 1; ear, nose, and throat n = 1; brain n = 1). A significant association has been found between colorectal cancer and Streptococcus gallolyticus and/or Enterococcus faecalis [12/26 vs. 6/33 for other cancers, p = 0.025, odds ratio = 3.86 (1.19–12.47)]. Two patients had a negative PET/CT (a colon cancer and a bladder cancer), and two patients, with positive PET/CT, had a benign colorectal tumor. PET/CT had a sensitivity of 94–100% for the diagnosis of cancer in this patient. Conclusions: Whole-body PET/CT confirmed the high incidence of cancer in patients with IE and could now be proposed in these cases.
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Affiliation(s)
- Frédérique Gouriet
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Hervé Tissot-Dupont
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Jean-Paul Casalta
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Sandrine Hubert
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Serge Cammilleri
- Service de Médecine Nucléaire Hôpital de la Timone, Marseille, France
| | - Alberto Riberi
- IHU Méditerranée Infection, Marseille, France.,Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France
| | - Hubert Lepidi
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Gilbert Habib
- IHU Méditerranée Infection, Marseille, France.,Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU Méditerranée Infection, Marseille, France
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41
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Polishchuk I, Stavi V, Awesat J, Ben Baruch Golan Y, Bartal C, Sagy I, Jotkowitz A, Barski L. Sex Differences in Infective Endocarditis. Am J Med Sci 2020; 361:83-89. [PMID: 32988595 DOI: 10.1016/j.amjms.2020.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/28/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The impact of sex on the presentation, etiology, and outcomes of infective endocarditis (IE) has not been adequately studied. The aim of the present research was to analyze the impact of sex on the presentation, etiology, and outcomes of IE. METHODS We performed a retrospective study of 214 adult patients (131 male and 83 female) with IE. All cases of IE were reviewed by two investigators- both senior physicians in internal medicine. Two groups of patients were compared: male and female patients with IE. The primary outcome was in-hospital mortality. RESULTS We found significant differences in etiologic factors of IE in male and female patients. Microbiologic etiology differences between male and female groups of patients were in coagulase negative staphylococcus (15.0% in male vs 3.8% in female groups, P = 0.011), and culture negative endocarditis (8.7% in male vs 23.8% in female groups, P = 0.004). We did not find a difference in the primary outcome between the two groups; however, all-cause mortality was significantly higher in the female group as compared to the male group (26 [31.3] vs 22 [16.8], P = 0.018). CONCLUSIONS We found that sex may have important role in both the microbial profile and the patient's outcome with IE.
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Affiliation(s)
- Ilya Polishchuk
- Internal Medicine Outpatient Ward, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Vered Stavi
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Jenan Awesat
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Yael Ben Baruch Golan
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Carmi Bartal
- Department of Internal Medicine E, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Department of Internal Medicine F, Soroka Univerity Medical Center, Beer-Sheva, Israel.
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Pelletier-Galarneau M, Abikhzer G, Harel F, Dilsizian V. Detection of Native and Prosthetic Valve Endocarditis: Incremental Attributes of Functional FDG PET/CT over Morphologic Imaging. Curr Cardiol Rep 2020; 22:93. [PMID: 32647931 DOI: 10.1007/s11886-020-01334-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The clinical and incremental value of functional imaging with 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis and management of patients with suspected native and prosthetic valve infective endocarditis (IE). RECENT FINDINGS The diagnosis of IE is challenging because of the highly variable clinical presentations, especially in the case of prosthetic valve endocarditis (PVE). FDG PET/CT has been shown to play an important role for the diagnosis of PVE as a major Duke criterion. Whether FDG PET/CT could play a similar role in patients with suspected native valve endocarditis (NVE) is less well established. It is increasingly recognized that IE is a multisystem disorder, and identification of extra-cardiac manifestations on whole-body FDG PET/CT impacts management and prognosis of patients with IE. Finally, FDG PET/CT provides incremental prognostic value over other clinical and para-clinical parameters, enabling prediction of in-hospital mortality, IE recurrence, hospitalization, and new onset heart failure and embolic events. FDG PET/CT plays a key role in the investigation of patients with suspected IE, enabling detection of valvular infection and extra-cardiac manifestations of the infection which has important prognostic implications.
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Affiliation(s)
- Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, 5000 Bélanger, Montréal, Québec, H1T1C8, Canada. .,Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gad Abikhzer
- Department of Medical Imaging, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Francois Harel
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, 5000 Bélanger, Montréal, Québec, H1T1C8, Canada
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Prasitlumkum N, Vutthikraivit W, Thangjui S, Leesutipornchai T, Kewcharoen J, Riangwiwat T, Dworkin J. Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 21:790-801. [DOI: 10.2459/jcm.0000000000001001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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45
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Com1 as a Promising Protein for the Differential Diagnosis of the Two Forms of Q Fever. Pathogens 2019; 8:pathogens8040242. [PMID: 31752191 PMCID: PMC6963606 DOI: 10.3390/pathogens8040242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Coxiella burnetii is the causative agent of acute and chronic Q fever in humans. Although the isolates studied so far showed a difference in virulence potential between those causing the two forms of the disease, implying a difference in their proteomic profile, the methods used so far to diagnose the two forms of the disease do not provide sufficient discriminatory capability, and human infections may be often misdiagnosed. The aim of the current study was to identify the outer membrane Com1 (CBU_1910) as a candidate protein for serodiagnostics of Q fever. The protein was cloned, expressed, purified, and used as an antigen in ELISA. The protein was then used for the screening of sera from patients suffering from chronic Q fever endocarditis, patients whose samples were negative for phase I immunoglobulin G (IgG), patients for whom at least one sample was positive for phase I IgG, and patients suffering from any kind of rheumatoid disease. Blood donors were used as the control group. Following statistical analysis, 92.4% (122/132) of the samples tested agreed with the negative clinical diagnosis, and 72.2% (26/36) agreed with the positive clinical diagnosis. Moreover, a significant correlation to the presence of the disease (p = 0.00) was calculated. The results support the idea that a Com1 antigen-based serodiagnostic test may be useful for differential diagnosis of chronic Q fever. Further studies are required to compare more immunogenic proteins of the bacterium against samples originating from patients suffering from different forms of the disease.
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Amuchastegui T, Hur DJ, Lynn Fillipon NM, Eder MD, Bonomo JA, Kim Y, McNamara RL, Malinis M, Sugeng L. An assessment of transesophageal echocardiography studies rated as rarely appropriate tests for infective endocarditis at an academic medical center. Echocardiography 2019; 36:2070-2077. [PMID: 31705577 DOI: 10.1111/echo.14525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/10/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Endocardial involvement documented by echocardiography is a major criterion of the modified Duke criteria (MDC) for infective endocarditis (IE). Though transesophageal echocardiography (TEE) is sensitive in the diagnosis of IE, it can be inappropriately used. METHODS This retrospective study included all patients who underwent TEE due to bacteremia, fever, and/or endocarditis in a single, tertiary academic medical center in 2013. Data collected from electronic medical charts were as follows: demographics, history, physical examination, blood cultures, and transthoracic (TTE) and TEE findings. Cases were categorized based on appropriate use criteria (AUC) and MDC. An infectious disease (ID) specialist reviewed cases with rarely appropriate TEE use. RESULTS In the 194 patients included, 147 (75.8%) were rated as appropriate, 36 (18.6%) rarely appropriate, and 11 (5.6%) uncertain. Of the 36 with rarely appropriate TEEs, using MDC 31 (86%) were rejected and 5 (14%) were possible for IE. Retrospective chart review by an ID specialist determined that 10 of these patients warranted TEE due to compelling issues, including immunosuppression or complicated infection. CONCLUSIONS In this retrospective cohort, almost one fifth of cases were rated as rarely appropriate. However, a review of these cases showed that TEE was often pursued when the clinical situation involved immunosuppression or complex infectious process. There remains room for improvement to our screening process for TEE and a need to implement a nuanced educational plan to better precisely identify appropriate cases for TEE usage.
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Affiliation(s)
- Tomas Amuchastegui
- Internal Medicine Service, Hospital Privado Universitario de Córdoba and Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.,Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - David J Hur
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Nicole M Lynn Fillipon
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiology, Worcester Medical Center, Worcester, Massachusetts
| | - Maxwell D Eder
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Jason A Bonomo
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Maricar Malinis
- Section of Infectious Diseases, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
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Di Domenico EG, Rimoldi SG, Cavallo I, D’Agosto G, Trento E, Cagnoni G, Palazzin A, Pagani C, Romeri F, De Vecchi E, Schiavini M, Secchi D, Antona C, Rizzardini G, Dichirico RB, Toma L, Kovacs D, Cardinali G, Gallo MT, Gismondo MR, Ensoli F. Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis. BMC Microbiol 2019; 19:228. [PMID: 31638894 PMCID: PMC6802308 DOI: 10.1186/s12866-019-1596-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is associated with high rates of mortality. Prolonged treatments with high-dose intravenous antibiotics often fail to eradicate the infection, frequently leading to high-risk surgical intervention. By providing a mechanism of antibiotic tolerance, which escapes conventional antibiotic susceptibility profiling, microbial biofilm represents a key diagnostic and therapeutic challenge for clinicians. This study aims at assessing a rapid biofilm identification assay and a targeted antimicrobial susceptibility profile of biofilm-growing bacteria in patients with IE, which were unresponsive to antibiotic therapy. RESULTS Staphylococcus aureus was the most common isolate (50%), followed by Enterococcus faecalis (25%) and Streptococcus gallolyticus (25%). All microbial isolates were found to be capable of producing large, structured biofilms in vitro. As expected, antibiotic treatment either administered on the basis of antibiogram or chosen empirically among those considered first-line antibiotics for IE, including ceftriaxone, daptomycin, tigecycline and vancomycin, was not effective at eradicating biofilm-growing bacteria. Conversely, antimicrobial susceptibility profile of biofilm-growing bacteria indicated that teicoplanin, oxacillin and fusidic acid were most effective against S. aureus biofilm, while ampicillin was the most active against S. gallolyticus and E. faecalis biofilm, respectively. CONCLUSIONS This study indicates that biofilm-producing bacteria, from surgically treated IE, display a high tolerance to antibiotics, which is undetected by conventional antibiograms. The rapid identification and antimicrobial tolerance profiling of biofilm-growing bacteria in IE can provide key information for both antimicrobial therapy and prevention strategies.
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Affiliation(s)
- Enea Gino Di Domenico
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Sara Giordana Rimoldi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Ilaria Cavallo
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giovanna D’Agosto
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Elisabetta Trento
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giovanni Cagnoni
- UOC Cardiochirurgia, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Alessandro Palazzin
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Cristina Pagani
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Francesca Romeri
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Orthopedic Institute Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Monica Schiavini
- Dipartimento di Malattie Infettive, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Daniela Secchi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Carlo Antona
- UOC Cardiochirurgia, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Giuliano Rizzardini
- Dipartimento di Malattie Infettive, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Rita Barbara Dichirico
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, Regina Elena National Cancer Institute IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology Lab, San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giorgia Cardinali
- Cutaneous Physiopathology Lab, San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Maria Teresa Gallo
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Maria Rita Gismondo
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Fabrizio Ensoli
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
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48
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Kolb M, Lazarevic V, Emonet S, Calmy A, Girard M, Gaïa N, Charretier Y, Cherkaoui A, Keller P, Huber C, Schrenzel J. Next-Generation Sequencing for the Diagnosis of Challenging Culture-Negative Endocarditis. Front Med (Lausanne) 2019; 6:203. [PMID: 31616669 PMCID: PMC6763761 DOI: 10.3389/fmed.2019.00203] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
Diagnosis of culture-negative infective endocarditis usually implies indirect pathogen identification by serologic or molecular techniques. Clinical metagenomics, relying on next-generation sequencing (NGS) is an emerging approach that allows pathogen identification in challenging situations, as evidenced by a clinical case. We sequenced the DNA extracted from the surgically-removed frozen valve tissue from a patient with suspected infective endocarditis with negative blood and valve cultures. Mapping of the sequence reads against reference genomic sequences, a 16S rRNA gene database and clade-specific marker genes suggested an infection caused by Cardiobacterium hominis.
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Affiliation(s)
- Manon Kolb
- Service of General Internal Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Emonet
- Bacteriology Laboratory, Service of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland.,Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandra Calmy
- Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Gaïa
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Yannick Charretier
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Abdessalam Cherkaoui
- Bacteriology Laboratory, Service of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Christoph Huber
- Service of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Bacteriology Laboratory, Service of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland.,Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
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49
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Arregle F, Gouriet F, Amphoux B, Edouard S, Chaudet H, Casalta JP, Habib G, Fournier PE, Raoult D. Western Immunoblotting for the Diagnosis of Enterococcus faecalis and Streptococcus gallolyticus Infective Endocarditis. Front Cell Infect Microbiol 2019; 9:314. [PMID: 31572688 PMCID: PMC6751308 DOI: 10.3389/fcimb.2019.00314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/21/2019] [Indexed: 12/17/2022] Open
Abstract
Blood culture-negative endocarditis (BCNE) remains a diagnostic challenge. In our center, despite a systematic and exhaustive microbiological diagnostics strategy, 22% of patients with BCNE remain without an identified etiology. In an effort to determine the relevance of using Western blot (WB) for the etiological diagnosis of BCNE in patients with early antibiotic use, we developed specific assays for the major infective endocarditis (IE) causative agents, namely, Staphylococcus aureus, Enterococcus faecalis, Streptococcus anginosus, and Streptococcus gallolyticus. Our technique was effective to identify the antigenic profiles of the four tested agents, but cross-reactions with S. aureus and S. anginosus antigens were frequent. A scoring method was developed for the diagnosis of E. faecalis and S. gallolyticus IE using the presence of reactivity to at least two antigenic bands for each bacterium and the positivity to at least one of the Ef300, Ef72, or Ef36 proteic bands for E. faecalis, and positivity for the two Sg75 and Sg97 proteic bands for S. gallolyticus. We tested these diagnostic criteria in a prospective cohort of 363 patients with suspected IE. Immunoblotting for the diagnosis of E. faecalis IE showed a sensitivity of 100% and a specificity of 99%. The positive and negative predictive values were 73 and 100%, respectively. Regarding S. gallolyticus infection, immunoblot had a sensitivity of 100% and a specificity of 95%. However, the positive predictive value was 22%, whereas the predictive negative value was 100%. Using WB, we identified a potential etiological agent in 4 of 14 BCNE cases with no identified pathogen. In conclusion, WB constitutes a promising and helpful method to diagnose E. faecalis or S. gallolyticus IE in patients with early antibiotic uptake and negative blood cultures.
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Affiliation(s)
- Florent Arregle
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Frédérique Gouriet
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France
| | | | - Sophie Edouard
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France
| | - Hervé Chaudet
- Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France.,Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - Jean-Paul Casalta
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France
| | - Gilbert Habib
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Pierre-Edouard Fournier
- Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France.,Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix Marseille Univ., IRD, AP-HM, MEPHI, Marseille, France.,Microbiology Laboratory, Institut Hospitalo-Universitaire (IHU) Mediterranée Infection, Marseille, France.,CNR des Rickettsies, fièvre Q, Bartonella, IHU Méditerranée Infection, Marseille, France
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50
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Elzein FE, Alsherbeeni N, Alnajashi K, Alsufyani E, Akhtar MY, Albalawi R, Albarrag AM, Kaabia N, Mehdi S, Alzahrani A, Raoult D. Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia. Int J Infect Dis 2019; 88:21-26. [PMID: 31382048 DOI: 10.1016/j.ijid.2019.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/21/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
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Affiliation(s)
- Fatehi E Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Nisreen Alsherbeeni
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - M Y Akhtar
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Rashed Albalawi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Naoufel Kaabia
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Syed Mehdi
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | | | - Didier Raoult
- Aix Marseille Université, MEPHI, IHU-Méditerranée Infection, Marseille, France; IHU-Méditerranée Infection, Marseille, France
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