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De Lillo A, Pathak GA, Low A, De Angelis F, Abou Alaiwi S, Miller EJ, Fuciarelli M, Polimanti R. Clinical spectrum of Transthyretin amyloidogenic mutations among diverse population origins. Hum Genomics 2024; 18:31. [PMID: 38523305 PMCID: PMC10962184 DOI: 10.1186/s40246-024-00596-7] [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: 12/06/2023] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE Coding mutations in the Transthyretin (TTR) gene cause a hereditary form of amyloidosis characterized by a complex genotype-phenotype correlation with limited information regarding differences among worldwide populations. METHODS We compared 676 diverse individuals carrying TTR amyloidogenic mutations (rs138065384, Phe44Leu; rs730881165, Ala81Thr; rs121918074, His90Asn; rs76992529, Val122Ile) to 12,430 non-carriers matched by age, sex, and genetically-inferred ancestry to assess their clinical presentations across 1,693 outcomes derived from electronic health records in UK biobank. RESULTS In individuals of African descent (AFR), Val122Ile mutation was linked to multiple outcomes related to the circulatory system (fold-enrichment = 2.96, p = 0.002) with the strongest associations being cardiac congenital anomalies (phecode 747.1, p = 0.003), endocarditis (phecode 420.3, p = 0.006), and cardiomyopathy (phecode 425, p = 0.007). In individuals of Central-South Asian descent (CSA), His90Asn mutation was associated with dermatologic outcomes (fold-enrichment = 28, p = 0.001). The same TTR mutation was linked to neoplasms in European-descent individuals (EUR, fold-enrichment = 3.09, p = 0.003). In EUR, Ala81Thr showed multiple associations with respiratory outcomes related (fold-enrichment = 3.61, p = 0.002), but the strongest association was with atrioventricular block (phecode 426.2, p = 2.81 × 10- 4). Additionally, the same mutation in East Asians (EAS) showed associations with endocrine-metabolic traits (fold-enrichment = 4.47, p = 0.003). In the cross-ancestry meta-analysis, Val122Ile mutation was associated with peripheral nerve disorders (phecode 351, p = 0.004) in addition to cardiac congenital anomalies (fold-enrichment = 6.94, p = 0.003). CONCLUSIONS Overall, these findings highlight that TTR amyloidogenic mutations present ancestry-specific and ancestry-convergent associations related to a range of health domains. This supports the need to increase awareness regarding the range of outcomes associated with TTR mutations across worldwide populations to reduce misdiagnosis and delayed diagnosis of TTR-related amyloidosis.
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Affiliation(s)
- Antonella De Lillo
- Department of Psychiatry, Yale University School of Medicine, 60 Temple, Suite 7A, New Haven, CT, 06510, USA
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Gita A Pathak
- Department of Psychiatry, Yale University School of Medicine, 60 Temple, Suite 7A, New Haven, CT, 06510, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Aislinn Low
- Department of Psychiatry, Yale University School of Medicine, 60 Temple, Suite 7A, New Haven, CT, 06510, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Flavio De Angelis
- Department of Psychiatry, Yale University School of Medicine, 60 Temple, Suite 7A, New Haven, CT, 06510, USA
- Department of Physical and Mental Health, and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sarah Abou Alaiwi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Fuciarelli
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, 60 Temple, Suite 7A, New Haven, CT, 06510, USA.
- VA CT Healthcare Center, West Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Patsiou V, Haidich AB, Baroutidou A, Giannopoulos A, Giannakoulas G. Epicardial Versus Endocardial Pacing in Paediatric Patients with Atrioventricular Block or Sinus Node Dysfunction: A Systematic Review and Meta-analysis. Pediatr Cardiol 2023; 44:1641-1648. [PMID: 37480376 PMCID: PMC10520152 DOI: 10.1007/s00246-023-03213-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023]
Abstract
Pacing indications in children are clearly defined, but whether an epicardial (EPI) or an endocardial (ENDO) pacemaker performs better remains to be elucidated. This systematic review and meta-analysis aimed to directly compare the incidence of pacemaker (PM) lead-related complications, mortality, hemothorax and venous occlusion between EPI and ENDO in children with atrioventricular block (AVB) or sinus node dysfunction (SND). Literature search was conducted in MEDLINE (via PubMed), Scopus by ELSEVIER, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and OpenGrey databases until June 25, 2022. Random-effects meta-analyses were performed to assess the pacing method's effect on lead failure, threshold rise, post-implantation infection and battery depletion and secondarily on all-cause mortality, hemothorax and venous occlusion. Several sensitivity analyses were also performed. Of 22 studies initially retrieved, 18 were deemed eligible for systematic review and 15 for meta-analysis. Of 1348 pediatric patients that underwent EPI or ENDO implantation, 542 (40.2%) had a diagnosis of congenital heart disease (CHD). EPI was significantly associated with higher possibility of PM-lead failure [pooled odds ratio (pOR) 3.00, 95% confidence interval (CI) 2.05-4.39; I2 = 0%]; while possibility for threshold rise, post-implantation infection and battery depletion did not differ between the PM types. Regarding the secondary outcome, the mortality rates between EPI and ENDO did not differ. In sensitivity analyses the results were consistent results between the two PM types. The findings suggest that EPI may be associated with increased PM-lead failure compared to ENDO while threshold rise, infection, battery depletion and mortality rates did not differ.
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Affiliation(s)
- Vasiliki Patsiou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Giannopoulos
- Second Department of Pediatrics, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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Ioannou P, Alexakis K, Spentzouri D, Kofteridis DP. Infective endocarditis by Serratia species: a systematic review. J Chemother 2022; 34:347-359. [PMID: 35209804 DOI: 10.1080/1120009x.2022.2043513] [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] [Indexed: 01/04/2023]
Abstract
Serratia species are facultative anaerobes, non-spore-forming, motile Gram-negative bacteria. Serratia spp. are currently thought to cause a variety of infections, such as bacteremia, urinary tract infections, and pneumonia, as well as other, less common infections, including ocular infections or skin and soft tissue infections. On the other hand, Infective Endocarditis (IE) is an infrequent disease with notable morbidity and mortality. Even though IE is rarely caused by Serratia spp., these infections can be quite problematic due to the lack of experience in their management. This study aimed to systematically review all published cases of IE by Serratia spp. in the literature. A systematic review of PubMed, Scopus, and Cochrane library (through 13th May 2021) for studies providing epidemiological, clinical, microbiological data as well as data on treatment and outcomes of IE by Serratia spp. was performed. In total, 50 studies, containing data for 72 patients, were included. A prosthetic valve was present in 18.1%. The mitral valve was the most commonly infected site, followed by the aortic valve. The diagnosis was facilitated by transthoracic echocardiography in 34.7%, while the diagnosis was set at autopsy in 22.4%. Fever, sepsis, and embolic phenomena were the most common clinical presentations, followed by heart failure. Aminoglycosides, cephalosporins, and carbapenems were the most commonly used antimicrobials. Clinical cure was noted only in 53.5%, while overall mortality was 47.2%. Having surgery along with antimicrobial treatment was independently associated with reduced overall mortality. IE by Serratia spp. was more likely to be associated with intravenous drug use, and to present with heart failure and embolic phenomena compared to IE by other non-HACEK Gram-negative bacilli, while mortality was also higher in IE by Serratia spp.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Alexakis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Despoina Spentzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Maaliki N, Verdecia J, Ravi M. Elusive Enterobacter cloacae causing pacemaker endocarditis. IDCases 2021; 24:e01149. [PMID: 34040983 PMCID: PMC8141458 DOI: 10.1016/j.idcr.2021.e01149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/22/2023] Open
Abstract
An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical history significant for heart failure with a cardiac resynchronization therapy pacemaker implantation. Extensive workup revealed Enterobacter cloacae endocarditis of the pacemaker leads and the mitral valve, a rare etiology with an unidentified source in our patient. He was managed with a rather unconventional method which proved to be successful. This case sheds light on non-HACEK (other than Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella spp). gram-negative organisms, and particularly E. cloacae, as uncommon causes of endocarditis with elevated mortality, and discusses potential treatment modalities.
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Affiliation(s)
- Naji Maaliki
- Department of Internal Medicine, University of Florida COM-Jacksonville, 4th Floor, 655 8th W 8th Street, Jacksonville, FL, USA
| | - Jorge Verdecia
- Department of Infectious Diseases, University of Florida COM-Jacksonville, 655 8th W 8th Street, Jacksonville, FL, USA
| | - Malleswari Ravi
- Department of Infectious Diseases, University of Florida COM-Jacksonville, 655 8th W 8th Street, Jacksonville, FL, USA
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Ursaru AM, Haba CM, Popescu ȘE, Crișu D, Petriș AO, Tesloianu ND. A Rare Entity-Percutaneous Lead Extraction in a Very Late Onset Pacemaker Endocarditis: Case Report and Review of Literature. Diagnostics (Basel) 2021; 11:diagnostics11010096. [PMID: 33435384 PMCID: PMC7827933 DOI: 10.3390/diagnostics11010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
The number of infections related to cardiac implantable electronic devices (CIEDs) has increased as the number of devices implanted around the world has grown exponentially in recent years. CIED complications can sometimes be difficult to diagnose and manage, as in the case of lead-related infective endocarditis. We present the case of a 48-year-old male diagnosed with Staphylococcus aureus device-related infective endocarditis, 12 years after the implant of a single chamber pacemaker. A recent history of the patient includes two urinary catheterizations due to obstructive uropathy in the context of a prostatic adenoma, 2 months previously, both without antibiotic prophylaxis; no other possible entry sites were found and no history of other invasive procedures. After initiation of antibiotic therapy according to antibiotic susceptibility testing, we decided to remove the right ventricular passive fixation lead along with the vegetation and pacemaker generator; because of severe lead adhesions in the costoclavicular region, and especially in the right ventricle, we needed mechanical sheaths to remove the abundant fibrous tissue that encompassed the lead. After a difficult, but successful, lead extraction along with a large vegetation and 6 weeks' antibiotic therapy, the clinical and biological evolution was favorable, without reappearance of symptoms. While very late lead endocarditis is a rarity, late lead-related infective endocarditis (more than 12 months elapsed since implant) is not an exception; this is why we find that endocarditis prophylaxis should be reconsidered in certain patient categories, our patient being proof that procedures with neglectable endocarditis risk according to the guidelines can lead to bacterial endocarditis.
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Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Correspondence: (A.M.U.); (Ș.E.P.); Tel.: +40-753-731-523 (A.M.U.); +40-752-114-139 (Ș.E.P.)
| | - Cristian Mihai Haba
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ștefan Eduard Popescu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Correspondence: (A.M.U.); (Ș.E.P.); Tel.: +40-753-731-523 (A.M.U.); +40-752-114-139 (Ș.E.P.)
| | - Daniela Crișu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
| | - Antoniu Octavian Petriș
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
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Mertes H, Morissens M, Mahadeb B, Maillart E, Moreau A, Clevenbergh P. Serratia marcescens and other non-AACEK GNB endocarditis: A case report and review of literature. World J Clin Infect Dis 2019; 9:23-30. [DOI: 10.5495/wjcid.v9.i3.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/03/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp. (non-AACEK) gram-negative bacilli (GNBs) are an infrequent and challenging cause of endocarditis associated previously with mainly intravenous drug use. Currently, this pathology has increasingly become a healthcare-associated issue. Current guidelines do not clearly define the management of non-AACEK GNB endocarditis due to a lack of prospective trials. We review characteristics, outcomes and treatment of non-AACEK GNB endocarditis, in particular Serratia marcescens endocarditis.
CASE SUMMARY We describe the case report of a 46-year-old man who presented to the emergency department with high-grade fever and a purulent exudate on an intracardiac device site. Serratia marcescens mitral valve endocarditis as a consequence of complicated generator pocket infection was diagnosed. The patient was treated with complete device removal and a long course of broad-spectrum antibiotics for 6 wk after surgery with intravenous piperacillin-tazobactam and ciprofloxacin, which was later switched to oral ciprofloxacin and sulfamethoxazole-trimethoprim. The patient had complete resolution of symptoms and inflammatory parameters at the end of the treatment and at follow-up.
CONCLUSION Long-term dual-antibiotic therapy containing a beta-lactam is indicated for most non-AACEK GNB endocarditis, whereas valve surgery may not be necessary in all patients.
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Affiliation(s)
- Helena Mertes
- Infectious Disease Department, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerpen 2020, Belgium
| | - Marielle Morissens
- Cardiology Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Bhavna Mahadeb
- Microbiology Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Evelyne Maillart
- Infectious Diseases Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Anthony Moreau
- Intensive Care Unit, Erasmus University Hospital, Intensive Care Unit, Brussels 1070, Belgium
| | - Philippe Clevenbergh
- Infectious Diseases Department, Brugmann University Hospital, Brussels 1020, Belgium
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A Complicated Case of Serratia marcescens Infective Endocarditis in the Era of the Current Opioid Epidemic. Case Rep Infect Dis 2018; 2018:5903589. [PMID: 30581636 PMCID: PMC6276409 DOI: 10.1155/2018/5903589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022] Open
Abstract
While bacteremia due to Serratia marcescens is not uncommon, it rarely causes infective endocarditis. We report an isolated case of a 53-year-old male with history of intravenous drug abuse who presented with multiple acute pain symptoms and was found to have S. marcescens bacteremia with septic emboli in his spleen, brain, and testes, secondary to a large aortic vegetation, as well as aortic infective endocarditis with severe aortic regurgitation requiring aortic valve replacement. His course of disease was further complicated by epidural and psoas abscesses and a necrotic testicle requiring orchiectomy due to his ongoing intravenous drug abuse. This case is an atypical presentation of S. marcescens infection, as he had no overt signs of infection such as fever or significant leukocytosis that are typical of bacteremia, and it also highlights the severity and complicated nature of S. marcescens-infective endocarditis.
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Marvelous but Morbid: Infective endocarditis due to Serratia marcescens. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016; 24:143-150. [PMID: 27346925 DOI: 10.1097/ipc.0000000000000360] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 46-year-old man with HIV infection and active intravenous drug use presented with approximately two weeks of fevers and body aches. On physical examination he was somnolent, had a new systolic murmur, bilateral conjunctival hemorrhages, diffuse petechiae, and left-sided arm weakness. Echocardiography revealed a large mitral valve vegetation and brain imaging demonstrated numerous embolic infarctions. Blood cultures grew Serratia marcescens. Despite aggressive treatment with meropenem the patient died due to intracranial hemorrhage complicated by herniation. Serratia marcescens is an uncommon cause of infective endocarditis. While this disease has historically been associated with intravenous drug use, more recent reports suggest that it is now largely a consequence of opportunistic infections of the chronically ill. Our case highlights several characteristic features of this infection, including isolation of a non-pigmented strain of the organism, an antibiotic susceptibility profile suggestive of AmpC β-lactamase production, and rapid clinical deterioration with multiple embolic complications resulting in death. In this review we discuss the history, epidemiology, and management of endovascular infections due to Serratia spp., emphasizing the continued importance of considering this organism in the differential diagnosis of endocarditis among intravenous drug users and as a potential indication for surgical therapy.
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