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Butler NR, Courtney PA, Swegle J. Endocarditis. Prim Care 2024; 51:155-169. [PMID: 38278569 DOI: 10.1016/j.pop.2023.07.009] [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] [Indexed: 01/28/2024]
Abstract
Infectious endocarditis (IE) is a universally fatal condition if left unmanaged, requiring urgent evaluation and treatment. Fever, new heart murmur, vegetations found by echocardiogram, and bacteremia are the most common symptoms and findings. Blood cultures and echocardiography are obligatory diagnostic modalities and should be used with the modified Duke criteria, the accepted diagnostic aid, when establishing a diagnosis of IE. When IE is suspected, consultations with cardiology, infectious disease, and cardiothoracic surgery teams should be made early. Staphylococci, Streptococci, and Enterococci are common pathogens, necessitating bactericidal antimicrobial therapy. Importantly, up to 50% of patients with IE will require cardiothoracic surgical intervention.
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Affiliation(s)
- Nicholas R Butler
- Department of Family Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Patrick A Courtney
- Department of Family Medicine, University of Iowa Carver College of Medicine, Mercy One North Iowa Family Medicine Residency, 1010 4th Street Southwest, Mason City, IA 50401, USA
| | - John Swegle
- University of Iowa College of Pharmacy, Mercy One Family Medicine Residency, 1010 4th Street Southwest, Mason City, IA 50401, USA
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2
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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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3
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Zeng X, Wu J, Li X, Xiong W, Tang L, Li X, Zhuang J, Yu R, Chen J, Jian X, Lei L. Application of Metagenomic Next-Generation Sequencing in the Etiological Diagnosis of Infective Endocarditis During the Perioperative Period of Cardiac Surgery: A Prospective Cohort Study. Front Cardiovasc Med 2022; 9:811492. [PMID: 35369282 PMCID: PMC8965566 DOI: 10.3389/fcvm.2022.811492] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The present study aimed to prospectively evaluate the role of metagenomic next-generation sequencing (mNGS) in the etiological diagnosis of patients with perioperative infective endocarditis (IE). Methods From May 1st, 2019 to December 31st, 2020, a total of 99 patients with IE were enrolled in the present study according to the modified Duke criteria, etiological, and pathological results. 11 non-IE patients undergoing heart valve surgery in the same period were selected as the control group. A blood culture test was performed immediately after admission, and the valves harvested operatively were examined by blood culture and mNGS. Results In the IE group, there were 29 cases (29.3%) with positive blood culture, 16 cases (16.2%) with positive valve culture, and 85 cases (85.9%) with positive valve mNGS. Compared to culture-based detection, mNGS achieved better performance with a sensitivity, specificity, area under the curve (AUC) of 0.859, 0.727, and 0.793, respectively. The combined approach using culture and mNGS further improved the diagnostic accuracy (sensitivity 89.9%, specificity 72.7%, AUC 0.813). Preoperative white blood cell (P = 0.029) and neutrophils (P = 0.046) were identified as independent factors affecting the detection rate of mNGS. In the mNGS-positive group, 95 strains of pathogens were found and 10 cases were identified with mixed infection. There were 72 gram-positive bacteria and 14 gram-negative bacteria. mNGS positive group displayed higher species richness than mNGS negative group with enrichment of Streptococcus sanguis, Streptococcus buccalis, and Streptococcus griseus. Proteobacteria and Actinomycetes were enriched in mNGS negative group. Notably, six patients showed disconcordant results between culture and mNGS. Rothia aeria was identified in the blood culture, valve culture, and valve mNGS in one patient. Bartonella Quintana and Coxiella burnetii, which were fastidious intracellular bacteria, were found in two blood and valve culture-negative cases. Conclusions mNGS outperformed the conventional culture method and displayed high accuracy in detecting pathogens in IE patients. This study provided support for the use of mNGS in the etiological diagnosis of IE.
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Affiliation(s)
- Xiaodong Zeng
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinlin Wu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiping Xiong
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lili Tang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueming Li
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | | | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Xuhua Jian
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liming Lei
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
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Podgórska A, Kordybach-Prokopiuk M, Jaworska-Wilczyńska M, Hoffman P, Biernacka K, Kuśmierski K, Kuthan R, Hryniewiecki T, Lutyńska A. The First Case of Granulicatella adiacens Identified from a Resected Heart Valve by Next Generation Sequencing (NGS) in Poland. Pathogens 2022; 11:pathogens11030295. [PMID: 35335619 PMCID: PMC8950401 DOI: 10.3390/pathogens11030295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
In this report, we describe the course and successful treatment of a case of complicated infective endocarditis (IE). A patient presented with a high-grade, irregular fever with chills lasting at least 2 months along with dyspnoea, chest pain, fatigue, weight loss, and night sweats during the previous 3 months. As well as cardiac congenital disorders, he was found to have Granulicatella adiacens infective aortic valve endocarditis, presumably transmitted from the oral cavity niche. Validated metagenomic 16S rDNA next generation sequencing was used to perform taxonomic identification, allowing for specific adequate antibiotic therapy instead of empiric therapy. This paper highlights the critical role of rapid taxonomic identification of nutritionally variant streptococci and the benefit of proper IE treatment in avoiding relapses or fatal complications.
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Affiliation(s)
- Anna Podgórska
- Department of Medical Biology, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland;
- Correspondence:
| | - Maria Kordybach-Prokopiuk
- Department of Congenital Heart Diseases, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland; (M.K.-P.); (P.H.); (K.B.)
| | - Maria Jaworska-Wilczyńska
- Department of Valvular Heart Disease, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland; (M.J.-W.); (T.H.)
| | - Piotr Hoffman
- Department of Congenital Heart Diseases, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland; (M.K.-P.); (P.H.); (K.B.)
| | - Katarzyna Biernacka
- Department of Congenital Heart Diseases, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland; (M.K.-P.); (P.H.); (K.B.)
| | - Krzysztof Kuśmierski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland;
| | - Robert Kuthan
- Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubińskiego Street, 02-004 Warsaw, Poland;
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Disease, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland; (M.J.-W.); (T.H.)
| | - Anna Lutyńska
- Department of Medical Biology, National Institute of Cardiology, Stefan Cardinal Wyszyński State Research Institute, 42 Alpejska Street, 04-628 Warsaw, Poland;
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Markowich AH, Romani L, Leccisotti L, De Luca M. Challenging case of chronic Q fever endocarditis: usefulness of 18F-FDG PET/CT in the diagnosis and follow-up. BMJ Case Rep 2021; 14:e243290. [PMID: 34417234 PMCID: PMC8381325 DOI: 10.1136/bcr-2021-243290] [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] [Accepted: 07/23/2021] [Indexed: 11/03/2022] Open
Abstract
Diagnosis of infective endocarditis can be challenging for clinicians, especially when involving prosthetic valves. Recent data suggest that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be a useful diagnostic tool in this setting. Here, we report a case of a patient with an aortic biological prosthesis who presented with a history of fever and fatigue. Echocardiograms were negative for vegetations. The 18F-FDG PET/CT revealed an infective process of the valve and serological tests were positive for chronic Coxiella burnetii infection. Specific treatment for chronic Q fever endocarditis was, therefore, started and the response was monitored using 18F-FDG PET/CT. This case highlights the challenges and pitfalls clinicians face when confronted with prosthetic valve endocarditis and the use of 18F-FDG PET/CT for diagnosis and follow-up.
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Affiliation(s)
- Anna Hermine Markowich
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
| | - Lorenza Romani
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
| | - Lucia Leccisotti
- UOC di Medicina Nucleare, Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Maia De Luca
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
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Vallejo Camazon N, Mateu L, Cediel G, Escolà-Vergé L, Fernández-Hidalgo N, Gurgui Ferrer M, Perez Rodriguez MT, Cuervo G, Nuñez Aragón R, Llibre C, Sopena N, Quesada MD, Berastegui E, Teis A, Lopez Ayerbe J, Juncà G, Gual F, Ferrer Sistach E, Vivero A, Reynaga E, Hernández Pérez M, Muñoz Guijosa C, Pedro-Botet L, Bayés-Genís A. Long-term antibiotic therapy in patients with surgery-indicated not undergoing surgery infective endocarditis. Cardiol J 2021; 28:566-578. [PMID: 34031866 DOI: 10.5603/cj.a2021.0054] [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: 02/15/2021] [Revised: 05/21/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To date, there is little information regarding management of patients with infective endocarditis (IE) that did not undergo an indicated surgery. Therefore, we aimed to evaluate prognosis of these patients treated with a long-term antibiotic treatment strategy, including oral long term suppressive antibiotic treatment in five referral centres with a multidisciplinary endocarditis team. METHODS This retrospective, multicenter study retrieved individual patient-level data from five referral centres in Spain. Among a total of 1797, 32 consecutive patients with IE were examined (median age 72 years; 78% males) who had not undergone an indicated surgery, but received long-term antibiotic treatment (LTAT) and were followed by a multidisciplinary endocarditis team, between 2011 and 2019. Primary outcomes were infection relapse and mortality during follow-up. RESULTS Among 32 patients, 21 had IE associated with prostheses. Of the latter, 8 had an ascending aorta prosthetic graft. In 24 patients, a switch to long-term oral suppressive antibiotic treatment (LOSAT) was considered. The median duration of LOSAT was 277 days. Four patients experienced a relapse during follow-up. One patient died within 60 days, and 12 patients died between 60 days and 3 years. However, only 4 deaths were related to IE. CONCLUSIONS The present study results suggest that a LTAT strategy, including LOSAT, might be considered for patients with IE that cannot undergo an indicated surgery. After hospitalization, they should be followed by a multidisciplinary endocarditis team.
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Affiliation(s)
- Nuria Vallejo Camazon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. .,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.
| | - Lourdes Mateu
- Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Escolà-Vergé
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercedes Gurgui Ferrer
- Unitat de Malalties Infeccioses, Hospital Santa Creu i Sant Pau,Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Guillermo Cuervo
- Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Nuñez Aragón
- Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cinta Llibre
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Nieves Sopena
- Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Dolores Quesada
- Microbiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabeth Berastegui
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Albert Teis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge Lopez Ayerbe
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Gladys Juncà
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Gual
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena Ferrer Sistach
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ainhoa Vivero
- Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Reynaga
- Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Hernández Pérez
- Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Lluisa Pedro-Botet
- Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.,Unitat Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
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Clinical usefulness of FDG-PET/CT for identification of abnormal extra-cardiac foci in patients with infective endocarditis. Int J Cardiovasc Imaging 2020; 36:939-946. [PMID: 32060776 DOI: 10.1007/s10554-020-01787-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/31/2020] [Indexed: 02/03/2023]
Abstract
The aim of the study was to evaluate the ability to detect extra-cardiac foci by means of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with definite endocarditis (IE) according to the modified Duke criteria and investigate the clinical impact of the findings. From January 2011 to December 2015 we included 178 patients (mean age 66 ± 14 years, 25% female) with IE in this multicentre study. FDG-PET/CT was part of the work-up for extra-cardiac foci in the including hospitals and was performed at a median of 9 days (IQR 10) after IE was diagnosed. In 114 patients FDG-PET/CT identified 166 lesions: 52 (31%) infectious lesions, 21 (13%) cases of cancer, 7 (4%) cases of embolism, 60 (36%) reactive findings, and 26 (16%) other types of lesions. A total of 74 new extra-cardiac findings, not previously discovered by other modalities, were identified in 62 patients and resulted in additional investigations in 29 patients and a change in treatment in 18 patients (10%). The most frequent diagnoses discovered by FDG-PET/CT were colon polyps, cancer, and spondylodiscitis. There was a higher rate of findings leading to a change in treatment in patients above 67 years of age infected with other bacterial aetiologies than streptococci. FDG-PET/CT was useful to detect extra-cardiac foci. FDG-PET/CT findings may lead to unnecessary investigations. One out of 10 the patients with definite endocarditis had underwent a change in treatment regimen based on the FDG-PET/CT findings.
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Givone F, Peghin M, Vendramin I, Carletti S, Tursi V, Pasciuta R, Livi U, Bassetti M. Salvage heart transplantation for Mycoplasma hominis prosthetic valve endocarditis: A case report and review of the literature. Transpl Infect Dis 2020; 22:e13249. [PMID: 31977151 DOI: 10.1111/tid.13249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/11/2019] [Accepted: 01/12/2020] [Indexed: 12/19/2022]
Abstract
Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a "last resort" procedure. Orthotropic HT with bicaval technique was performed in a man with culture-negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.
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Affiliation(s)
- Filippo Givone
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Maddalena Peghin
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Silvia Carletti
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Tursi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Renée Pasciuta
- Laboratory of Microbiology, San Raffaele Scientific Institute, Milan, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Matteo Bassetti
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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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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Millar BC, de Camargo RA, Alavi A, Moore JE. PET/Computed Tomography Evaluation of Infection of the Heart. PET Clin 2019; 14:251-269. [PMID: 30826023 DOI: 10.1016/j.cpet.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.
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Affiliation(s)
- Beverley Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK.
| | - Raphael Abegão de Camargo
- Nuclear Medicine and Infectious Diseases, University of Sao Paulo Medical School (FMUSP), Sao Paulo, Sao Paulo, Brazil; Hospital Aristides Maltez, Avenida Dom João VI, n° 332, Serviço de Medicina Nuclear, 2° subssolo, Brotas, CEP: 40285-001, Salvador-BA, Brazil
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - John Edmund Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK
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