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Carvajal V, Reyes FB, Gonzalez D, Schwartz M, Whiltlow A, Alegria JR. Endocarditis in Adult Congenital Heart Disease Patients: Prevention, Recognition, and Management. Curr Cardiol Rep 2024; 26:1031-1045. [PMID: 39212775 PMCID: PMC11379749 DOI: 10.1007/s11886-024-02103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW Present an updated overview of the prevention, diagnosis, and management of infective endocarditis in adult patients with congenital heart disease. RECENT FINDINGS Care for patients with infective endocarditis is changing in the areas of specialized teams, diagnostics, and prevention. Endocarditis teams should be involved in the care of ACHD patients. The 2023 Duke Criteria for Infective Endocarditis and the 2023 European Society of Cardiology Guidelines have updated the criteria for diagnosis including new major criteria such as CT and positron emission computed tomography with 18F-fluorodeoxyglucose (FDG) scans. Immunological, PCR, and nucleic acid-based tests are now acceptable means to isolate infective organisms. Clindamycin is no longer recommended for antibiotic prophylaxis due to resistance and side effect profile. Special considerations for antibiotic prophylaxis and management must be made for specific congenital heart diseases in adulthood and pregnant ACHD patients. Infective endocarditis (IE), a potentially devastating clinical entity, is a feared threat to the health of adults with congenital heart disease (ACHD). IE needs a systematic approach for its prevention, early diagnosis and management with a multidisciplinary IE team's involvement. There have been changes in the diagnostics and management of IE, which is reflected in updated diagnostic criteria. Timely blood cultures and imaging continue to be the mainstay of diagnosis, however the timing of blood cultures, microbiological testing, and types of diagnostic imaging such as the positron emission computed tomography with 18F-fluorodeoxyglucose (FDG) scan are new. Bicuspid aortic valves, ventricular septal defects, transcatheter pulmonary valve replacements, and tetralogy of Fallot are diagnoses at higher risk for IE in the ACHD population. The following article will focus on the preventive strategies, in addition to novel diagnostic and therapeutic approaches of IE in ACHD patients.
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Affiliation(s)
- Victoria Carvajal
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Fernando Baraona Reyes
- Department of Cardiology, Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David Gonzalez
- Department of Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH, 44307, USA
| | - Matthew Schwartz
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Angela Whiltlow
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Jorge R Alegria
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA.
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Hofmann M, Schulz-Weidner N, Krämer N, Hain T. The Bacterial Oral Microbiome in Children with Congenital Heart Disease: An Extensive Review. Pathogens 2023; 12:1269. [PMID: 37887785 PMCID: PMC10610089 DOI: 10.3390/pathogens12101269] [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: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Children with congenital heart disease have poorer oral health compared with healthy children. Oral diseases, such as dental caries and gingivitis, are associated with the oral microbiome. The objective of this review was to find evidence of differences in the bacterial colonization of the oral cavity of children with congenital heart disease (CHD) versus healthy children. A literature review was conducted according to predetermined criteria, including the need for controlled clinical trials. Half of the 14 studies that met the inclusion criteria reported significant differences in bacterial colonization in children with congenital heart disease. A variety of influencing factors were discussed. There is some evidence for alterations in the oral microflora as a result of physiopathological and treatment-related factors in children with CHD, but additional research is required to validate these findings.
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Affiliation(s)
- Maria Hofmann
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Nelly Schulz-Weidner
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Norbert Krämer
- Dental Clinic—Department of Paediatric Dentistry, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany; (N.S.-W.); (N.K.)
| | - Torsten Hain
- Institute of Medical Microbiology, Justus Liebig University, Schubertstrasse 81, 35392 Giessen, Germany;
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Schubertstrasse 81, 35392 Giessen, Germany
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Bumm CV, Folwaczny M. Infective endocarditis and oral health-a Narrative Review. Cardiovasc Diagn Ther 2021; 11:1403-1415. [PMID: 35070809 PMCID: PMC8748486 DOI: 10.21037/cdt-20-908] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/08/2021] [Indexed: 09/18/2023]
Abstract
Infective endocarditis is a rare but usually severe and often fatal inflammatory disease affecting the endocardial surface, native and prosthetic valves or cardiac devices. Besides various staphylococcus species, oral viridans streptococci are known to play a crucial role in the development of endocarditis, especially in patients with underlying cardiac conditions, such as valve replacement, congenital heart disease and a history of previous infective endocarditis. Particularly undetected persisting odontogenic infections and their secondary symptoms, as well as various therapeutic measures for their prevention and treatment, may lead to bacterial transfer from the oral cavity into the bloodstream, eventually enabling bacterial adherence to endocardial surfaces and thus promoting infective endocarditis. The administration of antibiotics prior to dental interventions in order to prevent this mechanism was initially recommended almost seventy years ago and has been the subject of research and intensive discussion ever since. Recently, numerous professional societies worldwide have published guidelines and updates on the prevention of endocarditis with divergent recommendations regarding the requirement of prophylactic antibiotic regimen prior to dental procedures. The objective of this article was therefore to review the currently available literature regarding oral health and infective endocarditis and to examine the rationale behind the inconsistent recommendation situation, critically.
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Pardo A, Signoriello A, Signoretto C, Messina E, Carelli M, Tessari M, De Manna ND, Rossetti C, Albanese M, Lombardo G, Luciani GB. Detection of Periodontal Pathogens in Oral Samples and Cardiac Specimens in Patients Undergoing Aortic Valve Replacement: A Pilot Study. J Clin Med 2021; 10:jcm10173874. [PMID: 34501320 PMCID: PMC8432007 DOI: 10.3390/jcm10173874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
This observational study aimed to: (i) assess the presence of periodontal disease among patients requiring aortic valve replacement; (ii) investigate the presence of oral pathogens in aortic valve specimens and compare them with the microorganisms detected in the oral cavity. Twenty-six patients (15 men and 11 women) were scheduled to be visited the day before the cardiac surgery: periodontal conditions were accurately registered through clinical and radiographic examinations; dental plaque or salivary samples were collected. Valve specimens were collected during surgical aortic valve replacement and analyzed for pathogens detection through microbiological 16SrRna gene sequencing. Bacteria found in plaque samples and valve specimens were assessed according to oral and periodontal conditions. A qualitative comparison between oral and cardiac profiles of the microorganisms detected was performed. The overall number of patients examined for soft tissues conditions was 19, as 7 patients were edentulous. Twelve and three individuals, respectively, presented moderate and severe periodontitis. Nine valves were found to be positive for the presence of oral and periodontopathic bacterial DNA. The microbial species found in valve samples of patients with periodontitis suggest that the presence of these microorganisms in valvular tissue seems to be not coincidental.
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Affiliation(s)
- Alessia Pardo
- Dentistry and Maxillo-Facial Surgery Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (A.P.); (A.S.); (E.M.); (M.A.)
| | - Annarita Signoriello
- Dentistry and Maxillo-Facial Surgery Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (A.P.); (A.S.); (E.M.); (M.A.)
| | - Caterina Signoretto
- Microbiology Section, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (C.S.); (M.C.)
| | - Elena Messina
- Dentistry and Maxillo-Facial Surgery Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (A.P.); (A.S.); (E.M.); (M.A.)
| | - Maria Carelli
- Microbiology Section, Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (C.S.); (M.C.)
| | - Maddalena Tessari
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale Stefani 1, 37134 Verona, Italy; (M.T.); (N.D.D.M.); (C.R.); (G.B.L.)
| | - Nunzio Davide De Manna
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale Stefani 1, 37134 Verona, Italy; (M.T.); (N.D.D.M.); (C.R.); (G.B.L.)
| | - Cecilia Rossetti
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale Stefani 1, 37134 Verona, Italy; (M.T.); (N.D.D.M.); (C.R.); (G.B.L.)
| | - Massimo Albanese
- Dentistry and Maxillo-Facial Surgery Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (A.P.); (A.S.); (E.M.); (M.A.)
| | - Giorgio Lombardo
- Dentistry and Maxillo-Facial Surgery Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy; (A.P.); (A.S.); (E.M.); (M.A.)
- Correspondence: ; Tel.: +39-0458124867
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale Stefani 1, 37134 Verona, Italy; (M.T.); (N.D.D.M.); (C.R.); (G.B.L.)
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Wojtkowska A, Zapolski T, Wysokińska-Miszczuk J, Wysokiński AP. The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes: case-control study. BMC Oral Health 2021; 21:5. [PMID: 33407375 PMCID: PMC7789370 DOI: 10.1186/s12903-020-01356-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronary atherosclerosis and periodontal disease, due to their prevalence, are a serious epidemiological problem. Pathophysiological evidence points to their possible common inflammatory etiopathological background. The aim of the study was to analyze the relationship between the presence and severity of periodontitis, systemic inflammation and selected parameters of myocardial injury and heart function in patients with acute myocardial infarction. METHODS The study group consisted of 71 patients 54.22 (7.05)-year-old hospitalized due to acute myocardial infarction. The patients underwent a coronary angiographic examination and echocardiography. The following laboratory parameters were determined: blood morphology, high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen, troponin I, creatine kinase myocardial band (CK-MB), brain natriuretic peptide (BNP), lipidogram, glucose, creatinine, glomerular filtration rate (GFR), thyroid stymulating hormone (TSH), glycated hemoglobin (HbA1c). Dental assessment of the patients was performed and the following indicators were included: the number of teeth preserved, approximal plaque index (API), bleeding on probing (BoP), pocket depth (PD), the number of bleeding periodontal pockets ≥ 4 mm in depth (NoPD ≥ 4 mm), the percentage of bleeding periodontal pockets ≥ 4 mm in depth (%PD ≥ 4 mm), clinical attachment loss (CAL). The control consisted of 40 patients 52 (± 8.43)-year-old without a history of coronary heart disease. These patients were subjected to a periodontal examination using the above parameters and classification methods. The following statistical tests were implemented: Shapiro-Wilk test, Levene's test, Mann Whitney's U analysis, Univariate Analysis of Variance (ANOVA); the post-hoc analysis was performed with the use of Tukey's honest significant difference test (HSD), Kruskal-Wallis's non-parametric test, Spearman's rank correlation, logistic regression analysis, linear regression analysis and ROC analysis. RESULTS The BoP (bleeding on probing) significantly correlated with fibrynogen (R-0.36; p-0.006). All indices regarding the pocket depth correlated significantly with the number of leukocytes: PD (R-0.27; p-0.02), NoPD ≥ 4 mm (R-0.28, p-0.02), %PD ≥ 4 mm (R-0.27; p-0.02). PD (R-0.28; p-0.01) and NoPD ≥ 4 mm (R-0.24; p-0.04) were also associated significantly with the level of hsCRP. The BoP is correlated closely with the levels of BNP (R-0.29, p-0.02). The multifactorial analysis showed that significant predictors of myocardial infarction are API and BoP. The analysis showed that API and BoP are important predictors of troponin levels. Linear regression analysis showed that only CAL is a significant predictor of BNP. CONCLUSIONS Patients with acute myocardial infarction have worse periodontal status compared to people without coronary heart disease. Greater severity of periodontitis, plaque accumulation and bleeding on probing are associated with acute myocardial infarction. Periodontitis is a risk factor for myocardial infarction and also affects the degree of post-infarction left ventricular damage, which means that there is an inflammatory link between these two diseases.
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Affiliation(s)
- Agnieszka Wojtkowska
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | | | - Andrzej P. Wysokiński
- Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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