1
|
Boukobza M, Ilic-Habensus E, Arregle F, Habib G, Duval X, Laissy JP. Hepatic Artery Aneurysms in Infective Endocarditis: Report of 10 Cases and Literature Review. Ann Vasc Surg 2024; 105:252-264. [PMID: 38574810 DOI: 10.1016/j.avsg.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hepatic artery aneurysms (HAAs), albeit rare in infective endocarditis (IE), are associated with a life-threatening morbidity. METHODS Retrospective review of 10 HAA-IE patients based on a total of 623 IE patients managed in 2 institutions (2008-2020) versus 35 literature cases. RESULTS In our patient population, HAAs (10 males, mean age 48) were incidentally found during IE workup. All were asymptomatic. IE involved mitral (n = 6), aortic (n = 3), or mitral-aortic valve (n = 1). Predisposing factors for IE were as follows: prosthetic valve (n = 6), previous IE (n = 2), IV drug user (n = 1). Streptococcus species (spp.) were predominant (n = 4), then staphylococcus spp (n = 2) and E. faecalis (n = 2). All patients presented associated lesions: infectious aneurysms (n = 5), emboli (n = 9), abscesses (n = 5), and spondylitis/spondylodiscitis (n = 2). HAA patterns on abdominal CT angiography (CTA) were solitary (70%), mean diameter 11.7 mm (range 2-30), intrahepatic location (100%) involving the right HA in 9 out of 10 (90%) patients. In 2 patients, HAAs were complicated (rectorragia and hemobilia in 1, cholestasis in the other). Six patients underwent endovascular hepatic embolization (2 with multiple HAAs). Three HAA-IEs <15 mm resolved under antibiotherapy on abdominal CTA follow-up. All patients underwent cardiac surgery. Late outcome was favorable in all followed patients (5/10). Literature review showed the preponderance of Streptococcus spp., of right lobe and intrahepatic HAA localization. Complications revealed HAAs in patients under antibiotic therapy and/or after cardiac surgery in 17 literature cases of delayed diagnosis. CONCLUSIONS Abdominal CTA was pivotal in the initial IE workup. Small aneurysms (≤15 mm) resolved under antibiotherapy. The usual treatment modality was HAA embolization and endovascular embolization before valve surgery was safe.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat - Claude Bernard, Hospital, Assistance Publique Hôpitaux de Marseille, Paris, France.
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Bichat - Claude Bernard, Hospital, Assistance Publique Hôpitaux de Marseille, Paris, France
| | - Florent Arregle
- Cardiology Department, La Timone Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Gilbert Habib
- Cardiology Department, La Timone Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, IRD (Institut de Recherche pour le Développement), Marseille, France
| | - Xavier Duval
- Department of Infectious Diseases, Bichat - Claude Bernard, Hospital, Assistance Publique-Hôpitaux de Paris, INSERM Clinical Investigation Center 007, INSERM U738, Paris University, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat - Claude Bernard, Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U1148, Paris University, Paris, France
| |
Collapse
|
2
|
Boukobza M, Ilic-Habensus E, Duval X, Laissy JP. MRI of unruptured infectious intracranial aneurysms in infective endocarditis. A case-control study. J Neuroradiol 2023; 50:539-547. [PMID: 36621458 DOI: 10.1016/j.neurad.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the usefulness of T2* and FLAIR sequences in the detection of unruptured infectious intracranial aneurysms (UIIAs) in infective endocarditis (IE) including the relationships between the lesion patterns within subarachnoid spaces and the presence of UIIA. METHODS Retrospective review of 15 consecutive patients with definite IE undergoing MR imaging (FLAIR, T2*, DWI, CE-MRA, 3D-T1, CE-3DT1 sequences), in whom DSA detected infectious intracranial aneurysms (IIA). Aneurysmal features (diameter, location, morphology on DSA) and signal patterns onT2*, FLAIR and conventional MR sequences at the site of the UIIA, follow-up MRI and IE background, were analyzed. A control-group of 15 IE-patients without IIA at DSA served for comparison. RESULTS Among 17 UIIAs studied, T2* sequence displayed a susceptibility vessel sign in 15/17 (88.2%), both distal and proximal, which matched with the IIA visualized on DSA. Three patterns of hyposignal areas were identified: (a) signet-ring or target-sign appearance (n = 7), (b) homogeneous, round-, oval- or pear-shaped area (n = 4), and (c) heterogeneous area (n = 4). A FLAIR hyperintensity of the lumen and of the adjacent cortex was present in 6 (35.3%) and 9 (53%) UIIAs, respectively. On T1 (12 UIIAs) a rounded hyposignal (n = 2), within the UIIA lumen matched with the FLAIR hypersignal. Using both T2* and FLAIR had an incremental value with 100% sensitivity and specificity. CONCLUSION The susceptibility vessel sign is an MR imaging pattern frequently observed at the site of UIIAs in IE-patients. Both T2* and FLAIR may have the potential to depict UIIAs, regardless of their location and shape.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, 46 rue Henri Huchard, Paris 75018, France.
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, 46 rue Henri Huchard, Paris 75018, France.
| | - Xavier Duval
- Clinical Investigation Center, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, 46 rue Henri Huchard, Paris 75018, France; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, INSERM Clinical Investigation Center 007, and INSERM U738, Paris University, Paris, France.
| | - Jean-Pierre Laissy
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, 46 rue Henri Huchard, Paris 75018, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, INSERM U1148, Paris University; Bichat Claude-Bernard, Hospital, Paris, France.
| |
Collapse
|
3
|
Boukobza M, Ilic-Habensus E, Mourvillier B, Duval X, Laissy JP. Brain abscesses in infective endocarditis: contemporary profile and neuroradiological findings. Infection 2023; 51:1431-1444. [PMID: 36853493 DOI: 10.1007/s15010-023-02008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Brain abscesses (BA) are severe lesions in the course of infective endocarditis (IE). We compare the bacteriological, clinical data, background, associated lesions, and outcome of IE patients with and without BAs, and assess the MRI characteristics of BAs. METHODS Retrospective study of 351 consecutive patients with definite IE (2005-2020) and at least one brain MRI. Patients with and without BAs were compared. RESULTS Twenty patients (5.7%) had BA (80% men; median age: 44.9 ± 11.5). They were younger (p = 0.035) and had a higher rate of predisposing factors (previous IE 20% vs 2.2%, p = 0.03), intravenous drug use [25% vs 2.2%; p < 0.0001]), underlying conditions (HIV infection, 20% vs 2.2%, p < 0.0001; alcohol abuse, 20% vs 2.2% p < 0.0001]; liver disease p = 0.04; hemodialysis, p = 0.001; type 2 diabetes, p = 0.001), bacterial meningitis (p = 0.0029), rare species involvement (35% vs 7%, p < 0.0006) and extra-cerebral abscesses (p = 0.0001) compared to patients without BA. Valve vegetations were larger in Group 1 (p = 0.046). Clinical presentation could suggest the diagnosis of BA in only 7/20 (35%) patients. MR identified 58 BAs (mean/patient 2.9; range 2-12): often multiple (80%), bilateral (55%) and ≤ 10 mm (72%). The presence of BA did not modify cardiac surgery indication and timing. Favorable outcome was observed in 85% of patients. CONCLUSION Rates of predisposing, underlying conditions, rare IE agents, meningitis and metastatic abscesses are significantly higher in BA-IE patients. As BAs can develop in asymptomatic IE patients, the impact of brain MRI on their management needs thoroughly to be further investigated.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France.
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Hopital Bichat, Claude-Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
| | - Bruno Mourvillier
- Medical Intensive Care Unit, University Hospital of Reims, Reims, France
| | - Xavier Duval
- Clinical Investigation Center, Hopital Bichat, Claude-Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM Clinical Investigation Center 007, Paris, France
- INSERM U738, Paris University, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM U1148, Paris University, Paris, France
| |
Collapse
|
4
|
Boukobza M, Ilic-Habensus E, Duval X, Laissy JP. Letter to the Editor: Multiple Brain Abscesses in Hemophilus parainfluenzae Endocarditis: A Case Report. Surg Infect (Larchmt) 2023. [PMID: 36856524 DOI: 10.1089/sur.2022.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard Hospital, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM Clinical Investigation Center 007, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U1148, Paris, France.,Paris University, Paris, France
| |
Collapse
|
5
|
Duval X, Le Moing V, Tubiana S, Esposito-Farèse M, Ilic-Habensus E, Leclercq F, Bourdon A, Goehringer F, Selton-Suty C, Chevalier E, Boutoille D, Piriou N, Le Tourneau T, Chirouze C, Seronde MF, Morel O, Piroth L, Eicher JC, Humbert O, Revest M, Thébault E, Devillers A, Delahaye F, Boibieux A, Grégoire B, Hoen B, Laouenan C, Iung B, Rouzet F. Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study. Clin Infect Dis 2021; 73:393-403. [PMID: 32488236 DOI: 10.1093/cid/ciaa666] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. METHODS In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. RESULTS Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV. CONCLUSIONS Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients. CLINICAL TRIALS REGISTRATION NCT02287792.
Collapse
Affiliation(s)
- Xavier Duval
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - Vincent Le Moing
- Department of Infectious Diseases, University Hospital of Montpellier, Montpellier, France
| | - Sarah Tubiana
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France
| | - Marina Esposito-Farèse
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Emila Ilic-Habensus
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Aurélie Bourdon
- Department of Nuclear Medicine, University Hospital of Montpellier, Montpellier, France
| | - François Goehringer
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | | | - Elodie Chevalier
- Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital of Nantes, Nantes, France
| | - Nicolas Piriou
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France.,Department of Nuclear Medicine, Nantes University Hospital, G. et R. Laennec Hospital, Nantes, France
| | - Thierry Le Tourneau
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France
| | - Catherine Chirouze
- University Hospital of Besançon, France, UMR CNRS 6249 Chrono-Environnement, Bourgogne University, Franche-Comté, Dijon, France
| | | | - Olivier Morel
- Department of Nuclear Medicine, University Hospital of Besançon, Besançon, France
| | - Lionel Piroth
- Department of Infectious Diseases, University Hospital of Dijon, INSERM CIC 1432, CHU Dijon, France
| | | | - Olivier Humbert
- Department of Nuclear Medicine, University Hospital of Dijon, Dijon, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, University Hospital of Rennes France, INSERM U1230 CHU Rennes, France.,INSERM CIC 1414, University Hospital of Rennes, France
| | | | - Anne Devillers
- Department of Nuclear Medicine, University Hospital of Rennes, France
| | | | - André Boibieux
- Department of Nuclear Medicine, University Hospital of Lyon, Lyon, France
| | - Bastien Grégoire
- Department of Infectious Diseases, University Hospital of Lyon, Lyon, France
| | - Bruno Hoen
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | - Cédric Laouenan
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Bernard Iung
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - François Rouzet
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Department of Nuclear Medicine, AP-HP, University Hospital of Bichat, Paris, France
| | | |
Collapse
|
6
|
Boukobza M, Ilic-Habensus E, Duval X, Laissy JP. Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up. J Neurol 2020; 267:2971-2982. [PMID: 32494850 DOI: 10.1007/s00415-020-09953-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To assess: (1) the prevalence of convexity subarachnoid hemorrhage (cSAH) in infective endocarditis (IE); (2) its relationship with IE features; (3) the associated lesions; (4) whether cSAH is a predictor of future hemorrhage; (5) whether cSAH could cause cortical superficial siderosis (cSS). METHODS We retrospectively evaluated the MRI data in 240 IE-patients: At baseline, the location of cSAH and associated lesions; at follow-up, the occurrence of new lesions and of cSS. Patients with and without cSAH were compared. RESULTS There were 21 cSAH-IE patients without (Group 1a) and 10 with intracranial infectious aneurysms (IIAs) (Group 1b). cSAH was revealed by headache (16.1%), confusion (9.7%), acute meningeal syndrome (3.2%) and was incidental in 71%. In most cases, the cSAH was: in the frontal (61.3%) and the parietal lobe (16.1%), unifocal, and mainly localized within a single sulcus (80.7%), appearing as a thick intrasulcal dark line on T2* in 70% of IIA patients. Valvular vegetations (87.1%, p < 0.0001), vegetations length ≥ 15 mm (58.1%, p < 0.0001) and mitral valve involvement (61.3%; p = 0.05) were significantly associated. There was no significant difference between the two groups in terms of pathogen distribution, valve characteristics and clinical expression. Associated lesions were: CMBs (77.4%), DWILs (51.6%), brain hemorrhages (16.1%) brain micro-abscesses (3.2%) meningitis (3.2%), visceral emboli (45.2%). At follow-up: no SAH recurrence or neurological event. cSS disappeared in 7/12 cases. CONCLUSION cSAH in IE is mostly an incidental finding but may be the telltale sign of an IIA. cSAH is not a marker of poor prognosis in non-IIA patients.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Emila Ilic-Habensus
- Center of Clinical Investigations, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Xavier Duval
- Center of Clinical Investigations, Inserm 1425, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1137, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1148, Paris, France
| |
Collapse
|
7
|
Grall N, Lazarevic V, Gaïa N, Couffignal C, Laouénan C, Ilic-Habensus E, Wieder I, Plesiat P, Angebault C, Bougnoux ME, Armand-Lefevre L, Andremont A, Duval X, Schrenzel J. Unexpected persistence of extended-spectrum β-lactamase-producing Enterobacteriaceae in the faecal microbiota of hospitalised patients treated with imipenem. Int J Antimicrob Agents 2017; 50:81-87. [PMID: 28499958 DOI: 10.1016/j.ijantimicag.2017.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
Imipenem is active against extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) but favours the intestinal emergence of resistance. The effects of imipenem on intestinal microbiota have been studied using culture-based techniques. In this study, the effects were investigated in patients using culture and metagenomic techniques. Seventeen hospitalised adults receiving imipenem were included in a multicentre study (NCT01703299, http://www.clinicaltrials.gov). Most patients had a history of antibiotic use and/or hospitalisation. Stools were collected before, during and after imipenem treatment. Bacterial and fungal colonisation was assessed by culture, and microbiota changes were assessed using metagenomics. Unexpectedly, high colonisation rates by imipenem-susceptible ESBL-E before treatment (70.6%) remained stable over time, suggesting that imipenem intestinal concentrations were very low. Carriage rates of carbapenem-resistant Gram-negative bacilli (0-25.0%) were also stable over time, whereas those of yeasts (64.7% before treatment) peaked at 76.5% during treatment and decreased thereafter. However, these trends were not statistically significant. Yeasts included highly diverse colonising Candida spp. Metagenomics showed no global effect of imipenem on the bacterial taxonomic profiles at the sequencing depth used but demonstrated specific changes in the microbiota not detected with culture, attributed to factors other than imipenem, including sampling site or treatment with other antibiotics. In conclusion, culture and metagenomics were highly complementary in characterising the faecal microbiota of patients. The changes observed during imipenem treatment were unexpectedly limited, possibly because the microbiota was already disturbed by previous antibiotic exposure or hospitalisation.
Collapse
Affiliation(s)
- N Grall
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France.
| | - V Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - N Gaïa
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - C Couffignal
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - C Laouénan
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - E Ilic-Habensus
- AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - I Wieder
- AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - P Plesiat
- Laboratoire de Bactériologie EA4266, Faculté de Médecine-Pharmacie, Université de Franche-Comté, Besançon, France
| | - C Angebault
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - M E Bougnoux
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - L Armand-Lefevre
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - A Andremont
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - X Duval
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - J Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Bacteriology, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
8
|
Hess A, Klein I, Iung B, Lavallée P, Ilic-Habensus E, Dornic Q, Arnoult F, Mimoun L, Wolff M, Duval X, Laissy JP. Brain MRI findings in neurologically asymptomatic patients with infective endocarditis. AJNR Am J Neuroradiol 2013; 34:1579-84. [PMID: 23639563 DOI: 10.3174/ajnr.a3582] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic complications in infective endocarditis are frequent and affect patient prognosis negatively. Additionally, detection of asymptomatic lesions by MR imaging could help early management of this condition. The objective of our study was to describe MR imaging characteristics of cerebral lesions in a neurologically asymptomatic population with infective endocarditis. MATERIALS AND METHODS One hundred nine patients at the acute phase of a definite or possible infective endocarditis according to the Duke modified criteria and without neurologic manifestations according to the NIHSS were prospectively included. Each patient underwent cerebral MR imaging and MRA within 7 days of admission. RESULTS MR imaging showed abnormalities in 78 patients (71.5%). Acute ischemic lesions (40 patients, 37%) and cerebral microbleeds (62 patients, 57%) were the most frequent lesions. Eight patients had an acute SAH, 3 patients had brain microabscesses, 3 had a small cortical hemorrhage, and 3 had a mycotic aneurysm. Acute ischemic lesions mostly appeared as multiple small infarcts disseminated in watershed territories (25/40, 62.5%) and as lesions of different ages (21/40, 52.5%). Cerebral microbleeds were preferentially distributed in cortical areas (362/539 cerebral microbleeds, 67%). No significant correlation was found among lesions, in particular between acute ischemia and cerebral microbleeds. CONCLUSIONS Occult cerebral lesions, in particular cerebral microbleeds and acute ischemic lesions, are frequent in infective endocarditis. The MR imaging pattern of acute small infarcts of different ages predominating in watershed territories and cortical cerebral microbleeds may represent a surrogate imaging marker of infective endocarditis.
Collapse
Affiliation(s)
- A Hess
- Service de Radiologie, EA 3964, Hôpital Universitaire Bichat, Paris, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|