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Do Lago Palacio Estrela M, Paiva MG, Ferreira RL, Gazola ASL, Pedreira PSC, Bermudez CWO, Murakami R, Pitombeira ECK, Oliveira AG, Lira SMC, Gomes MCC, Silveira GM, Wetten MP, Rotta TCA, Passarelli LCF. 1646 Complicated aortic prosthetic valve endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Prosthetic valve endocarditis (PVE) occurs in 1 to 3% of cases at 1 year and 3 to 9% at 5 years postoperative (PO) with 40% mortality. Clinical complications, uncontrolled infection and agents such as staphylococci and fungi indicate the need for surgery. Recent trial with stable patients (26.7% PVE), oral antibiotic therapy (ATB) proved to be as effect as intravenous antibiotic. However, in complicated cases, prolonged clinical treatment still an exception.
Case Report
ANFJ, male, 45 years old, aortic valve replacement by mechanical prosthesis in 2015, was hospitalized in Jun/18 with right front-temporal-parietal cerebral hemorrhage and sub febrile for 1 week. Transthoracic echocardiogram (TTE) showed pseudoaneurysm of the mitral valve anterior leaflet with 4+ regurgitation and aortic metallic prosthesis without dysfunction, but transesophageal echocardiogram (TEE) disclosed periprosthetic abscess. Empirical ATB was started until blood cultures yielded S. Agalactiae. After 3 weeks with ceftriaxone, patient persisted sub febrile, high CRP, pulmonary congestion and a new TEE showed mobile aortic prosthesis, fistula and periaortic regurgitation 4+. Urgent surgery was carried out at the same day for abscess drainage and replacement of prosthetic valve by biological aortic prosthesis but without mitral valve approach. Immediate PO underwent with hemodynamic instability, prolonged mechanical ventilation, pleural empyema, acute renal failure requiring dialysis and persistence of fever. Two weeks after surgery, TTE demonstrated new periprosthetic abscess with multiple collections along the ascending aorta. Reassessed by heart team and reoperation was contraindicated due to poor clinical conditions. Patient received parenteral broad-spectrum antibiotic evolving with clinical stabilization, normalization of inflammatory tests becoming afebrile. Aortic angiotomography in Aug/18 showed a periaortic collection of 3.0X2.0X1.9cm and contrast extravasation. New TEE in Aug/18 showed periprosthetic abscess and discrete aortic-right atrium fistula (2+). Maintained ATB until D42, persisting afebrile, negative blood cultures, normal leucogram and CRP. Considered inoperable, he was discharged on Sep/18. After 30 days, patient was stable, negative blood cultures however with worsening ESR (2 -> 99mm/h) and CRP (0.5 -> 15mg/dl). He performed ETT and 18F-FDG PET/CT on Nov/18 with persistence of abscess, fistula and high increase 18F-FDG uptake. Heart team again opted for prolonged oral ATB with amoxicillin 3.0gr/day. Re-evaluated on Dec/18 with laboratory normalization and good clinical evolution until last appointment on April/19 under oral antibiotic.
Conclusion
Reoperation of PVE improves prognosis, however in some cases where surgical risk is prohibitive, prolonged ATB may be the only option to control infecction or as a bridge for eventual heart transplantation.
Abstract 1646 Figure.
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Affiliation(s)
| | - M G Paiva
- Hospital Nove de Julho, Sao Paulo, Brazil
| | | | | | | | | | - R Murakami
- Hospital Nove de Julho, Sao Paulo, Brazil
| | | | | | - S M C Lira
- Hospital Nove de Julho, Sao Paulo, Brazil
| | | | | | - M P Wetten
- Hospital Nove de Julho, Sao Paulo, Brazil
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Yoshizawa K, Souza-Silva M, Ferreira RL. Disjunct Occurrence of Trichadenotecnum s.str. in Southeastern Brazil (Psocodea: "Psocoptera": Psocidae), with Description of a New Species. Neotrop Entomol 2017; 46:169-174. [PMID: 27743218 DOI: 10.1007/s13744-016-0449-z] [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] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/17/2016] [Indexed: 06/06/2023]
Abstract
A new barklouse species belonging to the Trichadenotecnum s.str. clade (Psocodea: "Psocoptera": Psocidae) was described from southeastern Brazil (Minas Gerais state). This locality is highly isolated (about 3400 km) from the closest known distributional range of this clade. It also represents the southernmost distributional record of Trichadenotecnum s.str. Phylogenetic placement of the species and biogeography of Neotropical Trichadenotecnum were briefly discussed. Trichadenotecnum punctipenne New, 1972 described from Brazil was synonymized with Trichadenotecnum pardus Badonnel, 1955.
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Affiliation(s)
- K Yoshizawa
- Systematic Entomology, School of Agriculture, Hokkaido Univ, Sapporo, 060-8589, Japan.
| | - M Souza-Silva
- Centro de Estudos em Biologia Subterrânea, Setor de Zoologia Geral, Departamento de Biologia, Univ Federal de Lavras, Lavras, Brasil
| | - R L Ferreira
- Centro de Estudos em Biologia Subterrânea, Setor de Zoologia Geral, Departamento de Biologia, Univ Federal de Lavras, Lavras, Brasil
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Rozenbaum R, Silva-Carvalho MC, Souza RR, Melo MCN, Gobbi CN, Coelho LR, Ferreira RL, Ferreira-Carvalho BT, Schuenck AL, Neves FMCS, Silva LRPOF, Figueiredo AMS. Molecular Characterization of Methicillin-ResistantStaphylococcus aureusDisseminated in a Home Care System. Infect Control Hosp Epidemiol 2016; 27:1041-50. [PMID: 17006810 DOI: 10.1086/507921] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 12/22/2005] [Indexed: 11/03/2022]
Abstract
Objective.To study colonization with methicillin-resistantStaphylococcus aureusin a home care service during a 4-month period.Design.Prospective study.Setting.A home care service located in Rio de Janeiro, Brazil.Participants.Patients admitted to the home care service during this period, their household contacts, and health care workers (HCWs).Methods.Swab specimens from the anterior nares were collected from each patient in the 3 groups at admission. Screening was repeated every 7 days. MRSA was detected using a mecA probe, and the clonality of isolates was evaluated by molecular methods, primarily pulsed-field gel electrophoresis.Results.Of the 59 study patients, 9 (15.3%) had MRSA colonization detected; these cases of colonization were classified as imported. Only 1 (2.0%) of the 50 patients not colonized at admission became an MRSA carrier (this case of colonization was classified as autochthonous). Two (0.9%) of 224 household contacts and 16 (7.4%) of 217 HCWs had MRSA colonization. Cross-transmission from patient to HCW could be clearly demonstrated in 8 cases. The great majority of MRSA isolates belonged to the Brazilian epidemic clone.Conclusions.MRSA colonization was common in the home care service analyzed. The fact that the majority of MRSA isolates obtained were primarily of nosocomial origin (and belonged to the so-called Brazilian epidemic clone) substantiated our findings that all but 1 patient had already been colonized before admission to the home care service. Only cross-transmission from patients to healthcare workers could be verified. On the basis of these results, we believe that a control program built on admission screening of patients for detection of MRSA carriage could contribute to the overall quality of care.
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Affiliation(s)
- R Rozenbaum
- Hospital Samaritano, Rio de Janeiro, Brazil.
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Niza ME, Ferreira RL, Coimbra IV, Guerreiro HM, Félix NM, Matos JM, de Brito TV, Vilela CL. Effects of Pine Processionary Caterpillar Thaumetopoea pityocampa Contact in Dogs: 41 Cases (2002-2006). Zoonoses Public Health 2011; 59:35-8. [DOI: 10.1111/j.1863-2378.2011.01415.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Melo MCN, Silva-Carvalho MC, Ferreira RL, Coelho LR, Souza RR, Gobbi CN, Rozenbaum R, Solari CA, Ferreira-Carvalho BT, Figueiredo AMS. Detection and molecular characterization of a gentamicin-susceptible, methicillin-resistant Staphylococcus aureus (MRSA) clone in Rio de Janeiro that resembles the New York/Japanese clone. J Hosp Infect 2005; 58:276-85. [PMID: 15564003 DOI: 10.1016/j.jhin.2004.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 04/22/2004] [Indexed: 11/18/2022]
Abstract
Staphylococcus aureus is the leading cause of hospital-acquired infections in many countries, and multiple factors contribute to the ability of these bacteria to disseminate and spread in hospitals. In Brazil it has been demonstrated that a multiresistant methicillin-resistant S. aureus clone, the so-called Brazilian epidemic clone, is widespread geographically. This clone was first detected in 1992 in Brazil, and recently from many other countries within South America, Europe and Asia. The study describes the detection of a gentamicin-susceptible heterogeneous MRSA clone that resembles another MRSA clone widely spread in US and Japanese hospitals, and supports the premise that the detection of heterogeneous MRSA isolates by some recommended methods is a challenging task that may, occasionally, result in MRSA misidentification.
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Affiliation(s)
- M C N Melo
- Laboratório de Biologia Molecular de Bactérias, Instituto de Microbiologia Prof Paulo de Góes, Universidade Federal do Rio de Janeiro, CCS, Bloco I, Cidade Universitária, Rio de Janeiro, RJ 21941-590, Brazil
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Machado SF, Ferreira RL, Martins RP. Aspects of the population ecology ofGoniosomasp. (Arachnida Opiliones Gonyleptidae) in limestone caves in southeastern Brazil. Tropical Zoology 2003. [DOI: 10.1080/03946975.2003.10531181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ferreira RL, Oliveira AF, Pereira ES, Hamada N. Occurence of larval Culicidae (Diptera) in water retained in Aquascypha hydrophora (Fungus: Stereaceae) in Central Amazônia, Brazil. Mem Inst Oswaldo Cruz 2001; 96:1165-7. [PMID: 11784940 DOI: 10.1590/s0074-02762001000800023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The community structure of insects, especially mosquito larvae, in water held in the fungus Aquascypha hydrophora (Berk.) Reid (Stereaceae) is reported. The study was done in the Adolpho Ducke Forest Reserve, 26 km east of Manaus, AM, Brazil, from September 1998 through November 1999. The most abundant entomofauna were immature Culicidae (n = 121) 91.7%, followed by adult Dytiscidae (n = 3) 2.3%, immature Chironomidae (n = 5) 3.8% and immature Tipulidae (n = 3) 2.3%. Culicidae associated with A. hydrophora comprised species of the subfamilies Anophelinae and Culicinae.
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Affiliation(s)
- R L Ferreira
- Coordenação de Pesquisas em Entomologia, Instituto Nacional de Pesquisas da Amazônia, Manaus, AM, 69011-970, Brasil.
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Abstract
Species richness, abundance, distribution and similarity between cave invertebrate communities were compared among seven caves located in the Peruaçu River valley, north of Minas Gerais State, Brazil. Such comparisons aimed to determinate the degree of biological complexity in the sampled caves, calculated by the "Index of Biological Complexity in Caves", presented in this manuscript. The presence of potential or real impacts on the cave fauna was also investigated. A total of 1,468 individuals belonging to 57 families of: Acarina, Pseudoscorpionida, Araneida, Opilionida, Amblypygi, Isopoda, Geophilomorpha, Scutigeromorpha, Spirostreptida, Coleoptera, Collembola, Diptera, Dictyoptera, Ephemeroptera, Ensifera, Heteroptera, Hymenoptera, Lepidoptera, Plecoptera, Psocoptera, and Trichoptera was collected. Caves with higher resource availability (as those hidrologicaly actives) had a higher biological complexity than those with less resource. There are two types of impacts that occur in the area: the natural (geological) and the anthropic, as intense "stepping" and visitation or use of cave entrances as cattle shelters. There are caves with different preservation degrees in the area, with invertebrate communities in varied complexity states. The communities of these caves undoubtedly deserve care, since the area is extremely important in the Brazilian biospeleological context.
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Affiliation(s)
- R L Ferreira
- Laboratório de Ecologia e Comportamento de Insetos, Departamento de Biologia Geral, Universidade Federal de Minas Gerais, CEP 30161-970, Belo Horizonte, MG, Brazil.
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Moisés VA, Ferreira RL, Nozawa E, Kanashiro RM, Campos O, Andrade JL, Carvalho AC, Tucci PJ. Structural and functional characteristics of rat hearts with and without myocardial infarct. Initial experience with Doppler echocardiography. Arq Bras Cardiol 2000; 75:125-36. [PMID: 10983029 DOI: 10.1590/s0066-782x2000000800005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess by Doppler echocardiography the structural and functional alterations of rat heart with surgical induced extensive myocardial infarction. METHODS Five weeks after surgical ligature of the left coronary artery, 38 Wistar-EPM rats of both sexes, 10 of them with extensive infarction, undergone anatomical and functional evaluation by Doppler echocardiography and then euthanized for anatomopathological analysis. RESULTS Echocardiography was 100% sensible and specific to anatomopathological confirmed extensive miocardial infarction. Extensive infarction lead to dilatation of left ventricle (diastolic diameter: 0.89 cm vs.0.64 cm; systolic: 0. 72 cm vs. 0.33 cm) and left atrium (0.55 cm vs. 0.33 cm); thinning of left ventricular anterior wall (systolic: 0.14 cm vs. 0.23 cm, diastolic: 0.11 cm vs. 0.14 cm); increased mitral E/ A wave relation (6.45 vs. 1.95). Signals of increased end diastolic ventricle pressure, B point in mitral valve tracing in 62.5% and signs of pulmonary hypertension straightening of pulmonary valve (90%) and notching of pulmonary systolic flow (60%) were observed in animals with extensive infarction. CONCLUSION Doppler echocardiography has a high sensitivity and specificity for detection of chronic extensive infarction. Extensive infarction caused dilatation of left cardiac chambers and showed in Doppler signals of increased end diastolic left ventricular pressure and pulmonary artery pressure.
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Affiliation(s)
- V A Moisés
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, 04023-900, Brazil
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Ferreira RL, Martins RP. Trophic structure and natural history of bat guano invertebrate communities, with special reference to Brazilian caves. Tropical Zoology 1999. [DOI: 10.1080/03946975.1999.10539391] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ferreira RL, de Carvalho H. [Renal cell carcinoma. Nephrectomy 7 years after diagnosis]. ACTA MEDICA PORT 1986; 7:97-8. [PMID: 3661247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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