Brucella Endocarditis Caused By Brucella Melitensis

Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various clinical findings. It can lead to complications affecting many systems. Endocarditis is an infrequent, but serious complication of brucellosis.The aim of this case presentation is to remind that endocarditis can be a complication of brucellosis and if is undiagnosed or misdiagnosed, progresses fatal in a high rate

Трудности диагностики инфекционного эндокардита у подростка (клинический случай)

Статья знакомит врачей (педиатров, семейных врачей, детских кардиологов, инфекционистов, дерматологов и др.) со случаем поздней диагностики инфекционного эндокардита у подростка. Представлены литературные данные и собственное наблюдение пациентки с инфекционным эндокардито

Staphylococcus aureus bakteriemi - en av de mest allvarliga och allt oftare förekommande blododlingspositiva infektionerna

English summar

İnfektif endokarditin epidemiyolojik, klinik ve prognostik sonuçları: 90 atağın retrospektif kohortu

To evaluate the epidemiological, clinical, microbiological, and echocardiographic features, as well as the prognosis and long- term outcome of patients with infective endocarditis. Methods: The clinical records and follow-up data of 90 endocarditis episodes in 86 patients diagnosed with definite and possible infec- tive endocarditis according to the modified Duke criteria in a tertiary university hospital, between 1998 and 2016, were reviewed. Results: Fifty-six patients were male (65.1%), and the mean age was 49.9 ± 14.3. Native valve endocarditis constituted 62.2% of the cases, while the remaining patients had prosthetic valve endocarditis. The aortic (34.4%) and mitral (24.4%) valves were infected more frequently. Streptococci (27.7%) and staphylococci (24.4%) were the most frequently isolated microorganisms. Embolic complications (35.5%) were the leading cause of morbidity, followed by valve insufficiency (28.8%) and heart failure (21.1%). Valve replacement surgery was performed in 28 patients (31%). The in-hospital mortality rate was 15.1% (n = 13). Chronic renal failure (P = .042) and degenerative valves (P = .036) were significantly associated with mortality. Among 43 of the 73 cases available for telephonic survey, 36 (83.7%) patients were alive and without disease, with a median follow-up of 52.9 (4-163) months. Twenty-five (69.4%) of these patients were younger than 55 years, and 24 (66.6%) had native valve endocarditis. Conclusion: Underlying cardiac conditions and chronic renal failure increase mortality in infective endocarditis, regardless of the patho- gen. Long-term survival seems promising in cases with native valve endocarditis and in younger patients with low rates of comorbidities.İnfektif endokardit tanısıyla izlenen hastaların epidemiyolojik, klinik, mikrobiyolojik, ekokardiyografik özellikleri, prognozu ve uzun dönem sonuçlarını değerlendirmek. Yöntemler: 1998 ve 2016 yılları arasında bir üniversite hastanesinde modifiye Duke kriterlerine göre kesin ve olası infektif endokardit tanısı konan 86 hastanın 90 endokardit atağının klinik kayıtları ve takip verileri retrospektif olarak incelendi. Bulgular: Çalışmamızda hastaların 56’sı (%65,1) erkek ve ortalama yaş 49,9 ± 14,3 idi. Doğal kapak endokarditi olguların %62,2’sini oluştururken, diğerlerinde protez kapak mevcuttu. En sık aort (%34,4) ve mitral (% 24,4) kapak tutulumu saptandı. Etken olarak strep- tokoklar (%27,7) ve stafilokoklar (%24,4) en sık izole edilen mikroorganizmalardı. Tüm komplikasyonlar içinde embolik komplikasyonlar (%35,5) ilk sırada yer almış, bunu kapak yetmezlikleri (%28,8) ve kalp yetmezliği (%21,1) izlemiştir. Hastaların 28’ine (%31) kapak replasman operasyonu yapılmış ve tüm hastalar içinde 13 hasta (%15,1) hastane takibinde kaybedilmiştir. Mortalite kronik böbrek yetmezliği (P = ,042) ve dejeneratif kapak hastalarında (P = ,036) istatistiksel olarak daha anlamlı bulundu. Taburculuk sonrası prognoz ve uzun dönem sonuçlar değerlendirildiğinde sağ kalan 73 hastanın 43’üne ulaşılabilmiş ve bu hastalardan 36’sının (%83,7) ortalama 52,9 ay (4-163) hayatta ve genel durumlarının iyi olduğu, 25 hastanın (%69,4) <55 yaş, 24’ünün (%66,6) doğal kapak endokarditi tanısıyla izlenmiş olduğu görülmüştür. Sonuç: İnfektif endokardit hastalarında altta yatan kalp hastalıkları ve kronik böbrek yetmezliği patojenden bağımsız olarak mortalit- eyi arttırmaktadır. Doğal kapak endokarditi ve komorbiditeleri daha az olan genç yaş hastalarda ise uzun dönem sağkalım umut verici görünmektedir

Aspects of infective endocarditis. Molecules, microbiology, management, and more.

AbstractEndocarditis, or heart valve infection, can be caused by a number of pathogens, many of which are Gram-positive bacteria. The diagnosis is based on imaging techniques such as echocardiography and on blood culture. The implementation of fast and accurate species identification methods, such as the matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS) in routine use for bacteria found in blood culture, has meant that bacteria previously thought to be rare have become increasingly recognised in the clinic. Some of these newly recognised bacteria are the aerococci, a genus of bacteria consisting of eight identified species, first identified in 1956. Other areas where MALDI-TOF MS and other new bacteriological methods have been helpful are the differentiation between the groups of NBHS (non-beta-haemolytic streptococci), also known as alpha streptococci, and in the identification of other Gram-positive cocci such as Abiotrophia, Gemella, and Granulicatella.This thesis consists of six different studies on endocarditis and endocarditis-causing Gram-positive bacteria. The first of these covers Aerococcus urinae. Using mass spectrometry, two distinct LPATG-anchored proteins named Asp 1 and Asp 2 were identified on the surface of the bacterium. The presence of these proteins was also confirmed using antibodies generated against recombinantly expressed Asp 1 and Asp 2. After sequencing 25 A. urinae genomes, six different variants of asp genes, named asp1-6, were found. All sequenced isolates contained one or two of these asp-genes located in the same region of the chromosome designated Locus Encoding Aerococcal Surface Protein (LASP).The possible synergy between benzylpenicillin and gentamicin against bacteria has long been an argument used in guidelines recommending combination therapy in infective endocarditis (IE). Two of the studies in this thesis look at this, one of which also describes the characteristics of IE caused by aerococci. Bactericidal synergy was shown against 14 of 24 streptococcal isolates and against 7 of 15 tested aerococcal isolates. The characterisation of aerococcal IE (based on data from the Swedish Endocarditis Registry) showed, amongst other things, that the mean age was significantly higher than in IE caused by NBHS or Staphylococcus aureus.By using a cohort of Swedish patients with NBHS-bacteraemia with or without IE, the HANDOC score was constructed: one point given for heart murmur or heart valve disease (H); one point given for an aetiology of Streptococcus bovis-group, Streptococcus sanguinis-group, or Streptococcus mutans-group, and one point subtracted for Streptococcus anginosus-group bacteraemia (A); one point added if the number of positive blood cultures was two or more (N); one point added for a duration of symptoms of seven days or more (D); one point if only one species was present in the blood culture (O); and one point added for a community-acquired infection (C). Using a cut-off of two points, the sensitivity was 100% for detecting IE and the specificity was 76%. The HANDOC score was then validated in a second cohort of Danish patients with NBHS in blood culture. The HANDOC score and the previously published DENOVA score (originally developed to distinguish IE from non-IE in enterococcal bacteraemia) were then applied in cases of bacteraemia with Aerococcus, Abiotrophia, Gemella, and Granulicatella. The sensitivities of HANDOC and DENOVA were 97% and 93%, respectively, with specificities of 85% and 90%. Thus, HANDOC can possibly be used to decide whether or not to perform IE diagnostics in cases of NBHS bacteremia, and both HANDOC and DENOVA can possibly be used for the decision to perform IE diagnostics in cases of bacteremia with Aerococcus, Abiotrophia, Gemella, or Granulicatella

Diagnosis, treatment and prevention of infective endocarditis: Turkish consensus report-2019 [İnfektif endokarditin tanısı, tedavisi ve önlenmesi: Ulusal uzlaşı raporu-2019]

Infective endocarditis (IE) is a rare but still important as an infectious disease due to high rate of morbidity and substantial mortality. Although IE is not a notifiable disease in Turkey, and an incidence study has not been performed, the incidence may be higher than that in the developed countries due to frequent predisposing cardiac conditions and higher rates of nosocomial bacteremia, which may lead to IE in risk groups. IE generally affects the elderly in developed countries but it is frequently encountered among young individuals in Turkey. In order to reduce mortality and morbidity, it is critical to diagnose IE, to determine the causative agent, and to start treatment rapidly. Most patients cannot be diagnosed at the first visit, about half can be diagnosed after 3 months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of the identification of a causative organism is significantly lower in Turkey than that in developed countries. Some important microbiological diagnostic tests are not performed in most centers and several antimicrobials that are recommended as the first option for the treatment particularly antistaphylococcal penicillins, are unavailable in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. The diagnosis and treatment processes of IE should be standardized at every stage so that the management can be conducted in a setting in which physicians of various specialties are involved and is consistent with the current recommendations. The Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases called for the collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the context of current information and local data in Turkey. © 2020 Turkish Society of Cardiology

Bir Hemodiyaliz Hastasında Üç Kapak Tutulumu Olan Endokardit Vakası

A 22 year-old male patient referred to cardiology clinic with complaints of fever, chills and malaise. He had been on haemodialysis for 12 months due to immunoglobulin A nephropathy. On admission his body temperature, pulse rate and blood pressure was 38.6°C, 115 beats/min and 110/70 mmHg, respectively. In the laboratory examination there were leukocyte, C-reactive protein and erythrocyte sedimentation rate elevation. There were vegetations on the mitral, aortic and tricuspid valves. Blood cultures were positive for Enterococcus faecalis which was susceptible to vancomycin. Since the patient did not accept the surgical operation, he died because of multi-organ dysfunction.On iki aydır immünglobulin A nefropatisi tanısıyla hemodiyaliz yapılan yirmi iki yaşında erkek hasta ateş, terleme ve halsizlik şikayeti ile kardiyoloji kliniğimize yönlendirildi. Hastanın başvurusunda vucut sıcaklığı 38,6°C, kalp hızı 115 atım/dk ve tansiyon arteriel 110/70 mmHg idi. Labaratuvar tetkiklerinde lökosit, eritrosit sedimantasyon hızı ve C-reaktif protein değerleri yüksekti. Mitral, aort ve triküspit kapakta vejetasyon vardı. Kan kültüründe vankomisine duyarlı Enterococus faecalis üredi. Cerrahi operasyonu kabul etmeyen hasta multiorgan disfonksiyonu nedeniyle kaybedildi