Infective Endocarditis in Argentina. Results of the EIRA 3 Study

Introduction: The clinical and epidemiological characteristics of infective endocarditis (IE), a complex disease with high morbidity and mortality, have been changing over the time. Our country lacks updated information since the publication of the EIRA 1 and 2 studies. Objective: The aim of this study is to analyze the epidemiology, clinical and microbiological characteristics and hospital outcome of IE. Methods: We conducted a prospective multicenter observational study of patients with definite IE according to the modified Duke criteria. Results: A total of 502 patients [mean age 60.7±19.3 years, 69.9% (n=351) were men] were recruited from 48 centers; 54.64% of the patients (n = 274) did not present underlying heart disease and 37.1% (n=191) had history of a healthcare-related procedure. The diagnosis was made within one month after the first clinical manifestation in 73.3% (n=368). The aortic valve was most commonly affected in native and prosthetic valves (48.24%; n=233), followed by mitral valve involvement (25.88%; n=125). The most common germs found were Staphylococcus spp 46.3% (n=210), Streptococcus spp 28.2% (n=128) and Enterococcus 12.8% (n=58). Blood cultures were negative in 48 patients (9.76%). Complications: heart failure (30.9%; n=155), peripheral embolism (19.6%; n = 98) and abscess (15.5%; n = 78). Adequate empirical antibiotic treatment was administered to 62.4% of the patients and 43.3% received surgical treatment (n=218). Overall hospital mortality was 25.5% (n=128). Age, history of chronic kidney failure, mitral valve affection and heart failure were independent predictors of hospital mortality. Conclusions: A high percentage of patients with IE do not present known prior heart disease. Staphylococcus spp was the most common microorganism. Mortality remains high and similar to the one observed in the EIRA 1 and 2 studies.La endocarditis infecciosa (EI) es una enfermedad compleja con elevada morbimortalidad, cuyas características clínicas y epidemiológicas han variado. Desde la realización de los Estudios EIRA 1 y 2 (1992 y 2002) no se dispone de información nacional actualizada. OBJETIVO: Analizar la epidemiología, características clínicas, microbiológicas y evolución hospitalaria de los pacientes con EI. METODOS: Estudio observacional prospectivo multicéntrico de EI definidas según los criterios de Duke modificados. RESULTADOS: En 48 centros, (69.5% Área Metropolitana Buenos Aires), se registraron 502 pacientes; edad 60,7 ± 19,3 años, hombres 69,9%. Tenían enfermedad cardíaca previa el 52,4% (9,6% congénita, 18,3% isquémico-necrótica, 3,8% reumática y 20,7% prótesis valvulares). El 38,1% tenía antecedentes de un procedimiento asociado al cuidado de la salud. En el 73,3% se realizó el diagnóstico dentro del mes de la primera manifestación clínica (76,5% en vávula nativa). La localización fue aórtica (55,6%), mitral (33,6%), catéter endocavitario (10,8%) y tricúspide (19,3%). Los gérmenes más frecuentes fueron: Staphylococcus spp 46,3%, Streptococcus spp 28,2% y Enterococcus spp 12,8%. En 8,6% de los casos los hemocultivos fueron negativos. Complicaciones: insuficiencia cardíaca (30,9%), embolias periféricas (19,6%) y absceso (15,5%). El 62,4% recibió tratamiento antibiótico empírico adecuado y el 43,6% tratamiento quirúrgico. Mortalidad hospitalaria global: 25,5%. La edad, el antecedente de insuficiencia renal, la afección de la válvula mitral y la presencia de insuficiencia cardíaca fueron predictores de mortalidad hospitalaria. CONCLUSIONES: El 47,6% de los pacientes con EI no tenía enfermedad cardíaca previa conocida. El Staphylococcus spp fue el germen causal más frecuente. La mortalidad se mantiene elevada, y similar a la de los estudios EIRA 1 y 2

Initial Studies of the Response of Rubber Tree Seedlings Treated with Saprobic Fungi from the Semiarid Region of Northeast Brazil to Anthracnose

Anthracnose, caused by fungi of the genus Colletotrichum, is present in the main areas where rubber trees (Hevea brasiliensis) are planted. Thus, considering that biological agents can be an alternative for disease control, the present study aimed to carry out initial studies to investigate the response of rubber tree seedlings inoculated with Colletotrichum and treated with saprobes fungi from the semiarid region of Northeast Brazil (Curvularia eragrostidis, Memnoniella levispora, Myrothecium roridum and Phialomyces macrosporus). Seedlings of the rubber tree clone RRIM600 were sprayed with biocontrol agents as preventive and curative treatments seven days before and after C. tamarilloi inoculation, respectively. Assessments included plant response to disease expression based on the percentage of symptomatic area on treated leaves, percentage of graft death, and percentage of apical death in seedlings 30 days after inoculation with C. tamarilloi. In addition, the enzymes peroxidase and phenylalanine ammonia lyase (PAL) had their activity quantified by their association with plant resistance to pathogens. The fungus C. eragrostidis had the best result in controlling anthracnose when applied as a preventive treatment, showing 10% less disease than the untreated plant. The same was observed for the fungus P. macrosporus when used in the curative form. These fungi also reduced the graft death. In these cases, PAL activity was higher and may be linked to the induction of resistance against the pathogen. The peroxidase activity was not expressive for treatments with saprobic fungi in the periods studied. Therefore, among the tested fungi, C. eragrostidis and P. macrosporus are promising for the control of anthracnose, deserving further studies