Posts filed under ‘Infecciones cardio-vasculares’

Infección por Coxiella burnetti (Fiebre Q)

Enf Infecciosas & Microbiologia Clínica 2010 V.28 Supl.1 P.29-32

Maria Teresa Fraile Fariñas (a) y Carlos Muóz Collado (b)

a Servicio de Microbiología, Hospital General de Valencia, Valencia, España

bDepartamento de Microbiología y Ecología, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España

La fiebre Q todavía es una enfermedad poco conocida, a pesar de que se describió hace más de 60 años. Aunque tampoco se conoce la prevalencia exacta, probablemente el número de casos de fiebre Q está subestimado.

La presentación clínica es muy variada e incluye formas graves con un mal pronóstico.

Frecuentemente, los casos agudos se presentan como una infección asintomática, un síndrome gripal, una neumonía o una hepatitis.

Probablemente, los factores del huésped juegan un papel importante en el desarrollo de la enfermedad crónica, que se puede presentar como una endocarditis con hemocultivo negativo.

El diagnóstico de fiebre Q debe considerarse en los casos de fiebre de origen desconocido, especialmente si el sujeto ha estado en contacto con mamíferos probablemente contaminados.

Los mejores métodos de diagnóstico microbiológico son los que permiten la detección directa de la bacteria (cultivo celular y reacción en cadena de la polimerasa, PCR), si bien estos procedimientos deben realizarse en laboratorios con un nivel de bioseguridad adecuado y con personal especializado.

Para el diagnóstico indirecto el método de referencia es la inmunofluorescencia indirecta (IFI), que es muy sensible y específica.

En los casos de fiebre Q aguda el diagnóstico deberían confirmarlo unos títulos de anticuerpos (IgG y/o IgM), obtenidos por inmunofluorescencia, superiores al punto de corte calculado para cada área geográfica, o bien por seroconversión.

PDF

https://www.seimc.org/contenidos/ccs/revisionestematicas/serologia/ccs-2008-serologia.pdf

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October 30, 2017 at 8:14 am

Fiebre Q

Anales de Medicina Interna (Madrid) Noviembre 2007 V.24 N.11

Roca

Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna. Hospital General de Castellón. Departamento de Medicina. Universidad de Valencia

La fiebre Q es una zoonosis producida por Coxiella burnetii. Se transmite al hombre principalmente a través de aerosoles generados a partir los productos del parto de las vacas y de otros animales.

Clínicamente se caracterizada por un síndrome febril agudo, acompañado de neumonitis y hepatitis. También puede presentarse con un cuadro crónico de endocarditis.

El diagnóstico suele realizarse mediante la serología.

La forma aguda responde bien al tratamiento con tetraciclinas u otros antibióticos, pero la endocarditis es mucho más difícil de tratar, y su pronóstico es malo.

PDF

http://scielo.isciii.es/pdf/ami/v24n11/revision2.pdf

October 30, 2017 at 8:12 am

Blood Culture–Negative Endocarditis, Morocco

Emerging Infectious Diseases November 2017 V.23 N.11

Research Letter

Najma Boudebouch, M’hammed Sarih, Abdelfattah Chakib, Salma Fadili, Drissi Boumzebra, Zahira Zouizra, Badie Azamane Mahadji, Hamid Amarouch, Didier Raoult, and Pierre-Edouard Fournier

Institut Pasteur du Maroc, Casablanca, Morocco (N. Boudebouch, M. Sarih); Centre Hospitalier Universitaire Ibn Rochd, Casablanca (A. Chakib, S. Fadili, B.A. Mahadji); Centre Hospitalier Universitaire Ibn Toufail Marrakech, Marrakech, Morocco (D. Boumzebra, Z. Zouizra); Faculté des Sciences Ain Chock, Casablanca (H. Amarouch); Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France (D. Raoult, P.-E. Fournier)

We investigated the microorganisms causing blood culture–negative endocarditis (BCNE) in Morocco.

We tested 19 patients with BCNE by serologic methods, molecular methods, or both and identified Bartonella quintana, Staphylococcus aureus, Streptococcus equi, and Streptococcus oralis in 4 patients.

These results highlight the role of these zoonotic agents in BCNE in Morocco.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/16-1066.pdf

October 18, 2017 at 8:23 am

Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm? –  A prospective, multicenter cohort

Medicine: September 2017 – Volume 96 – Issue 38 – p e7913

Fernández-Cruz, Ana MD, PhDa,b,*; Muñoz, Patricia MD, PhDa,b,c,d; Sandoval, Carmen MDb,e; Fariñas, Carmen MD, PhDf; Gutiérrez-Cuadra, Manuel MD, PhDf; Pericás Pulido, Juan M. MD, PhDg; Miró, José M. MD, PhDg; Goenaga-Sánchez, Miguel Á. MDh; de Alarcón, Arístides MDi; Bonache-Bernal, Francisco MDj; Rodríguez, MªÁngeles MD, PhDk; Noureddine, Mariam MD, PhDl; Bouza Santiago, Emilio MD, PhDa,b,c,d; on behalf of the Spanish Collaboration on Endocarditis (GAMES)

Abstract

The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.

Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.

During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.

When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).

A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Infective_endocarditis_in_patients_with_cancer___a.11.aspx

PDF (CLIC en “ARTICLE as PDF”)

September 22, 2017 at 4:19 pm

Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

Open Forum Infectious Diseases April 2017 V.4 N.2

Poorani Sekar; James R. Johnson; Joseph R. Thurn; Dimitri M. Drekonja; Vicki A. Morrison …

Background.

Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial.

Methods.

We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making.

Results.

Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P < .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P < .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%).

Conclusions.

Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

PDF

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdMwggHPBgkqhkiG9w0BBwagggHAMIIBvAIBADCCAbUGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMeFcAOsBub-Q7icrBAgEQgIIBhvFldBYwYOWKFTDnKiWkUjQyp_Gxbkh70UcMoyuF46dvh-nnVQTQy7ygLKkkpK6vTCU2tUMBizKzMT4XGA48UGtEM9DzFFasOBvRLsExTYiR39zBNKjAj1AwvwU84VDhgmJXtFxML40CHUM6ew40Ag8-FJQX5kS0NJEfis9te1G5VVL_DySxQeoW_79YrJfcIkbBEAQR5NdFmlINDBgaWIegD8wSyD1ejwbon7K_SiTsO7EDlEzq7nEJutnEGPqCJtFWeEmaFSC0_7mMEmkq7xKy9IQdPkRiLPNdPcWBoN-LkkwTK6SOMNyP3X8CKwkyNkPCZgcd-VVAN05Ydq3AGmsMQqNa8z0Fg9OXnJqaD9SjYKb5_cAX3bfVAx7I23aN7FMgAACaoK7AavAC9KdSPnitBIyIKcu2pNB7iyOTB2r8U5_BfSrTi_SHfYXApP72cbSWJVdWd1bnqmiCSHVVx5o9IrEvzPuVlORi0RRQQ7Wv7_dYRUY0LjbZsFiiJ5StZo4C1oq8YQ

September 3, 2017 at 6:46 pm

From Expert Protocols to Standardized Management of Infectious Diseases

Clinical Infectious Diseases  15 August 2017  V.65 N.suppl 1 S12–S19

Jean-Christophe Lagier; Camille Aubry; Marion Delord; Pierre Michelet; Hervé Tissot-Dupont …

We report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Méditerranée Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs.

First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome.

Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate.

Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria.

Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters.

Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/65/suppl_1/10.1093_cid_cix403/3/cix403.pdf?Expires=1502372492&Signature=LVAbXU3YuwNx~UkUFnKvXaFmayq1aLSWpor6xnVqc2jGiKuNc69M1UqI4xbuqSgRoOKoPhupwLOXRmDGZRMNfu1ydEj9NXbJnqvpBSeWUzfnWw~jYh2w3Y37B92GZwGPSe4XelatYtvhE7i8mqlvzzKKpL2cpkgYhApfvdGjdPIJ-cWZCHuU8dzEdHMOzmEjV-sJI1rBrwSqK4XlRyFojeLEKx5yBZxDukcIP2GQbPvbL1BYugZA~MAyA8mGR2GpExfsI14HZhD4mnTkj9UwjfA63wbptXdFn8jPuhfRCDI6Q52VtmEonPn~V4RR88mRqcV~l63vhtFfzysOXOk83A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

August 9, 2017 at 8:50 am

Moraxella osloensis, an emerging pathogen of endocarditis in immunocompromised patients?

Swiss Med Wkly. 2015 Sep 16;145:w14185.

Gagnard JC1, Hidri N2, Grillon A3, Jesel L4, Denes E5.

Author information

1 Infectious Diseases Department, Limoges Teaching Hospital, France.

2 Bacteriology Laboratory, Limoges Teaching Hospital, France.

3 Bacteriology Laboratory, Strasbourg Teaching Hospital, France.

4 Cardiology Department, Strasbourg Teaching Hospital, France.

5 CHU Dupuytren, 2 Ave Martin Luther King, LIMOGES, FRANCE.

Abstract

We report two cases of endocarditis due to Moraxella osloensis. Only one previous case of such infection has been described.

These infections occurred in immunocompromised patients (B-cell chronic lymphocytic leukaemia and kidney graft associated with Hodgkin’s disease) and both patients had a favourable outcome with a complete cure of their infectious endocarditis.

This bacterium could be an emerging pathogen revealed by MALDI-TOF. Indeed, its characterisation within the Moraxella group by use of biochemistry-based methods is difficult.

Moreover, this strain could be particularly involved in immunocompromised patients.

FULL TEXT

https://smw.ch/article/doi/smw.2015.14185

August 2, 2017 at 4:17 pm

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