RESUMO
Introducción: las infecciones por cándida en el ámbito intrahospitalario han ido en ascenso en las últimas décadas en especial en las unidades de cuidado intensivo (UCI), dado el uso cada vez más frecuente de antibióticos de amplio espectro y de procedimientos invasivos tanto diagnósticos como terapéuticos. Hoy se consideran las especies de cándida como la cuarta causa de infección del torrente sanguíneo en los Estados Unidos de Norteamérica, con alto riesgo de complicaciones que incluyen endocarditis, trombosis y embolismo séptico al sistema nervioso central (SNC) entre otros. En relación con la endocarditis por especies de cándida, se ha considerado de mal pronóstico por el alto riesgo de afectación al SNC, por lo que se ha recomendado el manejo quirúrgico como piedra angular de su tratamiento. Presentación del caso: se describe el caso clínico de un paciente con endocarditis y con candidemia por Candida parapsilosis a quien se le realizó manejo médico.
Nosocomial Candida infections have increased in the last decades particularly in the intensive care units (ICU) due to the rise in broad-spectrum antibiotics usage and invasive diagnostic and therapeutic procedures usage. Today, Candida species are recognized as the fourth causative organisms of endovascular infection in the United States of America posing a high risk of endocarditis, thrombosis and septic embolization to the central nervous system (CNS). Endocarditis due to Candida species is associated with a poor prognosis because of the increased risk of CNS involvement for which surgical approach has been recommended as the cornerstone of therapy. We hereby report a patient with endocarditis and candidemia due to Candida parapsilosis, who received medical management.
Assuntos
Humanos , Masculino , Idoso , Endocardite/microbiologia , Candidemia/complicações , Candida parapsilosis/isolamento & purificação , Doenças das Valvas Cardíacas/microbiologia , Endocardite/terapia , Candidemia/terapia , Doenças das Valvas Cardíacas/terapiaRESUMO
We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.
Assuntos
Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Stenotrophomonas maltophilia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Pessoa de Meia-Idade , Choque Séptico/etiologiaRESUMO
Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Infecções por Bactérias Gram-Negativas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Stenotrophomonas maltophilia , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Choque Séptico/etiologia , Infecções por Bactérias Gram-Negativas/complicações , Evolução Fatal , Implante de Prótese de Valva Cardíaca/efeitos adversos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/microbiologiaRESUMO
Objetivos: Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y métodos: Se evaluaron 176 p con EIN, divididos en grupo I: <3meses (27p) y grupo II: >3meses (149p). Resultados: Grupo I: el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal: infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II: el 57% presentaba cardiopatía previa. Microorganismos prevalentes: S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos: embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR:7,50 IC95%:1,7731,69) y a INC (OR:4,2-IC95%:1,1615,29). Conclusiones: La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.
Objectives: To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and methods: 176 p with NVE were evaluated and divided into group I: <3 months (27p) and group II: >3 months (149p). Results: Group I: 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event: Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II: 57% had previous heart disease. Prevalent microorganisms: S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events: systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR:7.50 95% CI:1.7731.69) and UCI (OR:4.2 -95% CI:1.1615.29). Conclusions: NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Staphylococcus aureus/isolamento & purificação , Estreptococos Viridans/isolamento & purificação , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/microbiologia , Endocardite/mortalidade , Doenças das Valvas Cardíacas/microbiologia , Estudos Retrospectivos , Estudos de CoortesRESUMO
Atherosclerosis is a progressive disease characterized by chronic inflammation of the arterial walls, associated with genetic and infectious factors. The present study investigated the involvement of Chlamydia trachomatis and Chlamydia pneumoniae infections and immunological markers (C-reactive protein, CRP, TNF-α, IL-6, IL-8, and IL-10) in the process of atherosclerosis. The evaluation included 159 patients for surgical revascularization (CAD) and 71 patients for surgical heart valve disease (HVD) at three hospitals in Belém, Brazil. The control group (CG) comprised 300 healthy individuals. Blood samples collected before surgery were used for antibodies detection (enzyme immunoassay), CRP (immunoturbidimetry) and IL-6 levels (enzyme immunoassay). Tissue fragments (atheroma plaque, heart valve and ascending aorta) were collected during surgery and subjected to qPCR for detection of bacterial DNA. Promoter region polymorphisms of each marker and relative quantification of TNF-α, IL-8, and IL-10 gene expression were performed. Demography and social information were similar to the general population involved with both diseases. Antibody prevalence to C. trachomatis was 30.6, 20.3, and 36.7% (in the CAD, HVD, and CG, respectively) and to C. pneumoniae was 83.6, 84.5, and 80.3% (in the CAD, HVD, and CG, respectively). C. trachomatis cryptic plasmid DNA was detected in 7.4% of the samples. Frequency of IL6-174G>C polymorphism was higher in CAD and HVD than in CG regardless of previous exposure to Chlamydia. Previous C. trachomatis infection showed involvement in HVD and CAD. Significant association between disease and previous C. pneumoniae infection was found only among HVD. GG genotype of IL6-174G>C is apparently a risk factor for heart disease, whereas AT genotype of IL8-251A>T was mainly involved in valvulopathies, including patients with prior exposure to C. pneumoniae.
Assuntos
Aterosclerose/microbiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/fisiologia , Chlamydophila pneumoniae/fisiologia , Doenças das Valvas Cardíacas/microbiologia , Interleucina-6/genética , Interleucina-8/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Aterosclerose/epidemiologia , Aterosclerose/imunologia , Brasil/epidemiologia , Proteína C-Reativa/genética , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/imunologia , Humanos , Interleucina-10/genética , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Prevalência , Regiões Promotoras Genéticas/genética , Risco , Fator de Necrose Tumoral alfa/genética , Adulto JovemAssuntos
Endocardite Bacteriana/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Valva Tricúspide/patologia , Adulto , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Humanos , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Valva Tricúspide/microbiologiaAssuntos
Humanos , Masculino , Adulto , Valva Tricúspide/patologia , Endocardite Bacteriana/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Valva Tricúspide/microbiologia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologiaRESUMO
The presence of the single nucleotide polymorphisms in exon 1 of the mannose-binding lectin 2 (MBL2) gene was evaluated in a sample of 159 patients undergoing coronary artery bypass surgery (71 patients undergoing valve replacement surgery and 300 control subjects) to investigate a possible association between polymorphisms and heart disease with Chlamydia infection. The identification of the alleles B and D was performed using real time polymerase chain reaction (PCR) and of the allele C was accomplished through PCR assays followed by digestion with the restriction enzyme. The comparative analysis of allelic and genotypic frequencies between the three groups did not reveal any significant difference, even when related to previous Chlamydia infection. Variations in the MBL plasma levels were influenced by the presence of polymorphisms, being significantly higher in the group of cardiac patients, but without representing a risk for the disease. The results showed that despite MBL2 gene polymorphisms being associated with the protein plasma levels, the polymorphisms were not enough to predict the development of heart disease, regardless of infection with both species of Chlamydia.