RESUMO
PURPOSE OF REVIEW: Gram-negative bacilli (GNB) cause between 1% and 10% of infective endocarditis (IE). Most episodes are caused by microorganisms of the Haemophilus spp., Aggregatibacter spp. Cardiobacterium spp., Eikenella spp., and Kingella spp (HACEK) group. The frequency of IE caused by non-HACEK (GNB-IE) has increased in recent years. Uncertainties persist regarding its best medical treatment and the appropriateness and timing of surgical treatment. In addition, there are new drugs with activity against multiresistant microorganisms, of which there is little experience in this disease. We review this topic by answering the most frequently asked questions that arise among our colleagues. RECENT FINDINGS: HACEK microorganisms cause 1.5-2% of IE with only a 2% mortality. In contrast, non-HACEK GNB-IE accounts for 2.5-3% of all IE cases and is associated with nosocomial acquisition, advanced age, solid organ transplantation and 20-30% mortality. Drug addiction is important in areas with epidemic opioid abuse. SUMMARY: The frequency of IE caused by GNB has been modified in recent years. HACEK episodes are no longer treated with ampicillin and aminoglycosides. In non-HACEK GNB-IE, combination therapy with a beta-lactam and a quinolone or aminoglycoside is recommended. The surgical indication and its value are evident in many patients. Management should rely on a collaborative group with experience in this disease.
Assuntos
Cardiobacterium , Endocardite Bacteriana , Endocardite , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Bactérias Gram-Negativas , Haemophilus , HumanosRESUMO
BACKGROUND: HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.) group organisms are responsible for 0.8% to 6% of all infective endocarditis cases, with Cardiobacterium spp. being the third most commonly implicated HACEK microorganism. Within this genus is Cardiobacterium valvarum (C. valvarum), a novel organism described in 2004. To date, only 15 cases of C. valvarum infection have been reported in the English-language literature, and have primarily been cases of infective endocarditis in patients with valvular disease. C. valvarum has not been reported to cause infections spreading to the surrounding bone. CASE PRESENTATION: We present a case of a 57-year-old man with a history of aortic dissection followed by aortic endograft replacement who presented with back pain. He was found to have radiographic evidence of an infected aortic endograft, along with vertebral osteomyelitis, discitis, and epidural phlegmon. Blood cultures identified C. valvarum as the causative organism. The patient was treated with ceftriaxone and surgical intervention was deferred due to the patient's complex anatomy. His course was complicated by septic cerebral emboli resulting in cerebrovascular accident. CONCLUSIONS: This case report highlights C. valvarum, a rare and emerging HACEK group microorganism that warrants consideration in high-risk patients with evidence of subacute infection and disseminated disease. While C. valvarum classically presents as infective endocarditis, extra-cardiac manifestations have also been described. As demonstrated in this case, endograft involvement and osteomyelitis may occur in rare circumstances.
Assuntos
Cardiobacterium , Endocardite Bacteriana/microbiologia , Osteomielite/microbiologia , Antibacterianos/uso terapêutico , Aorta , Aorta Torácica/microbiologia , Aorta Torácica/cirurgia , Endocardite , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , TransplantesRESUMO
We report a case of prosthetic arthritis caused by Cardiobacterium valvarum, which has been exclusively reported to cause intravascular infections. A 81-year-old Japanese female complained prosthetic knee joint pain. Arthrocentesis cultured no pathogen, and surgical replacement of the implant surface was performed. Modified Levinthal medium culture and 16S rRNA sequencing has finally led to diagnosis of C. valvarum prosthetic knee arthritis without cardiac lesions. Fastidious bacteria such as C. valvarum can be candidate pathogens of orthopedic infections whose causative agents are sometimes unidentified. Further development of molecular diagnostics is expected, but also the importance of conventional methods should be noted.
Assuntos
Artrite , Cardiobacterium , Endocardite Bacteriana , Idoso de 80 Anos ou mais , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , RNA Ribossômico 16S/genéticaRESUMO
OBJECTIVE: Mycotic aneurysms of the infrapopliteal vessels are rare, with few cases reported in the literature. Management strategies are diverse and should be tailored to the patient's presentation. METHODS: We describe the case of a 40-year-old male who presented with a painful left leg mass in the setting of bacteremia and infective endocarditis. Imaging revealed an aneurysm of the anterior tibial artery. RESULTS: The patient was treated with antibiotics and open surgical repair with excision of the aneurysmal sac, ligation of the anterior tibial artery, and primary repair of the popliteal artery and tibioperoneal trunk. CONCLUSION: The epidemiology, pathophysiology, and clinical management of infrapopliteal aneurysms are briefly reviewed in this case study.
Assuntos
Aneurisma Infectado/microbiologia , Cardiobacterium/isolamento & purificação , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Artérias da Tíbia/microbiologia , Adulto , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Ligadura , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
Eikenella corrodens is a facultatively anaerobic gram-negative rod bacterium in the oropharynx and respiratory tract. It is a member of HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, E. corrodens, and Kingella kingae) group commonly associated with endocarditis and craniofacial infections. It is usually susceptible to penicillin, second and third-generation cephalosporins, and carbapenem, but has variable susceptibility to first-generation cephalosporin. We herein provide a description of the first case of pediatric acute dacryocystitis caused by E. corrodens. The patient did not respond to oral cephalexin and required surgical drainage followed by intravenous cefotaxime. Also provided is a brief review of the current literature.
Assuntos
Dacriocistite/diagnóstico , Dacriocistite/microbiologia , Eikenella corrodens/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Doença Aguda , Aggregatibacter , Antibacterianos/administração & dosagem , Cardiobacterium , Cefotaxima/administração & dosagem , Cefalexina/administração & dosagem , Pré-Escolar , Dacriocistite/tratamento farmacológico , Vias de Administração de Medicamentos , Eikenella corrodens/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Haemophilus , Humanos , Kingella , Testes de Sensibilidade Microbiana , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Cardiobacterium , Endocardite Bacteriana , Cardiopatias Congênitas , Humanos , Antibacterianos/uso terapêutico , Cardiobacterium/isolamento & purificação , Cardiobacterium/genética , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/complicações , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Cardiopatias Congênitas/complicaçõesRESUMO
BACKGROUND: While it has been increasing cases of C. hominis endocarditis in the past decades due to advances of diagnostic methods, the epidemiology and clinical manifestations of IE caused by C. hominis is still unknown. CASE PRESENTATION: A 62-year old man was admitted to our institute with fever, anorexia and general fatigue for the preceding one month. He had a past medical history of both aortic and mitral valves replacement due to cardiac diseases. He was diagnosed as IE caused by C. hominis according to the modified duke criteria. The patient received 2 weeks of combination therapy of intravenous ceftriaxone (CTRX) 2g and gentamycin 180mg daily followed by 4 weeks CTRX 2g daily alone. Oral moxifloxacin 400mg once daily was given for an additional 4 weeks. After the antibiotic therapy was discontinued, disease recurrence was not observed. We reviewed previously reported C. hominis IE cases in 60 publications including ours. Of 73 patients enrolled, 53 were male, the mean age was 52 years. The most common risk factor of IE was past history of cardiac diseases in 44/73 (60%). As for antibiotics initially prescribed, third-generation cephalosporins was most frequently used in 28/69 (41%). While the cure rate was 67/73 (93%), 31/73 patients (43%) received a surgical intervention. Embolic lesions to the central nervous system and vertebrae were seen in 16/72 (22%) and 5/72 (7%). CONCLUSION: IE caused by C. hominis has a favorable prognosis, showing the cure rate of 93%. Physicians should recognize the possible occurrence of emboli among IE patients.
Assuntos
Antibacterianos/uso terapêutico , Cardiobacterium/efeitos dos fármacos , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of an 18-year-old woman who presented with infective endocarditis (IE), in two conduits percutaneously delivered in the right ventricle outflow tract ("double-barrel endocarditis"). The patient's clinical presentation, echocardiogram findings, infectious agent, clinical management, surgical approach, and follow-up assessment are described. Percutaneous pulmonary valve implantation has emerged as a viable therapy for conduit dysfunction in the right ventricular outflow tract. Although the percutaneous approach has several advantages, this strategy and the valves used are not complication-free. IE after transcatheter valve deployment has evoked the growing concern, as there is a higher incidence in these patients compared with patients with surgically repaired pulmonary valves. As a result, this type of surgical treatment is especially important.
Assuntos
Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Valva Pulmonar/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Cateterismo Cardíaco , Cardiobacterium/genética , DNA Bacteriano/análise , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/terapia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Radiografia Torácica , ReoperaçãoRESUMO
BACKGROUND: Cardiobacterium is a fastidious Gram-negative bacillus, and is a rare human pathogen in clinical settings. Herein, we describe a case of Cardiobacterium valvarum (C. valvarum) endocarditis with a rare complication of cerebral hemorrhage after mitral valve replacement (MVR), tricuspid valve prosthesis (TVP) and vegetation removal operation. CASE PRESENTATION: A 41-year-old woman who had a history of gingivitis developed into infective endocarditis due to the infection of C. valvarum. Then, she was hospitalized to receive MVR, TVP and vegetation removal operation. The indicators of patient tended to be normal until the abrupt cerebral hemorrhage occurred on day 15 after operation. This is the first well-described case of C. valvarum infection in China, and the first report of C. valvarum endocarditis with cerebral hemorrhage after MVR, TVP and vegetation removal operation worldwide. CONCLUSIONS: We reported the first case of C. valvarum infection in China clinically, with a rare complication of cerebral hemorrhage after MVR, TVP and vegetation removal operation.
Assuntos
Cardiobacterium/patogenicidade , Hemorragia Cerebral/complicações , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/microbiologia , Adulto , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Sangue/microbiologia , Cardiobacterium/efeitos dos fármacos , Cardiobacterium/isolamento & purificação , China , Endocardite Bacteriana/sangue , Endocardite Bacteriana/patologia , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/patologia , Próteses Valvulares Cardíacas/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Valva Mitral/microbiologia , Valva Mitral/cirurgiaRESUMO
Cardiobacterium hominis is an uncommon cause of prosthetic valve endocarditis (PVE) and often presents insidiously. In comparison, prosthetic valve thrombosis (PVT) is a rare, but life-threatening condition that commonly occurs due to inadequate anticoagulation. Anticoagulation is relatively contraindicated in patients with endocarditis as it may prove to be lethal due to increased risk of cerebral hemorrhage. However, anticoagulation is required in patients with PVT, or for its prevention. We present a case of a 35-year-old male with a history of hypercoagulability and St. Jude's aortic valve on warfarin, who presented with chest pain andwas found to have a mass on the aorticvalve, with blood cultures revealing C. hominis.The patient was treated with appropriate antibiotics and anticoagulation was continued. No neurological complications were noted during the treatment period. This case demonstrates that carefully weighing the risks and benefits of continuing anticoagulation is essential in preventing poor outcomes.
Assuntos
Cardiobacterium/isolamento & purificação , Endocardite Bacteriana/complicações , Infecções por Bactérias Gram-Negativas/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Trombofilia/complicações , Trombose/etiologia , Adulto , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Trombofilia/etiologia , Trombose/tratamento farmacológico , Resultado do Tratamento , Varfarina/uso terapêuticoRESUMO
The practices based on microbe cultivation are the corner stone of laboratory diagnostics of infectious diseases etiology. However, cultivation-independent molecular methods for microorganism detection are increasingly being used in a routine clinical setting as an important complement to the conventional procedures and, in some cases, they have already become the golden diagnostic standard. The PCR-based methods are used the most frequently.Key words: molecular genetic detection of microorganisms - polymerase chain reaction (PCR).
Assuntos
Cardiobacterium/genética , Reação em Cadeia da Polimerase , Tropheryma/genética , Infecções por Actinomycetales/diagnóstico , Adulto , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Pessoa de Meia-IdadeRESUMO
A 43-year-old male with a history of bioprosthetic aortic valve replacement and tricuspid valve annuloplasty presented with vertigo and was found to have an acute infarct in the left superior cerebellum, as well as a left-middle cerebral artery mycotic aneurysm. Blood cultures grew Cardiobacterium hominis and bioprosthetic aortic valve vegetation was found on transthoracic echocardiogram.
Assuntos
Aneurisma Infectado/microbiologia , Bioprótese , Cardiobacterium , Ceftriaxona/administração & dosagem , Infarto Cerebral , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Aneurisma Intracraniano/microbiologia , Complicações Pós-Operatórias , Adulto , Aneurisma Infectado/diagnóstico por imagem , Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Bioprótese/efeitos adversos , Bioprótese/microbiologia , Cardiobacterium/efeitos dos fármacos , Cardiobacterium/isolamento & purificação , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Infarto Cerebral/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
AIM: To determine microbial profiles that discriminate periodontal health from different forms of periodontal diseases. METHODS: Subgingival biofilm was obtained from patients with periodontal health (27), gingivitis (11), chronic periodontitis (35) and aggressive periodontitis (24), and analysed for the presence of >250 species/phylotypes using HOMIM. Microbial differences among groups were examined by Mann-Whitney U-test. Regression analyses were performed to determine microbial risk indicators of disease. RESULTS: Putative and potential new periodontal pathogens were more prevalent in subjects with periodontal diseases than periodontal health. Detection of Porphyromonas endodontalis/Porphyromonas spp. (OR 9.5 [1.2-73.1]) and Tannerella forsythia (OR 38.2 [3.2-450.6]), and absence of Neisseria polysaccharea (OR 0.004 [0-0.15]) and Prevotella denticola (OR 0.014 [0-0.49], p < 0.05) were risk indicators of periodontal disease. Presence of Aggregatibacter actinomycetemcomitans (OR 29.4 [3.4-176.5]), Cardiobacterium hominis (OR 14.9 [2.3-98.7]), Peptostreptococcaceae sp. (OR 35.9 [2.7-483.9]), P. alactolyticus (OR 31.3 [2.1-477.2]), and absence of Fretibacterium spp. (OR 0.024 [0.002-0.357]), Fusobacterium naviforme/Fusobacterium nucleatum ss vincentii (OR 0.015 [0.001-0.223]), Granulicatella adiacens/Granulicatella elegans (OR 0.013 [0.001-0.233], p < 0.05) were associated with aggressive periodontitis. CONCLUSION: There were specific microbial signatures of the subgingival biofilm that were able to distinguish between microbiomes of periodontal health and diseases. Such profiles may be used to establish risk of disease.
Assuntos
Periodontite Agressiva/microbiologia , Biofilmes , Periodontite Crônica/microbiologia , Gengivite/microbiologia , Periodonto/microbiologia , Adulto , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Bactérias/classificação , Bactérias/isolamento & purificação , Bacteroides/isolamento & purificação , Cardiobacterium/classificação , Carnobacteriaceae/isolamento & purificação , Feminino , Fusobacterium/classificação , Fusobacterium nucleatum/isolamento & purificação , Humanos , Masculino , Microbiota , Neisseria/classificação , Peptostreptococcus/classificação , Perda da Inserção Periodontal/microbiologia , Índice Periodontal , Bolsa Periodontal/microbiologia , Porphyromonas/classificação , Porphyromonas/isolamento & purificação , Porphyromonas endodontalis/isolamento & purificação , Prevotella/classificação , Adulto JovemRESUMO
A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly.
Assuntos
Aorta Torácica/microbiologia , Prótese Vascular/microbiologia , Cardiobacterium/isolamento & purificação , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Antibacterianos/uso terapêutico , Aorta Torácica/cirurgia , Hiperplasia Gengival/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite/microbiologiaAssuntos
Aneurisma Infectado/etiologia , Cardiobacterium/patogenicidade , Endocardite Bacteriana/complicações , Doenças das Valvas Cardíacas/etiologia , Aneurisma Intracraniano/etiologia , Adulto , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/microbiologia , MasculinoAssuntos
Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Sopros Cardíacos/diagnóstico , Prolapso da Valva Mitral/diagnóstico , Falso Aneurisma/diagnóstico , Cardiobacterium/isolamento & purificação , Erros de Diagnóstico , Endocardite Bacteriana/complicações , Infecções por Bactérias Gram-Negativas/complicações , Auscultação Cardíaca , Sopros Cardíacos/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
The accuracy of matrix-assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) in the identification of Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella (HACEK) species was compared to that of phenotypic methods (Remel RapID and Vitek 2). Overall, Vitek MS correctly identified more isolates, incorrectly identified fewer isolates, and failed to identify fewer isolates than both phenotypic methods.
Assuntos
Técnicas Bacteriológicas/métodos , Infecções por Bactérias Gram-Negativas/microbiologia , Neisseriaceae/isolamento & purificação , Pasteurellaceae/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Cardiobacterium/química , Cardiobacterium/classificação , Cardiobacterium/isolamento & purificação , Humanos , Neisseriaceae/química , Neisseriaceae/classificação , Pasteurellaceae/química , Pasteurellaceae/classificação , PediatriaRESUMO
Cardiobacterium valvarum is a relatively novel agent of infective endocarditis. We describe the first case of infective endocarditis due to this pathogen in the Asian Pacific. This case is unique in its involvement of the mitral valve as well as its clinical resolution exclusively resulting from treatment with antibiotics without resorting to valve replacement/explantation.
Assuntos
Cardiobacterium/isolamento & purificação , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Comunicação Interventricular/complicações , Valva Mitral/patologia , Antibacterianos/uso terapêutico , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/patologia , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Singapura , Resultado do TratamentoRESUMO
Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry is a rapid and accurate tool for the identification of many microorganisms. We assessed this technology for the identification of 103 Haemophilus parainfluenzae, Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae (HACEK) clinical isolates and 20 Haemophilus influenzae clinical isolates. Ninety-three percent of HACEK organisms were identified correctly to the genus level using the Bruker database, and 100% were identified to the genus level using a custom database that included clinical isolates.
Assuntos
Técnicas Bacteriológicas/métodos , Cardiobacterium/química , Eikenella corrodens/química , Haemophilus/química , Kingella kingae/química , Pasteurellaceae/química , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Cardiobacterium/classificação , Eikenella corrodens/classificação , Haemophilus/classificação , Humanos , Kingella kingae/classificação , Pasteurellaceae/classificação , Sensibilidade e EspecificidadeRESUMO
We present a case of polymicrobial subacute bacterial endocarditis and bacteremia with Bacillus cereus and Cardiobacterium hominis in a 72-year-old man with pre-existing mitral valve disease and prior mitral valve repair who presented with renal failure and glomerulonephritis. Bacillus is often a contaminant in blood cultures but has been rarely implicated in patients with invasive infections such as endocarditis. Intravenous drug use, prosthetic heart valves, valvular heart disease and venous catheters are the most frequently described risk factors for Bacillus bacteremia and endocarditis in the medical literature. Management is challenging as Bacillus is resistant to penicillin and cephalosporin antibiotics due to production of beta-lactamase. Polymicrobial endocarditis is uncommon and when it occurs typically involves Staphylococcal species. To our knowledge, this is the first reported case of polymicrobial endocarditis in which both Bacillus and a HACEK organism are implicated.