Periodontal Bacterial DNA and Their Link to Human Cardiac Tissue: Findings of a Pilot Study.

BACKGROUND: The aim of this pilot study was to detect correlations of microbiological DNA, inflammatory proteins, and infection parameters in patients with periodontal disease (PD) and valvular heart disease (VHD). METHODS: A perioperative comprehensive dental examination for the investigation of periodontal status, including sampling of specific subgingival bacteria, was performed in 10 patients with indication for surgery of aortic valve stenosis with or without concomitant myocardial revascularization. Standard protocol biopsies were taken from right atrium (A), left septal myocardium (M), and aortic valve (V). Eleven periodontal pathogens DNA in oral and cardiac tissue samples (A/M/V) were analyzed using polymerase chain reaction. For cardiac tissue samples, Western blot analysis of LPS-binding protein (LBP), immunohistochemical (IHC) detection of LBP-big42, LPS-binding protein receptor (CD14), and macrophages (CD68), as well as inflammation scoring measurement were performed. RESULTS: Periodontitis was present in all patients with severe intensity in 7, moderate in 2 and mild in one patient. Same bacterial DNA was detected in A, M, and V in different distribution, and detection was more often in atrium than in myocardium or valve tissue. Morphological investigation revealed increased extracellular inflammatory cell migration. In IHC markers of LBP, CD68 and CD14 showed positive findings for all patients in atrium and myocardium. CONCLUSION: Our results demonstrate the presence of oral bacterial DNA in human cardiac tissue, as well as inflammatory markers potentially indicating connection of PD and VHD. Further investigation is necessary to confirm these preliminary data.

Infectious endocarditis with five localisations--case reports.

Infectious endocarditis is defined as an infection of the endocardial surface area of the heart which can include one or more cardiac valves, mural endocardium or a septal defect. We present the case of a patient, aged 8, hospitalized in Hemato-Oncology Department with pontine glioma, who was also diagnosed with infectious endocarditis in five locations.

Inaccuracy of transthoracic echocardiography for the identification of right-sided vegetation in patients with no history of intravenous drug abuse or cardiac device insertion.

OBJECTIVE: The use of transthoracic echocardiography (TTE) to identify right-sided infective endocarditis (RSIE) vegetation is controversial. Data are scarce for patients with no history of intravenous drug abuse (IVDA) or cardiac device insertion. This study analysed the consistency of presurgical echocardiographic results with surgical findings for vegetation identification, and the factors that influence accuracy of echocardiography. METHODS: This retrospective trial divided infective endocarditis (IE) patients into three subgroups according to the results of their presurgical TTE: left-sided native IE (LSNIE), left-sided prosthetic valve IE (LSPIE) and RSIE. The accuracy of TTE was tested by comparing vegetation (number and location), detected presurgery by TTE, with actual findings during surgery. RESULTS: In total, 416 patients were analysed, 322 with LSNIE, 31 with LSPIE and 63 with RSIE. Consistency between TTE findings and surgical results was lower in the RSIE group compared with the LSPIE and LSNIE groups. Consistency was lowered by the presence of vegetation in multiple locations and atypical distribution--both of which were increased in the RSIE group. The chance of vegetation in both sides of the heart rose with increased numbers of vegetation locations in RSIE patients. A high proportion of RSIE patients had congenital heart defects, mostly ventricular septal defects. CONCLUSIONS: TTE may be unsuitable for RSIE patients with no history of IVDA or cardiac device insertion, because multifocal and atypically distributed vegetation may influence detection accuracy.

Endocarditis infecciosa sobre septo interauricular por chorro de insuficiencia mitral / Infective endocarditis of the interatrial septum due to a mitral regurgitant jet

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Interventricular hydatid cyst with atrioventricular block: a case report.

Hydatid cyst in the heart is rare, occurring in about 3% of human echinococcosis. A 21-year-old woman was admitted to hospital with a third degree atrioventricular block. Echocardiography showed a cystic mass with a diameter of 2.5 cm within the interventricular septum. Serologic testing for Echinococcus was clearly positive, and hence cardiac surgery was planned. Sterilization of the cystic cavity was achieved by injecting formaldehyde solution in the cavity before cystectomy. Definitive pacemaker implantation was necessary before discharge. Cardiac hydatid cysts constitute an indication for surgery which is necessary to prevent potentially lethal complications such as cystic rupture with embolic phenomena and anaphylactic shock.

Infected papillary fibroelastoma attached to the atrial septum.

A 61-year-old woman had intermittent fever of 2 months' duration following a dental extraction. On admission, her body temperature was 39.2 degrees C. A mid-systolic murmur was heard at the apex on ausculation. A 2-dimensional echocardiogram revealed a mobile, heavy stick-like mass with vegetation (5.0 x 1.5 cm) attached to the left atrial septum. Multiple blood cultures grew Streptococcus constellatus. On diagnosis of an infected left atrial myxoma, antibiotics were administered daily and 4 weeks later, the left atrial tumor was resected. The tumor was 5.3cm long, 1.5cm in diameter at the inter-atrial wall and had vegetation on the free edge. On microscopic examination, colonies of Gram-positive cocci were found in the thrombus, on the papillary fibroelastoma. After treatment with antibiotics for a further 4 weeks, the patient was discharged. This is the first report of infected papillary fibroelastoma.

Candida tropicalis pacemaker endocarditis.

A rare case of Candida tropicalis pacemaker endocarditis was diagnosed in a 77-year-old male who presented with lethargy. The organism was isolated from cultures of blood and vegetations on the tricuspid valve, interatrial septum and the pacing wire removed at surgery. The postoperative course was stormy and he succumbed to multiorgan failure.

Isolated apical intracavitary left ventricular abscess in a normal heart: a rare complication of Streptococcus milleri endocarditis.

A 31-year-old patient without past history of cardiac disease presented with an atypical form of Streptococcus milleri endocarditis. The disease progressed in an unusually aggressive manner, with abscess formation in the apex of the left ventricular cavity. The cardiac valves functioned normally and were not affected by the disease.

Pericardite tuberculosa: dificuldades diagnósticas e valor da biopsia pericárdica / Tuberculous pericarditis: diagnostic difficulties and values of pericardial biopsy

Foram estudados dez pacientes com pericardite e história clínica sugestiva de tuberculose. Pelos métodos habituais de pesquisa, em apenas dois pacientes, pôde-se comprovar tuberculose (ambos por identificaçäo de bacilos álcool-ácido resistentes (BAAR) no escarro e biopsia de gânglio periférico). Em oito casos, nenhuma causa foi demonstrada. Nestes oito pacientes, foi realizada biopsia pericárdica por via subxifóide, a qual mostrou pericardite tuberculosa em quatro. O teste PPD-tuberculina näo teve valor no diagnóstico, pois, dos seis casos com tuberculose comprovada, dois tinham resultado negativo. Pelo exame radiológico dos pulmöes, em apenas dois casos, houve suspeita de tuberculose, nos mesmos em que se isolou BAAR no escarro. Os exames histopatológicos, realizados em 8 casos, revelaram pericardite tuberculosa em 4, e pericardite inespecífica, em 4. Nos casos em que a biopsia näo demonstrou granulomas, näo se pode excluir de todo tuberculose. Apesar da importante contribuiçäo da biopsia do pericárdio, a pericardite tuberculosa é ainda uma doença de difícil comprovaçäo laboratorial

Life-threatening complications of infective endocarditis and their management.

Life-threatening complications of acute infective endocarditis are still a problem despite the availability of effective antimicrobial agents. These complications, divided into two main categories, cardiac and extracardiac, and a review of the literature are presented.