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2.
Clin Infect Dis ; 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30949690

RESUMO

BACKGROUND: 18Fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding the use of 18F-FDG-PET/CT for the diagnosis of native valve IE (NVE). METHODS: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE) / ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. RESULTS: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were: 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a re-categorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of PMN inflammatory infiltrate and reduced extent of fibrosis were observed in the PVE group only. CONCLUSIONS: The addition of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the Modified Duke criteria. In patients presenting with suspected NVE, the use of 18F-FDG-PET/CT is less accurate, and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.

4.
Autops Case Rep ; 8(1): e2018002, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29515977

RESUMO

Mesothelial/monocytic incidental cardiac excrescences (MICE) are unusual findings during the histological analysis of material from the pericardium, mediastinum, or other tissues collected in open-heart surgery. Despite their somewhat worrisome histological appearance, they show a benign clinical course, and further treatment is virtually never necessary. Hence, the importance of recognizing the entity relays in its differential diagnosis, as an unaware medical pathologist may misinterpret it for a malignant neoplasm. Other mesothelial and histiocytic proliferative lesions, sharing very close histological morphology and immunohistochemistry features with MICE, have been described in sites other than the heart or the mediastinum. This similarity has led to the proposal of the common denomination "histiocytosis with raisinoid nuclei." We report three cases from the pathology archives of the Heart Institute of São Paulo University (Incor/HC-FMUSP), diagnosed as "mesothelial/monocytic incidental cardiac excrescence," with immunohistochemical documentation, and provide a literature review of this entity.

5.
Autops. Case Rep ; 8(1): e2018002, Jan.-Mar. 2018. ilus
Artigo em Inglês | LILACS | ID: biblio-905467

RESUMO

Mesothelial/monocytic incidental cardiac excrescences (MICE) are unusual findings during the histological analysis of material from the pericardium, mediastinum, or other tissues collected in open-heart surgery. Despite their somewhat worrisome histological appearance, they show a benign clinical course, and further treatment is virtually never necessary. Hence, the importance of recognizing the entity relays in its differential diagnosis, as an unaware medical pathologist may misinterpret it for a malignant neoplasm. Other mesothelial and histiocytic proliferative lesions, sharing very close histological morphology and immunohistochemistry features with MICE, have been described in sites other than the heart or the mediastinum. This similarity has led to the proposal of the common denomination "histiocytosis with raisinoid nuclei." We report three cases from the pathology archives of the Heart Institute of São Paulo University (Incor/HC-FMUSP), diagnosed as "mesothelial/monocytic incidental cardiac excrescence," with immunohistochemical documentation, and provide a literature review of this entity.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Cardiopatias/patologia , Histiócitos , Diagnóstico Diferencial , Epitélio/lesões , Achados Incidentais
6.
Autops Case Rep ; 6(3): 17-22, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27818954

RESUMO

The case fatality rate of infective endocarditis (IE) is high and is associated with varying causes. Among them, acute myocardial infarction due to an embolism in a coronary artery is rare; the incidence of this complication in the setting of IE is reported to be up to 1.5%. We report a case of sudden death in a 22-year-old woman diagnosed with systemic lupus erythematosus who was referred to the Cardiology Center for the treatment of mitral valve incompetence due to IE. She was hemodynamically stable with antibiotic therapy and vasoactive drugs, despite severe mitral valve regurgitation. Unexpectedly, she presented cardiac arrest and died. The autopsy showed total occlusion of the left main coronary artery by septic embolus, which originated from the mitral vegetation, as the cause of death. Thus, although a rare complication, it should always be kept in mind that a coronary embolism can be a lethal complication of IE, and the possibility of surgical treatment combined with the underlying antibiotic therapy should be raised.

8.
Autops Case Rep ; 5(2): 49-53, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26484335

RESUMO

We report the case of a 63-year-old female patient who was evaluated due to a solitary pulmonary nodule. The final diagnosis was a solitary peripheral pulmonary artery saccular aneurysm. The patient was submitted to a pulmonary lobectomy with excellent recovery. Peripheral pulmonary artery aneurysms that arise from segmental or intrapulmonary branches are extremely rare, and their management is still controversial.

10.
Emerg Infect Dis ; 21(8): 1429-32, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26197233

RESUMO

We evaluated culture-negative, community-acquired endocarditis by using indirect immunofluorescent assays and molecular analyses for Bartonella spp. and Coxiella burnetii and found a prevalence of 19.6% and 7.8%, respectively. Our findings reinforce the need to study these organisms in patients with culture-negative, community-acquired endocarditis, especially B. henselae in cat owners.


Assuntos
Infecções por Bartonella/epidemiologia , Bartonella/patogenicidade , Infecções Comunitárias Adquiridas/epidemiologia , Coxiella burnetii/patogenicidade , Endocardite Bacteriana/diagnóstico , Animais , Anticorpos Antibacterianos/imunologia , Bartonella/crescimento & desenvolvimento , Infecções por Bartonella/diagnóstico , Brasil/epidemiologia , Gatos , Infecções Comunitárias Adquiridas/diagnóstico , Coxiella burnetii/crescimento & desenvolvimento , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
13.
Int J Infect Dis ; 25: 191-5, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24971520

RESUMO

OBJECTIVES: We studied the clinical characteristics, in-hospital mortality, and long-term prognosis of patients with culture-negative endocarditis. METHODS: In total, 221 episodes of definite endocarditis were studied (2004-2009). We compared the clinical, laboratory, and echocardiography characteristics and the survival rates of patients with culture-negative and culture-positive endocarditis. Survival after hospital discharge was evaluated using the Kaplan-Meier method and coefficient of mortality comparisons. RESULTS: Culture-negative endocarditis occurred in 51/221 (23.1%) episodes. Compared with the culture-positive endocarditis patients, the time elapsed between admission and initiation of antibiotic therapy was longer in patients with culture-negative endocarditis (p<0.001), and these patients also had lower C-reactive protein levels at admission (p<0.001). In-hospital mortality rates were not different between culture-negative and culture-positive patients. After hospital discharge, there was also no significant difference between groups in survival curves (p=0.471). Severe sepsis (adjusted prevalence ratio 3.32, p=0.010) and diabetes mellitus (adjusted prevalence ratio 2.32, p=0.009) were independently associated with in-hospital death in culture-negative patients. CONCLUSIONS: Culture-negative endocarditis patients presented with lower levels of C-reactive protein at admission and required more time for initiation of antibiotic therapy, although there was no difference in in-hospital mortality or long-term survival between culture-negative and culture-positive endocarditis patients. Diabetes mellitus and severe sepsis were associated with in-hospital death in patients with culture-negative endocarditis.


Assuntos
Infecções Comunitárias Adquiridas , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
14.
PLoS One ; 8(8): e71743, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23951234

RESUMO

BACKGROUND: Leptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL FINDINGS: Prominent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage. CONCLUSIONS: Pathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.


Assuntos
Pneumopatias/patologia , Pneumopatias/fisiopatologia , Doença de Weil/patologia , Doença de Weil/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/metabolismo , Células Epiteliais Alveolares/patologia , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/patologia , Estudos de Casos e Controles , Conexina 43/metabolismo , Canais Epiteliais de Sódio/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Pulmão/metabolismo , Pulmão/patologia , Masculino , Microcirculação , Microscopia Confocal , Pessoa de Meia-Idade , Adulto Jovem
15.
J. bras. patol. med. lab ; 47(6): 643-648, dez. 2011.
Artigo em Português | LILACS | ID: lil-610898

RESUMO

INTRODUÇÃO: A classificação da Organização Mundial da Saúde (OMS) para os tumores do tecido hematopoético e linfoide (4ª edição, 2008) representa uma revisão atualização da 3ª edição publicada em 2001. A tradução da nomenclatura utilizada para identificar as entidades descritas deve ser clara, precisa e uniforme no sentido de reproduzir de forma correta as diversas entidades clinicopatológicas para clínicos, patologistas e pesquisadores envolvidos na área da onco-hematopatologia. OBJETIVO: Os autores apresentam uma proposta de atualização e padronização terminológica em língua portuguesa, com base na OMS/2008.


INTRODUCTION: The World Health Organization (WHO) classification of hematopoietic and lymphoid tissue (4th edition, 2008) tumors constitutes an updated review of the 3rd edition published in 2001. The translation of the nomenclature used to describe the entities should be clear, precise and uniform so that clinicians, pathologists and researchers involved in the onco-hematopathological area may identify them accurately. OBJECTIVE: With this purpose, the authors present an updated proposal and a terminological standardization in Portuguese based on WHO/2008.


Assuntos
Leucemia/classificação , Linfoma/classificação , Neoplasias Hematológicas/classificação , Terminologia como Assunto , Organização Mundial da Saúde
16.
Braz J Infect Dis ; 15(4): 384-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21861012

RESUMO

Nocardia is a rare opportunistic agent, which may affect immunocompromised individuals causing lung infections and exceptionally infective endocarditis (IE). There are few reports of IE caused by Nocardia sp., usually involving biological prostheses but rarely in natural valves. Its accurate microbiological identification may be hampered by the similarity with Rhodococcus equi and Corynebacterium spp. Here we report a case of native mitral valve IE caused by this agent in which the clinical absence of response to vancomycin and the suggestion of Nocardia sp. by histology pointed to the misdiagnosis of Corynebacterium spp. in blood cultures. The histological morphology can advise on the need for expansion of cultivation time and use of extra microbiological procedures that lead to the differential diagnosis with Corynebacterium spp. and other agents, which is essential to establish timely specific treatment, especially in immunocompromised patients.


Assuntos
Endocardite Bacteriana/patologia , Nocardia/isolamento & purificação , Adulto , Anti-Infecciosos/uso terapêutico , Diagnóstico Diferencial , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
17.
Braz. j. infect. dis ; 15(4): 384-386, July-Aug. 2011. ilus
Artigo em Inglês | LILACS | ID: lil-595683

RESUMO

Nocardia is a rare opportunistic agent, which may affect immunocompromised individuals causing lung infections and exceptionally infective endocarditis (IE). There are few reports of IE caused by Nocardia sp., usually involving biological prostheses but rarely in natural valves. Its accurate microbiological identification may be hampered by the similarity with Rhodococcus equi and Corynebacterium spp. Here we report a case of native mitral valve IE caused by this agent in which the clinical absence of response to vancomycin and the suggestion of Nocardia sp. by histology pointed to the misdiagnosis of Corynebacterium spp. in blood cultures. The histological morphology can advise on the need for expansion of cultivation time and use of extra microbiological procedures that lead to the differential diagnosis with Corynebacterium spp. and other agents, which is essential to establish timely specific treatment, especially in immunocompromised patients.


Assuntos
Adulto , Humanos , Masculino , Endocardite Bacteriana/patologia , Nocardia/isolamento & purificação , Anti-Infecciosos/uso terapêutico , Diagnóstico Diferencial , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
18.
Braz J Infect Dis ; 15(3): 285-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21670932

RESUMO

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.


Assuntos
Infecções por Adenovirus Humanos/patologia , Bronquiolite Viral/patologia , Complicações Pós-Operatórias/patologia , Idoso , Bronquiolite Viral/virologia , Ponte de Artéria Coronária , Evolução Fatal , Cardiopatias/cirurgia , Humanos , Unidades de Terapia Intensiva , Masculino , Necrose , Complicações Pós-Operatórias/virologia
20.
Braz. j. infect. dis ; 15(3): 285-287, May-June 2011. ilus
Artigo em Inglês | LILACS | ID: lil-589963

RESUMO

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.


Assuntos
Idoso , Humanos , Masculino , Infecções por Adenovirus Humanos/patologia , Bronquiolite Viral/patologia , Complicações Pós-Operatórias/patologia , Bronquiolite Viral/virologia , Ponte de Artéria Coronária , Evolução Fatal , Cardiopatias/cirurgia , Unidades de Terapia Intensiva , Necrose , Complicações Pós-Operatórias/virologia
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