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1.
Medicine (Baltimore) ; 99(41): e22494, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031285

RESUMO

INTRODUCTION: Sneathia sanguinegens(S sanguinegens) is a gram-negative rod-shaped bacterium mostly reported to cause a perinatal infection, and there are no reports of S sanguinegens in prosthetic joint infection (PJI). The purpose of this report is to describe a very rare case of PJI after total hip arthroplasty (THA) caused by S sanguinegens. PATIENT CONCERNS: A 79-year-old woman presented with right coxalgia, inability to walk, and a fever of 39°C. She had undergone THA 28 years earlier for osteoarthritis of the hip. DIAGNOSES: The diagnosis was acute late-onset PJI, because blood tests revealed marked inflammatory reaction and computed tomography showed an abscess at the right hip joint; synovial fluid analysis resulted in detection of a gram-negative bacillus. INTERVENTION: Surgical debridement with retention of the implant and antibiotic therapy was performed. OUTCOMES: One month after surgery, polymerase chain reaction (PCR) assay showed that the pathogen was 99.9% likely to be S sanguinegens. There has been no recurrence of infection or loosening of the implant in the 2 years since her surgery. LESSONS: PCR should facilitate detection of previously unknown pathogens and potentially novel bacterial species.


Assuntos
Fusobactérias , Infecções por Bactérias Gram-Negativas/complicações , Infecções Relacionadas à Prótese/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Feminino , Fusobactérias/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia
2.
Medicine (Baltimore) ; 99(41): e22584, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031309

RESUMO

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.


Assuntos
Endocardite/microbiologia , Implante de Prótese de Valva Cardíaca , Infecções Relacionadas à Prótese/microbiologia , Trichosporon/isolamento & purificação , Tricosporonose/microbiologia , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada , Endocardite/diagnóstico por imagem , Endocardite/terapia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Reoperação , Tricosporonose/diagnóstico por imagem , Tricosporonose/terapia
3.
AJR Am J Roentgenol ; 215(3): 568-581, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32783556

RESUMO

OBJECTIVE. The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. CONCLUSION. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Artrocentese , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Artrite Infecciosa/microbiologia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Líquido Sinovial/microbiologia
4.
Methodist Debakey Cardiovasc J ; 16(2): 122-129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670472

RESUMO

With its high temporal and spatial resolution and relatively low radiation exposure, positron emission tomography (PET) is increasingly being used in the management of cardiac patients, particularly those with inflammatory cardiomyopathies such as sarcoidosis. This review discusses the role of PET imaging in assessing myocardial viability, inflammatory cardiomyopathies, and endocarditis; describes the different protocols needed to acquire images for specific imaging tests; and examines imaging interpretation for each image dataset-including identification of the mismatch defect in viability imaging, which is associated with significant improvement in LV function after revascularization. We also review the role of fluorodeoxyglucose PET in cardiac sarcoidosis diagnosis, the complementary role of magnetic resonance imaging in inflammatory cardiomyopathy, and the emerging use of cardiac PET in prosthetic valve endocarditis.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Miocárdio/patologia , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Endocardite/patologia , Endocardite/fisiopatologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/patologia , Infecções Relacionadas à Prótese/fisiopatologia , Sarcoidose/patologia , Sarcoidose/fisiopatologia , Sobrevivência de Tecidos , Função Ventricular Esquerda
5.
J Med Vasc ; 45(4): 177-183, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32571557

RESUMO

OBJECTIVE: To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection. MATERIAL AND METHOD: All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival. RESULTS: From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis. CONCLUSION: This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Poliésteres , Infecções Relacionadas à Prótese/cirurgia , Rifampina/administração & dosagem , Prata , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/efeitos adversos , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , França , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Rifampina/efeitos adversos , Fatores de Risco , Prata/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Circ Cardiovasc Imaging ; 13(6): e010600, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32507019

RESUMO

Background Infective endocarditis (IE) remains a difficult to diagnose condition associated with high mortality. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently emerged as another IE imaging modality, although diagnostic accuracy varies across observational studies and types of IE. This meta-analysis assessed the diagnostic performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched Pubmed, Cochrane, and Embase from January 1980 to September 2019 for studies reporting both sensitivity and specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for all cases of IE and its subgroups of native valve IE, prosthetic valve IE, and cardiac implantable electronic devices IE. Results We screened 2566 records from the search, assessed 52 full-text articles, and included 26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and specificity (95% CI, inconsistency I-square statistic) were 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of endocarditis. Corresponding parameters for native valve IE were sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99, 34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity 0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were higher for the 17 studies since 2015 than the 9 studies published before 2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes; however, sensitivity was markedly lower for native valve IE than prosthetic valve IE and cardiac implantable electronic devices IE. It is, therefore, a useful adjunct modality for assessing endocarditis, especially in the challenging scenarios of prosthetic valve IE and cardiac implantable electronic devices IE, with improving performance over time, related to advances in 18F-FDG PET/CT techniques.


Assuntos
Endocardite/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Valvas Cardíacas/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Desfibriladores Implantáveis/efeitos adversos , Endocardite/etiologia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Valor Preditivo dos Testes , Prognóstico , Infecções Relacionadas à Prótese/etiologia , Reprodutibilidade dos Testes , Fatores de Risco
7.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-343637

RESUMO

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Pneumonia Viral/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/virologia , Tempo para o Tratamento , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico , Ecocardiografia Transesofagiana/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pandemias , Infecções Relacionadas à Prótese/diagnóstico por imagem , Radiografia Torácica/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos
8.
Br J Radiol ; 93(1113): 20200103, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356457

RESUMO

Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Aortite/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Vasculite/diagnóstico por imagem
9.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32445276

RESUMO

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Pneumonia Viral/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/virologia , Tempo para o Tratamento , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico , Ecocardiografia Transesofagiana/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pandemias , Infecções Relacionadas à Prótese/diagnóstico por imagem , Radiografia Torácica/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos
10.
J Vasc Interv Radiol ; 31(5): 754-758, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359522

RESUMO

This brief report describes 3 patients with infected extrahepatic splanchnic venous stents or stent grafts. These devices had been placed to treat prehepatic portal hypertension 4 wk, 3 mo, and 31 mo, respectively, before readmission for fever. Blood cultures and fluorine-18 fludeoxyglucose positron emission tomography/CT were positive in all. With systemic antibiotic treatment, 2 patients showed a clinical recovery. In the third patient, antibiotic treatment failed. Therefore, the infected stent graft was surgically removed and a splenorenal shunt was created. No recurrent splanchnic venous infection was observed in these 3 patients.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hipertensão Portal/cirurgia , Infecções Relacionadas à Prótese/terapia , Stents/efeitos adversos , Resultado do Tratamento , Adolescente , Idoso , Implante de Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Pressão na Veia Porta , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Circulação Esplâncnica
11.
J Endovasc Ther ; 27(3): 509-515, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32295455

RESUMO

Purpose: To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Materials and Methods: Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study (ClinicalTrials.gov identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Results: Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Conclusion: Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Fluordesoxiglucose F18/administração & dosagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Diagnóstico Diferencial , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Infecções Relacionadas à Prótese/microbiologia , Reprodutibilidade dos Testes , Resultado do Tratamento
12.
Ann Vasc Surg ; 67: 566.e5-566.e9, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209412

RESUMO

BACKGROUND: Endovascular stent and prosthetic graft placement are commonplace techniques for correction of subclavian artery (SCA) lesions. However, when initial surgical repair of the SCA becomes complicated by subsequent infection or thrombosis of the repair site, stents and prosthetic grafts are no longer suitable for secondary repair due to the risk of recurrent failure and limited longevity. Autogenous tissue is more resistant to infection and has improved long-term patency, and thus may be a better option for secondary reconstruction in these complex clinical scenarios. The most commonly used autogenous conduit for SCA reconstruction is the great saphenous vein; however, the significant size mismatch makes this unsuitable in many circumstances. The autogenous femoral vein is a promising alternative conduit for SCA repair. Here we present 3 successful cases of its use as a salvage technique following iatrogenic complications of prior surgical repair. METHODS: From 2015 to 2019, 3 patients underwent harvest of the femoral vein for use in SCA repair, with 2 carotid-axillary bypasses and 1 carotid-subclavian bypass. Indications included a mycotic pseudoaneurysm secondary to an infected SCA stent, an SCA avulsion secondary to an infected carotid-subclavian bypass graft, and an occluded SCA stent in a young patient. Postoperative graft patency was monitored via clinical resolution of symptoms and maintenance of perfusion, intact pulses, and arterial duplex or computed tomography (CT) scan. RESULTS: All these patients had a good outcome following their procedures. Each had intact radial pulses immediately postoperatively and maintained normal perfusion to the upper extremity for the duration of follow-up, with bypass patency confirmed via CT scan or arterial duplex. The SCA repair also allowed for salvage of the upper extremity and symptomatic relief in all patients. None of the patients developed deep vein thrombosis in the donor extremity, and neither of the infected patients developed recurrent infection of the repair site. CONCLUSIONS: The success of these cases demonstrates that the autogenous femoral vein is an effective and safe option for SCA reconstruction. It is particularly useful for secondary salvage when prior surgical repair via standard techniques is complicated by infection or thrombosis, and when target vessel size precludes the use of the great saphenous vein. This is an excellent choice of conduit that vascular surgeons should consider for use in complex SCA repairs.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Veia Femoral/transplante , Oclusão de Enxerto Vascular/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Artéria Subclávia/cirurgia , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Autoenxertos , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Stents/efeitos adversos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
13.
J Nucl Med ; 61(3): 319-326, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32034110

RESUMO

Rapid and accurate diagnosis of cardiovascular device infection remains a challenge in the clinic. Anatomic imaging tools such as echocardiography and cardiac CT or CT angiography are the first-line modalities for clinically suspected endocarditis given their ability to detect vegetation and perivalvular complications. Accumulating data suggest that functional imaging with 18F-FDG PET/CT has unique merits over anatomic imaging and could potentially diagnose early cardiac device infection before morphologic damage ensues and identify infection sources or bacterial emboli in the rest of the body. Although an abnormal finding on 18F-FDG PET/CT was added to the 2015 guidelines of the European Society of Cardiology as a major criterion for the diagnosis of device-related and prosthetic valve endocarditis, that addition has not been incorporated in the U.S. guidelines. Beyond these clinically available imaging tools, attempts have been made to develop bacteria-targeting tracers for specific infection imaging, which include tracers of bacterial maltodextrin transporter, bacterial thymidine kinase, antibiotics, antimicrobial peptides, bacterial antibodies, bacteriophages, and bacterial DNA/RNA hybrid nucleotide oligomers. Most of the tracers have been studied only in experimental animals, except for radiolabeled antibiotics, which have been examined in humans without success in clinical translation for infection imaging. In this article, we compare the roles of anatomic and functional imaging for cardiac device infection and discuss the pros and cons of 18F-FDG and bacteria-targeting tracers. While anticipating continued investigations for bacteria-specific tracers in the future, we recommend that 18F-FDG PET/CT, which represents the host-pathogen immune response to infection, be used clinically for identifying cardiovascular device infection.


Assuntos
Infecções Bacterianas/diagnóstico por imagem , Infecções Bacterianas/imunologia , Sistema Cardiovascular/microbiologia , Interações Hospedeiro-Patógeno/imunologia , Imagem Molecular/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/imunologia , Sistema Cardiovascular/diagnóstico por imagem , Humanos
15.
Medicina (B Aires) ; 80(1): 17-22, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044737

RESUMO

Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with devices. Echocardiography and microbiological findings are essential for diagnosis but may be insufficient in this group of patients. Our objective was to evaluate the usefulness of positron emission tomography and fusion with computed tomography (PET / CT) in patients with suspected IE, carriers of prosthetic valves or intracardiac devices; 32 patients were studied, who underwent PET / CT with 18F-Fluorine deoxyglucose (18F-FDG). Those with intense focal and/or heterogeneous uptake with a Standard Uptake Value SUV) cut-off point greater than or equal to 3.7 were considered suggestive of infection. The initial diagnoses according to the modified Duke criteria were compared with the final diagnosis established by the Institutional Endocarditis Unit. The addition of PET / CT to these criteria, provided a conclusive diagnosis in 22 of the 32 initial cases reclassifying 11 cases in definitive EI; another 5 cases were negative for that diagnosis. EI continues to be a serious clinical problem. In those cases where the Duke criteria are not sufficient to establish the diagnosis and clinical suspicion persists, PET / CT can be a useful complementary tool to increase the diagnostic sensitivity.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Endocardite/diagnóstico por imagem , Endocardite/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Desfibriladores Implantáveis/microbiologia , Feminino , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/microbiologia , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Adulto Jovem
16.
J Endovasc Ther ; 27(2): 328-333, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31989857

RESUMO

Purpose: To present a novel 4-branched endovascular aortic plug (BEVAP) for treatment of patients with infrarenal aortic graft infection. Case Reports: Two polymorbid male patients with aortic graft infections and an unsuturable diseased paravisceral aorta were treated under compassionate use with a custom-made stent-graft. The BEVAP is a factory-modified Zenith t-Branch thoracoabdominal endovascular graft with the distal tubular main graft portion removed, creating an aortic plug that excludes the abdominal aorta while maintaining perfusion to the visceral organs. The BEVAP device is deployed using a femoral approach, and the branches are accessed through an axillary approach. A standard axillobifemoral bypass is created to perfuse the lower body. One to 2 days later, the infected infrarenal graft is resected without the need of aortic clamping or closure of the aortic stump. The BEVAP device in these 2 cases resulted in thrombosis of the abdominal aorta and the infected graft prior to explantation. Conclusion: Using the BEVAP enables radical treatment of selected patients with hostile anatomy and infrarenal aortic graft infections who have an aneurysmal paravisceral aortic segment that prevents traditional radical surgical treatment with in situ reconstruction or extra-anatomical bypass.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Remoção de Dispositivo , Procedimentos Endovasculares/instrumentação , Infecções Relacionadas à Prótese/cirurgia , Stents , Idoso , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Evolução Fatal , Humanos , Masculino , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Stents/efeitos adversos , Resultado do Tratamento
17.
Heart ; 106(7): 493-498, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31932285

RESUMO

Infective endocarditis complicating transcatheter aortic valve implantation (TAVI-IE) is a relatively rare condition with an incidence of 0.2%-3.1% at 1 year post implant. It is frequently caused by Enterococci, Staphylococcus aureus and c oagulase negative staphylococci While the incidence currently appears to be falling, the absolute number of cases is likely to rise substantially as TAVI expands into low risk populations following the publication of the PARTNER 3 and Evolut Low Risk trials. Important risk factors for the development of TAVI-IE include a younger age at implant and significant residual aortic regurgitation. The echocardiographic diagnosis of TAVI-IE can be challenging, and the role of supplementary imaging techniques including multislice computed tomography (MSCT) and positron emission tomography (18FDG PET) is still emerging. Treatment largely parallels that of conventional prosthetic valve endocarditis (PVE), with prolonged intravenous antibiotic therapy and consideration of surgical intervention forming the cornerstones of management. The precise role and timing of cardiac surgery in TAVI-IE is yet to be defined, with a lack of clear evidence to help identify which patients should be offered surgical intervention. Minimising unnecessary healthcare interventions (both during and after TAVI) and utilising appropriate antibiotic prophylaxis may have a role in preventing TAVI-IE, but robust evidence for specific preventative strategies is lacking. Further research is required to better select patients for advanced hybrid imaging, to guide surgical management and to inform prevention in this challenging patient cohort.


Assuntos
Endocardite Bacteriana/etiologia , Infecções Relacionadas à Prótese/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/terapia , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia
18.
Infection ; 48(2): 165-171, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31098926

RESUMO

PURPOSE: Extrapulmonary infections due to M. xenopi, particularly osteoarticular localizations, are rare. The purpose of this paper is to describe a case of prosthetic hip infection and to review the published literature on cases of M. xenopi osteoarticular infections. METHODS: Literature search was performed in the following databases: MEDLINE (PubMed), Embase, Central (the Cochrane Library 2019, Issue 1), LILACS (BIREME) (Latin American and Caribbean Health Science Information database) and Clinical Trials databases (14th August 2018). We included all case reports and case series on adult patients diagnosed with bone or joint infection by M. xenopi for whom the treatment and outcome were specified. RESULTS: We retrieved 30 cases published between 1982 and 2012, among which 25 (83.3%) were reported from Europe. The two most common infection sites were spine (12/30, 40%) and knee (9/30, 30%). Risk factors for infection were previous invasive procedures (11/30, 36.7%), autoimmune disease (8/30, 26.7%), AIDS (4/30, 13.3%) and other comorbidities (2/30, 6.7%); five patients had no past medical history. All patients were treated with antibiotic combinations, but composition and duration of regimens hugely varied. Surgical intervention was performed in 16 patients (53.3%). Only 11 patients obtained full recovery of articular mobility after treatment. CONCLUSION: This work highlights the difficulties in diagnosing and treating M. xenopi osteoarticular infections. Globally, evidence supporting the best practice for diagnosis and treatment of this infection is scanty.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium xenopi/fisiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Idoso , Artroplastia de Quadril/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Resultado do Tratamento
19.
AJR Am J Roentgenol ; 214(1): 171-176, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573855

RESUMO

OBJECTIVE. The diagnosis of early prosthetic joint infection (PJI)-defined as within 6 weeks after a total knee arthroplasty (TKA)-can be difficult because of expected postsurgical changes and elevated inflammatory markers. The role of radiographic evaluation in this situation carries unclear clinical significance. This study had three primary aims: first, to determine when soft-tissue gas is no longer an expected postoperative radiographic finding; second, to determine whether soft-tissue gas is predictive of early PJI; and, third, to determine whether the presence of soft-tissue gas correlates with specific patient characteristics and microbiology culture results. MATERIALS AND METHODS. This retrospective study was of patients who underwent TKA from 2008 to 2018 with available imaging between 5 days and 6 weeks after TKA and no interval intervention before imaging. All confirmed early PJIs were included (n = 24 cases; 15 patients). For comparison, patients who underwent TKA but did not have a PJI (n = 180 cases; 150 patients) were selected randomly. Radiographs were reviewed by two readers. A two-tailed p < 0.05 was considered significant. RESULTS. Soft-tissue gas was identified on postoperative radiography of 13 of 24 (54.2%) cases (mean ± standard error of the mean [SEM], 28.3 ± 2.3 days after TKA) with early PJI and four of 180 (2.2%) cases (mean ± SEM, 15.3 ± 7.3 days after TKA) without PJI (p < 0.0001; odds ratio, 52.0 [95% CI, 14.7-156.9]). The presence of soft-tissue gas on radiography 14 days after TKA had a sensitivity of 0.54 (95% CI, 0.35-0.72) and specificity of 0.99 (95% CI, 0.97-1.00) for early PJI. Staphylococcus species were the dominant organisms; cases with soft-tissue gas showed a wider variety of microbiology species (p < 0.01). CONCLUSION. Postoperative soft-tissue gas present on radiography performed 14 days or more after TKA is predictive of early PJI and is associated with a wider spectrum of microorganisms.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Idoso , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo
20.
J Orthop Res ; 38(6): 1359-1364, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31868953

RESUMO

Periprosthetic joint infection is among the most common and severe complications in total joint arthroplasty. Today, a combination of different methods is used for diagnosis because no single method with sufficient sensitivity and specificity is available. In this study, we explored the usability of single-molecule microscopy to characterize synovial fluid samples from periprosthetic joint infections. Patients (n = 27) that needed revision arthroplasty underwent the routine diagnostic procedures for periprosthetic joint infection of the University Hospital in Bonn. Additionally, the diffusion rate of two probes, dextran and hyaluronan, was measured in small volumes of periprosthetic synovial fluid samples using single-molecule microscopy. To evaluate the suitability of single-molecule microscopy to detect PJI the AUC for both markers was calculated. The diffusion rate of hyaluronan in periprosthetic synovial fluid from patients with septic loosening was faster than in samples from patients with aseptic loosening. Single-molecule microscopy showed excellent diagnostic performance, with an area under the receiver operating characteristic curve of 0.93, and allowed the detection of periprosthetic joint infection in patients that would be challenging to diagnose with current methods. For the first time, single-molecule microscopy was used to detect periprosthetic joint infection. Our results are encouraging to study the value of single-molecule microscopy in a larger patient cohort. The speed and accuracy of single-molecule microscopy can be used to further characterize synovial fluid, potentially allowing intraoperative diagnosis of periprosthetic joint infections in the future.


Assuntos
Artroplastia do Joelho/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Imagem Individual de Molécula/métodos , Líquido Sinovial/diagnóstico por imagem , Área Sob a Curva , Difusão , Feminino , Humanos , Ácido Hialurônico/farmacocinética , Masculino
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