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1.
Cardiovasc Ther ; 2019: 5164298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819762

RESUMO

Although the mechanism of the occurrence and development of heart failure has been continuously explored in the past ten years, the mortality and readmission rate of heart failure is still very high. Modern studies have shown that gut microbiota is associated with a variety of cardiovascular diseases, among which the study of gut microbiota and heart failure attracts particular attention. Therefore, understanding the role of gut microbiota in the occurrence and development of heart failure will help us further understand the pathogenesis of heart failure and provide new ideas for its treatment. This paper introduced intestinal flora and its metabolites, summarized the changes of intestinal flora in patients with heart failure, clarified that intestinal barrier damage and bacterial translocation induced inflammation and immune response aggravated heart failure, and altered intestinal microflora affected various metabolic pathways including trimethylamine/TMAO, SCFA, and Bile acid pathway leads to heart failure. At the same time, regulating intestinal microflora through diet, probiotics, antibiotics, fecal transplantation and microbial enzyme inhibitors has grown up to be a potential treatment for many metabolic disorders.


Assuntos
Bactérias/patogenicidade , Microbioma Gastrointestinal , Insuficiência Cardíaca/terapia , Intestinos/microbiologia , Animais , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/metabolismo , Translocação Bacteriana , Disbiose , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/microbiologia , Insuficiência Cardíaca/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Intestinos/efeitos dos fármacos , Probióticos/uso terapêutico , Resultado do Tratamento
2.
Med. clín (Ed. impr.) ; 153(10): 402-409, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186940

RESUMO

La insuficiencia cardíaca (IC) es una enfermedad crónica con una importante morbimortalidad asociada. Los pacientes con IC experimentan cambios hemodinámicos sustanciales, generadores de hipoperfusión y congestión esplácnica, que pueden alterar la composición de su microbiota intestinal. El objetivo de esta revisión sistemática es evaluar la influencia de la función intestinal en el paciente con IC, examinando el posible rol de la microbiota intestinal. Se incluyeron en la revisión 11 estudios. Los estudios evaluados ponen de manifiesto la existencia de alteraciones en la composición de la microbiota intestinal en pacientes con IC. El N-óxido de trimetilamina parece actuar como un mediador clave entre estas alteraciones en la microbiota intestinal y la IC; asimismo, su presencia en concentraciones anormales se correlaciona con un peor pronóstico en los pacientes con IC. En conclusión, los pacientes con IC sufren alteraciones en la microbiota intestinal que parecen incidir en el pronóstico de la enfermedad


Heart failure (HF) is a chronic disease with significant morbidity and mortality. Substantial haemodynamic changes such as hypoperfusion and intestinal congestion can alter the composition of the intestinal microbiota in patients with HF. The aim of this systematic review is to evaluate the influence of bowel function in patients with HF and the possible role of the intestinal microbiota in the development and evolution of the latter. Eleven studies were included in the review. These studies seem to confirm that HF patients present with substantial abnormalities in the composition of their intestinal microbiota. Trimethylamine N-oxide is identified as a key mediator between the alterations in the intestinal microbiota and HF and correlates with worse prognosis in HF patients. In conclusion, patients with HF present with frequent abnormalities in the characteristics of their intestinal microbiota, which may play a role in the prognosis of the disease


Assuntos
Humanos , Microbioma Gastrointestinal/fisiologia , Insuficiência Cardíaca/microbiologia , Microbioma Gastrointestinal/genética , Insuficiência Cardíaca/fisiopatologia , Metilaminas/metabolismo , Bibliometria
3.
Int Heart J ; 60(5): 1176-1183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564708

RESUMO

Recently, the potential role of gut microbiome (GM) in cardiovascular diseases has been revealed. Heart failure (HF) is one of the most prevalent cardiovascular diseases worldwide; however, whether GM dysbiosis participates in the development of HF remains largely unknown. This study aimed to investigate the specific changes in GM composition and function in isoproterenol (ISO)-induced HF in rats.The rats were divided into C (control), 4w-HF (ISO, 2.5 mg/kg/day for 4 weeks, intraperitoneally), and 2w-HF (ISO, 2.5 mg/kg/day for 2 weeks, intraperitoneally) groups. The cardiac structure and function in rats were assessed, and metagenomic analyses were then performed. Compared with the healthy control group, we found that the Shannon diversity index and microbial gene count in the 4w-HF and 2w-HF groups was drastically decreased. High-throughput sequencing showed that the three groups differed in intestinal bacterial community composition. Overgrowth of bacteria, such as Prevotella, was observed in the 4w-HF group, with reduced growth of bacteria, such as Roseburia, Lactobacillus, and Butyrivibrio, associated with healthy status compared with the C group on the genus level. Concomitant with the alteration of GM composition, underrepresentation of health-linked microbial function was observed in both the 4w-HF and 2w-HF groups compared with the C group.Iso-induced HF rats showed a significant decrease in the diversity and richness of the intestinal microbiome, with a downregulation of the key intestinal bacterial groups and overgrowth of bacteria considered to be involved in inflammatory responses as well as a decrease in health-linked microbial function. Our data indicated that altered GM may be a potential player in the pathogenesis and progression of HF.


Assuntos
Bactérias/classificação , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/microbiologia , Isoproterenol/efeitos adversos , Metagenômica/métodos , Animais , Bactérias/genética , Modelos Animais de Doenças , Ecocardiografia , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/diagnóstico por imagem , Sequenciamento de Nucleotídeos em Larga Escala , Injeções Intraperitoneais , Isoproterenol/farmacologia , Masculino , Filogenia , Ratos , Análise de Sequência de DNA
4.
Biomed Res Int ; 2019: 9637479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396536

RESUMO

Background: Changes in the gut microbiota are associated with cardiovascular disease progression. Xiao-Qing-Long Tang (XQLT), a traditional herbal formula, has an anti-inflammatory effect and regulates the steady state of the immune system, which is also associated with the progression of heart failure with preserved ejection faction (HFpEF). In this study, we investigated whether XQLT could contribute to prevent the development of HFpEF and whether the modulation of the gut microbiota by this herbal formula could be involved in such effect. Methods: The gut microbiota, SCFAs, the histology/function of the heart, and systolic blood pressure were examined to evaluate the effect of XQLT on the gut microbiota and the progression of HFpEF after oral administration of XQLT to model rats. Furthermore, we evaluated, through fecal microbiota transplantation experiments, whether the favorable effects of XQLT could be mediated by the gut microbiota. Results: Oral administration of XQLT contributed to the reduction of elevated blood pressure, inflammation, and compensatory hypertrophy, features that are associated with the progression of HFpEF. The gut microbiota composition, SCFA levels, and intestinal mucosal histology were improved after treatment with XQLT. Moreover, fecal transfer from XQLT-treated rats was sufficient to prevent the progression of HFpEF. Conclusions: These data suggested that XQLT prevented the development of HFpEF in model rats by regulating the composition of the gut microbiota.


Assuntos
Cardiomegalia , Medicamentos de Ervas Chinesas/farmacologia , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca , Miócitos Cardíacos/metabolismo , Volume Sistólico/efeitos dos fármacos , Administração Oral , Animais , Cardiomegalia/tratamento farmacológico , Cardiomegalia/metabolismo , Cardiomegalia/microbiologia , Cardiomegalia/fisiopatologia , Modelos Animais de Doenças , Fibrose , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/microbiologia , Insuficiência Cardíaca/fisiopatologia , Masculino , Ratos , Ratos Endogâmicos Dahl
5.
Arch Cardiovasc Dis ; 112(6-7): 381-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303461

RESUMO

BACKGROUND: Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration. AIMS: To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration. METHODS: This was a retrospective analysis of cases of IE discharged from our institution between January 2009 and May 2017. The 10% lowest CRP concentration (<20mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded. RESULTS: Of the 469 patients, 13 (2.8%; median age 68 [61-76] years) had definite (n=8) or possible (n=5) left-sided valvular IE with CRP<20mg/L (median 9.3 [4.7-14.2] mg/L). The median white blood cell count was 6.3 (5.3-7.5) G/L. The main presentations were heart failure (n=7; 54%) and stroke (n=3; 23%). Transthoracic echocardiography (TTE) showed vegetations (n=5) or isolated valvular regurgitation (n=4). Overall, eight patients (62%) had severe valvular lesions on transoesophageal echocardiography (TOE), and nine patients (69%) underwent cardiac surgery. All patients survived at 1-year follow-up. Bacterial pathogens were documented in eight patients (streptococci, coagulase-negative Staphylococcus, Corynebacteriumjeikeium, HACEK group, Coxiella burnetii, Bartonella henselae) using blood cultures, serology or valve culture and/or polymerase chain reaction analysis. CONCLUSIONS: Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration.


Assuntos
Proteína C-Reativa/análise , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Mediadores da Inflamação/sangue , Idoso , Biomarcadores/sangue , Tomada de Decisão Clínica , Ecocardiografia Transesofagiana , Endocardite Bacteriana/sangue , Endocardite Bacteriana/terapia , Feminino , França/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/microbiologia , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/microbiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/microbiologia
6.
Chin Med J (Engl) ; 132(15): 1843-1855, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31306229

RESUMO

OBJECTIVE: The purpose of this review is to stress the complicated interactions between the microbiota and the development of heart failure. Moreover, the feasibility of modulating intestinal microbes and metabolites as novel therapeutic strategies is discussed. DATA SOURCES: This study was based on data obtained from PubMed up to March 31, 2019. Articles were selected using the following search terms: "gut microbiota," "heart failure," "trimethylamine N-oxide (TMAO)," "short-chain fatty acid (SCFA)," "bile acid," "uremic toxin," "treatment," "diet," "probiotic," "prebiotic," "antibiotic," and "fecal microbiota transplantation." RESULTS: Accumulated evidence has revealed that the composition of the gut microbiota varies obviously in people with heart failure compared to those with healthy status. Altered gut microbial communities contribute to heart failure through bacterial translocation or affecting multiple metabolic pathways, including the trimethylamine/TMAO, SCFA, bile acid, and uremic toxin pathways. Meanwhile, modulation of the gut microbiota through diet, pre/probiotics, fecal transplantation, and microbial enzyme inhibitors has become a potential therapeutic approach for many metabolic disorders. Specifically, a few studies have focused on the cardioprotective effects of probiotics on heart failure. CONCLUSIONS: The composition of the gut microbiota in people with heart failure is different from those with healthy status. A reduction in SCFA-producing bacteria in patients with heart failure might be a notable characteristic for patients with heart failure. Moreover, an increase in the microbial potential to produce TMAO and lipopolysaccharides is prominent. More researches focused on the mechanisms of microbial metabolites and the clinical application of multiple therapeutic interventions is necessarily required.


Assuntos
Microbioma Gastrointestinal/fisiologia , Insuficiência Cardíaca/microbiologia , Insuficiência Cardíaca/terapia , Disbiose/microbiologia , Disbiose/terapia , Humanos , Microbiota/fisiologia
7.
Mol Med Rep ; 20(1): 779-786, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31180562

RESUMO

Myocardial infarction (MI) is a common cause of chronic heart failure (HF). Increasing evidence has revealed that trimethylamine N­oxide (TMAO), a gut­microbiota­derived metabolite, contributes to the pathogenesis of cardiovascular disease by promoting inflammation. Elevated levels of circulating TMAO have been reported in patients following MI and were associated with unfavorable outcomes. The present study examined whether reductions in circulating TMAO could attenuate the progression of HF in rats following MI. Sprague­Dawley rats underwent coronary ligation to induce MI or a sham operation. Echocardiography confirmed MI and cardiac dysfunction one day following coronary ligation. MI and sham rats were then treated with either vehicle (tap water) or 1.0% 3,3­dimethyl­1­butanol (DMB, a trimethylamine formation inhibitor) in tap water, for 8 weeks. At the end of the experiment, TMAO plasma levels were markedly elevated in vehicle­treated MI rats compared with vehicle­treated sham rats; however, TMAO plasma levels were reduced in DMB­treated MI rats compared with vehicle­treated MI rats. Both MI groups exhibited cardiac hypertrophy, lung congestion, left ventricular remodeling and impaired cardiac function, according to the results of anatomical analysis, echocardiography and left ventricular hemodynamics; however, these manifestations of MI­induced HF were significantly improved in DMB­treated MI rats compared with vehicle­treated MI rats. The plasma levels of the chemokine interleukin (IL)­8, and cardiac expression of IL­8 and its receptors were significantly increased in vehicle­treated MI rats compared with vehicle­treated sham rats; however, these were normalized in DMB­treated MI rats. In addition, elevated TMAO plasma level was positively correlated with increased IL­8 plasma level in MI groups. Notably, DMB treatment of sham rats also reduced plasma TMAO, but did not alter other parameters. These results indicated that reducing circulating TMAO may ameliorate the development of chronic HF following MI in rats, potentially by inhibiting IL­8 secretion. The results from the present study suggested that inhibition of TMAO synthesis may be considered as a novel therapeutic approach for the prevention and treatment of patients with chronic MI­induced HF.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Hexanóis/uso terapêutico , Metilaminas/antagonistas & inibidores , Infarto do Miocárdio/tratamento farmacológico , Animais , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/microbiologia , Interleucina-8/sangue , Masculino , Metilaminas/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Infarto do Miocárdio/microbiologia , Ratos , Ratos Sprague-Dawley
8.
BMJ Case Rep ; 12(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31189544

RESUMO

We report a rare case of native valve endocarditis caused by Staphylococcus warneri in an immunocompetent 79-year-old man with known degenerative valvular heart disease but no previous risk factors such as recent invasive treatment or medical implant. The patient presented with heart failure, due to perforation of the mitral valve, and lacked any signs of infection. The diagnosis of endocarditis with S. warneri was established by echocardiography and positive blood cultures.


Assuntos
Endocardite Bacteriana/microbiologia , Insuficiência Cardíaca/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Infecções Estafilocócicas/complicações , Staphylococcus , Idoso , Humanos , Masculino , Valva Mitral/microbiologia , Infecções Estafilocócicas/microbiologia
10.
Med. clín (Ed. impr.) ; 152(6): 222-225, mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-182081

RESUMO

Introduction and objective: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. Material and methods: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. Results: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. Conclusion: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission


Introducción y objetivo: Se estudió la evolución natural de los pacientes con enfermedades crónicas que son colonizados por Staphylococcus aureus resistente a la meticilina (SARM) para determinar la persistencia de colonización al año, e identificar factores predictores de persistencia. Material y métodos: Estudio multicéntrico, prospectivo y observacional. Se incluyeron los ingresados en un hospital y los 4 centros sociosanitarios de referencia, recogiendo datos estadísticos, clínicos y microbiológicos (muestras nasales y cutáneas), trimestralmente durante un año. Los portadores recibieron mupirocina. Resultados: Se identificaron 114 portadores de SARM entre los 699 ingresados. Fueron portadores persistentes el 59,4% de aquellos que completaron el seguimiento. Los factores basales asociados a la persistencia fueron la insuficiencia cardíaca, las comorbilidades, la antibioterapia y las úlceras. Al año: CSS, bajo peso, índice de Barthel<60, y úlceras (estos 2 últimos de forma independiente). Persistencia y descolonización no estuvieron estadísticamente relacionados. Conclusión: Se detectó una elevada persistencia de SARM al año, independientemente asociada a dependencia funcional y úlceras. Esta información es útil para detectar el riesgo de ser portador de SARM desde su ingreso


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Portadores de Fármacos , Doença Crônica , Técnicas de Cocultura , Estudos Prospectivos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Fatores de Virulência
11.
Nat Rev Cardiol ; 16(3): 137-154, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30410105

RESUMO

Advances in our understanding of how the gut microbiota contributes to human health and diseases have expanded our insight into how microbial composition and function affect the human host. Heart failure is associated with splanchnic circulation congestion, leading to bowel wall oedema and impaired intestinal barrier function. This situation is thought to heighten the overall inflammatory state via increased bacterial translocation and the presence of bacterial products in the systemic blood circulation. Several metabolites produced by gut microorganisms from dietary metabolism have been linked to pathologies such as atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus. These findings suggest that the gut microbiome functions like an endocrine organ by generating bioactive metabolites that can directly or indirectly affect host physiology. In this Review, we discuss several newly discovered gut microbial metabolic pathways, including the production of trimethylamine and trimethylamine N-oxide, short-chain fatty acids, and secondary bile acids, that seem to participate in the development and progression of cardiovascular diseases, including heart failure. We also discuss the gut microbiome as a novel therapeutic target for the treatment of cardiovascular disease, and potential strategies for targeting intestinal microbial processes.


Assuntos
Bactérias/metabolismo , Dieta , Metabolismo Energético , Microbioma Gastrointestinal , Insuficiência Cardíaca/microbiologia , Intestinos/microbiologia , Animais , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Disbiose , Microbioma Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/dietoterapia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Interações Hospedeiro-Patógeno , Humanos , Intestinos/efeitos dos fármacos , Valor Nutritivo , Prebióticos , Probióticos/uso terapêutico
12.
Curr Opin Cardiol ; 34(2): 225-232, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30575647

RESUMO

PURPOSE OF REVIEW: The human gut is populated by a complex community of microbiota that coexists with the host to maintain homeostasis. Accumulating evidence shows that changes in the composition and diversity of gut microbiota, known as dysbiosis, is associated with cardiovascular diseases, such as atherosclerosis, hypertension, and heart failure. RECENT FINDINGS: Although recent advances in biochemical and molecular analyses have contributed to the detection, identification, and characterization of a variety of gut microbiota genomes and their associated metabolites, the exact mechanisms of action remain unclear. As the prevalence of cardiovascular disease continues to rise, investigating the gut microbiome as a potential strategy for clinical intervention is highly warranted. SUMMARY: In this review, we discuss correlations between the gut microbiome and heart failure, as well as the effects of altering the microbiome as a potential therapeutic target in cardiovascular diseases including heart failure.


Assuntos
Microbioma Gastrointestinal , Insuficiência Cardíaca , Hipertensão , Disbiose , Insuficiência Cardíaca/microbiologia , Humanos , Hipertensão/microbiologia
13.
Circ J ; 83(1): 182-192, 2018 12 25.
Artigo em Inglês | MEDLINE | ID: mdl-30487369

RESUMO

BACKGROUND: Gut microbiome composition or circulating microbiome-related metabolites in patients with heart failure (HF) have not been investigated at different time points (i.e., in the decompensated (Decomp) and compensated (Comp) phases). Methods and Results: We prospectively enrolled 22 patients admitted for HF and 11 age-, sex-, and comorbidity-matched hospitalized control subjects without a history of HF. Gut flora and plasma microbiome-related metabolites were evaluated by amplicon sequencing of the bacterial 16S ribosomal RNA gene and capillary electrophoresis time-of-flight mass spectrometry, respectively. HF patients were evaluated in both the Decomp and Comp phases during hospitalization. The phylum Actinobacteria was enriched in HF patients compared with control subjects. At the genus level, Bifiodobacterium was abundant while Megamonas was depleted in HF patients. Meanwhile, plasma concentration of trimethylamine N-oxide (TMAO), a gut microbiome-derived metabolite, was increased in HF patients (Decomp HF vs. control, P=0.003; Comp HF vs. control, P=0.004). A correlation analysis revealed positive correlations between the abundance of the genus Escherichia/Shigella and levels of TMAO and indoxyl sulfate (IS, a microbe-dependent uremic toxin) in Comp HF (TMAO: r=0.62, P=0.002; IS: r=0.63, P=0.002). Escherichia/Shigella was more abundant in Decomp than in Comp HF (P=0.030). CONCLUSIONS: Our results suggest that gut microbiome composition and microbiome-related metabolites are altered in HF patients.


Assuntos
Bifidobacterium , Escherichia coli , Microbioma Gastrointestinal , Insuficiência Cardíaca , Shigella , Idoso , Idoso de 80 Anos ou mais , Bifidobacterium/classificação , Bifidobacterium/isolamento & purificação , Escherichia coli/classificação , Escherichia coli/isolamento & purificação , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/microbiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Shigella/classificação , Shigella/isolamento & purificação
14.
BMC Infect Dis ; 18(1): 444, 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30170557

RESUMO

BACKGROUND: Corynespora cassiicola infection is common in plants, but the human Corynespora cassiicola infection in our report is rare according to the literature. CASE PRESENTATION: We report a case of subcutaneous phaeohyphomycosis caused by a plant pathogen in a patient with acute heart failure. The organism was isolated and identified as Corynespora cassiicola according to its morphological characteristics and gene analysis. The patient was treated successfully with systemic voriconazole. CONCLUSIONS: This is the third reported case of subcutaneous infection caused by Corynespora cassiicola and the first reported case with accompanied renal impairment, which was associated with acute heart failure. Our case also suggests the importance of renal function monitoring in patients receiving intravenous voriconazole treatment.


Assuntos
Ascomicetos/isolamento & purificação , Feoifomicose/diagnóstico , Feoifomicose/microbiologia , Idoso , Ascomicetos/patogenicidade , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/microbiologia , Humanos , Nefropatias/complicações , Nefropatias/tratamento farmacológico , Nefropatias/microbiologia , Masculino , Feoifomicose/tratamento farmacológico , Voriconazol/uso terapêutico
15.
Int J Infect Dis ; 77: 48-52, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30248465

RESUMO

OBJECTIVE: To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis. METHODS: A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality. RESULTS: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023). CONCLUSIONS: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.


Assuntos
Endocardite/mortalidade , Insuficiência Cardíaca/mortalidade , Micoses/mortalidade , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Equinocandinas/uso terapêutico , Endocardite/tratamento farmacológico , Feminino , Fluconazol/uso terapêutico , Seguimentos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/microbiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
J Emerg Med ; 55(4): 465-471, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30115388

RESUMO

BACKGROUND: Acute heart failure is a heterogenous syndrome defined by a number of factors, such as its physiopathology, clinical picture, time of onset, and relation to acute coronary syndrome. Acute cardiogenic pulmonary edema (ACPE) constitutes approximately 10-20% of acute heart failure syndromes, and it is the most dramatic symptom of left heart failure. Platelet to lymphocyte ratio (PLR) is a relatively novel inflammatory marker that can be utilized for prognosis in various disease processes. OBJECTIVE: In this study, we investigated the value of the PLR for the prediction of mortality in patients with ACPE. METHODS: A total of 115 patients hospitalized with a diagnosis of ACPE were included in this study. The patients were divided into tertile groups according to their PLR values: high (PLR > 194.97), medium (98.3-194.97), and low tertile (PLR < 98.3). RESULTS: We compared the PLR groups for in-hospital mortality and total mortality after discharge. Multivariate Cox regression analysis showed that PLR was independently associated with total mortality (hazard ratio 5.657; 95% confidence interval 2.467-12.969; p < 0.001). Survival analysis using the Kaplan-Meier curve showed that the high-PLR group had a significantly higher mortality rate than the other groups. CONCLUSIONS: We showed an association between high PLR and mortality in patients with ACPE. PLR, together with other inflammatory markers and clinical findings, may be used as an adjunctive parameter for the stratification of mortality risk, hospitalization, or discharge criteria scoring.


Assuntos
Plaquetas/microbiologia , Linfócitos/microbiologia , Edema Pulmonar/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/microbiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Contagem de Linfócitos/métodos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/métodos , Prognóstico , Modelos de Riscos Proporcionais , Edema Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de Risco
17.
Circ J ; 82(6): 1640-1650, 2018 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-29607983

RESUMO

BACKGROUND: Research suggests that heart failure with reduced ejection fraction (HFrEF) is a state of systemic inflammation that may be triggered by microbial products passing into the bloodstream through a compromised intestinal barrier. However, whether the intestinal microbiota exhibits dysbiosis in HFrEF patients is largely unknown.Methods and Results:Twenty eight non-ischemic HFrEF patients and 19 healthy controls were assessed by 16S rRNA analysis of bacterial DNA extracted from stool samples. After processing of sequencing data, bacteria were taxonomically classified, diversity indices were used to examine microbial ecology, and relative abundances of common core genera were compared between groups. Furthermore, we predicted gene carriage for bacterial metabolic pathways and inferred microbial interaction networks on multiple taxonomic levels.Bacterial communities of both groups were dominated by the Firmicutes and Bacteroidetes phyla. The most abundant genus in both groups wasBacteroides. Although α diversity did not differ between groups, ordination by ß diversity metrics revealed a separation of the groups across components of variation.StreptococcusandVeillonellawere enriched in the common core microbiota of patients, whileSMB53was depleted. Gene families in amino acid, carbohydrate, vitamin, and xenobiotic metabolism showed significant differences between groups. Interaction networks revealed a higher degree of correlations between bacteria in patients. CONCLUSIONS: Non-ischemic HFrEF patients exhibited multidimensional differences in intestinal microbial communities compared with healthy subjects.


Assuntos
Microbioma Gastrointestinal/fisiologia , Insuficiência Cardíaca/microbiologia , Volume Sistólico , Bacteroidetes/isolamento & purificação , Estudos de Casos e Controles , Classificação , DNA Bacteriano/isolamento & purificação , Microbioma Gastrointestinal/genética , Insuficiência Cardíaca/fisiopatologia , Humanos , RNA Ribossômico 16S/análise , Streptococcus/isolamento & purificação , Veillonella/isolamento & purificação
18.
Diagn Microbiol Infect Dis ; 91(2): 141-143, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29433998

RESUMO

It has been reported that patients with chronic heart failure exhibit an intestinal overgrowth of primary gut bacterial pathogens, such as Shigella spp., Salmonella spp., Campylobacter spp., and Yersinia enterocolitica. We failed to reproduce these findings in a cohort of 39 patients admitted to the hospital with decompensated heart failure by means of conventional stool bacterial cultures and a multiplexed polymerase chain reaction assay.


Assuntos
Enterobacteriaceae , Microbioma Gastrointestinal/genética , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/microbiologia , Idoso , Idoso de 80 Anos ou mais , Técnicas Bacteriológicas , Campylobacter/isolamento & purificação , Campylobacter/patogenicidade , Doença Crônica , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/patogenicidade , Fezes/microbiologia , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase
19.
PLoS One ; 12(3): e0174099, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28328981

RESUMO

Emerging evidence has suggested a potential impact of gut microbiota on the pathophysiology of heart failure (HF). However, it is still unknown whether HF is associated with dysbiosis in gut microbiota. We investigated the composition of gut microbiota in patients with HF to elucidate whether gut microbial dysbiosis is associated with HF. We performed 16S ribosomal RNA gene sequencing of fecal samples obtained from 12 HF patients and 12 age-matched healthy control (HC) subjects, and analyzed the differences in gut microbiota. We further compared the composition of gut microbiota of 12 HF patients younger than 60 years of age with that of 10 HF patients 60 years of age or older. The composition of gut microbial communities of HF patients was distinct from that of HC subjects in both unweighted and weighted UniFrac analyses. Eubacterium rectale and Dorea longicatena were less abundant in the gut microbiota of HF patients than in that of HC subjects. Compared to younger HF patients, older HF patients had diminished proportions of Bacteroidetes and larger quantities of Proteobacteria. The genus Faecalibacterium was depleted, while Lactobacillus was enriched in the gut microbiota of older HF patients. These results suggest that patients with HF harbor significantly altered gut microbiota, which varies further according to age. New concept of heart-gut axis has a great potential for breakthroughs in the development of novel diagnostic and therapeutic approach for HF.


Assuntos
Envelhecimento/fisiologia , Disbiose/microbiologia , Insuficiência Cardíaca/microbiologia , Adulto , Idoso , Bacteroidetes/genética , Estudos de Casos e Controles , Fezes/microbiologia , Feminino , Microbioma Gastrointestinal/genética , Humanos , Masculino , Microbiota/genética , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética
20.
Microb Drug Resist ; 23(4): 500-506, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27525808

RESUMO

Urinary tract infections (UTIs), which are common among nursing home patients, are associated with adverse outcomes and increased healthcare costs. Antibiotic resistance is an emerging problem, associated with excess morbidity and mortality; it has been suggested that this condition might be more prevalent among subjects with comorbid conditions. The aim of this study was to assess the association, if any, of antibiotic resistance with the burden of comorbidity in elderly with UTIs. This retrospective study enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy, which includes 80 beds under the direction of two geriatricians. The burden of comorbidity was quantified using the Charlson comorbidity score index. Diagnosis of UTI was ascertained by urine culture. Antibiotic resistance was defined according to the European Centre for Disease Prevention and Control expert proposal. Logistic regression was used to assess the adjusted association of the variables of interest with the presence of antibiotic resistance. Antibiotic resistance was detected in 162/299 (54%) patients. In logistic regression, the presence of antibiotic resistance was independently associated with higher Charlson score, after adjusting (odds ratio = 1.06; 95% confidence interval = 1.01-1.10). Antibiotic resistance is highly prevalent among nursing home residents; it is associated with the burden of comorbidity, but not with single diseases. This association and its potential implications should be assessed in dedicated studies.


Assuntos
Infecções Bacterianas/epidemiologia , Demência/epidemiologia , Resistência Microbiana a Medicamentos/genética , Fraturas do Quadril/epidemiologia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Infecções Urinárias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Comorbidade , Demência/tratamento farmacológico , Demência/microbiologia , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Enterococcus/patogenicidade , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/microbiologia , Fraturas do Quadril/tratamento farmacológico , Fraturas do Quadril/microbiologia , Humanos , Itália/epidemiologia , Klebsiella/efeitos dos fármacos , Klebsiella/isolamento & purificação , Klebsiella/patogenicidade , Masculino , Lesão por Pressão/tratamento farmacológico , Lesão por Pressão/epidemiologia , Lesão por Pressão/microbiologia , Proteus/efeitos dos fármacos , Proteus/isolamento & purificação , Proteus/patogenicidade , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
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