Search Results (103)

Infective endocarditis (IE) as a diagnosis remains challenging, particularly in prosthetic valve endocarditis (PVE). This study evaluates the diagnostic utility of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in patients with suspected IE. Seventy patients with suspected IE underwent clinical, microbiological, echocardiographic, and ¹⁸F-FDG PET/CT evaluation. Diagnostic performance of PET/CT was assessed against clinical classification based on modified Duke criteria. Definitive PVE was diagnosed in 18 patients (26%), while 52 (74%) had possible IE. PET/CT reclassified 13 patients from possible to definite IE, demonstrating an overall sensitivity of 83.3%, specificity of 93.7%, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 93.7%. Excluding native valve endocarditis cases, sensitivity and specificity increased to 94.1% and 95.7%, respectively. PET/CT detected septic emboli in five patients and incidental malignancies in three cases, underscoring its role in comprehensive patient evaluation. False-negative results were mostly observed in early post-surgical PVE and native valve endocarditis. PET/CT also identified alternative diagnoses in patients reclassified as rejected IE. ¹⁸F-FDG PET/CT provides high diagnostic accuracy for suspected PVE, significantly aiding reclassification of ambiguous cases and detection of extracardiac complications and malignancies. Its integration into diagnostic algorithms may improve clinical management and outcomes in complex IE cases. Full article

Background: Cryptococcus species constitute opportunistic fungi that seldom cause infections in individuals with competent immune systems. In the rare case of cryptococcal endocarditis, the fungus infiltrates the endocardium. This disease occurs almost exclusively in patients with active immunosuppression, implanted cardiac devices, or prosthetic valves. Objectives: This study aims to analyze all documented cases of Cryptococcus spp. endocarditis in humans, emphasizing the epidemiology, microbiology, clinical manifestations, therapeutic approaches, and infection outcomes. Methods: A comprehensive review was performed by searching the PubMed and Scopus databases. Results: A total of 16 studies reported data on 16 patients diagnosed with cryptococcal endocarditis. The mean patient age was 46.6 years, with males comprising 81.25% of cases. Immunosuppression was the most prevalent predisposing factor (31.25%), followed by a history of end-stage renal disease and prosthetic cardiac valves (25%). The most commonly affected intracardiac sites were the mitral (60%) and aortic valve (46.6%), while in 33.3% of cases, multiple-valve infection was observed. Cryptococcus neoformans was detected as the causative organism in the majority of cases (87.5%). The most frequently administered antifungal treatments included amphotericin B (87.5%) and fluconazole (43.75%), with combination therapy used in 62.5% of cases. Overall mortality was relatively high at 56.25%, with 50% of deaths directly attributed to the infection. Conclusions: Considering the ability of Cryptococcus spp. to induce severe systemic infections, healthcare providers should consider this pathogen in the differential diagnosis when yeast microorganisms are identified in microbiological samples. This is particularly crucial for patients with underlying comorbidities or immunodeficiency, as early recognition is crucial to ensure precise diagnosis and treatment. Full article

Background: Transcatheter aortic valve implantation (TAVI) is becoming the most important treatment strategy for aortic valve disease. With its dramatic increase, the rate of major complications and the impact of TAVI on long term outcomes is becoming a pressing issue, especially in terms of comparison with surgical aortic valve replacement (SAVR). PVE is a severe complication that can arise post-procedure, leading to significant morbidity and mortality. The aim of this meta-analysis is to compare the incidence of PVE and 30-day mortality rates between TAVI and SAVR. Methods: A comprehensive literature review was conducted, identifying studies that reported the incidence and outcomes of PVE in patients undergoing TAVI and SAVR. The selected studies were assessed for heterogeneity using the χ² test and I² statistic. A random effect model was applied to account for variability among studies. The Odds Ratios (ORs) for 30-day mortality and the incidence of PVE were calculated. Funnel plots were utilized to assess the reliability of the data and potential publication bias. Results: The analysis showed no significant difference in 30-day mortality of PVE in TAVI and SAVR, with an OR of 1.29 (CI 0.98–1.69). However, there was a significant difference in the incidence of PVE (HR 0.76, CI 0.61–0.96), with TAVI demonstrating a protective effect attributed to its lesser invasiveness and shorter procedural times. The funnel plots indicated high reliability of the data, with low standard errors and minimal publication bias. Conclusions: TAVI and SAVR carry similar 30-day mortality rates for patients with PVE; on the other hand, TAVI shows a lower incidence of PVE due to its minimally invasive nature. These findings suggest that TAVI might be a preferable option for certain patient populations, though further randomized clinical trials are needed to confirm these results and address the limitations of the current study. Full article

Together with Granulicatella spp., A. defectiva was formerly classified within the group of nutritionally variant streptococci (NVS). NVS-related endocarditis has been associated with higher rates of complications, bacteriological failure, and mortality compared to other streptococci, partially due to challenges related to timely and accurate identification. PJI caused by A. defectiva are rarely reported, and standardized management strategies have not yet been established. We describe a case of a 68-year-old man with concomitant A. defectiva PJI and native mitral valve endocarditis. The patient was managed conservatively for endocarditis and subsequently underwent a two-stage arthroplasty of the infected prosthetic knee. A. defectiva was identified using MALDI-TOF mass spectrometry on both synovial fluid and blood cultures. As penicillin susceptibility data were not available, the patient was treated with vancomycin at a dose of 2 g/day, resulting in a favorable clinical response. In addition, we performed a literature review on A. defectiva and Granulicatella PJI. Despite the limited number of reported cases in the literature, the findings suggest a potential correlation between clinical outcomes and antimicrobial treatment duration. Further comprehensive studies are needed to establish standardized management strategies for A. defectiva and Granulicatella PJI. Full article

Kytococcus belongs to the family Kytococcaceae, in the order Micrococcales, in the class Actinomycetes, and the phylum Actinomycetota. Kytococcus are aerobic, Gram-positive, non-spore forming bacteria that form coccoid, non-motile, non-encapsulated cells, and their colonies on agar have a yellow color. Infections by these species are increasingly identified nowadays. This narrative review aimed to present all available cases of Kytococcus spp. infections in humans, emphasizing data on the epidemiology, antimicrobial resistance, antimicrobial treatment, and mortality. A narrative review based on a literature search of the PubMed/MedLine and Scopus databases was performed. Results: In total, 26 articles providing data on 30 patients with Kytococcus spp. infections were included in this analysis. The median age was 59.5 years, while 56.7% were male. The presence of a prosthetic cardiac valve was the main predisposing factor in 36.7% of patients (100% among those with infective endocarditis), while immunosuppression due to underlying hematological malignancy under chemotherapy was the second most common. Bacteremia was the most common type of infection, with infective endocarditis being the most common subtype in this infection type, while respiratory tract infections and osteoarticular infections were also relatively common. K. schroeteri was the most commonly identified species. Microbial identification required the use of advanced molecular techniques such as 16s rRNA sequencing in most cases. Kytotoccus spp. was resistant to all beta-lactams with the exception of carbapenems and macrolides. The most commonly used antimicrobials were vancomycin and rifampicin. Mortality was significant (30%). Due to the potential of Kytotoccus spp. to cause infective endocarditis in patients with prosthetic cardiac valves and respiratory tract infections with concomitant bacteremia in patients with hematological malignancy under chemotherapy along with the difficulties in pathogen identification, clinicians and laboratory personnel should consider this pathogen in the differential diagnosis in patients with typical predisposing factors and clinical presentation, especially when traditional microbiological techniques are used for pathogen identification. Full article

Mycobacterium chimaera infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, and respiratory symptoms that emerged seven years after they underwent heart surgery for prosthetic aortic valve replacement. A kidney biopsy revealed non-caseating necrotizing granulomatous interstitial nephritis, which was initially diagnosed as idiopathic granulomatous interstitial nephritis. The patient was treated with intravenous corticosteroids since no active infections, including mycobacterial infections, were detected. The negativity of the Mycobacterium molecular test following the kidney biopsy delayed the diagnosis of a Mycobacterium chimaera disseminated infection with endocarditis, myositis, cerebral, and kidney involvement, as blood cultures were available only after six weeks. The patient was started on antimicrobial therapy with azithromycin, moxifloxacin, rifampicin, and ethambutol while prednisone was tapered down, leading to an improvement in kidney function, blood count, and blood calcium level. Our case suggests that a Mycobacterium chimaera infection should be considered for patients with a history of cardiac surgery and granulomatous interstitial nephritis even in the absence of mycobacteria in a kidney biopsy. Full article

Background/Objectives: Transcatheter Aortic Valve Implantation (TAVI) has significantly improved the management of aortic valve disease, but post-TAVI infective endocarditis, occurring in 0.5–3.1% of cases, remains a serious complication. Due to a high mortality rate and technical challenges, surgical replacement of infected TAVI prosthetic valves is performed in only 11.4% of cases. Methods: This case describes a standardized surgical technique for the removal and replacement of self-expanding TAVI prosthetic valves in the case of infective endocarditis. Results: The proposed approach aims to facilitate valve explantation while minimizing surgical risks. Conclusions: We believe that this technique could be particularly beneficial for surgeons managing these complex cases, by reducing surgical complications and improving patient outcomes. Further studies are necessary to validate its long-term efficacy and applicability in broader clinical settings. Full article

Infective endocarditis (IE) is a relatively rare but potentially life-threatening disease characterized by substantial mortality and long-term sequelae among the survivors. In recent decades, a dramatic change in the profile of patients diagnosed with IE has been observed primarily in developed countries, most likely due to an aging population and a recent increase in invasive medical procedures. Nowadays, the typical IE patient is usually older, with complex comorbidities, and a history significant for cardiac disease, including degenerative heart valve disease, prosthetic valves, or cardiovascular implantable electronic devices (CIEDs). Moreover, as patient risk factors change, predisposing them to more healthcare-associated IE, the microbiology of IE is also shifting; there are growing concerns regarding the rise in the incidence of IE caused by difficult-to-treat resistance (DTR) bacteria in at-risk patients with frequent healthcare contact. The present review aims to explore the evolving landscape of IE and summarize the current knowledge on novel diagnostics to ensure timely diagnosis and outline optimal therapy for DTR bacterial IE. Full article

Candida infective endocarditis presents therapeutic challenges with high mortality. A complex case of Candida prosthetic valve endocarditis refractory to standard antifungals (anidulafungin and fluconazole) and high-dose caspofungin was successfully treated with heart transplantation. The literature review revealed a few cases of bacterial endocarditis successfully treated with heart transplantation, but with only two transplanted cases of fungal endocarditis. This report explores heart transplantation as a last resort for managing refractory infective endocarditis. The patient is still alive and free of infection, two and a half years after transplantation. Full article

Background: Infective endocarditis (IE) is a serious public health concern due to its high morbidity and lethality. This study investigates epidemiological trends in aortic valve endocarditis, focusing on sex-related differences in microbial etiology and surgical outcomes over a 15-year period. Methods: From January 2010 to January 2024, 608 patients underwent cardiac surgery for IE at our center. Of these, 274 patients received isolated aortic valve replacement. This retrospective, single-center study analyzes these cases. Results: Despite a decline in overall aortic valve replacement surgeries, a significant increase in surgeries due to aortic valve endocarditis was observed (p < 0.001). Both sexes showed a rising incidence of aortic valve endocarditis, with females undergoing surgery at an older age, particularly in native valve cases (p = 0.008). In prosthetic valve cases, this age difference was less pronounced (p = 0.050). While sex did not influence microbial etiology in native valve endocarditis, females with prosthetic valves were more frequently infected by Streptococcus (p = 0.033). Staphylococcus aureus infections increased in native valves (p = 0.016). Conclusions: Over 15 years, surgical aortic valve endocarditis has risen in both sexes. Males are more often affected by native valve cases, while females develop it later. Neither gender nor microbial etiology independently predicts death. Full article

Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE. Methods: All adult patients undergoing surgery for NVE and PVE at our institution between January 2001 and December 2022 were included in the study. Preoperative NLR, NPR, PLR, MLR, NMR, and SII were calculated using hemograms with complete blood count. Results: During the study period, 503 patients, 371 (74%) males, median age 65 (52–73) years, underwent surgery for NVE (n = 337, 67%) or PVE (n = 166, 33%). Patients with PVE had significantly more aortic annulus abscess (95 (57%) vs. 51 (15%); p < 0.001), longer CPB (180 (131–235) vs. 105 (84–145) min; p < 0.001) and aortic cross-clamping times (129 (96–175) vs. 82 (64–114) min; p < 0.001), and received more aortic homografts (47 (28%) vs. 28 (9%); p < 0.001) and postoperative pacemaker implantation (25 (15%) vs. 20 (6%); p < 0.001 compared to patients with NVE. Preoperative NLR was 3.7 (2.4–6.1), NPR was 23 (16–37), PLR was 159 (106–210), NMR was 8.4 (6.6–12), MRL was 0.41 (0.29–0.62], and SII was 790 (485–1396). NLR, NPR, and MLR were significantly lower in patients with NVE compared to patients with PVE and in survivors compared to non-survivors. Overall mean survival time was 12.2 ± 0.5 years, with patients with NVE having better early and late survival compared to patients with PVE. Patients with preoperative NLR < 3.8, NPR < 30.9, and MLR < 0.4 had significantly better mean survival time compared to patients with preoperative NLR > 3.8, NPR > 30.9, and MLR > 0.4, respectively. Conclusions: In patients undergoing surgery for IE, preoperative higher NLR, NPR, and MLR are associated with increased early and long-term mortality. Full article

Staphylococcus caprae is a coagulase-negative staphylococcus commonly associated with animals which can also be a zoonotic human pathogen. To date, there is little data available on S. caprae infections. The aim of this study was to characterize the S. caprae infections identified in two hospitals located, respectively, in rural and urban areas of Catalonia, Spain. In this retrospective, observational study, data were compiled from clinical records of all S. caprae infections diagnosed between January 2010 and December 2023. Over the study period, altogether 31 cases of S. caprae infection were identified, with most (23) of these cases occurring in the second half of the period (2017–2023). The mean age of patients was 58.87 ± 20.65 years, and 58.1% were males. Eight patients had had livestock exposure. The most frequent manifestation of infection was skin and soft subcutaneous tissue infections (10; 32.3%), osteomyelitis (6; 19.4%), and joint prosthetic infections (5; 16.1%). All the strains were susceptible to oxacillin, fluoroquinolones, rifampicin, and trimethoprim–sulfamethoxazole. Twenty-two (71%) of the patients required surgical treatment. Only one patient (3.2%) died, because of aortic prosthetic valve infective endocarditis. Skin and soft tissue infections were the most frequently identified manifestations of S. caprae infection. Over 75% of the cases occurred in the last six years, and 25.8% involved significant exposure to livestock. Ongoing surveillance is necessary to better understand the prevalence and transmission dynamics of this emerging zoonotic pathogen. Full article

Background: The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) highlighted the essential role of multimodal imaging in the diagnostic algorithm of IE and its complications. Methods: We hereby report a case series of IE in which the diagnosis was confirmed or excluded by the use of multimodal imaging during the period between January 2024 and July 2024 at the Infectious Diseases Clinic, Perugia Hospital, Italy. Results: Six patients were retrospectively included. Prosthetic valve endocarditis (PVE) was suspected in four patients and native valve endocarditis (NVE) in two cases. In patients with prosthetic valves, 18F FDG-PET/CT was performed, except in one case (P1) where cardiac CTA was performed for suspicion of perigraft aneurysm. Patients underwent transesophageal echocardiography (TOE), which was diagnostic in two cases and inconclusive in the remaining cases. In case of inconclusive TOE, the use of multimodal imaging added a major criterion and allowed us to consider (from ‘rejected’ to ‘possible’) or confirm (from ‘possible’ to ‘definite’) the diagnosis of EI based on the 2023 Duke–ESC Criteria. In one case (P6), it was possible to exclude the diagnosis. For patients with diagnostic TOE, 18F FDG-PET/CT allowed for the enhancement of diagnostic accuracy, identifying the site of valve involvement and the extension of the infection to the device (cases P3 and P5, respectively). Conclusions: In clinical practice, the use of cardiac CTA and/or 18F FDG-PET/CT based on the latest ESC guidelines demonstrated a significant impact on the diagnosis and therapeutic management of IE. Full article

Background: Histological findings of infective endocarditis (IEs) in mechanical valves present a complex diagnostic challenge owing to the lack of a precise definition. This ambiguity is further complicated by the natural degenerative processes that occur in the mechanical valves over time. Consequently, pathologists and clinicians face significant difficulties in distinguishing between genuine infective processes and the normal wear and tear of mechanical valves. Method: This retrospective cohort study was conducted between January 2017 and January 2024 and examined tissue samples from 93 patients who underwent a surgical removal of mechanical heart valves, with 41 cases suspected of infective endocarditis and 52 cases of non-IE. The researchers aimed to establish more precise histological criteria for distinguishing between these two conditions, focusing on two key features: vegetations and inflammatory patterns. Results: IE in patients with prosthetic heart valves presents distinct histological features that aid in the diagnosis and differentiation of non-infective complications. Hallmark characteristics include vegetation and inflammatory infiltrates with neutrophils. Valve tissue specimens from patients whose mechanical valves were removed because of non-infectious complications showed a different histological profile. Inflammatory infiltrates were observed in approximately 26% of these cases; however, they were primarily composed of macrophages and lymphocytes rather than neutrophils. Conclusions: By emphasizing neutrophil-rich inflammation as a key indicator, clinicians and pathologists could more effectively distinguish between true infective endocarditis and non-IE that can occur in the mechanical valves. This distinction is crucial for appropriate patient management as the treatment strategies for infective and non-infective valve conditions differ significantly. Full article

Prosthetic valve endocarditis (PVE) has undergone significant changes over the past five decades and is currently affecting an aging population, with an increasing prevalence in patients with transcatheter valve implants. The introduction of transcatheter aortic valve replacement (TAVR) represents a significant advance in the field of interventional cardiology and cardiac surgery. The incidence of IE after TAVR has remained stable, with rates similar to those reported after surgical aortic valve replacement. This is despite significant refinements in the TAVR procedure, with less invasive handling and its extension to younger and healthier patients. TAVR should be considered as a potential treatment option for patients with PVE, despite some differences. In terms of evolutionary advances, there have been notable and significant developments in the fields of microbiology and imaging diagnostics. The 2023 Duke-International Society for Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis now incorporate significant advances in molecular biology and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. This has led to a significant enhancement in diagnostic sensitivity for PVE while maintaining the same level of specificity in validation studies. PVE is a deadly disease. A multidisciplinary endocarditis treatment team in a cardiac center is essential to improve outcomes. The availability of novel surgical options allows clinicians to offer an increasing number of patients the opportunity to avoid surgical intervention. Some patients will complete antimicrobial treatment at home. Those with prosthetic valves are eligible for antibiotic prophylaxis before dental procedures. Post-TAVR infective endocarditis (IE) is a subcategory of prosthetic valve endocarditis. This condition presents a particularly complex scenario, characterized by a distinctive clinical and microbiological profile, a high prevalence of IE-related complications, an ambiguous role of cardiac surgery, and a poor prognosis for the majority of patients with TAVR IE. The number of TAVR procedures is set to skyrocket in the coming years, which will undoubtedly lead to a significant rise in the number of people at risk of this life-threatening complication. This review will provide an overview of this rare complication in light of the advent of IE following TAVR. It is crucial to gain a comprehensive understanding of the disease and its associated complications to enhance clinical outcomes. Full article