RESUMEN
BACKGROUND: Coxiella burnetii is a bacterium with extreme tenacity and contagiousness that is mainly transmitted by inhalation of contaminated aerosols. Nevertheless, a transmission by ticks is under discussion. We report a case of Q fever in an urban environment and far away from sheep breeding that caused a rare right-sided endocarditis. CASE PRESENTATION: A 55-year-old man who was in good health before the event developed a C. burnetii -endocarditis of the tricuspid valve. He had no contact with sheep and no recent travel in a rural or even endemic area. The infection originated in a strictly urban environment, and the patient's occupation as a cemetery gardener in Berlin, coupled with the close temporal and local exposure to wild boar, made a transmission by these animals a plausible hypothesis. The infection was confirmed by the German Reference Laboratory, and the patient recovered completely after treatment with doxycycline and hydrochlorquine. CONCLUSIONS: The specialities of this case report are the right-sided endocarditis and the transmission of C. burnetii in a metropolitan area without sheep contact. We think that this case should serve to increase awareness of the potential for Q fever infection even in non-rural areas.
Asunto(s)
Coxiella burnetii , Endocarditis Bacteriana , Fiebre Q , Válvula Tricúspide , Fiebre Q/transmisión , Fiebre Q/microbiología , Fiebre Q/diagnóstico , Fiebre Q/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Humanos , Válvula Tricúspide/microbiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/transmisión , Endocarditis Bacteriana/tratamiento farmacológico , Coxiella burnetii/aislamiento & purificación , Animales , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , OvinosRESUMEN
SummaryWe describe a case of culture-negative infective endocarditis due to Neisseria gonorrhoeae, where the application of metagenomics shotgun sequencing in blood played a pivotal role in elucidating the underlying aetiology, guiding targeted therapy and ultimately resulting in the patient's complete recovery. Beyond its immediate clinical impact, prompt treatment bears significant implications for public health. The utilisation of molecular testing emerges as a valuable strategy to enhance diagnostic accuracy, particularly in cases involving fastidious organisms that are infrequently associated with infective endocarditis.
Asunto(s)
Antibacterianos , Endocarditis Bacteriana , Gonorrea , Neisseria gonorrhoeae , Válvula Tricúspide , Humanos , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/complicaciones , Neisseria gonorrhoeae/aislamiento & purificación , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/tratamiento farmacológico , Masculino , Válvula Tricúspide/microbiología , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Adulto , EcocardiografíaRESUMEN
INTRODUCTION: Haemophilus influenzae (HI) is an exceedingly rare cause of infective endocarditis (IE). CASE PRESENTATION/METHODS: We present a case of a 90-year-old female diagnosed with HI-IE involving the native tricuspid valve in the absence of traditional risk factors for right-sided endocarditis. She was treated with a 5-week course of IV Ampicillin from negative cultures and suffered no complications. We also conducted a thorough literature review through PubMed and Google Scholar, which yielded a mere 15 reported cases of HI-IE. RESULTS: Fourteen of the reported HI-IE cases included epidemiological data, showing no gender predominance. The mean age of the subjects was 39.5, with the mitral valve being the most implicated (64%) and tricuspid valve involvement being rare (21%). CONCLUSION: Native tricuspid valve IE is an uncommon entity, especially in the absence of IV drug use. Haemophilus influenzae is an extremely rare cause of IE, with a literature review showing merely 15 reported cases. This article cites the 16th case of HI-IE published in the literature.
Asunto(s)
Antibacterianos , Endocarditis Bacteriana , Infecciones por Haemophilus , Haemophilus influenzae , Humanos , Femenino , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/microbiología , Infecciones por Haemophilus/diagnóstico , Anciano de 80 o más Años , Haemophilus influenzae/aislamiento & purificación , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/diagnóstico , Ampicilina/uso terapéutico , Válvula Tricúspide/microbiología , Válvula Tricúspide/diagnóstico por imagenRESUMEN
Vancomycin-resistant enterococcal (VRE) bacteremia is associated with higher mortality rates and longer hospitalizations than vancomycin-sensitive enterococcal (VSE) bacteremia. A 67-year-old man with a right psoas abscess and pacemaker-associated tricuspid valve endocarditis in September 2020 grew VSE Enterococcus faecium from blood cultures that cleared after administration of intravenous vancomycin and gentamicin. Subsequently, he underwent tricuspid valve repair, pacemaker removal, and partial lead extraction. Valve and postoperative blood cultures grew VRE E. faecium, which cleared after administration of intravenous daptomycin. One VSE and two VRE isolates were collected and sequenced. All isolates belonged to E. faecium multilocus sequence type ST17 and were closely related, having <20 mutations in pairwise genome comparisons. Vancomycin resistance was due to the acquisition of a plasmid-encoded VanA operon. None of the isolates encoded the virulence factors asa1, gelE, cylA, or hyl; all encoded a homologue of efaAfm. VSE E. faecium, but not VRE E. faecium isolates, encoded a glucose transporter gene mutation. Two VRE E. faecium isolates formed more robust biofilms than the VSE E. faecium isolate (p < 0.001). The VRE E. faecium isolates, which generated larger biofilms than the VSE E. faecium isolate, could have remained protected in the heart valve and only caused bacteremia when disrupted during cardiac surgery. This study demonstrates that bacteria detected in the bloodstream of patients with endocarditis may not fully represent the organisms adherent to the cardiac valves or indwelling devices.
Asunto(s)
Bacteriemia/microbiología , Endocarditis Bacteriana/microbiología , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Anciano , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Daptomicina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Endocarditis Bacteriana/tratamiento farmacológico , Enterococcus faecium , Genes Bacterianos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Marcapaso Artificial/microbiología , Válvula Tricúspide/microbiología , Enterococos Resistentes a la Vancomicina/efectos de los fármacosRESUMEN
A 46-year-old male was having un-resolving fever for six weeks. Trans-esophageal echocardiography showed tricuspid valve myxoma (TVM). Kodamaea ohmeri was identified in 2 blood cultures and confirmed by 28S rDNA sequencing. Over three weeks of liposomal Amphotericin-B, fever has subsided thus indicated a clinical response. Subsequent echocardiography revealed no regression of suspected vegetation, and it was removed, and TV replacement was done. Histopathology revealed an infected myxoma and K. omeri was detected following 28S rDNA sequencing. For cardiac myxoma, excision is offered while for IE prolonged use of antifungals with or without vegetectomy is offered. So proper identification is important.
Asunto(s)
Fungemia , Mixoma , Saccharomycetales/patogenicidad , Válvula Tricúspide/microbiología , ADN Ribosómico/genética , Fungemia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Mixoma/diagnóstico , Mixoma/microbiologíaRESUMEN
Tricuspid valve infective endocarditis is an increasingly common sequela of the opioid epidemic. While often managed medically, certain subsets of patients will require surgical intervention, including repair, replacement, and possibly even excision. Historically, simple valvectomy was performed in instances of recidivism and reinfection; however, reoperation and replacement has become the preferred treatment in the current era. Given the increasing incidence of intravenous drug use and the increase in the number of patients presenting with recurrent infections, simple valvectomy has regained favor in recent years. In this article, we present the management of a critically ill patient with recurrent tricuspid valve endocarditis who underwent tricuspid valvectomy that was complicated by a left ventricle to right atrium fistula and discuss some of the most important perioperative issues and complications for patients who undergo tricuspid valvectomy.
Asunto(s)
Endocarditis/complicaciones , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/cirugía , Válvula Tricúspide/cirugía , Adulto , Femenino , Humanos , Recurrencia , Reoperación , Resultado del Tratamiento , Válvula Tricúspide/microbiologíaRESUMEN
HISTORY AND CLINICAL FINDINGS: Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months. INVESTIGATIONS AND DIAGNOSIS: In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE). TREATMENT AND COURSE: Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea. DISCUSSION: The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications.
Asunto(s)
Disnea/etiología , Endocarditis/cirugía , Cuerpos Extraños/diagnóstico por imagen , Embolia Pulmonar/cirugía , Toracotomía/efectos adversos , Vertebroplastia/efectos adversos , Anciano , Disnea/mortalidad , Ecocardiografía , Endocarditis/diagnóstico , Resultado Fatal , Humanos , Masculino , Complicaciones Posoperatorias , Embolia Pulmonar/diagnóstico , Válvula Tricúspide/microbiología , Válvula Tricúspide/cirugíaRESUMEN
Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.
Asunto(s)
Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Picaduras de Escorpión/complicaciones , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/microbiología , Válvula Tricúspide/cirugía , Bioprótesis , Cardiomiopatías/etiología , Niño , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Marruecos , MiocardioRESUMEN
We present a case of endocarditis wherein organisms cultured from different valve leaflets yielded different daptomycin susceptibilities from each other and from organisms obtained from peripheral blood culture. Genomic analyses showed mutations in mprF, purR, and agrA Pharmacokinetic simulations showed consistent activity of daptomycin plus beta-lactam against all subpopulations. This represents an opportunity to understand S. aureus evolution and fitness in vivo on daptomycin therapy and the role of beta-lactams to prevent the selection of daptomycin-resistant subpopulations.
Asunto(s)
Daptomicina/farmacología , Endocarditis Bacteriana/microbiología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/genética , Válvula Tricúspide/microbiología , Válvula Tricúspide/patología , Aminoaciltransferasas/genética , Proteínas Bacterianas/genética , Daptomicina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/genética , Humanos , Pruebas de Sensibilidad Microbiana , Mutación/genética , Proteínas Represoras/genética , Válvula Tricúspide/efectos de los fármacos , Secuenciación Completa del GenomaAsunto(s)
Infecciones por Corynebacterium/cirugía , Corynebacterium/aislamiento & purificación , Endocarditis Bacteriana/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Infecciones por Corynebacterium/diagnóstico por imagen , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/microbiología , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/microbiología , Válvula Tricúspide/cirugíaAsunto(s)
Bioprótesis , Cateterismo Cardíaco/instrumentación , Endocarditis/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Endocarditis/diagnóstico por imagen , Endocarditis/microbiología , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Persona de Mediana Edad , Falla de Prótesis , Recurrencia , Abuso de Sustancias por Vía Intravenosa/complicaciones , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/microbiología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiologíaRESUMEN
Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it's important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution.
Asunto(s)
Aneurisma Infectado , Endocarditis , Válvula Tricúspide , Anciano , Aneurisma Infectado/etiología , Vasos Coronarios , Endocarditis/complicaciones , Humanos , Masculino , Stents , Válvula Tricúspide/microbiologíaRESUMEN
A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7-10 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery.
Asunto(s)
Endocarditis Bacteriana/tratamiento farmacológico , Eosinofilia/inducido químicamente , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Marcapaso Artificial/efectos adversos , Vancomicina/efectos adversos , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Síndrome de Hipersensibilidad a Medicamentos , Eosinofilia/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Válvula Tricúspide/microbiología , Vancomicina/uso terapéuticoRESUMEN
A 46-year-old female presented with native tricuspid valve endocarditis complicated by a stroke with a hemorrhagic component. There was no evidence of intracardiac shunt nor left-sided valve involvement. Delayed surgery was planned to allow neurologic recovery, however, the patient developed an ST-elevation myocardial infarction and cardiac arrest from an occluded right posterior ventricular branch of the right coronary artery from a septic embolism. Repeat imaging demonstrated new aortic valve vegetation involving the right coronary cusp. This case highlights a unique sequence of events in a patient initially presenting with presumed isolated tricuspid valve vegetation.
Asunto(s)
Enfermedad de la Arteria Coronaria/etiología , Embolia/etiología , Endocarditis Bacteriana/complicaciones , Infecciones Estafilocócicas/complicaciones , Válvula Tricúspide/diagnóstico por imagen , Antibacterianos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Ecocardiografía Transesofágica , Embolia/diagnóstico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Femenino , Humanos , Persona de Mediana Edad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Staphylococcus aureus/aislamiento & purificación , Válvula Tricúspide/microbiología , Válvula Tricúspide/cirugíaRESUMEN
PURPOSE: A case report of the use of linezolid and daptomycin for the treatment of multidrug-resistant right-sided infective endocarditis is presented. SUMMARY: A 36-year-old patient with a history of intravenous drug use was hospitalized for treatment of native tricuspid valve endocarditis resulting in persistent methicillin-resistant Staphylococcus aureus bacteremia. During the admission the patient was unsuccessfully treated with vancomycin monotherapy (final E-test minimum inhibitory concentration, 4 µg/mL). The patient's treatment was switched to daptomycin and gentamicin, with no improvement in blood culture results over 4 days. Gentamicin was discontinued, and linezolid was administered in combination with daptomycin; bacteremia was cleared after 13 days of linezolid and daptomycin combination therapy. Due to daptomycin resistance (minimum inhibitory concentration, 4 µg/mL), gentamicin was substituted for daptomycin due to the former agent's synergistic effects with linezolid. After 23 days of therapy the patient was transferred to another facility for a tricuspid valve replacement procedure, which was completed without complications. The patient was transferred in stable condition to a skilled nursing facility to continue antibiotic therapy lasting 6 weeks from the date of surgery. The patient's blood cultures remained negative. CONCLUSION: A 36-year-old woman with resistant tricuspid valve endocarditis was successfully treated with linezolid in combination with daptomycin.
Asunto(s)
Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Linezolid/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Adulto , Antibacterianos/farmacología , Daptomicina/farmacología , Farmacorresistencia Bacteriana Múltiple , Sustitución de Medicamentos , Sinergismo Farmacológico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Femenino , Gentamicinas/farmacología , Gentamicinas/uso terapéutico , Humanos , Linezolid/farmacología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Resultado del Tratamiento , Válvula Tricúspide/microbiología , Vancomicina/farmacología , Vancomicina/uso terapéuticoAsunto(s)
Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/cirugía , Corazón Auxiliar/efectos adversos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Válvula Tricúspide/cirugía , Endocarditis Bacteriana/diagnóstico , Corazón Auxiliar/tendencias , Humanos , Italia/epidemiología , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Válvula Tricúspide/microbiologíaAsunto(s)
Válvula Aórtica/microbiología , Endocarditis Bacteriana/microbiología , Agricultores , Infecciones Estreptocócicas/microbiología , Streptococcus suis/patogenicidad , Sus scrofa/microbiología , Insuficiencia de la Válvula Tricúspide/microbiología , Válvula Tricúspide/microbiología , Animales , Antibacterianos/uso terapéutico , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Bioprótesis , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/transmisión , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/cirugía , Infecciones Estreptocócicas/transmisión , Resultado del Tratamiento , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/cirugía , ZoonosisRESUMEN
Infective endocarditis is a high morbidity-mortality condition despite advancements in supportive care and medical therapy. One of the strongest risk factors is intravenous drug use, which has high prevalence in the Hawai'i population. Klebsiella pneumoniae is a rare but aggressive pathogen causing infective endocarditis. There is no strong evidence to guide management. We present a rare case of isolated tricuspid valve infective endocarditis due to Klebsiella pneumoniae in an intravenous drug user causing septic pulmonary emboli and multiple abscesses. The patient was managed with combined 6-week ceftriaxone and 2-week gentamicin together with early tricuspid valve repair.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Endocarditis Bacteriana/etiología , Femenino , Humanos , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , Persona de Mediana Edad , Abuso de Sustancias por Vía Intravenosa/microbiología , Abuso de Sustancias por Vía Intravenosa/psicología , Válvula Tricúspide/anomalías , Válvula Tricúspide/microbiologíaRESUMEN
Polyamines are small aliphatic cationic molecules synthesized via a highly regulated pathway and involved in general molecular and cellular phenomena. Both mammalian cells and microorganisms synthesize polyamines, and both sources may contribute to the presence of polyamines in the circulation. The dominant location for microorganisms within the body is the gut. Accordingly, the gut microbiota probably synthesizes most of the polyamines in the circulation in addition to those produced by the mammalian host cells. Polyamines are mandatory for cellular growth and proliferation. Established evidence suggests that the polyamine spermidine prolongs lifespan and improves cardiovascular health in animal models and humans through both local mechanisms, involving improved cardiomyocyte function, and systemic mechanisms, including increased NO bioavailability and reduced systemic inflammation. Higher levels of polyamines have been detected in non-dilated aorta of patients affected by bicuspid aortic valve congenital malformation, an aortopathy associated with an increased risk for thoracic ascending aorta aneurysm. In this review, we discuss metabolism of polyamines and their potential effects on vascular smooth muscle and endothelial cell function in vascular pathology of the thoracic ascending aorta associated with bicuspid or tricuspid aortic valve.
Asunto(s)
Diente Premolar/metabolismo , Diente Premolar/microbiología , Microbioma Gastrointestinal , Cardiopatías Congénitas/metabolismo , Cardiopatías Congénitas/microbiología , Enfermedades de las Válvulas Cardíacas/metabolismo , Enfermedades de las Válvulas Cardíacas/microbiología , Poliaminas/metabolismo , Válvula Tricúspide/metabolismo , Válvula Tricúspide/microbiología , Animales , Válvula Aórtica/metabolismo , Válvula Aórtica/microbiología , Válvula Aórtica/fisiopatología , Diente Premolar/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide , Progresión de la Enfermedad , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/fisiopatología , Enfermedades de las Válvulas Cardíacas/sangre , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Poliaminas/sangre , Poliaminas/química , Válvula Tricúspide/fisiopatologíaRESUMEN
BACKGROUND: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. CASE PRESENTATION: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. CONCLUSION: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.