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Mycobacterial endocarditis: a comprehensive review.

Yuan SM - Rev Bras Cir Cardiovasc (2015 Jan-Mar)

Bottom Line: This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis.Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses.With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results.

View Article: PubMed Central - PubMed

Affiliation: Teaching Hospital, Fujian Medical University, Putian, People's Republic of China.

ABSTRACT

Objective: A systematic analysis was made in view of the epidemiology, clinical features, diagnosis, treatment and main outcomes of mycobacterial endocarditis.

Methods: The data source of the present study was based on a comprehensive literature search in MEDLINE, Highwire Press and Google search engine for publications on mycobacterial endocarditis published between 2000 and 2013.

Results: The rapidly growing mycobacteria become the predominant pathogens with Mycobacterium chelonae being the most common. This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis.

Conclusion: Mycobacterial endocarditis is rare and the causative pathogens are predominantly the rapidly growing mycobacteria. Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses. Patients with deep infections may warrant a surgical operation or line withdrawal. With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results.

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A comparison of latencies between different risk factors. IDU=intravenous drug use
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f01: A comparison of latencies between different risk factors. IDU=intravenous drug use

Mentions: The latency from the presence of the predisposing risk factors to symptom onsetwas 21.9±25.9 (range, 0.067-96; median, 12) months (n=31)[7,9,11,12,14-18,20,21,23,26,27,31-33,37].There were 9 (29.0%) early onsets (latency <8 weeks), 2 (6.5%) intermediateonsets (latency was between 8 weeks and 8 months) and 20 (64.5%) late onsets(latency >8 months) (χ 2=23.9, P=0.000). Thelatency of the patients with cardiac operations was much shorter than that ofthe patients with a foreign material implant, but did not reach a statisticalsignificance (16.4±20.1 months vs. 34.8±39.0 months, P=0.136).It was incompatible with intravenous drug use patients, of which latency wasreported in only one patient, and was much shorter than that of themiscellaneity reaching a quasi-statistical difference (16.4±20.1 months vs.44±34.6 months, P=0.051) (Figure1). Bioprosthetic valve endocarditis was associated with a longerlatency than mechanical without showing a significant difference (17.5±22.5months vs. 10.8±7.1 months, P=0.569). Four patients had adelayed diagnosis for 0.81±0.24 (range, 0.5-1; median, 0.88) months(n=4)[12,13,20,26].


Mycobacterial endocarditis: a comprehensive review.

Yuan SM - Rev Bras Cir Cardiovasc (2015 Jan-Mar)

A comparison of latencies between different risk factors. IDU=intravenous drug use
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389517&req=5

f01: A comparison of latencies between different risk factors. IDU=intravenous drug use
Mentions: The latency from the presence of the predisposing risk factors to symptom onsetwas 21.9±25.9 (range, 0.067-96; median, 12) months (n=31)[7,9,11,12,14-18,20,21,23,26,27,31-33,37].There were 9 (29.0%) early onsets (latency <8 weeks), 2 (6.5%) intermediateonsets (latency was between 8 weeks and 8 months) and 20 (64.5%) late onsets(latency >8 months) (χ 2=23.9, P=0.000). Thelatency of the patients with cardiac operations was much shorter than that ofthe patients with a foreign material implant, but did not reach a statisticalsignificance (16.4±20.1 months vs. 34.8±39.0 months, P=0.136).It was incompatible with intravenous drug use patients, of which latency wasreported in only one patient, and was much shorter than that of themiscellaneity reaching a quasi-statistical difference (16.4±20.1 months vs.44±34.6 months, P=0.051) (Figure1). Bioprosthetic valve endocarditis was associated with a longerlatency than mechanical without showing a significant difference (17.5±22.5months vs. 10.8±7.1 months, P=0.569). Four patients had adelayed diagnosis for 0.81±0.24 (range, 0.5-1; median, 0.88) months(n=4)[12,13,20,26].

Bottom Line: This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis.Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses.With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results.

View Article: PubMed Central - PubMed

Affiliation: Teaching Hospital, Fujian Medical University, Putian, People's Republic of China.

ABSTRACT

Objective: A systematic analysis was made in view of the epidemiology, clinical features, diagnosis, treatment and main outcomes of mycobacterial endocarditis.

Methods: The data source of the present study was based on a comprehensive literature search in MEDLINE, Highwire Press and Google search engine for publications on mycobacterial endocarditis published between 2000 and 2013.

Results: The rapidly growing mycobacteria become the predominant pathogens with Mycobacterium chelonae being the most common. This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis.

Conclusion: Mycobacterial endocarditis is rare and the causative pathogens are predominantly the rapidly growing mycobacteria. Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses. Patients with deep infections may warrant a surgical operation or line withdrawal. With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results.

Show MeSH
Related in: MedlinePlus