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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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Distribution of infection sites
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f02: Distribution of infection sites

Mentions: The infection sites could be divided into 5 types according the location andnumber of the mycobacterial infections: single intracardiac infection in 38(76%), two intracardiac infections in 9 (18%), and triple valve infections,single intracardiac + single extracardiac infections, and double intracardiac +single extracardiac infections in 1 (2%) patient, each (χ 2=128.5,P=0.000). Including extracardiac infections associated withthe endocarditis, totally 64 sites were affected with a mean of 1.28±0.54(range, 1-3; median, 1) infection sites per patient. There were 1.24±0.48infection sites in the non-tuberculous and 1.75±0.96 infection sites in thetuberculous endocarditis patients (P=0.067). Native aortic,mitral and tricuspid valves were the most commonly affected sites ofmycobacterial endocarditis, representing 29.7%, 26.6% and 10.9%, respectively(Figure 2). No difference was found inthe prevalence of infection sites between non-tuberculous and tuberculousmycobacterial endocarditis (Table 2), orin the strain distributions between aortic and mitral valves (Table 3).


Mycobacterial endocarditis: a comprehensive review.

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

Distribution of infection sites
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f02: Distribution of infection sites
Mentions: The infection sites could be divided into 5 types according the location andnumber of the mycobacterial infections: single intracardiac infection in 38(76%), two intracardiac infections in 9 (18%), and triple valve infections,single intracardiac + single extracardiac infections, and double intracardiac +single extracardiac infections in 1 (2%) patient, each (χ 2=128.5,P=0.000). Including extracardiac infections associated withthe endocarditis, totally 64 sites were affected with a mean of 1.28±0.54(range, 1-3; median, 1) infection sites per patient. There were 1.24±0.48infection sites in the non-tuberculous and 1.75±0.96 infection sites in thetuberculous endocarditis patients (P=0.067). Native aortic,mitral and tricuspid valves were the most commonly affected sites ofmycobacterial endocarditis, representing 29.7%, 26.6% and 10.9%, respectively(Figure 2). No difference was found inthe prevalence of infection sites between non-tuberculous and tuberculousmycobacterial endocarditis (Table 2), orin the strain distributions between aortic and mitral valves (Table 3).

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