Malassezia Restricta: An Underdiagnosed Causative Agent of Blood Culture-Negative Infective Endocarditis

2021 ◽  
Author(s):  
Linda Houhamdi-Hammou ◽  
Yvonne Benito ◽  
André Boibieux ◽  
Damien Dupont ◽  
François Delahaye ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Causative Agent ◽  
Severe Disease ◽  
Tertiary Hospital ◽  
Molecular Technique ◽  
Microbial Identification ◽  
Fungal Identification ◽  
Indirect Immunofluorescent Assay ◽  
Microbial Dna ◽  
Malassezia Restricta

Abstract BACKGROUND Infective endocarditis (IE) is a severe disease requiring microbial identification to successfully adapt its treatment. Nowadays, identification of its etiological microorganism remains unresolved in 5.2% of cases. We aimed to improve IE diagnosis using an ultra-sensitive molecular technique on cardiac samples in microbiologically non-documented (culure and conventional PCR) IE (NDIE) cases. METHODS Cardiac samples explanted in a tertiary hospital in Lyon, France, from patients with definite-IE over a five-year period were retrospectively analyzed. NDIE was defined as Duke definite-IE associated with negative explorations including cardiac samples culture, bacterial amplification, and serologies. Ultra-sensitive molecular diagnosis was achieved using the Universal Microbe Detection kit (Molzym®). Fungal identification was confirmed using 26S-rDNA and Internal Transcribed Spacer amplifications. Fungal infection was confirmed using Grocott-Gromori staining and auto-immunohistochemistry on cardiac samples, and mannan serologies. RESULTS Among 88 included patients, microbial DNA was detected in all 16 NDIE cases. Bacterial taxa typical of IE etiologies were detected in 13/16 cases, and Malassezia restricta in the three other cases. In these three cases, histological examination confirmed the presence of fungi pathognomonic of Malassezia that reacted with patient sera in an auto-immunohistochemistry assay and cross-reacted with Candida albicans in an indirect immunofluorescent assay. CONCLUSIONS M. restricta appears to be an underestimated causative agent of NDIE. Importantly, serological cross-reaction of M. restricta with C. albicans may lead to its misdiagnosis. This is of a major concern since M. restricta is intrinsically resistant to echinocandins; the reference treatment for Candida-fungal IE.

scholarly journals CSMD: a computational subtraction-based microbiome discovery pipeline for species-level characterization of clinical metagenomic samples

2019 ◽  
Author(s):  
Yu Liu ◽  
Paul W Bible ◽  
Bin Zou ◽  
Qiaoxing Liang ◽  
Cong Dong ◽  
...  
Keyword(s):  
Species Level ◽  
Supplementary Information ◽  
Clinical Samples ◽  
Plasma Dna ◽  
Bioinformatics Pipeline ◽  
Microbial Identification ◽  
Reference Databases ◽  
Microbial Dna ◽  
Higher Sensitivity

Abstract Motivation Microbiome analyses of clinical samples with low microbial biomass are challenging because of the very small quantities of microbial DNA relative to the human host, ubiquitous contaminating DNA in sequencing experiments and the large and rapidly growing microbial reference databases. Results We present computational subtraction-based microbiome discovery (CSMD), a bioinformatics pipeline specifically developed to generate accurate species-level microbiome profiles for clinical samples with low microbial loads. CSMD applies strategies for the maximal elimination of host sequences with minimal loss of microbial signal and effectively detects microorganisms present in the sample with minimal false positives using a stepwise convergent solution. CSMD was benchmarked in a comparative evaluation with other classic tools on previously published well-characterized datasets. It showed higher sensitivity and specificity in host sequence removal and higher specificity in microbial identification, which led to more accurate abundance estimation. All these features are integrated into a free and easy-to-use tool. Additionally, CSMD applied to cell-free plasma DNA showed that microbial diversity within these samples is substantially broader than previously believed. Availability and implementation CSMD is freely available at https://github.com/liuyu8721/csmd. Supplementary information Supplementary data are available at Bioinformatics online.

scholarly journals Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Mohamed Sunil ◽  
Huynh Quoc Hieu ◽  
Ramesh Singh Arjan Singh ◽  
Sasheela Ponnampalavanar ◽  
Kelvin S. W. Siew ◽  
...  
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Major Complication ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Medical Progress ◽  
Streptococcus Group ◽  
Rheumatic Heart

Abstract Background Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear. Aim To examine the epidemiological trends of infective endocarditis in a developing nation. Methods Single-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period. Results The analysis included 182 patients (n = 153 Duke’s definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%). Conclusion Staphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.

scholarly journals 504 Infective Endocarditis at a Tertiary Hospital in Adelaide, Australia

2020 ◽  
Vol 29 ◽  
pp. S264
Author(s):  
L. Murray ◽  
A. Mugwagwa ◽  
M. Horsfall ◽  
P. Tam ◽  
J. Teh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Hospital

scholarly journals Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

2019 ◽  
Author(s):  
Zhenzhu Wu ◽  
Yi Chen ◽  
Tingting Xiao ◽  
Tianshui Niu ◽  
Qingyis Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Tertiary Hospital ◽  
The Past ◽  
Increasing Trend ◽  
One Year

Abstract Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

scholarly journals Adolescents Hospitalized with SARS-CoV-2: Analysis of Clinical Profile and Risk Factors for Severe Disease over a two-year period

2022 ◽  
Author(s):  
Tamoghna Ghosh ◽  
Tejas M Suri ◽  
Kana Ram Jat ◽  
Aditya Kumar Gupta ◽  
Sushma Bhatnagar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severe Disease ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
North India ◽  
Mild Disease ◽  
Reactive Protein ◽  
Northern India ◽  
Severity Grading ◽  
Second Wave

Introduction: There is a lack of studies in adolescents with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in adolescents hospitalized with COVID-19. Methods: A retrospective analysis of a prospectively admitted cohort of COVID-19 patients was performed at a tertiary hospital in north India. Adolescents aged 12 to 18 years who were hospitalized during the first wave (March 2020 to December 2020) and the second wave (March 2021 to June 2021) of the pandemic were included. Data on the demographic details, clinical presentation, laboratory parameters, disease severity at admission, treatments received, and in-hospital outcomes were retrieved and logistic regression was used to identify the risk factors for occurrence of moderate or severe disease. Results: The study included 197 adolescents with median (IQR) age 15 (13-17) years, of whom 117 (59.4%) were male. Among these, 170 (86.3%) were admitted during the 1st wave. Underlying comorbidities were present in 9 (4.6%) patients. At the time of hospital admission, 60 (30.9%) patients were asymptomatic. In the severity grading, 148 (84.6%) had mild, 16 (9.1%) had moderate, and 11 (6.3%) had severe disease. Fever (14.9%) and cough (14.9%) were the most commonly encountered symptoms. The median (IQR) duration of hospital stay was 10 (8-13) days and 6 (3.1%) patients died in hospital. The odds of moderate to severe disease were 3.8 for second wave, 1.9 for fever and 1.1 for raised C reactive protein (CRP). Conclusion: In our single-center study from northern India, adolescents admitted with COVID-19 had predominantly asymptomatic or mild disease. Admission during the second wave of COVID-19 pandemic, presence of fever and raised CRP were risk factors for moderate or severe disease.

scholarly journals 694. Prediction Tool for Infective Endocarditis in Beta-hemolytic Streptococcal Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S448-S449
Author(s):  
Ryo Hasegawa ◽  
Takahiro Matsuo ◽  
Osamu Takahashi ◽  
Nobuyoshi Mori
Keyword(s):  
Infective Endocarditis ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Tertiary Hospital ◽  
Predictive Score ◽  
Characteristic Analysis ◽  
Group B Streptococci ◽  
Reactive Protein ◽  
Multivariable Analyses ◽  
Group B

Abstract Background Although beta-hemolytic streptococci (BHS) is a rare causative pathogen of infective endocarditis (IE), IE is a serious condition and it is important to predict IE in BHS bacteremia (BHS-IE). The purpose of this study was to develop a predictive score for BHS-IE. Methods We conducted a retrospective study comparing the clinical features of BHS-IE and BHS-non infective endocarditis (BHS-nIE) in adult patients with BHS bacteremia at a 520-bed tertiary hospital in Tokyo, Japan from 2004 to 2020. IE was diagnosed according to modified Duke's criteria, and both “Definite” and “Possible” were included. Univariate and multivariable analyses were conducted using logistic regression. Results Among 250 patients with BHS bacteremia, 47 (19%) were diagnosed with BHS-IE. The median (IQR) patient age was 71 (59, 84) years and 121 (68%) were male. The proportions of A, B, C/G groups were 14%, 38.4%, and 47.6%, respectively. Five predictors, either independently associated with BHS-IE or clinically relevant, were used to develop the prediction score: C-reactive protein ≥ 10 mg/dl (2 points); Group B Streptococci (1 point); Auscultation of heart murmur (1 point); Platelet count &lt; 150 /µl (1 point); and Hypotension (systolic blood pressure &lt; 90 mmHg or on vasopressor) (1 point). In a receiver operating characteristic analysis, the area under the curve was 0.74 (95% confidence interval [CI]: 0.66 - 0.82). The cut-point was 2. A score ≥2 had a sensitivity of 87% (95%CI: 0.743 - 0.952), a specificity of 37% (95%CI: 0.308 - 0.445), a positive predictive value of 24%, and a negative predictive value of 93%, respectively. Conclusion We developed the score to help clinicians rule out IE in BHS bacteremia. Further research is warranted for validation. Disclosures All Authors: No reported disclosures

scholarly journals The clinical features and prognosis of infective endocarditis in the elderly from 2007-2016 in a tertiary hospital in China

2019 ◽  
Author(s):  
Zhenzhu Wu ◽  
Yi Chen ◽  
Tingting Xiao ◽  
Tianshui Niu ◽  
Qingyi Shi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Renal Insufficiency ◽  
Hospital Mortality ◽  
Older Patients ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Old Patients ◽  
Younger Patients ◽  
One Year

Abstract Background Infective endocarditis (IE) is a serious disease, with a worse prognosis in the elderly. Aims To explore the clinical features and prognosis of old patients with IE in a tertiary hospital. Methods A retrospective cohort study was conducted. A total of 407 patients diagnosed as IE were divided into two groups: 348 patients under 65 years old and 59 patients over 65 years old. Results For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as in younger patients. Comorbidities like hypertension (P＜0.001) and diabetes (P=0.023) were more common in older patients. Complications like renal insufficiency (P=0.027) and arrhythmia (P＜0.001) were also more common in older patients. The old patients had a lower operation rate (40.7% vs 60.6%, P=0.004) and higher in-hospital mortality (20.3% vs 8.9%, P=0.008) compared with the younger patients. Pitt score ≥4 (P=0.043, OR=28.0, 95% CI 1.1-700.4) and renal insufficiency (P=0.011, OR=34.2, 95% CI 2.2-521.2) were independent risk factors of in-hospital mortality for older patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 1.722, 95% CI 0.563-5.365, P = 0.005).The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P=0.007). Conclusions IE in older patients present with more comorbidities and complications as well as a higher mortality than younger patients. Surgery were underused in old patients and old patients with surgical treatment had better long-term prognosis.

Sign in / Sign up

Export Citation Format

Share Document