.: ORİJİNAL ARAŞTIRMA
Pandemi Döneminde Gözden Kaçabilen Bir Enfeksiyon Acili Enfektif Endokardit: Retrospektif Kohort Çalışması
An Infection Emergency Overlooked During the Pandemic Period Infective Endocarditis: Retrospective Chort Study
Turkiye Klinikleri J Med Sci. 2025;45(2):49-55
doi: 10.5336/medsci.2024-104731
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Enfektif endokarditler, enfeksiyon hastalıkları acillerinden olup, tedavi edilmediği takdirde mortal seyredebilir. Bu yazıda, kliniğimizde koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisi döneminde yatarak tedavi ettiğimiz enfektif endokardit olgularını retrospektif olarak irdelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Sağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniğinde enfektif endokardit tanısıyla yatarak izlenen 16 hasta dâhil edildi. Hastaların tanısı modifiye Duke kriterlerine göre konuldu. Hastaların kan kültüründen izole edilen mikroorganizmalar konvansiyonel yöntemler, Matriks Destekli Lazer Desorpsiyonu/İyonizasyon Süresi-Kütle Spektrometresi (MALDI-TOF) ve VITEK-2 otomatize sistemleri ile tanımlandı, antibiyotik duyarlılıkları VITEK-2 otomatize sistemi ile belirlendi. Hastalarda kalp kapaklarındaki tutulum (vejetasyon, apse vb.) transtorasik ekokardiyografi (EKO) ve/veya transösofagial EKO (TEE) ile değerlendirildi. Bulgular: Çalışmaya dâhil edilen enfektif endokardit tanısı konulan 16 hastanın 9'u (%56) erkek, 7'si (%44) kadındı. Hastaların yaş aralığı 47-80 arasında, ortalama yaş 62,3 idi. Hastaların %81'i doğal kapak endokarditi, %19'u yapay kapak endokarditi idi. Fizik muayenede 13 hastada (%81,25) ateş mevcuttu. Üç hastada (%18,75) enfektif endokardit tanısı ile eş zamanlı septik emboli mevcuttu. Hastaların 13'ünde transtorasik EKO'da vejatasyon saptandı, 2 hastada EKO'da bulgu yok iken TEE'de vejetasyon görüldü, 1 hastada ise sadece TEE'de vejetasyon saptandı. Tüm hastaların 10'unda mitral, 4'ünde triküspit, 2'sinde aort kapak tutulumu mevcuttu. Hastaların kan kültüründen 19 mikroorganizma izole edildi. Beş hastada kan kültüründe birden fazla etken üremesi mevcuttu. Altı (%37,5) hastada operasyon (kapak replasmanı) uygulandı. Enfektif endokardit hastalarının 5'inde (%31,3) mortalite gelişti. Sonuç: Sonuç olarak, COVID-19 pandemisinde yüksek ateş yakınması ile başvuran veya nedeni belirlenemeyen ateş nedeniyle irdelenen olgularda enfektif endokarditin de ayırıcı tanıda akılda tutulması uygun bir yaklaşım olacaktır.
Anahtar Kelimeler: COVID-19; pandemi; enfektif endokardit; tanı
Amaç: Enfektif endokarditler, enfeksiyon hastalıkları acillerinden olup, tedavi edilmediği takdirde mortal seyredebilir. Bu yazıda, kliniğimizde koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisi döneminde yatarak tedavi ettiğimiz enfektif endokardit olgularını retrospektif olarak irdelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Sağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniğinde enfektif endokardit tanısıyla yatarak izlenen 16 hasta dâhil edildi. Hastaların tanısı modifiye Duke kriterlerine göre konuldu. Hastaların kan kültüründen izole edilen mikroorganizmalar konvansiyonel yöntemler, Matriks Destekli Lazer Desorpsiyonu/İyonizasyon Süresi-Kütle Spektrometresi (MALDI-TOF) ve VITEK-2 otomatize sistemleri ile tanımlandı, antibiyotik duyarlılıkları VITEK-2 otomatize sistemi ile belirlendi. Hastalarda kalp kapaklarındaki tutulum (vejetasyon, apse vb.) transtorasik ekokardiyografi (EKO) ve/veya transösofagial EKO (TEE) ile değerlendirildi. Bulgular: Çalışmaya dâhil edilen enfektif endokardit tanısı konulan 16 hastanın 9'u (%56) erkek, 7'si (%44) kadındı. Hastaların yaş aralığı 47-80 arasında, ortalama yaş 62,3 idi. Hastaların %81'i doğal kapak endokarditi, %19'u yapay kapak endokarditi idi. Fizik muayenede 13 hastada (%81,25) ateş mevcuttu. Üç hastada (%18,75) enfektif endokardit tanısı ile eş zamanlı septik emboli mevcuttu. Hastaların 13'ünde transtorasik EKO'da vejatasyon saptandı, 2 hastada EKO'da bulgu yok iken TEE'de vejetasyon görüldü, 1 hastada ise sadece TEE'de vejetasyon saptandı. Tüm hastaların 10'unda mitral, 4'ünde triküspit, 2'sinde aort kapak tutulumu mevcuttu. Hastaların kan kültüründen 19 mikroorganizma izole edildi. Beş hastada kan kültüründe birden fazla etken üremesi mevcuttu. Altı (%37,5) hastada operasyon (kapak replasmanı) uygulandı. Enfektif endokardit hastalarının 5'inde (%31,3) mortalite gelişti. Sonuç: Sonuç olarak, COVID-19 pandemisinde yüksek ateş yakınması ile başvuran veya nedeni belirlenemeyen ateş nedeniyle irdelenen olgularda enfektif endokarditin de ayırıcı tanıda akılda tutulması uygun bir yaklaşım olacaktır.
Anahtar Kelimeler: COVID-19; pandemi; enfektif endokardit; tanı
ABSTRACT
Objective: Infective endocarditis is one of the infectious diseases emergencies, and if not treated, can be mortal. In this article, we aimed to retrospectively analyze the infective endocarditis cases that we treated in our clinic during the coronavirus disease-2019 (COVID-19) pandemic. Material and Methods: Sixteen patients who were hospitalized with the diagnosis of infective endocarditis in the Infectious Diseases and Clinical Microbiology Clinic of Health Science University, Ankara Training and Research Hospital were included in the study.The diagnosis of the patients was made according to the modified Duke criteria. Microorganisms isolated from the patients' blood cultures were identified by conventional methods, Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrophotometry (MALDI-TOF) and VITEK-2 automated systems, and the antibiotic susceptibility of the isolated bacteria was determined by the VITEK2 automated system. Involvement in the heart valves of the patients (vegetation, abscess, etc.) was evaluated by transthoracic echocardiography (ECHO) and/or transesophageal ECHO (TEE). Results: Nine (56%) of 16 patients diagnosed with infective endocarditis included in the study were male and 7 (44%) were female, respectively. The age range of the patients was between 47 and 80, with an average age were 62.3 years. Of the patients, 81% had natural valve endocarditis and 19% had prosthetic valve endocarditis. On physical examination, fever was present in 13 (81.25%) patients. Three patients (18.75%) had septic embolism concurrently with the diagnosis of infective endocarditis.Vegatations were detected on transthoracic ECHO in 13 of the patients, vegetation was observed on TEE while there was no finding on ECHO in 2 patients, and a vegatation was detected only on TEE in 1 patient. Of all patients, 10 had mitral, 4 had tricuspid, and 2 had aortic valve involvement. Nine-teen microorganism were isolated from bloood culture of patients. Blood culture showed growth of more than one agent in five patients. Operation (valve replacement) was performed in 6 (37.5%) patients. Mortality occurred in 5 (31.3%) of infective endocarditis patients. Conclusion: In conclusion, it would be an appropriate approach to keep infective endocarditis in mind in the differential diagnosis of patients who present with high fever in the COVID-19 pandemic who search for fever of unknown origin.
Keywords: COVID-19; pandemic; infective endocarditis; diagnosis
Objective: Infective endocarditis is one of the infectious diseases emergencies, and if not treated, can be mortal. In this article, we aimed to retrospectively analyze the infective endocarditis cases that we treated in our clinic during the coronavirus disease-2019 (COVID-19) pandemic. Material and Methods: Sixteen patients who were hospitalized with the diagnosis of infective endocarditis in the Infectious Diseases and Clinical Microbiology Clinic of Health Science University, Ankara Training and Research Hospital were included in the study.The diagnosis of the patients was made according to the modified Duke criteria. Microorganisms isolated from the patients' blood cultures were identified by conventional methods, Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrophotometry (MALDI-TOF) and VITEK-2 automated systems, and the antibiotic susceptibility of the isolated bacteria was determined by the VITEK2 automated system. Involvement in the heart valves of the patients (vegetation, abscess, etc.) was evaluated by transthoracic echocardiography (ECHO) and/or transesophageal ECHO (TEE). Results: Nine (56%) of 16 patients diagnosed with infective endocarditis included in the study were male and 7 (44%) were female, respectively. The age range of the patients was between 47 and 80, with an average age were 62.3 years. Of the patients, 81% had natural valve endocarditis and 19% had prosthetic valve endocarditis. On physical examination, fever was present in 13 (81.25%) patients. Three patients (18.75%) had septic embolism concurrently with the diagnosis of infective endocarditis.Vegatations were detected on transthoracic ECHO in 13 of the patients, vegetation was observed on TEE while there was no finding on ECHO in 2 patients, and a vegatation was detected only on TEE in 1 patient. Of all patients, 10 had mitral, 4 had tricuspid, and 2 had aortic valve involvement. Nine-teen microorganism were isolated from bloood culture of patients. Blood culture showed growth of more than one agent in five patients. Operation (valve replacement) was performed in 6 (37.5%) patients. Mortality occurred in 5 (31.3%) of infective endocarditis patients. Conclusion: In conclusion, it would be an appropriate approach to keep infective endocarditis in mind in the differential diagnosis of patients who present with high fever in the COVID-19 pandemic who search for fever of unknown origin.
Keywords: COVID-19; pandemic; infective endocarditis; diagnosis
REFERANSLAR:
- Şimşek-Yavuz S, Akar AR, Aydoğdu S, Berzeg-Deniz D, Demir H, Tuncay H, et al. Enfektif endokarditin tanısı, tedavisi ve önlenmesi: ulusal uzlaşı raporu. Klimik Derg. 2019;32(Suppl. 1):2-116. [Crossref]
- Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016;387(10021):882-93. [Crossref] [PubMed]
- Wang A, Gaca JG, Chu VH. Management considerations in ınfective endocarditis: a review. JAMA. 2018;320(1):72-83. [PubMed]
- Rajani R, Klein JL. Infective endocarditis: a contemporary update. Clin Med (Lond). 2020;20(1):31-5. [Crossref] [PubMed] [PMC]
- Chambers HF, Bayer AS. Native-valve ınfective endocarditis. N Engl J Med. 2020;383(6):567-76. [PubMed]
- Ramos-Martínez A, Fernández-Cruz A, Domínguez F, Forteza A, Cobo M, Sánchez-Romero I, et al. Hospital-acquired infective endocarditis during Covid-19 pandemic. Infect Prev Pract. 2020;2(3):100080. [Crossref] [PubMed] [PMC]
- George A, Alampoondi Venkataramanan SV, John KJ, Mishra AK. Infective endocarditis and COVID-19 coinfection: an updated review. Acta Biomed. 2022;93(1):e2022030. [Crossref]
- Amir M, Djaharuddin I, Sudharsono A, Ramadany S. COVID-19 concomitant with infective endocarditis: A case report and review of management. Int J Infect Dis. 2020;98:109-12. [Crossref] [PubMed] [PMC]
- Vincent LL, Otto CM. Infective endocarditis: update on epidemiology, outcomes, and management. Curr Cardiol Rep. 2018;20(10):86. [Crossref] [PubMed]
- Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, et al. Challenges in infective endocarditis. J Am Coll Cardiol. 2017;69(3):325-44. [Crossref] [PubMed]
- Hubers SA, DeSimone DC, Gersh BJ, Anavekar NS. Infective endocarditis: a contemporary review. Mayo Clin Proc. 2020;95(5):982-97. [Crossref] [PubMed]
- Vahabi A, Gül F, Garakhanova S, Sipahi H, Sipahi OR. Pooled analysis of 1270 infective endocarditis cases in Turkey. J Infect Dev Ctries. 2019;13(2):93-100. [Crossref] [PubMed]
- Çalık AN, Özlük ÖA, Karataş MB, Çanga Y, Eren S, Ayhan G, et al. Endocarditis-TR: diagnosis, treatment, and prognosis of the infective endocarditis patients admitting tertiary centres of Turkey. Turk J Med Sci. 2022;52(2):445-55. [Crossref] [PubMed] [PMC]
- Agca FV, Demircan N, Peker T, Ari H, Karaagac K, Ozluk OA, et al. Infective endocarditis: a tertiary referral centre experience from Turkey. Int J Clin Exp Med. 2015;8(8):13962-8. [PubMed] [PMC]
- Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A, et al. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. Int J Infect Dis. 2015;30:106-14. [Crossref] [PubMed]
- Erdem H, Puca E, Ruch Y, Santos L, Ghanem-Zoubi N, Argemi X, et al. Portraying infective endocarditis: results of multinational ID-IRI study. Eur J Clin Microbiol Infect Dis. 2019;38(9):1753-3. [Crossref] [PubMed]
- Bouza E, Muñoz P, Burillo A. Gram-negative endocarditis: disease presentation, diagnosis and treatment. Curr Opin Infect Dis. 2021;34(6):672-80. [Crossref] [PubMed]
- Morpeth S, Murdoch D, Cabell CH, Karchmer AW, Pappas P, Levine D, et al; International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med. 2007;147(12):829-35. [Crossref] [PubMed]
- Arnold CJ, Johnson M, Bayer AS, Bradley S, Giannitsioti E, Miró JM, et al. Candida infective endocarditis: an observational cohort study with a focus on therapy. Antimicrob Agents Chemother. 2015;59(4):2365-73. [Crossref] [PubMed] [PMC]
- Hoen B, Béguinot I, Rabaud C, Jaussaud R, Selton-Suty C, May T, et al. The Duke criteria for diagnosing infective endocarditis are specific: analysis of 100 patients with acute fever or fever of unknown origin. Clin Infect Dis. 1996;23(2):298-302. [Crossref] [PubMed]
- Saltoglu N, Tasova Y, Midikli D, Aksu HS, Sanli A, Dündar IH. Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study. J Infect. 2004;48(1):81-5. [Crossref]
- Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003;163(5):545-51. [Crossref]
.: İşlem Listesi