.: 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
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
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