Disseminated Mycobacterium chimaera infection associated with heater–cooler units after aortic valve surgery without endocarditis

Asadi, Tannaz; Mullin, Katherine; Roselli, Eric E.; Johnston, Douglas R.; Tan, Carmela D.; Rodríguez, E. René; Gordon, Steven M.

doi:10.1016/j.jtcvs.2017.12.049

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…These patients had systemic manifestations due to the widespread dissemination of MAC. 11,12 Two prior cases of a monomicrobial MAC-related aortic infection were found on review. 13,14 A woman with AIDS (CD4 of 50) was diagnosed with a mycotic aneurysm of the infrarenal abdominal aorta after presenting with abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Aortic Graft Infection With Mycobacterium Avium Complex

Shaikh

Bennett

Kirkwood

2019

Vasc Endovascular Surg

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Aortic graft infections are uncommon complications after endovascular aortic surgery. In the majority of cases, gram-positive and then gram-negative organisms are the causative agents leading to this condition. Atypical organisms are traditionally not responsible for graft infection unless the patient is immunocompromised. We are reporting a case of culture-confirmed mycobacterium avium complex infection of an aortic graft in a well-controlled patient with HIV who had an undetected viral load and a CD4 count of 324 while on highly active antiretroviral therapy.

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Section: Discussionmentioning

confidence: 99%

Aortic Graft Infection With Mycobacterium Avium Complex

Shaikh

Bennett

Kirkwood

2019

Vasc Endovascular Surg

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“…However, there is growing thought that early surgical discussion with view to removal of infected prosthetic material may be essential for successful treatment of the underlying infection. 12 …”

Section: Discussionmentioning

confidence: 99%

The utility of 18F-fluorodeoxyglucose positron emission tomography with computed tomography in Mycobacterium chimaera endocarditis: a case series

Dafaalla

Weight

Cajic

et al. 2019

European Heart Journal - Case Reports

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Background Infective endocarditis secondary to Mycobacterium chimaera can present with classical constitutional symptoms of infective endocarditis but can be blood culture negative and without vegetations on transthoracic or transoesophageal echocardiogram. Patients with prosthetic valves are at particularly high risk. Case summary We present two patients who were diagnosed with infective endocarditis secondary to M. chimaera infection. They presented similarly with pyrexia of unknown origin and night sweats. Both patients had previously undergone aortic valve replacement; one with a tissue valve and the other with a metallic valve. New cardiac murmurs were evident on auscultation, but clinical examination showed no peripheral stigmata of endocarditis. Transoesophageal echo and transthoracic echo were both unremarkable, as were serial blood cultures. FDG PET CT scan was the key investigation, which showed increased uptake in the spleen beside other areas. Histopathology and mycobacterial cultures confirmed the diagnosis of M. chimaera infection in both cases. The first patient completed medical therapy and is now fit and well. However, the second patient unfortunately developed disseminated infection causing death. Discussion The management of M. chimaera infective endocarditis is challenging, often with delayed diagnosis and poor outcomes. In the context of negative blood cultures and inconclusive echocardiograms where there remains a high index of suspicion for endocarditis, FDG PET CT scanning can be a crucial diagnostic importance and should be considered early in patients with prosthetic valves.

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“…The diagnosis of cardiac M. chimaera infection can be difficult as initial symptoms may be non-specific, subtle and appear months to years after surgery [7,8,14,15]. Extrathoracic symptoms may precede cardiac or vascular manifestations [7,10,48] and signs of cardiac infection may be absent and detected only at surgery or post-mortem examination [3,10,49]. Symptom development occurs, on average, 15e17 months post-surgery, but the incubation period can range from 6 weeks to more than 5 years [9,12,50].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Due, in part, to the long incubation period, clinician suspicion of disseminated M. chimaera infection is often low at initial presentation [13]. Cardiopulmonary bypass surgery involving a 3T-HCD and one or more of the following: Prosthetic material used for cardiac valve or aortic repair [7,21] a Mechanical circulatory support device implantation [19] Implant of palliative shunts, conduits or other prostheses for congenital heart disease (CHD) [7,20,49] Coronary artery bypass grafting [9,30] b Heart transplantation [13] IIa C a Aortic surgery is reported to have the highest risk [14].…”

Section: Clinical Featuresmentioning

confidence: 99%