Molecular diagnosis of prosthetic valve endocarditis with aorto-right atrial fistula

Takamura, Takeshi; Takao, Masaki; Onishi, Katsuya; Yamazato, Shoichiro; Nakamura, Akiko; Onoda, Koji; Wada, Hideo; Shimpo, Hideto; M, Ito

doi:10.1016/j.ijcard.2008.03.029

Cited by 11 publications

(15 citation statements)

References 6 publications

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“…1 Molecular biology techniques have recently proven to be useful for direct detection of pathogens from clinical samples, and effective PCR-based diagnostics have been developed for a wide range of microbes, including bacteria, fungi, protozoa, and viruses. 6,7 When culture results remain negative and the clinical suspicion for infection remains high, especially in patients who have received antibiotics before a sample collection, broad-range PCR and DNA sequencing can be extremely useful in specifying the infecting microbial species, and may help the final diagnosis as an infectious disease. Without PCR, we were not able to result in an early diagnosis of infectious aortitis.…”

Section: Discussionmentioning

confidence: 99%

Molecular diagnosis of nonaneurysmal infectious aortitis

Kanemitsu

Shimono

Nakamura

et al. 2011

Journal of Vascular Surgery

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We report a 79-year-old patient who presented with a fever and abdominal pain. The patient was initially thought to have a retroperitoneal fibrosis or inflammatory abdominal aortitis in a normal-sized caliber aorta. Broad-range polymerase chain reaction (PCR) and DNA sequencing revealed the presence of Enterobacter. We finally diagnosed nonaneurysmal infectious aortitis, and we performed a successful surgical resection. Establishing a diagnosis of aortic infection before formation of an aneurysm is difficult. The molecular diagnostic technique was particularly useful in specifying the microbial species and diagnosis.

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Section: Discussionmentioning

confidence: 99%

Molecular diagnosis of nonaneurysmal infectious aortitis

Kanemitsu

Shimono

Nakamura

et al. 2011

Journal of Vascular Surgery

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“…Molecular techniques combined with broad-range PCR amplification and direct sequencing have been useful tools to diagnose culture-negative cases involving pathogens that are difficult to culture or cases involving prior antibiotic treatment (2-4). Our group has applied this technique to culture-negative intravascular infection cases and also reported a case of culture-negative infective endocarditis (14). When using molecular techniques, care must be taken to consider the possibility of false positives due to contamination or transient bacteremia, especially when working with whole-blood samples (4).…”

Section: Case Reportmentioning

confidence: 99%

Mycotic Aortic Aneurysm Associated with Legionella anisa

Takao¹,

Nakajima²,

Nakamura³

et al. 2009

J Clin Microbiol

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Legionella anisa is rarely associated with human disease. Its gene was identified by broad-range PCR in whole blood and excised tissue from a patient with a culture-negative mycotic aneurysm and was considered as a possible pathogen. This case report is potentially useful for the future diagnosis of intravascular infection. CASE REPORTThe patient was a 79-year-old healthy man with a history of Y-graft replacement for an abdominal aortic aneurysm 3 years ago. Although the postoperative treatment course had been uneventful, he complained of high fever and tenderness of the right inguinal region 1 week before admission. After two sets of blood cultures were drawn, levofloxacin at 200 mg orally (p.o.) every 12 h was prescribed at the outpatient clinic 4 days before admission. However, his condition worsened and he was subsequently admitted to our hospital. Upon admission, his lungs were clear to auscultation and a vascular murmur and tenderness were observed in the right inguinal region. A chest X-ray showed no infiltrate. Laboratory data revealed a leukocyte count of 9,130/ mm 3 and an elevated C-reactive protein level of 20.1 mg/dl. A BinaxNOW Legionella pneumophila urinary antigen test was negative. Blood samples were cultured with the BacT/ Alert 3D blood culture system (bioMérieux) by using both aerobic and anaerobic media (11). Blood cultures collected at the outpatient clinic and upon admission showed negative results. We stopped levofloxacin upon admission and repeated blood cultures 2, 3, and 4 days after cessation of the antibiotic. However, the blood cultures were all negative. Enhanced computed tomography (CT) revealed a pseudoaneurysm at the anastomotic site of the artificial vessel and the right common iliac artery (Fig. 1A), and 67

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“…I have read with great interest the article entitled 'Molecular diagnosis of prosthetic valve endocarditis with aorto-right atrial fistula' by Takamura et al in the recent issue of the journal [1]. The authors presented a case with bioprosthetic aortic valve endocarditis with left to right shunting.…”

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confidence: 99%

“…Modified Duke's criteria have been used for diagnosis of IE [2]. Causative agent, however, is not always isolated from the blood cultures because of some slowly growing agents that need special environment [3], inappropriate laboratory processes including transportation and inoculation, and previous antimicrobial use [1]. Therefore appropriate antibiotics have not been used for appropriate organisms.…”

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confidence: 99%