Patient with native valve infective endocarditis and concomitant bacterial myopericarditis

Royston, Alexander Peter; Gosling, O

doi:10.1136/bcr-2018-224907

Cited by 4 publications

(5 citation statements)

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“…Differential diagnosis and exclusion of other potential complications are best assessed using echocardiography and cardiac MRI. [509][510][511] Pericarditis is an infrequent complication of IE. In one retrospective series of 95 patients with aortic valve IE, 19% developed pericarditis usually related to ring abscess formation.…”

Section: Myocarditis and Pericarditismentioning

confidence: 99%

ESC guidelines 2023 on the management of endocarditis

de Waha,

Desch,

Tilz

et al. 2023

Herz

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Section: Myocarditis and Pericarditismentioning

confidence: 99%

ESC guidelines 2023 on the management of endocarditis

de Waha,

Desch,

Tilz

et al. 2023

Herz

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“… Year Bacterial Gender Age (years) Clinical presentation Chest pain CRP peak (mg/L) STN Troponin ratio ECG Arrhythmias fQRS CMRI LGE EF at admission (%) EMB/Autopsy ICU Complete recovery Partial recovery Death Associated conditions Diagnosis Royston et al. 34 2018 Streptococcus sanguinis M 39 GE + – 580 ST-elevation 0 – + – 0 + 0 + 0 Endocarditis Probable Aguirre et al. 35 2015 Streptococcus A M 42 Fever, Resp + – 686 ST-elevation 0 + + 55 0 0 + 0 0 – Probable Sundbom et al.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with gastrointestinal involvement were the youngest, with an average age of 25 years 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 and always had negative blood cultures, while those with urogenital infection were the oldest, with an average age of 50 years (28.5–64.5) (p = 0.009).…”

Section: Resultsmentioning

confidence: 99%

“…The overall median LVEF at admission was 45%, 20 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 and patients with sepsis had significantly lower values (35% 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 vs 50% 39 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ; (p < 0.001)).…”

Section: Resultsmentioning

confidence: 99%

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Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis

Ferrero

Piazza

Lorini

et al. 2020

Indian Heart Journal

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We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis. Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis. Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively). In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.

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“…Учитывая отрицательные посевы (в том числе биоптатов миокарда) и отсутствие признаков эндокардита при ЭМБ, мы не можем до конца исключить вирусную природу поражения клапана, хотя спленомегалия и резкое повышение уровня прокальцитонина в сочетании с эффектом антибиотиков говорят в пользу ИЭ. Для «классического» ИЭ возможность сочетания с миокардитом (как иммунным, так и бактериальным) хорошо известна, однако на практике тяжелый миокардит с резким падением ФВ развивается редко, описания подобных случаев буквально единичны [37]. Назначения кортикостероидов рекомендуют всячески избегать, используя иные возможности (плазмаферез, иммуноглобулин внутривенно) [38].…”

Section: Discussionunclassified

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

et al. 2021

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Aim To study clinical features of myoendocarditis and its possible mechanisms, including persistence of SARS-Cov-2 in the myocardium, in the long-term period following COVID-19.Material and methods This cohort, prospective study included 15 patients aged 47.8±13.4 years (8 men) with post-COVID myocarditis. The COVID-19 diagnosis was confirmed for all patients. Median time to seeking medical care after COVID-19 was 4 [3; 7] months. The diagnosis of myocarditis was confirmed by magnetic resonance imaging (MRI) of the heart (n=10) and by endomyocardial biopsy of the right ventricle (n=6). The virus was detected in the myocardium with PCR; immunohistochemical (IHC) study with antibody to SARS-Cov-2 was performed; anticardiac antibody level was measured; and echocardiography and Holter monitoring were performed. Hemodynamically significant coronary atherosclerosis was excluded for all patients older than 40 years.Results All patients showed a clear connection between the emergence or exacerbation of cardiac symptoms and COVID-19. 11 patients did not have any signs of heart disease before COVID-19; 4 patients had previously had moderate arrhythmia or heart failure (HF) without myocarditis. Symptoms of myocarditis emerged at 1–5 months following COVID-19. MRI revealed typical late gadolinium accumulation, signs of hyperemia, and one case of edema. The level of anticardiac antibodies was increased 3-4 times in 73 % больных. Two major clinical variants of post-COVID myocarditis were observed. 1. Arrhythmic (n=6), with newly developed extrasystole or atrial fibrillation without systolic dysfunction. 2. Decompensated variant with systolic dysfunction and biventricular HF (n=9). Mean left ventricular ejection fraction was 34.1±7.8 %, and left ventricular end-diastolic dimension was 5.8±0.7 cm. In one case, myocarditis was associated with signs of IgG4‑negative aortitis. SARS-Cov-2 RNA was found in 5 of 6 biopsy samples of the myocardium. The longest duration of SARS-Cov-2 persistence in the myocardium was 9 months following COVID-19. By using antibody to the Spike antigen and nucleocapsid, SARS-Cov-2 was detected in cardiomyocytes, endothelium, and macrophages. Five patients were diagnosed with lymphocytic myocarditis; one with giant-cell myocarditis; three patients had signs of endocarditis (infectious, lymphocytic with mural thrombosis).Conclusion Subacute/chronic post-COVID myocarditis with isolated arrhythmias or systolic dysfunction is characterized by long-term (up to 9 months) persistence of SARS-Cov-2 in the myocardium in combination with a high immune activity. Endocarditis can manifest either as infectious or as nonbacterial thromboendocarditis. A possibility of using corticosteroids and anticoagulants in the treatment of post-COVID myoendocarditis should be studied.

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Patient with native valve infective endocarditis and concomitant bacterial myopericarditis

Cited by 4 publications

References 20 publications

ESC guidelines 2023 on the management of endocarditis

ESC guidelines 2023 on the management of endocarditis

Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

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