Infective endocarditis without biological inflammatory syndrome: Description of a particular entity
| Autor: | Jean-Winocq Decousser, Nicolas Mongardon, Antonio Fiore, Louis Nahory, Julien Ternacle, Raphaëlle Huguet, Vincent Fihman, Sovannarith San, Laureline Faivre, Pascal Lim, S. Gallien, Leopold Oliver, Raphaël Lepeule, Amina Moussafeur, Sophie Ribeyrolles |
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| Přispěvatelé: | Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Dynamic Microbiology - EA 7380 (DYNAMIC), École nationale vétérinaire - Alfort (ENVA)-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)-Université Paris-Est (UPE)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), École nationale vétérinaire d'Alfort (ENVA)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12) |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty [SDV]Life Sciences [q-bio] Clinical Decision-Making Heart Valve Diseases Heart failure 030204 cardiovascular system & hematology Valvular regurgitation C-reactive protein 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Endocarditis In patient cardiovascular diseases 030212 general & internal medicine Aged Retrospective Studies Inflammation Cardioembolic stroke biology business.industry Incidence Patient Selection Incidence (epidemiology) Endocarditis Bacterial General Medicine Middle Aged Prognosis Infective endocarditis medicine.disease 3. Good health Stroke biology.protein Female France Inflammation Mediators Cardiology and Cardiovascular Medicine business Biomarkers Echocardiography Transesophageal |
| Zdroj: | Archives of cardiovascular diseases Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2019, 112, pp.381-389. ⟨10.1016/j.acvd.2019.02.005⟩ |
| ISSN: | 1875-2136 1875-2128 |
| DOI: | 10.1016/j.acvd.2019.02.005 |
| Popis: | Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration.To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration.This was a retrospective analysis of cases of IE discharged from our institution between January 2009 and May 2017. The 10% lowest CRP concentration (20mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded.Of the 469 patients, 13 (2.8%; median age 68 [61-76] years) had definite (n=8) or possible (n=5) left-sided valvular IE with CRP20mg/L (median 9.3 [4.7-14.2] mg/L). The median white blood cell count was 6.3 (5.3-7.5) G/L. The main presentations were heart failure (n=7; 54%) and stroke (n=3; 23%). Transthoracic echocardiography (TTE) showed vegetations (n=5) or isolated valvular regurgitation (n=4). Overall, eight patients (62%) had severe valvular lesions on transoesophageal echocardiography (TOE), and nine patients (69%) underwent cardiac surgery. All patients survived at 1-year follow-up. Bacterial pathogens were documented in eight patients (streptococci, coagulase-negative Staphylococcus, Corynebacteriumjeikeium, HACEK group, Coxiella burnetii, Bartonella henselae) using blood cultures, serology or valve culture and/or polymerase chain reaction analysis.Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration. |
| Databáze: | OpenAIRE |
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