Guío Laura, Sarriá Cristina, de las Cuevas Carmen, Gamallo Carlos, Duarte Juan
Servicio de Medicina Interna, Enfermedades Infecciosas, Hospital de La Princesa, Madrid, Spain.
Rev Esp Cardiol. 2009 Feb;62(2):167-77. doi: 10.1016/s1885-5857(09)71535-x.
To determine the characteristics of Propionibacterium acnes prosthetic valve endocarditis (PAPVE).
Prospective descriptive study of 16 consecutive cases of PAPVE.
Seven patients developed PAPVE early and 9 developed it late. In all those who developed PAPVE late, there was a history of mucocutaneous barrier manipulation. The delay in diagnosis was >3 months in 75%. The clinical presentation was asymptomatic prosthetic valve dysfunction in 31%, heart failure in 19%, coronary syndrome in 12.5%, fever in 25%, and neurological deficits in 19%. At diagnosis, 62.5% had heart failure and 44% had fever. The predominant echocardiographic finding was prosthesis dysfunction due to dehiscence of metallic aortic valves (6 out of 7) or stenosis of metallic mitral valves (4 out of 7). In 2 of the 3 biological aortic prostheses, dysfunction was due to leaflet distortion. Blood cultures and surgical specimens tested positive after a mean of 11.6 and 12.2 days, respectively. In 2 cases, the diagnosis was confirmed by PCR. The principle intraoperative finding was the presence of abundant grayish pannus. Histology demonstrated the absence of acute inflammatory features. Twelve patients received antibiotic treatment with valve replacement: 7 were cured, 4 experienced early prosthesis dehiscence and 1 relapsed. All 3 patients who were initially treated with antibiotics alone suffered relapses.
Generally, PAPVE presents as prosthetic valve dysfunction with few symptoms of infection. Prolonged incubation of cultures is essential for diagnosis. Antibiotic treatment provides clinical control but does not eradicate the infection, and valve replacement is necessary for a cure. The postoperative course can be complicated by prosthesis dehiscence.
确定痤疮丙酸杆菌人工瓣膜心内膜炎（PAPVE）的特征。
对16例连续性PAPVE病例进行前瞻性描述性研究。
7例患者早期发生PAPVE，9例患者晚期发生。在所有晚期发生PAPVE的患者中，均有黏膜皮肤屏障操作史。75%的患者诊断延迟超过3个月。临床表现为31%为无症状人工瓣膜功能障碍，19%为心力衰竭，12.5%为冠状动脉综合征，25%为发热，19%为神经功能缺损。诊断时，62.5%的患者有心力衰竭，44%的患者有发热。主要的超声心动图表现为金属主动脉瓣裂开导致的人工瓣膜功能障碍（7例中的6例）或金属二尖瓣狭窄（7例中的4例）。在3个生物主动脉人工瓣膜中的2个，功能障碍是由于瓣叶变形。血培养和手术标本分别在平均11.6天和12.2天后检测呈阳性。2例通过PCR确诊。术中主要发现是存在大量灰白色赘生物。组织学显示无急性炎症特征。12例患者接受抗生素治疗并进行瓣膜置换：7例治愈，4例早期人工瓣膜裂开，1例复发。最初仅接受抗生素治疗的3例患者均复发。
一般来说，PAPVE表现为人工瓣膜功能障碍，感染症状较少。培养物长时间孵育对诊断至关重要。抗生素治疗可提供临床控制，但不能根除感染，治愈需要进行瓣膜置换。术后病程可能因人工瓣膜裂开而复杂化。
