Heart Institute InCor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
J Infect. 2010 Jun;60(6):467-73. doi: 10.1016/j.jinf.2010.03.008. Epub 2010 Mar 20.
A rapid-growing mycobacteria biological prosthetic valve (BPV) endocarditis related to prosthetic manufacturing process is described in Brazil.
From 1999 to 2008, thirty-nine patients underwent BPV replacement due to culture-negative suspected endocarditis. All these cases had histological sections stained by Ziehl-Neelsen method. Clinical and microbiological data were reviewed in all acid-fast bacilli (AFB) positive cases. The 16S-23S internal transcribed sequence (ITS) was amplified using DNA extracted from paraffin-embedded samples, digested with restrictions enzymes and/or sequenced.
Eighteen AFB positive BPV (18/39)(46%) were implanted in 13 patients and were from the same manufacturer. Four of them were implanted in other hospitals. Thirteen BPV were histologically proven endocarditis and five showed a colonization pattern. The examination of six non-implanted "sterile" BPV from this manufacturer resulted in 5 AFB positive. Mycobacterium chelonae was the AFB identified by ITS restriction analysis and sequencing.
Rapid-growing mycobacteria infections must be suspected and Ziehl-Neelsen stain always performed on histology of either early or late BPV endocarditis, particularly when blood cultures are negative.
在巴西，有一起与人工生物瓣膜制造工艺相关的快速生长分枝杆菌性人工生物瓣膜（BPV）心内膜炎病例报告。
1999 年至 2008 年期间，由于培养阴性疑似心内膜炎，39 名患者接受了 BPV 置换。所有这些病例均进行了 Ziehl-Neelsen 法染色的组织学切片。对所有抗酸杆菌（AFB）阳性病例均进行了临床和微生物学数据回顾。从石蜡包埋样本中提取 DNA，使用 16S-23S 内部转录间隔区（ITS）扩增，然后用限制酶消化和/或测序。
18 例 AFB 阳性 BPV（18/39）（46%）植入 13 名患者体内，均来自同一家制造商。其中 4 例植入其他医院。13 例 BPV 经组织学证实为心内膜炎，5 例显示为定植模式。对该制造商的 6 个未植入的“无菌”BPV 进行检查，发现 5 例 AFB 阳性。通过 ITS 限制分析和测序鉴定出 AFB 为龟分枝杆菌。
当血培养为阴性时，应怀疑发生快速生长分枝杆菌感染，并对早期或晚期 BPV 心内膜炎的组织学进行 Ziehl-Neelsen 染色。
