García-Álvarez Lara, Sanz María Mercedes, Marín Mercedes, Fariñas MCarmen, Montejo Miguel, Goikoetxea Josune, Rodríguez García Raquel, de Alarcón Arístides, Almela Manuel, Fernández-Hidalgo Núria, Alonso Socas María Del Mar, Goenaga Miguel Ángel, Navas Enrique, Vicioso Luis, Oteo José Antonio
aDepartamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR) bDepartamento de Enfermedades Infecciosas, Hospital San Pedro, Logroño cServicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid dServicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander eUnidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Universidad del País Vasco fUnidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao gServicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo hUnidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla iServicio de Microbiología y Parasitología, Hospital Clinic de Barcelona, Barcelona jServicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona kServicio de Enfermedades Infecciosas, Hospital Universitario de Canarias, Tenerife lServicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián mServicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid nServicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Medicine (Baltimore). 2016 Jun;95(26):e4058. doi: 10.1097/MD.0000000000004058.
Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España.From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3.5% of these had T. whipplei endocarditis. This condition was more frequent in men. The average age was 60.3 years. Previous cardiac condition was present in 35.3% of the cases. The main clinical manifestation was cardiac failure (76.5%) while fever was only present in the 35.3%. Ecocardiography showed vegetations in 64.7% of patients. Surgery was performed in all but 1 cases and it allowed the diagnosis when molecular assays were performed. A broad range rRNA 16S polymerase chain reaction was used for first instance in all laboratories and different specific targets for T. whipplei were employed for confirmation. A concomitant Whipple disease was diagnosed in 11.9% of patients. All patients received specific antimicrobial treatment for at least 1 year, with no relapse and complete recovery.T. whipplei endocarditis is an uncommon condition with an atypical presentation that must be considered in the diagnosis of BCNE. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given.
惠普尔嗜组织菌心内膜炎是一种罕见疾病，仅有少数系列报道，文献中报告的病例不足90例。本研究的目的是分析我国从西班牙心内膜炎协作组-西班牙感染性心内膜炎治疗支持小组的25家西班牙医院的多中心队列中招募的17例惠普尔嗜组织菌心内膜炎患者的流行病学、临床和结局特征。在该队列纳入的3165例病例中，14.2%被诊断为血培养阴性的心内膜炎（BCNE），其中3.5%为惠普尔嗜组织菌心内膜炎。这种情况在男性中更为常见。平均年龄为60.3岁。35.3%的病例有既往心脏疾病。主要临床表现为心力衰竭（76.5%），而发热仅出现在35.3%的病例中。超声心动图显示64.7%的患者有赘生物。除1例患者外，所有患者均接受了手术，手术在进行分子检测时有助于确诊。所有实验室首先使用广泛的16S rRNA聚合酶链反应，然后采用不同的惠普尔嗜组织菌特异性靶点进行确认。11.9%的患者同时被诊断为惠普尔病。所有患者均接受了至少1年的特异性抗菌治疗，无复发且完全康复。惠普尔嗜组织菌心内膜炎是一种罕见疾病，表现不典型，在BCNE的诊断中必须予以考虑。给予适当的手术治疗和特异性抗菌治疗时，预后非常好。
