Givone Filippo, Peghin Maddalena, Vendramin Igor, Carletti Silvia, Tursi Vincenzo, Pasciuta Renée, Livi Ugolino, Bassetti Matteo
Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.
Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Transpl Infect Dis. 2020 Apr;22(2):e13249. doi: 10.1111/tid.13249. Epub 2020 Feb 10.
Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a "last resort" procedure. Orthotropic HT with bicaval technique was performed in a man with culture-negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.
心脏移植（HT）在感染性心内膜炎（IE）患者中很少进行，被视为一种“最后手段”的手术。一名患有血培养阴性心内膜炎的男性接受了采用双腔静脉技术的原位心脏移植。后来通过对手术切除的瓣膜组织进行16S核糖体DNA聚合酶链反应（PCR）检测出人形支原体。对文献回顾及既往结果进行了总结。对于选定的患有顽固性IE的患者，可考虑将心脏移植作为挽救性治疗。在培养无细菌生长的情况下，16S核糖体DNA PCR测序可用于鉴定切除的瓣膜组织中的病原体。支原体属极为罕见，是感染性心内膜炎（IE）难以诊断的病因。对于难治性IE患者，目前尚无关于心脏移植（HT）的推荐标准或明确标准，在这种情况下很少进行心脏移植。我们报告了一例在接受挽救性心脏移植的患者中通过16S核糖体DNA PCR诊断为人形支原体人工瓣膜心内膜炎的病例。我们在文献中回顾了其他由支原体属引起的IE病例。
