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自体瓣膜心内膜炎:病例报告与文献综述

Native-Valve Endocarditis: Case Report and Literature Review.

作者信息

Caroselli Claudio, Suardi Lorenzo Roberto, Besola Laura, Fiocco Alessandro, Colli Andrea, Falcone Marco

机构信息

Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy.

Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy.

出版信息

Antibiotics (Basel). 2023 Jul 14;12(7):1190. doi: 10.3390/antibiotics12071190.

Abstract

endocarditis represents the second etiological cause of prosthetic endocarditis following spp. On the other hand, native-valve endocarditis due to are anecdotally reported with increasing numbers in the last decade due to new diagnostic technologies such as (PCR) on samples like valve tissue or entire blood. We performed a review of the literature presenting one case report observed at Pisa University Hospital. Seventy-four case reports have been included in a period between 1950-2022. Immunocompromised status (patients with solid tumor/oncohematological cancer or transplanted patients) was confirmed to be the main risk factor for this rare opportunistic infection with a high rate of metastatic infection (above all, central nervous system) and mortality. Diagnosis relies on serum galactomannan and culture with PCR on valve tissue or whole blood. Cardiac surgery was revealed to be a life-saving priority as well as appropriate antifungal therapy including b-liposomal amphotericin or new triazoles (isavuconazole). The endocarditis team, facing negative blood culture endocarditis affecting an immunocompromised patient, should investigate this difficult-to-treat pathogen.

摘要

在 菌种之后,心内膜炎是人工心脏瓣膜心内膜炎的第二大病因。另一方面,由于诸如对瓣膜组织或全血等样本进行 (聚合酶链反应)等新诊断技术,过去十年中因 导致的天然瓣膜心内膜炎的报道数量呈轶事性增加。我们对文献进行了综述,并呈现了在比萨大学医院观察到的一例病例报告。1950年至2022年期间共纳入了74例病例报告。免疫功能低下状态(实体瘤/肿瘤血液学癌症患者或移植患者)被证实是这种罕见的机会性感染的主要危险因素,转移性感染(尤其是中枢神经系统)和死亡率很高。诊断依赖于血清半乳甘露聚糖以及对瓣膜组织或全血进行培养并结合PCR。心脏手术被证明是挽救生命的首要措施,同时适当的抗真菌治疗包括β-脂质体两性霉素或新型三唑类药物(艾沙康唑)。面对影响免疫功能低下患者的血培养阴性的心内膜炎,心内膜炎治疗团队应调查这种难以治疗的病原体。

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