Trauth Janina, Matt Ulrich, Kohl Thomas A, Niemann Stefan, Herold Susanne
Department of Medicine V-Infectious Diseases, Justus-Liebig-University, Klinikstr 33, 35392 Giessen, Germany.
Molecular and Experimental Mycobacteriology, Priority Area Infections, Research Center Borstel, Borstel, Germany.
Eur Heart J Case Rep. 2023 Aug 17;7(8):ytad400. doi: 10.1093/ehjcr/ytad400. eCollection 2023 Aug.
The recently published 2023 Duke-ISCVID Criteria for Infective Endocarditis for the first time consider mycobacteria (esp. ) as 'typical' microorganisms for prosthetic valve endocarditis (major criteria). This reflects the ongoing worldwide outbreak of prosthetic valve endocarditis.
Our case series demonstrates a diagnostic pathway for mycobacterial endocarditis. Symptoms are unspecific, and standard microbiological testing does not result in identification of the causative agent (see Graphical Abstract); therefore patients require special microbiological and imaging diagnostics. One patient with early diagnosis and stringent antibiotic and surgical therapy survived. Two patients with disseminated infection at the time point of diagnosis had fatal outcomes.
The diagnostic approach in our small retrospective case series is in line with the new modified Duke criteria and underlines the diagnostic gap in the previous definitions. Outcome of prosthetic valve endocarditis is related to timely diagnosis and anti-mycobacterial as well as surgical treatment. Non-tuberculous mycobacteria should be given more attention in future endocarditis guidelines.
最近发布的2023年杜克-国际心血管感染学会感染性心内膜炎标准首次将分枝杆菌（尤其是 ）视为人工瓣膜心内膜炎的“典型”微生物（主要标准）。这反映了全球范围内人工瓣膜心内膜炎的持续爆发。
我们的病例系列展示了分枝杆菌性心内膜炎的诊断途径。症状不具有特异性，标准微生物检测无法确定病原体（见图摘要）；因此，患者需要特殊的微生物学和影像学诊断。一名早期诊断并接受严格抗生素和手术治疗的患者存活下来。两名在诊断时出现播散性感染的患者死亡。
我们这个小型回顾性病例系列中的诊断方法符合新修订的杜克标准，并突出了先前定义中的诊断差距。人工瓣膜心内膜炎的预后与及时诊断、抗分枝杆菌治疗以及手术治疗有关。未来的心内膜炎指南应更加关注非结核分枝杆菌。
