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Florence Fenollar - One of the best experts on this subject based on the ideXlab platform.
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a serum protein signature with high diagnostic value in bacterial Endocarditis results from a study based on surface enhanced laser desorption ionization time of flight mass spectrometry
The Journal of Infectious Diseases, 2006Co-Authors: Florence Fenollar, Gilbert Habib, Anthony Goncalves, Benjamin Esterni, Said Azza, Jeanpaul Borg, Didier RaoultAbstract:Background. Bacterial Endocarditis is a serious disease. Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) based on serum protein profiling is a powerful approach that can generate biomarkers with diagnostic value. Methods. To identify a protein signature associated with bacterial Endocarditis, we retrospectively performed SELDI-TOF MS profiling of serum samples from 88 patients hospitalized because of clinical suspicion of Endocarditis. The diagnosis was confirmed by conventional criteria for 34 patients (Endocarditis positive) and was excluded for 54 patients (Endocarditis negative). Serum samples were incubated with cation-exchange ProteinChip arrays. The protein profiles generated were subjected to biostatistical processing. Results. Fifty-nine samples (23 Endocarditis positive and 36 Endocarditis negative) were randomly selected for a learning set, with the 29 remaining samples (11 Endocarditis positive and 18 Endocarditis negative) serving as an independent testing (validation) set. Sixty-six protein peaks were differentially expressed between the Endocarditis-positive and the Endocarditis-negative patients. By combining partial least squares and logistic regression methods, we built a serum protein model that perfectly discriminated between Endocarditis-positive and Endocarditis-negative patients. Importantly, when this model was tested on the independent testing set, a correct prediction rate of nearly 90% was demonstrated. Overall, sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 98%, 96%, and 96%, respectively. Conclusions. SELDI-TOF MS profiling revealed a serum signature with high diagnostic potential for Endocarditis.
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Bacterial zoonoses and infective Endocarditis, Algeria
Emerging Infectious Diseases, 2005Co-Authors: Akila Benslimani, Florence FenollarAbstract:Blood culture-negative Endocarditis is common in Algeria. We describe the etiology of infective Endocarditis in this country. Samples from 110 cases in 108 patients were collected in Algiers. Blood cultures were performed in Algeria. Serologic and molecular analysis of valves was performed in France. Infective Endocarditis was classified as definite in 77 cases and possible in 33. Causative agents were detected by blood cultures in 48 cases. All 62 blood culture-negative Endocarditis cases were tested by serologic or molecular methods or both. Of these, 34 tested negative and 28 had an etiologic agent identified. A total of 18 infective Endocarditis cases were caused by zoonotic and arthropodborne bacteria, including Bartonella quintana (14 cases), Brucella melitensis (2 cases), and Coxiella burnetii (2 cases). Our data underline the high prevalence of infective Endocarditis caused by Bartonella quintana in northern Africa and the role of serologic and molecular tools for the diagnosis of blood culture-negative Endocarditis.
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whipple s Endocarditis review of the literature and comparisons with q fever bartonella infection and blood culture positive Endocarditis
Clinical Infectious Diseases, 2001Co-Authors: Florence Fenollar, Hubert Lepidi, Didier RaoultAbstract:Whipple's disease is a systemic infection sometimes associated with cardiac manifestations. Recently, there has been an increase in the number of reported cases of Whipple's Endocarditis. The purpose of our study was to describe this entity. Data from 35 well-described cases of Whipple's Endocarditis were collected and compared with those of blood culture-positive Endocarditis, Q fever Endocarditis, and Bartonella Endocarditis. Some patients with generalized Whipple's disease presented with cardiac involvement, among other symptoms. Others presented with a nonspecific, blood culture-negative Endocarditis with no associated symptoms. In comparison with cases of Endocarditis due to other causes, congestive heart failure, fever, and previous valvular disease were less frequently observed in the cases of Whipple's Endocarditis. Without examination of the excised valves, the diagnosis of infective Endocarditis could not have been confirmed in most cases. Treatment is not well established. Whipple's Endocarditis is a specific entity involving minor inflammatory reactions and negative blood cultures, and its incidence is probably underestimated.
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risks factors and prevention of q fever Endocarditis
Clinical Infectious Diseases, 2001Co-Authors: Florence Fenollar, Gilbert Habib, Patrizia M Carrieri, Pierre-edouard Fournier, Thierry MessanaAbstract:Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic Endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985-2000 was conducted. Twelve patients with acute Q fever who developed Endocarditis and 102 patients with Q fever Endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease (P< 10 7 ), especially a prosthetic valve (P =.01), were encountered more often among patients with Endocarditis. Among patients with valvular defects, we estimate the risk of developing Endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of Endocarditis than doxycycline alone (P = .009). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing Endocarditis.
Gilbert Habib - One of the best experts on this subject based on the ideXlab platform.
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a serum protein signature with high diagnostic value in bacterial Endocarditis results from a study based on surface enhanced laser desorption ionization time of flight mass spectrometry
The Journal of Infectious Diseases, 2006Co-Authors: Florence Fenollar, Gilbert Habib, Anthony Goncalves, Benjamin Esterni, Said Azza, Jeanpaul Borg, Didier RaoultAbstract:Background. Bacterial Endocarditis is a serious disease. Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) based on serum protein profiling is a powerful approach that can generate biomarkers with diagnostic value. Methods. To identify a protein signature associated with bacterial Endocarditis, we retrospectively performed SELDI-TOF MS profiling of serum samples from 88 patients hospitalized because of clinical suspicion of Endocarditis. The diagnosis was confirmed by conventional criteria for 34 patients (Endocarditis positive) and was excluded for 54 patients (Endocarditis negative). Serum samples were incubated with cation-exchange ProteinChip arrays. The protein profiles generated were subjected to biostatistical processing. Results. Fifty-nine samples (23 Endocarditis positive and 36 Endocarditis negative) were randomly selected for a learning set, with the 29 remaining samples (11 Endocarditis positive and 18 Endocarditis negative) serving as an independent testing (validation) set. Sixty-six protein peaks were differentially expressed between the Endocarditis-positive and the Endocarditis-negative patients. By combining partial least squares and logistic regression methods, we built a serum protein model that perfectly discriminated between Endocarditis-positive and Endocarditis-negative patients. Importantly, when this model was tested on the independent testing set, a correct prediction rate of nearly 90% was demonstrated. Overall, sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 98%, 96%, and 96%, respectively. Conclusions. SELDI-TOF MS profiling revealed a serum signature with high diagnostic potential for Endocarditis.
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diagnosis of infectious Endocarditis in patients undergoing valve surgery
The American Journal of Medicine, 2005Co-Authors: Gilbert Greub, Gilbert Habib, Jean Paul Casalta, Pierre-edouard Fournier, Hubert Lepidi, Clarisse Rovery, Frederic Collard, Didier RaoultAbstract:Purpose Histologic examination of valve samples is considered as the gold standard for the diagnosis of infectious Endocarditis. Molecular tools are also very promising for patients with negative-culture Endocarditis. Thus, we studied the contribution of valvular histology, culture, and 16S rRNA PCR amplification plus sequencing to the diagnosis of infectious Endocarditis in patients undergoing valve surgery. Subjects and methods We performed culture, histological examination, and broad-range PCR amplification plus sequencing on valve samples taken from 127 patients with infectious Endocarditis and from 118 patients without Endocarditis. The sensitivity and specificity of these tests for the diagnosis of Endocarditis in patients undergoing valve surgery were studied. Results The sensitivity of PCR was of 61% (64/105) whereas that of histological examination was of 63% (62/98) and that of valve culture was of only 13% (14/105). All 68 positive PCR results considered reliable according to an interpretation scheme were from patients with infectious Endocarditis, resulting in a 100% (118/118) specificity of the interpreted molecular approach. The specificity of histology was also of 100% (118/118) when using stringent criteria (ie, presence of vegetation, microorganisms, and/or valvular inflammation with mainly polymorphonuclear cells). PCR identified an etiological agent in 38% (5/13) of definite blood culture-negative infectious Endocarditis. Conclusion We show that valvular histology with stringent criteria is the gold standard for the diagnosis of infectious Endocarditis. Broad-range amplification of 16S rRNA gene is indicated for infectious Endocarditis of unknown etiology, whereas valve culture is of limited sensitivity.
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comparison of clinical and echocardiographic characteristics of streptococcus bovis Endocarditis with that caused by other pathogens
American Journal of Cardiology, 2001Co-Authors: Valeria Pergola, Gilbert Habib, Jean Paul Casalta, Giovanni Di Salvo, Jeanfrancois Avierinos, Emmanuel Philip, Jeanmarie Vailloud, Franck Thuny, Pierre Ambrosi, Marc LambertAbstract:The aim of our study was to compare the clinical, echographic, and prognostic features of Streptococcus bovis (S. bovis) Endocarditis with those caused by other streptococci and pathogens in a large sample of patients with definite Endocarditis by Duke criteria, using transesophageal echocardiography. Two hundred six patients (149 men, mean age 57 ± 15 years) with a diagnosis of infective Endocarditis formed the study population. All patients underwent multiplane transesophageal echocardiography and blood cultures. Cerebral, thoracoabdominal computed tomographic scan was performed in almost all patients (95%). All patients with S. bovis Endocarditis underwent colonoscopy. Incidence of S. bovis Endocarditis in our sample was 19%. Patients with S. bovis Endocarditis were older than other groups. Multiple valve involvement, native valves, and large vegetations (>10 mm) were more frequent in patients with S. bovis. There was a significantly higher occurrence of embolism in the S. bovis group. Splenic embolism and multiple embolisms were significantly more frequent in patients with S. bovis. Gastrointestinal lesions, anemia, and spondylitis were observed more frequently with S. bovis Endocarditis. In addition to the requirement for gastrointestinal examination for S. bovis Endocarditis, our study underlines the need for systematic screening for vertebral and splenic localizations, and suggests the use of early surgery to prevent the high risk of embolism in these patients.
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risks factors and prevention of q fever Endocarditis
Clinical Infectious Diseases, 2001Co-Authors: Florence Fenollar, Gilbert Habib, Patrizia M Carrieri, Pierre-edouard Fournier, Thierry MessanaAbstract:Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic Endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985-2000 was conducted. Twelve patients with acute Q fever who developed Endocarditis and 102 patients with Q fever Endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease (P< 10 7 ), especially a prosthetic valve (P =.01), were encountered more often among patients with Endocarditis. Among patients with valvular defects, we estimate the risk of developing Endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of Endocarditis than doxycycline alone (P = .009). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing Endocarditis.
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modification of the diagnostic criteria proposed by the duke Endocarditis service to permit improved diagnosis of q fever Endocarditis
The American Journal of Medicine, 1996Co-Authors: Pierre-edouard Fournier, Gilbert Habib, Jean Paul Casalta, Thierry MessanaAbstract:Background Q fever Endocarditis is a lifethreatening disease for which the diagnosis is usually based on serology. The major microbiologic criterion for the diagnosis of infectious Endocarditis (two separate positive blood cultures) cannot be achieved in most routine laboratories because of the biohazard associated with the culture of Coxiella burnetii , the etiological agent of Q fever. Purpose Recently, new criteria for the diagnosis of infectious Endocarditis have been proposed, and in this study we attempted to assess the suitability of these criteria specifically for the diagnosis of Q fever Endocarditis. Patients and methods To achieve this aim, we first selected from our series 20 recent cases in whom Endocarditis had been confirmed following valvular pathological examination, and for whom microbiological evidence for the involvement of C burnetii was available. Then, we applied the criteria proposed by the Duke Endocarditis Service (ie, C burnetii positive serology being considered a minor criterion) to this cohort of patients but excluding pathological findings. Although the Duke Endocarditis Service criteria confirmed diagnosis in 16 of the patients, 4 were misclassified as "possible" cases (20%). However, when the Q fever serological results (using an 1/800 antiphase I immunoglobulin G cut off) and single blood culture results were changed from minor to major diagnostic criteria, Endocarditis was confirmed in them all. A second time, prospectively, we applied the Duke Endocarditis Service criteria to a further 5 patients affected with Q fever Endocarditis. Strict application of these criteria resulted in 1 of the 5 being misdiagnosed. Applying the suggested modification for C burnetii results, all 5 were confirmed as having infectious Endocarditis. Conclusion We propose that the modifications discussed in this study be applied to the Duke Endocarditis Service criteria in order that the diagnosis of C burnetii induced Endocarditis is improved.
Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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a serum protein signature with high diagnostic value in bacterial Endocarditis results from a study based on surface enhanced laser desorption ionization time of flight mass spectrometry
The Journal of Infectious Diseases, 2006Co-Authors: Florence Fenollar, Gilbert Habib, Anthony Goncalves, Benjamin Esterni, Said Azza, Jeanpaul Borg, Didier RaoultAbstract:Background. Bacterial Endocarditis is a serious disease. Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry (MS) based on serum protein profiling is a powerful approach that can generate biomarkers with diagnostic value. Methods. To identify a protein signature associated with bacterial Endocarditis, we retrospectively performed SELDI-TOF MS profiling of serum samples from 88 patients hospitalized because of clinical suspicion of Endocarditis. The diagnosis was confirmed by conventional criteria for 34 patients (Endocarditis positive) and was excluded for 54 patients (Endocarditis negative). Serum samples were incubated with cation-exchange ProteinChip arrays. The protein profiles generated were subjected to biostatistical processing. Results. Fifty-nine samples (23 Endocarditis positive and 36 Endocarditis negative) were randomly selected for a learning set, with the 29 remaining samples (11 Endocarditis positive and 18 Endocarditis negative) serving as an independent testing (validation) set. Sixty-six protein peaks were differentially expressed between the Endocarditis-positive and the Endocarditis-negative patients. By combining partial least squares and logistic regression methods, we built a serum protein model that perfectly discriminated between Endocarditis-positive and Endocarditis-negative patients. Importantly, when this model was tested on the independent testing set, a correct prediction rate of nearly 90% was demonstrated. Overall, sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 98%, 96%, and 96%, respectively. Conclusions. SELDI-TOF MS profiling revealed a serum signature with high diagnostic potential for Endocarditis.
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diagnosis of infectious Endocarditis in patients undergoing valve surgery
The American Journal of Medicine, 2005Co-Authors: Gilbert Greub, Gilbert Habib, Jean Paul Casalta, Pierre-edouard Fournier, Hubert Lepidi, Clarisse Rovery, Frederic Collard, Didier RaoultAbstract:Purpose Histologic examination of valve samples is considered as the gold standard for the diagnosis of infectious Endocarditis. Molecular tools are also very promising for patients with negative-culture Endocarditis. Thus, we studied the contribution of valvular histology, culture, and 16S rRNA PCR amplification plus sequencing to the diagnosis of infectious Endocarditis in patients undergoing valve surgery. Subjects and methods We performed culture, histological examination, and broad-range PCR amplification plus sequencing on valve samples taken from 127 patients with infectious Endocarditis and from 118 patients without Endocarditis. The sensitivity and specificity of these tests for the diagnosis of Endocarditis in patients undergoing valve surgery were studied. Results The sensitivity of PCR was of 61% (64/105) whereas that of histological examination was of 63% (62/98) and that of valve culture was of only 13% (14/105). All 68 positive PCR results considered reliable according to an interpretation scheme were from patients with infectious Endocarditis, resulting in a 100% (118/118) specificity of the interpreted molecular approach. The specificity of histology was also of 100% (118/118) when using stringent criteria (ie, presence of vegetation, microorganisms, and/or valvular inflammation with mainly polymorphonuclear cells). PCR identified an etiological agent in 38% (5/13) of definite blood culture-negative infectious Endocarditis. Conclusion We show that valvular histology with stringent criteria is the gold standard for the diagnosis of infectious Endocarditis. Broad-range amplification of 16S rRNA gene is indicated for infectious Endocarditis of unknown etiology, whereas valve culture is of limited sensitivity.
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whipple s Endocarditis review of the literature and comparisons with q fever bartonella infection and blood culture positive Endocarditis
Clinical Infectious Diseases, 2001Co-Authors: Florence Fenollar, Hubert Lepidi, Didier RaoultAbstract:Whipple's disease is a systemic infection sometimes associated with cardiac manifestations. Recently, there has been an increase in the number of reported cases of Whipple's Endocarditis. The purpose of our study was to describe this entity. Data from 35 well-described cases of Whipple's Endocarditis were collected and compared with those of blood culture-positive Endocarditis, Q fever Endocarditis, and Bartonella Endocarditis. Some patients with generalized Whipple's disease presented with cardiac involvement, among other symptoms. Others presented with a nonspecific, blood culture-negative Endocarditis with no associated symptoms. In comparison with cases of Endocarditis due to other causes, congestive heart failure, fever, and previous valvular disease were less frequently observed in the cases of Whipple's Endocarditis. Without examination of the excised valves, the diagnosis of infective Endocarditis could not have been confirmed in most cases. Treatment is not well established. Whipple's Endocarditis is a specific entity involving minor inflammatory reactions and negative blood cultures, and its incidence is probably underestimated.
Pierre-edouard Fournier - One of the best experts on this subject based on the ideXlab platform.
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bartonella henselae Endocarditis in laos the unsought will go undetected
PLOS Neglected Tropical Diseases, 2014Co-Authors: Sayaphet Rattanavong, Pierre-edouard Fournier, Vang Chu, Khamthavy Frichitthavong, Pany Kesone, Mayfong Mayxay, Mariana Mirabel, Paul N NewtonAbstract:Background: Both Endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella Endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos), probably because people have neglected to look. Methodology/Principal Findings: We conducted a retrospective (2006–2012), and subsequent prospective study (2012– 2013), at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged .1 year admitted with definite or possible Endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective Endocarditis, acute and convalescent sera from 30 patients with culture negative Endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae Endocarditis. Conclusions/Significance: We argue that it is likely that Bartonella Endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of Endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of Endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella Endocarditis are needed, as it is likely that proven Bartonella Endocarditis can be treated with simpler and less expensive regimens than ''conventional'' Endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for Bartonella Endocarditis and the importance of vectors and vector control.
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diagnosis of infectious Endocarditis in patients undergoing valve surgery
The American Journal of Medicine, 2005Co-Authors: Gilbert Greub, Gilbert Habib, Jean Paul Casalta, Pierre-edouard Fournier, Hubert Lepidi, Clarisse Rovery, Frederic Collard, Didier RaoultAbstract:Purpose Histologic examination of valve samples is considered as the gold standard for the diagnosis of infectious Endocarditis. Molecular tools are also very promising for patients with negative-culture Endocarditis. Thus, we studied the contribution of valvular histology, culture, and 16S rRNA PCR amplification plus sequencing to the diagnosis of infectious Endocarditis in patients undergoing valve surgery. Subjects and methods We performed culture, histological examination, and broad-range PCR amplification plus sequencing on valve samples taken from 127 patients with infectious Endocarditis and from 118 patients without Endocarditis. The sensitivity and specificity of these tests for the diagnosis of Endocarditis in patients undergoing valve surgery were studied. Results The sensitivity of PCR was of 61% (64/105) whereas that of histological examination was of 63% (62/98) and that of valve culture was of only 13% (14/105). All 68 positive PCR results considered reliable according to an interpretation scheme were from patients with infectious Endocarditis, resulting in a 100% (118/118) specificity of the interpreted molecular approach. The specificity of histology was also of 100% (118/118) when using stringent criteria (ie, presence of vegetation, microorganisms, and/or valvular inflammation with mainly polymorphonuclear cells). PCR identified an etiological agent in 38% (5/13) of definite blood culture-negative infectious Endocarditis. Conclusion We show that valvular histology with stringent criteria is the gold standard for the diagnosis of infectious Endocarditis. Broad-range amplification of 16S rRNA gene is indicated for infectious Endocarditis of unknown etiology, whereas valve culture is of limited sensitivity.
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risks factors and prevention of q fever Endocarditis
Clinical Infectious Diseases, 2001Co-Authors: Florence Fenollar, Gilbert Habib, Patrizia M Carrieri, Pierre-edouard Fournier, Thierry MessanaAbstract:Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic Endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985-2000 was conducted. Twelve patients with acute Q fever who developed Endocarditis and 102 patients with Q fever Endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease (P< 10 7 ), especially a prosthetic valve (P =.01), were encountered more often among patients with Endocarditis. Among patients with valvular defects, we estimate the risk of developing Endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of Endocarditis than doxycycline alone (P = .009). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing Endocarditis.
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modification of the diagnostic criteria proposed by the duke Endocarditis service to permit improved diagnosis of q fever Endocarditis
The American Journal of Medicine, 1996Co-Authors: Pierre-edouard Fournier, Gilbert Habib, Jean Paul Casalta, Thierry MessanaAbstract:Background Q fever Endocarditis is a lifethreatening disease for which the diagnosis is usually based on serology. The major microbiologic criterion for the diagnosis of infectious Endocarditis (two separate positive blood cultures) cannot be achieved in most routine laboratories because of the biohazard associated with the culture of Coxiella burnetii , the etiological agent of Q fever. Purpose Recently, new criteria for the diagnosis of infectious Endocarditis have been proposed, and in this study we attempted to assess the suitability of these criteria specifically for the diagnosis of Q fever Endocarditis. Patients and methods To achieve this aim, we first selected from our series 20 recent cases in whom Endocarditis had been confirmed following valvular pathological examination, and for whom microbiological evidence for the involvement of C burnetii was available. Then, we applied the criteria proposed by the Duke Endocarditis Service (ie, C burnetii positive serology being considered a minor criterion) to this cohort of patients but excluding pathological findings. Although the Duke Endocarditis Service criteria confirmed diagnosis in 16 of the patients, 4 were misclassified as "possible" cases (20%). However, when the Q fever serological results (using an 1/800 antiphase I immunoglobulin G cut off) and single blood culture results were changed from minor to major diagnostic criteria, Endocarditis was confirmed in them all. A second time, prospectively, we applied the Duke Endocarditis Service criteria to a further 5 patients affected with Q fever Endocarditis. Strict application of these criteria resulted in 1 of the 5 being misdiagnosed. Applying the suggested modification for C burnetii results, all 5 were confirmed as having infectious Endocarditis. Conclusion We propose that the modifications discussed in this study be applied to the Duke Endocarditis Service criteria in order that the diagnosis of C burnetii induced Endocarditis is improved.
Michael H Gewitz - One of the best experts on this subject based on the ideXlab platform.
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prevention of infective Endocarditis guidelines from the american heart association a guideline from the american heart association rheumatic fever Endocarditis and kawasaki disease committee council on cardiovascular disease in the young and the council on clinical cardiology council on cardiovascular surgery and anesthesia and the quality of care and outcomes research interdisciplinary working group
Circulation, 2007Co-Authors: Walter R Wilson, Larry M. Baddour, Ann F Bolger, Matthew E Levison, Michael H Gewitz, Kathryn A Taubert, Peter B Lockhart, Christopher H Cabell, Masato Takahashi, Robert S BaltimoreAbstract:Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective Endocarditis that were last published in 1997. Methods and Results— A writing group was appointed by the AHA for their expertise in prevention and treatment of infective Endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective Endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective Endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective Endocarditis, results of prophylactic studies in animal models of experimental Endocarditis, and retrospective and prospective studies of prevention of infective Endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: Endocarditis, infective Endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. Conclusions— The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective Endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective Endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective Endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective Endocarditis. (5) Administration of antibiotics solely to prevent Endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective Endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
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infective Endocarditis diagnosis antimicrobial therapy and management of complications a statement for healthcare professionals from the committee on rheumatic fever Endocarditis and kawasaki disease council on cardiovascular disease in the young and
Circulation, 2005Co-Authors: Larry M. Baddour, Arnold S. Bayer, Vance G. Fowler, Walter R Wilson, Ann F Bolger, Matthew E Levison, Patricia Ferrieri, Michael A Gerber, Lloyd Y Tani, Michael H GewitzAbstract:Background—Despite advances in medical, surgical, and critical care interventions, infective Endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective Endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results—This work represents the third iteration of an infective Endocarditis “treatment” document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective Endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective Endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective Endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective Endocarditis, evaluation and treatment of culture-negative Endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions—The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective Endocarditis, as well as management of associated complications. Clinical variability and complexity in infective Endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)
