Dermatologic manifestations of infective endocarditis

Gomes, Rafael Tomaz; Tiberto, Larissa Rezende; Bello, Viviane Nardin Monte; Lima, Mayara; Nai, Gisele Alborghetti; Abreu, Marilda Aparecida Milanêz Morgado de

doi:10.1590/abd1806-4841.20164718

Cited by 16 publications

(12 citation statements)

References 8 publications

(13 reference statements)

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“…This procedure allowed isolation of pathogenic microorganisms in all samples, thus significantly improving (P = 0.004) the assay sensitivity, which by conventional methods allowed microbiological diagnosis in only one case (12.5%). Although gathered in a relatively small group of patients, these results show that by dispersing microbial cells from the tissue/biofilm matrix, sonication can increase significantly the probability to isolate microbial pathogens even in blood culture-negative endocarditis [18,70,71]. Even considering that all patients received antibiotic therapy before surgery and tissue collection, the very low sensitivity of the direct tissue culture as compared to the blood culture is intriguing as well as the significant difference observed between the direct tissue culture and sonication.…”

Section: Discussionmentioning

confidence: 89%

“…However, negative blood cultures are frequent, thus contributing to diagnostic uncertainty [12][13][14][15]. In suspected cases, skin examination may provide important indicators to support a diagnostic suspect of IE [16][17][18]. Staphylococci, streptococci and enterococci are leading causes of IE, accounting for more than 70% of cases [1,10].…”

Section: Introductionmentioning

confidence: 99%

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Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis

et al. 2019

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Background: Infective endocarditis (IE) is associated with high rates of mortality. Prolonged treatments with highdose intravenous antibiotics often fail to eradicate the infection, frequently leading to high-risk surgical intervention. By providing a mechanism of antibiotic tolerance, which escapes conventional antibiotic susceptibility profiling, microbial biofilm represents a key diagnostic and therapeutic challenge for clinicians. This study aims at assessing a rapid biofilm identification assay and a targeted antimicrobial susceptibility profile of biofilm-growing bacteria in patients with IE, which were unresponsive to antibiotic therapy. Results: Staphylococcus aureus was the most common isolate (50%), followed by Enterococcus faecalis (25%) and Streptococcus gallolyticus (25%). All microbial isolates were found to be capable of producing large, structured biofilms in vitro. As expected, antibiotic treatment either administered on the basis of antibiogram or chosen empirically among those considered first-line antibiotics for IE, including ceftriaxone, daptomycin, tigecycline and vancomycin, was not effective at eradicating biofilm-growing bacteria. Conversely, antimicrobial susceptibility profile of biofilm-growing bacteria indicated that teicoplanin, oxacillin and fusidic acid were most effective against S. aureus biofilm, while ampicillin was the most active against S. gallolyticus and E. faecalis biofilm, respectively. Conclusions: This study indicates that biofilm-producing bacteria, from surgically treated IE, display a high tolerance to antibiotics, which is undetected by conventional antibiograms. The rapid identification and antimicrobial tolerance profiling of biofilm-growing bacteria in IE can provide key information for both antimicrobial therapy and prevention strategies.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis

et al. 2019

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“…The overall frequency of cutaneous lesions amongst IE cases varies between 5% to 25%, though none of them are pathognomonic for endocarditis [24,25]. Histologically, lesions show findings of septic emboli with associated inflammatory response or leukocytoclastic vasculitis [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 compares the differences and similarities between these two distinct clinical diagnoses. Leukocytoclastic vasculitis is a common histological finding between the cutaneous lesions of both diseases [17,22,25,26]. The presence of purpura and necrotic skin lesions may be present in either disease, and their correct interpretation can be challenging.…”

Section: Discussionmentioning

confidence: 99%

Explosive Granulomatosis with Polyangiitis Mimicking Infective Endocarditis

Shue¹,

Chow²,

Cohen³

et al. 2019

Intern Med

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Background: Granulomatosis with polyangiitis (GPA) is a rare systemic disease that causes necrotizing granulomatous inflammation of small-and medium-sized blood vessels. Infective endocarditis (IE), which is a disease due to infection of the innermost surface of the heart, is pathophysiologically distinct from GPA and yet these two entities can manifest in strikingly similar ways. Case presentation: We report a case of a 46-year-old male whose presentation and history were strikingly suggestive of IE but was ultimately diagnosed with GPA. Originally, he presented with fever, oral ulcers, and purpuric lesions on the extremities. The patient had a history of illicit drug use and had recently undergone a dental procedure one week prior to presentation, which were classic risk factors for IE. His fever and respiratory difficulty were unresponsive to antibiotic therapy. His respiratory and renal status declined explosively during his hospitalization, requiring intubation and intensive level care. His clinical progression, negative blood cultures, and a positive c-ANCA screen prompted a workup that was more consistent with GPA. Administration of anti-inflammatory medications and plasmapheresis eventually lead to the resolution of his symptoms. Because of his precipitous pulmonary decline, his outcome would have been poor if the correct diagnosis of GPA were to have been overlooked. Conclusions: ANCA-associated vasculitis and infective endocarditis can demonstrate similar clinical findings, including in the skin. Overlap in serologic markers and other organ involvement can lead to difficulty in distinguishing these two diseases, which require contrasting treatment methods. We highlight and compare the similarities and differences between GPA and IE in discussion of this interesting case to emphasize the importance of being clinically vigilant in differentiating these two separate disease processes.

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“…Cutaneous manifestations associated with adult-onset Still's disease: differential diagnosis[9][10][11][12][13][14][15] Diagnostic criteria of adult-onset Still's disease[1,3,5] tabela 1. Kryteria diagnostyczne choroby Stilla u dorosłych[1,3,5] …”

mentioning

confidence: 99%

Cutaneous manifestations in a patient with adult-onset Still’s disease

Aleksandrowicz¹,

Kasprowicz-Furmańczyk²,

Owczarczyk‐Saczonek³

et al. 2021

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Introduction. Adult-onset Still's disease is a systemic inflammatory disease characterized by fever, arthritis, lymphadenopathy, splenomegaly, inflammation of internal organs, and skin lesions. Objective. Presentation of a rare, systemic inflammatory disease associated with cutaneous manifestations. Case report. A 52-year-old woman was admitted to the Department of Dermatology with erythematous skin lesions associated with with intermittent itch. For a year before hospital admission, the skin lesions recurrently appeared in the late afternoon and resolved completely at night. Conclusions. The cutaneous lesions in adult-onset Still's disease have a tendency tends to develop and disappear in episodes associated with fever. The typical cutaneous manifestations include erythematous or erythematopapular lesions, usually with a salmon-like tint. However, the disease may also be associated with an atypical cutaneous presentation, which should be taken into consideration to ensure early diagnosis and effective treatment to prevent joint damage. streszczenie Wprowadzenie. Choroba Stilla u dorosłych jest układową chorobą zapalną cechującą się gorączką, zapaleniem stawów, powiększeniem węzłów chłonnych i śledziony, stanami zapalnymi narządów wewnętrznych oraz zmianami skórnymi. Cel pracy. Przedstawienie przypadku choroby Stilla, rzadkiej układowej choroby zapalnej przebiegającej z objawami skórnymi. Opis przypadku. Kobieta 52-letnia została przyjęta do Kliniki Dermatologii w celu diagnostyki zmian rumieniowych z okresowo występującym świądem. Od roku, przed przyjęciem do Kliniki, zmiany skórne pojawiały się w późnych godzinach popołudniowych i ustępowały całkowicie w nocy. Wnioski. Osutka w przebiegu choroby Stilla u dorosłych występuje u około 90% pacjentów. Pojawia się i ustępuje wraz z występującą epizodycznie gorączką. Typowe zmiany skórne mają postać plam rumieniowych lub zmian rumieniowo-grudkowych o charakterystycznym, łososiowym zabarwieniu. W przebiegu choroby Stilla mogą również wystąpić nietypowe objawy skórne, co utrudnia postawienie właściwej

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Dermatologic manifestations of infective endocarditis

Cited by 16 publications

References 8 publications

Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis

Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis

Explosive Granulomatosis with Polyangiitis Mimicking Infective Endocarditis

Cutaneous manifestations in a patient with adult-onset Still’s disease

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