Infectious Causes of Vasculitis

Choucair, Jacques

doi:10.5772/55189

Cited by 6 publications

(9 citation statements)

References 122 publications

(129 reference statements)

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“…The majority of patients were male representing 83%, and the remaining 17% were female patients. Similar findings were previously reported [ 6 , 13 , 32 ]. The higher incidence of the young, male IE patients in our study can be correlated to the high number of injection drug users (IDUs), which is considered a problem related mainly to the young males in our Egyptian society [ 33 ].…”

Section: Discussionsupporting

confidence: 93%

“…In 2018, Asgeirsson et al reported that S. aureus is the foremost cause of IE where it comprises about 15–40% of all IE cases worldwide [ 4 ]. IE is primarily caused by bacteria or fungi that may progress to serious cardiac complications [ 6 ]. IE is typically characterized by the development of “cauliflower-like” vegetations, consisting of host factors including fibrin, platelets, and bacterial aggregates on the damaged endothelium of heart valves [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Staphylococcal Enterotoxins and Toxic Shock Syndrome Toxin-1 and Their Association among Bacteremic and Infective Endocarditis Patients in Egypt

Elsherif

Helal

El-Ansary

et al. 2020

BioMed Research International

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Purpose. Infective endocarditis (IE) is a major complication in patients with bacteremia of Staphylococcus (S.) aureus infection. Our aim was to determine the association of the major Staphylococcal superantigens (SAgs), including Staphylococcal enterotoxins (SEs) and toxic shock syndrome toxin-1 (TSST-1), among hospitalized patients diagnosed with bacteremia and those with IE. Methods. This study was conducted on 88 patients; of these, 84 (95.5%) had two positive blood cultures. Eighteen out of the 84 patients (21.4%) were diagnosed based on the modified Duke criteria by a cardiologist to have IE. The recovered isolates were screened phenotypically using ELISA followed by molecular analysis of sea, seb, sec, sed, see, and tsst-1, the major SAg coding genes, and the obtained findings were statistically analyzed. Results. Phenotypic screening for SE production of 26 selected Staphylococci (15 isolated from the IE patients (10 S. aureus and 5 coagulase negative staphylococci (CoNS)) and 11 from bacteremic patients (10 S. aureus and 1 CoNS)) using ELISA revealed that 12/26 (46%) isolates were SE producers. PCR analysis showed that 19 (73%) isolates were PCR positive for SAg genes with the highest prevalence of the sea gene (79%), followed by seb (63%) and tsst-1 (21%). The least frequent gene was sed (5.3%). Statistical correlations between bacteremic and IE isolates with respect to prevalence of SAgs showed no significant difference ( P value = 0.139, effect size = 0.572 ) indicating no specific association between any of the detected SAgs and IE. Conclusion. There is high prevalence of SEs among clinical isolates of Staphylococci recovered from patients suffering bacteremia and those with IE. No significant difference was found among Staphylococcal isolates recovered from patients with bacteremia or IE regarding both phenotypic and genotypic detection of the tested SAgs.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Staphylococcal Enterotoxins and Toxic Shock Syndrome Toxin-1 and Their Association among Bacteremic and Infective Endocarditis Patients in Egypt

Elsherif

Helal

El-Ansary

et al. 2020

BioMed Research International

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“…The majority of patients were male representing 83% and the remaining 17% were female patients. Similar findings were previously reported [30, 5, 12]. The higher incidence of IE among the young, male patients is attributed to the predominance of the injection drug users (IDUs), which is considered a problem related mainly to the young males in our Egyptian society [31].…”

Section: Discussionsupporting

confidence: 84%

“…IE is caused principally with bacteria or fungi where serious clinically relevant complications including, damaging of one or more of the heart valves, necrosis of mural endocardium, or sometimes septal defects could occur [5]. Moreover, IE is distinguished by the development of “cauliflower– like” vegetations, consisted of host factors including, fibrin, platelets and bacterial aggregates on the damaged endothelium of heart valves [6,7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Staphylococcal Superantigens and their association among bacteremic and Infective Endocarditis patients in Egypt

Elsherif

Helal

El-Ansary

et al. 2020

Preprint

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31Aim: Infective endocarditis (IE) is a major complication of Staphylococcus (S.) aureus infection 32 in humans particularly those with bacteremia. Although Staphylococcus species are commensal 33 on or in different parts of the human body, it is also known to be a serious pathogen causing 34 bacteremia and sepsis that could lead to IE. Therefore, our aim was to assess the prevalence as 35 well as phenotypic and genotypic association of the Staphylococcal superantigens (SAgs) among 36 bacteremic and IE patients.37 Methods: This study was conducted on Staphylococcus isolates recovered from bacteremic and 38 IE patients. The isolates were screened phenotypically for the detection of SAgs including 39Staphylococcal enterotoxins (SEs) and toxic shock syndrome toxin-1 (TSST-1). Molecular 40 detection and analysis of sea, seb, sec, sed, see and tsst-1, the major SAgs coding genes were 41 performed using PCR and agarose gel electrophoresis, respectively. The obtained findings were 42 statistically analyzed using standard methods. 43Results: Detection of SAgs using ELISA revealed that 12 (46%) isolates were positive for 44 enterotoxin production. However, the PCR revealed that 19 (73%) isolates were positive for 45 enterotoxin genes with the highest prevalence of the sea gene (79%), followed by the seb (63%), 46 tsst-1 (21%). The least frequent gene was the sed (5.3%). Accordingly, phenotypic and genotypic 47 screening for prevalence of SAgs among Staphylococcal isolates showed significant difference 48 (P value =0.046703), however, no significant correlation could be observed among the coagulase 49 negative Staphylococci (CoNS) isolates (P value =0.248213). Statistical correlations between 50 bacteremic and IE isolates with respect to prevalence of SAgs, showed no significant difference 51 (P-value = 0.139, Effect size = 0.572) indicating no specific association between any of the 52 detected SAgs and IE. 3 53 Conclusion: no significant difference has been found between Staphylococcal IE and bacteremia 54 isolates regarding both phenotypic and genotypic detection of the most commonly SAgs. 55 Therefore, all Staphylococcal bacteremic patients are suspected for IE. Also, future work should 56 be conducted for analysis of SAgs gene expression. 57 58 59 Introduction 60 S. aureus is a dangerous and versatile human pathogen because of its ability to cause various 61 types of infections, including skin and soft tissue sepsis, pneumonia, bloodstream infections 62 (BSIs), osteomyelitis and infective endocarditis (IE) [1]. Higher mortality rate (15-25%) was 63 recently reported from serious S. aureus infections, particularly bacteremia and endocarditis 64 [2,3]. IE is a major devastating complications of Staphylococcal bacteremia [3,4]. In 2018, 65 Asgeirsson et al. reported that S. aureus is the foremost cause of IE where it comprises about 15-66 40% of all IE cases worldwide [3]. 67 IE is caused principally with bacteria or fungi where serious clinically relevant complications 68 including, damaging of one or more of the ...

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“…Cutaneous small-vessel vasculitis is classified as idiopathic or secondary due to infection, drugs, connective tissue disease, malignancy, or other diseases. The etiology of secondary vasculitis is challenging to differentiate due to the same cellular component in histology [8]. Additionally, antibodies as autoimmune markers may become positive in infection [2,10].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Vasculitis and Generalized Lymphadenopathy Associated with Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli Endocarditis: A Rare Case Report

et al. 2020

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Introduction Infective endocarditis (IE) has been known as the great imitator due to variable clinical manifestation, making its diagnosis challenging. A missed diagnosis could lead to inappropriate therapy. We presented a rare case of blood culture-negative infective endocarditis (BCNIE) due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli manifest with cutaneous vasculitis and generalized lymphadenopathy. We highlighted its diagnostic challenge and management. Case Illustration and Discussion A 36-year-old male with known asymptomatic ruptured sinus of Valsalva (SOV) presented with fever of unknown origin for six months, fatigue, weight loss with a history of multiple hospitalizations. The physical examination revealed a continuous murmur at Erb's point, cutaneous vasculitis, and bilateral inguinal lymphadenopathy. The laboratory result was leukocytosis and elevated C-Reactive Protein (CRP). Generalized lymphadenopathy was detected from the thorax and abdominal Computed Tomography (CT) Scans. Positive Anti Nuclear Antibody (ANA) Indirect Immunofluorescence (IF) speckled pattern led us to consider an autoimmune as the etiology, but we still considered IE as a differential diagnosis due to history of structural heart disease. Detection of multiple tiny oscillating masses at the tricuspid valve from the echocardiogram and cardiac CT led to possible IE diagnosis. Negative three consecutive blood cultures led the diagnosis to BCNIE. Surgery was performed to evacuate the vegetations, repair the SOV, and tricuspid valve replacement with a bioprosthetic valve. These results in improvement of the patient’s condition. ESBL-producing Escherichia coli yielded in tissue culture made the diagnosis of IE became definite. Conclusion ESBL-producing Escherichia coli should be considered as the etiology of BCNIE. Cutaneous vasculitis and generalized lymphadenopathy as a manifestation of IE could lead to diagnostic confusion. A thorough investigation will help clinician to avoid delay or inappropriate treatment that could be detrimental for the patient.

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Infectious Causes of Vasculitis

Abstract: Table 1. Names and definitions of vasculitides adopted by the Chapel Hill Concensus Conference on the Nomenclature of Systemic Vasculitis Updates in the Diagnosis and Treatment of Vasculitis 132

Cited by 6 publications

References 122 publications

Staphylococcal Enterotoxins and Toxic Shock Syndrome Toxin-1 and Their Association among Bacteremic and Infective Endocarditis Patients in Egypt

Staphylococcal Enterotoxins and Toxic Shock Syndrome Toxin-1 and Their Association among Bacteremic and Infective Endocarditis Patients in Egypt

Prevalence of Staphylococcal Superantigens and their association among bacteremic and Infective Endocarditis patients in Egypt

Cutaneous Vasculitis and Generalized Lymphadenopathy Associated with Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli Endocarditis: A Rare Case Report

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