New Perspectives for Prosthetic Valve Endocarditis: Impact of Molecular Imaging by FISHseq Diagnostics

Abstract

Background The causative microbial etiology of prosthetic valve infective endocarditis (PVE) can be difficult to identify. Our aim was to investigate the benefit of the molecular imaging technique fluorescence in situ hybridization (FISH) combined with 16S rRNA-gene PCR and sequencing (FISHseq) for the analysis of infected prosthetic heart valves. Methods We retrospectively evaluated the diagnostic outcome of 113 prosthetic valves from 105 patients with suspected PVE, treated in the years 2003-2013 in the Department of Cardiac Surgery, Charité University Medicine Berlin. Each prosthetic valve underwent cultural diagnostics and was routinely examined by FISH combined with 16S rRNA-gene PCR and sequencing. We compared classical microbiological culture outcomes (blood and valve cultures) with FISHseq results and evaluated the diagnostic impact of the molecular imaging technique. Results Conventional microbiological diagnostic alone turned out to be insufficient, as 67% of preoperative blood cultures were non-informative (negative, inconclusive or not obtained) and 67% valve cultures remained negative. FISHseq improved the conventional cultural diagnostic methods in PVE in 30% of the cases and increased diagnostic accuracy. Out of the valve culture-negative PVE cases, FISHseq succeeded to identify the causative pathogen in 35%. Conclusions FISHseq improves PVE diagnostics, complementing the conventional cultural methods. In addition to species identification, FISH provides information about the severity of PVE and state of the pathogens, e.g. stage of biofilm formation, activity and localization on and within the prosthetic material. As a molecular imaging technique, FISHseq enables the unambiguous discrimination of skin flora as contaminant or infectious agent.

ESC guidelines 2023 on the management of endocarditis

“…For patients with prosthetic valve BCNIE, molecular imaging technique fluorescence in situ hybridization combined with 16S rRNA-gene PCR and sequencing improved the conventional cultural diagnostic methods in 30% of cases. 159 Next-generation sequencing of plasma microbial cell-free deoxyribonucleic acid (DNA) may facilitate a rapid diagnosis of IE in the future. 160 When all microbiological assays are negative, the diagnosis of nonbacterial endocarditis should systematically be considered and assays for antinuclear antibodies as well as antiphospholipid syndrome (APLs) (anticardiolipin antibodies [immunoglobulin (Ig)G] and anti-β 2 -glycoprotein 1 antibodies [IgG and IgM]) should be performed (although these antibodies may also be present in patients with proven IE).…”

Diagnosis and treatment of Whipple disease after kidney transplantation: A case report

“…It is also detected in the general population as an asymptomatic pathogen. A study reported its incidence to be 3 in a million, and no relevant epidemiological report from China exists[ 13 ]. It is primarily manifested with intermittent and recurrent arthralgia or arthritis with chronic diarrhea, abdominal pain, and weight loss.…”

Cập nhật tiêu chuẩn Duke trong chẩn đoán viêm nội tâm mạc nhiễm khuẩn theo hướng dẫn của Hiệp hội bệnh truyền nhiễm tim mạch quốc tế năm 2023

“…Tiêu chuẩn Duke-ISCVID 2023 đã làm rõ và mở rộng tiêu chuẩn này bởi phối hợp các kĩ thuật di truyền, phân tử, nhuộm mô ở đó vi sinh vật gây bệnh có thể được phát hiện (bảng 1). Đa dạng các cận lâm sàng chẩn đoán mới, bao gồm PCR 16S/18S rRNA, kĩ thuật giải trình tự gen 9 , và lai huỳnh quang tại chỗ 10 , có thể tăng khả năng của chúng ta cho chẩn đoán VNTMNK. e Xác định chẩn đoán thay thế giải thích triệu chứng cơ năng và thực thể của VNTMNK bao gồm nguyên nhân vi sinh và không phải vi sinh.…”