Diagnosis of endocarditis caused by Mycobacterium abscessus

We report a fatal case of native valve endocarditis due to Mycobacterium abscessus in a hemodialysis patient. The diagnosis was based on culture isolation of acid-fast bacilli from peripheral blood and a permanent catheter tip, and their identification as M abscessus by a reverse hybridization-based assay and direct DNA sequencing of the 16S-23S internal transcribed spacer region. Rapid diagnosis and combination therapy are essential to minimize mortality due to this pathogen. Although combination therapy was started with clarithromycin and tigecycline, the patient refused to take clarithromycin due to severe abdominal pain. The patient became afebrile after therapy with tigecycline alone although bacteremia persisted. He was discharged against medical advice and readmitted three months later for persistent fever. His blood cultures again yielded M abscessus and a transesophageal echocardiogram showed two mobile vegetations. The patient was noncompliant with therapy and died due to cardiac arrest and multiorgan failure. This report shows that M abscessus should also be considered in the differential diagnosis of infective endocarditis in hemodialysis patients

epidemiological profile of anemia, blood transfusions and iron overload in paitients on maintenance dialysis

Anaemia contributes considerably to morbidity and impairs the quality of life in patients on maintenance dialysis [MD]. This study analyzed the epidemiological profile of anaemia, transfusional requirements [TR] and iron stores in patients on MD in Kuwait during 1989-1990. In those years, recombinant erythropoietin [rHuEPO] therapy had just been initiated. One hundred and eighty-nine patients were studied. Forty four [28.8%] patients were found to be severely Anaemic and/or required excessive blood transfusions, 25 of whom were receiving maintenance haemodialysis [MHD]] for <18 months. During the first 18 months of dialysis, 33% of MHD] patients were found to be iron depleted i.e. serum ferritin [SF] <30 micro g/l, compared to only <2% of MHD patients on longer duration of dialysis, and 0% of those on maintenance peritoneal dialysis [MPD]. Twenty six [13.8%] patients were Iron overloaded [10] [SF>1100 micro g/I] of whom 24 were receiving MHD]. Iron stores correlated positively with duration on dialysis only In those who exhibited excessive TR Our study emphasize the need for periodic assessment and replenishment of iron stores especially during the early months of MHD. Early application of iron monitoring and use of rHuEPO will limit the need for blood transfusions and prevent the development of 10 in this patient population