Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Pulmonary endarteritis in a patient with patent ductus arteriosus and a bicuspid aortic valve

BACKGROUND: Infective endarteritis of the pulmonary artery is an unusual event. While congenital heart disease (CHD) is a risk factor, pulmonary endarteritis as a complication is a rare occurrence especially in the era of antibiotic therapy.CASE PRESENTATION: We present a case of a 43-year-old female who initially sought consultation due to fever. Physical examination revealed a continuous murmur at the second intercostal space left parasternal border. There was no petechiae or any other skin lesions noted. Transthoracic two dimensional echocardiogram showed eccentric left ventricular hypertrophy with an ejection fraction of 65%. She had a patent ductus arterioscus as well as a bicuspid aortic valve. Further interrogation revealed a vegetation at the main pulmonary artery. Patient was initially started on ceftriaxone and gentamycin. Blood cultures were positive for coagulase negative Staphylococcus aureus. Ceftriaxone was then shifted to vancomycin, which was completed for 28 days.OUTCOME: Clinical improvement was accompanied by the disappearance of the vegetation and negative blood cultures. Patient was maintained on enalapril and advised closure of the patent ductus arteriosus. She opted medical management for the time being and was discharge stable and improved.CONCLUSION: Pulmonary endarteritis is an uncommon complication of CHD. A high index of suspicion must prompt careful evaluation, combining clinical, laboratory and echocardiographic modalitites in order to provide early diagnosis and effective treatment.

Bacteriemias e infección endovascular por Campylobacter spp: nuestra experiencia en un cuarto de siglo de historia / Bacteremia and endarteritis cases secondary to Campylobacter spp. in a metropolitan hospital: Our experience along a quarter of a century

Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacterfetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.

Se presentan seis casos de bacteriemia y uno de infección vascular por Campylobacter spp, observados en 25 años, con el fin de describir sus características clínicas. Cinco de ellos se registraron en la segunda mitad del período, en concomitancia con el incremento de este agente en el porcentaje de coprocultivos, lo que sugiere un perfil emergente. Las infecciones fueron más frecuentes en los meses cálidos, asociadas principalmente a C. fetus (5 de 7) y a co-morbilidad. La edad promedio de los pacientes fue de 32,4 años (rango 19 a 63 años) y todos tenían comorbilidades. Las manifestaciones clínicas más frecuentes fueron diarrea y fiebre (5 de 7 casos) y dos pacientes cursaron con shock séptico (28,6 por ciento). La evolución fue favorable en cinco pacientes pero los dos que presentaron shock asociado a C. fetus fallecieron (28,6 por ciento). Las bacteriemias o infecciones vasculares por Campylobacter spp., aunque infrecuentes, pueden presentarse en pacientes vulnerables y debutar como cuadros febriles, en presencia o ausencia de diarrea. La identificación de la especie involucrada es de suma importancia debido a la escasa actividad terapéutica de cefalosporinas de tercera generación y quinolonas. El pronóstico de estas bacteriemias es grave debido a las características del hospedero y a su elevada letalidad.

A Case of Pulmonary Artery Endarteritis due to Staphylococcus lugdunensis in Patient with Clinically Silent Patent Ductus Arteriosus / 이화의대지

Staphylococcus lugdunensis (S. lugdunensis) is an unusually virulent coagulase-negative staphylococci (CNS) and uncommon cause of infective endocarditis (IE) involving mainly native left sided valves. S. lugdunensis IE, which was described previously as "surreptitious" and "wolf in sheep's clothing", runs an aggressive course with a high rate of severe in-hospital complications. Therefore, early surgical treatment has been considered for the treatment of S. lugdunensis IE. However, we experienced a case of S. lugdunensis pulmonary endarteritis which was cured with antibiotic therapy alone.

The cell type of renal allograft intimal arteritis and its relationship with peritubular capillaries C4d deposition / 中华肾脏病杂志

Objective To investigate the cell types of renal allograft intimal arteritis in posttransplantation patients and its relationship with peritubular capillaries (PTCs)C4d deposition. Methods Twenty allograft kidney transplant recipients from Jun 2006 to Jun 2008 were enrolled in the retrospective study. Twenty-one biopsy specimens with acute vascular rejection were immunostained for macrophages, T cells and C4d. In each biopsy specimen, arterial intimal macmphages and T cells were counted, and mean number of macrophages per "artery and T cells per artery were determined. The recipients were divided into C4d + and C4d- group according to whether C4d deposition in the PTCs. Results In the intimal arteritis of biopsies diagnosed as acute vascular rejection, the infiltrating cells were predominantly macrophages including C4d+ and C4d- group. T cells were the minority. The mean macrophage number per artery cross-section was significantly higher than the mean T cell number per artery cross-section in the C4d + group (12.45±9.86 vs 3.91±3.03, P=0.007) and in the C4d- group (3.47±1.89 vs 1.45±1.37, P=0.006). Forther more, the mean number of macrophage per artery cross-section in the C4d+ group was significantly higher than that in the C4d- group (P=0.007). Conclusions In the intimal arteritis of biopsies diagnosed as acute vascular rejection, the infiltrating cells are predominantly macrophages which has relationship with peritubular capillary C4d deposition. The mean number of macmphage per artery cross-section in the C4d+ biopsies is significantly higher than that in the C4d- biopses.

A Case with Patent Ductus Arteriosus Complicated by Pulmonary Artery Endarteritis

Infective endarteritis in the pulmonary artery is unusual. However, congenital heart disease such as patent ductus arteriosus (PDA) could be a predisposing factor of infective endarteritis. We report a patient with PDA complicated by infective endarteritis and large pulmonary artery vegetation. After three weeks of antibiotic treatment, the patient underwent surgical closure of the PDA and removal of the vegetation.

A Case of Femoral Endarteritis Related to Using a Percutaneous Closure Device after Coronary Angiography

Percutaneous arterial closure devices allow earlier mobilization and discharge of patients after arterial catheterization than manual compression for achieving puncture site hemostasis. Our case is representative of Perclose(r) associated infections; our patient had a delayed presentation of a staphylococcal arterial infection that required arterial debridement and reconstruction. Physicians should be aware of this uncommon, but serious complication to expedite the evaluation and treatment of patients with suspected infections that can arise from using these devices.

Femoral Endarteritis as a Complication of Percutaneous Suture Closure Device: A case report / 대한흉부외과학회지

Percutaneous suture closure device is known as relatively safe and convenient tool, which can decrease not only bed rest period of patient but also time consuming effort of manual compression of doctor after femoral artery puncture. However [C1], there are also some reports on complication of its use. We report a 62-year-old male patient who had femoral artery endarteritis [0] with pseudoaneurysm as a complication of percutaneous suture closure device after percutaneous coronary angiography [C2]. He was treated successfully by appropriate antibiotics and vessel reconstruction using autologous saphenous vein patch.