ABSTRACT
Infective Endocarditis (IE) has high morbidity and mortality. To date, in addition to classic Gram-positive pathogens were isolated exigent Gram negative bacteria responsible of endocarditis as A. baumannii, A. lwoffii, C. burnetii, Bartonella, Chlamydia and Legionella. We report our experience about the isolation of Salmonella enterica phagetype 35 (PT35) from blood heart cavity of a 74-year-old woman after having consumed a portion of baked pasta bought in a rotisserie. Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. To the best of our knowledge, after careful evaluation of existing literature, this is the first report of endocarditis due S. enterica PT 35.
Subject(s)
Endocarditis, Bacterial/microbiology , Salmonella Infections/microbiology , Salmonella enterica , Aged , Female , Humans , Salmonella enterica/classificationABSTRACT
Infective Endocarditis (IE) is a disease with high morbidity and mortality. Nowadays, in addition to classic pathogens were isolated exigent Gram negative bacteria as A. baumannii, A. lwoffii, C. burnetii, Bartonella, Chlamydia and Legionella. We present our experience of Legionella isolations in environmental sample (water and air) collected from the Cardiology units belonging to two hospitals in Messina (Italy). A total of 80 samples were carried out, 30 and 50, respectively in the first and in the second structure: 55 of water and 25 of aerosol. The positivity of 30% of the water samples analyzed and 15% of those aerosol strengthens the conviction of the need for greater environmental monitoring, especially in the wards at high risk.
Subject(s)
Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/microbiology , Environmental Monitoring/methods , Legionellosis/epidemiology , Legionellosis/microbiology , Air Microbiology , Hospitals , Humans , Italy , Risk Assessment , Water MicrobiologyABSTRACT
INTRODUCTION: Two-dimensional strain echocardiography (2D-SE) quantifies left ventricular global longitudinal strain (GLS) and global circumferential strain (GCS). Our aim was to test 2D-SE during dipyridamole stress echocardiography (Dipy-Stress) in patients with non-diagnostic result, checking by way of coronary CT angiography (CCTA) the possible presence of coronary artery disease (CAD). METHODS: Over twenty-four months 65 consecutive patients with non-diagnostic Dipy-Stress were studied by 2D-SE and by CCTA. GCS and GLS at rest and after stress were compared according to data derived from CCTA. CAD was graded as significant (stenosis ≥50%), mild (stenosis between 15 and 50%) or absent (stenosis <15%). CCTA was defined as "positive" in presence of mild CAD and "negative" in absence of stenoses. Furthermore, Δ strain was defined as follows: [(stressS-restS)/restS]×100. RESULTS: GCS at rest and after stress was similar in CCTA-positive (26±5% and 27±5% respectively) and CCTA-negative groups (27±3% and 28±3% respectively). GLS at rest was significantly reduced (P<0.0001) in CCTA-positive (23±3%) compared to CCTA-negative group (25±2%). GLS after stress was lower (P<0.0001) in CCTA-positive group (20±3%) than CCTA-negative one (26±2%). A significant reduction (P<0.0001) of GLS at rest versus after stress was found in positive-CCTA group. ΔGLS showed a significant decrease (P<0.0001) in CCTA-positive (-10±8%) compared to CCTA-negative (4.4±5.8%) group. ROC analysis of ΔGLS showed high accuracy (area under the ROC curve 0.916, 95% CI: 0.820-0.970) in distinguishing positive and negative CCTA groups. CONCLUSIONS: 2D-SE during Dipy-Stress allows, in case of non-diagnostic test, identification of mild-CAD with high sensitivity and specificity.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Echocardiography/methods , Exercise Test/methods , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/physiopathology , Aged , Early Diagnosis , Female , Humans , Male , Middle Aged , Predictive Value of TestsSubject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Disease , Intraoperative Complications , Stents/adverse effects , Aged , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Coronary Artery Disease/physiopathology , Coronary Artery Disease/surgery , Humans , Iatrogenic Disease , Intraoperative Care/methods , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Male , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Treatment OutcomeABSTRACT
The effect of theophylline on atrioventricular conduction in atrial fibrillation was investigated by determining ventricular response rates at rest and during exercise treadmill tests in eight patients (mean [+/- SEM] age, 64.2 +/- 2.0 years) with chronic atrial fibrillation. Tests were performed before and after 7 days of oral theophylline treatment (plasma level, 87.7 +/- 7.8 mumol/L). There was no significant change in baseline ventricular rate or duration of exercise, but the maximum ventricular rate with theophylline treatment was 12.3% +/- 2.4% higher than that with placebo (176.3 +/- 7.5 vs 158.1 +/- 8.8 beats per minute), and, during each stage of exercise, the ventricular rate with theophylline exceeded that with placebo. The increased heart rate during theophylline administration occurred without a significant difference in the exercise-induced increase in circulating plasma catecholamine levels. We conclude that treatment with theophylline may contribute to difficulties with rate control in acutely ill patients with coexisting atrial fibrillation.
