Differential Diagnosis Of Infective Endocarditis Research Articles

The clinical pattern differentiates ANCA-positive infective endocarditis patients from ANCA-associated vasculitis patients: a 23years' retrospective cohort study in China and follow-ups.

ObjectivesPatients with infective endocarditis (IE) may present rheumatic manifestations concurrent with various autoantibodies and thus mimic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aims to characterize the specific features in a long-term cohort of ANCA-positive IE patients and to perform comparative analysis with primary AAV patients.MethodsWe performed a retrospective thorough review of 475 consecutive IE patients over 23 years, identifying 22 patients positive for proteinase 3 and/or myeloperoxidase and 36 treatment-naïve AAV patients. The clinical, laboratory, and follow-up data were collected to perform comparative analysis.ResultsOur study illustrated that ANCA-positive IE patients were younger and had a shorter duration than AAV patients. Pulmonary lesions, ENT signs, peripheral neuropath, and proteinuria were more commonly seen in AAV patients, while heart valve involvement, spleen enlargement, and cerebral hemorrhage were more typical for IE patients (all p < 0.05). Besides, ANCA-positive IE patients presented a higher level of PR3-ANCA but lower C3 (both p < 0.05). Hyperleukocytosis and thrombocytopenia were more frequently found in AAV patients (both p < 0.05). No significant difference was noticed in the survival rate.ConclusionsOur study urges the early differential diagnosis of IE in ANCA-positive patients. It supports the claim that ANCA-positive IE patients and AAV patients do not share the same clinical spectrum. Echocardiography, serological profiles, and evaluation of multi-organ involvement might be required to improve diagnostic accuracy.Key Points•Early differential diagnosis of ANCA-positive IE from AAV is challenging even for expert rheumatologists.•Our study is so far one of the largest to include 22 ANCA-positive IE patients in one single center and spanning over 23 years. It is also the first study to include both ANCA-positive IE patients and AAV patients in one center.•Our study aides to identify a clinical picture to differentiate ANCA-Positive IE Patients from AAV Patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06313-w.

Left Atrial Myxoma Misdiagnosis as Infective Endocarditis: A Case Report

Introduction: Myxomas, as primary cardiac tumors, are rare neoplasms manifesting with constitutional, obstructive, and embolic symptoms. Systemic signs and symptoms make infective endocarditis one of the most common differential diagnoses. Nonspecific systemic signs and symptoms of myxomas can cause great challenges in management and treatment. Case Presentation: A 21-month-old boy was admitted to our center with a high-grade fever and gastrointestinal symptoms, but no significant respiratory complaints were noted. A history of lower limb pain and morning claudication was also present. The patient had leukocytosis with an elevated erythrocyte sedimentation rate (ESR) of two months' duration. Other acute phase reactants were detected despite previous antibiotic therapy; however, his blood culture result was negative. In echocardiography, multiple masses were seen in the left atrium near the mitral valve apparatus. The diagnosis of infective endocarditis was made, and intravenous antibiotics were prescribed for up to two weeks. He then underwent surgery because of poor response to medical treatment and renal complications. During surgery, a small mass was seen in the left atrium, and two other masses were within the mitral chordae. The histopathology report confirmed atrial myxoma. Shortly after surgical resection of the tumors, the patient's symptoms improved, and inflammatory indices returned to normal. Conclusions: Constitutional manifestations of myxoma render it reasonable to consider it as a differential diagnosis of infective endocarditis. Obtaining a complete clinical history and using imaging tools are necessary for the correct diagnosis and prevention of complications of inappropriate treatment.

Cardiac myxoma misdiagnosed as infective endocarditis: a case of Carney complex

BackgroundInfective endocarditis and cardiac myxoma have common features including fever, systemic embolism and intra-cardiac masses. For this reason, these diseases are often misdiagnosed one for another despite proper imaging studies. Herein, we report a case of suspected infective endocarditis in a patient with acute stroke, fever and a mass adjacent to the mitral valve.Case presentationA 24-year-old male patient presented with recurrent fever and stroke. In view of a history of Cushing syndrome and a mobile mass in the left atrium, infective endocarditis was highly suspected. He was transferred for emergency cardiac surgical intervention. During surgery, intraoperative transesophageal echocardiography revealed a 7 cm mass attached to the interatrial septum. The mass was excised through right mini-thoracotomy and pathological examination confirmed the presence of a myxoma. Based on the above clinical findings and genetic analysis, the diagnosis of Carney complex was confirmed.ConclusionsInfective endocarditis and cardiac myxoma have common features and can be misdiagnosed. If a young patient presenting with embolic stroke had a history of an endocrine neoplasm, Carney complex should be considered in the differential diagnosis of infective endocarditis.

PP-444 - Role of Pet-CT in the Differential Diagnosis of Infective Endocarditis After Bentall Procedure

Introduction: The incidence of infective endocarditis following Bentall procedure is reported as 1.2% and the differential diagnosis may be quite challenging as the symptoms may be quite atypical.

An Ineffective Differential Diagnosis of Infective Endocarditis and Rheumatic Heart Disease after Streptococcal Skin and Soft Tissue Infection.

We herein report the case of a 68-year-old woman with a skin and soft tissue infection at her extremities. The blood culture results were positive for Streptococcus pyogenes, and we started treatment using ampicillin and clindamycin, although subsequent auscultation revealed a new-onset heart murmur. We therefore suspected rheumatic heart disease and infective endocarditis. The case met both the Jones criteria and the modified Duke criteria. Transesophageal echocardiography revealed vegetation on the aortic valve, although the pathological findings were also compatible with both rheumatic heart disease and infective endocarditis. The present findings suggest that these two diseases can coexist in some cases.

INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST’S PRACTICE: ISSUES OF ITS CLINICAL PRESENTATION AND DIAGNOSIS

At present, the problem of infective endocarditis (IE) remains relevant for clinicians of different specialties, including rheumatologists. The distinctive feature of present-day IE is its polyetiological pattern due to a broad spectrum of pathogens. The lecture highlights in detail clinical picture of the disease, laboratory and instrumental findings. It presents current international diagnostic criteria for IE. The obvious clinical polymorphism, subtle symptoms, and monosyndromic onset as masks, all increases the significance of differential diagnosis of IE, in early disease stages in particular. Main approaches to differentiating IE from diseases posing the greatest differentially diagnostic challenges are set forth.

Diagnosis of endocarditis caused byMycobacteriumabscessus

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.

Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II)

Infective endocarditis (IE) is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

CE Forum. Differential Diagnosis of Infective Endocarditis

Infective endocarditis (IE) is a deadly disease if left untreated. Early detection and treatment of IE reduces the high mortality rate. Mitral valve prolapse is now the leading risk factor for development of IE. The Duke (1994) criteria includes echocardiography as a diagnostic tool. Outclient i.v. therapy is increasing due to once-daily dosing regimens, which reduces the cost of treatment. Identifying at risk clients and educating them is vital to the prevention of IE. This article familiarizes the primary care provider with the pathophysiology, clinical presentation, diagnostic testing, complications, medical treatment, prophylactic management, and client education of IE.

Clinical Utility of Assays for Circulating Immune Complexes

There are now many assays for the quantification of circulating immune complexes, each with distinct specificity and sensitivity. In a wide variety of rheumatic, infectious, neoplastic, and metabolic conditions, levels of circulating immune complexes may be elevated. In select situations, determination of circulating immune complex levels may help clinicians in the management of their patients. In lupus erythematosus, circulating immune complex levels, in conjunction with other immune parameters, may provide more insight into the disease course and activity than assessment of end organ parameters alone. In the differential diagnosis of infective endocarditis, serial levels of circulating immune complexes may provide evidence of effectiveness or failure of treatment. There is evidence that assays for circulating immune complexes may be of potential benefit in the management of Lyme disease and acute myelogenous leukemia.