Download P 859

Infective Endocarditis due to Bartonella spp and Coxiella burnetti
Comparative Analysis from Prevalence to Management
Presentation Number
859
Mounir Ben Jemaa
E-mail : [email protected]
Phone : +21698290589
Fax : +21674246906
S. Ben Kahla1; L. Abid1; M. Koubaa2; D. Abid1; A. Znazen3;
A. Hammami3; M. Ben Jemaa2; S. Kammoun1
[email protected]
1) Department of Cardiology; Hedi Chaker University Hospital; Sfax Southern Tunisia
2) Department of Infectious Diseases; Hedi Chaker University Hospital; Sfax Southern Tunisia
3) Microbiology Laboratory; Habib Bourguiba University Hospital; Sfax Southern Tunisia
INTRODUCTION
Overall pre-existing cardiac disease was
 Electrocardiogram (EKG) :
 All patients with Coxiella IE had a positive
Blood culture-negative infective endocarditis
mainly recorded in G2 (100% vs. 52%; p=
EKG reveal abnormalities in 60% of patients
serological tests.
(IE) can occur in up to 31% of all cases of IE
0.003) (Figure 2).
when IE was secondary to Bartonella spp
 Molecular biology with PCR of surgical
(Figure 3).
and offen poses considerable diagnostic and
therapeutic dilemmas1.
Bartonella IE
Coxiella IE
75%
Both Bartonella and Coxiella are intracellular
Abnormal EKG
p= 0.032
OR = 6.3
bacteria involved in IE with negative blood
60%
cultures.
p= 0.1
OR = 3.67
P= 0.07
OR= 4.5
Surgical management (%)
G1
G2
p
64
41.7
0.19
Hemodynamic Cpls (%)
83.3
50
0.1
material was performed in 8 patients with
Uncontrolled infection (%)
23.5
50
0.3
Bartonella IE and in 4 patients with Coxiella IE.
Post operative Cpls (%)
68.8
80
NS
Persisting sepsis (%)
36
16.7
0.2
Post operative IE (%)
17.6
16.7
NS
Post operative prosthetic
valve dehiscence (%)
17.6
0
0.5
In summary, IE affected predominantly native
p= 0.03
OR = 12
Table IV: Surgical management and outcome
valve (88% in G1 and 66.7% in G2 ; p= 0.18).
Cpls: complications
OBJECTIVES
33.4%
32%
33.3%
Mean delay of consultation was far longer in
25%
We aim to compare patients with infective
4%
endocarditis (IE) due to Bartonella spp and
Coxiella
burnetti
prevalence,
clinical
regarding
their
presentation
and
patients with Coxiella IE (158.4 ± 229 days vs.
12%
Bartonella IE
Rheumatic Heart Disease Congenital Heart Disease
Figure 2: Major pre-existing cardiac disease
encountered in our population
 Clinical features :
• A retrospective study (1994 - 2013)
• N= 290 patients with IE diagnosed according
 Imaging tests :
 Regarding in-hospital stay, there was no
Patients with Coxiella IE performed abdominal
difference between 2 groups as mean duration
ultrasound
of hospitalization was 50.7 ± 39 days in G1 and
exam
and
cerebral
computed
There was no clinical particularities between 2
tomography in 83.3% and 41.7% respectively
groups unless pallidness which was more
(Figure 4).
Coxiella IE
Empirical antibiotics:
outlined in patients with Coxiella IE (Table I).
• Comparative analysis between 2 groups:
– G2= Coxiella burnetti IE ; 12 patients
Table I: Comparison of clinical characteristics
G1
G2
p
Dental portal of entry (%)
24
16.7
NS
Previous antibiotic (%)
12
33.3
0.1
Fever >38°C (%)
80
66.7
0.4
Heart murmur (%)
84
83.3
NS
Pallidness (%)
8
58.3
0.002
Renal failure* (%)
28
41.7
NS
Systemic embolism* (%)
4
25
0.09
Hemodynamic Cpls* (%)
60
25
0.07
Neurological Cpls* (%)
4
16.7
0.2
• Among overall study population, penicillins
 Prevalence : Bartonella spp. IE was twofold
patients respectively. They had Bartonella IE in
41.7%
more frequent than Coxiella IE (Figure 1).
Prevalence (case per year)
1.25
3.67
8%
8
4.8
Cpls: complications; *: At admission
 Biological findings
0.6
White
blood
cells
:
was
the
sole
noted between 2 groups (Table II).
Figure 1: Prevalence of Bartonella and Coxiella IE
 Sex Ratio : Men were far more affected in 2
groups (Sex ratio was 3.1 in G1 vs. 3 in G2; p=
NS).
 Mean age : 40.6 ±12 years in G1 and 44 ± 15
years in G2 (p= NS).
G1
White blood cells (E/mm3)
www.PosterPresentations.com
p
0.03
78 ± 40
65 ± 43
0.4
C reactive protein (mg/l)
50.4 ± 40
64 ± 54
0.4
Hemoglobin (g/dl)
9.32 ± 1.9
10.1 ± 3.2
0.3
Serum creatinin (µmol/l)
153 ± 148
130 ± 96
0.6
ESR (mm)
ESR: Erythrocyte Sedimentation Rate
RESEARCH POSTER PRESENTATION DESIGN © 2015
G2
9998 ± 4230 6643 ± 3869
Bartonella IE (Follow up duration was at mean
Conversely, no patient with Coxiella IE had
633 ± 457 days.
COMMENTS & CONCLUSION
Blood culture-negative IE exhibits a great
challenge and imply collaborative approach of
cardiologist, infectious disease specialist and
• Only 3 patients in G2 were treated with
microbiologists. The ‘Endocarditis team’ is
Doxycyclin and hydroxychloroquine.
newly born in the lastest European guidelines
echocardiographic finding in both groups (Table
• Mean period of treatment was far longer in G2
dealing with IE1.
III).
(742 ± 429 vs. 54 ± 38 days; p<0.0001).
Many differences are exhibited through this
 Echocardiography:
Vegetation
was
the
most
important
study regarding epidemiological and clinical
G1
G2
p
70.8
83.3
0.6
Aortic position (%)
64
50
0.4
Mitral position (%)
56
25
0.09
Valvular abscess (%)
12
0
NS
Vegetation (%)
Valvular perforation (%)
Table II: Comparison of biological findings
 Recurrence rate was 8% among patients with
 Second line antibiotic therapy:
Figure 4: Need for imaging exams in our population
finding
IE. Elsewhere, similar biological findings were
Coxiella IE
• Fluoroquinilones were used in 23 patients.
Cerebral computed tomography
Table III: Echocardiographic assessment
significantly higher in patients with Bartonella
Bartonella IE
83.4 and 68% of cases respectively.
Abdominal ultrasound exam
16.1
(29% in G1 vs. 28% in G2; p= NS).
P= 0.02
32%
RESULTS
•Late mortality rate was similar in both groups
and gentamicin were prescribed in 18 and 23
P= 0.005
OR
(24% in G1 vs. 16% in G2; p= NS).
reccurence with a mean follow up duration of
83.3%
– G1= Bartonella spp EI ; 25 patients
58.1 ± 38 days in G2 (p=0.6).
• In hospital mortality was equally recorded
32 ± 50 days)
Bartonella IE
to modified Duke’s criteria.
p=0.013).
Figure 3: EKG findings in our population study
management.
METHODS
5.6 ± 7.3 days when Bartonella spp. was implied;
Coxiella IE
Mechanical Prosthesis
 Mortality rate:
10
•Referral to surgery:
No difference was outlined between 2 groups
regarding the need of surgical correction of IE
8.3
0.6
devastating damage. The main reasons leading
to surgery was hemodynamic complications
Aortic annular abscess (%)
8
0
NS
Mitral chordea rupture (%)
20
8.3
0.6
Prosthetic valve vegetation (%)
8
25
0.3
Prosthetic valve dehiscence (%)
4
16.7
0.2
(Table IV).
features as well as severity of complications
although mortality rate didn't exhibit any
difference between Bartonella and coxiella
burnetti IE.
REFERENCES
1) 2015 ESC Guidelines for the management of infective endocarditis
Authors/Task Force Members, Gilbert Habib, Patrizio Lancellotti, Manuel J.
Antunes, Maria Grazia Bongiorni, Jean-Paul Casalta, Francesco Del
Zotti, Raluca Dulgheru, Gebrine El Khoury, Paola Anna Erba, Bernard
Iung, Jose M. Miro, Barbara J. Mulder, Edyta Plonska-Gosciniak, Susanna
Price, Jolien Roos-Hesselink, Ulrika Snygg-Martin, Franck Thuny, Pilar
Tornos Mas, Isidre Vilacosta, Jose Luis Zamorano
European Heart Journal Aug 2015, DOI: 10.1093/eurheartj/ehv319