Lec7 các vi khuẩn thấp tim, nội tâm mạc, xét nghiệm vi sinh

CÁC VI KHUẨN THƯỜNG GẶP GÂY THẤP TIM, VIÊM NỘI TÂM MẠC VÀ CÁC XÉT NGHIỆM VI SINH CHẨN ĐOÁN Phạm Hồng Nhung Bộ môn Vi sinh, Đại học Y Hà Nội Khoa Vi sinh, Bệnh viện Bạch Mai MỤC TIÊU Trình bày đặc điểm sinh học, chế gây thấp tim S pyogenes Trình bày xét nghiệm vi sinh sử dụng cho chẩn đốn thấp tim Trình bày nguyên gây viêm nội tâm mạc Phân tích giá trị phương pháp chẩn đốn viêm nội tâm mạc CĂN NGUYÊN GÂY THẤP TIM CÁC XÉT NGHIỆM VI SINH CHẨN ĐỐN Thấp tim • Thấp tim tình trạng van tim bị thương tổn vĩnh viễn xảy sau hay nhiều đợt viêm họng hay sốt ban đỏ do nhiễm Streptococcus pyogenes không điều trị điều trị không cách Phân loại học streptococci Organism Direct invasion and inflammation Local spread Distant spread Distant toxin effects Immune mechanisms Strep pyogenes Throat, wound and burn infections Puerperal sepsis Erysipelas Septicaemia Scarlet fever Rheumatic fever Glomerulonephritis Strep agalactiae Neonatal pneumonia Puerperal sepsis Abscess Neonatal meningitis Enterococci Urinary tract infection Abscess Endocarditis Septicaemia Strep pneumoniae Bronchitis Pneumonia Septicaemia Meningitis Strep viridans Caries resistant enterococci, are increasingly common Phân loại học streptococci • Dựa vào cấu trúc carbohydrate C ở vách • Dựa vào đặc điểm tan máu nuôi cấy Endocarditis Bacteraemia Streptococci Control A multivalent pneumococcal vaccine is used to protect those particularly at risk, Lancefield groups including splenectomised and immunocompromised patients Locating carriers (nose, throat, skin or perineal carriage) is important in controlling outbreaks, A B orCclosed D com T especially in hospitals munities Others U α Streptococcus bovis or γ Capsule Hyaluronic acid Cell wall Protein antigens Group-specific carbohydrate Streptococci and enterococci ■ ■ ■ ■ ■ ■ Peptidoglycan layer Cytoplasmic membrane Fig Structure of Strep pyogenes ■ Streptococcus agalactiae β Streptococci are Gram-positive cocci, usually growing in chains, Streptococcus pyogenes β facultative anaerobes, nutritionally fastidious and catalase negative Enterococci are more resistant than streptococci to bile, salt and antibiotics Identification depends on Gram stain, haemolysis, biochemicalpneumoniae tests α Streptococcus and Lancefield grouping The complex cell wall and enzymes and toxins have importantmutans α Streptococcus or functions, including adhesion, virulence and spread γ Strep pyogenes and Strep pneumoniae are aggressive pathogens, invasive and virulent even in normal hosts.Key: Other streptococci are opportunistic pathogens, i.e normal flora that α α hosts = α-Hemolytic cause disease in abnormal sites or abnormal Disease is caused by invasion and spread,βtoxin effects and immune or = α or γ hemolytic = β-Hemolytic γ mechanisms γ = γ-Hemolytic II S p p m in S a e s ro c b a A capsulated (Fig 1c) C Đặc điểm sinh học • Cầu khuẩn, Gram dương • Xếp thành chuỗi • Catalase âm tính ification of Significant Isolates • Hiếu kỵ khí tùy tiện Pe St (F st by ■ (a) Capsule T Teichoic acid S pyogenes Cell membrane Liên cầu tan máu ß nhóm A (b) S (b S S E S S S Extracellular products: Like Staphylococcus aureus (see p 70), 108 S pyogenes secretes a wide range of exotoxins that often vary from one strain to another and that play roles in the pathogenesis of disease caused by these organisms (Figure 9.4) Clinical Bacteriology Yếu tố độc lực 108 Dissolves fibrin in clots and thrombi Apoptosis inhibits phagocytosis EGRATED REVIEW OGY AND BIOLOGY Tissue necrosis Pyrogenic exotoxins The only known reservoir for S pyogenes in nature is the skin and Inflammation Immune Activationdroplets or skin mucous membranes of theand human host Respiratory contact spreads group A streptococcal infection from person to person, especially in crowded environments such as classrooms and children’s play areas Tissue necrosis Exotoxin B Streptolysin O, S Lysis of RBCs, WBCs, platelets Lysis of RBCs, WBCs, platelets Toxins and Hemolysins Toxins and Hemolysins Capsule, ISBN: 978-0-323-07447-6 Damage mammalian cells, resulting in cell lysis and release of lysosomal enzymes Fibrin clot Plasmin Streptokinase Catalyzes conversion of plasminogen to plasmin, causing lysis of clots, facilitating the rapid spread of organisms C5a C5 C5a C5a peptidase Inactivates complement component C5a Prevents phagocytosis, Exotoxins, M-protein allows attachment : Pharyngitis is the most Acute pharyngitis or pharyngotonsilitis to tissue superantigens common type of S pyogenes infection S pyogenes pharyngitis (exotoxin A)(“strep throat”) is associated with severe, purulent inflammation of Exotoxins, superantigens the posterior oropharynx and tonsillar areas (see Figure 9.16) (exotoxin A) If a sunburnlike rash develops on the neck, trunk, and [Note: extremitiesactivator in response to the release of pyrogenic exotoxin to Mitogenic which the patient does not have antibodies, the syndrome is desof T cells Mitogenic ignated scarletactivator fever.] Many strep throats are mild, and many sore of T cells throats caused by viruses are severe Hence, laboratory confirmation is important for accurate diagnosis and treatment of streptococcal pharyngitis, particularly for the prevention of subsequent acute rheumatic fever and rheumatic heart disease JeffreyFigure K Actor, PhD 12-2 Pathogenic formechanisms group A streptococci (Streptococcus pyogenes) RBCs, red cells;WBCs, WBCs, white Figuremechanisms 12-2 Pathogenic for group A streptococci (Streptococcus pyogenes) RBCs, redblood blood cells; white Professor ELSEVIER’S INTEGRATED REVIEW IMMUNOLOGY blood cells blood cells AND MICROBIOLOGY, EDITION Medicine partment of Pathology SECOND and Laboratory Streptolysin O Streptolysin S phagocytosis, peptidase Prevents Inhibits complement D Capsule, ClinicalC5a significance anaphylatoxin M-protein allows attachment S pyogenes is a major cause cellulitis Other more specific syntooftissue Streptococcus dromes include: Streptolysin O, S Cause various effects, including the rashes seen in scarlet fever and streptococcal toxic shock disease C Pathogenesis Allows spreading in S pyogenes cells, perhaps in an inhaled droplet, attach to the pharynsubcutaneous tissue Inflammation and Immune Activation geal mucosa via actions of protein F, lipoteichoic acid, and M protein The bacteria may simply replicate sufficiently to maintain themselves without causing injury in which case the patient is then considered colStreptokinase Dissolves fibrin in onized Alternatively, bacteria may grow and secrete toxins, causing Erythrogenic toxins (fibrinolysin) clots and thrombi damage to surrounding cells, invading the mucosa, and eliciting an Apoptosis inhibits (pyrogenic toxins) Hyaluronidase phagocytosis inflammatory with attendant influx of white cells, fluid leakAllows response spreading in subcutaneous tissueThe patient then has streptococcal pharyngiage, and pus formation tis Occasionally, there is sufficient spread that the bloodstream is Streptokinase Streptodornase Depolymerizes significantly invaded, possibly resulting in septicemia and/or seeding Erythrogenic toxins (fibrinolysin) (DNAase) DNA(acute in necrotic of distant sites, where cellulitis inflammation of subcutaneous (pyrogenic toxins) Hyaluronidase tissue tissue), fasciitis (inflammation of the tissue under the skin that covers a surface of underlying tissue), or myonecrosis (death of muscle cells) Toxemia, Exotoxin B C5a peptidase Inhibits complement may develop rapidly or insidiously However, direct inoculation of skin skin rash Streptodornase Depolymerizes anaphylatoxin from another person's infection probably more common as the (DNAase) DNA is in necrotic Streptococcus pathogenesis of streptococcal skintissue and soft tissue infection SECOND EDITION 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 Cytokines B Epidemiology Clinical Bacteriology Toxemia, skin rash Streptococcus pyogenes Impetigo: Although S aureus is recovered from most contemporary cases of impetigo (see p 72), S pyogenes is the classic cause of DNA Streptodornases DNAses that degrade the viscous DNA in necrotizing tissue or exudates, aiding the spread of infection Hyaluronic acid Hyaluronidase Disrupts the organization of ground substance, facilitating the spread of infection (group A, β-hemolytic) 4All isolates remain sensitive to penicillin G and ampicillin Acute pharyngitis or 5In life-threatening infections, an aminopharyngotonsillitis glycoside can be added to the regimen (group B, β-hemolytic) • • Acute rheumatic fever • Erysipelas sepsis • Puerperal group A streptococcal • Invasive disease 6Penicillin G has been the drug of choice, but resistant are regularly seen Meningitis andstrains septicemia in neonates 7Most resistant strains remain sensitive Endometritis to vancomycin • • Septicemia or pneumonia • in individuals with impaired Khả gây bệnh • immune systems Diabetic foot infections • Acute bacterial pneumonia • Otitis media • Meningitis Penicillin G6 Cefotaxime Penicillin Penicillin G1,2 (α-hemolytic) G4 Ceftriaxone Clarithromycin • Viêm họng Azithromycin An aminoglycoside5 Vancomycin7 pyogenes has not acquired resistance to •1S.penicillin Nhiễm khuẩn da mủ G 2Clindamycin may be added to pencillin G for soft tissue infection such as necrotizing fasciitis 3For penicillin-allergic patient • Hội chứng shock độc tố Impetigo • Các biến chứng sau nhiễm 4All isolates remain sensitive to penicillin G and ampicillin 5In life-threatening infections, an aminoglycoside can be added to the regimen 6Penicillin G has been the drug of choice, but resistant strains are regularly seen 7Most resistant strains remain sensitive to vancomycin Streptococcal pharyngitis S pyogenes dicates first-line drugs; indicates alternative drugs Facial erysipelas Impetigo Streptococcal pharyngitis Cơ chế gây bệnh • Tổn thương van tim • 100 0.1 0.01 References 124 Hébert and Bloch, 1921 ? 25% 67% 8% 0%? < > -< -> < > < - Typhoid fever 12 Reynes, 1947 ? 54% 13% 7% 8% 17% < > -< -< > -> < > < - Watson and Pietermaritzburg, 1955 ? 7% 67% 26% 0%? < > -< -> < -> < - Werner et al., 1967 ? 0%? 24% 34% 15% 17% < - < > < > -< > < Henry et al., 1983 ? 41% 16% 42% < > -< > < -> Kiehn et al., 1983 ? 54% 28% 11% 6% < > -< > < > < Wain et al., 1998 25% 28% 34% 12% 1% < -> -< -> < > < -> < Any type of bacteriemia ? 35% 39% 16% 10% < > -< -> < > < Warren and Herrick, 1916 Any type of bacteriemia 1026 Typhoid fever 15 Infective endocarditis 206 Any type of bacteriemia 61 Any type of bacteriemia 385 Typhoid fever 349 All studies from this table performed colony count using the pour plate or spread plate technique As methodology varies between studies, concentration range and categories vary Of ? 54% 28% 11% 6% < > -< > < > < Kiehn et al., 1983 Thể tích máu cấy 25% 28% 34% 12% 1% < -> -< -> < > < -> < Wain et al., 1998 Any type of bacteriemia 385 Typhoid fever 349 All studies from this table performed colony count using the pour plate or spread plate technique As methodology varies between studies, concentration range and categories vary Of note, the quality and fertility of culture media may have varied between 1916 and 1998 TABLE | Fungal concentration in blood from bloodstream infection Fungal concentration 0.1 0.01 10 Type of patients 50 References 100 >100 36% 26% 38% < > < > -< Kiehn et al., 1983 47% 30% 15% 8% < > < > -< > < - Bille et al., 1984 52% 48% < -> < > Kiehn, 1989 26% 28% 24% 22% < > < -> < > < Pfeiffer et al., 2011 19% 35% 21% 12% 13% < -> < -> < -> -< > < Henry et al., 1983 have long been similar (Baron et al., 2005b) Recent ASM/IDSA joint guidelines for adults recommend 20–30 mL of blood per Number of patients Adult only 61 – 91 – 23 Immunocompromised patient 68 Adult and children 152 For optimal recovery, each BC set should include paired aerobic and anaerobic bottles, the aerobic bottle being filled first One exception must be outlined: for the diagnosis of central line associated BSI (CLABSI), most current guidelines recommend simultaneous sampling of BC drawn from the suspected catheter, and through a venipuncture, to be able to estimate the differential time to positive BC (Baron et al., 2013; Dellinger et al., 2013) Indeed, if BC drawn from the central line grows at least h earlier than BC drawn from venipuncture, the central line is most likely the source of BSI (Kirn and Weinstein, 2013) However, improper collection of BCs is associated with 100 potential over-reporting of CLABSI (Kaasch et al., 2014; Garcia 90 et al., 2015) techniques for Despite concordant recommendations,8 the collection of BCs vary across countries 7in0 routine practice A study performed in intensive care units across European 60 countries found that the preferred means for BCs collection % Re la t ive 0and Italy (42 and were peripheral venipuncture in Germany 76% via peripheral venipuncture, Y ie ld respectively, vs and 0% via intravenous catheter, while 50 and 24% reported no preference), 30 while sampling through intravenous catheter was more common via intravenous in France and the UK (respectively, 33 and223% 10 catheter, vs 20 and 23% via peripheral venipuncture, while 47 and 54% reported no preference; Schmitz et al., 2013) Thể tích máu cấy Impact of Volume Sampled on BCs5Yield 10 15 Data available could be summarized as follows: “The higher the blood volume cultured, the higher the yield.” Indeed, adequate volume sampling is the most important parameter for the in Pfeiffer et al.’s study, 53% of 152 patients had a fungal density of less than CFU/mL (Pfeiffer et al., 2011) Overall, data from modeling, as well as clinical studies are remarkably concordant: 50% of BSI episodes are associated with a bacterial concentration in the range of 0.01–1 CFU/mL (Tables 1, 2) Comparing the yield of standard-volume BC (mean, 8.7 mL), and low-volume BC (mean, 2.7 mL), a study from the Wisconsin Hospital and Clinics demonstrated that the sensitivity of BCs for the diagnosis of BSI was 92% with standard-volume, and 69% with low-volume (difference of 23%, [95% CI, 9–37%]; P< 0, 001; Mermel and Maki, 1993) Examining 7783 BCs, including 624 classified as true positive BCs, Li et al (1994) demonstrated that increasing the volume of blood cultured from 20 to 40 mL increased the yield by 19%, with an additional gain of 10% when the incubated volume was increased from 40 to 60 mL (Li et al., 1994) Since then, several studies have confirmed that the volume of blood cultured is the key parameter of BC yield (Cockerill et al., 2004; Patel et al., 2011) The most recent studies showed that sampling blood volumes of 20, 40, and 60 mL was associated with sensitivities of 65.0–75.7%, 80.4–89.2%, and 95.7–97.7%, respectively (Cockerill et al., 2004; Bouza et al., 2007; Lee et al., 2007; Patel et al., 2011) Of note, since Washington’s seminal works (Washington, 1975), 2the5 recommended 3 0volume of5 0blood 5to 6be0 cultured gradually increased over decades This increase resulted both from the need to develop (and accept) the concept of culturing m l of blood, and from the study design on which data larger volumes Sepsis Diagnosis: Workflow Order Culture Collect Specimen Send to Lab Accession Specimen Remove Bottle and Process Bottle Signaled Positive Place in Blood Culture Instrument Incubator Huyết học chẩn đốn • C burnetii: hiệu giá kháng thể ≥ 1:800 có giá trị chẩn đốn • Bartonella • Phản ứng chéo Chlamydia với Bartonella • Huyết học chẩn đốn khơng khuyến cáo sử dụng cho nguyên VNTM hiếm gặp Legionella, Chlamydia do có thể có dương tính giả Ni cấy mảnh sùi van tim • Can thiệp phẫu thuật van tim định 2553% các trường hợp viêm nội tâm mạc • VNTM cấy máu dương: khơng cần thiết • VNTM cấy máu âm: độ nhạy (6-26%) và độ đặc hiệu thấp PCR mảnh sùi van tim • PCR đặc hiệu • PCR đa nguyên (16S rDNA) • Streptococci và enterococci: 45-60% • Staphylococci: 15-23% • Căn nguyên khác: Enterobacteriaceae, Candida • HACEK: 4% Rebecca Godfrey, PCR mảnh Authors: sùi van tim Clinical Medicine 2020 Vol 20, No 4: 412–6 REVIEW A B Rebecca Godfrey, Sally Curtis, WilliamCHK Schilling and P Rachael James Authors: Sally Curtis, William HK Schilling and P Rachael Jame A B C D B C D A B C D ABSTRACT ABSTRACT A ABSTRACT ABSTRACT The patient was treated with high dose intr Blood culture negative endocarditis (BCNE) accounts for up to Blood culture negative endocarditis in the modern era of and gentamicin and clinically improved Co 20% of infective endocarditis While the most common cause was negative and the patientof was negative of BCNE remains the initiation of antibiotics prior to culture, Blood culture negative endocarditis in the modern era 16S rRNA sequencing Currently there are no serological tests for B intracellular organisms such as Coxiella and Bartonella spp UK A diagnosis of blood culture negative e account for a significant proportion of cases Identifying 16S rRNA sequencing and the excised treated valve tissue was referred The patient was withfo the infecting organism remains optimal Blood culture negative endocarditis (BCNE) accounts for upimportant to to ensure 16S ribosomal ribonucleic acid (rRNA) bact antimicrobial treatment However, these organisms can be Authors: Rebecca Godfrey, Sally Curtis, William HK Schilling and P Rachael James reaction (PCR) analysis positive for Bar difficult to diagnose Wecause outline a systematic approach and togentamicin andwas clinically 20% of infective endocarditis While the most common causative pathogen of cat scratch disease BCNE Sally Over half of patients with endocarditis now James Authors: Rebecca Godfrey, Curtis, William HKinfective Schilling and P Rachael was changed to doxycycline 100 mg twice early surgery and 16S ribosomal ribonucleic acidnegative was and the patient of BCNE remains the initiation of antibioticsundergo prior to culture, This regimen has increased efficacy in treat (rRNA) polymerase chain reaction (PCR) of excised tissue can The patient was treated with high dose intravenous amoxicillin Blood culture negative endocarditis (BCNE) accounts for up to endocarditis and is advised by the Europea be vitally important to secure a diagnosis Molecular testing is and gentamicin and clinically improved Coxiella burnetii serology 20% of infective endocarditis While the most common cause Currently there are noamoxicillin serolog intracellular organisms such as Coxiella and Bartonella spp The patientfrom was BCNE treated with high doseThe intravenous guidelines patient was discharged on Blood culture negative endocarditis (BCNE)aaccounts forimproving up to likely to become key tool in outcomes was negative and the patient was negative for HIV infection of BCNE remains the initiation of antibiotics prior to culture, and gentamicin and clinically improved Coxiellaand burnetii serology 20% of infective endocarditis the most cause complete treatment made a full recove and While contribute to ancommon improved understanding of the aetiology Currently there are no serological tests for Bartonella spp in the intracellular organisms such as Coxiella and Bartonella spp UK A of blood account for a significant proportion of cases Identifying was negative and thediagnosis patient was for HIV infection of BCNE remains the initiation of antibiotics prior to culture, that thenegative patient’s partner worked cultu for a cat We advocate modifying the Duke criteria to incorporate UK A diagnosis of blood culture negative endocarditis was made account for a significant proportion of cases Identifying Currently there are no serological tests for Bartonella sppfor in the intracellular organisms such as Coxiella and Bartonella spp testing, occasionally they would care abandone organisms identified on molecular including 16S rRNA and the excised valve tissue was referred for molecular sequencing the infecting organism remains important to ensure optimal andofthe excised valve tissue wb blood culture negative endocarditis was made the infecting organism remains account important optimal for a significantto proportion of cases.from Identifying Bartonella spp are a recognised cause of PCR,ensure in particular explanted tissue UK A diagnosis 16S ribosomal ribonucleic acid (rRNA) bacterial polymerase chain antimicrobial treatment However, these organisms can be and the excised valve tissueendocarditis was referred(BCNE) for molecular sequencing the infecting organism remains important to ensure optimal Although six Barton reaction (PCR) analysis was positive for Bartonella henselae, the difficult to diagnose We outline a systematic approach to acid (rRNA) bacterial polymeraseinchain antimicrobial treatment However, these organisms can 16S ribosomal ribonucleic acidB KEYWORDS: Endocarditis, 16Sribosomal rRNA, PCR,ribonucleic to cause infective endocarditis humans, antimicrobial treatment However, these organisms can culture bebenegative,16S causative pathogen of cat scratch disease The antibiotic regimen BCNE Over half of patients with infective endocarditis now reaction (PCR) analysis wasand positive for Bartonella the by hu difficult to diagnose We outline a systematic Bartonella henselae approach to Bartonella quintanahenselae, (transmitted was changed to doxycycline 100 mg twice daily and gentamicin undergo early surgery and 16S ribosomal ribonucleic acid pathogen of cat (PCR) scratch disease The antibiotic BCNE Over half of patients with infective endocarditis historically called ‘trench fever’,regimen now increa reaction analysis was po difficult diagnose We outline a systematic approach tonow causative Thisto regimen has increased efficacy in treating Bartonella spp (rRNA) polymerase chain reaction (PCR) of excised tissue can was changed to doxycyclinehomeless 100 mg twice daily and gentamicin undergo early surgery andDOI: 16S 10.7861/clinmed.2019-0342 ribosomal ribonucleic acid population) account for 95% of c endocarditis and is advised by the European Society of Cardiology be vitally important to secure a diagnosis Molecular testing is regimen has increasedincreasingly in treating Bartonellaas spp polymerase chain reaction (PCR) of excised tissue can being recognised a cause causativebyefficacy pathogen of cat scrof BCNE Over ofwaspatients with(rRNA) infective endocarditis now This guidelines half The patient discharged on oral doxycycline to likely to become a key tool in improving outcomes from BCNE endocarditis and is advised Most thepatients European Society of Cardiology be vitally important to secure a diagnosis Molecular testing is have pre-existing valvular dis complete treatment and made a full recovery We discovered and contribute to an improved understanding of the aetiology guidelines The patient wasand discharged on oralBartonella doxycycline likely to become a key tool in improving outcomes from BCNE infection with spptotypically1 r Case presentationacid was changed towith doxycycline undergo early 16S ribonucleic that the patient’ssurgery partner worked forand a cat rescue centreribosomal and contribute to an improved We advocate modifying the Duke criteria to incorporate complete treatment and made a full recovery and understanding of the aetiology endocarditis a We highdiscovered incidence of valve occasionally they would care for abandoned cats at home organisms identified on molecular testing, including 16S rRNA A 34-year-old man worked as a delivery driver was partner worked that theand patient’s cat series rescue centre and We advocate modifying the Duke criteria to who incorporate as 80%forinaone This case highlig Bartonella spp are a recognised cause of reaction blood culture organisms negative This has increased ef PCR, in particular from explanted tissue (rRNA) polymerase chain (PCR) ofon molecular excised tissue can usually fittesting, and well, was admitted with a two-week history of regimen occasionally they would care for abandoned cats at home identified including 16S rRNA history taking even in the modern era as be endocarditis (BCNE) Although six Bartonella spp are known breathlessness was afebrile, had Bartonella spp are a recognised cause of blood culture negative PCR, in particular from explanted tissue.on exertion and a dry cough He or coming into contact with cat fleas are im KEYWORDS: Endocarditis, culture negative, 16S rRNA, PCR, to cause infective endocarditis to in humans, Bartonellaa hensalae endocarditis isspp advised by signs of severe aortictesting regurgitation andis pulmonary congestion endocarditis (BCNE) Although sixand Bartonella are known The be vitally important secure diagnosis Molecular Bartonella hensalae infection se Bartonella henselae and Bartonella quintana (transmitted by human body lice and KEYWORDS: Endocarditis, culture negative, 16S rRNA,stigmata PCR, There were no peripheral of endocarditis tests to causeBlood infective endocarditis in humans,was Bartonella hensalae for1 Bartonella withdrawn in the UK in called ‘trench increasingly in the Bartonella henselaeoutcomes and protein Bartonella quintana (transmitted by human body(personal lice and showed white blood cells 7.2×10 /L, C-reactive 33 mg/L, guidelines The patient was d likely tohistorically become afever’, keynowtool infound improving from BCNE by Public Health England commu DOI: 10.7861/clinmed.2019-0342 homeless population) account for 95% of cases Bartonella is historically ‘trench fever’, now increasingly found haemoglobin 92 g/L and creatinine 151 µmol/L He wascalled started Brown, Reference Lab 2019).in Atthe least one la increasingly being recognised as a cause of endocarditisDOI: in the10.7861/clinmed.2019-0342 UK population)aaccount for 95% of cases to aBartonella is on diuretics and transthoracic echocardiography demonstrated complete treatment and mad samples for serology French research la and contribute to an improved understanding of the aetiology.homeless Most patients have pre-existing valvular disease as in this case increasingly being recognised as a cause endocarditis in the UK bicuspid aortic valve with severe aortic regurgitation and several relatively largeofnumber of cases of Bartone and infection with Bartonella spp typically results in destructive Mostunderwent patients have valvularThe disease as in this case up to 1.8 cm in length The patient an pre-existing Case presentation population contemporary diagnosis of that the patient’s partner wor We advocate modifying the Duke criteria tovegetations incorporate endocarditis with a high incidence of valve replacement, as high and infection with Bartonella spp typically results in destructive urgent aortic valve replacement on haemodynamic grounds Case presentation in the UK is made predominantly through m A 34-year-old man who worked as a delivery driver and was a high incidence of valve replacement, as high as 80% in one series This case highlights the importance of Several sets of peripheral blood cultures were negative.with There of infected tissue or from culture.care The latterf occasionally 34-year-old man who worked as a delivery driver and was usually fit and well, was admitted with a two-week history of organisms identified on testing, including 16S rRNA endocarditis as 80% in one series This casethey highlightswould the importance of history taking even in the modern era asmolecular being scratchedAby a cat, was no history of antibiotic administration in the community and thus rarely performed Bartonella speci usuallyfor fit and well, was admitted with a two-week history of breathlessness on exertion and a dry cough He was afebrile, had history taking even in the modern era as being scratched by a cat, or coming into contact with cat fleas are important risk factors sensitivity from valve tissue of up to 92% breathlessness on exertion and a dry cough He was afebrile, had signs of severe aortic regurgitation and pulmonary congestion Bartonella spp are ariskrecogni PCR, inBartonella particular from The explanted tissue or coming into contact with cat fleas are important factors for hensalae infection serodiagnostic service signs of severe aortic regurgitation andcardiology pulmonary congestion There were no peripheral stigmata of endocarditis Blood tests hensalae The serodiagnostic Authors: fellow, Sussex CardiacBartonella Centre, Brighton, UK;infection for Bartonella was withdrawn in the UK in 2015 following a review 2,3service Introduction There were no peripheral stigmata of endocarditis Blood tests showed white blood cells 7.2×10 /L, C-reactive protein 33 mg/L, for Bartonella was withdrawn in the(BCNE) UK in 2015 following aAlthou review endocarditis microbiology consultant, Brighton and Sussex University Hospitals by Public Health England (personal communication with Dr Colin showed white blood cells 7.2×10 /L, C-reactive protein 33 mg/L, 2,3 1 3,4,6,8 2,3 2,3 3,4,8–10 4–6 4–6 3,4,6,8 3,4,6,8 11 3,4,8–10 A B 3,4,8–10 Những thách thức VNTM • Tăng đề kháng nguyên cầu khuẩn Gram dương thuộc vi hệ • Đề kháng do biofilm • Sự thay đổi phổ nguyên gây bệnh (Bartonella, T whipplei, nấm…) • Sự thay đổi xu hướng dịch tễ đối tượng VNTM (BN HIV/AIDS, trẻ em tim bẩm sinh, người đeo khuyên thể…) ... NGUYÊN GÂY VI? ?M NỘI TÂM MẠC CÁC XÉT NGHIỆM VI SINH CHẨN ĐỐN Định nghĩa • Vi? ?m nội tâm mạc nhiễm trùng vi? ?m bề mặt nội tâm mạc • Phân loại chính: • Vi? ?m nội tâm mạc van tim tự nhiên • Vi? ?m nội tâm mạc... điểm sinh học, chế gây thấp tim S pyogenes Trình bày xét nghiệm vi sinh sử dụng cho chẩn đoán thấp tim Trình bày nguyên gây vi? ?m nội tâm mạc Phân tích giá trị phương pháp chẩn đoán vi? ?m nội tâm. .. vi? ?m nội tâm mạc CĂN NGUYÊN GÂY THẤP TIM CÁC XÉT NGHIỆM VI SINH CHẨN ĐỐN Thấp tim • Thấp tim tình trạng van tim bị thương tổn vĩnh vi? ??n xảy sau hay nhiều đợt vi? ?m họng hay sốt ban đỏ do nhiễm