Imed Frikha

Endocarditis Due to Kytococcus schroeteri: Case Report and Review of the Literature

ABSTRACT We report the third case of endocarditis caused by the newly described micrococcal species Kytococcus schroeteri. A 49-year-old woman was admitted to the hospital with suspected prosthetic valve endocarditis. Five blood cultures and prosthetic valve cultures grew the same type of organism, initially identified as Micrococcus sp. Assignment to the genus Kytococcus was suggested by the arginine dihydrolase activity and resistance to oxacillin. After sequencing of the 16S rRNA genes, the isolate was recognized as K. schroeteri. The patient was treated first with vancomycin combined with gentamicin and later with pristinamycin and rifampin. Three cases of K. schroeteri endocarditis described within a short period of time might indicate a specific pathogenicity of this new species. The isolation of kytococci from normally sterile sites should not be overlooked.

Prosthetic valve endocarditis: management strategies and prognosis: A ten-year analysis in a tertiary care centre in Tunisia.

Background Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined.Objective To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short- and midterm outcome in a tertiary care centre in a developing country (Tunisia).Methods All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria.Results A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09).Conclusion PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach. (Neth Heart J 2009;17: 56-60.)

Short- and long-term outcomes of surgery for active infective endocarditis: a Tunisian experience

From January 1997 to December 2006, all patients with a Duke criteria-based definite diagnosis of infective endocarditis (IE) operated on during the active phase in a Tunisian high volume tertiary-care centre were included. Among the 186 patients with IE identified during the study period, 88 (48.35%) required surgery in the active phase. Mean age was 34.9 years, 54 (61.4%) were men. The infected valve was native in 70 cases (79.5%) and prosthetic in 18 (20.5%). Streptococcus sp. were the most common causative microorganisms. The most frequent indication for operation was congestive heart failure. There were 24 in-hospital deaths (27.27% early mortality). By multivariate analysis, severe congestive heart failure (HR=13.82, 95% CI [3.38-38.15], P<0.001) and large >15 mm vegetations (HR=6.02, 95% CI [1.48-18.52], P=0.03) were predictive of in-hospital mortality. Survivors were followed-up from 3 to 120 months, mean of 28.6. Actuarial 5- and 10-year survivals free from the combined endpoint of recurrent IE, cardiovascular death and late surgery in survivors were 69+/-5% and 63+/-7%, respectively. In conclusion, despite medical progress, surgery for endocarditis in Tunisia remains challenging and yields high mortality rates. Severe heart failure is the most powerful predictor of mortality. Long-term outcome is, however, satisfactory.

Tumeur myofibroblastique pulmonaire : intérêt de la chirurgie première

Resume Introduction Les tumeurs myofibroblastiques ou pseudo inflammatoires pulmonaires sont rares. Bien que benignes, elles peuvent etre invasives et recidiver apres exerese. Observation Nous rapportons le cas d’un enfant âge de 14 ans, porteur d’un nodule solitaire basal du poumon gauche revele par des hemoptysies de faible abondance. Le scanner thoracique etait en faveur d’une tumeur hypervascularisee. La fibroscopie bronchique etait normale, la biopsie transparietale n’a pu etre realisee du fait de sa localisation proximale. Une lobectomie fut realisee a travers une thoracotomie postero laterale avec des suites favorables. L’etude histopathologique a conclu a une tumeur myofibroblastique. Conclusion Le recours a la chirurgie de premiere intention est indispensable pour confirmer le diagnostic d’une tumeur myofibroblastique pulmonaire. La resection complete est le seul garant pour prevenir les recidives.

Localisation médiastinale d’une lymphocèle du canal thoracique : à propos d’un cas opéré

Resume Introduction La lymphocele du canal thoracique est une entite pathologique exceptionnelle ; secondaire a la deterioration et a la dilatation kystique de la paroi de ce vaisseau. Son origine peut-etre congenitale ou degenerative. Observation Nous rapportons l’observation d’un patient âge de 47 ans, opere pour formation kystique symptomatique, localisee au niveau du mediastin postero-inferieur, confirmee au scanner. Une thoracotomie postero laterale a permis la resection totale de cette formation qui s’est revelee etre une lymphocele. L’analyse chimique du liquide et l’etude histopathologique de la poche kystique ont confirme le diagnostic. Les suites operatoires etaient simples. Conclusion L’interet de cette observation est de montrer les particularites cliniques de cette entite et d’insister sur les modalites du diagnostic et de la prise en charge operatoire.