Mf Tripodi

Streptococcus bovis Endocarditis and Its Association with Chronic Liver Disease: An Underestimated Risk Factor

Clinical and epidemiological characteristics of Streptococcus bovis endocarditis were prospectively studied among 199 patients with definite endocarditis. Thirty patients (15.1%) had S. bovis endocarditis. Compared with patients with non-S. bovis endocarditis, these 30 patients were older (mean age, 58.6+/-12.4 years vs. 46.0+/-17.0 years; P<.001) and had higher rates of bivalvular involvement (43.3% vs. 7.7%; P<.001), embolism (73.3% vs. 40.2%; P=.002), and diskitis (23.3% vs. 0.6% P<.001). In patients with S. bovis biotype I (S. bovis I) endocarditis, advanced liver disease was present in 56.7%, compared with 15.3% of patients with non-S. bovis endocarditis (P<.001), and colonic adenoma was present in 46.7%. The in-hospital mortality rate (16.7%) was correlated with delayed diagnosis and advanced liver diseases. In our city, S. bovis I endocarditis is frequently correlated with liver diseases; diskitis may be the first sign of the disease.

Hepatic cryptococcosis in a heart transplant recipient

Abstract: Cryptococcosis primarily occurs in patients with impaired immune response. While pulmonary and/or cerebral involvement are more often described, there is limited experience of its presence in other sites. We present a case of hepatic cryptococcosis with possible pulmonary involvement in a 54‐year‐old male heart transplant recipient. Two months after heart transplantation, he developed a persistent, moderate dyspnea with fever and signs of liver damage. Diagnosis was made with liver biopsy for a concurrent reactivation of chronic hepatitis B virus (HBV) infection already present before transplant. Along with a mild chronic HBV hepatitis with fibrosis, we observed sinusoidal dilation and groups of bright, rounded, colorless cells with a central nucleus suggestive of cryptococci. Periodic acid–Schiff stain clearly showed encapsulated yeasts, which supported the diagnosis. Cryptococcal antigen was positive in serum and negative in the cerebrospinal fluid. Computed tomography scan of the chest demonstrated a mild interstitial infiltrate. The patient promptly responded to reduction of immunosuppressive therapy and antifungal treatment with amphotericin B lipid complex and flucytosine followed by maintenance treatment with fluconazole. Cryptococcosis should always be considered in the differential diagnosis in immunocompromised hosts with dyspnea and signs of extrapulmonary involvement. Diagnosis of extrapulmonary and extraneural cryptococcosis is difficult and often fortuitous; a histopathological examination of tissues involved is probably warranted.

023 CURRENT TRENDS IN INFECTIVE ENDOCARDITIS IN ITALY: REPORT ON 852 CASES FROM THE MULTICENTER, PROSPECTIVE SEI STUDY

and pulmonary and rheumatologic presentations were more frequent in Group I, whereas in Group II cardiac and abdominal presentations were more common. During hospitalization, septic shock (12.7% vs 18.9%; p = 0.021) was observed more frequently in Group II. There were no differences in periannular complications, heart failure, valvular dysfunction, persistent infection and embolism. In Group II the need of cardiac surgery was higher than in Group I (49.3 vs 58.7%; p 0.011). No differences were observed in hospital mortality (28.1% vs 28%). Conclusions: In the last years the incidence of infective endocarditis was higher in older patients with a higher degree of comorbidity. Prosthetic valve IE increased and IE in IVDU was less frequent. The need for cardiac surgery has also increased. Mortality remained similar.