Diagnosis and Treatment of Infective Endocarditis in Chronic Hemodialysis Patients

Objective To analyze the clinical features of hemodialysis patients complicated by infective endo-carditis.Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed.All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.Results The average age of the six patients was 52.3±19.3 years old.Four were males.Vascular accesses at the onset of infective endocarditis were as follows:permanent catheters in three,temporary catheters in two,and arteriovenous fistula in one.Three were found with mitral valve involvement,two with aortic valve involvement,and one with both.Five vegetations were found by transthoracic echocardiography,and one by transesophageal echocardiography.Four had positive blood culture results.The catheters were all removed.Four of the patients were improved by antibiotics treatment,in which two were still on hemodialysis in the following 14-24 months and the other two were lost to follow-up.One patient received surgery,but died of heart failure after further hemodialysis for three months.One was well on maintenance hemodialysis for three months after surgery.Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever,for which prompt blood culture and transthoracic echocardiography confirmation could be performed.Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings.With catheters removed,full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing

Objectives To investigate the positive rate of different hepatitis B virus(HBV) serological markers,and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers,such as HBV surface antigen(HBsAg),HBV surface antibody(HBsAb),hepatitis B e antigen(HBeAg),hepatitis B e antibody(HBeAb),HBV core antibody(HBcAb),and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital.The positive rate of each HBV serological marker was calculated according to gender,age,and department,respectively.The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included,2681(9.8%) were HBsAg positive.When patients were divided into 9 age groups,the age-specific positive rate of HBsAg was 1.2%,9.6%,12.3%,10.9%,10.3%,9.7%,8.0%,S.8%,and 4.3%,respectively.The positive rate of HBsAg in non-surgical department,surgical department,and health examination center was 16.2%,5.8%> and 4.7%,respectively.The positive rate of HBsAg of males(13.3%) was higher than that of females(7.3%,P=0.000).Among the 2681 HBsAg(+)patients,1230(45.9%) had HBV-DNA test,of whom 564(45.9%) were positive.Patients with HBsAg(+),HBeAg(+),and HBcAg(+) result usually had high positive rate of HBV-DNA results(71.8%,P=0.000).Conclusions Among this group of patients in our hospital,the positive rate of HBsAg was relatively high.Age group of 20-29,males,and patients in non-surgical departments were factors associated with high positive rate of HBsAg.

Retrospective Examination of Q Fever Endocarditis： An Underdiagnosed Disease in the Mainland of China

Background： Q fever endocarditis, a chronic illness caused by Coxiella burnetii, can be fatal ifmisdiagnosed or left untreated. Despite a relatively high positive rate of Q fever serology in healthy individuals in the mainland of China, very few cases of Q fever endocarditis have been reported. This study summarized cases of Q fever endocarditis among blood culture negative endocarditis （BCNE） patients and discussed factors attributing to the low diagnostic rate. Methods： We identified confirmed cases of Q fever endocarditis among 637 consecutive patients with infective endocarditis （IE） in the Peking Union Medical College Hospital between 2006 and 2016. The clinical findings for each confirmed case were recorded. BCNE patients were also examined and each BCNE patient＇s Q fever risk factors were identified. The risk factors and presence of Q fever serologic testing between BCNE patients suspected and unsuspected of Q fever were compared using the Chi-squared or Chi-squared with Yates＇ correction for continuity. Results： Among the IE patients examined, there were 147 BCNE patients, of whom only 11 patients （7.5%） were suspected of Q fever and undergone serological testing for C. burnetii. Six out of 11 suspected cases were diagnosed as Q fever endocarditis. For the remaining 136 BCNE patients, none of them was suspected of Q fever nor underwent relevant testing. Risk factors for Q fever endocarditis were comparable between suspected and unsuspected patients, with the most common risk factors being valvulopathy in both groups. However, significantly more patients had consulted the Infectious Diseases Division and undergone comprehensive diagnostic tests in the suspected group than the unsuspected group （100% vs. 63%, P = 0.03）. Conclusions： Q fever endocarditis is a serious yet treatable condition. Lacking awareness of the disease may prevent BCNE patients from being identified, despite having Q fever risk factors. Increasing awareness and guideline adherence are crucial in avoiding misdiagnosing and missed diagnosing of the disease.