BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contaminati...BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.展开更多
Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal condition in which abnormal activation of the immune system results in haemophagocytosis, inflammation and tissue damage. This results in a variety of s...Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal condition in which abnormal activation of the immune system results in haemophagocytosis, inflammation and tissue damage. This results in a variety of signs and symptoms but most commonly fever, lymphadenopathy, splenomegaly, cytopenias, hyperferritinaemia and hypertriglyceridaemia. There are multiple reports of acquired HLH developing on a background of disseminated Mycobacterium infection. Simultaneously, since 2011, cases of invasive cardiovascular infection caused by Mycobacterium chimaera (M. chimaera) in patients having previously undergone cardiac surgery in Europe have been reported. We report a case of acquired HLH occurring one year after open-heart surgery to place a prosthetic valve due to M. chimaera.展开更多
<span style="font-family:Verdana;">Chimaeras</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, fish in the order Chimaerif...<span style="font-family:Verdana;">Chimaeras</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, fish in the order Chimaeriformes, are among the rarest and least studied fish in the class Chondrichthyes (cartilaginous fish). Previous records have indicated that a species of chimaera known as the elephantfish, or cockfish, </span><i><span style="font-family:Verdana;">Callorhinchus callorynchus</span></i><span style="font-family:Verdana;">, may be found in marine waters off southeastern Brazil, as far north as the state of S<span style="font-size:10.0pt;font-family:"">ã</span>o Paulo. Here we report that </span><i><span style="font-family:Verdana;">C. callorynchus</span></i><span style="font-family:Verdana;">, caught with bottom gillnet, was found in an urban fish market in the city of Rio de Janeiro (~23<span style="white-space:nowrap;">˚</span>S). This and other records from a variety of places call into question the distribution limits of the American elephantfish in the southwestern Atlantic Ocean and whether, at least seasonally, this species may often be found as far north as the state of Rio de Janeiro. Because of scientific and conservation interests in the poorly known Chimaeriformes, we recommend long-term monitoring of the fish catch in ports along the southern Brazilian coast, to better understand the natural history of the intriguing chimeras.</span></span>展开更多
文摘BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.
文摘Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal condition in which abnormal activation of the immune system results in haemophagocytosis, inflammation and tissue damage. This results in a variety of signs and symptoms but most commonly fever, lymphadenopathy, splenomegaly, cytopenias, hyperferritinaemia and hypertriglyceridaemia. There are multiple reports of acquired HLH developing on a background of disseminated Mycobacterium infection. Simultaneously, since 2011, cases of invasive cardiovascular infection caused by Mycobacterium chimaera (M. chimaera) in patients having previously undergone cardiac surgery in Europe have been reported. We report a case of acquired HLH occurring one year after open-heart surgery to place a prosthetic valve due to M. chimaera.
文摘<span style="font-family:Verdana;">Chimaeras</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, fish in the order Chimaeriformes, are among the rarest and least studied fish in the class Chondrichthyes (cartilaginous fish). Previous records have indicated that a species of chimaera known as the elephantfish, or cockfish, </span><i><span style="font-family:Verdana;">Callorhinchus callorynchus</span></i><span style="font-family:Verdana;">, may be found in marine waters off southeastern Brazil, as far north as the state of S<span style="font-size:10.0pt;font-family:"">ã</span>o Paulo. Here we report that </span><i><span style="font-family:Verdana;">C. callorynchus</span></i><span style="font-family:Verdana;">, caught with bottom gillnet, was found in an urban fish market in the city of Rio de Janeiro (~23<span style="white-space:nowrap;">˚</span>S). This and other records from a variety of places call into question the distribution limits of the American elephantfish in the southwestern Atlantic Ocean and whether, at least seasonally, this species may often be found as far north as the state of Rio de Janeiro. Because of scientific and conservation interests in the poorly known Chimaeriformes, we recommend long-term monitoring of the fish catch in ports along the southern Brazilian coast, to better understand the natural history of the intriguing chimeras.</span></span>