AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The ...AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.展开更多
Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, tra...Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.展开更多
文摘AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.
文摘Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.
