During a 2014 outbreak, 450 patients with confirmed chikungunya virus infection were admitted to the University Hospital of Pointe-à-Pitre, Guadeloupe. Of these, 110 were nonpregnant adults; 42 had ...severe disease, and of those, 25 had severe sepsis or septic shock and 12 died. Severe sepsis may be a rare complication of chikungunya virus infection.
Severe thrombocytopenia during or after the course of Zika virus infection has been rarely reported. We report 7 cases of severe thrombocytopenia and hemorrhagic signs and symptoms in Guadeloupe ...after infection with this virus. Clinical course and laboratory findings strongly suggest a causal link between Zika virus infection and immune-mediated thrombocytopenia.
In 2014, a first outbreak of chikungunya hit the Caribbean area where chikungunya virus (CHIKV) had never circulated before.
We conducted a cross-sectional study to measure the seroprevalence of ...CHIKV immediately after the end of the 2014 outbreak in HIV-infected people followed up in two clinical cohorts at the University hospitals of Guadeloupe and Martinique. Study patients were identified during the first months of 2015 and randomly selected to match the age and sex distribution of the general population in the two islands. They were invited to complete a survey that explored the symptoms consistent with chikungunya they could have developed during 2014 and to have a blood sample drawn for CHIKV serology. The study population consisted of 377 patients (198 in Martinique and 179 in Guadeloupe, 178 men and 199 women), 182 of whom reported they had developed symptoms consistent with chikungunya. CHIKV serology was positive in 230 patients, which accounted for an overall seroprevalence rate of 61% 95%CI 56-66, with only 153 patients who reported symptoms consistent with chikungunya. Most frequent symptoms included arthralgia (94.1%), fever (73.2%), myalgia (53.6%), headache (45.8%), and skin rash (26.1%).
This study showed that the seroprevalence of CHIKV infection was 61% after the 2014 outbreak, with one third of asymptomatic infections.
ClinicalTrials.gov NCT02553369.
BACKGROUND: The 2023 Duke-ISCVID Criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated ...for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 ESC criteria. METHODS: Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated, with 95% confidence intervals. RESULTS: Of the 1194 patients analyzed (mean age 66.1 years, 71.2% men), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% 91.6-94.8, 95.0% 93.7-96.4, and 97.6% 96.6-98.6, respectively (p<.001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% 55.2-67.4), 60.5% 54.4-66.6, and 46.0% 39.8-52.2, respectively. In patients without CIED, sensitivity rates were 94.8% 93.2-96.4, 96.5% 95.1-97.8, and 97.7% 96.6-98.8 and specificity rates were 59.0% 51.6-66.3, 56.6% 49.3-64.0, and 53.8% 46.3-61.2, respectively. CONCLUSION: Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity, compared to older criteria. This decreased specificity was mainly attributable to patients with CIED.
Abstract
Background
The 2023 Duke–International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. ...Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria.
Methods
Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals.
Results
Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke–ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval CI, 91.6–94.8), 95.0% (95% CI, 93.7–96.4), and 97.6% (95% CI, 96.6–98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2–67.4), 60.5% (95% CI, 54.4–66.6), and 46.0% (95% CI, 39.8–52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2–96.4), 96.5% (95% CI, 95.1–97.8), and 97.7% (95% CI, 96.6–98.8); specificity rates were 59.0% (95% CI, 51.6–66.3), 56.6% (95% CI, 49.3–64.0), and 53.8% (95% CI, 46.3–61.2), respectively.
Conclusions
Overall, the 2023 Duke–ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.
The 2023 Duke–International Society for Cardiovascular Diseases criteria had a significantly higher sensitivity but a significantly lower specificity than older criteria. Decreased specificity was mainly attributable to patients with cardiac implantable electronic devices.
Graphical abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/compared-performance-of-the-2023-duke-international-society-for-cardiovascular-infectious-diseases-the-2000-modified-duke-and-the-2015-esc-criteria-for-the-diagnosis-of-infective-endocarditis-in-a-french-multicenter-prospective-cohort/update
Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication ...bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE.
Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors.
The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001).
Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated.
Objective
Restoring anti‐JC virus (JCV) immunity is the only treatment of progressive multifocal leukoencephalopathy (PML). Interleukin‐7 is a cytokine that increases number and function of T cells. ...We analyzed a population of PML patients who received recombinant human IL‐7 (rhIL‐7) to estimate survival and its determinants.
Methods
After exclusion of patients with missing data or receiving other immunotherapies, findings from 64 patients with proven PML who received rhIL‐7 between 2007 and 2020 were retrospectively analyzed. Logistic regression was used to analyze variables associated with one‐year survival.
Results
Underlying conditions were HIV/AIDS (n = 27, 42%), hematological malignancies (n = 16, 25%), primary immunodeficiencies (n = 13, 20%), solid organ transplantation (n = 4, 6%) and chronic inflammatory diseases (n = 4, 6%). One‐year survival was 54.7% and did not differ by underlying condition. Survival was not associated with baseline characteristics, but with a >50% increase in blood lymphocytes (OR 4.1, 95%CI 1.2–14.9) and CD4+ T cells (OR 5.9, 95%CI 1.7–23.3), and a > 1 log copies/mL decrease in cerebrospinal fluid JCV DNA (OR 7.6, 95%CI 1.6–56.1) during the first month after rhIL‐7 initiation. Side effects were mainly local and flu‐like symptoms (n = 8, 12.5%) and PML‐immune reconstitution inflammatory syndrome (IRIS) (n = 5, 8%).
Interpretation
In this non‐controlled retrospective study, survival did not differ from that expected in HIV/AIDS patients, but might have been improved in those with hematological malignancies, primary immunodeficiencies and transplant recipients. RhIL‐7 might have contributed to the increase in blood lymphocytes and decrease in CSF JCV replication that were associated with better survival. ANN NEUROL 2022;91:496–505
To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).
All consecutive adult patients with incident SAB (n = 2008) ...were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.
SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval CI 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).
SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.
Background. We aimed to compare oral hygiene habits, orodental status, and dental procedures in patients with infective endocarditis (IE) according to whether the IE-causing microorganism originated ...in the oral cavity. Methods. We conducted an assessor-blinded case-control study in 6 French tertiary-care hospitals. Oral hygiene habits were recorded using a self-administered questionnaire. Orodental status was analyzed by trained dental practitioners blinded to the microorganism, using standardized clinical examination and dental panoramic tomography. History of dental procedures was obtained through patient and dentist interviews. Microorganisms were categorized as oral streptococci or nonoral pathogens using an expert-validated list kept confidential during the course of the study. Cases and controls had definite IE caused either by oral streptococci or nonoral pathogens, respectively. Participants were enrolled between May 2008 and January 2013. Results. Cases (n = 73) were more likely than controls (n = 192) to be aged <65 years (odds ratio OR, 2.85; 95% CI, 1.41–5.76), to be female (OR, 2.62; 95% CI, 1.20–5.74), to have native valve disease (OR, 2.44; 95% CI, 1.16–5.13), to use toothpicks, dental water jet, interdental brush, and/or dental floss (OR, 3.48; 95% CI, 1.30–9.32), and to have had dental procedures during the prior 3 months (OR, 3.31; 95% CI, 1.18–9.29), whereas they were less likely to brush teeth after meals. The presence of gingival inflammation, calculus, and infectious dental diseases did not significantly differ between groups. Conclusions. Patients with IE caused by oral streptococci differ from patients with IE caused by nonoral pathogens regarding background characteristics, oral hygiene habits, and recent dental procedures, but not current orodental status.
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•We compared patients aged > 75 years treated for IE, who did/did not undergo TEE.•Patients without TEE were older, with more comorbidities.•Patients without TEE had poorer ...functional, nutritional and cognitive statuses.•Patients without TEE underwent surgery for a recognized indication less often.•Patients without TEE had a poorer prognosis.
Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions.
To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality.
A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75–101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE.
Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE.
Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.
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