Copyright
©The Author(s) 2019.
World J Clin Cases. Sep 26, 2019; 7(18): 2776-2786
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2776
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2776
Table 1 Clinical features and outcome
Case | sex/age | Cardiac surgery | Date surgery | Symptoms beginning | Date hospitali-zation | Micro-biological diagnosis (date) and disease history | Clinical syndromes | Medical therapy (mo) | Repeat surgery and disease history | Outcome |
1 | M 37 | CARR | 12/2012 TH | After 35 mo | 05/2016 | 09/2016, after 10 mo | PVE, AAP, DI | Anti-MAC (1) | After 8 mo | Deceased |
2 | M 60 | AVR + MVA | 01/2013 oH | After 40 mo | 05/2016 | 10/2016, after 11 mo | PVE, AAP, DI | No | No (see text) | Deceased |
3 | M 42 | AVR + ARR | 05/2015 TH | After 6 mo | 10/2016 | 11/2016, after 12 mo | PVE, AAP, DI | No | No | Deceased |
4 | M 75 | AVR | 02/2011 TH | After 64 mo | 07/2016 | 01/2017, after 7 mo | PVE, DI, SD | Anti-MAC (13) | After 15 mo | Deceased |
5 | M 80 | MVR + AW | 03/2016 TH | After 12 mo | 08/2018 | 09/2018, after 18 mo | PVE, SD | Targeted (14) | No | On therapy |
6 | M 56 | AVR | 06/2016 TH | After 27 mo | 11/2018 | 10/2018, after 1 mo | PVE, DI, SD | Targeted (12) | After 8 mo | On therapy |
ARR | 05/2015 TH | |||||||||
7 | M 75 | AVR | 01/2014 oH | After 21 mo | 02/2019 | 04/2019, after 8 months | PVE | Targeted (4) | No | On therapy |
AVR | 11/2016 oH | |||||||||
8 | M 76 | AVR + CABG | 02/2011 TH | After 97 mo | 05/2019 | 05/2019, after 2 mo | PVE, DI, SD | Targeted (3) | No | On therapy |
9 | M 82 | AVR + CABG | 08/2016 oH | After 12 mo | 06/2019 | 06/2019, after 22 mo | PVE | Targeted (2) | No | On therapy |
Table 2 Clinical features of Mycobacterium chimaera infections and selected laboratory abnormalities of Mycobacterium chimaera infected patients at presentation in United Kingdom and Treviso patients (modified, from Scriven et al[16], 2018)
Variable | UK patients (n = 30) | Italian patients (n = 9) |
Clinical finding, n (%) | ||
Fever | 24 (80) | 7 (78) |
Malaise (astenia) | 24 (80) | 7 (78) |
Weight loss | 18 (60) | 6 (66) |
Cough | 11 (37) | 3 (33) |
Dyspnoea | 10 (33) | 2 (22) |
Arthralgia | 6 (20) | 0 |
Chest pain | 6 (20) | 0 |
Abdominal pain | 3 (10) | 0 |
Back pain | 2 (7) | 5 (55) |
New cardiac murmur | 9 (30) | 6 (66) |
Oedema | 6 (20) | 1 (11) |
Crepitations | 6 (20) | 0 |
Splenomegaly | 8 (27) | 6 (66) |
Hepatomegaly | 6 (20) | 3 (33) |
Lymphadenopathy | 1 (3) | 1 (11) |
Sternal wound | 4 (13) | 0 |
Skin lesion | 2 (7) | 0 |
Choroiditis | 2 (7) | 5 (55) |
Neurological symptoms | NA | 5 (55) |
Laboratory findings, median (IQR) | ||
Haemoglobin (g/L) | 110 (96-127) | 105 (95-114) |
WBC (× 109/L) | 3.9 (2.2-5.4) | 3.9 (2.8-6.7) |
Neutrophils (× 109/L) | 2.4 (1.3-3.3) | 2.6 (1.4-3.8) |
Lymphocytes (× 109/L) | 0.9 (0.6-1.3) | 0.76 (0.56–1.05) |
Platelets (× 109/L) | 175 (86-223) | 166 (76-257) |
Albumin (g/L) | 30 (26-37) | 34 (27-39) |
ALT (IU/L) | 43 (33-85) | 41 (15-70) |
ALP (IU/L) | 256 (132-357) | 242 (157-254) |
Sodium (µmol/L) | 134 (131-136) | 131 (128-136) |
eGFR (mL/min) | 66 (53-80) | 52 (35-81) |
CRP (mg/L) | 33 (17-46) | 19 (14-31) |
ESR (mm/h) | NA | 65 (36-111) |
LDH (IU/L) | NA | 463 (244-680) |
gammaGT (IU/L) | NA | 104 (44-156) |
Table 3 Microbiological features
Case | Specimens | Time for cultural identification | Other positive tests | Antimicrobial susceptibility test |
11 | Sputum | 8 wk | Macrolid (S)2 | |
Broncholavage | 10 wk | |||
Bioprosthesis | np | PCR | ||
Pericardial abscess | 8 wk | |||
Blood | np | |||
2 | Blood | 4 wk | Macrolid (S)2 | |
3 | Blood | 4 wk | Macrolid (S)2 | |
4 | Blood (2) | 3 wk | Clarithromycin (S); Linezolid (R); Moxifloxacin (S); Aminoglycoside (S)2; Macrolid (S)2 | |
Bioprosthesis | 6 wk | Microscopy after enrichment | ||
Vertebral bone | 12 wk | |||
5 | Vertebral bone (3) | 3, 5, and 10 wk | Auramine rhodamine stain | Clarithromycin (S); Linezolid (I); Moxifloxacin (R) |
Blood (2) | Negative | |||
6 | Blood (3) | 3, 4, and 5 wk | Clarithromycin (S); Linezolid (I); Moxifloxacin (R) | |
Bone Marrow | 2 wk | Microscopy after enrichment | ||
Bioprosthesis (5) | 3 wk | Microscopy after enrichment | ||
7 | Blood | 6 wk | Clarithromycin (S); Linezolid (I); Moxifloxacin (S) | |
8 | Blood (2) | 4 wk | Clarithromycin (S); Linezolid (S); Moxifloxacin (S) | |
9 | Blood | 4 wk | ip |
Table 4 Measures taken to mitigate the risk of Mycobacterium chimaera infections after cardiac surgery in Veneto region
Measures | |
Environmental control measures | Mycrobiological surveillance of HCUs and operating room |
Culture-negative HCUs: carry out maintenance and cleaning of the device according to the manufacturer's recommendations | |
Culture-positive HCUs: remove the HCU from the operating room and/or send the device to the manufacturer for sterilization and cleaning | |
Clinical control measures | Enhance active case finding |
Alert clinicians for passive case findings | |
Notify the confirmed or probable cases |
- Citation: Inojosa WO, Giobbia M, Muffato G, Minniti G, Baldasso F, Carniato A, Farina F, Forner G, Rossi MC, Formentini S, Rigoli R, Scotton PG. Mycobacterium chimaera infections following cardiac surgery in Treviso Hospital, Italy, from 2016 to 2019: Cases report. World J Clin Cases 2019; 7(18): 2776-2786
- URL: https://www.wjgnet.com/2307-8960/full/v7/i18/2776.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v7.i18.2776