AIM: To investigate the etiology and management of a poorly understood complication of transjugular intrahepatic portosystemic shunt; "endotipsitis".METHODS: A MEDLINE database search was carriedout, reviewi...AIM: To investigate the etiology and management of a poorly understood complication of transjugular intrahepatic portosystemic shunt; "endotipsitis".METHODS: A MEDLINE database search was carriedout, reviewing all papers with specific words in the title or abstract, and excluding appropriately. Of 283 papers that were reviewed, 22 papers reporting 53 cases in total were included in the analyses. RESULTS: No predominant etiology for endotipsitis was identified, but gram-positive organisms were more common among early-onset infections(P < 0.01). A higher mortality rate was associated with Staphylococcus aureus and Candida spp infections(P < 0.01). There was no trend in choice of antibiotic based on the microorganisms isolated and treatment varied from the guidelines of other vegetative prosthetic infections. In endotipsitis "high risk" organisms have been identified, emphasizing the importance of ensuring optimal antimicrobial therapy and adjunctive management strategies.CONCLUSION: Higher mortality rate was associated with Staphylococcus aureus and Candida spp infections. A prospective multicenter trial is needed before specific treatment can be recommended.展开更多
BACKGROUND Bartonellosis is a rare but challenging condition to diagnose with a spectrum of clinical presentations in the immunocompromised host.AIM To further characterize the presentation of Bartonella henselae(B.he...BACKGROUND Bartonellosis is a rare but challenging condition to diagnose with a spectrum of clinical presentations in the immunocompromised host.AIM To further characterize the presentation of Bartonella henselae(B.henselae)infections in solid organ and hematopoietic stem cell transplant recipients.METHODS We conducted a single-center retrospective study of all B.henselae testing for 5012 transplant recipients receiving care at a single institution between 2011 and 2018.RESULTS We identified 38 patients who underwent testing for B.henselae,and three of 38 were found to have bartonellosis.Two of the patients were renal transplant recipients who presented with visceral bartonellosis and symptoms concerning for post-transplant lymphoproliferative disorder.One autologous stem cell transplant recipient presented with cat scratch disease.We detail the clinical courses of these three cases and review the literature concerning the clinical presentations,differential diagnosis,and limitations of diagnostic tests for B.henselae infections in transplant recipients.CONCLUSION Although the incidence of B.henselae infection in transplant recipients is unknown,it merits inclusion in the differential diagnosis for fever of unknown origin in this population.展开更多
文摘AIM: To investigate the etiology and management of a poorly understood complication of transjugular intrahepatic portosystemic shunt; "endotipsitis".METHODS: A MEDLINE database search was carriedout, reviewing all papers with specific words in the title or abstract, and excluding appropriately. Of 283 papers that were reviewed, 22 papers reporting 53 cases in total were included in the analyses. RESULTS: No predominant etiology for endotipsitis was identified, but gram-positive organisms were more common among early-onset infections(P < 0.01). A higher mortality rate was associated with Staphylococcus aureus and Candida spp infections(P < 0.01). There was no trend in choice of antibiotic based on the microorganisms isolated and treatment varied from the guidelines of other vegetative prosthetic infections. In endotipsitis "high risk" organisms have been identified, emphasizing the importance of ensuring optimal antimicrobial therapy and adjunctive management strategies.CONCLUSION: Higher mortality rate was associated with Staphylococcus aureus and Candida spp infections. A prospective multicenter trial is needed before specific treatment can be recommended.
文摘BACKGROUND Bartonellosis is a rare but challenging condition to diagnose with a spectrum of clinical presentations in the immunocompromised host.AIM To further characterize the presentation of Bartonella henselae(B.henselae)infections in solid organ and hematopoietic stem cell transplant recipients.METHODS We conducted a single-center retrospective study of all B.henselae testing for 5012 transplant recipients receiving care at a single institution between 2011 and 2018.RESULTS We identified 38 patients who underwent testing for B.henselae,and three of 38 were found to have bartonellosis.Two of the patients were renal transplant recipients who presented with visceral bartonellosis and symptoms concerning for post-transplant lymphoproliferative disorder.One autologous stem cell transplant recipient presented with cat scratch disease.We detail the clinical courses of these three cases and review the literature concerning the clinical presentations,differential diagnosis,and limitations of diagnostic tests for B.henselae infections in transplant recipients.CONCLUSION Although the incidence of B.henselae infection in transplant recipients is unknown,it merits inclusion in the differential diagnosis for fever of unknown origin in this population.
