Mycobacterium chimaera infections following cardiac surgery in Treviso Hospital, Italy, from 2016 to 2019: Cases report

作     者：Walter O Inojosa Mario Giobbia Giovanna Muffato Giuseppe Minniti Francesco Baldasso Antonella Carniato Francesca Farina Gabriella Forner Maria C Rossi Stefano Formentini Roberto Rigoli Pier G Scotton 

作者机构：Infectious Diseases UnitTreviso HospitalTreviso 31100Italy Microbiology UnitTreviso HospitalTreviso 31100Italy Cardiac Surgery UnitTreviso HospitalTreviso 31100Italy Health Management UnitTreviso HospitalTreviso 31100Italy 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2019年第7卷第18期

页      面：2776-2786页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Department of Microbiology of Padua University Hospital 

主　　题：Mycobacterium chimaera Prosthetic valve endocarditis Spondylodiscitis Cardiac surgery infections Case report 

摘      要：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.