{"id":1904,"date":"2020-05-05T15:06:37","date_gmt":"2020-05-05T13:06:37","guid":{"rendered":"https:\/\/www.newslab.sk\/diferencialna-diagnostika-lozisk-v-mozgu-mozna-komplikacia-infekcnej-endokarditidy\/"},"modified":"2020-05-05T15:18:50","modified_gmt":"2020-05-05T13:18:50","slug":"differential-diagnosis-of-brain-foci-a-possible-complication-of-infective-endocarditis","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/differential-diagnosis-of-brain-foci-a-possible-complication-of-infective-endocarditis\/","title":{"rendered":"Differential diagnosis of brain foci &#8211; a possible complication of infective endocarditis?"},"content":{"rendered":"<p><span style=\"color: #ff0000;\"><strong>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.<\/strong><\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><strong>\u00davod<\/strong><\/h2>\n<p>Napriek pokrokom v poznatkoch medic\u00ednskych technol\u00f3gi\u00ed a v antimikrobi\u00e1lnej terapii je infek\u010dn\u00e1 endokardit\u00edda (IE) st\u00e1le \u0165a\u017eko diagnostikovate\u013en\u00e9 ochorenie spojen\u00e9 s v\u00e1\u017enymi komplik\u00e1ciami a st\u00e1va sa \u010doraz \u010dastej\u0161\u00edm probl\u00e9mom s vysokou \u00famrtnos\u0165ou. Abiotrophia defectiva patr\u00ed do skupiny satelitn\u00fdch streptokokov, ozna\u010dovan\u00fdch aj ako nutri\u010dne deficientn\u00e9 varianty<br \/>\nstreptokokov. Prv\u00fdkr\u00e1t boli identifikovan\u00e9 v roku 1961 (Frenkel a Hirsch) ako grampozit\u00edvne koky neschopn\u00e9 syntetizova\u0165 tioly, vitam\u00edn B6 a pyridox\u00edn a boli pova\u017eovan\u00e9 za nutri\u010dn\u00e9 mutanty viriduj\u00facich streptokokov(1-5). P\u00f4vodn\u00e9 dva druhy, Streptococcus defectivus a Streptococus adiacens, boli zaraden\u00e9 do rodu Abiotrophia. Na z\u00e1klade hybridiz\u00e1cie chromozom\u00e1lnej<br \/>\nDNA-DNA v roku 1989(3) a sekven\u00e1cie 16S rRNA v rokoch 1995 a 2000(2,5) boli izol\u00e1ty reklasifikovan\u00e9 na dva rody, Abiotrophia a Granulicatella, ktor\u00e9 zah\u0155\u0148aj\u00fa \u0161tyri druhy:<br \/>\nAbiotrophia defectiva, Granulicatella adiacens, Granulicatella elegans a Granulicatella balaenopterae. Skupina zah\u0155\u0148a viriduj\u00face streptokoky, ktor\u00e9 s\u00fa charakteristick\u00e9 satelitn\u00fdm rastom<br \/>\nokolo niektor\u00fdch in\u00fdch bakt\u00e9ri\u00ed, preva\u017ene z rodu Staphylococcus spp. (obr\u00e1zok 1)(2,3,5). A. defectiva je s\u00fa\u010das\u0165ou fyziologickej fl\u00f3ry faryngu, urogenit\u00e1lneho a intestin\u00e1lneho traktu. Ojedinele sa podie\u013ea na r\u00f4znych patologick\u00fdch procesoch. Boli opisovan\u00e9 n\u00e1lezy z abscesov mozgu, pankreasu, infekci\u00ed r\u00e1n, osteomyelit\u00eddy, zo septickej artrit\u00eddy, z keratit\u00eddy a z ucha pri otitis media. Taktie\u017e je to zriedkav\u00e1, ale nie neobvykl\u00e1 pr\u00ed\u010dina IE, \u010dasto s negat\u00edvnym kultiva\u010dn\u00fdm n\u00e1lezom (culture-negative endocarditis)(6,10,13).<\/p>\n<p>V \u010dl\u00e1nku uv\u00e1dzame pr\u00edpad IE sp\u00f4sobenej Abiotrophia defectiva u zdrav\u00e9ho mlad\u00e9ho mu\u017ea s nat\u00edvnymi chlop\u0148ami. Po\u010das ochorenia sa u pacienta rozvinuli komplik\u00e1cie, ktor\u00e9<br \/>\nvy\u00fastili do n\u00e1hrady mitr\u00e1lnej chlopne. Kazuistika 24-ro\u010dn\u00fd pacient, bez anamn\u00e9zy intern\u00fdch ochoren\u00ed s potvrdenou alergiou na penicil\u00edn a bez in\u00fdch anamnesticky v\u00fdznamn\u00fdch \u00fadajov, bol v novembri 2018 prijat\u00fd na Intern\u00fa kliniku Onkologick\u00e9ho \u00fastavu s cie\u013eom diferenci\u00e1lnej diagnostiky viacpo\u010detn\u00fdch lo\u017e\u00edsk v mozgu. Pacient ud\u00e1val nieko\u013eko mesiacov trvaj\u00facu \u00fanavu, subfebrility, \u00fabytok hmotnosti (8 kg za posledn\u00e9 dva mesiace), k\u0155\u010dovit\u00e9 bolesti brucha, pocit stuhnutosti k\u013abov (\u010dlenok, s\u00e1nka). Bol opakovane ambulantne empiricky lie\u010den\u00fd antibiotikami bez zlep\u0161enia stavu. Absolvoval komplexn\u00e9 mikrobiologick\u00e9 vy\u0161etrenia s negat\u00edvnym n\u00e1lezom. Pred hospitaliz\u00e1ciou na Internej klinike absolvoval pacient v j\u00fali 2018 pre v\u00fdrazn\u00e9 bolesti brucha a zv\u00fd\u0161en\u00e9 z\u00e1palov\u00e9 parametre (leukocyty 13,4 x 109, C-reakt\u00edvny prote\u00edn 53 mg\/l) laparoskopicky apendekt\u00f3miu, pri ktorej sa v\u0161ak z\u00e1pal apendixu histologicky nepotvrdil. Gastroenterologick\u00e9 vy\u0161etrenie bolo len s n\u00e1lezom gastropatie. Bolesti brucha ust\u00fapili a\u017e po vyl\u00fa\u010den\u00ed lepku. V septembri 2018 pre n\u00e1hle vzniknut\u00e9 tunelov\u00e9 videnie, bolesti a to\u010denie hlavy, tinitus bol pacient hospitalizovan\u00fd na Neurologickej klinike, kde v r\u00e1mci diferenci\u00e1lnej diagnostiky absolvoval magnetick\u00fa rezonanciu (MR) mozgu s opisom viacpo\u010detn\u00fdch bilater\u00e1lnych l\u00e9zi\u00ed supratentori\u00e1lne. Vzniklo podozrenie na metast\u00e1zy, lymf\u00f3m alebo sarkoid\u00f3zu. V r\u00e1mci p\u00e1trania po onkologickom ochoren\u00ed bolo doplnen\u00e9 vy\u0161etrenie PET\/CT, pri ktorom bol n\u00e1lez na mozgu hodnoten\u00fd ako suspektn\u00e1 prim\u00e1rna vaskulit\u00edda centr\u00e1lnej nervovej s\u00fastavy (CNS) a boli op\u00edsan\u00e9 aj zmeny na obli\u010dk\u00e1ch a slezine.<\/p>\n<p>N\u00e1sledne bol pacient prijat\u00fd s diagn\u00f3zou C79.3 (sekund\u00e1rny zhubn\u00fd n\u00e1dor mozgu a mozgov\u00fdch plien) na Intern\u00fa kliniku Onkologick\u00e9ho \u00fastavu. Vo vstupn\u00fdch laborat\u00f3rnych parametroch bola pr\u00edtomn\u00e1 an\u00e9mia \u013eahk\u00e9ho stup\u0148a, CRP 33 mg\/l, sediment\u00e1cia 49\/89 mm\/h, pozitivita cANCA protil\u00e1tok (protil\u00e1tky proti neutrofiln\u00fdm leukocytom). Ostatn\u00e9 parametre (horm\u00f3ny \u0161t\u00edtnej \u017e\u013eazy, onkomarkery, neuron\u00e1lne autoprotil\u00e1tky) boli v norme. Zo zobrazovac\u00edch vy\u0161etren\u00ed pacient absolvoval echokardiografick\u00e9 vy\u0161etrenie, kde bol op\u00edsan\u00fd len n\u00e1lez drobn\u00e9ho fluidotoraxu, zhrubnut\u00e9ho zadn\u00e9ho papil\u00e1rneho svalu a \u013eahk\u00e1 a\u017e stredne \u0165a\u017ek\u00e1 p\u013e\u00facna hypertenzia. Po\u010d\u00edta\u010dov\u00e1 tomografia (CT) hrudn\u00edka, brucha a malej panvy bola len s opisom<br \/>\nrelat\u00edvne \u010derstv\u00fdch ren\u00e1lnych infarktov, ktor\u00e9 by mohli by\u0165 pr\u00edznakom vaskulit\u00eddy. Na opakovanej MR mozgu bola zachyten\u00e1 aneuryzma cievy inzul\u00e1rne vpravo so z\u00e1palov\u00fdm lemom a zn\u00e1mky arterit\u00eddy na inom mieste (obr\u00e1zok 2). Vzh\u013eadom na izol\u00e1ciu kme\u0148a A. defectiva z hemokult\u00fary (obr\u00e1zok 3) a systolick\u00fd \u0161elest bolo doplnen\u00e9 aj transezof\u00e1gov\u00e9 echokardiografick\u00e9 (TEE) vy\u0161etrenie, ktor\u00e9 diagn\u00f3zu infek\u010dnej endokardit\u00eddy nepotvrdilo. Kme\u0148 bol identifikovan\u00fd met\u00f3dou hmotnostnej spektrometrie (MALDI-TOF, Bruker, Nemecko) a bol citliv\u00fd na v\u0161etky testovan\u00e9 antibiotik\u00e1<br \/>\n(penicil\u00edn, ampicil\u00edn, erytromyc\u00edn, klindamyc\u00edn, vankomyc\u00edn, cefurox\u00edm, ceftriaxon, ofloxac\u00edn). Napriek opakovan\u00e9mu negat\u00edvnemu echokardiografick\u00e9mu vy\u0161etreniu bola za\u010dat\u00e1<br \/>\nkombinovan\u00e1 lie\u010dba ceftriaxonom a gentamic\u00ednom. Na z\u00e1klade pozitivity autoprotil\u00e1tok cANCA, PET\/CT n\u00e1lezu a suponovan\u00fa vaskulit\u00eddu ciev bol pacient prelo\u017een\u00fd do N\u00e1rodn\u00e9ho \u00fastavu reumatick\u00fdch chor\u00f4b (N\u00daRCH), kde sa reumatologick\u00e9 ochorenie vyl\u00fa\u010dilo. Po\u010das hospitaliz\u00e1cie v N\u00da-RCH pokra\u010dovali v antibiotickej lie\u010dbe, ale v redukovan\u00fdch d\u00e1vkach (cefotax\u00edm len v jednej dennej d\u00e1vke, ceftriaxon \u00fadajne nebol dostupn\u00fd).<\/p>\n<p>Na pokra\u010dovanie intraven\u00f3znej lie\u010dby s diagn\u00f3zou suspektnej infek\u010dnej endokardit\u00eddy s perif\u00e9rnymi emboliz\u00e1ciami bol pacient prelo\u017een\u00fd na raj\u00f3nne intern\u00e9 oddelenie. Po\u010das hospitaliz\u00e1cie bola op\u00e4\u0165 v hemokult\u00fare zachyten\u00e1 A. defectiva. TEE vy\u0161etrenie bolo op\u00e4tovne negat\u00edvne. Antibiotick\u00e1 lie\u010dba bola ukon\u010den\u00e1 po 6 t\u00fd\u017ed\u0148och jej trvania \u2013 po negat\u00edvnej hemokultiv\u00e1cii a vzniku alergie na ceftriaxon a nesk\u00f4r aj na vankomyc\u00edn. Pacient bol prepusten\u00fd do ambulantnej starostlivosti bez \u010fal\u0161ej lie\u010dby. Mesiac po prepusten\u00ed pacient ambulantne absolvoval pl\u00e1novan\u00fa kontroln\u00fa MR mozgu, kde bolo zaznamenan\u00e9 zmen\u0161enie lo\u017e\u00edsk postkontrastn\u00e9ho vysycovania, pretrv\u00e1vala zmen\u0161en\u00e1 mykotick\u00e1 (infek\u010dn\u00e1) aneuryzma v oblasti inzuly vpravo. R\u00e1diol\u00f3g hodnotil n\u00e1lez v s\u00falade s klinick\u00fdmi a laborat\u00f3rnymi \u00fadajmi ako septick\u00fa arterit\u00eddu (vaskulit\u00eddu) s mykotickou (infek\u010dnou) aneuryzmou inzul\u00e1rne l.dx. (pri infekcii A. defectiva). Na kontrole pacient subjekt\u00edvne ud\u00e1val celkov\u00e9 zlep\u0161enie, intermitentne v\u0161ak poci\u0165oval b\u00fa\u0161enie srdca a op\u00e4tovne zaznamenal zv\u00fd\u0161en\u00fa teplotu (37,2 \u00b0C). Z hemokult\u00fary odobratej pri afebrilnom stave bola nasleduj\u00faci de\u0148 hl\u00e1sen\u00e1 znovu A. defectiva.<\/p>\n<p>Pacient nebol akceptovan\u00fd na raj\u00f3nnom internom oddelen\u00ed, preto bol znovu prijat\u00fd na hospitaliz\u00e1ciu na intern\u00e9 oddelenie Onkologick\u00e9ho \u00fastavu. Pred hospitaliz\u00e1ciou v de\u0148 prijatia absolvoval objednan\u00e9 TEE v N\u00e1rodnom \u00fastave srdcov\u00fdch a cievnych chor\u00f4b s n\u00e1lezom z\u00e1va\u017enej mitr\u00e1lnej regurgit\u00e1cie, v \u013eavej predsieni sa nach\u00e1dzali vlaj\u00face mobiln\u00e9 veget\u00e1cie upnut\u00e9 na predn\u00fd c\u00edp mitr\u00e1lnej chlopne, s vysok\u00fdm emboliza\u010dn\u00fdm potenci\u00e1lom. Na z\u00e1klade n\u00e1lezu na TEE bola odpor\u00fa\u010dan\u00e1 n\u00e1hrada mitr\u00e1lnej chlopne, pred ktorou pacient absolvoval extrakciu zuba v r\u00e1mci defokiz\u00e1cie, ktor\u00fd bol pravdepodobn\u00fdm zdrojom infekcie. Op\u00e4tovne bola za\u010dat\u00e1 intraven\u00f3zna antibiotick\u00e1 lie\u010dba s oh\u013eadom na alergick\u00fa anamn\u00e9zu (penicil\u00edn, ceftriaxon, vankomyc\u00edn) \u2013 kombin\u00e1cia gentamic\u00edn s moxifloxac\u00ednom. D\u0148a 15. 2. 2019 pacient podst\u00fapil oper\u00e1ciu mitr\u00e1lnej chlopne za mechanick\u00fa n\u00e1hradu. Po\u010das oper\u00e1cie bolo tkanivo chlopne odoslan\u00e9 na kultiv\u00e1ciu, kde bol znova potvrden\u00fd n\u00e1lez A. defectiva. Po oper\u00e1cii pokra\u010dovala antibiotick\u00e1 lie\u010dba kombin\u00e1ciou moxifloxac\u00ednu prechodne s klindamyc\u00ednom, n\u00e1sledne s rifampic\u00ednom a bola doplnen\u00e1 antikoagula\u010dnou terapiou. Pre suspektn\u00fa centr\u00e1lnu neurotoxicitu moxifloxac\u00ednu bol nahraden\u00fd linezolidom.<\/p>\n<p>Po troch mesiacoch po n\u00e1hrade mitr\u00e1lnej chlopne pacient absolvoval panangiografiu mozgu s n\u00e1lezom sakul\u00e1rnej vydutiny v perif\u00e9rii kaud\u00e1lneho trunku art\u00e9ria cerebri media<br \/>\nvpravo ve\u013ekosti 9,2 x 7 mm, ktor\u00e1 bola n\u00e1sledne o\u0161etren\u00e1 implant\u00e1ciou koilov (obr\u00e1zok 4, 5). V\u00fdkon prebehol bez komplik\u00e1ci\u00ed. Po opakovanej kontrole je pacient v stabilizovanom<br \/>\nstave, bez tepl\u00f4t a in\u00fdch subjekt\u00edvnych \u0165a\u017ekost\u00ed.<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Diskusia<\/strong><\/h2>\n<p>Incidencia pr\u00edpadov IE je 1,9 \u2013 6,2 pr\u00edpadu\/100 000 obyvate\u013eov ro\u010dne. V popul\u00e1cii s vysok\u00fdm po\u010dtom intraven\u00f3znych narkomanov a star\u0161\u00edch \u013eud\u00ed je incidencia v\u00fdskytu IE vy\u0161\u0161ia.<br \/>\nV predantibiotickej \u00e9re v prvej polovici 20. storo\u010dia sa medi\u00e1n veku pacientov s IE pohyboval medzi 20. \u2013 35. rokom. V s\u00fa\u010dasnosti sa ochorenie pos\u00fava do vy\u0161\u0161\u00edch vekov\u00fdch kateg\u00f3ri\u00ed<br \/>\n(50 \u2013 74 rokov), pri\u010dom u mlad\u00fdch \u013eud\u00ed s\u00fa v literat\u00fare op\u00edsan\u00e9 len pr\u00edpady rizikov\u00fdch skup\u00edn pacientov (intraven\u00f3zni narkomani, pacienti s vrodenou alebo so z\u00edskanou srdcovou chybou, pacienti s umelou n\u00e1hradou srdcovej chlopne), u ktor\u00fdch je vysok\u00e1 predispoz\u00edcia na vznik ochorenia. IE sa \u010dastej\u0161ie vyskytuje u mu\u017eov ako u \u017eien, niekedy aj v pomere 4 : 1(8,10,11,12).<br \/>\nAko syst\u00e9mov\u00e9 ochorenie vedie IE k charakteristick\u00fdm patologick\u00fdm zmen\u00e1m vo viacer\u00fdch cie\u013eov\u00fdch org\u00e1noch. \u010casti do\u0161ti\u010dkovej fibr\u00ednovej matrice veget\u00e1cie sa m\u00f4\u017eu uvo\u013e\u0148ova\u0165<br \/>\nz infikovanej srdcovej chlopne a pohybova\u0165 sa krvn\u00fdm rie\u010diskom. Tak\u00e9to septick\u00e9 emboly m\u00f4\u017eu atakova\u0165 takmer ak\u00fdko\u013evek org\u00e1nov\u00fd syst\u00e9m v tele a m\u00f4\u017eu sa klinicky prejavi\u0165 vytvoren\u00edm viscer\u00e1lneho abscesu alebo m\u00f4\u017ee d\u00f4js\u0165 k infarktu myokardu, obli\u010diek, sleziny, mezent\u00e9rie a ko\u017ee.<br \/>\nVysok\u00e1 frekvencia emboliz\u00e1ci\u00ed bola zaznamenan\u00e1 hlavne pri endokardit\u00eddach vyvolan\u00fdch S. aureus, Candida spp., Abiotrophia sp. a bakt\u00e9riami skupiny HACEK. Celkovo sa syst\u00e9mov\u00e9<br \/>\nemboliz\u00e1cie vyskytuj\u00fa v 22 \u2013 50 % pr\u00edpadov a naj\u010dastej\u0161ie ide o emboliz\u00e1ciu do mozgu. Inou komplik\u00e1ciou je vytvorenie mykotickej aneuryzmy, ako d\u00f4sledok vyplavenia<br \/>\n\u00falomkov veget\u00e1cie do vasa vasorum. Lok\u00e1lne zoslabnutie a vydutina arteri\u00e1lnej steny sp\u00f4sobuj\u00fa tlak, tak\u017ee m\u00f4\u017ee d\u00f4js\u0165 k rupt\u00fare a ku krv\u00e1caniu(6,8,13). Podozrenie na IE vznik\u00e1 u febriln\u00fdch pacientov s bakteri\u00e9miou a pr\u00edtomnos\u0165ou nov\u00e9ho alebo meniaceho sa srdcov\u00e9ho \u0161elestu. IE je diagnostikovan\u00e1 na z\u00e1klade pr\u00edtomnosti veget\u00e1cie na echokardiografii a pozit\u00edvneho kultiva\u010dn\u00e9ho n\u00e1lezu z krvi pri hemokultiv\u00e1cii. Neurologick\u00e9 komplik\u00e1cie, ktor\u00e9 vznikaj\u00fa emboliz\u00e1ciou do CNS, sa \u010dasto objavuj\u00fa u\u017e v \u00favode IE alebo s\u00fa dokonca prv\u00fdm prejavom ochorenia, ktor\u00e9 prived\u00fa<br \/>\npacienta k lek\u00e1rovi. Pribli\u017ene 50 \u2013 60 % neurologick\u00fdch komplik\u00e1ci\u00ed vznik\u00e1 e\u0161te pred stanoven\u00edm diagn\u00f3zy IE(10,11). Za naj\u010dastej\u0161iu pr\u00ed\u010dinu endokardit\u00eddy sa vo v\u0161eobecnosti pova\u017euj\u00fa viriduj\u00face streptokoky a stafylokoky. Medzi \u010fal\u0161ie etiologick\u00e9 agensy patria bakt\u00e9rie skupiny HACEK (Haemophilus spp., Agreggatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae), gramnegat\u00edvne pali\u010dky, enterokoky a kvasinky rodu Candida(8,10,12). Odhaduje sa, \u017ee A. defectiva sp\u00f4sobuje pribli\u017ene 5-6 % z celkov\u00e9ho po\u010dtu streptokokov\u00fdch endokardit\u00edd so z\u00e1va\u017en\u00fdmi komplik\u00e1ciami, ktor\u00e9 vy\u017eaduj\u00fa chirurgick\u00fd z\u00e1krok, ak nie je dostato\u010dne skoro identifikovan\u00e1 a lie\u010den\u00e1(1,4). V\u010faka virulen\u010dn\u00e9mu potenci\u00e1lu m\u00e1 vysok\u00fa afinitu k endovaskul\u00e1rnym \u0161trukt\u00faram, d\u00f4sledkom \u010doho vznik\u00e1 de\u0161trukcia srdcovej chlopne, \u010do vedie k srdcov\u00e9mu zlyhaniu a septickej emboliz\u00e1cii (10).<\/p>\n<p>A. defectiva je \u0161tandardne citliv\u00e1 na vankomyc\u00edn, ceftriaxon a aminoglykozidy, 90 % izol\u00e1tov je v\u0161ak rezistentn\u00fdch proti penicil\u00ednu(7). Pod\u013ea pokynov American Heart Association<br \/>\nje odpor\u00fa\u010dan\u00e1 kombinovan\u00e1 terapia penicil\u00ednom a gentamic\u00ednom po\u010das 4 a\u017e 6 t\u00fd\u017ed\u0148ov(7,8). Napriek dobrej citlivosti na antibiotik\u00e1 a adekv\u00e1tnej terapii si takmer polovica pr\u00edpadov vy\u017eaduje chirurgick\u00fd z\u00e1krok pozost\u00e1vaj\u00faci z n\u00e1hrady chlopne. Aj pri najlep\u0161ej dostupnej terapii je s\u00fa\u010dasn\u00e1 \u00famrtnos\u0165 pri IE pribli\u017ene 25 %(9,10,13).<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Z\u00e1ver<\/strong><\/h2>\n<p>Infek\u010dn\u00e1 endokardit\u00edda je sp\u00f4soben\u00e1 po\u0161koden\u00edm endokardu srdca, po ktorom nasleduje mikrobi\u00e1lna, zvy\u010dajne bakteri\u00e1lna koloniz\u00e1cia. IE je multisyst\u00e9mov\u00e9 ochorenie a v pr\u00edpade,<br \/>\n\u017ee nie je lie\u010den\u00e9, kon\u010d\u00ed sa smr\u0165ou pacienta. Cie\u013eom \u010dl\u00e1nku bolo op\u00edsa\u0165 ne\u0161pecifick\u00e9 klinick\u00e9 prejavy IE a zv\u00fd\u0161i\u0165 povedomie lek\u00e1rov a mikrobiol\u00f3gov o IE sp\u00f4sobenej A. defectiva. V \u00favode opakovan\u00e9 negat\u00edvne TEE vy\u0161etrenie nevylu\u010duje diagn\u00f3zu IE a pri diagnostike treba zoh\u013eadni\u0165 celkov\u00fd klinick\u00fd obraz pacienta. Na\u0161a kazuistika opisuje pr\u00edpad pacienta s viacpo\u010detn\u00fdmi lo\u017eiskami v mozgu, ktor\u00e9 boli prv\u00fdmi prejavmi a z\u00e1rove\u0148 komplik\u00e1ciou IE. V\u010dasn\u00e1 a spr\u00e1vna identifik\u00e1cia patog\u00e9nneho mikroorganizmu a vhodne nastaven\u00e1 terapia je d\u00f4le\u017eit\u00e1 na dosiahnutie \u00faspe\u0161nej lie\u010dby.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>LITERAT\u00daRA<\/strong><\/h3>\n<p>1. Ruoff KL. Nutritionally variant streptococci. Clinical Microbiology Reviews 1991;4(2): 184-190. doi: 10.1128\/cmr.4.2.184.<br \/>\n2. Collins MD, Lawson PA. The genus Abiotrophia is not monophyletic: proposal of Granulicatella gen. nov., Granulicatella adiacens comb. nov., Granulicatella elegans comb. nov. and Granulicatella galaenopterae comb. International Journal of Systematic and Evolutionary Microbiology 2000; 50(11): 365-369.<br \/>\n3. Bouvet A, Grimont F, Grimont PA. Streptococcus defectivus sp. nov. and Streptococcus adjacens sp. nov, nutritionally variant streptococci from human clinical specimens. Int J Sys Bacteriol 1989; 39: 290-294.<br \/>\n4. Pinkney JA, Nagassar RP, Roye-Green KJ, et al. Abiotrophia defectiva endocarditis. BMJ Case Reports 2014; 2014: p. bcr2014207361. doi: 10.1136\/bcr-2014-207361.<br \/>\n5. Kawamura Y, Hou XG, Sultana F, et al. Transfer of Streptococcus adjacens and Streptococcus defectivus to Abiotrophia gen. nov. as Abiotrophia adiacens comb. nov. and Abiotrophia defectiva comb. nov., respectively. International Journal of Systematic Bacteriology 1995; 45(4): 798-803. doi: 10.1099\/00207713-45-4-798.<br \/>\n6. Murray PR, Baron EJ, Landry ML, et al. Manual of clinical microbiology. 9th ed. ASM press Washington DC, 2007; 443-454p.<br \/>\n7. Alberti MO, Hindler JA, Humphries RM. Antimicrobial susceptibilities of Abiotrophia defectiva, Granulicatella adiacens, and Granulicatella elegans. Antimicrob Agents Chemother 2015; 60: 1411-1420.<br \/>\n8. Holland TL, Badurkalo LM, Bayer AS, et al. Infective endocarditis. Nat Rev Dis Primers 2016; 2: 16059.<br \/>\n9. Brouqui P., Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 2001; 14(1): 177-207.<br \/>\n10. Bene\u0161 J, Gregor P. Infek\u010dn\u00ed endokarditida. 1. vydanie. Praha: Triton 2002; 23-138p.<br \/>\n11. Bene\u0161 J, et al. Infek\u010dn\u00ed l\u00e9ka\u0159stv\u00ed. 1. vydanie. Gal\u00e9n 2009; 431-438p.<br \/>\n12. Vallejo FAG. Epidemiology of Infective Endocarditis. Contemporary Challenges in Endocarditis 2016; IntechOpen, doi: 10.5772\/65030<br \/>\n13. Rudrappa M, Kokatnur L. Infective Endocarditis due to Abiotrophia defectiva and its feared complications in an immunokompetent person: Rare, but real. J Glob Infect Dis 2017; 9(2): 79-81.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; \u00davod Napriek pokrokom v poznatkoch medic\u00ednskych technol\u00f3gi\u00ed a v antimikrobi\u00e1lnej terapii je infek\u010dn\u00e1 endokardit\u00edda (IE) st\u00e1le \u0165a\u017eko diagnostikovate\u013en\u00e9 ochorenie spojen\u00e9 s v\u00e1\u017enymi komplik\u00e1ciami a st\u00e1va sa \u010doraz \u010dastej\u0161\u00edm probl\u00e9mom<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292],"tags":[1377,1381,1380,1378,1379],"class_list":["post-1904","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-abiotrophia-defectiva-en","tag-infectious-aneurysm","tag-infective-endocarditis","tag-infekcna-aneuryzma-en","tag-infekcna-endokarditida-en","typ_clanku-casuistry"],"acf":{"abstrakt":"<p>Infective endocarditis (IE) is a disease caused by various microorganisms, but mostly by staphylococci and streptococci. The pathological process is mostly localized in the heart valves and is divided into acute, subacute and chronic endocarditis. The clinical course is very diverse. The symptoms are not very specific and occur in different combinations. The basis of diagnosis constitutes of positive blood cultures and echocardiography. The course and development of complications depend on the etiological agent and adequate therapy. The most serious complications include heart valve damage leading to heart failure and excessive embolization rates. The primary treatment consists of administering antibiotics for 4-6 weeks. The surgical solution is used only after the failure of antibiotic therapy. In the case report, we will present a case of a 24-year-old man who was admitted to the Internal Clinic of the Oncological Institute with the diagnosis of multiple deposits of unknown etiology in the brain.<\/p>\n<p><strong>Keywords:<\/strong> infective endocarditis, Abiotrophia defectiva, infectious aneurysm<\/p>\n","casopis":[{"ID":1893,"post_author":"7","post_date":"2020-05-05 11:32:54","post_date_gmt":"2020-05-05 09:32:54","post_content":"<ul>\r\n \t<li>Identification of metabolic pathways in pathogenesis of diabetic retinopathy using exome sequencing \u2013 a pilot study<\/li>\r\n \t<li>Anti-tumour effects of vitamin D<\/li>\r\n \t<li>Molecular detection methods of mutations in the kinase domain of fusion gene bcr-abl1 in patients with chronic myelocyte leukemia<\/li>\r\n \t<li>The case report of toxoplasmic meningoencephalitis with fatal outcome in HIV patient<\/li>\r\n \t<li>Carcinosarcoma-like endometrioid carcinoma of the uterus: case report of rare non-high-grade tumor<\/li>\r\n<\/ul>","post_title":"newsLab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-4","to_ping":"","pinged":"","post_modified":"2020-05-05 15:13:41","post_modified_gmt":"2020-05-05 13:13:41","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.newslab.sk\/?post_type=casopis&#038;p=1893","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"51-54","upload_clanok":{"ID":1902,"id":1902,"title":"NEWSLAB_1-2020_Bedn\u00e1rov\u00e1","filename":"NEWSLAB_1-2020_Bedn\u00e1rov\u00e1.pdf","filesize":266472,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2020\/05\/NEWSLAB_1-2020_Bedn\u00e1rov\u00e1.pdf","link":"https:\/\/www.newslab.sk\/en\/differential-diagnosis-of-brain-foci-a-possible-complication-of-infective-endocarditis\/newslab_1-2020_bednarova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab_1-2020_bednarova-2","status":"inherit","uploaded_to":1904,"date":"2020-05-05 12:49:08","modified":"2020-05-05 12:49:08","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1904","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1904"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1904\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1904"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1904"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1904"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}