Clinical Case Database / Category: Clinical Care
Infective endocarditis: how immunology tests may help or mislead
Publication details
John Maher MRCPI MRCP MSc PhD FRCPath
Foundation Years Journal, volume 5, issue 2, p.57 (123Doc Education, London, March 2011)
Abstract
Immunopathology plays an important role in infective endocarditis. In this context, two cases are presented here. In both patients, several abnormal immunological test results were obtained. Some findings were typical, whereas others were unanticipated and potentially misleading. Failure to interpret such findings correctly could lead to selection of inappropriate and potentially highly dangerous treatment. Pitfalls associated with immunological testing in this model of chronic infection are discussed. The need for clinicopathological liaison in the interpretation of diagnostic results is emphasized.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
Product | Price | Subscription | |
---|---|---|---|
Foundation Years Clinical Cases Database | £29.00 | 6 months | |
Foundation Years Clinical Cases Database | £39.00 | 12 months |
Authors
John Maher MRCPI MRCP MSc PhD FRCPath
Senior Lecturer in Immunology
Research Oncology
Hon Consultant
Allergy & Clinical Immunology
References
1. Lock R.J., Virgo P.F., Unsworth D.J. Pitfalls in the performance and interpretation of clinical immunology tests. J Clin Pathol 2008; 61:1236–42.
2. Choi H.K., Lamprecht P., Niles J.L., et al. Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase
3 antibodies. Arthritis Rheum 2000; 43:226–31.
3. Tiliakos A.M., Tiliakos N.A. Dual ANCA positivity in subacute bacterial endocarditis. J Clin Rheumatol 2008; 14:38–40.
4. Sugiyama H., Sahara M., Imai Y., et al. Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis. Cardiology 2009; 114:208–11.
5. Bonaci-Nikolic B., Andrejevic S., Pavlovic M., et al. Prolonged infections associated with antineutrophil cytoplasmic antibodies specific to proteinase 3 and myeloperoxidase: diagnostic and therapeutic challenge. Clin Rheumatol 2010 (in press).
6. Kishimoto N., Mori Y., Yamahara H., et al. Cytoplasmic antineutrophil cytoplasmic antibody positive pauci-immune glomerulonephritis associated with infectious endocarditis. Clin Nephrol 2006; 66:447–54.
7. Chirinos J.A., Corrales-Medina V.F., Garcia S., et al. Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature. Clin Rheumatol 2007; 26:590–5.
8. Bauer A., Jabs W.J., Süfke S., et al. Vasculitic purpura with antineutrophil cytoplasmic antibody-positive acute renal failure in a patient with Streptococcus bovis case and Neisseria subflava bacteremia and subacute endocarditis. Clin Nephrol 2004; 62:144–8.
9. Turner J.W., Pien B.C., Ardoin S.A., et al. A man with chest pain and glomerulonephritis. Lancet 2005; 365:2062.
10. O’Connor D.T., Weisman M.H., Fierer J. Activation of the alternate complement pathway in Staph. aureus infective endocarditis and its relationship to thrombocytopenia, coagulation abnormalities, and acute glomerulonephritis. Clin Exp Immunol 1978; 34:179–87.
11. Walport M.J. Complement. First of two parts. N Engl J Med 2001; 344:1058–66.
12. Frémeaux-Bacchi V., Weiss L., Demouchy C., et al. Hypocomplementaemia of poststreptococcal acute glomerulonephritis is associated with C3 nephritic factor (C3NeF) IgG autoantibody activity. Nephrol Dial Transplant 1994; 9:1747–50.
13. Craddock C.F., Richards N.P., Powell R.J., et al. Novel C3 nephritic factor activity in the glomerulonephritis of staphylococcal endocarditis. Q J Med 1987; 65:895–8.
Disclaimers
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
Financial Statement
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.