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Fieber und erniedrigte CD4-Zellzahl bei einem 22-jährigen Patienten aus Ghana

A 22-year-old patient from Ghana with fever and reduced CD4 T-cell count

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Zusammenfassung

Ein 22-jähriger Patient aus Ghana ohne relevante Komorbiditäten wurde 2-malig bei unklarem Fieber und erniedrigter CD4-Zellzahl hospitalisiert. Beim zweiten stationären Aufenthalt konnte nach verlängerter Bebrütungsdauer der Blutkulturen und Nachweis von Vegetationen im transösophagealen Echokardiogramm eine Mitralklappenendokarditis durch Aggregatibacter aphrophilus diagnostiziert werden. Die entsprechend den Leitlinien über 4 Wochen durchgeführte Therapie führte zur Entfieberung, Auflösung der Vegetationen und zum Wiederanstieg der CD4-Zellzahl.

Abstract

A 22-year-old patient from Ghana without relevant co-morbidities was admitted twice with fever of unknown origin and reduced CD4 T-cell count. During the second hospital stay, after prolonged incubation of blood cultures and detection of vegetations on the mitral valve in a transesophageal echocardiogram, infectious endocarditis with Aggregatibacter aphrophilus was diagnosed. Treatment according to European guidelines resulted in resolution of the fever, dissolution of the mitral valve vegetations and recovery of CD4 T-cell count.

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Literatur

  1. Baron EJ, Scott JD, Tompkins LS (2005) Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures. Clin Infect Dis 41:1677–1680

    Article  PubMed  Google Scholar 

  2. Chirenda J (1999) Low CD4 count in HIV negative malaria cases and normal CD4 count in HIV positive and malaria negative patients. Cent Afr J Med 45:248

    PubMed  CAS  Google Scholar 

  3. Daniel WG, Mügge A, Grote J et al (1993) Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol 71:210–215

    Article  PubMed  CAS  Google Scholar 

  4. Das M, Badley AD, Cockerill FR et al (1997) Infective endocarditis caused by HACEK microorganisms. Annu Rev Med 48:25–33

    Article  PubMed  CAS  Google Scholar 

  5. El Khizzi N, Kasab SA, Osoba AO (1997) HACEK group endocarditis at the Riyadh Armed Forces Hospital. J Infect 34:69–74

    Google Scholar 

  6. Forte WC, Mario AC, Costa A da et al (2001) Immunologic evaluation in infective endocarditis. Arq Bras Cardiol 76:43–52

    Article  PubMed  CAS  Google Scholar 

  7. Habib G, Hoen B, Tornos P et al (2009) Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 30:2369–2413

    Google Scholar 

  8. Junker AK, Ochs HD, Clark EA et al (1986) Transient immune deficiency in patients with acute Epstein-Barr virus infection. Clin Immunol Immunopathol 40:436–446

    Article  PubMed  CAS  Google Scholar 

  9. Nishijima MK, Takezawa J, Hosotsubo KK et al (1986) Serial changes in cellular immunity of septic patients with multiple organ-system failure. Crit Care Med 14:87–91

    Article  PubMed  CAS  Google Scholar 

  10. Petti CA, Bhally HS, Weinstein MP et al (2006) Utility of extended blood culture incubation for isolation of Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella organisms: a retrospective multicenter evaluation. J Clin Microbiol 44:257–259

    Google Scholar 

  11. Sabatier F, Dignat-George F, Mège JL et al (1997) CD4 + T-cell lymphopenia in Q fever endocarditis. Clin Diagn Lab Immunol 4:89–92

    PubMed  CAS  Google Scholar 

  12. Shindler N (2002) Clinical decision making in endocarditis. In: Otto C (Hrsg) Clinical echocardiography. W.B. Saunders, Philadelphia, S 451–468

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Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung (BMBF) gefördert (Förderkennzeichen: 01EO1002 und 01KI1204).

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Correspondence to M.W. Pletz.

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Ghanem, H., Hagel, S., Keller, P. et al. Fieber und erniedrigte CD4-Zellzahl bei einem 22-jährigen Patienten aus Ghana. Internist 54, 100–104 (2013). https://doi.org/10.1007/s00108-012-3159-6

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  • DOI: https://doi.org/10.1007/s00108-012-3159-6

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