Elsevier

Cardiovascular Pathology

Volume 19, Issue 3, May–June 2010, Pages 171-182
Cardiovascular Pathology

Symposia Paper 2008
Cardiac infections: focus on molecular diagnosis

https://doi.org/10.1016/j.carpath.2009.09.010Get rights and content

Abstract

The role of different types of infections in heart diseases is more important than commonly thought, with new and re-emerging infections (i.e., Mycobacterium tuberculosis).

This review addresses the pathology of infective pericarditis, myocarditis, and endocarditis, mainly focusing on the significance of molecular techniques in the detection of infective agents. Molecular investigations represent important ancillary diagnostic tools and combined with other conventional approaches provide a more precise final diagnosis. A close collaboration and communication among cardiologists, cardiac surgeons, pathologists, and microbiologists is essential to ensure optimal diagnoses and management as well as a favorable impact on patient outcome.

Introduction

The influence of different types of infections in heart diseases is more important than commonly thought with new emerging infections and re-emergence of previous infections (i.e., Mycobacterium tuberculosis).

During the past 10–15 years, the development and application of molecular techniques have significantly improved the diagnosis and monitoring of infectious diseases, overcoming some environmental conditions that make Koch's postulates inapplicable, at least in living subjects. Nucleic acid techniques, particularly polymerase chain reaction (PCR), have significantly enhanced sensitivity in the detection and characterization of different microorganisms, particularly in those cases in which a limited number of pathogenic organisms are sought. Their use has become the new gold standard for the identification of uncultivable or fastidious microorganisms. The addition of molecular methods to the other conventional techniques (serology, culture, and morphology) now permits a rapid and accurate etiological diagnosis to be reached bringing about an earlier initiation of a focused antimicrobial regimen and, thus, increasing the likelihood of blocking disease progression.

The present review will mainly focus on infective pericarditis, myocarditis and endocarditis.

The influence of different infective agents in cardiovascular diseases will not be the objective of the present study.

Section snippets

Pericarditis

Pericarditis is an inflammation of the pericardium generally characterized by inflammatory infiltrate in the epi- and pericardial layers of tissue, sometimes associated with exudates and usually consisting of fibrin and inflammatory cells [1].

The true incidence and prevalence of pericarditis are difficult to measure; benign and autoptic studies report a rate of around 1% suggesting that pericarditis might frequently be subclinical [2]. Pericardial abnormalities are seen in up to 20% of patients

Myocarditis

Myocarditis, an inflammation of the myocardium associated with cardiac dysfunction, is often viewed as an early stage in the progression of the disease leading to cardiomyopathy and heart failure in humans [20]. The symptoms of myocarditis are different, often starting with flu-like syndrome, either of the upper respiratory or gastrointestinal tract. Clinical presentations of the disease range from non specific systemic symptoms to fulminant hemodynamic collapse and sudden death [21]. That

Endocarditis

Endocarditis is an endovascular microbial infection of intracardiac structures facing the blood, including infections of the large intrathoracic vessels and intracardiac foreign bodies [71], [72]. Formerly known as bacterial endocarditis, endocardial infections are currently named infective endocarditis (IE), in order to include both bacterial and fungal microorganisms. No viral infection has been reported. As a consequence, sterile thrombotic lesions (thrombotic nonbacterial endocarditis)

Conclusions

Different pathogenic organisms, mainly viruses in pericarditis and myocarditis and bacterial agents in endocarditis, may now be more sensitively and quickly detected and characterized by using molecular techniques. The optimal use of molecular methodologies resides in a correct interpretation by skilled personnel and in the integration of molecular findings, with other data coming from current traditional diagnostic tools (serology, culture and morphology).

Increased emphasis on symptoms and

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