دورية أكاديمية
Cerebral Abscess Associated With Odontogenic Bacteremias, Hypoxemia, and Iron Loading in Immunocompetent Patients With Right-to-Left Shunting Through Pulmonary Arteriovenous Malformations.
| العنوان: | Cerebral Abscess Associated With Odontogenic Bacteremias, Hypoxemia, and Iron Loading in Immunocompetent Patients With Right-to-Left Shunting Through Pulmonary Arteriovenous Malformations. |
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| المؤلفون: | Boother EJ; NHLI Cardiovascular Sciences, Imperial College London, London, UK.; Imperial College School of Medicine, Imperial College London., Brownlow S; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom., Tighe HC; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom., Bamford KB; Department of Microbiology, Hammersmith Campus, Imperial College Healthcare NHS Trust, London, United Kingdom., Jackson JE; Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom., Shovlin CL; NHLI Cardiovascular Sciences, Imperial College London, London, UK.; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom. |
| المصدر: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2017 Aug 15; Vol. 65 (4), pp. 595-603. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Jan. 2011- : Oxford : Oxford University Press Original Publication: Chicago, IL : The University of Chicago Press, c1992- |
| مواضيع طبية MeSH: | Arteriovenous Malformations*/complications , Arteriovenous Malformations*/epidemiology , Arteriovenous Malformations*/microbiology , Arteriovenous Malformations*/physiopathology , Bacteremia*/complications , Bacteremia*/epidemiology , Bacteremia*/microbiology , Bacteremia*/physiopathology , Brain Abscess*/complications , Brain Abscess*/epidemiology , Brain Abscess*/microbiology , Brain Abscess*/physiopathology , Hypoxia*/complications , Hypoxia*/epidemiology , Hypoxia*/microbiology , Hypoxia*/physiopathology , Telangiectasia, Hereditary Hemorrhagic*/complications , Telangiectasia, Hereditary Hemorrhagic*/epidemiology , Telangiectasia, Hereditary Hemorrhagic*/microbiology , Telangiectasia, Hereditary Hemorrhagic*/physiopathology, Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Prospective Studies ; Pulmonary Artery/abnormalities ; Pulmonary Veins/abnormalities ; Young Adult |
| مستخلص: | Background: Cerebral abscess is a recognized complication of pulmonary arteriovenous malformations (PAVMs) that allow systemic venous blood to bypass the pulmonary capillary bed through anatomic right-to-left shunts. Broader implications and mechanisms remain poorly explored. Methods: Between June 2005 and December 2016, at a single institution, 445 consecutive adult patients with computed tomography-confirmed PAVMs (including 403 [90.5%] with hereditary hemorrhagic telangiectasia) were recruited to a prospective series. Multivariate logistic regression was performed and detailed periabscess histories were evaluated to identify potential associations with cerebral abscess. Rates were compared to an earlier nonoverlapping series. Results: Thirty-seven of the 445 (8.3%) patients experienced a cerebral abscess at a median age of 50 years (range, 19-76 years). The rate adjusted for ascertainment bias was 27 of 435 (6.2%). Twenty-nine of 37 (78.4%) patients with abscess had no PAVM diagnosis prior to their abscess, a rate unchanged from earlier UK series. Twenty-one of 37 (56.7%) suffered residual neurological deficits (most commonly memory/cognition impairment), hemiparesis, and visual defects. Isolation of periodontal microbes, and precipitating dental and other interventional events, emphasized potential sources of endovascular inoculations. In multivariate logistic regression, cerebral abscess was associated with low oxygen saturation (indicating greater right-to-left shunting); higher transferrin iron saturation index; intravenous iron use for anemia (adjusted odds ratio, 5.4 [95% confidence interval, 1.4-21.1]); male sex; and venous thromboemboli. There were no relationships with anatomic attributes of PAVMs, or red cell indices often increased due to secondary polycythemia. Conclusions: Greater appreciation of the risk of cerebral abscess in undiagnosed PAVMs is required. Lower oxygen saturation and intravenous iron may be modifiable risk factors. (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.) |
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| فهرسة مساهمة: | Keywords: hereditary hemorrhagic telangiectasia; hypoxemia; intravenous iron; oxygen; transferrin saturation index |
| تواريخ الأحداث: | Date Created: 20170422 Date Completed: 20180529 Latest Revision: 20220408 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC5849101 |
| DOI: | 10.1093/cid/cix373 |
| PMID: | 28430880 |
| قاعدة البيانات: | MEDLINE |
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