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Biomedical subjects

J E Geraci

Publications and source records attributed to J E Geraci.

At least 37 records · Page 2Linked to original sources
PubMed1982

Treatment of penicillin-sensitive streptococcal infective endocarditis.

Patients with infective endocarditis caused by penicillin-sensitive streptococci (minimal inhibitory concentration less than or equal to 0.1 microgram/ml of penicillin) may be treated successfully with one of the following three regimens: (1) aqueous penicillin G administered intravenously for 4 weeks, (2) aqueous penicillin G administered intravenously for 4 weeks in combination with streptomycin for the first 2 weeks of therapy, or (3) parenterally administered penicillin plus streptomycin for 2 weeks. No substantial difference in the relapse rate exists among the three regimens, and a cure rate of at least 98% may be anticipated with each of the three forms of therapy. The major advantage of the 2-week regimen is that it is more cost-effective than 4 weeks of hospitalization and therapy. The major disadvantage of the 2-week regimen and the 4-week regimen that uses streptomycin is the relatively low risk of streptomycin-associated vestibular toxicity. Patients unable to tolerate penicillin may be treated with vancomycin or a cephalosporin administered parenterally for 4 weeks.

Adult↗
PubMed1982

Symposium on infective endocarditis. III. Endocarditis due to gram-negative bacteria. Report of 56 cases.

At the Mayo Clinic, 56 patients with infective endocarditis caused by gram-negative bacteria were seen from 1958 through 1979, 35 of whom were seen from 1970 through 1979. The patients were categorized into two divisions: those with medical, naturally acquired valve infections (40 [71%]) and those with infective endocarditis after cardiac operation (16 [29%]). The overall cure rate was 82% (46 of 56 patients); 35 of 40 patients (88%) were cured in the medical group, and 11 of 16 patients (69%) were cured in the surgical group. The patients were further classified on the basis of organism: group 1 (33 patients)--infections caused by Haemophilus (18), Actinobacillus actinomycetemcomitans (4), Cardiobacterium hominis (6), Eikenella corrodens (2), Kingella kingii (2), and Bordetella bronchiseptica (1); 32 of these 33 patients (97%) were cured, and 6 of these infections were on prosthetic valves; group 2 (21 patients)--infections caused by enteric aerobic bacilli; 13 of the 21 patients (62%) were cured; group 3 (1 patient)--infection caused by anaerobes (Bacteroides fragilis); this patient died; and group 4 (1 patient)--infection caused by Neisseria gonorrhoeae; this patient was cured. The gram-negative bacteria in the survivors and nonsurvivors and the curative antibiotic regimens were tabulated. Among the 35 survivors in the medical group, a combined antibiotic regimen cured 21 patients (60%) and a single antibiotic agent cured 14 (40%). Among the 11 survivors in the surgical group, combined therapy was given to 8 (73%), a single drug was used once, and operation alone achieved a cure in 2 patients. Compared with past data, the current study indicates an increasing incidence of gram-negative bacterial endocarditis (approximately 10%) and an improving cure rate 82%).

Anti-Bacterial Agents↗
PubMed1982

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is an infrequent but serious complication of cardiac valve replacement. The overall frequency of prosthetic valve endocarditis is approximately 2%. The frequency of early-onset and late-onset infections is 0.78% and 1.1%, respectively. Staphylococci are the most common isolate from patients with early-onset infection, accounting for 47.5% of the total number of isolates. Staphylococcus epidermidis causes 27% of these staphylococcal infections. Among patients with late-onset infection, streptococci are the predominant microorganism, constituting 42% of the total number of isolates from patients in this group. The overall mortality among patients with prosthetic valve endocarditis is high--59%; the mortality among patients with early- or late-onset infections is 77% and 46%, respectively. Most patients with staphylococcal prosthetic valve endocarditis should undergo cardiac valve replacement in addition to antimicrobial therapy. Closely monitored anticoagulant therapy should be cautiously continued in patients with prosthetic valve endocarditis.

Anti-Bacterial Agents↗
PubMed1980

Synergy of penicillin and decreasing concentration of aminoglycosides against enterococci from patients with infective endocarditis.

To determine whether low concentrations of aminoglycosides in combination with penicillin could effectively kill enterococci in vitro, we tested penicillin (20 micrograms/ml) in combination with decreasing concentrations of either streptomycin (20, 10, 5, and 1 micrograms/ml) or gentamicin (5, 3, 1, and 0.5 micrograms/ml) against 13 strains of streptomycin-susceptible and 7 strains of streptomycin-resistant enterococci isolated from patients with infective endocarditis. At 24 h, penicillin plus each increment in streptomycin concentration resulted in a statistically significant increase in killing of streptomycin-susceptible enterococci, compared with the next lower streptomycin concentration (P less than 0.01). At 24 h, against streptomycin-susceptible and streptomycin-resistant enterococci, there were no statistically significant differences in killing between combinations containing 5 micrograms of gentamicin per ml and those containing 3 micrograms/ml. Against streptomycin-susceptible enterococci, there were statistically significant differences in killing between combinations containing 3 micrograms of gentamicin per ml and those containing 1 micrograms/ml. Against streptomycin-resistant enterococci, statistically significant differences in killing were detected with combinations containing 5 micrograms of gentamicin per ml and those containing 1 microgram/ml.

Drug Synergism↗
PubMed1980

Visceral leishmaniasis (kala-azar) as a cause of fever of unknown origin.

A patient with a rare cause of fever of unknown origin, visceral leishmaniasis (kala-azar), is reported. The diagnosis was made by exploratory laparotomy and splenectomy after diagnostic studies had failed to reveal the cause of the fever. The patient was cured with a 6-day course of therapy with Pentostam (sodium antimony gluconate). Visceral leishmaniasis should be considered in the differential diagnosis of patients with obscure fever who have traveled in endemic areas.

Adult↗
PubMed1980

Infective endocarditis caused by Actinobacillus actinomycetemcomitans: report of four cases.

Four patients with infective endocarditis caused by Actinobacillus actinomycetemcomitans are reported. The clinical course was characterized by chronicity. Three of the four patients were treated with combined penicillin and aminoglycoside therapy on an empiric basis; the fourth patient was given ampicillin alone for 3 weeks. Cure was achieved in all four cases, with antibiotic therapy alone in the first three and ampicillin alone plus valve replacement surgery in the fourth patient. Further in vitro bactericidal data are needed, and actual therapy with ampicillin alone is desirable to see whether these patients with endocarditis of natural valves cannot be treated with ampicillin alone for a 3-week period.

Actinobacillus Infections↗
PubMed1979

Cardiac valve replacement in congestive heart failure due to infective endocarditis.

From January 1961 to July 1974, 138 patients underwent cardiac valve replacement because of complications of infective endocarditis. The overall operative mortality was higher in patients with Class IV cardiac functional disability (17%) than in patients with Class III (7%) or II (8%). The mortality for patients who had undergone aortic valve replacement with Class IV disability was higher (22%) than that for patients with Class III (0) or II (6%). When compared with patients without infective endocarditis who had undergone cardiac valve replacement, the operative mortality per valve replacement was approximately the same when the degree of cardiac disability was the same at the time of surgery for both groups of patients. Patients with aortic regurgitant murmurs caused by infective endocarditis should be observed closely for the onset of heart failure, especially during the first month of disease. In patients with aortic or mitral incompetence, if heart failure develops or progresses during the first month, we believe that prompt cardiac valve replacement should be considered, because even heart failure that may initially appear mild often progresses to severe heart failure during this period.

Aortic Valve Insufficiency↗
PubMed1978

Anticoagulant therapy and central nervous system complications in patients with prosthetic valve endocarditis.

Among 52 cases of prosthetic valve endocarditis, adequate anticoagulant therapy was administered in 38 and discontinued or given in subtherapeutic dosage in 14. Our data suggest that anticoagulant therapy does not appreciably increase morbidity or mortality in patients with prosthetic valve endocarditis. On the contrary, in our patients the incidence of major clinical CNS (central nervous system) complications was increased and the mortality was higher if anticoagulant therapy was discontinued. CNS complications occurred in 10 of the 14 patients without adequate anticoagulant therapy and in three of the 38 with adequate anticoagulant therapy. Mortality was 57% among those treated without adequate anticoagulation and 47% among those with adequate anticoagulation. At autopsy, CNS complications were thought to be the primary cause of five of the eight deaths in cases without adequate anticoagulation.

Adolescent↗
PubMed1978

Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to viridans streptococci.

Thirty-three patients with viridans streptococcal infective endocarditis were treated for two weeks with intramuscular procaine pencillin, 1.2 million units every 6 hours, plus streptomycin, 500 mg intramuscularly every 12 hours. Nine patients (27%) had infections with relatively penicillin-resistant microorganisms (MIC greater than 0.1 microgram/ml or MBC greater than or equal 3.12 microgram/ml). Follow-up ranged from 2 months to 3.5 years. There were no relapses; Mild vestibular toxicity developed in one patient. One patient died two months after completion of antimicrobial therapy from sudden onset of severe congestive heart failure; Seven patients required cardiac valve replacement after completion of antimicrobial therapy. None died. We believe that this therapeutic regimen is effective antimicrobial therapy for infective endocarditis caused by viridans streptococci, irrespective of in vitro microbiologic data.

Adolescent↗
PubMed1978

Valve replacement in patients with active infective endocarditis.

Eleven of 138 patients with infective endocarditis (IE) who underwent cardiac valve replacement for IE during a 12 1/2-year period had active IE. Eight of the 11 (all with aortic IE) had positive blood cultures within 48 hours preoperatively; six of the eight had positive Gram stains and cultures of the excised cardiac tissue. All 11 patients had Class IV cardiac functional disability (New York Heart Association classification) at the time of surgery. Staphylococci (three patients with Staphylococcus aureus and one with S. epidermidis) were the most frequent isolates. Three patients died; two of these three deaths occurred in patients who had a sudden onset preoperatively of severe aortic regurgitation and heart failure. In one patient (S. epidermidis infection) prosthetic valve endocarditis developed. Cardiac valve replacement may be performed successfully in patients with active IE even when blood cultures are positive in the immediate perioperative period. The hemodynamic status of patients with IE should be the determining factor in the timing of cardiac valve replacement, rather than the activity of the infection or the length of preoperative antimicrobial therapy. A radical surgical procedure may be necessary in patients with myocardial or aortic abscesses in whom conventional aortic valve replacement is not possible.

Adolescent↗
PubMed1978

Cardiobacterium hominis endocarditis. Four cases with clinical and laboratory observations.

The clinical and microbiologic features of Cardiobacterium hominis endocarditis in four patients seen at the Mayo Clinic from 1971 through 1976 are described. All four were men ranging in age from 39 to 60 years. The precipitating factor in three was a dental procedure, and the illness was a prolonged, chronic one, with symptoms having been present 10 to 18 months before diagnosis. The other patient had a late prosthetic valve endocarditis and had had symptoms for only 3 months. Three patients were cured; the fourth died after 32 days of adequate therapy and what was considered a bacteriologic cure. Because of the pronounced fastidiousness of these bacteria, in vitro susceptibility tests could be done in only two of the four; the minimum inhibitory concentration for penicillin G was 0.07 microgram/ml in both. The therapeutic regimens were penicillin G plus streptomycin in the first case, predominantly penicillin G alone in the second, penicillin G for 2 weeks in the third, and ampicillin for 4 weeks in the fourth (prosthetic valve case) in addition to valve replacement. Clinical and laboratory experiences in the total reported cases lead us to believe that 3 weeks of therapy with penicillin G or ampicillin alone is adequate therapy for C. hominis endocarditis of natural valves.

Adult↗
PubMed1977

Musculoskeletal manifestations of bacterial endocarditis.

In a retrospective analysis of bacterial endocarditis, 84 of 192 cases (44%) were found to have musculoskeletal manifestations of one or more types. Common manifestations were arthralgias (32 cases), arthritis (26 cases), low back pain (24 cases), diffuse myalgia (16 cases), and myalgias localized to the thigh or calf (11 cases). The joint manifestations typically were monarticular or oligoarticular, and the myalgias were commonly unilateral. No association was found between the pattern of rheumatic symptoms and other clinical manifestations, laboratory tests, or causative bacterial organisms. In 52 patients (27%), musculoskeletal complaints were the first or among the first symptoms of bacterial endocarditis. The frequency and character of these manifestations and their tendency to occur early in the course of the disease indicate that they are an important feature of endocarditis which, if not recognized, may cause a delay in the diagnosis by mimicking a rheumatic disease.

Adolescent↗
PubMed1977

Haemophilus endocarditis. Report of 14 patients.

From 1963 through December 1976, 14 patients with Haemophilus endocarditis were seen, 10 since January 1972. Four different species representing 15 isolates were cultured from the 14 patients: H. influenzae (1), H. aphrophilus (5), H. PARAPHROPHILUS (5), and H. parainfluenzae (4). One patient had infection with both H. aphrophilus and H. paraphrophilus. Minimal inhibitory concentrations of 12 of the tested 14 strains with ampicillin were 1.25 mug/ml or less. Tube dilution tests were not possible for minimal bactericidal concentrations (7 times) or serum bactericidal titers (5 times) of the 12 tested strains. The clinical picture varied from an insidious onset and mild uncomplicated disease to abrupt onset with severe multisystem disease. Twelve patients had murmurs on admission; congestive heart failure was absent in all 14 but embolization occurred in 6. Treatment periods of 3 to 7 weeks consisted of penicillin G or ampicillin plus aminoglycoside in nine patients and ampicillin alone in five. All 14 patients were cured; no relapses occurred. Value surgery was not needed for bacteriologic cure but was necessary 15 days after therapy in one patient and in four others from 12 to 22 months after therapy. We believe that ampicillin, 12 g/day alone for 3 weeks, is adequate treatment for Haemophilus endocarditis.

Adolescent↗
PubMed1977

Coryneform bacterial endocarditis: difficulties in diagnosis and treatment, presentation of three cases, and review of literature.

Three patients who had coryneform bacterial endocarditis affecting a prosthetic valve are presented and 64 case reports are reviewed. Diagnostic difficulties occur because coryneform bacteria often are fastidiuos, with long incubation periods, and often contaminate blood cultures. Although some coryneform bacteria are killed by penicillin G, many are resistant to most of the commonly used antibiotics. Vancomycin is bactericidal in resistant strains studied. Treatment with vancomycin is indicated until in vitro bactericidal data are available. Coryneform endocarditis often occurs on prosthetic valves, thus making therapy and its evaluation even more difficult.

Adult↗
PubMed1977

Vancomycin.

Vancomycin, a useful bactericidal antibiotic for selective clinical infections, is the therapy of choice for serious staphylococcal infections when the penicillins and cephalosporins cannot be used. The antibacterial spectrum of vancomycin also covers other gram-positive cocci and bacteria and gram-negative cocci. Vancomycin is given intravenously in most cases, usually in a dose of 1 g every 12 hours in patients who have normal renal function. The indications for vancomycin therapy are as follows. 1. Serious staphylococcal infections in patients who are intolerant to the penicillins and cephalosporins or when the organism is resistant to the commonly used bactericidal agents. 2. Streptococcal endocarditis in patients intolerant to penicillin G; in enterococcal infections, it is used with an associated aminoglycoside. Vancomycin is not used alone in enterococcal endocarditis. In nonenterococcal (Streptococcus bovis) and viridans streptococcal endocarditis, vancomycin may be used alone if the minimum bactericidal concentration is less than or equal to 10 microgram/ml; otherwise, it is combined with an aminoglycoside. 3. Other serious infections caused by organisms resistant to the commonly used agents such as corynebacterial endocarditis. 4. Acute staphylococcal ileocolitis, for which vancomycin is given orally or orally and intravenously if indicated. Vancomycin is relatively nontoxic; the predominant toxic response is neurotoxicity, but this is rarely seen if the serum levels are 30 microgram/ml or less.

Acute Disease↗
PubMed1975

Bactericidal activity of combinations of penicillin or clindamycin with gentamicin or streptomycin against species of viridans streptococci.

Checkerboard bactericidal studies were performed with two strains each of Streptococcus mitis, S. salivarius, and S. sanguis, and the results were analyzed by the use of isobolograms. Synergy between penicillin and streptomycin or gentamicin was demonstrated with four strains, representing two of S. salivarius, one of S. sanguis, and one of S. mitis; the remainder were either too susceptible or too resistant to be analyzed. Clindamycin with streptomycin or gentamicin acted synergistically with three strains, representing two of S. sanguis and one of S. salivarius; the remainder were either too susceptible or too resistant to be analyzed.

Clindamycin↗