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At least 217 records · Page 12Linked to original sources
PubMed2003

[Infectious endocarditis. A study of 50 patients in a non-university hospital].

The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.

Aged↗
PubMed2006

Simultaneously performed mitral valve replacement and Hartmann's operation for infectious endocarditis from Streptococcus bovis and rectal cancer.

In patients with surgical indications for both cardiac surgery and a malignant neoplasm, cardiac surgery should generally be performed first; however, in some cases simultaneous surgery is recommended. We report a case of infectious endocarditis of the mitral valve caused by Streptococcus bovis with rectal cancer. Blood cultures showed a rise in coagulase-negative S. bovis, and the source of infection was thought to be the rectal cancer. The patient presented with cerebral infarction prior to surgery, and the possibility of recurrence of an infarction was predicted. The tumor of the rectum was hemorrhagic, so to avoid hemorrhagic complications due to perioperative heparinization and anticoagulant therapy and to remove the source of infection, mitral valve replacement and a Hartmann's operation were performed simultaneously. The postoperative course was uneventful.

Colectomy↗
PubMed2004

A woman with infectious endocarditis caused by Abiotrophia defectiva.

A 74-year-old woman with recurrent fever and multiple joint pain was admitted to Hokkaido University Hospital. Trans-esophageal echocardiogram revealed bacterial vegetation and destruction of the aortic valve. Although few bacteria grew in regular blood agar, Gram-positive coccobacillus was specifically grown in chocolate blood agar and Brucella agar, and it was identified to be Abiotrophia defectiva. Infectious endocarditis caused by Abiotrophia defectiva was diagnosed, she was treated with diuretics, penicillin G and gentamicin, and she immediately improved. Infectious diseases caused by Abiotrophia defectiva are extremely rare, and identification of this pathogen is important, as its bacterial characteristics require proper attention.

Aged↗
PubMedDate not supplied

[Infectious endocarditis of the heart valves and valvular prostheses. report of 21 cases].

During 1978, and 1979, the Surgery Division of The Cardiology and Pneumology Hospital of The National Medical Center (Mexican Institute for Social Security), studied and treated surgically twenty one cases -- in twenty patients -- of infectious endocarditis. Nine patients had an active infection in the heart valves and twelve in the prosthesis. The survival rate of the first group was 88.88% and of the second group 58.33%. The causes of death were due to the hemodynamic damage that the valvular or prosthetic dysfunction leads to, when there is a delay in the arrival of the patient to a medical unit of third level. The conventional medical treatment applicable to a reduced number of cases whose characteristics are discussed do not operate when dealing with patients with infected prosthesis or valve infections caused by non-gram positive bacteria. We conclude that this problem demands a better approach, principally surgical, to improve the prognosis of these patients.

Endocarditis↗
PubMed2004

Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis.

The goal of our study was to determine the prevalence of older patients with cardiac valvular abnormalities warranting endocarditis prophylaxis. We performed a retrospective analysis of 1,000 randomly selected echocardiograms (inpatients and outpatients) from our tertiary care institution. We found that the prevalence of valvular abnormalities increased significantly with age, and that 50% of patients > or =60 years of age warranted endocarditis prophylaxis using current guidelines. With the aging population of the United States and the negative consequences of widespread antibiotic prophylaxis, further investigation is needed to identify patients who are truly at risk for infectious endocarditis.

Adolescent↗
PubMed1997

[Coxiella burnetti infectious endocarditis. Apropos of a case].

Chronic forms of Q fever (endocarditis) are rare, but are responsible for severe and desperately recurrent infections, resulting in multiple valve replacements with a reserved prognosis. The authors report the case of a 35-year-old patient with a known history of rheumatic fever, who developed blood culture negative infectious endocarditis on a mitral bioprosthesis. The diagnosis of Q fever was based on serological arguments. Despite long-term antibiotic therapy, serology remained strongly positive and was associated with repeated mitral valve disinsertion. The patient died immediately after the fourth operation in a context of haemodynamic failure. This clinical case emphasizes the importance of performing Q fever serology in any case of culture negative endocarditis and the therapeutic difficulties encountered in chronic recurrent endocarditis.

Adult↗
PubMed1999

Post-parturition infectious endocarditis in a patient with a normal mitral valve.

A 29-year-old woman with no history of heart disease was admitted for the treatment of congestive heart failure. Six months earlier, she had given birth, then 20 days later developed a fever and cardiac failure ensued. An echocardiogram demonstrated severe mitral valve regurgitation. Her blood cultures were positive, and we made a diagnosis of mitral valve regurgitation due to infectious endocarditis. Despite treatment for congestive heart failure and antibiotic therapy, resulting in negative blood cultures, her congestive heart failure did not improve, and vegetation on the mitral valve was observed by echocardiography. We successfully removed the infected tissue with mitral valve plasty.

Adult↗
PubMed2001

[Subacute infectious endocarditis due to the agent of cat scratch fever: Bartonella henselae].

The diagnosis of severe mitral stenosis with left atrial thrombus was rectified at valvular replacement in a 48-year old immuno-competent man who was a cat owner. The mass in the left atrium was, in fact, a large endocarditic vegetation. Pre- and postoperative blood cultures were negative as was culture of the excised mitral valve. The diagnosis of infectious endocarditis (IE) due to Bartonella Henselae was made from a positive serological test (1600) and identification of the germ by genetic amplification. Antibiotic therapy was continued for 6 months and the patient was cured with a follow-up of 4 years. Bartonella Henselae IE is very rare (14 reported cases) and affects mainly the aortic valve, often giving rise to very large vegetations which, in half the cases, are complicated by systemic emboli. Germs like Batonella are sensitive to most antibiotics, especially the aminosides and macrolides. In Bartonella Henselae IE, valve replacement is the rule (13 out of 14 cases) and the prognosis is usually good. Sero-diagnosis of Bartonellosis should be part of the systematic investigation of all blood culture negative IE.

Azithromycin↗
PubMed2003

[Pulmonary septic emboli in a patient with right-side infectious endocarditis].

An 18-year-old woman afflicted with ventricular septal defect was admitted for high fever and dyspnea. She had undergone no surgical repair. Chest CT showed numerous nodular opacities in both lungs. The majority of them were situated on the pleura. Echocardiography revealed an area of vegetation 20 mm in diameter just beneath the tricuspid valve. Staphylococcus aureus was cultured from venous blood. We diagnosed right-side bacterial infectious endocarditis caused by Staphylococcus aureus and culminating in septic pulmonary emboli. Intravenous panipenem/betamiprom was prescribed, and after 5 weeks, the patient recovered, was negative for C-reactive protein and had a negative venous blood culture. Cardiac septal defect with bacterial endocarditis is a major risk factor in the development of septic pulmonary emboli.

Adolescent↗
PubMed1994

[Sampling study on practitioners' attitude to the prevention of infectious endocarditis].

UNLABELLED: BACKGROUNDS AND METHODS: The opinions and the experience of Veneto practitioners about prevention of infective endocarditis were detected through a sample survey among the 386 practitioners of Health and Social Unit Nr 16, 17, and 36 of Veneto Region. The interview was carried out through a questionnaire, sent by mail, asking for: 1) general information on the practitioner's profession; 2) information about the previous experience in diagnosis and care of heart diseases, particularly of infective endocarditis, of atrial septal defect ostium secundum type without pulmonary hypertension, of unstable angina, and moderate mitral stenosis; 4) attitudes in the prevention of infective endocarditis. Of 386 practitioners surveyed, 186 (48.2%) responded. More than 60% of the responders held a diploma of specialization and 7% were cardiologists, half of the responders had worked in public hospitals. The 63.8% of the practitioners had patients over sixty in a percentage of 15-44%. In 1990 only 5.9% of the practitioners observed new cases of infective endocarditis, while half of them stated that some of their patients had suffered from this disease in the past. RESULTS: The assessment of the level of severity for every heart disease is ranged between 0 (the minimum) and 10 (the maximum). The statistical analysis showed that the minimum arithmetic mean (+/- SD) is given for atrial septal defect without pulmonary hypertension with 4.6 +/- 2. Then for moderate mitral stenosis with 7.1 +/- 1.6, unstable angina pectoris with 7.4 +/- 2 and the maximum mean is given for infectious endocarditis with 8 +/- 1.7. ANOVA statistical analysis applied on the four paired series of assessment of severity carried out a high significant difference (F of Snedecor = 328.2; P < 0.001) among assessments, and among practitioners (F = 1.71; P < 0.01). High significant linear correlation (at least P < 0.01) is observed among the severity of the four heart diseases. Vice versa not significant association is showed between severity for every heart diseases and the experience of the interviewed. CONCLUSIONS: Most practitioners would prescribed prophylaxis for infective endocarditis to patients with rheumatic valve disease (91% of the responders), with previous episodes of infective endocarditis (90.4%), with prosthetic valve (67.6%) or with degenerative valve disease (57.3%). On the contrary most practitioners would not prescribe the prevention for infective endocarditis to patients with coronary heart disease (84.9%), with coronary bypass (71.4%), with mitral valve prolapse without insufficiency (60.6%), with dilatative cardiomyopathy (67%) or with obstructive cardiomyopathy (57.8%). A prevailing trend in case of congenital heart disease and mitral valve prolapse with insufficiency was not observed. The 86.6% of practitioners would prescribe the prophylaxis for infective endocarditis in case of dental extraction, but only the 64.4% would prescribe it in case of any potentially haemorrhagic oral or dental procedure. The 61.7% of the responders would not prescribe the prevention for infective endocarditis to patients receiving the prophylaxis for rheumatic fever. The practitioners would use in the following order: amoxicillin (77.3%), erythromycin (76.9%), penicillin V (76.3%) and ampicillin-gentamycin (61.3%). On the contrary, most responders would prescribe neither tetracycline (73%) nor spiramycin (69.8%). There is no prevailing trend to the employ of oral cephalosporins. The 90.3% of the practitioners think that infective endocarditis can be a quite interesting and useful subject for an up-to-date course.

Analysis of Variance↗
PubMed1997

[Mycotic aneurysms and multiple peripheral embolisms in a patient with infectious endocarditis].

Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regurgitation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischemic legs and multiple asymptomatic mycotic aneurysms: Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequent angiogram. She recovered uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools has led to a decrease of these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment.

Abscess↗
PubMed1985

[Diagnosis and echocardiographic course of infectious endocarditis in obstructive cardiomyopathy].

A typical case of advanced obstructive cardiomyopathy in a young subject was revealed by Streptococcal mitral valve endocarditis and was diagnosed by one and two dimensional echocardiography, which revealed a pedunculated vegetation on the large mitral valve and rupture of the chordae of the small mitral valve. This was complicated by biventricular heart failure, peripheral arterial embolism in the leg due to migration of the vegetation which disappeared on the repeat echocardiography and pulmonary embolism with arterial clot emboli due to heparin-induced thrombocytopenia. This condition resolved without requiring cardiac surgery. Patients with obstructive cardiomyopathy should be treated routinely with prophylactic antibiotics, particularly when dental treatment is required. Echocardiography has become an essential examination in the diagnosis of this disease and its complications, especially in cases with infectious endocarditis.

Adult↗
PubMed1999

Nonculture Laboratory Methods for the Diagnosis of Infectious Endocarditis.

Over the past few years new techniques have been developed to improve the diagnosis of infectious diseases. However, despite the various available culture systems, culture-negative endocarditis currently represents a challenge for physicians. In our laboratory, in an effort to reduce the rate of endocarditis of unknown etiology, we have used several recent histologic, serologic, and molecular tests. We review the latest technical developments for the diagnosis of infectious endocarditis, including those that we are currently using.

Journal Article↗
PubMed2001

[Antibiotic treatment of infectious endocarditis].

BACKGROUND: Infective endocarditis is a septic condition in which the heart valves and the endocardial surfaces are infected, causing bacteraemia. In Norway, infective endocarditis is the most common infectious disease of the heart and accounts for approximately one case per 1,000 hospital admissions. The mortality rate is 15-40%. MATERIAL AND METHODS: This article presents a review of antimicrobial treatment of infective endocarditis, based on relevant literature and the author's clinical experience. Prophylactic treatment is not described. RESULTS AND INTERPRETATION: Early start of antimicrobial treatment is extremely important in order to avoid destruction of the heart valves and should always be started as soon as endocarditis is suspected and blood cultures have been drawn. The patient must be treated with bactericidal antibiotics in high doses given intravenously for four to eight weeks, depending on the aetiologic agents and the response. Only antibiotics that have been proven effective against endocarditis should be used. The minimal inhibitory concentration (MIC) should be determined for all antibiotics used.

Anti-Bacterial Agents↗
PubMed1998

[Propionibacterium acnes infectious endocarditis].

BACKGROUND: Propionibacterium acnes, a Gram positive microaerophilic bacteria is considered to have a low level of virulence. Nevertheless, it can be associated with infective endocarditis. We report 2 cases and a review of the literature. CASE REPORTS: The first man developed an acute prosthetic valve infective endocarditis and died. The second case was also a prosthetic valve infective endocarditis in a patient who developed infectious spondylitis. DISCUSSION: P. acnes is an uncommon causal agent in infective endocarditis and appears to have a predilectio for prosthetic valves. A prior history of skin infection is rare. P. acnes grow quite slowly, often requiring 7 to 14 days for identification. All isolates of P. acnes from blood or valve do not necessarily mean contamination.

Discitis↗
PubMed1987

[Current perspectives in the treatment of infectious endocarditis of a natural heart valve].

In view of the severity of infective endocarditis, which is due to local and general infectious processes and the hemodynamic consequences of valvular destruction, a policy of earlier valve replacement has been adopted. Clinical, bacteriologic and pathologic data collected over two years suggest that early surgery can be recommended in the following cases: congestive heart failure, inadequate results of antimicrobial therapy, and multiple emboli. Further studies should validate this policy, but the necessity of general prophylaxis for infective endocarditis must always be borne in mind.

Aortic Valve Insufficiency↗