[Endocarditis, with special reference to bacterial endocarditis].
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Endocarditis, Bacterial↗
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Compiling the identifying features of bacterial endocarditis. Vague clues may point to this dangerous infection.
Bacterial endocarditis is a life-threatening disease. Before the advent of antibiotics, its mortality rate was nearly 100%, but with today's diagnostic and therapeutic advances, it can be successfully managed in most cases. In this article, Drs Harris and Steimle explain the changes that occur when someone, who usually has an underlying cardiac defect, contracts bacteremia with an organism likely to adhere to heart valve surfaces. They describe risk factors, clinical presentations, identification of causative organisms, and empirical and specific therapy. A case report illustrates the many possible manifestations of the disease.
Adult↗
Virulent streptococcus viridans bacterial endocarditis.
A particularly virulent form of bacterial endocarditis due to Streptococcus viridans is described in selected patients. The diagnosis of purulent pericarditis and myocardial abscess is delineated. In addition, emphasis is placed on early surgical intervention in the appropriate management of these potentially lethal complications.
Abscess↗
Acute coronary embolism complicating bacterial endocarditis: operative treatment.
A patient with bacterial endocarditis and no previous history of angina substained an acute anterolateral myocardial infarction while awaiting surgery. Selective coronary arteriography revealed a filling defect in the left anterior descending coronary artery with limited flow beyond the area of occlusion. A calcific embolus from the infected aortic valve was removed at the time of valve replacement, and the patient had an uneventful immediate postoperative course. Late postoperatively paravalvular aortic regurgitation recurred before and after a second repair.
Acute Disease↗
[Echocardiographic diagnosis of bacterial endocarditis (authors' transl)].
Five cases of bacterial endocarditis are reported to illustrate typical findings in the echo-cardiogram. Serial echocardiograms provide a non-invasive method of determining localisationand extent of vegetations or lesions, as well as haemodynamic changes. This facilitates early consideration of possible surgical valve replacement.
Adult↗
Treatment of bacterial endocarditis with vancomycin.
Five patients with bacterial endocarditis who were allergic to penicillin were treated successfully with vancomycin. The causative microorganisms were Streptococcus bovis, S faecalis, S agalactiae, S intermedius, and Staphylococcus aureus. Except for the strain of S faecalis, vancomycin was bactericidal against these organisms at easily achievable serum concentrations. To insure a bactericidal serum titer of 1:8 or greater, streptomycin was added in the therapy of the case caused by S faecalis. There was no toxicity from vancomycin therapy in our patients except for mild phlebitis at the infusion site. Vancomycin appears to be an effective alternative to penicillin in individuals with endocarditis due to susceptible organisms. Vancomycin in combination with an aminoglycoside may be appropriate therapy for enterococcal endocarditis.
Adult↗
Detection of bacterial endocarditis with indium-111 labeled leukocytes.
Bacterial endocarditis in a patient with dense mitral annular calcification secondary to renal failure and hyperparathyroidism was detected by indium-111 labeled leukocyte imaging. Although the gallium-67 image was negative, echocardiography subsequently confirmed the diagnosis.
Citrates↗
Circulating immune complexes associated with decreased complement-mediated inhibition of immune precipitation in sera from patients with bacterial endocarditis.
The sera of patients with bacterial endocarditis frequently contain high levels of circulating immune complexes. In in vitro assays these sera have been shown to be deficient in the complement mediated inhibition of immune precipitation (immune complex solubilization) although C3 and C4 levels were often normal. The deficiency is due to the presence of a factor which also inhibits the ability of normal serum to solubilize immune complexes. This inhibitor is possibly rheumatoid factor which is frequently detected in endocarditis. Serial studies on 16 patients showed the levels of immune complexes, the ability to prevent immune precipitation and rheumatoid factor to correlate with disease activity. The similarity of the findings to those in rheumatoid arthritis are discussed.
Adult↗
Transient hilar lymphadenopathy due to bacterial endocarditis.
Transient hilar and mediastinal lymphadenopathy accompanying right-sided bacterial endocarditis without concurrent roentgenographically-demonstrable pulmonary parenchymal abnormalities has not, to our knowledge, been previously reported. The roentgenographic finding of hilar or mediastinal lymphadenopathy should not be considered incompatible with the diagnosis of bacterial endocarditis in the appropriate clinical setting. Possible mechanisms for the development of lymphadenopathy secondary to bacterial endocarditis are discussed.
Adult↗
Bacterial endocarditis in idiopathic hypertrophic subaortic stenosis.
Bacterial endocarditis complicating idiopathic hypertrophic subaortic stenosis (IHSS) is uncommon but endocarditis may be the first clinical manifestation of IHSS. In this report of such a case, the aortic and the mitral valves were the sites of the bacterial infection. Many chordae tendineae to the mitral valve were ruptured from the extension of the infectious process. The endothelial lesions, which served as the seat for the bacterial infection on the anterior mitral leaflet, likely resulted from its abutting action against the septal prominence. Damage to the aortic valve leaflet may have resulted from abnormal valve motion caused by IHSS and created an environment conducive to endocarditis. This patient developed aortic insufficiency during the course of bacterial endocarditis, suggesting that the occasional association of aortic insufficiency in patients with IHSS may be secondary to healed endocarditis of the aortic valve.
Adult↗
Infective endocarditis. Part III. Prevention of bacterial endocarditis.
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Animals↗
Correlation of echocardiographic and surgical findings in acute bacterial endocarditis.
From January 1979 to April 1983, 72 patients (pts) with bacterial endocarditis were treated. During their first stay in hospital 36 of them (age range: 23-67 years) underwent cardiac surgery because of severe congestive heart failure, unsuccessful antibiotic treatment of the infection and/or embolic events. In all these cases cardiac surgery was performed without preoperative catheterization. Surgery was recommended on the basis of clinical as well as M-mode and 2D echocardiographic findings. In 32 of the 36 pts the echocardiographic study completely predicted the surgical findings (23x the aortic valve, 1x the mitral valve, 1x the tricuspid valve, 5x the mitral and aortic valve, 1x the aortic valve and a VSD and 1x the triscuspid valve and a VSD were involved). The preoperative echocardiographic diagnosis was incomplete in 4 of the 36 pts. One aortic aneurysm, one aortic root abscess and 2x vegetations on the mitral valve were not detected by echocardiography. Surgery was recommended in these 4 pts because of additional aortic valve endocarditis proven by echocardiography. We conclude that combined M-mode and 2D echocardiography allows the accurate prediction of morphological alterations of the heart in the setting of acute bacterial endocarditis. Thus cardiac surgery can be recommended in pts with acute bacterial endocarditis without preoperative heart catheterization and coronary angiography.
Acute Disease↗
Native aortic valve tissue systemic embolization complicating bacterial endocarditis.
Systemic embolic events are known complications of bacterial endocarditis. Embolization of prosthetic valves has previously been reported in the literature. We report a case of embolization of native aortic valve tissue to the popliteal artery as the presenting event in a patient with subacute bacterial endocarditis. To our knowledge, this rare complication has not been previously reported.
Adult↗
Hospitalizations for bacterial endocarditis after renal transplantation in the United States.
PURPOSE: The national rate of and risk factors for bacterial endocarditis in renal transplant recipients has not been reported. METHODS: Retrospective registry study of 33,479 renal transplant recipients in the United States Renal Data System (USRDS) between 1 July 1994 and 30 June 1997. Hospitalizations for a primary diagnosis of bacterial endocarditis (ICD-9 codes 421.x) within three years after renal transplant were assessed. RESULTS: Renal transplant recipients had an unadjusted incidence ratio for endocarditis of 7.84 (95% confidence interval 4.72-13.25) in 1996. In multivariate analysis, a history of hospitalization for valvular heart disease (adjusted odds ratio (AOR), 25.81, 95% confidence interval 11.28-59.07), graft loss (AOR, 2.81, 95% CI 1.34-5.09), and increased duration of dialysis prior to transplantation were independently associated with hospitalizations for bacterial endocarditis after transplantation. Hospitalization for endocarditis was associated with increased patient mortality in Cox Regression analysis, hazard ratio 4.79, 95% CI 2.97-6.76. CONCLUSIONS: The overall incidence of bacterial endocarditis was much greater in renal transplant recipients than in the general population, although it is still relatively infrequent. Independent risk factors for bacterial endocarditis in the renal transplant recipients were identified, the most significant of which was valvular heart disease. Endocarditis substantially impacts renal transplant recipient survival.
Adolescent↗
The unsuspected complications of bacterial endocarditis imaged by gallium-67 scanning.
In this case report, we present a patient with bacterial endocarditis who was evaluated by 67Ga imaging for persistent fever despite treatment with multiple intravenous antibiotics. Although evidence of bacterial endocarditis was absent with 67Ga imaging, the study demonstrated findings that represent complications of bacterial endocarditis. The procedure demonstrated moderate pericardial uptake of isotope and thus provided the first evidence of pericarditis which was later confirmed at surgery. The study also demonstrated mildly increased activity in the vicinity of the aortic root and right atrium. A sinus of valsalva abscess, complicating the underlying diagnosis of bacterial endocarditis, was found and treated with surgery and antibiotics. At autopsy 4 wk later, a persistence sinus of valsalva abscess was found which extended into the right atrium.
Abscess↗
Satellite streptococci. A major cause of "negative" blood cultures in bacterial endocarditis?
In three of the 20 patients with bacterial endocarditis in our institution since 1975, satellite streptococci were recovered from the blood stream (15%). These organisms do not grow under usual laboratory conditions and may only be demonstrable after fortuitous contamination of the media. Clinicians and microbiologists must be alert to the possibility of satellite streptococci in patients with suspected bacterial endocarditis, and measures should be instituted to identify the organism.
Adolescent↗
Oral treatment of subacute bacterial endocarditis in children.
Fourteen episodes of subacute bacterial endocarditis in 11 children were successfully treated with antibiotics, which in 13 cases were given largely by mouth. It is suggested that oral treatment of bacterial endocarditis should be considered for children who are only moderately but not severely ill, and who have sensitive organisms.
Administration, Oral↗
Improving survival in bacterial endocarditis.
Twenty six cases of bacterial endocarditis in infancy and childhood were treated with a mortality of less than 8%. Twenty two had recognised congenital heart disease and four had previously normal hearts. Thirteen out of the 24 cases with positive blood cultures had staphylococcal infection. Appropriate antibiotics were identified by measurement of the minimum bactericidal concentration as an indicator of antibiotic sensitivity. The bactericidal activity of the patient's serum during treatment was monitored by back titration against the causative organism to assess the optimal antibiotic combination and dosage. Treatment was continued for six weeks in most cases, comprising intravenous treatment for at least the first three weeks, but then being substituted with oral treatment in some. Twenty one cases were successfully treated medically. Five developed complications requiring surgery, two of whom died.
Administration, Oral↗