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PubMed2002

[Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users].

BACKGROUND: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. RESULTS: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. CONCLUSIONS: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

Adult↗
PubMed1975

[Epidemiology and clinical aspects of infectious endocarditis].

There has been a change in the epidemiological, etiological and clinical pattern of infective endocarditis. This changing pattern has been substantiated by comparison of 156 cases of infective endocarditis seen over the period 1947-1957 (period I) and 227 cases treated during the period 1961-1974 (period II). Epidemiologically the pathomorphosis consists in a slight decline in "medical" cases, contrasted with a marked increase of--predominantly acute--cases after cardiac surgery. Etiologically the change is characterized mainly by a reduction of streptococci (61%/33%) and a much higher incidence of virulent organisms, especially staphylococci (3%/21%), as the infective agent. With regard to the clinical picture of infective endocarditis, the changing pattern is apparent in an increase in atypical and misleading features and an often oligosymptomatic presentation. In period II the classical signs were more often absent. The difference in the course of infective endocarditis consists in a higher hospital mortality during period II. In this period the main cause of death was refractory heart failure, often provoked by acute rupture of the aortic valve. The factors which may be responsible for this change and the clinical implications are discussed. The difficulties in early diagnosis and the role of misleading symptoms of this still "malignant" disease are outlined. Special interest is focused on the diagnostic problems involved in recognizing acute endocarditis, right-heart endocarditis and acute rupture of the aortic valve.

Adult↗
PubMed1975

[Proceedings: Surgical treatment of infectious endocarditis].

Surgical therapy of infective endocarditis can be undertaken as a prophylactic measure to avoid infection, e.g. in patent ductus arteriosus. In the majority of cases operations are done electively for correction of residual valvular defects ensuing on healed endocarditis. The most challenging problem is cardiac failure in the presence of active infection. While the surgical indication for life-threatening failure is generally recognized, the necessity of early operation, i.e. for acute valvular insufficiency with only mild cardiac failure, is still controverted. Valve replacement to remove a valvular form refractory to antibiotic therapy is less frequently necessary. In fungal endocarditis surgical intervention is recommended as soon as the diagnosis is established. Seven personal cases operated on in the presence of active infection are presented. All survived, but in one patient with fungal endocarditis the infected valve had to be replaced three times before healing was achieved.

Adult↗
PubMed1975

[Proceedings: Results of early surgery in infectious endocarditis].

23 patients with infective endocarditis have been treated surgically during the period 1965 to 1975. 20 patients underwent operation for intractable heart failure, complicated in 4 instances by systemic embolization and in 4 others by intractable infection. Two patients were operated upon only for intractable infection and one patient for severe hemolysis. There were 5 early deaths within 12 days and 2 late deaths 2 and 21 months after operation. Four months to 9 1/2 years after operation 16 patients were alive, only one of whom had mild heart failure. The best prognosis (1 death) was apparent in the 12 patients who underwent operation for intractable heart failure only.

Adult↗
PubMedDate not supplied

[Infectious endocarditis in a neurosurgical unit].

Clinico-pathological study of 15 cases of cerebral complications of bacterial endocarditis referred to a neurosurgical unit for suspected cerebral abcess. In all cases but one, cerebral symptoms appeared with the cardiac condition undiagnosed, and complete diagnosis was made only at autopsy. Cerebral lesions consisted mainly in focal softening due to embolisms, generally multiple, with in about half the cases histological manifestations of bacterial seeding, without any abcess such as could be amenable to neurosurgical treatment. Surgical treatment of mycotic aneurysms was unsuccessful, due mainly to their multiplicity.

Adolescent↗
PubMed2002

[Role of transesophageal echocardiography in infectious endocarditis].

The role of transoesophageal echocardiography in infective endocarditis is detailed after concisely restating the precautions required by this examination. The diagnosis is nowadays based on the Duke University criteria, the major echocardiographic criteria being a typical image of vegetation, of abscess or of prosthetic valve dehiscence. The assessment of the complications includes the evaluation of the extent of destruction of the valvar or intracardiac structures and its hemodynamic consequences, the occurrence of a pericarditis and the assessment of the embolic risk. The different pitfalls and limitations of the examination are considered. The indications for repeating transoesophageal echocardiography during follow-up are considered, based on recently published recommendations. The respective advantages of the transthoracic and the transoesophageal approach are discussed, with a special focus on right heart endocarditis.

Aftercare↗
PubMed2002

[Prognosis of infectious endocarditis].

OBJECTIVE: To study clinical course and prognostic factors of infective endocarditis. PATIENT AND METHODS: Infective endocarditis was identified in 126 consecutive patients (criteria of DURACK). Of these, 73 were male, mean age was 29.9 + 15 years, 98 (77.7%) had past history of cardiac disease. The evolution has been marked by 38 deaths (30%) in spite of the recourse to surgery (69 patients). The mean follow-up period was 52 months, the event-free survival was 61% at 5 years. RESULTS: By univariate analysis the predictors of bad prognosis: Large vegetations > 10 mm, delay of apyrexia > 10 days presence of a neurological accident and the absence of surgical treatment. Multivariate analysis: Vegetation > 10 mm (OR 1.97, 1-4.1, p = 0.05), presence of a neurological accident (OR:2.76, 1.32-5.76, p = 0.007) and the absence of surgical treatment (OR: 5.03, 2-11.4, p < 0.001). CONCLUSION: Infective endocarditis remains a serious affection, identification of patients with poor prognosis should lead to early surgical referral: this attitude provides good immediate and long-term results.

Adolescent↗
PubMed2003

[Infectious endocarditis: morbi-mortality in Chile. Results of the National Cooperative Study of Infective Endocarditis (1998-2002)].

BACKGROUND: Infective endocarditis is a severe condition, with a mortality that fluctuates between 16 and 25% in the Metropolitan area of Chile. AIM: To perform a prospective assessment of clinical and microbiological features of patients with infective endocarditis in Chile. MATERIAL AND METHODS: Collaborative study of regional hospitals in the whole country and teaching hospitals in Santiago. Patients with a possible or definitive infective endocarditis, according to Duke's criteria, were included in the protocol and a structured data entry form was completed. RESULTS: Three hundred twenty one patients (65% male, mean age 49 +/- 16.5 years) were studied. According Duke's criteria, 89% had a definitive and 11% a possible endocarditis. The subacute form occurred in 64% of patients. The most frequent predisposing cardiopathies were rheumatic in 25%, prosthetic valves in 15% and congenital in 13%. There was no evidence of cardiopathy in 20%. Twenty percent of patients were on hemodialysis, 11% were diabetic and only one patient abused intravenous drugs. The most frequent complication was cardiac failure in 59% of cases, followed by renal failure in 32% and embolism in 28%. The most frequent causing organism was coagulase positive Staphylococcus in 35%. Blood cultures were negative in 28% of cases from the metropolitan region, in 56% of cases from the north and 38% of cases from the south. Echocardiographic diagnosis was done in 92% of cases. Aortic valve was involved in 42% and mitral valve in 29%. Successful antimicrobial treatment was achieved in 59% of patients. Thirty five percent of patients were subjected to surgical procedures with a 78% survival. Overall mortality was 29%. Univariate analysis identified sepsis, an age over 60 years and the presence of cardiac or renal failure as prognostic indicators of mortality. On multivariate analysis, the identified prognostic indicators were the presence of sepsis, renal failure, mitroaortic involvement associated to combined surgery and failure of antimicrobial treatment not associated to surgery. CONCLUSIONS: Subacute form is the most common presentation of infective endocarditis and rheumatic valve disease is the most common underlying cardiac lesion. Intravenous drugs users infective endocarditis is exceptional in Chile. The most frequent causing agent is coagulase positive Staphylococcus and the most frequent complication is cardiac failure. Surgical and overall mortality were 22 and 29% respectively. Sepsis, renal failure, combined surgical procedures, failure of medical treatment were identified as prognostic indicators of mortality.

Adolescent↗