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Results for “ENDOCARDITIS, INFECTIOUS”

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PubMed1997

[The Epstein-Barr virus in patients with infectious endocarditis].

Serological markers of Epstein-Barr virus (EBV) infection has been investigated in 28 patients with infectious endocarditis. In 75% of patients IgM antibodies to "early" antigen of the virus which are the marker of active viral infection occurred vs 6.2% among healthy blood donors. Specific for infectious endocarditis reaction profile (anti-EBV combination in one person) indicates reactivation of latent viral infection. The conclusion is made on the necessity of further investigation of both the role of EBV in pathogenesis of pyoseptic diseases and immunologic mechanisms for reactivation of latent viral infections.

Antibodies, Viral↗

PubMedDate not supplied

[Oral-dental health status in patients with infectious endocarditis].

Mouth and dental examination is a systematic act in the etiologic follow up of an infectious endocarditis. Our study concerned 42 patients collected during 5 years period, starting july 1995 until July 2000, in the dental medical service of Hedi Chaker university hospital of Sfax oriented by the cardiovascular diseases service looking for a buccodental entry of bacteria. Our patients group is divided into 25 men and 17 women of 36.1 years mean age. Dental or parodontal lesions were observed in 25 patients. Panoramic X-rays showed periapical lesions of granuloma or cystic type in 15 patients. Among the etiological factors encountered we noticed dental acts accomplished without antibioprophylaxis and dental bacterial collection medically treated without extraction. Buccodental lesions were a frequent cause of the infectious endocarditis in 59.5% of the patients studied in this report, and were due more to defectious hygienic conditions than to a disabled dental act.

Adult↗

PubMed1991

[Analysis of results of surgical treatment of patients with infectious endocarditis].

The results of surgical treatment of 180 patients were studied according to the character of infectious endocarditis (primary--PIE and secondary--SIE), the functional class (FC) in the preoperative period, and the patients' immune status. The survival of patients with PIE (with hospital mortality taken into account) was somewhat higher than that of patients with SIE. Survival in the late-term periods was significantly higher in patients with PIE. There were no fatal outcomes among patients with PIE of FC III, mortality among patients with SIE was 7.7%; mortality in FC IV was, respectively, 10 and 21.6%; the mortality rate among patients with PIE and SIE of FC V was 43.5 and 57.5%, respectively. The late-term results were good in 85.5 and satisfactory in 14.5% of patients. Twenty-one (16%) patients died. Cardiac failure and recurrent sepsis were the main causes of fatal outcomes. The preoperative immunological parameters (the concentration of ceruloplasmin, blood serum IgG and IgM, the activity of lymphocyte mitochondrial enzymes and the neutrophil test) reflect the activity of infectious endocarditis and have an effect on the development of postoperative complications and on the mortality.

Adolescent↗

PubMed1985

[Bacteriologic surveillance of patients with infectious endocarditis. Value and limitations of the determination of minimal inhibitory concentration and serum bactericidal activity].

This is a retrospective study of the records of 17 patients who suffered from infectious endocarditis with positive blood cultures, and concerns the possibilities of predicting immediate infectious signs in patients:--by testing each of the antibiotics used for the minimal inhibitory concentration;--by determining the peak of the serum bactericidal activity of patients. All the patients were under observation, as outpatients, for more than a year and proved completely cured of their infectious endocarditis. A satisfactory minimal inhibitory concentration does not necessarily prevent an infectious evolution in the immediate future. The determination of the peak serum bactericidal activity does not reflect faithfully and instantaneously the anti-infectious action of the treatment; this is shown by the excellent and rapid evolution 13 times out 20 although serum bactericidal activity was considered insufficient (less than 1/8). This level of 1/8 is not a guarantee of therapeutic efficiency. Finally the antiinfectious treatment has been, in the majority of cases, determined by clinical signs and in very few cases by serum bactericidal activity results.

Adult↗

PubMed1996

[A case of aortic valve replacement for active infectious endocarditis with multi-organ failure preoperatively].

A 57-year-old man underwent aortic valve replacement for active infectious endocarditis with multi-organ failure. He had become unconscious suddenly and had undergone transient pacing and endoteacheal intubation in the first hospital. Then he had been transferred to the second hospital, where careful medical treatment had been done for cardiac and hepatorenal failure. When he was transferred to our hospital, he was in New York Heart Association functional class IV with catecholamine support and had acute renal failure required hemodialysis. Aortic valve replacement with bileaflet mechanical valve and direct closure of perivalvular ring abscess made the patient free from catecholamine support and hemodialysis, while he needed permanent pacemaker implantation. This case suggests that both careful medical treatment before surgery and timing of surgical intervention were important for active infectious endocarditis with multi-organ failure preoperatively.

Aortic Valve↗

PubMed1985

[Diagnosis of infectious endocarditis and the assessment of the effectiveness of its treatment].

The results of investigation and treatment of 58 patients with infectious endocarditis are presented. Changed clinical pattern of the disease, its increasing incidence among older people and the emergence of its "immunologic" variety with signs of myocarditis, vasculitis and, less commonly, glomerulonephritis have been noted over recent years. The disease has become polyetiologic. Methods of treatment for infectious endocarditis are discussed with reference to the etiology and clinical pattern of the disease. Indications for surgical treatment are outlined.

Adolescent↗

PubMed2006

[Bacteriological profile of infectious endocarditis in the area of Sfax (Tunisia)].

We performed a study to analyze epidemiological characteristics and bacteriological profile of infectious endocarditis (I.E) in the area of Sfax (Tunisia). We analyzed, retrospectively, all cases of I.E, according to Duke Criteria, hospitalized in the CHU Hédi Chaker of Sfax between January 1997 and December 2000. Bacteriological investigation included blood culture, cardiac valve culture and serology. Seventy-two cases of I.E were diagnosed. The average of age was 32.3 years. 47.3% of the patients did not have cardiac disease, 25% had a valvular prosthesis, 20.8% a native valvulopathy and 6.9% a congenital cardiopathy. Antecedent of acute rheumatic fever was noted in 66% of I.E on native valvulopathy and in 55.5% of I.E on prosthesis. The mitral valve was involved in 39%, the aortic in 27.5% and the two in 26% of the cases. The origin of bacteremia was found or supposed in 55.5% of the cases and was commonly dental (33 % of EI). The bacteriological diagnosis was positive in 51 cases (70.8%). Staphylococci were isolated in 17 cases (23.6%), Streptococci in 17 cases (23.6%) and dominated by oral streptococci (12 cases). Chlamydial serology was positive in 8 cases (11.1%). Diagnosis of infectious endocarditis due to Chlamydia pneumoniae was confirmed in a case by genomic amplification (PCR) and in situ hybridization on the valve. Endocarditis in Tunisia remains frequent. It reaches with predilection the young person in particular with rheumatic heart diseases. The bacteriological profile remains dominated by Streptococci and the Staphylococci.

Adolescent↗

PubMed2003

[Factors associated with the time to clinical diagnosis of infectious endocarditis. Analysis of a multicentre case-record].

The authors demonstrate that time necessary for diagnosis in 902 patients with validated infectious endocarditis was significantly shorter in 249 drug addicts confronted with 653 non-addicted patients. With regard to the latter category we noticed a significant tendency in diagnostic time reduction in the last five years of observation and this is probably due to the improved knowledge on infectivologists regarding the clinical presentation of infectious endocarditis rather than the application of validating protocols

Comorbidity↗

PubMed2006

Cytoplasmic antineutrophil cytoplasmic antibody positive pauci-immune glomerulonephritis associated with infectious endocarditis.

Renal deterioration often occurs in cases of infectious endocarditis (IE), but, IE- associated nephritis with rapidly progressive glomerulonephritis (RPGN) is rare. Patients with severe infection (e.g., IE) sometimes show positivity for cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA). Therefore, diagnosis and treatment are very difficult in cases of RPGN with IE and positivity for C-ANCA. Such cases are rare, only 12 have been reported in the English literature. Herein, we describe the case of a 50-year-old man who presented with RPGN with IE and tested positively for C-ANCA. He was referred to our hospital because of leg edema, purpura and renal dysfunction. Laboratory tests revealed serum creatinine elevation and positivity for C-ANCA and proteinase 3-specific (PR3)-ANCA. RPGN and acute renal failure were diagnosed. Hemodialysis and steroid therapy were started. Streptococcus oralis was isolated by blood culture. Transthoracic echocardiography revealed grade III mitral valve insufficiency with two vegetations. Therefore, IE was diagnosed. The steroid therapy was stopped, and antibiotic therapy was begun. Because there was no improvement, surgical therapy was performed. The operation was successful, but the patient died of brain hemorrhage. Our experience in this case indicates C/PR3-ANCA positive RPGN must be ruled out in patients with infectious disease, particularly IE, together with renal symptoms, and renal biopsy should be performed.

Acute Kidney Injury↗

PubMed1984

[Infectious endocarditis in the elderly].

Thirty three cases of infectious endocarditis in patients over 65 years of age (mean age: 72,5 years) observed between 1966 and 1982, were analysed; there were 22 male and 11 female patients, a male predominance of 67%. The data was compared with 68 cases of patients aged less than 65 years of age (mean age: 48,4 years; 49 male and 19 female patients, a male predominance of 72%) treated during the same period. In the patients over 65 years old, compared to those under the age of 65, we observed that: the previous condition of the cardiac valves was more commonly unknown (39% compared to 21%), rheumatic valvular disease was rare (12% of cases), the diagnosis was not delayed, the reason for hospital admission was usually a complication (30% compared to 7%), the two cardinal signs (pyrexia and a cardiac murmur) were always present, as in the younger age group, the urinary tract was the only commoner site of primary infection, the blood cultures were as frequently positive in both groups (79% compared to 85%), in cases with negative blood cultures, antibiotics had not always been given beforehand, but this was commoner than in the younger age group, the causal organisms and usual biological changes were unremarkable, echocardiography, often more difficult because of the high incidence of valvular thickening, remained a valuable tool for diagnosis and management, cardiac failure was more common (55% compared to 37%) as were neurological complications (24% compared to 10%) and renal failure, mortality was greater (39% compared to 25%) and higher in both groups in patients with aortic valve disease and infection with staph-aureus.

Aged↗

PubMed2000

[Infectious endocarditis in intravenous drug abusers].

Clinical course of infectious endocarditis (IE) was analysed for 43 intravenous drug abusers. 42 of them had primary IE, one patient--secondary. Acute course and high activity of the disease were registered in 86% of the patients. IE was provoked by Staphylococcus aureus (50%), Staphylococcus epidermidis 920%), Staphylococcus haemolyticus (11%), E. coli (8%), Pseudomonas aeruginosa (2%), Candida albicans (2%), mixed microflora (7%). Vegetations were detected on the tricuspid, mitral and aortic valves (52, 23 and 19%, respectively), on more than one valve (6%). Pneumonia, pleuricy, hydrothorax, enlargement of the liver, spleen, nephritis and anemia were found in 76, 44, 9, 100, 75, 70 and 88% of the patients, respectively. Cardiac failure aggravated the disease in half of the patients, lethality was 18%. Thus, IE in intravenous drug abusers is characterized by a primary form, acute active course, prevalent damage to the tricuspid valve, polyorganic involvement, high lethality. IE cure in such patients is feasible only in adequate antibacterial therapy, timely surgical correction and giving up drug abuse.

Acute Disease↗

PubMed2002

[Approaches to late prognosis in patients with subacute infectious endocarditis].

AIM: To ascertain late prognosis of subacute infectious endocarditis (IE), factors involved in the prognosis, formulate approaches to assessment of late prognosis. MATERIAL AND METHODS: A retrospective trial included 98 patients discharged from a hospital with diagnosis "subacute IE", treated without surgery or without endocarditis of the prosthesis. The diagnosis was verified at echocardiography. A mean follow-up 4.8 +/- 3.7 years. Clinical and echo-CG follow-up findings were computer-processed. RESULTS: 5-year lethality was 31%. The patients died of cardiac failure (CF) and acute failure of cerebral circulation (84 and 16%, respectively). Late complications in the survivors were the following: severe CF (18 patients, 32%), moderate CF (18 patients, 32%), recurrent IE (12 patients, 20%). Such factors as IE variant (primary or secondary), affection of the aortic valve, severity of regurgitation, size of the left ventricle, CF progression in the acute phase proved to have a significant influence on late prognosis. CONCLUSION: The prevalent cause of death in IE is CF. The progression of CF depends on combination of the above factors. High risk group patients should be examined by a cardio-surgeon even in the absence of clinical symptoms of CF.

Adult↗

PubMed1991

[Clinico-morphological comparison in children with infectious endocarditis].

As many as 21 children suffering from infectious endocarditis (IE) were examined for the clinical and morphological picture of the disease. The patients' age ranged from 2 to 15 years. In 15 children, IE developed in association with different congenital diseases; in one patient, in the presence of rheumatic heart disease, and in 5 patients, in unaffected heart valves. The sectional material was examined in 19 cases whereas the operational material in 2 cases. Analysis of the data obtained has shown that early diagnosis of IE (primary and secondary) may not infrequently be fairly difficult, which is likely to result in the late administration of antibacterial therapy. In addition to the involvement of the valvular apparatus of the heart, the majority of the patients demonstrated the signs of focal myocarditis and postmyocarditic cardiosclerosis, which is one of the causes of the development of refractory heart insufficiency. IE children mostly die from heart insufficiency and thromboembolism.

Adolescent↗

PubMed1990

[Infectious endocarditis. Role of surgical therapy].

The problem of infectious endocarditis (IE) is approached through a review of personal experience. The series examined consists of patients, 17 with active and 21 dormant infection. Furthermore 12 in the first group, 18 in the second had natural heart valves, while 5 in group I, 3 in group II had been given artificial ones. After an analysis of the aetiopathogenic, clinical and diagnostic aspects of the condition with emphasis on the fact that Staphylococcus aureus is currently more responsible for infections in natural valves and the epidermidis for acute prosthesis infections which have a higher early and late mortality rate (40% in hospital, 33.3% long-term), the paper discusses the criteria for surgical intervention. In line with opinions expressed in the literature, it is pointed out that, while the patient's haemodynamic status is certainly the main criterion for any decision, other factors such as embolism, impaired conduction, kidney failure and expansion of the infection to contiguous tissues, should not be under-estimated.

Endocarditis, Bacterial↗

PubMed1989

[A rapidly progressing variant of subacute infectious endocarditis].

A total of 122 patients with subacute infectious endocarditis (SIE) were examined. Of these, 33 patients demonstrated an extremely severe disease course. In spite of adequate antibacterial treatment, the lethal outcome ensued within the first 2-2.5 years of the disease. A rapidly progressing variant of SIE was characterized by persistent fever, predominance of aortal heart diseases, renal injuries with an early development of renal failure, hemorrhagic vasculitis, relapsing thromboembolism, refractory heart failure, persistent anemia, lymphopenia, and by the presence of large movable vegetations discovered on echocardiography.

Adolescent↗

PubMed1995

[The role of echocardiography in the diagnosis of infectious endocarditis].

Echocardiography is irreplaceable in the diagnosis of infectious endocarditis. If in easily examined patients transthoracic examination suffices, in all other cases transoesophageal echocardiography is essential. It is important to emphasize the importance of searching carefully for complications, of assessment of the patient's risk and whether it is suitable to repeat the examination during treatment.

Echocardiography↗

PubMed1991

[Mycotic aneurysm of the sinus of Valsalva and complete atrioventricular block complicating infectious endocarditis with aortic regurgitation: a case report].

A patient with a mycotic aneurysm of the sinus of Valsalva and heart block secondary to infectious endocarditis was described. This 46-year-old man was admitted to our hospital on May 9, 1990, because of fever and progressive general malaise after extraction of a tooth. Physical examination on admission revealed blood pressure of 98/62 mmHg, pulse rate 96 per min, temperature 37.7 degrees C and respiration 35 per min. Auscultation of the heart revealed a grade 3/6 systolic murmur and a grade 2/6 diastolic murmur at the third left intercostal space. Chest radiograph showed mild cardiomegaly with moderate lung congestion. Electrocardiography revealed the first grade atrioventricular block. Echocardiography demonstrated vegetations on the aortic valve, and perforation of the non-coronary sinus of Valsalva. The prolapsed non-coronary sinus of Valsalva extended into the right atrium. Doppler echocardiography revealed a severe aortic regurgitant jet in the diastolic phase. We diagnosed the patient as having aortic regurgitation with a mycotic aneurysm of the non-coronary sinus of Valsalva due to infectious endocarditis. His condition remained severely ill despite intensive medical treatment. On May 14, 1990, aortic valve replacement and excision of the mycotic aneurysm were performed. The commissural portions of the aortic cusps were heavily thickened and calcified. The mycotic aneurysm was very fragile. During manipulating the mycotic aneurysm, the sinus accidentally perforated into the right atrium. The cardioaortic fistula was closed with a goretex patch. A demand pacemaker was implanted because of postoperative complete atrioventricular block.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, Infected↗

PubMed1991

[Infectious endocarditis from the morphologic viewpoint: on the pathology and clinical aspects of 97 autopsy cases].

In continuous autopsy material between 1978 and 1987 an infectious endocarditis was present in 97 cases of 8745 postmortem examinations. Hospital acquired or iatrogenic infections were at the top of the list with 60% contribution and intravasal devices, cardiovascular or abdominal surgery acting as predominant entrance spots of the infection. In community acquired disease the portal of entry could not be ascertained in most of the cases. The spectrum of causative organisms showed staphylococcus aureus in first position (37%), followed by enterococci (20%), candida (12%) and gram-negative rods (10%). Streptococcus viridans could be isolated in only one case. The majority of patients already had cardiac valve lesions before the onset of infection (48%), immune-defence tangent illnesses (47%) and/or were treated immunosuppressively (14%). In many of the patients, however, no predisposing factors could be established. Factors determining the clinical outcome were - independent of the localization - the local destruction (47%), purulent and non-purulent myocarditis (58%), fresh myocardial infarction (17%) and embolization to various organs (76%), whereby the central nervous system was affected to a high degree (43%). Only 39% of the analyzed cases were discovered at lifetime; especially mural (n = 10) and tricuspidal (n = 9) infections were overlooked. In spite of highly suspicious infection parameters, blood-cultures were drawn from only 59% of the patients; however, an antibiotic therapy had been given to 85%. Only through an early diagnosis before serious complications set in, the poor prognosis of infectious endocarditis can be improved by specific chemotherapy and well-timed surgical measures.

Adolescent↗