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Results for “ENDOCARDITIS, INFECTIOUS”

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PubMed1998

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology].

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Abscess↗

PubMed1995

Complementary role of MRI in infectious endocarditis.

The usefulness of magnetic resonance for imaging of cardiac structures is well established. In this study, we evaluated the role of this technique in the diagnosis of perivalvular extension of infectious endocarditis. Our initial experience and the few case reports in the literature show that magnetic resonance imaging can complement echocardiography in the assessment of periannular extension of infectious endocarditis.

Adult↗

PubMedDate not supplied

[The treatment of infectious endocarditis. Cefotaxime versus "traditional" medical management].

We performed an open study to compare efficacy and renal toxicity of cephotaxime versus the usual beta lactam plus aminoglucoside treatment of infectious endocarditis. Twenty cases were studied, 10 treated with cephotaxime 4 g/day per 21 days and aminoglucoside for only 10 days. Comparison group received a combination of different beta lactam antibiotic plus aminoglucoside for 21 to 50 days, these patients were under care of nonparticipant physicians. Although cephotaxime treatment was as good as conventional antimicrobial scheme for control of infectious endocarditis, the treatment cost increases, and there is only marginal benefit in regard renal toxicity.

Adolescent↗

PubMed1986

[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases].

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

[Infectious endocarditis: a current overview on an "old" disease].

The infectious endocarditis, first described by William Osler in 1885, is and still remains nowadays as a severe disease, with difficult diagnosis and coursing with high morbi-mortality rates. However, along the years, the disease showed significant modifications in its epidemiology, risk factors, etiologic agents, new study and diagnostic tests and new treatment modalities, medical and surgical, which are the subject of an extensive review by the author, based on an accumulated clinical experience during the last three decades.

Endocarditis, Bacterial↗

PubMed2005

[Update on infectious endocarditis].

Although one of the oldest known cardiac disease, infectious endocarditis (IE) remains a subject of constant change from epidemiological, diagnostic and therapeutic points of view. In the epidemiological field, the main feature is the increasing incidence of IE due to streptococcus bovis. Representing a quarter of cases in France, this type of IE is particularly frequent in the elderly and underlying colonic disease should be investigated. In the diagnostic field, the progress of methods of microbiological identification has been considerable, especially in molecular (PCR) and histological diagnosis which are particularly useful in IE with negative blood cultures. From the prognostic point of view, the role of echocardiography has recently been emphasised not only for diagnosis but also for prognosis and for predicting the embolic risk. The longest vegetations (>10 or 15 mm) are associated with a greater risk not only of embolism but also in terms of prognosis. The recent recommendations of the French Society of Cardiology recall the main surgical indications in IE and include a new indication of echocardiography.

Electrocardiography↗

PubMed1991

[Kidney involvement in infectious endocarditis (hematuria)].

As many as 113 patients suffering from infectious endocarditis (IE) were placed under observation. Renal damage was discovered in 28 patients (24.7%). Hematuria was the common laboratory sign of renal damage. 15% of patients showed microhematuria, 9.7 had macrohematuria. In 15% of patients with IE, hematuria was due to diffuse glomerulonephritis, in 5.3% to renal infarction, and in 4.4% to focal glomerulonephritis. In 3.5% of patients, the nephrotic syndrome developed at the disease onset, it was attended by hematuria and was thus a cause of erroneous diagnoses. The appearance of hematuria at the IE onset, attesting to involvement of the kidneys into the pathological process, complicates the diagnosis and early treatment institution. Detection of the hematuric syndrome in patients with a verified diagnosis of IE requires specification of the character of renal damage. The latter one contributes to a graver and prognostically unfavourable course of IE. In 2 out of 8 patients with associated IE and renal damage, the death was caused by progressive chronic renal failure. Postmortem examination confirmed mesangioproliferative glomerulonephritis in all the subjects; in 4, it was coupled with renal infarction. 14.1% of the patients manifested complete and 3.5% partial disappearance of hematuria under the influence of adequate antibacterial therapy of IE.

Adult↗

PubMed1991

[Infectious endocarditis: reasons for a delayed diagnosis].

The diagnosis of infectious endocarditis (IE) remains difficult. The delay until diagnosis is remarkably long. Despite progress in microbiological culture technology and the use of echocardiography, no improvement has been seen in recent years. We analyze the causes of delay in all patients with IE admitted to the Cantonal Hospital Aarau between 1976 and 1987. 60 patients with 62 episodes were included in the study. The delay from first medical consultation with IE-related symptoms to hospital admission was 46 days. In cases of antibiotic pretreatment (45%) it extended to 66 days. IE was included in the differential diagnosis by the referring physicians in 29% only, whereas it was considered in the hospital on admission in 64%. Despite long lasting fever of unknown origin, only in one case was a blood culture performed before hospitalization. The symptoms of IE were different at the beginning of the disease compared to the time of admission (general malaise in 35% and 87% respectively, fever 80% and 85%, night sweat 2% and 66%, weight loss 0% and 56%, chills 21% and 47%, joint pain 16% and 27%, dyspnea 13% and 24%). We conclude that the main reasons of the diagnostic delay in IE are antibiotic therapy prior to microbiological workup, different symptoms at the onset of IE and at the time of hospitalization, insufficient awareness of the disease among general practitioners and omission of blood cultures in patients with fever of unknown origin, especially where there is a history of valvular heart disease.

Adult↗

PubMed1984

[Infectious endocarditis: clinical aspects and diagnosis].

In a discussion of infectious endocarditis (IE), the clinical picture, current most important diagnostic methods (especially echocardiography) and prognosis under conservative therapy and valve replacement are described in detail, in the light of experience at the Hanover Medical School in recent years. While the clinical picture is usually typical, at any rate in the early stages of the disease, antibiotic therapy (when started without blood cultures and exact characterization of the germs involved) or severe complications can change the symptoms to the extent that diagnosis becomes very difficult. Apart from blood cultures, echocardiography, is of prime importance in diagnosis, the latter allows demonstration of vegetations either by M-mode or two-dimensional echocardiography (conventional or esophageal) in some 80% of cases. A special situation is encountered in prosthetic valve endocarditis (PVE): although the incidence of early PVE (which follows hard on the heels of valve replacement) is decreasing, mortality is still high despite early reoperation. Late PVE (after a free interval of approximately 2 months to years) resembles IE of the native valves and often allows medical treatment, especially in the presence of biological valves. The prognosis in IE is still poor and depends mainly on early diagnosis, i.e. a very early start with antibiotic treatment, which must be based on a positive bacterial diagnosis.

Anti-Bacterial Agents↗

PubMed1977

[Infectious endocarditis in patients with intracardiac prosthesis (author's transl)].

Infectious endocarditis involving intracardiac prosthesis continues to be a common and dangerous complication of cardiac surgery, but the incidence and severity of the disease are probably underestimated in this country. 14 cases of prosthetic endocarditis observed in a 5 years period are reported in this paper. 7 were early cases and 7 late cases. Etiology, clinical course, and pathological lesions, were similar in the two groups, while mortality was higher in the first group (100%) than in the second (85%). Delay in the diagnosis, negative blood cultures in a third of all cases, and doubts in indications for surgery, were the main reasons for a higher mortality than usual. Only one patient was reoperated on, unsuccessfully, but no patient who had not improved after two weeks of correct antibiotic treatment, survived; such cases, especially if diagnosis has been late and/or blood cultures negative, should be reoperated on without delay. The greatest efforts should be made in the prevention of the disease and, in particular, pre-operative and late post-operative prophylaxis should become more rigid and systematic.

Adult↗

PubMed2001

Thrombolytics in infectious endocarditis associated myocardial infarction.

The use of thrombolytics in the management of acute myocardial infarction in eligible patients is the accepted standard of practice. We present the case of an embolic myocardial infarction in the setting of acute infectious endocarditis, treated with thrombolytics, resulting in a massive intracerebral hemorrhage and the patient's death. Historical and current literature has shown a consistent and significant incidence of concurrent intracerebral mycotic aneurysms in the setting of infectious endocarditis. Despite this, a literature review of contraindications to the use of thrombolytics rarely recognizes endocarditis as a contraindication. It is imperative that the etiology for myocardial infarction be identified; if contraindications to thrombolytic treatment exist, alternative therapeutic interventions must be pursued. This case highlights the importance of the correct etiologic diagnosis of myocardial ischemia, and increases the awareness of the significant risks of intracerebral hemorrhage associated with the use of thrombolytics in the setting of endocarditis.

Contraindications↗

PubMed1995

[Infectious endocarditis of the native valve: its epidemiological profile and an analysis of its mortality between the years 1984 and 1993].

BACKGROUND: The description of the epidemiologic profile and analysis of the mortality of infectious endocarditis (IE) observed from 1984-1993. METHODS: One hundred thirty episodes of IE in a native valve (30 in drug addicts [IVDA] and 20 cases of nosocomial acquisition) were analyzed with right/left/bilateral localization (42/84/4, respectively), infection of the mitral/aortic/tricuspid valve (52/47/34, respectively) and the etiology was determined as Staphylococcus aureus in 52 cases, 41 Streptococcus, 13 negative coagulase Staphylococcus, and 11 Enterococcus. High risk IE were identified by uni and multivariate analysis (MVA). RESULTS: The incidence of IE ranged from 0.36 and 0.70 cases x 1.000 admitted adults/year (mean: 0.50). Transthoracic echocardiography detected bacterial vegetations in 67% of the cases with the validity to predict the development of embolisms being 55%. MVA showed the embolic episodes (present in 45% of the IE) to be associated with the IVDA patients and prolonged fever. The latter complication, being defined as > or = 10 days of fever under appropriate treatment, was observed in 32% of the cases and was due to mild (n = 15) and severe causes (n = 27). Postembolic septic complications were associated to fever with MVA. Twenty three patients died (18%), 2 IVDA and 5 nosocomial IE, mainly due to heart failure (n = 13). The independent risk factor predictors for death (p < 0.05) were: age > or = 60 years (mortality 34%), cerebral embolisms (55%), severe heart failure (37%), and the exclusion of the patient as a candidate for surgery (73%). To the contrary, right IE (mortality 0%) and cardiac surgery (5%) favoured survival. CONCLUSIONS: To improve the prognosis of infectious endocarditis in high risk patients more opportune cardiac surgery accepting greater risks should be performed.

Adult↗

PubMed2002

[Value of the protein profile in the diagnosis of infectious endocarditis when hemolysis is present].

PURPOSE: Haptoglobin (H) and orosomucoid (O) are acute phase proteins that increase in a parallel manner. When hemolysis and inflammation are both present, study of the O-H couple on the protein profile may reveal an unknown hemolysis. METHODS: To determine if hemolysis is more frequent during infectious endocarditis than during septicemia without valvulopathy or during valvulopathy without septicemia. Study of three groups of patients: 26 patients with infectious endocarditis, 13 patients with septicemia and 36 patients with valvulopathy without septicemia. Studied parameters were the O-H couple, hemoglobin and rate of O. RESULTS: Hemolysis is clear in patients with endocarditis. The difference O-H is significantly more important during endocarditis than during septicemia without valvulopathy (P < 0.001) and during valvulopathy without sepsis (P < 0.001). CONCLUSION: Study of the O-H couple may be useful for the diagnosis of endocarditis showing a difficult-to-diagnose hemolysis.

Biomarkers↗

PubMed2005

[Meningeal febrile syndrome and hemiplegia revealing infectious endocarditis: the story of a catheter-related infection].

INTRODUCTION: We report the case of a 48-years patient who is under chimotherapy because of a breast cancer. She was initially found at her place in coma with hyperthermia and neurological deficiency signs. The clinic history and the paraclinical investigations have enabled to detect a catheter-related infection (CRI) as soon as the diagnosis of disseminated infectious endocarditis was made. The resonance imaging confirmed the cerebral blow when it found suspicious images of septic embolus. EXEGESIS: The CRI are usually detected at an early stage and if the classical association CRI-infectious endocarditis-systemical embolus is well known, the discovery on a CRI not treated at the stade of a febril coma is exceptional. CONCLUSION: More than ever the taking care of infectious endocarditis, still delicate and sometimes perilous, requires a global taking care of the patient.

Catheterization↗

PubMed2002

[Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice].

INTRODUCTION AND OBJECTIVES: The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis. MATERIAL AND METHODS: Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period. The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment. A system was constructed, scoring each phase with the greatest detected error (on a severity scale of 0 to 8 points) and adding together the scores for the four phases. RESULTS: The mean degree of discordance was 30.5% (range, 0-66%). Scores of more than six points were clearly associated with an unfavourable evolution. CONCLUSIONS: The recommendations of clinical guidelines for infectious endocarditis are inadequately followed in practice, which can affect the course of the disease. It is necessary to increase adherence to clinical guidelines in practice, in order to improve the care of patients with this serious disease.

Adult↗

PubMed1983

Statistical analysis of five immune complex screening assays: patterns of detection in patients with rheumatoid arthritis, systemic lupus erythematosus, infectious endocarditis, and diabetes mellitus.

A comparative study of four nonspecific screening techniques (direct nephelometry, PEG-C4, PEG-IgG, and radiolabeled Clq binding) for immune complexes (IC) and of a technique specific for the detection of insulin-anti-insulin IC was undertaken in four groups of patients with diagnosis of infectious endocarditis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and diabetes. The highest frequency of positive results was given by the PEG-IgG test in RA, the Clq-binding test in SLE, the insulin-anti-insulin IC screening test in diabetes, and the PEG-IgG and Clq-binding tests in infectious endocarditis. Of the four nonspecific tests, the PEG-C4 assay appeared to be the least discriminative, since it failed to show significant differences between any group of patients and the group of controls. Direct nephelometry, PEG-IgG, and radiolabeled Clq binding gave consistently higher results in RA than in other diseases, and in this disease the rates of agreement between these tests were highly significant. Significant agreements between the rates of positivity of Clq binding and PEG-IgG tests were seen in all groups of patients studied. Spearman's analysis of rank showed the best correlations among tests based on similar principles (ie, PEG precipitation), and also a strong correlation between Clq binding and the PEG-IgG test in RA. The PEG-IgG test appears to be a reliable IC screening test for general use with the advantage of not involving radioisotopes. In regard to antigen-specific tests, although their specificity and sensitivity may be high, their results may show no correlation with nonspecific screening tests nor with the presence or absence of clinical or laboratory abnormalities suggestive of IC deposition, as exemplified by the insulin-anti-insulin IC screening test in diabetic patients.

Antigen-Antibody Complex↗

PubMed2001

[Diagnosis of myocardial lesions in infectious endocarditis].

To decide on treatment policy and specify prognosis in infectious endocarditis (IE) it is necessary to investigate myocardium. This is better to do using most informative criteria of myocardial affection--structural and geometrical changes of the left ventricle, various focal lesions, high-grade ventricular extrasystole, supraventricular tachycardia, atrioventricular block of various degree.

Adult↗

PubMedDate not supplied

Superior mesenteric artery aneurysm secondary to infectious endocarditis.

A case of superior mesenteric artery aneurysm secondary to infectious endocarditis is presented. Although selective angiography was necessary to detect the shape and precise location of the aneurysm, non-invasive diagnostic techniques including ultrasonography and computed tomography were also useful in detecting the aneurysm and planning the management of this unusual condition. Mitral valve replacement and aneurysmorrhaphy with bypass grafting of the superior mesenteric artery were successfully performed.

Aneurysm, Infected↗