SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors describe 2 cases of infectious endocarditis in patients with idiopathic hypertrophic subaortic stenosis. In one case, the disease eventuated in lethal outcome. Photomicrographs of histological preparations are provided.
Four varieties of infectious endocarditis were identified after cardiac valve bioprostheses: early acute, early subacute, late acute, and late subacute forms. Any of these forms may be of bacterial, fungal, or mixed (bacterial and fungal) origin. In the early forms, the infection was of exogenous origin, with a predominance of Gram-positive organisms, whereas in the late forms it was endogenous with a preponderance of Gram-negative flora. The hallmarks of fungal thromboendocarditis were an early massive thrombosis of the bioprosthesis, multiple thromboembolism, and an absence of cellular reaction in the cuspal tissue. In the subacute bacterial endocarditis, progressive dysfunction of the bioprosthesis resulting from calcination of bacteria-containing cusps and thrombi was noted.
A patient with hypertrophic cardiomyopathy and infectious endocarditis has been described, confirmed clinically and bacteriologically. L-forms of alpha-streptococcus were isolated from the hemocultures. Aortic valve was affected in the course of the septic process. That morbid state was very favourable influenced by the treatment with high dose penicillin, combined with streptomycin. The control hemocultures 40 days after the discontinuation of the treatment proved to be negative.
Altogether 240 patients with infectious endocarditis (IE) were examined. The problems of IE diagnosis, particularly the reasons for late and initially erroneous disease diagnosis are discussed on the basis of the authors' own and reported data. The differential-diagnostic table containing the criteria of differential diagnosis of IE, rheumatic fever, systemic lupus erythematosus, lymphogranulomatosis is presented.
Although prophylaxis with antibiotics cannot avoid all cases of infectious endocarditis, it remains the main approach capable of reducing the frequency of this severe disease. It consists in using an adapted antibiotic cover in situations exposing to bacteraemia in patients at-risk with known cardiopathy. In France, recommendations have been established by a consensus conference in 1992. The fact that the incidence of this infection has not decreased merits recalling these recommendations.
Although the incidence and prognosis of infectious endocarditis have remained relatively stable for many years, this disease has recently undergone major modifications of its aetiological and bacteriological profiles, and has benefited from progress in echocardiographic techniques. New diagnostic criteria have been proposed and considerable therapeutic progress has been accomplished, in both medical (antibiotic therapy) and surgical (conservative surgery, homografts) modalities.
The aim of this retrospective study was to analyse cases of infectious endocarditis (IE) of native or repaired ventricular septal defects (VSD) to determine its incidence, the circumstances of its occurrences, the outcome and prognosis of this complication. From 1966 to 2002, 36 IE occurred in 19 boys and 17 girls: the age at diagnosis was 13.4 +/- 11.8 years; 26 had an isolated VSD and 10 had VSD associated with a minor lesion. Eleven of the 36 cases (30.5%) had been previously operated: repair of an isolated VSD with a patch in 5 cases, associated with a Crafoord procedure for coarctation of the aorta in 2 cases, three times with conservative treatment of associated aortic regurgitation (AR) and with ligature of patent ductus arteriosus (PDA) in 1 case. Twenty-five of the 36 cases (69.5%) had not been operated before: 21 isolated type 1 VSD; 2 VSD + AR, 1 VSD with PDA (undiagnosed), 1 VSD with valvular pulmonary stenosis (PS). The portal of entry was post-surgical in 7 out of 36 cases (19.4%): 4 VSD patches, 2 VSD patches + Crafoord and 1 VSD patch with ligature of PDA. The source of infection was dental in 14 out of the 36 cases (38.9%): one isolated VSD repair with residual shunt, 11 native VSDs, and 2 cases of unoperated VSD + AR. The other infectious causes (15 = 41.7%) were ENT (2 cases), skin (2 cases), gastrointestinal (2 cases), pulmonary (1 case) or unknown (8 cases), on operated lesions (3 VSD patches + AR) or native lesions (12 cases: 10 isolated VSDs, 1 VSD with PSD and 1 VSD with PS). Twelve episodes occurred (33.3%) despite antibiotic prophylaxis, 7 out of 7 post-surgical and 5 out of 14 dental cases. The commonest localisation was the tricuspid valve (10 cases, always in isolated VSD). Embolism was observed in 60% of right heart endocarditis (always multiple) and in 55% of IE of the left heart (single embolism). Early surgery was required in 6 patients (16.7%). The risk of early surgery was higher in patients with VSDs associated with other lesions (4 out of 10 = 40%) than in isolated VSD (2 out of 26, 7.7%, p = 0.027). Thirteen patients underwent secondary surgery after an average interval of 2.96 years, median 0.86 years (from 4 months to 22.8 years) for VSD repair (10 cases), aortic valve replacement (2 cases) and aorto-aortic conduit (1 case). The global follow-up period was 7.4 +/- 8.3 years, from 28 days to 27.9 years (median 3.3 years). Five deaths were observed on average 3.7 +/- 6.2 years after the episode of IE (median 6 months): 2 were early, occurring less than 6 months after IE and directly related to the infective episode. The survival was 97.1% at 1 month, 94.3% at 6 months, 91.4% at 1 year and 86.6% at 5 and 10 years after IE. VSD is a benign cardiac lesion, the prognosis of which can be severely compromised by infectious endocarditis: surgical repair reduces the risk but does not totally exclude it because of minor associated abnormalities. Prophylactic antibiotic therapy and the diagnosis of latent infectious problems, particularly dental, remains essential before and after cardiac surgery.
For one year all narcotic addicts admitted to the Detroit Medical Center with infectious endocarditis (74 cases) were compared with a control group of bacteremic addicts who had other infections (106 cases). Endocarditis was caused by Staphylococcus aureus (60.8% of cases), streptococci (16.2%), Pseudomonas aeruginosa (13.5%), mixed bacteria (8.1%), and Corynebacterium JK (1.4%). S. aureus endocarditis most frequently involved the tricuspid valve; streptococci infected left-sided valves significantly more often than other organisms (P = .001). Biventricular and multiple-valve infections were commonest in patients with pseudomonas endocarditis (P = .05). Two-dimensional echocardiography, when combined with an abnormal chest roentgenogram, was highly predictive of endocarditis. Bacteremia in the absence of endocarditis was associated with primary skin and soft tissue infection, mycotic aneurysm at the site of narcotic injection, septic arthritis, septic thrombophlebitis, pneumonia, osteomyelitis, mediastinal abscess, and unclassified infection. Polymicrobial bacteremia in the nonendocarditis group was associated with markedly increased morbidity. Mild hyponatremia occurred in 41% of all patients and was also associated with significantly increased morbidity. Analysis of the two groups disclosed similarities and differences with implications for the pathophysiology and treatment of addicts with bacteremic infection.
With the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramón y Cajal in Madrid (Spain) between 1977 and 1985. The incidence was high (1.3 cases per 1000 children admitted). The male/female ratio was 2:1. Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents. The two groups presented marked etiological and prognostic differences. Congenital heart disease was the predisposing factor in 20 of the 23 cases. Streptococcus viridans (nine cases) and Staphylococcus aureus (eight cases) were the most frequent organisms. Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches). In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26%. Factors associated with a poor prognosis were: age less than 2 years, Staphylococcus aureus as the causative agent, and the presence of prosthetic material.
AIM: Immunological assessment of variants of infectious endocarditis (IE) and design of differentiated approach to the disease therapy. MATERIALS AND METHODS: Of 150 patients treated (90 males and 60 females, mean age 41.9 +/- 3.3 years) 28.7% and 71.3% had primary and secondary endocarditis, respectively. With chronization of the process, there was a trend to growing immune unbalance (IU). RESULTS: The IU in IE patients manifested with leukocytosis changing for leukopenia, reduced absolute and relative number of lymphocytes, complement, T- and B-lymphocytes, growing content of CIC, IgM, rheumatoid factor and cryoproteins. CONCLUSION: Besides antibacterial therapy, IE patients need immunocorrective and efferent therapy.
The electrocardiogram should be recorded at the very beginning of infectious endocarditis. It provides information on the origin and complications of possible organic disease (aortal stenosis--left ventricular hypertrophy). Moreover regular follow up of ECG tracings can reveal changes signalizing spread of the infection beyond the endocardium. Thus the conduction system may be affected--bundle branch block, atrioventricular blocks grade I to III, ectopic functional tachycardia, extrasystoles, myocardium--by development of typical ECG changes during myocardial infarction after embolization of the vegetation into the coronary artery, or last not least, the pericardium, after spread of the infection into the pericardial cavity with the serious finding of purulent pericarditis with diffuse ST-T elevations on the ECG tracing.
A case of right and left ventricular myocardial infarction in infectious endocarditis of the aortic valve in an injected drug abuser is reported. The infarction was diagnosed only in autopsy. Diagnostic difficulties are discussed. The literature on the problem is listed.
A study of 22 patients with a diagnosis of primary infectious endocarditis based on clinical, laboratory and instrumental (electro-, phono- and echocardiography) investigation showed the fever syndrome and rigors to be the main clinical manifestations of the disease. Echocardiography can contribute to its early diagnosis, while increased erythrocyte sedimentation rate remains the most valuable diagnostic test.
One hundred and one cases of infectious endocarditis were reviewed, from 1966 to 1982. The mean age of the patients was 56.3 +/- 15 years. There was a marked predominance of men (70.2 p. 100); the commonest portal of entry was dental (45.9 p. 100); the number of iatrogenic portals of entry and cases of endocarditis on prosthetic valves has been increasing in recent years. Blood cultures were positive in 83 p. 100 of cases; the commonest responsible organism was the non-D streptococcus (31 p. 100 of cases) followed by the D streptococcus (18.8 p. 100), the staphylococcus aureus (17.8 p. 100), and the staphylococcus epidermidis (2.9 p. 100). Gram-negative bacilli were isolated in 9.9 p. 100 of cases. Rare and slow growing organisms have been isolated since 1977. Echocardiography was then introduced and helped the diagnostic in 70 p. 100 of cases. Circulating immune complexes were measured in 25 patients and were found to be raised in 14 cases (56 p. 100). The commonest complication was cardiac failure (43 p. 100) which led to valve replacement in the acute phase in 14 p. 100 of cases. The occurrence of cardiac arrhythmias was a poor prognostic factor. The other complications were neurological (15 p. 100), renal (10 p. 100), embolic (19 p. 100), and pulmonary (9 p. 100). The mortality rate in the acute phase was 30 p. 100 and the probability of a five year survival was 54 p. 100.
AIM: Study of blood clotting to evaluate hemostatic disorders in infectious endocarditis (IE). MATERIALS AND METHODS: The trial included 124 patients with IE (61 males and 63 females aged 15-70 years). Primary and secondary IE was in 38 and 62% of patients, respectively. RESULTS: Clinically evident hemostatic disorders were observed in 93(74.2%) cases. They manifested as intravascular platelet activation with development of hypercoagulatory status and chronic DIC-syndrome. CONCLUSION: A differentiated approach is advisable to correction of thrombotic disorders in IE basing on the severity of blood coagulation impairment.
In 98.2% patients with infectious endocarditis, admitted to the hospital for surgical treatment, the moderate immune deficiency state is revealed with the cell link of immunity depression and phagocytic function of neutrophils insufficiency, which become aggravated after operative intervention performance, especially using artificial blood circulation. The cell link of immunity depression, the B-lymphocytes function inhibition are preserved during 6 months after the operation.
One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with both methods. Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There were 3 false negative results by TEE: small anterior abscesses marked by the prosthesis or aortic calcifications. In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%. These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.
Actinobacillus actinomycetemcomitans is a very uncommon cause of infectious endocarditis. The organism was first described in 1912. Thjotta and Sydnes reported its isolation in pure culture from a long standing abscess which had developed after tooth extraction. Subsequently this organism was found to be part of the normal flora, and the organism was defined as a slow growing, fastidious gram negative bacillus. Carbon dioxide is essential for the growth of A. actinomycetemcomitans. Approximately 50 cases of endocarditis due to A. actinomycetemcomitans have been reported since the first case reported in 1964. The purpose of this report is to document a case of endocarditis due to A. actinomycetemcomitans and to stress the value of the echocardiogram in the assessment of patients with endocarditis.