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PubMed1999

[Masks of subacute infectious endocarditis].

AIM: Formulation of approaches to differential diagnosis and treatment policy for subacute infectious endocarditis (SIE) when it is masked by another monoorganic or systemic disease. MATERIALS AND METHODS: The course of SIE was analysed in 132 patients of whom 74(56%) had erroneous admittance diagnoses. Rheumocarditis was not confirmed in 34 patients, 24 patients had nonspecific reactions masking SLE (4 cases), glomerulonephritis (7 cases), myocarditis (4 cases), hemorrhagic vasculitis, nodular periarteritis, polymyositis (9 cases). RESULTS: The "masks" made the SIE diagnosis more difficult, resulted in late or invalid treatment--monotherapy with steroid hormones, in particular. This complicated the diagnostic process and aggravated the disease course. CONCLUSION: To detect SIE it is necessary besides analysis of case record and symptoms to performe echocardiography in dynamics, because of possible late development of valvular defect. High-dose antibiotic therapy is justified for diagnosis of ex juvantibus when the diagnosis remains controversial.

Adult↗
PubMed2006

[Unusual outcome of mitral valve infectious endocarditis in a premature infant].

The authors report a case of Staphylococcus Aureus infectious endocarditis in a premature baby. Echocardiography on the 8th day of life showed a large vegetation on the anterior mitral leaflet without significant regurgitation. Intravenous antibiotics and platelet antiaggregant therapy were given. At three weeks of age the vegetation split into two, one part attached to the foramen ovale and the other to the anterior mitral leaflet. At one month, the development of severe mitral regurgitation led to surgical valvuloplasty in a 2 kg neonate, the vegetation on the foramen ovale having spontaneously fragmented. The ablation of the mitral vegetation associated with commissuroplasty reduced the mitral regurgitation. At 3 months after surgery, the child was asymptomatic with a minimal mitral regurgitation.

Anti-Bacterial Agents↗
PubMed1984

[Isolation of the L forms of Acinetobacter calcoaceticus var. Lwoffii in infectious endocarditis].

In the bacteriological study of blood samples taken from a patient with infectious endocarditis the hemoculture of the L-forms of A. calcoaceticus, var. lwoffii, was isolated. This hemoculture reverted into the bacterial form in the process of subculturing on solid media. The species of the isolated L-forms was established on the basis of the data obtained in the study of the biological properties of the revertants. To ensure the effectiveness of bacteriological investigations, a special search for atypical cultures is recommended in those cases when the inoculation of blood samples yields negative results.

Acinetobacter↗
PubMed1996

[Infectious endocarditis: old myths and current concepts].

Updating of several main themes concerning the infectious endocarditis with the aim to denounce various old myths and to precise different actual concepts. The authors consider principally the echocardiographic revolution and the new diagnostic criteria, the bacteriologic pitfalls and the preventive strategies.

Algorithms↗
PubMed1998

[Hospital infectious endocarditis and endocarditis in drug addicts].

AIM: To specify etiology and clinical course of nosocomial infectious endocarditis (IE) and IE of drug addicts (AIE). MATERIALS AND METHODS: 8 cases of AIE and 27 IE cases after various invasive interventions (nosocomial endocarditis). RESULTS: Among causing agents of IE and AIE were Staphylococcus aureus, Proteus, Escherichia coli, Pseudomonas aeruginosa, anaerobic microflora, pathogenic fungi. AIE is characterized by affection of the tricuspid valve, pulmonary artery thromboembolism. Among nosocomial endocarditides are frequent IE of the replaced valve, caused by infection of venous catheters, dental manipulations, chronic hemodialysis. IE and AIE are most frequently treated with the following antibiotics: ampicilin, gentamycin, augmentin, unasin, cephalosporins, rifadin, ciprofloxin, tienam. CONCLUSION: Nosocomial IE and AIE have drawn much attention in the last decade because of development of new complex invasive treatments and expansion of narcomania.

Adult↗
PubMedDate not supplied

[Infectious endocarditis in patients on periodic hemodialysis].

Nineteen patients originating from four hemodialysis centers with infectious endocarditis (IE) were studied during the period of 1985-1989. It was observed high proportion of patients with apparent normal cardiac valves preceding the IE; in 68.42% (13 out of 19 cases) there was an association with vascular access infection, the dialysis treatment time had a variation from 5 days to 6 years (median 19.5 months) and the interval between the initial symptoms and the IE diagnosis was from 2 to 30 days with an average of 5 days. The echocardiogram showed vegetation in 18 cases studied. The mostly affected cardiac valves were mitral in 42.1% and aortic in 31.5%. The predominant organism was S. aureus (75%). In 8 cases the primary focus was identified as the hemodialysis catheter and in 6 others as the arteriovenous fistula, one patient presented infection in both access simultaneously. The outstanding clinical manifestations were embolic (12 out of 19 cases) neurological (13 out of 19) and of cardiac failure (13 out of 19). The median hospitalization time was 24 days (4-55 days) and the mortality rate was 68.4%, the majority of sepsis. The authors emphasize the large proportion of cases linked to hemodialysis catheters and propose an increase in the infectious preventive measurements in those patients.

Adolescent↗
PubMed2000

[Current aspects of differentiated therapy of infectious endocarditis].

150 patients (90 males and 60 females, mean age 41.9 +/- 3.3 years) with infectious endocarditis (IE) were treated. 26.7 and 71.3% of the patients had primary and secondary IE, respectively. Clinical and laboratory manifestations of the variants indicate that each variant is associated with a certain clinicolaboratory syndrome: acute IE is associated with toxicoseptic syndrome, subacute--with immune unbalance, and thromboembolic complications, chronic--with immunocomplex visceral lesions. Different variants of the course predetermine different therapy. It is recommended to combined active antibacterial therapy with UV radiation of autoblood and hemosorption, hyperbaric oxygenation. Immunocorrective and efferent therapy hold promise in IE treatment. Glucocorticosteroids are effective in immunocomplex disorders.

Acute Disease↗
PubMed2001

[Clinical, diagnostic and therapeutic features of tricuspid infectious endocarditis].

From 1987 to 1998, examination and treatment were conducted of 12 patients with infectious endocarditis of the tricuspid valve (TIE). 11 of them were operated. TIE was clinically characterized by lesser circulation thromboembolism and marked right ventricular failure. TIE was successfully diagnosed by echo-CG (diagnostic sensitivity 83.3%). Serious disturbances of cellular immunity demanded immunocorrection. Indications for surgical treatment are listed.

Adolescent↗
PubMed1992

[Infectious endocarditis in parenteral drug addicts: study of 57 cases].

We present 57 cases of infectious endocarditis (IE) in 51 parenterally drug addicts (PDA) admitted at the Internal Medicine Service of the Hospital Clínico of Valencia between January ist, 1988 and January 15th, 1992. The disease affected young patients, 84% of them being HIV-1+ and 86% presenting CD4+ lymphocytes lower than 200 cells/mm3. Fever was the most constant symptom, with radiological disorders and presence of vegetations by echocardiogram in 65% and 53% of episodes, respectively, and affectation of the tricuspid valve in 59% of patients. The diagnosis of endocarditis was definitive in 51% of cases, possible in 15% and probable in 22%, being cardiac failure the most severe complication, present in 23% of episodes. The detection of significant valve regurgitation in patients with IE and without developing cardiac failure is not predictive of future complications, nor its absence identifies patients with a favourable prognosis. Staphylococcus aureus was the most frequently isolated germ (48%), being methicillin-resistant in 15% of cases and with a slower response to the treatment with vancomycin than the methicillin-sensitive. Five patients died, all of them with CD4+ lower than 50 cells/mm3, which may have a predictive value in the follow-up of these patients.

Adolescent↗
PubMed1984

[Infectious endocarditis. Current aspects of its epidemiology and occurrence].

In epidemiological terms the frequency of infectious endocarditis is constant. In contrast acute forms in males and old people are on the increase. Atypical cases are more frequent than in the past so that prompt diagnosis is often difficult. Aetiologically, mycete and gram-negative cases are increasingly common.

Adult↗
PubMedDate not supplied

[The microflora characteristics of the large intestine in infectious endocarditis].

The state of the microflora of the large intestine in 18 patients with infectious endocarditis (IE) was studied. The study revealed that the existing specific features of the microbial picture of the large intestine were caused by changes in the content of some representatives of the indigenous group of microbes, as well as in the concentration and occurrence of transitory microbial species. Changes in the character of the microbial picture were found to depend on the activity of IE, as well as on the dynamics of the disease. In the course of this study no correlations between changes in the microbial picture of the intestine and the sex of the patients, as well as between the fact of the infection being primary or not and the presence of different clinical symptoms and syndromes of IE, were established. On the basis of the data thus obtained the most informative diagnostic signs reflecting the general character of changes typical of this disease were selected.

Acute Disease↗
PubMed1998

[The current course and treatment of infectious endocarditis].

Clinical study of 172 patients treated in the Burdenko Military Hospital for subacute infectious endocarditis in 1980-1996 compared with 192 cases in 1950-1979. Contemporary course of the disease is attended by a few symptoms, primordiality and single-valve affection. On the grounds of antibiotics sensitivity of the most prevalent infection agents discovered in 1996, the article develops some schemes of antibacterial therapy for Streptococcus, Enterococcus and staphylococcal etiology of disease. Rational antibiotic therapy together with surgery measures reduced lethality to 14.3% for Streptococcus endocarditis, to 16.7%--for Enterococcus and to 34.4%--for Staphylococcus.

Adolescent↗
PubMed2004

[Infectious endocarditis with negative blood cultures].

Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.

Adolescent↗
PubMed1982

[Clinico-morphologic analysis of septic (infectious) endocarditis].

Pathomorphosis of the disease has been studied on the basis of clinical and autopsy observations in the last three decades. The importance of staphylococcus, enterococcus, and gram-negative bacteria has been shown to increase among the causative agents of septic endocarditis; frequently the infectious agents have been observed to alternate in the course of the disease. Many manifestations of endocarditis were established to be associated with the circulating immune complexes containing bacterial antigens. In the last decade, primary septic endocarditis comprised about half of the observations. The proportion of isolated endocarditis and destructive changes of aortal valves increased. Myocarditis has become more frequent and in more than half of the cases it is associated with glomerulonephritis. In contrast, peripheral manifestations of endocarditis have considerably lost their diagnostic value. Among thromboembolic complications, venous thromboembolus of the pulmonary artery, and pulmonary infarction became more prevalent.

Adolescent↗
PubMed1998

[Infectious endocarditis on permanent endocavitary stimulation leads: apropos of 2 cases].

BACKGROUND: Permanent endocavitary pacemaker lead infectious endocarditis is rare. Two new cases are reported. CASE REPORTS: The first case appeared in a 63-year-old white woman with a permanent endocavitary pacemaker for 3 years. It was caused by Streptococcus bovis, unique to this pathology. The second case was caused by Streptococcus epidermidis in a diabetic 72-year-old woman. In these two cases, the clues to the diagnosis were hemocultures and transesophageal echocardiography. CONCLUSION: These two cases emphasize the importance of transesophageal echocardiography (TEE) for diagnosis and for driving treatment. Treatment is based on appropriate antibiotics and pacemaker removal. In the second, case, the material was surgically removed under cardiopulmonary bypass because of the size of the infection.

Aged↗
PubMed1992

[Vascular complications in infectious endocarditis. Apropos of 86 cases].

During a 20 year period, 285 patients were hospitalised for infectious endocarditis (IE) in the Department of Cardiology of the Ernest-Conseil Hospital in Tunis and 86 of them, i.e. 30%, developed a vascular complication (VC). Among these 86 patients, there were a total of 108 lesions, including 52 neurological complications, 14 peripheral acute ischemic syndromes, 16 peripheral arterial aneurysms, 9 aortic aneurysms, 7 pulmonary embolisms, 6 splenic infarctions and 4 coronary lesions. The mortality in this patient group proved to be slightly greater than in the series as a whole, in particular concerning patients with multiple lesions and those with an artificial valve. No prognostic difference was seen between patients with a VC of aneurysmal type and of ischemic type, but the presentation and severity of lesions was very variable. The vascular complication was a presenting feature of IE in almost 40% of cases. The organism found most often was the streptococcus, above all in ischemic type IE as well as in the total patient group. Similarly, the preferential site was aortic, above all for aneurysmal type IE. Ultrasonography revealed a higher incidence of vegetations in this series of patients, above all in ischemic type VC, but anatomical studies have shown this to be an investigation of moderate sensitivity and poor specificity, poorly correlated from a prognostic standpoint with the risk of embolism. The conclusion of the study is above all the need to prevent such complications: embolic complications by early antibiotic treatment and valve replacement and aneurysmal complications by methodical routine angiographic evaluation and appropriate treatment.

Adolescent↗
PubMed1988

[Subacute infectious endocarditis in the elderly. Retrospective study of 33 cases].

The authors reviewed 33 cases of infectious endocarditis in patients over 65 years of age and classified according to Von Reyn's diagnostic criteria. Twenty-four patients had organic valvular disease, 4 had a prosthetic valve, and in 4 cases the diagnosis of the murmur was uncertain. Positive blood cultures were obtained in 79 p. 100 of cases. The commonest infecting organism was the streptococcus (21 out of 26). In 11 patients, it was a Group D streptococcus and a recto-sigmoid colonic tumour was found in 3 cases. A dental portal of entry was suspected in 55 p. 100 of patients and this should guide the choice of prophylactic antibiotic therapy. The initial choice of antibiotic had to be changed in 19 patients, usually because of poor tolerance. Eight patients died and one underwent valve replacement within two months of hospital admission.

Aged↗