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At least 19 recordsLinked to original sources
PubMed1999

Current status of taxonomic groups of oral streptococci in endocarditis. Can virulence factors discriminate between endocarditis and non-endocarditis strains?

OBJECTIVE: Infective endocarditis is frequently caused by oral streptococci, especially Streptococcus sanguis. In this group, many strains have recently been reclassified on the basis of new taxonomic schemes. The purpose of this study was to classify oral streptococci from patients with infective endocarditis and, further, to assess the importance of specific virulence factors for the development of streptococcal endocarditis. METHODS: Twenty-eight previously identified and 10 new streptococcal isolates from infective endocarditis were classified according to Kilian et al (1989) and compared to 30 streptococcal isolates from the oral cavities of periodontal patients without endocarditis. Subsequently, surface hydrophobicity was assessed by hydrophobic interaction chromatography, production of extracellular dextran was determined by precipitation, and non-specific proteolytic activity was evaluated by determination of hydrolysis of gelatin, and casein-precipitating activity. RESULTS: Eight streptococcal species were represented in the endocarditis isolates. Most strains were highly hydrophobic and none showed non-specific proteolytic activity. Dextran was produced with similar frequency in endocarditis and non-endocarditis isolates. CONCLUSIONS: The present study showed that infective endocarditis may be caused by a variety of oral streptococcal species. The possible virulence factors investigated were found in the same proportions in endocarditis and non-endocarditis isolates, and thus did not seem to be crucial for development of endocarditis.

Journal Article↗
PubMed1996

Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis.

BACKGROUND: Q fever endocarditis is a life-threatening disease for which the diagnosis is usually based on serology. The major microbiologic criterion for the diagnosis of infectious endocarditis (two separate positive blood cultures) cannot be achieved in most routine laboratories because of the biohazard associated with the culture of Coxiella burnetii, the etiological agent of Q fever. PURPOSE: Recently, new criteria for the diagnosis of infectious endocarditis have been proposed, and in this study we attempted to assess the suitability of these criteria specifically for the diagnosis of Q fever endocarditis. PATIENTS AND METHODS: To achieve this aim, we first selected from our series 20 recent cases in whom endocarditis had been confirmed following valvular pathological examination, and for whom microbiological evidence for the involvement of C burnetii was available. Then, we applied the criteria proposed by the Duke Endocarditis Service (ie, C burnetii positive serology being considered a minor criterion) to this cohort of patients but excluding pathological findings. Although the Duke Endocarditis Service criteria confirmed diagnosis in 16 of the patients, 4 were misclassified as "possible" cases (20%). However, when the Q fever serological results (using an 1/800 antiphase I immunoglobulin G cut off) and single blood culture results were changed from minor to major diagnostic criteria, endocarditis was confirmed in them all. A second time, prospectively, we applied the Duke Endocarditis Service criteria to a further 5 patients affected with Q fever endocarditis. Strict application of these criteria resulted in 1 of the 5 being misdiagnosed. Applying the suggested modification for C burnetii results, all 5 were confirmed as having infectious endocarditis. CONCLUSION: We propose that the modifications discussed in this study be applied to the Duke Endocarditis Service criteria in order that the diagnosis of C burnetii induced endocarditis is improved.

Coxiella burnetii↗
PubMed2001

Whipple's endocarditis: review of the literature and comparisons with Q fever, Bartonella infection, and blood culture-positive endocarditis.

Whipple's disease is a systemic infection sometimes associated with cardiac manifestations. Recently, there has been an increase in the number of reported cases of Whipple's endocarditis. The purpose of our study was to describe this entity. Data from 35 well-described cases of Whipple's endocarditis were collected and compared with those of blood culture-positive endocarditis, Q fever endocarditis, and Bartonella endocarditis. Some patients with generalized Whipple's disease presented with cardiac involvement, among other symptoms. Others presented with a nonspecific, blood culture-negative endocarditis with no associated symptoms. In comparison with cases of endocarditis due to other causes, congestive heart failure, fever, and previous valvular disease were less frequently observed in the cases of Whipple's endocarditis. Without examination of the excised valves, the diagnosis of infective endocarditis could not have been confirmed in most cases. Treatment is not well established. Whipple's endocarditis is a specific entity involving minor inflammatory reactions and negative blood cultures, and its incidence is probably underestimated.

Adult↗
PubMed1981

Infective endocarditis and mitral prolapse: a comparison with other types of endocarditis.

We compared clinical features, response to therapy, and outcome of infective endocarditis in ten patients with mitral valve prolapse and 23 patients with endocarditis involving other types of left-sided valvular lesions. Signs of endocarditis were more subtle in patients with mitral valve prolapse, and antimicrobial therapy was instituted later in those patients. Nevertheless, nine of ten patients with mitral valve prolapse and endocarditis responded optimally to antimicrobials; only five of 23 patients with other types of endocarditis responded similarly. Four patients with mitral valve prolapse experienced increasing valvular dysfunction during the year after treatment of endocarditis; one died. We conclude that endocarditis in patients with mitral valve prolapse is more responsive to antimicrobial therapy even though recognition of the infection often is delayed. However, mitral valve prolapse endocarditis is not a benign infection, because progressive valvular dysfunction is a frequent sequel.

Adolescent↗
PubMed1992

[Surgical treatment of active infective endocarditis and prosthetic valve endocarditis].

Fifteen patients with active native valve endocarditis (NVE) and 5 with prosthetic valve endocarditis (PVE) were subjected to this study. Among the patients with NVE, one of 10 with simple destruction of leaflets and 2 of 5 with annular infection died postoperatively of cerebral bleeding and persistent infection. Five patients with annular infection, whose microorganisms were Streptococcus faecalis, Staphylococcus epidermidis and gram-negative coccus, had a shorter duration from onset to operation (mean 38 days) compared with the others (mean 85 days). A patient with NVE requires an urgent operation, especially when these microorganisms are identified. Among those with PVE, 3 underwent operation at the active phase and one at the chronic phase. Two patients with mechanical valve endocarditis by Staphylococcus and Candida died, but the other 2 with bioprosthetic valve endocarditis by alpha-Streptococcus survived, because infection was localized in the leaflets. Another patient with mechanical valve endocarditis by alpha-Streptococcus survived with conservative management. While a patient with bioprosthetic valve endocarditis requires an early operation as well as NVE, a patient with mechanical valve endocarditis requires selected management considering the microorganism and general condition.

Adult↗
PubMed1983

Surgical treatment of infective endocarditis with special reference to prosthetic valve endocarditis.

Patients with native valve endocarditis treated surgically between 1968 and 1978 (n = 15) and all patients presenting with prosthetic valve endocarditis during this period (n = 21) were followed up for at least four years. Five of the patients with native valve endocarditis required urgent early surgical intervention, of whom two died. The remaining 10 underwent valve replacement after a course of antibiotic treatment: all survived, though one required further valve replacement. The 21 patients with prosthetic valve endocarditis suffered 25 attacks. Nine were cured by medical treatment alone; two died before surgical intervention was possible; 11 required valve replacement, of whom three died; and two required valve replacement after a course of antibiotic treatment. The incidence of early prosthetic valve endocarditis--that occurring within two months of operation--was 0.67%, but that of late prosthetic valve endocarditis could not be determined. Medical treatment when started early should cure endocarditis in most patients, but vigilance should be maintained for the appearance of indications for surgery. When such indications exist surgery should not be delayed.

Adult↗
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↗
PubMed1976

Prosthetic valve endocarditis: clinicopathologic analysis of 22 necropsy patients with comparison observations in 74 necropsy patients with active infective endocarditis involving natural left-sided cardiac valves.

Clinical and morphologic features are described in 22 necropsy patients with endocarditis involving rigid-framed prosthetic valves: aortic in 15 patients and mitral in 7. The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 8 patients and longer than 2 months in 14 patients. The most frequent infecting organism was the Staphylococcus (13 patients). In each of the 22 patients the infection was located behind the site of attachment of the prosthesis to the valve ring, and the infection spread to adjacent structures in 13 patients, 11 of whom had aortic prostheses. Prosthetic detachment causing severe regurgitation occurred in 12 of the 15 patients with an infected aortic valve prosthesis, and in 2 of the 7 with an infected mitral valve prosthesis. Prosthetic obstruction by vegetative material occurred in 5 of 7 patients with prosthetic mitral infection and in only 1 of 15 with prosthetic aortic infection. High degrees of conduction defects developed in seven patients with aortic prosthetic valve endocarditis: complete heart block in five, and complete left bundle branch block in two. Comparison of observations in the 22 patients with prosthetic valve endocarditis with those in 74 patients with active infective endocarditis involving natural left-sided cardiac valves revealed significant (P less than 0.05) differences in the percent with ring abscess, hemodynamic consequences of the endocarditis (valve stenosis), frequency of Staphylococcus as the causative organism and percent with complete heart block or left bundle branch block. No significant differences were observed between the two groups when comparing age, sex, type of underlying valve disease or frequency of organ infarcts of splenomegaly.

Abscess↗
PubMed1994

New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service.

PURPOSE: This study was designed to develop improved criteria for the diagnosis of infective endocarditis and to compare these criteria with currently accepted criteria in a large series of cases. PATIENTS AND METHODS: A total of 405 consecutive cases of suspected infective endocarditis in 353 patients evaluated in a tertiary care hospital from 1985 to 1992 were analyzed using new diagnostic criteria for endocarditis. We defined two "major criteria" (typical blood culture and positive echocardiogram) and six "minor criteria" (predisposition, fever, vascular phenomena, immunologic phenomena, suggestive echocardiogram, and suggestive microbiologic findings). We also defined three diagnostic categories: (1) "definite" by pathologic or clinical criteria, (2) "possible," and (3) "rejected." Each suspected case of endocarditis was classified using both old and new criteria. Sixty-nine pathologically proven cases were reclassified after exclusion of the surgical or autopsy findings, enabling comparison of clinical diagnostic criteria in proven cases. RESULTS: Fifty-five (80%) of the 69 pathologically confirmed cases were classified as clinically definite endocarditis. The older criteria classified only 35 (51%) of the 69 pathologically confirmed cases into the analogous probable category (p < 0.0001). Twelve (17%) pathologically confirmed cases were rejected by older clinical criteria, but none were rejected by the new criteria. Seventy-one (21%) of the remaining 336 cases that were not proven pathologically were probable by older criteria, whereas the new criteria almost doubled the number of definite cases, to 135 (40%, p < 0.01). Of the 150 cases rejected by older criteria, 11 were definite, 87 were possible, and 52 were rejected by the new criteria. CONCLUSION: Application of the proposed new criteria increases the number of definite diagnoses. This should be useful for more accurate diagnosis and classification of patients with suspected endocarditis and provide better entry criteria for epidemiologic studies and clinical trials.

Adolescent↗
PubMedDate not supplied

Central venous catheter-induced endocarditis: human correlate of the animal experimental model of endocarditis.

A case of right-sided endocarditis clearly associated with the presence of a right atrial catheter is presented, and the literature on septicemia and endocarditis associated with central venous and pulmonary artery catheterization is reviewed. In the majority of cases of catheter-associated endocarditis reported in the literature, diagnosis has been made at autopsy; echocardiographic diagnosis has been reported only recently. The case presented in this report represents the only case in this literature in which the lesion causing right-sided endocarditis has been identified by two-dimensional echocardiogram and confirmed by tissue diagnosis. The mechanism of direct traumatization of the endocardium by the catheter makes central venous catheter-induced endocarditis bear pathophysiologic similarity to the experimental model of endocarditis in animals.

Adult↗
PubMed1995

Staphylococcus aureus endocarditis in Danish intravenous drug users: high proportion of left-sided endocarditis.

In a retrospective study covering the years 1982-1989 episodes of Staphylococcus aureus endocarditis in 51 intravenous drug users were studied. Tricuspid involvement dominated (34/51), but the frequency of left-sided involvement (33.3%) was greater than in earlier reports. Involvement of both sides of the heart was not detected, but 27.8% of the left-sided endocarditis cases had multiple pulmonary infiltrates, indicating that some of them might have had a concomitant right-sided endocarditis. The 2 groups were compared: patients with left-sided endocarditis were significantly older and with a longer time of intravenous drug use. The complication rate was the same (44.1%) as was the duration of antibiotic treatment (median 42 days). In total, five patients underwent surgery, two (5.8%) due to right-sided failure and three (29.4%) because of left-sided endocarditis. The mortality of tricuspid endocarditis was low (2.9%), whereas 5 patients (29.4%) with left-sided involvement died. The patients who died were significantly older and had a shorter duration of symptoms before hospitalization.

Adolescent↗
PubMed2001

[Endocarditis due to HACEK bacteria. A case report of endocarditis due to Kingella kingae].

Endocarditis is a common disease in hospital practice. Identification of the microorganism responsible for the valvular damage is essential to establish the prognosis and to determine the optimal antibiotic treatment. In some cases of endocarditis the diagnosis is laborious, especially when the responsible microorganism is difficult to detect using standard culture techniques. Here we report a case of native aortic valve endocarditis due to Kingella kingae, a Gram negative organism of the HACEK group. In addition we review 6 other cases of endocarditis caused by organism belonging to this group, treated in our hospital between 1983 and 1999. Epidemiological studies show that less than 5% of all cases of endocarditis are caused by organisms of the HACEK group. The diagnosis is often delayed because their slow growth on a standard culture medium. We describe clinical and microbiological characteristics of this group of endocarditis.

Adult↗
PubMedDate not supplied

The diagnostic challenge of infective endocarditis: cutaneous vasculitis leading to the diagnosis of infective endocarditis.

BACKGROUND: Signs and symptoms of infectious endocarditis are protean. They result from destruction of cardiac endothelium, metastatic embolization, hematogenous seeding, and immune complex deposition. Embolic manifestations of infectious endocarditis can mimic several other pathologic conditions and make the diagnosis of infectious endocarditis difficult. METHODS: We describe a case of cutaneous vasculitis leading to the diagnosis of infectious endocarditis. A review of the literature highlights the variable clinical presentations and key diagnostic strategies in the evaluation of infectious endocarditis. RESULTS AND CONCLUSION: Infective endocarditis has protean clinical symptoms and signs and can be a challenging diagnosis. Being alert to the condition is crucial, and where a high clinical probability exists despite a negative transthoracic echocardiogram, diagnostic evaluation with transesophageal echocardiograph is required.

Anti-Bacterial Agents↗
PubMed1987

Fungal endocarditis complicating treatment of prosthetic valve bacterial endocarditis: value of prophylactic oral nystatin.

We describe two patients in whom fungal endocarditis occurred during antibiotic therapy for prosthetic valve bacterial endocarditis. Successful management of both patients was eventually achieved with antifungal therapy and replacement of the prosthetic valves. These cases and review of the literature suggest that (1) high-dose antibacterial therapy predisposes to fungal endocarditis; (2) during prolonged antibiotic therapy in patients predisposed to endocarditis, clinicians should consider the use of oral nystatin as prophylaxis against fungemia and possible fungal endocarditis; and (3) early replacement of prosthetic valves infected with fungi is indicated because chemotherapy alone is predictably inadequate to effect a cure.

Adult↗
PubMed1990

A comparison of Q fever endocarditis with native valve endocarditis.

We compared 10 episodes (8 patients) of Q fever endocarditis with 27 episodes (27 patients) of native valve endocarditis. Patients with Q fever endocarditis were more likely to have weight loss (p less than 0.003), experience fatigue (p less than 0.07), have clubbing of the fingers (p less than 0.005), have a diastolic murmur at the time of admission (p less than 0.03), be anemic (p less than 0.05), have a normal white blood cell count (p less than 0.005), and have a higher serum globulin concentration (p less than 0.007). While valve replacement was required for 50% of the episodes in both groups of patients, it was required later--mean 107 days following the onset of treatment--for the Q fever patients than for the native valve patients--mean 27 days. The mortality rates for these two diseases were not significantly different (30% for native endocarditis vs. 12.5% for Q fever endocarditis), but the Q fever patients experienced significantly fewer complications.

Endocarditis↗