Pedro; A; Villablanca; Shashvat; Sukhal; Oscar; Maitas; Afiachuukwu; Onuegbu; Juan; M; Muoz-Pea; Ajay; Joseph; Carlos; Requena; Divyanshu; Mohananey
Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.
Ikeda, Akihiko; Nakajima, Tomomi; Konishi, Taisuke; Matsuzaki, Kanji; Sugano, Akinori; Fumikura, Yuko; Nishina, Hidetaka; Jikuya, Tomoaki
Asymptomatic rupture of a sinus of Valsalva aneurysm is rare. A fistula following rupture of a sinus of Valsalva aneurysm may cause infective endocarditis. Here, we report a case of infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm. A 45-year-old male, who was first diagnosed with a heart murmur at the age of 37 years, presented with fever. Blood culture was positive for Streptococcus gordonii. Ultrasound echocardiography revealed an aorto-right atrial fistula caused by rupture of a sinus of Valsalva aneurysm. After the infective endocarditis was healed by antibiotics, we successfully performed surgical repair of the aorto-right atrial fistula. Although asymptomatic rupture of a sinus of Valsalva aneurysm is uncommon, it should be recognized as a possible cause of infective endocarditis. PMID:27180251
Marcelo Luiz Peixoto Sobral; Luis Alberto Saraiva Santos; Gilmar Geraldo dos Santos; Noedir Antonio Groppo Stolf
Aneurisma de arco aórtico com fístula aorto-pulmonar aguda é uma afecção rara e, geralmente, diagnosticada postmortem. Poucos relatos de sucesso cirúrgico foram realizados e persiste uma alta taxa de mortalidade. Os autores relatam o caso de um paciente de 78 anos, com comunicação aguda entre aneurisma de arco aórtico e artéria pulmonar com precordialgia, instabilidade hemodinâmica e congestão pulmonar. A operação foi realizada com sucesso, sendo realizada a substituição da porção proximal da...
程蕾蕾; 赵维鹏; 潘翠珍; 丁文军; 王春生; 舒先红
IntroductionAorto-left ventricular tunnel(ALVT)is an extrenle rare(0.001%)congenital para-valvular conmmnication between aorta and the left ventricle.It was first reported by Edwards and his colleagues in 1961[ 1].Only about 100 cases have been reported until now.We re port Out"first ease of ALVT with infective endocarditis demonstrated by two-dimensional and three-dimensional echocardiography and confirmed by surgery.%@@ IntroductionAorto-left ventricular tunnel ( ALVT) is an extreme rare (0.001% ) congenital para-valvular communication between aorta and the left ventricle.It was first reported by Edwards and his colleagues in 1961.Only about 100 cases have been reported until now.We report our first case of ALVT with infective endocarditis demonstrated by two-dimensional and three-dimensional echocardiography and confirmed by surgery.
Full Text Available Abstract Aorto-atrial fistulas (AAF are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.
Estudio de las complicaciones perianulares en la endocarditis infecciosa. Análisis de aspectos clínicos, microbiológicos, ecocardiográficos, terapéuticos y pronósticos en pacientes con abscesos perianulares y fístulas aorto-cavitarias en la endocarditis complicada.
Anguera Camós, Ignasi
[spa] La endocarditis infecciosa (EI) es una enfermedad potencialmente muy grave, que puede llegar a ser mortal sin tratamiento, cuyo pronóstico ha experimentado una gran mejoría en las ultimas décadas. Este importante cambio en la historia natural de la enfermedad se ha reflejado en una progresiva disminución de la morbi-mortalidad, sobretodo gracias al uso de potentes antibióticos y al empleo de las técnicas quirúrgicas de reparación valvular. La EI es la infección del endotelio de las válv...
Ferro, José M; Fonseca, Ana Catarina
Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated. PMID:24365290
Full Text Available La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de haces de músculo liso que comprime las estructuras antes mencionadas y que causa entonces su dilatación. El pronóstico es malo, ya que las pacientes desarrollan insuficiencia respiratoria, lo que las conduce a la muerte. La enfermedad se asocia a la ingesta de estrógenos, píldoras anticonceptivas y se exacerba con el embarazo-, por ello se ha tratado con medróxi-progesterona y tamoxifén, con estabilización de la evolución en algunos pero no en todos los casos. Eventualmente, algunas pacientes pueden necesitar transplante pulmonar. Presentamos el caso de una mujer de 38 años con tres episodios de pneumotórax espontáneo y documentación radiológica e histológica de linfangioleiomiomatosis pulmonar.
Full Text Available El transplante pulmonar suele ser la última opción terapéutica para pacientes con insuficiencia respiratoria. A pesar de los muchos avances en inmunología y el manejo de las complicaciones, la mortalidad y morbilidad asociadas a este trasplante son muy superiores a los demás. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones respiratorias también cumplen un papel importante en las complicaciones asociadas al trasplante pulmonar por la constante exposición del injerto al medio exterior. No obstante, los éxitos de esta opción terapéutica que depende fundamentalmente de una correcta selección de donante y receptor, son evidentes, sobre todo en cuanto a calidad de vida se refiere.
Full Text Available La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de haces de músculo liso que comprime las estructuras antes mencionadas y que causa entonces su dilatación. El pronóstico es malo, ya que las pacientes desarrollan insuficiencia respiratoria, lo que las conduce a la muerte. La enfermedad se asocia a la ingesta de estrógenos, píldoras anticonceptivas y se exacerba con el embarazo-, por ello se ha tratado con medróxi-progesterona y tamoxifén, con estabilización de la evolución en algunos pero no en todos los casos. Eventualmente, algunas pacientes pueden necesitar transplante pulmonar. Presentamos el caso de una mujer de 38 años con tres episodios de pneumotórax espontáneo y documentación radiológica e histológica de linfangioleiomiomatosis pulmonar.Pulmonary lymphangioleiomyomatosis is an uncommon disease, that affects only women of child-bearing age. The patients present themselves with progressive dyspnea, frequent episodes of spontaneous pneumothorax and, occasionally, with hemoptysis and chylothorax. High resolution CAT sean shows bilateral lung cysts of variable size up to frank bullae. Histologically, numerous thin walied cavities are seen, and dilatation of lymphaties, veins, arteries, bronchioles and alveolar sacs with extensiva smooth muscle proliferation, which engulfs the previously mentioned structures and causes their dilatation. The patients eventually develop respiratory insufficieney and die. This disease is associated with estrogen intake, contraceptivas and becomes worse
Liu, Alexander; Nicol, Edward; Hu, Yanmin; Coates, Anthony
Mycobacterium tuberculosis (TB) is a major cause of death globally. TB is capable of infecting every organ in the body, and the heart is no exception. Tuberculous endocarditis (TBE) was first reported in 1892 and subsequently many other cases have been described, highlighting the significant morbidity and mortality associated with this manifestation of TB. TBE usually presents with miliary tuberculosis and most early cases were diagnosed on autopsy. With increasing application of prosthetic valve replacements in the treatment of infective endocarditis (IE), TB infections have begun to affect these as well as native valves. With the introduction of TB culture methods and drug therapy, the prognosis has improved. HIV and drug resistance are likely to make the management of TBE more difficult in the future. Large scale studies, both prospective and retrospective, are required to ascertain the true incidence of TBE whilst development of novel anti-TB therapy is also required to combat resistance. We present the first extensive literature review on TBE in over 75 years. PMID:23021600
Dahl, Anders; Rasmussen, Rasmus V; Bundgaard, Henning;
Because of the nephrotoxic effects of aminoglycosides, the Danish guidelines on infective endocarditis were changed in January 2007, reducing gentamicin treatment in enterococcal infective endocarditis from 4 to 6 weeks to only 2 weeks. In this pilot study, we compare outcomes in patients with...... Enterococcus faecalis infective endocarditis treated in the years before and after endorsement of these new recommendations....
Mohammad Ali Hatamizadeh
Full Text Available Infective endocarditis is one of the most severe complications of parenteral drug abuse. The outstanding clinical feature of infective endocarditis in intravenous drug abusers is the high incidence of right-sided valve infection, and the tricuspid valve is involved in 60% to 70% of the cases. We herein report a case of isolated pulmonic valve infective endocarditis with a native pulmonary valve.
Leggieri, Nicola; Gouriet, Frédérique; Thuny, Frank; Habib, Gilbert; Raoult, Didier; Casalta, Jean-Paul
We report a case of infectious endocarditis attributable to Legionella longbeachae. L. longbeachae is usually associated with lung infections. It is commonly found in composted waste wood products. L. longbeachae should be regarded as an agent of infectious endocarditis, notably in the context of gardening involving handling of potting soils.
... from IE include: • artificial (prosthetic) heart valves or heart valves repaired with artificial material • a history of endocarditis • some kinds of congenital heart defects • abnormality of the heart valves after a ...
Riddell, James; Kauffman, Carol A.; Smith, Jeannina A.; Assi, Maha; Blue, Sky; Buitrago, Martha I.; Deresinski, Stan; Wright, Patty W.; Drevets, Douglas A.; Norris, Steven A.; Vikram, Holenarasipur R.; Carson, Paul J.; Vergidis, Paschalis; Carpenter, John; Seidenfeld, Steven M.
Abstract Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was...
Dahl, Anders; Bruun, Niels Eske
Enterococcus faecalis infective endocarditis (IE) is a disease of increasing importance, with more patients infected, increasing frequency of health-care associated infections and increasing incidence of antimicrobial resistances. The typical clinical presentation is a subacute course with fever...... ceftriaxone. E. faecalis infective endocarditis continues to be a very serious disease with considerable percentages of high-level gentamicin resistant strains and in-hospital mortality around 20%. Strategies to prevent E. faecalis IE, improve diagnostics, optimize treatment and reduce morbidity will be...
Benn, Marianne; Hagelskjaer, L H; Tvede, M
To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population.......To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population....
Kelly, Patrick; Rolain, Jean-Marc; Maggi, Ricardo; Sontakke, Sushama; Keene, Bruce; Hunter, Stuart; Lepidi, Hubert; Breitschwerdt, Kyle T.; Breitschwerdt, Edward B.; Raoult, Didier
We provide the first evidence that Bartonella quintana can infect dogs and cause typical signs of endocarditis. Using PCR and sequencing, we identified B. quintana in the blood of a dog from the United States with aortic valve endocarditis and probably also in the mitral valve of a dog from New Zealand with endocarditis.
Bangsborg, Jette Marie; Tvede, M; Skinhøj, P
Haemophilus segnis is a rarely recognised commensal in the oropharynx. We wish to report the first published case of endocarditis caused by H. segnis. The patient, a 76-year-old female did not recover until after 2 courses of ampicillin given for a total of 57 days. In the second course of...
Luiz Eduardo Mendes Campos
Full Text Available As formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinofilia pulmonar pode também estar associada a doenças pulmonares difusas, doenças do tecido conectivo e neoplasias.Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid or in tissue (lung biopsy specimens. Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis
Full Text Available Enterococci are normal inhabitants of gastrointestinal tract, being responsible for 5 to 18% of infective endocarditis and the incidence appears to be increasing. Eleven patients with enterococcal endocarditis were studied. In a case series group, 10 men (average 57 years and one woman (37 years were studied. Two patients had rheumatic heart disease, 5 patients arteriosclerotic disease and one patient chronic renal failure on hemodialysis. Ten patients were treated with ampicillin and gentamycin. Valve replacement was performed in 3 patients with aortic valve endocarditis, one on 8th day and two at the end of the treatment. Overall clinical cure was achieved in 9 patients. Two relapses occurred and 2 patients died as a result of refractory congestive heart failure and cerebral emboli. All of the enterococcal endocarditis cases were community acquired. In conclusion, infective endocarditis in patients with preexistent valvular heart disease, community acquisition and non specific symptoms with bacteriuria should be considered as enterococcal endocarditis.
Objective: To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement (AVR) or ascending aortic replacement. Methods: Eighty-seven patients with aortic-right atrial fistula underwent CT after operation. The CT features were retrospectively analyzed. Fistula was measured according to maximum width of the shunt. Results: Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them, 25 patients were diagnosed as mild aorto-right atrial fistula, 47 patients as moderate, and 15 patients as severe. Thirty-seven patients underwent follow-up CT.Among them, 10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression, 8 patients with mild aorto-right atrial fistula considered to have incomplete regression, 14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition, and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up. Conclusion: CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up. (authors)
Pedro Medeiros Junior; Carlos Roberto Ribeiro de Carvalho
Linfangioleiomiomatose pulmonar (LAM) é uma doença rara, de etiologia desconhecida, que basicamente afeta mulheres jovens no período fértil de sua vida. Clinicamente, manifesta-se através de dispnéia progressiva, pneumotórax de repetição, tosse seca e, menos freqüentemente, por quilotórax e escarros hemoptóicos. Essas alterações surgem devido à proliferação anormal de células de músculo liso no parênquima pulmonar, linfonodos e em outros tecidos. Mais recentemente, estudos citogenéticos verif...
Santoro, Giuseppe; Carrozza, Marianna; Russo, Maria Giovanna; Calabrò, Raffaele
Enlarged bronchial arteries and/or systemic-to-pulmonary collaterals have been frequently demonstrated in association with transposition of the great arteries. They are usually clinically silent, although they might be large enough to cause accelerated pulmonary vascular obstructive disease or symptomatic cardiac volume overload after surgical repair. We report on a low-weight neonate with transposition of the great arteries and intact ventricular septum who showed a stormy postoperative course because of multiple aorto-pulmonary collaterals early after a successful arterial switch operation. Percutaneous coil embolization of these anomalous vessels resulted in sudden weaning from mechanical ventilation and hospital discharge in a few weeks. PMID:18185950
The objective of the present study was to review all cases of infective endocarditis at our hospital between 2002 and 2006 concerning the bacteriological aetiology and outcomes.......The objective of the present study was to review all cases of infective endocarditis at our hospital between 2002 and 2006 concerning the bacteriological aetiology and outcomes....
BOMBARDA SIDNEY; FIGUEIREDO CLÁUDIA MARIA; FUNARI MARCELO BUARQUE DE GUSMÃO; SOARES JÚNIOR JOSÉ; SEISCENTO MÁRCIA; TERRA FILHO MÁRIO
A tuberculose é uma doença de alta incidência e prevalência no Brasil. Sinais sugestivos de atividade ou seqüela da tuberculose podem ser obtidos através dos métodos de imagem. Na radiografia de tórax, a tuberculose pulmonar ativa pode manifestar-se sob a forma de consolidações, cavitações, padrões intersticiais (reticulares/retículo-nodulares), linfonodomegalias hilares ou mediastinais e derrame pleural. Imagens compatíveis com doença ativa, como nódulos centrolobulares de distribuição segme...
Full Text Available El absceso hepático piógeno producido por Klebsiella pneumoniae es relativamente raro y puede complicarse con lesiones sépticas a distancia. Esto se relaciona con características propias del germen que incluyen el genotipo K1, resistencia a la fagocitosis y la presencia del gen mag-A. Tales metástasis sépticas contemplan absceso pulmonar, meningitis, endocarditis bacteriana y, muy especialmente, endoftalmitis. Esta última ocurre con mayor frecuencia en pacientes diabéticos, y puede causar ceguera. Se reporta caso de absceso hepático por K. pneumoniae asociado a absceso pulmonar y endoftalmitis, y se revisa epidemiología, fisiopatología, diagnóstico y tratamiento de la entidad.
Henriksen, L O; Mejdahl, Steen; Petersen, F; Tønnesen, Knud Henrik; Holstein, P E
Hydronephrosis is reported to be an infrequent complication of aorto-femoral bypass operations. To define the true incidence of this complication, renography (131I-Hippuran) and renal scintigraphy (99 Technetium) were performed both pre- and postoperatively on 56 asymptomatic patients following s...... successful aortic reconstruction. No patient developed signs of ureteral obstruction. It is concluded that hydronephrosis is a rare complication to aorto-femoral bypass surgery and postoperative control is only indicated in patients with symptoms from the urinary tract....
Mehanic, Snjezana; Mulabdic, Velida; Baljic, Rusmir; Hadzovic-Cengic, Meliha; Pinjo, Fikret; Hadziosmanovic, Vesna; Topalovic, Jasna
SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined...
Winter Richard K
Full Text Available Abstract Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16; type II (n = 37 and type III (n = 33. The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7% patients: thrombosis within diseased superficial femoral arteries (n = 4; haemorrhage and subsequent death (n = 2. Ten (14% late complications (> 12 months occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3; graft thrombosis (n = 4, graft infection (n = 3. Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co
Pedro Medeiros Junior
Full Text Available Linfangioleiomiomatose pulmonar (LAM é uma doença rara, de etiologia desconhecida, que basicamente afeta mulheres jovens no período fértil de sua vida. Clinicamente, manifesta-se através de dispnéia progressiva, pneumotórax de repetição, tosse seca e, menos freqüentemente, por quilotórax e escarros hemoptóicos. Essas alterações surgem devido à proliferação anormal de células de músculo liso no parênquima pulmonar, linfonodos e em outros tecidos. Mais recentemente, estudos citogenéticos verificaram a presença de mutações do gene TSC-2 em células de angiomiolipoma renal e linfonodos abdominais de pacientes com LAM, indicando uma possível origem para as lesões hamartomatosas da doença. Radiologicamente, caracteriza-se pela presença de infiltrado intersticial reticulonodular e sinais de hiperinsuflação ao radiografia de tórax. Na tomografia computadorizada de alta resolução, cistos de paredes finas, localizados centralmente, são visibilizados por todo o parênquima do pulmão. O ultrassom e a tomografia de abdome podem revelar angiomiolipomas renais e linfonodomegalias retroperitoneais. Meningeomas também podem estar associados, porém a sua presença deve sempre levar à pesquisa de esclerose tuberosa. Funcionalmente, a doença caracteriza-se por um distúrbio ventilatório obstrutivo, de caráter progressivo, com hiperinsuflação pulmonar e diminuição da difusão de monóxido de carbono. Apesar da ausência de comprovação quanto à eficácia, o principal tratamento utilizado ainda é o anti-estrogênico e constitui-se de oofarectomia, progesterona contínua, tamoxifeno e análogos de GnRH. Além desse, a realização de transplantes pulmonares tem elevado para além de dez anos a sobrevida média das pacientes.Lymphangioleiomyomatosis (LAM is a rare lung disease of unkwnon etiology that frequently affects women in childbearing age. Clinically it manifests itself by and pneumothorax. Chylous pleural
Full Text Available El transplante pulmonar suele ser la última opción terapéutica para pacientes con insuficiencia respiratoria. A pesar de los muchos avances en inmunología y el manejo de las complicaciones, la mortalidad y morbilidad asociadas a este trasplante son muy superiores a los demás. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones respiratorias también cumplen un papel importante en las complicaciones asociadas al trasplante pulmonar por la constante exposición del injerto al medio exterior. No obstante, los éxitos de esta opción terapéutica que depende fundamentalmente de una correcta selección de donante y receptor, son evidentes, sobre todo en cuanto a calidad de vida se refiere.A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient, are evident, above all with respect to quality of life.
Brouqui, P; Raoult, D
The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, ...
Cortes, Christopher D.; Carl Urban; Glenn Turett
Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces.
Christopher D. Cortes
Full Text Available Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces.
Cortes, Christopher D; Urban, Carl; Turett, Glenn
Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces. PMID:26697243
Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried; Weigang, Ernst; Livi, Ugolino; Verzini, Fabio; Schmidli, Jürg; Chiesa, Roberto; Melissano, Germano; Kahlberg, Andrea; Amabile, Philippe; Harringer, Wolfgang; Horacek, Michael; Erbel, Raimund; Park, Kay-Hyun; Beyersdorf, Friedhelm; Rylski, Bartosz; Blanke, Philipp; Canaud, Ludovic; Khoynezhad, Ali; Lönn, Lars; Rousseau, Hervè; Trimarchi, Santi; Brunkwall, Jan; Gawenda, Michael; Dong, Zhihui; Fu, Weiguo; Schuster, Ingrid; Grimm, Michael
To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR).......To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR)....
G M Tarasova
Full Text Available Objective. To assess rheumatologic aspects of modern infectious endocarditis (IE and to determine role of anti-inflammatory therapy in complex treatment of the disease. Material and methods. 50 pts with IE (24 female, 26 male aged 16 to 60 years were included. Primary IE was diagnosed in 15, secondary - in 35 cases. 7 pts had acute and 43 — subacute course. 40 pts had definite and 10 — probable IE. Results. Mean period till correct diagnosis establishment was 112± 116,5 days. Diagnostic difficulties were more frequent in subacute variant of IE (p=0,03. Heart diseases prevailed among cardiac risk factors (p=0,0l. Clinical picture of IE was very polymorphous. Glucocorticoids (GC were administered to 21 pts in addition to antibiotics due to signs of organ immunopatology and high laboratory measures of immune activity. Positive effect of glucocorticoids was achieved in 64% of pts. Conclusion. Development of immunological changes complicates timely diagnosis of IE and requires exclusion of different diseases including rheumatic pathology. IE treatment strategy does not exclude administration of GC low doses for prominent immunopathological signs in addition to massive antibacterial therapy.
Objective: Infective Endocarditis (IE) during pregnancy is a rare but grave condition. The diagnosis and management can be challenging, especially when the pregnant patient warrants a cardiac operation under cardiopulmonary bypass. The present article describes IE during pregnancy based on a series of published case reports in the literature. IE during pregnancy often causes embolic events and mycotic aneurysms. Two-thirds of IE in the pregnant patients requires timely or urgent cardiac surgery to alleviate patients deterioration. At least a 3-week antibiotic therapy is mandatory before cardiac surgery aiming at improving the patients. Conditions. During cardiac surgery, fetal heart rates may temporarily be slowed down but may gradually recover to normal after the operation. The fetal and maternal mortalities were 16.7% and 3.3%, respectively. The fetal deaths were apparently associated with a cardiac surgery during early pregnancy. Cardiopulmonary bypass, hypothermia and rewarming can adversely affect both the mother and the fetus by triggering placental deficits, fetal hypoxia and uterine contraction. Avoidance of cardiac operations before 24th gestation week and preferably deferred until after 28th gestation week have been a plausible argument as per the possible fetal deaths related to immaturity. (author)
Asma M Al-Jasser
Full Text Available A 35-year–old man with pre-existing rheumatic heart disease and aortic regurgitation (AR presented with intermittent fever, ankle swelling and clinical evidence of endocarditis. Transoesophageal echocardiogram (TEE revealed vegetations and destruction of the aortic valve (AV. Blood cultures grew a gram positive coccobacillus which was phenotypically identified as Abiotrophia defectvia (A.defectiva. A diagnosis of infective endocarditis (IE due to A.defectiva was made. Treatment, with penicillin and gentamicin, was administered for 4 weeks. Mechanical valve replacement was required few days after starting the antibiotic therapy. The patient had a favorable outcome on follow up.Although A.defectiva is an uncommon cause of endocarditis, early and correct identification of this pathogen is important to improve the outcome and the prognosis of patients with IE due to this organism.
Mehanic, Snjezana; Mulabdic, Velida; Baljic, Rusmir; Hadzovic-Cengic, Meliha; Pinjo, Fikret; Hadziosmanovic, Vesna; Topalovic, Jasna
SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed. PMID:24493988
Full Text Available The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE. She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25 day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected.
Sabzi, Feridoun; Heidari, Aghighe; Faraji, Reza
The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic Brucella endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve Brucella endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE). She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25(th) day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected. PMID:26605134
Wilma C. Neves Forte
Full Text Available OBJECTIVE: To analyze the immune response in peripheral blood of patients with infective endocarditis. METHODS: We studied 10 patients with infective endocarditis, age range from 20 to 50 years-old, males and females, and 20 healthy subjects in the same age range. The diagnosis of the disease was based on the clinical picture, echocardiogram, and hemoculture based upon samples drawn and tested before the treatment started. The were no history of atopy or malnutrition, no autoimmune disease, and they were not using any immunosuppressant or antibiotic medication. RESULTS: The patients with endocarditis had significantly higher T and B lymphocyte, CD4+ and CD8+ cell counts, IgM and IgG serum levels, and C4 component of the complement than the control group; no significant difference concerning serum IgA and neutrophil oxidative metabolism; a significant decrease in C3, chemotaxis, and monocyte phagocytosis;cryoglobulins were detected in 66.6% of patients and they were formed by IgG, IgM, IgA, C3, and C4. CONCLUSION: The patients with infective endocarditis were immunocompetent in most sectors of immune response and, at a certain moment, an autoimmune component may be present.
Iversen, Kasper; Høst, Nis; Bruun, Niels Eske;
Guidelines for the treatment of left-sided infective endocarditis (IE) recommend 4 to 6 weeks of intravenous antibiotics. Conversion from intravenous to oral antibiotics in clinically stabilized patients could reduce the side effects associated with intravenous treatment and shorten the length of...
Agustina Sosa Beláustegui
Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.
Full Text Available La tuberculosis (TB que compromete sólo los campos pulmonares inferiores (TBCI es poco frecuente en el adulto y en general está asociada a alguna causa de inmunodepresión. El objetivo de nuestro trabajo fue determinar la incidencia de TBCI en nuestra población y comparar sus características respecto de la TB pulmonar de localización habitual. Se estudiaron en forma retrospectiva en el período de 2004 a 2008, 42 pacientes con TBCI que fueron comparados con 84 pacientes con TB pulmonar de localización habitual (grupo control. Se excluyeron pacientes con HIV. La TBCI representó el 6% del total de TB pulmonar. No se encontraron diferencias significativas en cuanto a edad, sexo, presencia de cavidades en la radiografía, días de evolución y nivel de albúmina. La TBCI tuvo significativamente mayor proporción de comorbilidades (p < 0.001, presencia de condensación (p < 0.001 y compromiso unilateral (p < 0.001 en la radiografía de tórax, junto con mayor número de internaciones (p = 0.02. Cabe destacar que sólo16 de los 42 pacientes con TBCI (38% tenían alguna comorbilidad demostrada. La TBCI puede presentarse aun sin comorbilidades asociadas y debe sospecharse en neumonías de evolución tórpida independientemente de su localización.
Bruun, Niels Eske; Habib, Gilbert; Thuny, Franck;
Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use...... structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission...... the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested....
Reda Abdelsamie Alarabawy
Conclusions: MDCT angiography is excellent noninvasive scanning technique for patients suspected of having aorto-iliac occlusive disease, with higher spatial resolution and faster acquisition times, allowing assessment of the aorta and its branches with greater accuracy than other modalities.
Lezaun, R; Teruel, J.; Maître, M. J.; De Artaza, M
The case is reported of a 48-year-old man suffering from Brucella endocarditis on a double prosthesis. The successful medical and surgical treatment is described. So far as the authors know, this is the first report of Brucella endocarditis from a heart valve prosthesis.
Rifon, J. (José); Paramo, J. A.; Panizo, C. (Carlos); R. Montes; Rocha, E
Early graft occlusion is a common complication in patients undergoing aorto-coronary bypass surgery. Both mechanical and haemostatic factors play a role in the pathogenesis of thrombotic occlusion. Several studies have demonstrated a relationship between fibrinolytic activity and venous or arterial thrombosis. We undertook this study to evaluate the possible contribution of the fibrinolytic system to postoperative occlusion in patients undergoing aorto-coronary bypass graft (CABG). A venous o...
Henn L.A.; Gonzaga R.V.; Crestani J.; Cerski M.R.
Schwannoma é uma neoplasia mesenquimal, usualmente solitária, encontrada no mediastino, retroperitônio ou pelve, sendo rara sua apresentação na parede torácica. OBJETIVO: Relatar o caso de um paciente masculino, tabagista, com um nódulo pulmonar direito com características de malignidade, detectado em radiografia de tórax de rotina, cujo diagnóstico anatomopatológico foi de schwannoma benigno de nervo intercostal. MÉTODOS: Revisaram-se os dados referentes ao quadro clínico, exames laboratoria...
Bayliss, R.; Clarke, C.; Oakley, C.; Somerville, W; Whitfield, A. G.
During 1981 and 1982 544 cases of infective endocarditis were investigated retrospectively by means of a questionnaire. Only 13.7% had undergone any dental procedure within three months of the onset of the illness, and in 42.5% there was no known cardiac abnormality before the onset of the disease. Furthermore, the number of cases occurring annually was about the same as or more than it was before the introduction of penicillin. The mouth and nasopharynx were the most likely sources of the co...
Madsen, Rasmus Gaarde; Ladefoged, Karin; Kjaergaard, Jens Jørgen;
in studies on Caucasian populations, where pneumococcal infection was seen in 1-3% of endocarditis cases. The overall mortality rate was 12%. Pneumococcal endocarditis (PE) had the clinical characteristics of fulminant disease with frequent heart failure, complications and need for surgery. Among......OBJECTIVES: The aim of this retrospective study was to determine the incidence and outcome of infectious endocarditis in Greenland with an emphasis on pneumococcal endocarditis. STUDY DESIGN: Retrospective, non-interventional study. METHODS: Review of files and medical history of all patients with...... infectious endocarditis from the Patient Registry in Greenland in the 11-year period 1995-2005. RESULTS: There were 25 cases of endocarditis, giving an incidence rate of 4.0/100,000 per year. Twenty-four percent of these cases were caused by Streptoccous pneumonia, which is significantly more frequent than...
Muhammad Tariq Shakoor
Full Text Available Transcatheter aortic valve replacement (TAVR techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.
Agustina Sosa Beláustegui
Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic
Larsen, Tove; Fiehn, Nils-Erik; Gutschik, Ernö;
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...... 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...
Lucía R. Kazelian
Full Text Available La endocarditis infecciosa es una enfermedad de baja incidencia que en las últimas décadas mostró modificaciones respecto de su presentación, posibilidad diagnóstica y tratamiento. A pesar de estos avances, la mortalidad hospitalaria sigue siendo muy elevada. Nuestro objetivo fue analizar las características de los pacientes con endocarditis infecciosa activa y su relación con la mortalidad hospitalaria a lo largo de 16 años. Se realizó un registro prospectivo entre 1994 y 2010 de pacientes ingresados con endocarditis. Se analizaron características clínicas, evolución y tratamiento y se registraron los eventos intrahospitalarios. Ingresaron 152 pacientes, 64.5% varones, edad 45 ± 16 años, las causas más frecuentes de cardiopatía de base fueron: congénita 32 (21% y reumática 20 (13.2%. Los motivos de internación fueron síndrome febril 116 (76.3% e insuficiencia cardíaca 61 (40.1%. Se identificó el agente infeccioso en 106 (69.7% de los casos, el más frecuente fue Streptococcus viridans. El ecocardiograma mostró vegetaciones en 123 (80.9% de los pacientes y 88 (57.8% presentaron complicaciones durante su internación, siendo la más frecuente la insuficiencia cardíaca. Se indicó tratamiento quirúrgico en 96 (63.1% de los casos, fundamentalmente por insuficiencia cardíaca en 66. La mortalidad hospitalaria global fue 46 (30.2%. El desarrollo de complicaciones en la internación, la indicación de cirugía y la presencia de insuficiencia cardíaca refractaria al tratamiento fueron predictores independientes de mortalidad hospitalaria, mientras que la presencia de vegetaciones resultó un predictor independiente de mejor supervivencia. La identificación temprana de estos predictores descriptos podría ayudar a mejorar los resultados.Active infective endocarditis (IE is a disease of low incidence that has showed changes in presentation, diagnosis and treatment options during the past decades. Despite these advances
Goel, Rohan; Sekar, Baskar; Payne, Mark N
Infective endocarditis (IE) is a life-threatening condition with adverse consequences and increased mortality, despite improvements in treatment options. Diagnosed patients usually require a prolonged course of antibiotics, with up to 40-50% requiring surgery during initial hospital admission. We report a case of a 42-year-old intravenous drug user who presented feeling generally unwell, with lethargy, rigours, confusion and a painful swollen right leg. He was subsequently diagnosed with Proteus mirabilis endocarditis (fulfilling modified Duke criteria for possible IE) and deep vein thrombosis (DVT). He was successfully treated with single antibiotic therapy without needing surgical intervention or requiring anticoagulation for his DVT. Proteus endocarditis is extremely uncommon, with a limited number of case reports available in the literature. This case illustrates how blood cultures are invaluable in the diagnosis of IE, especially that due to unusual microorganisms. Our case also highlights how single antibiotic therapy can be effective in treating Proteus endocarditis. PMID:26611486
Romney, M; Cheung, S; Montessori, V
Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered. PMID:18159347
Dahl, Anders; Schaadt, Bente K; Santoni-Rugiu, Eric;
cardiothoracic surgery and pathologic examinations showed characteristic morphology of Libman-Sacks vegetations. All microbiological examinations including blood cultures, microscopy, culture and 16s PCR of the valve were negative and the diagnosis of Libman-Sacks endocarditis was convincing. It is difficult to...... distinguish Libman-Sacks endocarditis from culture-negative infective endocarditis (IE). Molecular imaging techniques are being used increasingly in cases of suspected IE but no studies have previously reported the use in patients with Libman-Sacks endocarditis. In the present case, (18)F-FDG-PET-CT clearly...... demonstrated the increased glucose uptake caused by infiltrating white blood cells in the ongoing inflammatory process at the mitral valve. In conclusion, (18)F-FDG-PET-CT cannot be used to distinguish between IE and non-infective Libman-Sacks vegetations....
Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj;
Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....
Full Text Available Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various clinical findings. It can lead to complications affecting many systems. Endocarditis is an infrequent, but serious complication of brucellosis.The aim of this case presentation is to remind that endocarditis can be a complication of brucellosis and if is undiagnosed or misdiagnosed, progresses fatal in a high rate.
Gentry, L O; Nasser, M M; Kielhofner, M
Fungal endocarditis is rare and is usually caused by Aspergillus and Candida species. We present a patient with endocarditis caused by Scopulariopsis brevicaulis. The patient had a history of mitral valve disease and, 1 year earlier, had undergone valvuloplasty with the placement of a prosthetic Duran ring in the mitral valve position. S. brevicaulis was cultured from samples of a large vegetation on the mitral valve apparatus. The mitral valve was replaced with a St. Jude mechanical prosthes...
Serrano-Mollar, Anna; Closa, Daniel; Bulbena, Oriol
Se describe el empleo de neumocitos tipo II como agentes inhibidores de la proliferación de fibroblastos, por lo que pueden ser utilizados en la elaboración de un medicamento para el tratamientode enfermedades pulmonares que cursan con fibrosis pulmonar.
Lucía R. Kazelian
Full Text Available La endocarditis infecciosa es una enfermedad de baja incidencia que en las últimas décadas mostró modificaciones respecto de su presentación, posibilidad diagnóstica y tratamiento. A pesar de estos avances, la mortalidad hospitalaria sigue siendo muy elevada. Nuestro objetivo fue analizar las características de los pacientes con endocarditis infecciosa activa y su relación con la mortalidad hospitalaria a lo largo de 16 años. Se realizó un registro prospectivo entre 1994 y 2010 de pacientes ingresados con endocarditis. Se analizaron características clínicas, evolución y tratamiento y se registraron los eventos intrahospitalarios. Ingresaron 152 pacientes, 64.5% varones, edad 45 ± 16 años, las causas más frecuentes de cardiopatía de base fueron: congénita 32 (21% y reumática 20 (13.2%. Los motivos de internación fueron síndrome febril 116 (76.3% e insuficiencia cardíaca 61 (40.1%. Se identificó el agente infeccioso en 106 (69.7% de los casos, el más frecuente fue Streptococcus viridans. El ecocardiograma mostró vegetaciones en 123 (80.9% de los pacientes y 88 (57.8% presentaron complicaciones durante su internación, siendo la más frecuente la insuficiencia cardíaca. Se indicó tratamiento quirúrgico en 96 (63.1% de los casos, fundamentalmente por insuficiencia cardíaca en 66. La mortalidad hospitalaria global fue 46 (30.2%. El desarrollo de complicaciones en la internación, la indicación de cirugía y la presencia de insuficiencia cardíaca refractaria al tratamiento fueron predictores independientes de mortalidad hospitalaria, mientras que la presencia de vegetaciones resultó un predictor independiente de mejor supervivencia. La identificación temprana de estos predictores descriptos podría ayudar a mejorar los resultados.
Full Text Available Abstract Introduction Numerous pathogens can cause infective endocarditis, including Haemophilus parainfluenzae. H. parainfluenzae is part of the H. aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae group that may cause about 3% of the total endocarditis cases, and is characterized by a subacute course and large vegetations. Case presentation Acute H. parainfluenzae endocarditis developed in a 54-year-old woman, with no underlying predisposing factors. The patient presented with fever of 3 days duration and a severe headache. Magnetic resonance imaging of the brain revealed multiple cerebral emboli with hemorrhagic foci. Upon suspicion of endocarditis, cardiac transesophageal ultrasonography was performed and revealed massive vegetations. The patient underwent emergency mitral valve replacement, and was further treated with ceftriaxone. Blood cultures grew H. parainfluenzae only after valve replacement, and a 6-week course of ceftriaxone was prescribed. Conclusion We underline the typical presentation of large vegetations in H. parainfluenzae endocarditis, which are associated with embolic phenomena and resulting severity. Although the majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that H. parainfluenzae endocarditis may develop rapidly. Thus, awareness of the imaging characteristics of the pathogen may enhance early appropriate diagnosis and therapeutic response.
Edmundo Clarindo Oliveira
Full Text Available A hipertensão arterial pulmonar é classificada como idiopática ou secundária (associada a colagenoses, cardiopatias, hipertensão portal, tromboembolismo pulmonar e doenças da vasculatura pulmonar. O teste de vasorreatividade pulmonar é indicado para definir a melhor opção terapêutica. Muitas drogas têm sido utilizadas para a realização desse teste, sendo o óxido nítrico inalado a melhor opção, por apresentar ação específica pulmonar e meia vida muita curta (5-10 s. O resultado desse teste identifica candidatos à cirurgia cardíaca nas cardiopatias congênitas e candidatos ao uso de antagonista de cálcio nas outras formas de hipertensão pulmonar. A realização e interpretação do teste de vasorreatividade pulmonar exigem grande responsabilidade, e erros podem levar a decisões erradas e à ocorrência de óbitos.Pulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases. Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due its specific pulmonary effect and very short half-life (5-10 s. The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.
... IE mainly affects people who have: Damaged or artificial (man-made) heart valves Congenital heart defects (defects present at birth) Implanted medical devices in the heart or blood vessels People who have normal heart valves also can ...
La Scola, Bernard; Raoult, Didier
Gemella morbillorum and Gemella haemolysans are opportunistic pathogens which cause endocarditis and other severe infections. We report on three patients with endocarditis, one with endocarditis caused by G. haemolysans and two with endocarditis caused by G. morbillorum. The paucity of reports concerning these bacteria is probably related to the difficulties associated with their identification. For example, one of the strains reported in this study was originally sent to our laboratory with ...
Angelina Su-Min Yong
Full Text Available Endogenous endophthalmitis is a rare ocular infection affecting the vitreous and/or aqueous humours. It is associated with poor visual prognosis and its commonest endogenous aetiology is infective endocarditis. The causative organisms of endogenous endophthalmitis complicating endocarditis are mainly Group A or B streptococci. The identification of Group C and G streptococci such as Streptococcus dysgalactiae is comparatively uncommon and has only been reported in a few case reports or series. We therefore report a case of infective endocarditis caused by Streptococcus dysgalactiae first presenting with endogenous endophthalmitis, the most likely source being bilateral feet osteomyelitis in a patient with type I diabetes. The patient was treated with a course of intravenous benzylpenicillin, intravitreal antibiotics, bilateral below knee amputations and mitral valve replacement. She survived all surgical procedures and regained partial visual acuity in the affected eye.
Bacterial endocarditis as the consequence of an iatrogenic bacteraemia has been recognized for a long time in the Nordic countries, and national recommendations were issued by groups of experts. It is generally agreed that antibiotic prophylaxis is needed in patients with high-risk conditions and that the maintenance of healthy gums and teeth is of major importance. Investigations, however, reported poor level of compliance, and pointed out that the procedural/practical aspect of interactions between patients, dentists and physicians have largely been neglected. In order to improve the level of compliance an 'endocarditis risk' card has been produced, and there has been a remarkable degree of harmonization of chemotherapeutic regimens recommended by the national organizations. Generally, a single dose of prophylaxis is recommended, because there is little evidence that antibiotic levels in humans must be maintained more than 6-7 h for effective prevention of endocarditis, and because compliance with a multiple dose regimen is highly questionable. PMID:7671914
Revest, Matthieu; Egmann, Gérald; Cattoir, Vincent; Tattevin, Pierre
The HACEK group of bacteria - Haemophilus parainfluenzae, Aggregatibacter spp. (A. actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, and A. segnis), Cardiobacterium spp. (C. hominis, C. valvarum), Eikenella corrodens, and Kingella spp. (K. kingae, K. denitrificans) - are fastidious gram-negative bacteria, part of the normal microbiota of oral and upper respiratory tract in humans. Although their pathogenicity is limited, they are responsible for 1-3% of all infective endocarditis. HACEK endocarditis mostly affect patients with underlying heart disease or prosthetic valves, and are characterized by an insidious course, with a mean diagnosis delay of 1 month (Haemophilus spp.) to 3 months (Aggregatibacter and Cardiobacterium spp.). The advent of continuously monitored blood culture systems with enriched media has erased the need for extended incubation for the diagnosis of HACEK endocarditis. Medical treatment relies on third-generation cephalosporin, with a favorable outcome in 80-90% of cases, with or without cardiac surgery. PMID:26953488
Falase, A O; Jaiyesimi, F; Iyun, A O; Attah, E B
Ninety cases of infective endocarditis seen over a 10-year-period at University College Hospital, Ibadan, are reviewed. The peak incidence was in the third decade and rheumatic heart disease was the commonest pre-existing lesion in 59 cases with subacute endocarditis. In most cases the source of infection was not known. In 41 of the 90 cases (44%) the diagnosis was made only at autopsy. The bacterial isolation rate was low, the commonest organisms being staphylococci, streptococci, micrococci and gramnegative bacilli. The overall mortality was 70%. A plea is made for increasing awareness of the disease and prompt institution of effective treatment. PMID:941246
Loh, Poay Huan; Bundgaard, Henning; S�ndergaard, Lars
Transcatheter aortic valve replacement (TAVR) can improve the symptoms and prognosis of patients with severe aortic stenosis who, due to a high expected operative risk, would not have otherwise been treated surgically. If these patients develop prosthetic valve endocarditis, their presentations may...... be atypical causing a delay in the diagnosis and treatment. The management is also complicated by their comorbidities, and surgical treatment may not be feasible leading to a significant morbidity and mortality. We describe a case of an 85-year-old man with TAVI prosthetic valve endocarditis...
Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas;
Although Escherichia coli is among the most common causes of Gram-negative bacteraemia, infectious endocarditis (IE) due to this pathogen is rare. A 67-y-old male without a previous medical history presented with a new mitral regurgitation murmur and persisting E. coli bacteraemia in spite of broad...
Lerche, Christian Johann; Haugan, Ketil Jørgen; Reimers, Jesper Irving;
A 17-year-old male with a history of newly implanted mechanical valve at the aortic position, presented with fever, rigors, and painful cutaneous abscesses on his lower extremities and was suspected for infective endocarditis. Transthoracic echocardiography (TTE) showed a vegetation-like structure...
Full Text Available Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos, probably because people have neglected to look.We conducted a retrospective (2006-2012, and subsequent prospective study (2012-2013, at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for
Nomura, Akihiro; Nagashima, Michio; Tomoi, Yusuke; Tosaka, Atsushi; Soga, Yoshimitsu
A 73-year-old man with a history of intermittent claudication for the previous six years visited our hospital. His ankle-brachial index (ABI) was very low on both sides, and computed tomography (CT) indicated bilateral aorto-iliac occlusive disease (AIOD). As he refused to undergo open surgery, endovascular treatment (EVT) was administered. After the first and second EVT sessions, the intermittent claudication improved completely. In addition, the ABI normalized (right: 1.01, left: 0.99), and CT demonstrated full expansion of the stents. His post-EVT course was uneventful for 18 months. The use of EVT to treat AIOD is technically feasible and may serve as a potential treatment option for patients with an inoperable condition. PMID:25876573
Georvasili, Vaia K; Bali, Christina; Peroulis, Michalis; Kouvelos, George; Avgos, Stavros; Godevenos, Dimitris; Liakakos, Theodoros; Matsagkas, Miltiadis
Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary. PMID:24838140
Full Text Available
Primary aorto-enteric fistula (PAEFis a serious complication of abdominal aortic aneurysm(AAA. We report a patient with PAEF associated with inflammatory AAA who underwent emergent surgery. A 52-year-old male presented with recurrent hematemesis. A computer tomography scan showed a sealed rupture of the AAA adjacent to the duodenum. At surgery, a coin-sized PAEF was noted. The aorta was replaced with a Dacron graft in situ . Histological examination revealed the characteristics of an inflammatory AAA. The postoperative course was uneventful, and there has been no evidence of infection during a follow-up period of 3 years. We discuss the etiologic and surgical considerations regarding this unusual entity.
Fabiana Sobral Peixoto-Souza; Camila Piconi-Mendes; Letícia Baltieri; Irineu Rasera-Junior; Marcela Cangussu Barbalho-Moulim; Maria Imaculada Lima Montebelo; Dirceu Costa; Eli Maria Pazzianotto-Forti
OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC) e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obes...
Blaich, A; Fasel, D; Kaech, C; Frei, R
Erysipelothrix rhusiopathiae is the causative agent of swine erysipelas. Systemic infections caused by E. rhusiopathiae are rare, but often (90%) associated with endocarditis. In about 60% of cases endocarditis develops on normal heart valves, and despite appropriate antibiotic therapy about one-third of the patients requires valve replacement. We report the case of a housewife, who developed a mitral valve endocarditis due to E. rhusiopathiae after preparing meat for the Turkish "Festival of Sacrifice". PMID:21152883
The acute myocardial infarction is a rare complication in the course of an acute endocarditis. It takes place in the first weeks infection. Although is not associated with any particular microorganism it has been associated with virulent microorganism and is common in aortic valve endocarditis insufficiency. This report is a case of a patient who suffered a myocardial infarction during a acute endocarditis of native valve
Full Text Available Endocarditis is an inflammatory state of the endothelium that promotes thrombus formation and tissue damage on the surface of heart valves. Recent studies have reported endocarditis mortality rates ranging from 12% to 46% (2008. The Streptococcus gordonii is a normal inhabitant of the human oral cavity. It is a component of the microbial communities responsible of plaque formation, associated with dental caries and also regarded as the main causative agent in the development of subacute bacterial endocarditis (SBE.
Full Text Available Infective endocarditis is a common clinical problem in industrialized countries. Risk factors include abnormal cardiac valves, a history of endocarditis, intracardiac devices, prosthetic valves and intravenous drug use. We report a case of polymicrobial infective endocarditis in a 33 year-old female with a history chronic heroin use caused by Neisseria sicca and Haemophilus parainfluenzae. We believe the patient was exposed to these microbes by cleansing her skin with saliva prior to injection. Pairing a detailed history with the consideration of atypical agents is crucial in the proper diagnosis and management of endocarditis in patients with high-risk injection behaviors.
Hayani, Omar; Higginson, Lyall A J; Toye, Baldwin; Burwash, Ian G
Infective endocarditis caused by zoonotic microorganisms is an uncommon clinical entity. A 55-year-old man was diagnosed with endocarditis due to Capnocytophaga canimorsus, a commensal bacterium contained in the saliva of dogs, that involved the aortic and tricuspid valves and was complicated by a para-aortic valve abscess and aorta-to-right atrial fistula. The patient was successfully treated with antibiotic therapy and surgical intervention. C canimorsus endocarditis should be considered in patients with culture-negative endocarditis, particularly in immunosuppressed, asplenic or alcoholic individuals who have recently suffered a dog bite or have had close contact with dogs. PMID:19340358
Koshkelashvili, Nikoloz; Shah, Mahek; Codolosa, J Nicolas; Climaco, Antonette
Infective endocarditis is a common clinical problem in industrialized countries. Risk factors include abnormal cardiac valves, a history of endocarditis, intracardiac devices, prosthetic valves and intravenous drug use. We report a case of polymicrobial infective endocarditis in a 33 year-old female with a history chronic heroin use caused by Neisseria sicca and Haemophilus parainfluenzae. We believe the patient was exposed to these microbes by cleansing her skin with saliva prior to injection. Pairing a detailed history with the consideration of atypical agents is crucial in the proper diagnosis and management of endocarditis in patients with high-risk injection behaviors. PMID:27051571
De Clerck, K F; Van Offel, J F; Vlieghe, E; Van Marck, E; Stevens, W J
We describe the case of a 39-year-old Caucasian woman who was admitted to the University Hospital of Antwerp with a clinical picture suggestive of adult Still's disease. Even though a transoesophageal echocardiography showed endocarditis of the aortic valve, blood cultures remained negative. Additional serological testing revealed a positive result for Bartonella henselae. Histology of the supraclavicular lymph node showed a reactive lymph node with a positive polymerase chain reaction (PCR) for Bartonella henselae. Prednisolone treatment was started in a dosage of 10 mg per day and rifampicin 600 mg/d in combination with doxycyclin 200 mg/d was given for 6 months. During therapy the patient gradually improved and signs of endocarditis disappeared on echocardiography. PMID:18714850
Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas;
Although Escherichia coli is among the most common causes of Gram-negative bacteraemia, infectious endocarditis (IE) due to this pathogen is rare. A 67-y-old male without a previous medical history presented with a new mitral regurgitation murmur and persisting E. coli bacteraemia in spite of broad......-spectrum intravenous antibiotics. Transthoracic and transoesophageal echocardiography revealed a severe mitral endocarditis. E. coli DNA was identified from the mitral valve and the vegetation, and no other pathogen was found. The case was further complicated by spondylodiscitis and bilateral endophthalmitis. Extra......-intestinal pathogenic E. coli (ExPEC) are able to colonize tissue outside the gastrointestinal tract and contain a variety of virulence factors that may enable the pathogens to invade and induce infections in the cardiac endothelia. In these cases echocardiography as the imaging technology is of paramount importance...
Berastegui García, Cristina; Román Broto, Antonio
Les malalties pulmonars intersticials difuses ( MPID) representen la segona indicación de trasplantamente pulmonar (TP) després del enfisema. El treball és un estudi retrospectiu de 150 malalts sotmesos a un TP per MPID entre agost-1990 i gener de 2010. Es tracta de 86 (57%) homes amb una edad mitja de 49 (r: 20-67) anys. Es van fer 104 (69%) trasplantaments unipulmonares ( TUP) i 46 bipulmonars ( TBP). El diagnòstic més freqüent va ser en 94 ( 63%) malalts la Neumonía intersticial Usual. L'o...
E. Yu. Ponomareva; Andrei Petrovich Rebrov
Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE) and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the p...
Rangarajan, D.; Ramakrishnan, S.; Patro, K. C.; Devaraj, S.; V Krishnamurthy; Kothari, Y.; Satyaki, N.
Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure.
Holmes, A H; Greenough, T C; Balady, G J; Regnery, R L; Anderson, B E; O'Keane, J C; Fonger, J D; McCrone, E L
We describe a case of aggressive Bartonella henselae endocarditis in an immunocompetent man who owned a cat. Aortic valve replacement was required, and his infection was diagnosed by histology, serology, and polymerase chain reaction analysis. The manifestations of his disease included mediastinal lymphadenopathy, glomerulonephritis, myocarditis, and a petechial rash; the unusual finding of a positive titer of c-antineutrophil cytoplasmic antibodies was noted. Serological titers were markedly elevated for > 1 year despite clinical improvement. PMID:8645787
Mitrev, Zan; Veljanovska, Lidija; HRISTOV, Nikola
A 68-year-old man, who is a smoker with hypertension and hyperlipidemia, presented in our hospital with rest pain in both calves. His symptoms started 1 year prior with short distance walking pain in both legs. Preoperative work up discovered Leriche's syndrome with occlusion of both superficial femoral arteries, as shown on the 64-slice computerized tomographic scan (Fig 1). Operative treatment included aorto-bilateral femoral bypass, using 16/8 mm Dacron (Edwards Lifesciences, Irvine, CA) Y...
Hudson, Christopher C C; Stewart, Jeremie; Dennie, Carole; Malas, Tarek; Boodhwani, Munir
We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner's syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events. PMID:25281630
Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent
Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163
Khan, Shahzad; Smyrlis, Athanasios; Yaranov, Dmitry; Oelberg, David; Jimenez, Eric
Infective endocarditis (IE) is an infection of the endocardium that involves valves and adjacent mural endocardium or a septal defect. Local complications include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. Diagnosing IE can be straightforward in patients with the typical oslerian manifestations such as bacteremia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to a S. aureus infection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valve MSSA (methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications. PMID:26146571
Streptococcus uberis was cultured from vegetative endocarditis lesions in a scimitar-horned oryx (Oryx dammah) from the Parc de la Haute Touche, France. This is the first reported single isolation of S. uberis from an oryx with vegetative endocarditis leading to fatal congestive heart failure. PMID:10749451
Full Text Available Of all the causes of bacterial endocarditis, HACEK group consisting of Haemophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella Kingae are rare causative agents. We report a case of bacterial endocarditis by E. corrodens, which is one of the members of the HACEK group.
Peuchant, O; Wirth, G; Tixier, R; Dijos, M; Camou, F; Greib, C; Mégraud, F; Ménard, A
Streptococcus species are important causes of infective endocarditis but species identification remains challenging. We report two cases of infective endocarditis due to Streptococcus tigurinus-like organisms, which were first identified by 16S ribosomal RNA gene sequence analysis and subsequently confirmed using phylogeny based on the analysis of the shetA gene encoding exfoliative toxin. PMID:27408744
SIDNEY BOMBARDA; CLÁUDIA MARIA FIGUEIREDO; MARCELO BUARQUE DE GUSMÃO FUNARI; JOSÉ SOARES JÚNIOR; MÁRCIA SEISCENTO; MÁRIO TERRA FILHO
A tuberculose é uma doença de alta incidência e prevalência no Brasil. Sinais sugestivos de atividade ou seqüela da tuberculose podem ser obtidos através dos métodos de imagem. Na radiografia de tórax, a tuberculose pulmonar ativa pode manifestar-se sob a forma de consolidações, cavitações, padrões intersticiais (reticulares/retículo-nodulares), linfonodomegalias hilares ou mediastinais e derrame pleural. Imagens compatíveis com doença ativa, como nódulos centrolobulares de distribuição segme...
Kelser de Souza Kock; Hektor França Barros
O tabagismo é um hábito frequente entre os brasileiros, causador de doenças que podem ser evitáveis, e um dos maiores causadores de morte por câncer de pulmão, doença coronariana, DPOC e AVC. O objetivo deste estudo foi avaliar a funcionalidade pulmonar, dispneia, índices socioeconômicos e perfil dos pacientes relacionado com o tabagismo, em pacientes que participam do programa de controle ao tabagismo do SUS em Tubarão – SC no ano de 2013. Foram avaliados 39 pacientes, sendo 76,9% mulheres, ...
Çetin, Süha; Heper, Gülümser; Gökhan Vural, Mustafa; Hazirolan, Tuncay
We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices. PMID:26980214
Sousa, AM; Lourenço, C.; Barros, I.; Martinho, T; Brás, A; Santos, T.; Barros Veloso, AJ
O Síndrome de Turner foi descrito pela primeira vez em 1938 por Henry Turner e tem uma incidência de 1:3000 mulheres nascidas. Os autores apresentam um caso raro de uma mulher de 48 anos com Síndrome de Turner, cujo cariótipo era (46, X, i (Xq)), tardiamente diagnosticado, associado a enfisema pulmonar e hipertensão pulmonar. O caso e os métodos de estudo são apresentados. Alguns aspectos deste caso, nomeadamente a hipótese do enfisema pulmonar se relacionar com Síndrome de Turner, são dis...
MARÍA TERESA PARADA C; VÍCTOR ALISTE C; RODRIGO GIL D; PATRICIO RODRÍGUEZ D; MAURICIO FICA D; CRISTINA HERZOG O; LORENA CALABRÁN R; ALVARO UNDURRAGA P
La silicosis es una enfermedad prevalente en Chile, que es un país minero y en desarrollo. Existe escasa bibliografía sobre trasplante pulmonar, como alternativa de tratamiento en silicosis avanzada. Objetivo: Describir el tiempo y forma de exposición a la sílice y las características clínicas de enfermos silicóticos tratados con trasplante pulmonar en la Clínica Las Condes de Santiago. Pacientes y Métodos: De un total de 38 pacientes en los que se practicó trasplante pulmonar entre 1999 y 20...
Pablo M. A Pomerantzeff
Full Text Available O comprometimento valvar direto do coração pela endocardite infecciosa, com indicação cirúrgica, tem sido classicamente tratada por excisão da valva e tecidos adjacentes comprometidos, associada ou não a implante de prótese. Dois casos de operação conservadora em endocardite infecciosa da valva tricúspide com 42 e 3 meses de evolução são descritos. Os autores discutem as vantagens de, quando possível, não retirar toda a valva tricúspide na endocardite bacteriana.Valve replacement and excision without using a prosthesis are the two mostfrequently used surgical techniques for the treatment of infective endocarditis of the tricuspid valve. Conservative operation with preservation of the native valve and resection of the infected tissue is a more recent approach, which is becoming the procedure of choice whenever feasible, specialy in intravenous drug abusers. Two cases of tricuspid valve reconstruction with good results are reported. One of the patients has also been aorto coronary bypassed at the same operation time.
Full Text Available Bartonella species have been shown to cause acute, undifferentiated fever in Thailand. A study to identify causes of endocarditis that were blood culture-negative using routine methods led to the first reported case in Thailand of Bartonella endocarditis A 57 year-old male with underlying rheumatic heart disease presented with severe congestive heart failure and suspected infective endocarditis. The patient underwent aortic and mitral valve replacement. Routine hospital blood cultures were negative but B. henselae was identified by serology, PCR, immunohistochemistry and specific culture techniques.
Graziano Antonio Minafra
Full Text Available Despite significant improvements in surgical and medical therapy, prosthetic valve endocarditis (PVE is a diagnostic and therapeutic challenge and is often associated with a severe prognosis. We report a case of a 59-year-old woman, with PVE and bacterial endocarditis (Streptococcus bovis successfully treated with linezolid. Linezolid is a bacteriostatic oxazolidinone antibiotic that has been proven to be effective for the treatment of patients with pneumonia, skin and soft tissue infections, and infections due to Gram-positive cocci. Linezolid is not yet recognised as a standard therapy for infective endocarditis, but its use becomes a necessity when infection is due to multidrug-resistant microorganisms.
Kawabata, Vitor Sérgio; Bittencourt, Márcio Sommer; Lovisolo, Silvana Maria; Felipe-Silva, Aloísio; de Lemos, Ana Paula Silva
The incidence of severe complications of the Neisseria gonorrhoeae infection has presented variations over recent decades since the advent of penicillin. Gonococcal endocarditis (GE) still remains an ever-present threat afflicting the society’s poor and sexually active young population. This entity frequently requires surgical intervention and usually exhibits a poor outcome. The interval between the onset of symptoms and the diagnosis does not usually exceed 4 weeks. One of the characteristics of GE is a proclivity for aortic valve involvement with large vegetation and valve ring abscess formation. The authors report the case of a young man with a 2-week history of fever, malaise, weakness, and progressive heart failure symptoms, who had no previous history of genital complaints or cardiopathy. The physical examination was consistent with acute aortic insufficiency, which was most probably of an infectious origin. The echocardiogram showed thickened aortic cusps and valve insufficiency. After hospital admission, the patient’s clinical status worsened rapidly and he died on the second day. The autopsy findings disclosed aortic valve destruction with vegetation and a ring abscess besides signs of septic shock, such as diffuse alveolar damage, acute tubular necrosis, and zone 3 hepatocellular necrosis. The blood culture isolated N. gonorrhoeae resistant to penicillin and ciprofloxacin. The authors call attention to the pathogen of this particular infectious endocarditis, and the need for early diagnosis and evaluation by a cardiac surgery team. PMID:27547739
de Campos, Fernando Peixoto Ferraz; Kawabata, Vitor Sérgio; Bittencourt, Márcio Sommer; Lovisolo, Silvana Maria; Felipe-Silva, Aloísio; de Lemos, Ana Paula Silva
The incidence of severe complications of the Neisseria gonorrhoeae infection has presented variations over recent decades since the advent of penicillin. Gonococcal endocarditis (GE) still remains an ever-present threat afflicting the society's poor and sexually active young population. This entity frequently requires surgical intervention and usually exhibits a poor outcome. The interval between the onset of symptoms and the diagnosis does not usually exceed 4 weeks. One of the characteristics of GE is a proclivity for aortic valve involvement with large vegetation and valve ring abscess formation. The authors report the case of a young man with a 2-week history of fever, malaise, weakness, and progressive heart failure symptoms, who had no previous history of genital complaints or cardiopathy. The physical examination was consistent with acute aortic insufficiency, which was most probably of an infectious origin. The echocardiogram showed thickened aortic cusps and valve insufficiency. After hospital admission, the patient's clinical status worsened rapidly and he died on the second day. The autopsy findings disclosed aortic valve destruction with vegetation and a ring abscess besides signs of septic shock, such as diffuse alveolar damage, acute tubular necrosis, and zone 3 hepatocellular necrosis. The blood culture isolated N. gonorrhoeae resistant to penicillin and ciprofloxacin. The authors call attention to the pathogen of this particular infectious endocarditis, and the need for early diagnosis and evaluation by a cardiac surgery team. PMID:27547739
Seminari, E; De Silvestri, A; Ravasio, V; Ludovisi, S; Utili, R; Petrosillo, N; Castelli, F; Bassetti, M; Barbaro, F; Grossi, P; Barzaghi, N; Rizzi, M; Minoli, L
Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17.4 %) occurred in CHD+ patients. The cause of CHD mainly consisted of chronic viral infection. Staphylococcus aureus was the most common bacterial species in CHD+ patients; the frequency of other bacterial species (S. epidermidis, streptococci, and enterococci) were comparable among the two groups. The percentage of patients undergoing surgery for IE was 38.9 in CHD+ patients versus 43.7 in CHD- patients (p = 0.06). Complications were more common among CHD+ patients (77 % versus 65.3 %, p infection sustained by S. aureus, a prosthetic valve, diabetes and a neoplasia, and CHD. Being an intravenous drug user (IVDU) was a protective factor and was associated with a reduced death risk. CHD is a factor worsening the prognosis in patients with IE, in particular in patients for whom cardiac surgery was required. PMID:26690071
Bablyak, O D
The results of surgical treatment of 83 patients, suffering conotruncal cardiac failures and large aorto-pulmonary collateral arteries, were analyzed. In 2007 - 2014 yrs a radical correction of the failure (RCF) was performed in 53 (64%) of them. RCF was achieved, using three surgical approaches. The algorithm of a surgical approach choice was introduced, guaranteeing the operation time shortening and artificial blood circulation application, have improved the course of early postoperative period. It was proved, that improvement of surgical results is possible, if a correct surgical tactic choosed and surgical approaches rationally applied. PMID:26817084
Fabiana Sobral Peixoto-Souza
Full Text Available OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos às eutróficas (38,8 ± 11,4 anos. Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente. Houve uma correlação negativa entre a capacidade vital forçada (CVF, volume expiratório forçado no primeiro segundo (VEF1, razão (VEF1/CVF e volume de reserva expiratório (VRE com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente. CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.
Full Text Available Abstract Introduction Lactococcus garvieae is a well-recognized fish pathogen, and it is considered a rare pathogen with low virulence in human infection. We describe the 11th case of L. garvieae infective endocarditis reported in the literature, and the first reported case in Japan. Case presentation We report a case of a 55-year-old Japanese woman who had native valve endocarditis with L. garvieae. The case was complicated by renal infarction, cerebral infarction, and mycotic aneurysms. After anti-microbial treatment, she was discharged from the hospital and is now well while being monitored in the out-patient clinic. Conclusion We encountered a case of L. garvieae endocarditis that occurred in a native valve of a healthy woman. The 16S ribosomal RNA gene sequencing was useful for the identification of this pathogen. Although infective endocarditis with L. garvieae is uncommon, it is possible to treat high virulence clinically.
Thauvin, C; Eliopoulos, G M; Willey, S; Wennersten, C; Moellering, R C
Intermittent administration of ampicillin alone has resulted in high failure rates in previously described animal models of enterococcal endocarditis. We developed a rat model of enterococcal endocarditis which permits comparison of continuous intravenous infusion of ampicillin with intramuscular therapy. Continuous low-dose ampicillin infusion (450 mg/kg [body weight] per day) was compared with the same dose given intramuscularly in three divided doses and with high-dose infusion (4.5 g/kg p...
Tsur, A; Slutzki, T; Flusser, D
Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve. PMID:25295408
Overend, Louise; Rose, Edward
Embolic myocardial infarction is an uncommon but increasingly recognised complication of infective endocarditis. This complication has a high mortality rate and is deemed a relative contraindication to thrombolytic therapy. The present article describes an episode of acute myocardial infarction associated with infective endocarditis. Systemic thrombolytic therapy was administered, which resulted in resolution of cardiac ischemia but was complicated by a fatal intracerebral bleed. There are a ...
Full Text Available A tuberculose é uma doença de alta incidência e prevalência no Brasil. Sinais sugestivos de atividade ou seqüela da tuberculose podem ser obtidos através dos métodos de imagem. Na radiografia de tórax, a tuberculose pulmonar ativa pode manifestar-se sob a forma de consolidações, cavitações, padrões intersticiais (reticulares/retículo-nodulares, linfonodomegalias hilares ou mediastinais e derrame pleural. Imagens compatíveis com doença ativa, como nódulos centrolobulares de distribuição segmentar, cavidades de paredes espessas, espessamento de parede brônquica ou bronquiolar, bronquiectasias e linfonodomegalias, podem ser observadas pela tomografia computadorizada do tórax; cavidades de paredes finas, bronquiectasias de tração e estrias são imagens sugestivas de seqüela da doença, assim como o enfisema e o aspecto em mosaico do parênquima pulmonar. A cintilografia com o citrato de gálio-67 é um método complementar útil na detecção de processos infecciosos, incluindo a tuberculose, especialmente em pacientes imunossuprimidos. Estudos de inalação e perfusão pulmonar são utilizados na avaliação pré-operatória de pacientes com seqüelas de tuberculose ou tuberculose multirresistente. A tomografia por emissão de pósitrons utilizando a deoxiglicose marcada com o flúor-18 permite a detecção do processo inflamatório que ocorre na fase ativa da tuberculose e que pode persistir, em menor intensidade, após o término do tratamento. Métodos de imagem constituem importantes recursos para o diagnóstico e acompanhamento da tuberculose pulmonar.Tuberculosis is a disease of high incidence and prevalence in Brazil. Imaging methods can reveal signs suggestive of tuberculosis activity or sequelae. Chest radiographs can reveal active lung tuberculosis through consolidations, cavitations, interstitial patterns (nodular and reticulo-nodular, mediastinal or hilar lymphadenopathy and pleural effusions. Images compatible
Zarate Galeano, Hernán; Martín, Francisco
Se revisa la literatura de la F.L.H.M.P. se concretan algunos aspectos de su patogenia y tratamiento y se reporta un caso correspondiente a una mujer de 55 años, que consulta al Hospital Santa Clara de Bogotá, por presentar sintomatología respiratoria de 10 años de evolución. A los Rx. se le hallaron múltiples nodulaciones en ambos campos pulmonares. Se le trató durante 5 años con tuberculostáticos, sin mejoría clínica ni radiológica, por lo que se le tomó una biopsia, en donde se hizo el dia...
Juan Ignacio Padilla; Donato Salas-Segura; Suen Kwoh-Sánchez
El edema pulmonar postobstructivo (EPPO) es una complicación postoperatoria cuyo manejo adecuado depende de un diagnóstico etiológico correcto. El EPPO se clasifica en dos tipos. El tipo I es secundario a la obstrucción aguda de la vía aérea superior. Por su parte, el tipo II ocurre luego de corregir quirúrgicamente una obstrucción crónica de la vía aérea. Fisiopatológicamente, el mecanismo que explica el cuadro es una disminución marcada de la presión intersticial en el nivel pericapilar pul...
Rocha, Ana Carolina dos Santos Silva
Introdução: A embolia pulmonar é uma condição clínica potencialmente letal em todos os grupos etários, pelo que é considerada uma emergência cardiovascular. O diagnóstico é difícil de estabelecer, pela pouca especificidade do quadro clínico, condicionando, diferentes prognósticos e riscos de mortalidade. O tratamento depende da apresentação clínica e a terapêutica trombolítica tem um papel decisivo na melhoria do outcome dos doentes, em situações seleccionadas. Objectivos: A actual revisão...
Full Text Available A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.
Loren Garrison Morgan
Full Text Available Actinomycotic endocarditis is a rare disease with only 18 documented cases to date. Most of these cases are sub-acute or chronic infections and usually lack the stigmata of classic endocarditis. This article reviews the details of previously published reports of endocarditis due to various species of actinomyces, along with consensus opinion on diagnosis and treatment. We also present our unique case of Actinomyces naeslundii infective endocarditis, the first case ever attributed to this organism in medical literature.
Loren Garrison Morgan; Ashley L. Davis; Paul Poommipanit; Yasir Ahmed
Actinomycotic endocarditis is a rare disease with only 18 documented cases to date. Most of these cases are sub-acute or chronic infections and usually lack the stigmata of classic endocarditis. This article reviews the details of previously published reports of endocarditis due to various species of actinomyces, along with consensus opinion on diagnosis and treatment. We also present our unique case of Actinomyces naeslundii infective endocarditis, the first case ever attributed to this orga...
Compain, F; Bruneval, P; Jarraud, S; Perrot, S; Aubert, S; Napoly, V; Ramahefasolo, A; Mainardi, J-L; Podglajen, I
Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025
Collarino, R; Vergeylen, U; Emeraud, C; Latournèrie, G; Grall, N; Mammeri, H; Messika-Zeitoun, D; Vallois, D; Yazdanpanah, Y; Lescure, F-X; Bleibtreu, A
Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis. PMID:27408740
Briggs, Benjamin J; Raoult, Didier; Hijazi, Ziyad M; Edouard, Sophie; Angelakis, Emmanouil; Logan, Latania K
Coxiella burnetii endocarditis is a rare diagnosis in children. We present a case of Q fever endocarditis due to a new genotype, MST 54, and review recent literature on Q fever infections in children. Practitioners should consider Q fever in culture-negative endocarditis, particularly in children with congenital heart disease and history of travel or residence in endemic regions. PMID:26535879
Full Text Available Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist.
Compain, F.; Bruneval, P.; Jarraud, S.; Perrot, S.; Aubert, S.; Napoly, V.; Ramahefasolo, A.; Mainardi, J.-L.; Podglajen, I.
Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025
Using MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis: a case report of a patient with mitral valve infective endocarditis caused by Abiotrophia defectiva
Holler, Jon Gitz; Pedersen, Line; Calum, Henrik;
A case of infective endocarditis caused by Abiotrophia defectiva is presented. The use of MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis is discussed.......A case of infective endocarditis caused by Abiotrophia defectiva is presented. The use of MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis is discussed....
Juan A. Mazzei
Full Text Available El trmino hipertensin pulmonar agrupa a un conjunto heterogneo de enfermedades que tienen en comn una remodelacin obstructiva del lecho vascular pulmonar. Esta alteracin provoca un estado hemodinmico caracterizado por una elevacin sostenida de la presin del circuito arterial pulmonar. La morbilidad y mortalidad de esta enfermedad son la consecuencia del fracaso de la compensacin del ventrculo derecho a este aumento de la poscarga. La presuncin clnica y el diagnstico precoz, una estratificacin adecuada basada en las causas subyacentes y los diferentes territorios vasculares comprometidos, la respuesta a los frmacos y el grado de gravedad, la seleccin de las diferentes alternativas teraputicas y su indicacin oportuna son los objetivos para el tratamiento contemporneo ptimo de los enfermos con hipertensin pulmonar y ser una importante tarea en el futuro. Estas recomendaciones estn destinadas al mdico general y tienen por objeto facilitar la deteccin precoz, el diagnstico y el tratamiento de los pacientes con hipertensin pulmonar, y pueden representar una diferencia significativa en el pronstico. Adems, como la evaluacin diagnstica requiere exmenes complementarios que habitualmente no estn disponibles en todas las instituciones asistenciales, tambin pueden ser utilizadas como fundamento para solicitar la derivacin oportuna a centros asistenciales de referencia.
Andrezza Araújo de Oliveira Duarte
Full Text Available A ossificação pulmonar difusa é uma condição rara, de etiologia desconhecida, na qual osso maduro é encontrado no parênquima pulmonar. É quase sempre descoberta como um achado incidental de autópsias. Freqüentemente afeta homens de meia-idade e é assintomática. Relata-se o caso de um paciente de 75 anos, que apresentou uma radiografia torácica com comprometimento pulmonar difuso e cujo diagnóstico foi baseado no exame histopatológico de fragmento pulmonar obtido através da biópsia a céu aberto, o qual demonstrou fibrose intersticial acentuada com ossificação do parênquima pulmonar.Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.
Full Text Available We discuss a unique case of a 52-year-old man with no history of intravenous drug use or dental procedures who presented with neck pain, 2 weeks of fevers, chills, night sweats, cough, and dyspnea found to have isolated pulmonic valve (PV endocarditis. The patient did not have an associated murmur, which is commonly seen in right-sided infectious endocarditis. A transthoracic echocardiogram showed a thickened PV leaflet, with subsequent transesophageal echocardiogram showing a PV mass. Speciation of blood cultures revealed Streptococcus oralis. In right-sided infective endocarditis, usually the tricuspid valve is involved; however, in our case the tricuspid valve was free of any mass or vegetation. The patient did meet Duke criteria and was thus started on long-term intravenous antibiotics for infectious endocarditis. The patient's symptoms quickly improved with antibiotics. A careful history and evaluating the patient's risk factors are key in earlier detection of infective endocarditis (IE. Because of early detection and a high index of suspicion, the patient had no further complications and did not require any surgery. In conclusion, clinical suspicion of right-sided IE should be high in patients who present with persistent fevers and pulmonary symptoms in order to reduce the risk of complications, and to improve outcomes.
Diagnosing infective endocarditis and its complications can be difficult because of the nonspecific symptoms. We reviewed findings of intracranial abnormalities on magnetic resonance imaging (MRI) in 14 patients with neurological complications and herein discuss the overall intracranial MRI findings. We retrospectively reviewed patients with infective endocarditis from August 2004 to August 2006. Brain MRI, the causative bacteria, and abnormal neurological symptoms were reviewed for 14 patients with neurological complications. Of the 14 patients, 13 showed intracranial abnormalities on MRI. Embolization was seen in 10 patients, hemorrhage in 3, abscess formation in 3, and encephalitis in 2. Hyperintense lesions with a central hypointense area on T2-weighted and/or T2*-weighted imaging (Bull's-eye-like lesion) were seen in four patients. A combination of these intracranial abnormalities was observed in 6 patients. The MRI findings associated with infective endocarditis are wide-ranging: embolization, hemorrhage, meningitis, cerebritis, abscess, the bull's-eye-like lesion. Clinicians should consider the possibility of infective endocarditis in patients with unknown fever and neurological abnormality. Brain MRI should be promptly performed for those patients, and T2*-weighted imaging is recommended for an early diagnosis of infective endocarditis. (author)
Alvarez-Gordillo Guadalupe del Carmen
Full Text Available Objetivo. Evaluar la posibilidad de aplicar el tratamiento acortado estrictamente supervisado (TAES en el Programa de Control de la Tuberculosis en Chiapas, México. Material y métodos. Se evaluó la eficacia y la eficiencia del tratamiento en una cohorte de pacientes con tuberculosis pulmonar confirmada por baciloscopía, que ingresaron a tratamiento con esquemas de autoadministración semisupervisión y estricta supervisión, de enero a junio de 1996. Resultados. La eficacia fue de 90.9. 97.7 y 100% para los esquemas de tratamiento autoadministrado, semisupervisado y TAES, respectivamente, mientras que la eficiencia fue de 68.1. 77.6 y 88.5% en el mismo orden. Conclusiones. Para la salud pública el TAES demostró ser la actividad más importante en el control de la tuberculosis, al elevar las tasas de curación y disminuir, por lo tanto, las fuentes de transmisión de la enfermedad.
Reinaldo Pino Blanco
Full Text Available La enfermedad pulmonar obstructiva crónica se ha convertido en una de las enfermedades crónicas atendidas con mayor frecuencia en la atención primaria de salud. Produce altas tasas de morbilidad y mortalidad en todo el mundo, con una evolución lenta aunque progresivamente mortal, a pesar de tratarse de una enfermedad prevenible, que depende en gran medida, del hábito de fumar. La prevalencia variará según el consumo de tabaco, y se espera que siga aumentando en los próximos 25 años. La mortalidad y morbilidad son cada vez mayores, lo que supone un enorme gasto sanitario, social y personal, pero es una enfermedad potencialmente modificable, motivo por el que requiere de un abordaje multifactorial.Chronic Obstructive Pulmonary Disease has become one of the most frequently treated chronic diseases in primary health care. High rates of morbidity and mortality are worldwide related to this disease. Although it is a preventable disease closely related to smoking, its evolution is slow but progressively fatal. Prevalence varies according to tobacco consumption and is expected to increase in the next 25 years. Even when it is a potentially modifiable disease, mortality and morbidity are also increasing, causing a major health, social and personal spending. For all these reasons, a multifactorial approach is needed both, for health and social issues.
Full Text Available We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.
Kjerulf, A; Espersen, F; Gutschik, E;
A modified rat model of endocarditis with catheterization for 2 days was established in female Lewis rats using different inocula of Enterococcus faecalis (strain no. EF 19) in order to measure IgG antibodies in serum during the course of infection. Increasing the inocula intravenously resulted in...... an increase in the CFU/g vegetation and the CFU/g spleen, the ID50 being about 10 CFU/ml and the ID90 about 1x10(2) CFU/ml. The lowest bacterial inoculum infecting 100% of the rats was 3x10(3) CFU/ml, and for further investigations we used this inoculum size. Rats were sacrificed on day 2, 5, 7, 9......, 11 and 28 after infection. The CFU/g vegetation and the CFU/g spleen increased until day 7 and then decreased. Serum samples were collected from 129 rats at different times after challenge. Three different ELISA systems were established to measure the IgG antibody responses: E. faecalis sonicate...
Boils, Christie L; Nasr, Samih H; Walker, Patrick D; Couser, William G; Larsen, Christopher P
Glomerulonephritis (GN) due to infective endocarditis (IE) is well documented, but most available data are based on old autopsy series. To update information, we now present the largest biopsy-based clinicopathologic series on IE-associated GN. The study group included 49 patients (male-to-female ratio of 3.5:1) with a mean age of 48 years. The most common presenting feature was acute kidney injury. Over half of the patients had no known prior cardiac abnormality. However, the most common comorbidities were cardiac valve disease (30%), intravenous drug use (29%), hepatitis C (20%), and diabetes (18%). The cardiac valve infected was tricuspid in 43%, mitral in 33%, and aortic in 29% of patients. The two most common infective bacteria were Staphylococcus (53%) and Streptococcus (23%). Hypocomplementemia was found in 56% of patients tested and ANCA antibody in 28%. The most common biopsy finding was necrotizing and crescentic GN (53%), followed by endocapillary proliferative GN (37%). C3 deposition was prominent in all cases, whereas IgG deposition was seen in <30% of cases. Most patients had immune deposits detectable by electron microscopy. Thus, IE-associated GN most commonly presents with AKI and complicates staphylococcal tricuspid valve infection. Contrary to infection-associated glomerulonephritis in general, the most common pattern of glomerular injury in IE-associated glomerulonephritis was necrotizing and crescentic glomerulonephritis. PMID:25607109
Sousa, C; Botelho, C; Rodrigues, D; Azeredo, J; Oliveira, R
Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts. PMID:22714640
O'Connor, Cormac T; Kiernan, Thomas J
Infective endocarditis involving prosthetic valves accounts for 20% of all endocarditis cases. Rising in prevalence due to increasing placement of valvular prostheses, prosthetic valve endocarditis (PVE) is more difficult to diagnose by conventional methods, associated with more invasive infection and increased mortality. This report explores the existing literature in identifying a direct approach to the management of PVE; such as adjuncts to establishing a diagnosis (for instance positron emission tomography/computed tomography and radiolabeled leukocyte scintigraphy), the trends in specific pathogens associated with PVE and the recommended antimicrobials for each. The patterns of disease requiring surgical intervention are also highlighted and explored. In addition, a 5-year outlook offers consolidated knowledge on epidemiological trends of both culprit organisms and population subgroups suffering (and projected to suffer) from PVE. PMID:25865118
Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.
Karstrup, C.C.; Jensen, H.E.; Aalbæk, B.;
Left-sided valvular endocarditis (LSVE) is a common finding in slaughter pigs. The lesion is often associated with renal thromboembolism, but information on embolization to other organs is sparse. This study focuses on the presence and type of endocarditis-associated brain lesions (EABLs). The...... brains of 20 slaughter pigs with spontaneously arising LSVE and 11 controls were examined by sectioning half of a formalin-fixed brain into 4mm slices for histological examination. The aetiology of the endocarditis was determined by bacteriological and, in some cases, by fluorescence in......-situ hybridization examinations. These examinations identified 11 cases of Streptococcus suis, six cases of Erysipelothrix rhusiopathiae, one Streptococcus spp. and two cases that remained aetiologically undetermined. One of the S. suis cases had a dual infection with S. suis in the aortic valve lesions and...
Full Text Available Abstract Introduction Stenotrophomonas maltophilia is an environmental bacterium increasingly involved in nosocomial infections and resistant to most antibiotics. It is important to recognize and efficiently treat infections with this bacterium as soon as possible. Case presentation We present a case of Stenotrophomonas maltophilia prosthetic valve endocarditis secondary to an indwelling catheter infection. The patient was cured without surgery. We review other cases of S. maltophilia endocarditis from the literature and describe the peculiarities of this case. Conclusion S. maltophilia endocarditis is a rare disease that is often hospital-acquired and related to an indwelling catheter infection. The high lethality is likely related to the intrinsic resistance of nosocomial bloodstream infections to commonly prescribed antibiotics.
B. de Escalante Yangüela; J. Rubio Gracia; G. Muñoz González; B. Gracia Tello; M. Rodero Roldán; V. Alastrué del Castaño
Los embolismos tumorales pulmonares (ETP) representan una causa poco frecuente de disnea en pacientes oncológicos. La mayoría se diagnostican en pacientes con tumores avanzados, sobre todo localizados en mama, pulmón o estómago. Existen pocos casos publicados en pacientes con tumores uroteliales. Presentamos el caso de un varón de 69 años, sin diagnóstico previo de cáncer, que ingresó por disnea subaguda, con sospecha clínica inicial de tromboembolismo pulmonar (TEP). El paciente falleció al ...
Voldstedlund, Marianne; Fuursted, Kurt; Bruun, Niels Eske;
The degree to which the results of valve culture depend on different laboratory procedures as well as other factors is unknown. The aim of this study was to compare the results of heart valve culture at 2 different endocarditis centres in order to clarify this.......The degree to which the results of valve culture depend on different laboratory procedures as well as other factors is unknown. The aim of this study was to compare the results of heart valve culture at 2 different endocarditis centres in order to clarify this....
Di Gioacchino, Lorena; Balestrini, Fabrizio
Enterococci are common organisms associated with endocarditis, but infection by Enterococcus durans is very rare. To our knowledge, only 3 cases have been reported in the medical literature, and all 3 have involved native valves. Here we publish the first reported case (to our knowledge) of E. durans endocarditis in association with a bioprosthetic aortic valve. After the organism and its antibiotic susceptibility were identified, the 74-year-old male patient was treated successfully with teicoplanin and gentamicin, over a course of 6 weeks. PMID:27127436
Margarita González Tapia
Full Text Available Sr. Editor: La tuberculosis es una de las enfermedades remergentes en Cuba; por ello en todas las provincias cubanas se trabaja con mucha fuerza, dedicación y profesionalidad con respecto a esta problemática. En este contexto, resulta muy acertada la publicación del artículo “Algunas variables clínico-epidemiológicas de la tuberculosis pulmonar. Puerto Padre, 2008-2012”, que salió en el Vol.38 No.6.01 del mes de junio de 2013 de la Revista Electrónica Dr. Zoilo E. Marinello Vidaurreta; tanto por el significado social que reviste la divulgación de este tema, como por el propio resultado de la investigación realizada. La historia de la tuberculosis es un tema apasionante. En pocas enfermedades es posible documentar su estrecha relación con la historia de la propia humanidad como en la que nos ocupa. Existen evidencias paleológicas de tuberculosis vertebral en momias egipcias que datan aproximadamente del año 2400 a.C. La tuberculosis se ha conocido a través de la historia, con los nombres de: tisis, consunción, escrófula, mal de Pott, plaga blanca y mal del rey.1 En el artículo se plantea como conclusión que la tendencia de la tuberculosis en el quinquenio de estudio es estacionaria, pero en los últimos cuatro años tiende al ascenso. En los casos diagnosticados de tuberculosis en este quinquenio más de dos tercios correspondieron al sexo masculino y mayores de 45 años, las ocupaciones que más prevalecieron fueron recluso, desocupado, ama de casa y jubilado. Los factores de riesgo que más se relacionaron fueron el albergamiento prolongado en instituciones cerradas, el alcoholismo, y la edad mayor de 65 años; la forma clínica de mayor incidencia en casi la totalidad de los pacientes fue la pulmonar y, dentro de ella, los casos con baciloscopia positiva. Hubo fallas en el diagnóstico, ya que alrededor de la mitad de los casos se diagnosticaron en la atención secundaria y con un tiempo de demora de más de dos meses de
Full Text Available Introduction: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries. The combination of aorto-right ventricular fistula with aortic valve injury is rare.Case Presentation: A 19 year-old man referred with an aorto-right ventricular fistula accompanied with aortic regurgitation and delayed tamponade following a stab in the chest. The patient was scheduled for fistula repair, aortic valve replacement and pericardectomy two months after trauma.Conclusions: To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed. In addition, cardiac injuries should be repaired during the same hospital stay.
Martínez Carnovale, Lucía Inés
La malaltia renal crònica terminal, el tractament substitutiu d'elecció és el trasplantament renal, és un problema de salut pública mundial en augment. L'envelliment de la població i la major prevalença de diabetis i hipertensió arterial en aquests pacients, s'associa a una major incidència de malaltia aorto-ilíaca i possible fracàs del ronyó trasplantat. En aquest treball es va analitzar l'evolució del filtrat glomerular en pacients trasplantats renals amb patologia aorto-ilíaca que van requ...
E Yu Ponomareva
Full Text Available Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the presence of rheumatic heart disease. Results. Locomotor apparatus lesion was noted in 44.8% of the patients with IE, cutaneous hemorrhagic vasculitis in 18%, pericarditis in 10%, pleurisy in 19%, glomerulonephritis in 60%, leukopenia in 9%, thrombocytopenia in 32%, elevated C-reactive protein levels in 92%, circulating immune complexes in 72%. Glomerulonephritis and hemorrhagic vasculitis more frequently develop in injection drug users (p < 0.0001. Rheumatic heart disease was pre-ceded by IE in 24 patients (13% among the all patients and 27% among those with secondary IE. In the patients with secondary IE evolving in the presence of prior rheumatic heart disease, pulmonary artery systolic pressure (PASP and cardiac arrhythmia rates were significantly higher than those in primary IE (62.5 and 53 mm Hg; p < 0.05; 62 and 32%; p < 0.025. Conclusion. The «rheumatic» manifestations were common in patients with IE and require their differential diagnosis with rheumatic diseases. Their degree correlates with systemic in-flammatory disease activity. In the patients with IE and prior rheumatic heart involvement, PASP and the frequency of arrhythmias are higher than in those with primary IE.
Christopher C .C. Hudson
Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.
Purpose: The purpose of this study was to investigate correlations between the aorto-popliteal bolus transit speed and aortic and popliteal bolus transit time in order to evaluate the possibility for prediction of bolus transit speed by single test injection technique. Materials and methods: Approval was obtained from our institutional review board for this study, which included 42 patients, from all of whom written informed consent was obtained. Low-dose serial CT scanning after injection of 12 ml contrast material (300 mg/ml) at a rate of 3 ml/s followed by saline flush was performed twice, first at the level of the upper abdomen and second at the level of the knee joint. The times needed to reach peak enhancement of the upper abdominal aorta (T-aorta) and bilateral popliteal arteries (T-popliteal) were obtained, and aorto-popliteal bolus transit speeds between the abdominal aorta and popliteal arteries were calculated. ABI was recorded for the bilateral feet. The Pearson's product-moment correlation coefficient was used to investigate the correlation between the bolus transit speed and T-aorta, T-popliteal, ABI, and patient age. Result: The respective correlation coefficients for bolus transit speed on the one hand and T-aorta, T-popliteal, ABI, patient age on the other were -0.50, -0.84, 0.36, and -0.52. Conclusion: The time to peak enhancement for popliteal arteries showed the strongest correlation with aorto-popliteal bolus transit speeds, and was considered to be the most accurate predictor for aorto-popliteal bolus transit speeds.
Hudson, Christopher C. C.; Jeremie Stewart; Carole Dennie; Tarek Malas; Munir Boodhwani
We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essentia...
Manuel Antonio Villalobos-Zúñiga; Edith Barrantes-Valverde; Patricia Monge-Ortega
Paciente masculino de 36 años de edad, proveniente de la zona rural de Costa Rica, con un cuadro clínico de 8 meses de evolución de fiebre, mialgias, artralgias, pérdida de peso y lumbalgia; referido por la detección de un soplo de insuficiencia aórtica. El ecocardiograma reveló endocarditis de la válvula aórtica, y se obtuvieron 4 hemocultivos positivos por Brucella abortus biotipo 3, con serologías negativas por brucelosis. Se inició tratamiento con antibióticos y luego se le realizó un ree...
Manuel Antonio Villalobos-Zúñiga
Full Text Available Paciente masculino de 36 años de edad, proveniente de la zona rural de Costa Rica, con un cuadro clínico de 8 meses de evolución de fiebre, mialgias, artralgias, pérdida de peso y lumbalgia; referido por la detección de un soplo de insuficiencia aórtica. El ecocardiograma reveló endocarditis de la válvula aórtica, y se obtuvieron 4 hemocultivos positivos por Brucella abortus biotipo 3, con serologías negativas por brucelosis. Se inició tratamiento con antibióticos y luego se le realizó un reemplazo valvular aórtico; 4 meses después ingresó con dolor torácico que se atribuyó a una oclusión de la arteria descendente anterior, demostrada angiográficamente, por posible embolismo. En la actualidad cursa clínicamente estable con manejo médico para su cardiopatía, sin recaída infecciosa.The case of a 36-year-old patient from a rural area is presented. He came with an 8 month history of fever, myalgias, arthralgias, weight loss and lower back pain; who also had an aortic insufficiency murmur detected. The diagnosis of aortic valve endocarditis was made by echocardiography, and had 4 positive blood cultures for Brucella abortus biotype 3, and negative serologic test for brucellosis. He was started on antibiotics and later on underwent aortic valve replacement, with a late coronary cardioembolism as a complication.
Full Text Available Staphylococcus lugdunensis is a common skin flora not typically associated with infection. There are, however, several cases reported in the literature of Staphylococcus lugdunensis as a causative bacterium of various infections. This paper reports an additional case of pacemaker associated endocarditis with Staphylococcus lugdunensis as the causative bacterium.
Wilczynska, M; Khoo, JP; McCann, GP
Isolated native tricuspid valve endocarditis (TVE) in non-intravenous drug users is a very rare condition. We describe an unusual presentation of Enterococcus faecalis TVE associated with spondylodiscitis, positive cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase-3 antibodies vasculitic rash in an otherwise healthy patient with no history of intravenous drug use or underlying cardiac abnormalities.
Full Text Available In humans, one of the major factors associated with infective endocarditis (IE is the concurrent presence of periodontal disease (PD. However, in veterinary medicine, the relevance of PD in the evolution of dogs' endocarditis remains poorly understood. In order to try to establish a correlation between mouth-associated Enterococcus spp. and infective endocarditis in dogs, the present study evaluated the presence and diversity of enterococci in the gum and heart of dogs with PD. Samples were collected during necropsy of 32 dogs with PD and visually diagnosed with IE, which died of natural causes or euthanasia. Enterococci were isolated, identified and further characterized by Pulsed-Field Gel Electrophoresis (PFGE; susceptibility to antimicrobial agents and pathogenicity potential was also evaluated. In seven sampled animals, PFGE-patterns, resistance and virulence profiles were found to be identical between mouth and heart enterococci obtained from the same dog, allowing the establishment of an association between enterococcal periodontal disease and endocarditis in dogs. These findings represent a crucial step towards understanding the pathogenesis of PD-driven IE, and constitute a major progress in veterinary medicine.
Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G S
We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem. PMID:8586732
Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G. S.
We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem.
Pedersen, Karl; Jørgensen, J.C.; Dietz, Hans-Henrik; Andersen, T.H.
Between 1998 and 2001, mortalities due to verrucous endocarditis were experienced at several mink farms. Gram-positive cocci were isolated from the endocardium of all the animals examined but not always from other internal organs. Almost all the isolates were identified as Streptococcus bovis and...
Lauridsen, Trine Kiilerich; Bruun, Louise E; Rasmussen, R V;
The increasing number of resistant bacterial strains in infective endocarditis (IE) emphasizes the need for a constant development of antimicrobials. Linezolid is an oxazolidinone with an effect on Gram-positive cocci. Only a few casuistic reports describe its utilization in the treatment of IE...
Anthony A Holmes
Full Text Available Kingella kingae , a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.
João T. Ribeiro-Paes
Full Text Available A terapia celular poderia ser conceituada de forma ampla e genérica como o emprego de células para tratamento de doenças. Apesar de um número não tão expressivo de relatos tendo o pulmão como objeto de estudo na terapia celular em pacientes humanos, há dados consistentes da literatura, tanto em humanos, quanto em modelos animais,que evidenciam a migração de células-tronco da medula óssea para o pulmão,em diferentes situações experimentais. Esses resultados forneceram o embasamento experimental para o emprego de células-tronco na regeneração do tecido pulmonar em modelos animais. Em nosso laboratório, vários projetos de pesquisa têm sido conduzidos com a finalidade de avaliar a resposta pulmonar (morfológica e funcional ao tratamento com células-tronco adultas em camundongos com doença pulmonar obstrutiva crônica (DPOC induzida experimentalmente. Os resultados obtidos, aliados àqueles de outros grupos de pesquisa, permitem aventar a possibilidade de aplicação, a curto prazo, da terapia celular em pacientes com DPOC. Em outra patologia pulmonar, fibrose cística (FC, cuja abordagem terapêutica com células-tronco apresenta aspectos particulares em relação às patologias pulmonares crônico-degenerativas, há avanços promissores e potencialmente interessantes; no entanto, os resultados podem ser considerados incipientes e deve-se assinalar, portanto, que a associação da terapia gênica e celular apresenta-se como uma alternativa possível, mas ainda muito distante quanto à sua consolidação e incorporação como opção terapêutica segura e eficaz em FC. Por outro lado, tendo por embasamento os resultados obtidos em modelos experimentais, é possível postular que a terapia celular com células-tronco hematopoéticas (ou de outras fontes encerra perspectivas consistentes de aplicação em diversas outras patologias pulmonares humanas, especialmente em DPOC.
Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard; Raoult, Didier
Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis c...
Malani, A. N.; Aronoff, D. M.; Bradley, S. F.; Kauffman, C A
Cardiobacterium hominis, a member of the HACEK group (Haemophilus parainfluenzae, Haemophilus aphrophilus, and Haemophilus paraphrophilus, Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella species), is a rare cause of endocarditis. There are 61 reported cases of C. hominis infective endocarditis in the English-language literature, 15 of which involved prosthetic valve endocarditis. There is one reported case of C. hominis after upper endoscopy and none report...
Nayak, Hemanta K; Vangipuram, Deepak Rajkumar; Kumar, Suresh; Kar, Premashish; Gupta, Ankit; Kapoor, Neha; Sonika, Ujjwal
Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, has been associated with malignancy, autoimmune disease and collagen vascular disease. The association of infective endocarditis and Sweet’s syndrome is rare. The authors report a case of Sweet’s syndrome in a patient with infective endocarditis. Infective endocarditis should be excluded in patients of rheumatic heart disease presenting with Sweet’s syndrome. Alternatively, Sweet’s syndrome should be considered as a differ...
Winkler, Jonathan; Chaudhry, Sunit-Preet; Stockwell, Philip H.
Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myo...
Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz;
Treatment of infectious endocarditis (IE) comprises intravenously administered antibiotic medications given at high doses for 4-6 weeks--sometimes even longer. Approximately 50% of patients referred to tertiary care centres require additional surgical intervention. At present there are few papers...... describing the effects of oral antibiotic treatment in IE, and only in patients with right-sided endocarditis. In this case report we present a patient with left-sided Streptococcus endocarditis successfully treated with oral antibiotic drugs....
Hayani, Omar; Higginson, Lyall AJ; Toye, Baldwin; Burwash, Ian G.
Infective endocarditis caused by zoonotic microorganisms is an uncommon clinical entity. A 55-year-old man was diagnosed with endocarditis due to Capnocytophaga canimorsus, a commensal bacterium contained in the saliva of dogs, that involved the aortic and tricuspid valves and was complicated by a para-aortic valve abscess and aorta-to-right atrial fistula. The patient was successfully treated with antibiotic therapy and surgical intervention. C canimorsus endocarditis should be considered in...
Guillaume Coutance; Olivier Lepage; Christophe Bachelet; Michèle Hamon; Damien Legallois; Arnaud Pellissier; Fabien Labombarda
Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.
Full Text Available Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.
Mahek Shah; Soumya Patnaik; Supakanya Wongrakpanich; Yaser Alhamshari; Talal Alnabelsi
Incidence of infective endocarditis during pregnancy is around 0.006% with high maternal and fetal mortality. Bacillus cereus is an extremely rare cause for endocarditis in intravenous drug abusers (IVDA) or those with valvular disease or devices such as pacemakers. We report a case of B. cereus endocarditis, which, to the best of our knowledge, has never been reported in pregnancy. A 30-year-old, 25-week pregnant female presented with right shoulder pain, swelling and erythema on the lateral...
Aslani, M. R; Ebrahimi Kahrisangi, A; Baghban, F; Kazemi, A; Heidari, M; Salehi, N
Endocarditis is rarely reported in sheep and information presented for ovine endocarditis is based mostly on comparative findings in the cattle. Infective vegetative endocarditis of the right heart was diagnosed in a 3-year-old fat-tailed ram. Clinical findings included tachycardia, marked brisket edema, jugular veins distention and pulsation and pale mucous membranes. Hematologic abnormality included neutrophilic leukocytosis. Necropsy confirmed severe right atrioventricular and pulmonary valves vegetative endocarditis with evidence of right heart failure. Erysipelothrix rhusiopathiae was isolated from those vegetative lisions.
Chen, Ming; Kemp, Michael; Bruun, Niels E;
Cardiobacterium valvarum is a newly recognized human pathogen related to infective endocarditis. Cardiobacterium species are, however, only rarely the aetiology of infective endocarditis. An infective endocarditis case is presented and, additionally, phenotypic and phylogenetic comparison of a...... further 10 collection strains, representing the two species within the genus, was performed. C. valvarum was isolated from the blood and DNA was present in valvular tissue (partial 16S rRNA gene analysis) from a 64-year-old man with infective endocarditis of the mitral valve, rupture of chordae and...
Elisaf Moses; Miltiadous George
Abstract Introduction Micrococcus luteus endocarditis is a rare case of infective endocarditis. A total of 17 cases of infective endocarditis due to M luteus have been reported in the literature to date, all involving prosthetic valves. To the best of our knowledge, we describe the first case of native aortic valve M luteus endocarditis in an immunosuppressed patient in this report. Case report A 74-year-old Greek-Cypriot woman was admitted to our Internal Medicine Clinic due to fever and mal...
Full Text Available Primary aorto-duodenal fistula (PADF is a rare condition that may result in rapid exsanguination if untreated. PADF due to radiotherapy appears to be extremely rare with only a few cases reported in the medical literature. We report the case of a 61-year-old man who presented with massive gastrointestinal bleeding 25 years after surgery and radiotherapy for seminoma of the testicle and was successfully treated at our institution. We also review the literature on this very uncommon condition. A Medline search was conducted for the period from 1966 to June 2006 to identify case reports of PADF following radiotherapy. Only 7 cases of PADF due to radiotherapy were identified in addition to our own, 4 males and 3 females, aged 40 to 73 years, all treated for various forms of abdominal malignancies. The latency period ranged from 2 weeks to 25 years. None of the aortas were aneurysmatic. One patient died before he could be taken to the operating room. 5 patients underwent surgical repair and 4 survived. 2 patients underwent endovascular treatment but did not survive. PADF may develop up to 25 years after radiotherapy. Diagnosis should be considered when massive upper gastrointestinal bleeding develops in a patient who had previous abdominal radiotherapy, no matter how long before the episode of bleeding. Prompt surgical repair offers a reasonable chance of cure. Endovascular procedures do not appear to be efficacious.
Telo, M; Sampayo, F.
Descrevem-se 4 casos de Insuficiência Pulmonar Valvular Congénita com septo interventricular intacto em crianças de sexo masculino com idades compreendidas entre os 20 meses e os 10 anos, na 1a observação na Consulta de Cardiologia Pediátrica. 0 diagnóstico clínico de regurgitação pulmonar foi confirmado por electrocardiograma, fonocardiograma e radiografia de tórax em todos os doentes e também por ecocardiograma, exame hemodinâmico e angiocardiográfico em 3 deles. Após um follow-up que vario...
Penuela Rozo, Aquiles
La literatura de los cinco últimos años presenta numerosos informes de complicación pulmonar por parásitos animales. Estos parásitos causan complicación pulmonar por tres vías diferentes: l.-Por medio de la larva migratoria mientras pasa al través de los pulmones. 2.-Por una acción directa del parásito adulto sus larvas migratorias o sus huevos. 3.-Por una acción indirecta (Toxina o acción anafiláctica). Como el espacio no permite el estudio de tántos parásitos, tengo que limitarme a un solo ...
Jose Alexis Quesada
Full Text Available La carcinomatosis leptomeningea se diagnostica en aproximadamente un 5% al 7% de los tumores malignos, dentro de los cuales, el mas frecuente es el Carcinoma pulmonar en todos sus subtipos histológicos. Presentamos un caso clínico en el cual el paciente se presenta con un cuadro cefelea, visión borrosa e hidrocefalia de origen idiopático como síntoma inicial. Meses después de la colocación de una derivación Ventriculo-peritoneal, reingresa con un síndrome de desgaste, pérdida de peso, hiporexia, astenia y adinamia, en donde el estudio de necropsia revelo un adenocarcinoma pulmonar poco diferenciado con micrometastasis cerebrales y carcinomatosis leptomeningea.
Mario Enrique Baltazares-Lipp
Full Text Available Hypereosinophilic syndrome (HES is a rare disorder with unknown global prevalence, barely reported in Hispanic population, and characterized by persistent eosinophilia in association with organ dysfunctions directly attributable to eosinophilic infiltration. Cardiac involvement may be present in 50 to 60% of the patients. This is known as Löffler endocarditis. We present a case of a 36-year-old Hispanic man with signs of heart failure. Laboratory studies showed eosinophilia (23,100/μL. Thoracic computer tomography showed bilateral pleural effusion and a large left ventricular mass. Transthoracic echocardiography showed left ventricle apical obliteration and a restrictive pattern. Pulmonary angiography demonstrated a thrombus in the lingular and middle lobe. Despite treatment, the patient deceased seven days after admission. Autopsy confirmed the diagnosis of Löffler endocarditis.
Full Text Available Background: Infective endocarditis (IE is an infection of the endocardial surface of the heart. Despite recent advances in diagnosis and treatment, mortality rates remain high. Data on the prevalence, epidemiology and etiology of IE from India are sparse. Aims and Objectives: The aim of this study was to evaluate the clinical, laboratory, microbiological, and echocardiographic characteristics of IE patients in Chennai, south India. Materials and Methods: Patients were classified based on modified Duke criteria. Details of the clinical profile of the patients and laboratory data were recorded. Blood cultures were performed to establish the etiology. Results: Ninety six percent of patients had native valve endocarditis. Mitral valve was the most commonly affected valve. Conclusion: Rheumatic heart disease was the most common predisposing factor and fever was the most common clinical feature. Viridans group streptococci accounted of the culture positive cases.
T. F. Said
Full Text Available Aim. The study was aimed to analyze the results of surgical treatment of infectious endocarditis associated with intravenous drug abuse. Methods and results. The study included 53 patients, 36 male and 17 female, 28,7 ± 7 years old. 60 operations were performed: 41 patients underwent tricuspid valve replacement, 7 pts – tricuspid valve repair, 7 pts – tricuspid valve rereplacement, 2 pts – mitral and tricuspidal valves replacement, 2 pts – aor- tic and tricuspid valves replacement, 1 patient – trivalve replacement. Hospital mortality was 1,7%. Conclusi- on. The used principles of surgical treatment of infectious endocarditis in drug abuse patients allow to rich a low mortality and complications rates in the postoperative period in this heavy group of patients.
Pasrija, Chetan; Mohammed, Isa; Shats, Inna; Hong-Zohlman, Susie; Reoma, Junewai; Mazzeffi, Michael A; Rajagopal, Keshava
A 63-year-old male patient with HIV disease presented with dyspnea and complete heart block, and was found to have aortic valve (AV) endocarditis secondary to Candida parapsilosis infection. Echocardiography demonstrated AV endocarditis and possible aortic root versus subannular abscess with moderate AV regurgitation (AR), a ventricular septal defect (VSD) and possible left ventricular to right atrial shunt (Gerbode defect). Large AV vegetations, subannular abscess with an acquired membranous VSD, Gerbode defect, and tricuspid annular abscess at the insertion of septal leaflet were noted intraoperatively. The patient underwent AV replacement with a stented bioprosthesis, two-sided VSD patch closure, and tricuspid valve (TV) repair with an annuloplasty ring. The left-sided patch closed the VSD and facilitated AV replacement, while the right-sided patch facilitated the TV repair. PMID:26901898
Full Text Available The epidemiological and clinical study “Studio Endocarditi Italiane” (SEI evaluated 947 cases of infective endocarditis in 2004-2008. Enterococcal aethiology was described in 11% cases.The aim of our study was to evacuate the in vitro activity of twelve antibiotics alone and in association against 20 strains (15 E. faecalis, 5 E. faecium. Results show the in vitro activity of tigecyicline, daptomicine and linezolid. Synergism is appreciated for ceftriaxone-fosfomycin (FICindex50=0.34, FICindex90=0.56 against E. faecalis and for imipenem-fosfomycin against E. faecium.The majority of the tested strains show addition using ampicillin-ceftriaxone (FICindex50=0.85, FICindex90=1.01 and moxifloxacin- tigecycline (FICindex50=0.77, FICindex90=1.96.
Tan, S Y; Gill, G
A dental source of infection remains the most common identifiable risk factor in infective endocarditis and this may be particularly important in patients at 'high risk'. We therefore performed a questionnaire survey of dental practitioners to assess acceptance of The British Society of Antimicrobial Chemotherapy (BSAC) recommendations, especially with regards to selection of dental procedures for antibiotic prophylaxis. The results showed that the dental practitioners surveyed treated the 'high risk' patient group differently by extending the range of dental procedures covered by antibiotics but the BSAC only recommend that they be treated differently by hospital treatment and/or parenteral antibiotics. This must be an area of concern and deserves further attention, especially with regards to the need for wider publicity and the range of dental procedures that should be covered in the 'high risk' group where morbidity and mortality from infective endocarditis are higher. PMID:1452880
B. de Escalante Yangüela
Full Text Available Los embolismos tumorales pulmonares (ETP representan una causa poco frecuente de disnea en pacientes oncológicos. La mayoría se diagnostican en pacientes con tumores avanzados, sobre todo localizados en mama, pulmón o estómago. Existen pocos casos publicados en pacientes con tumores uroteliales. Presentamos el caso de un varón de 69 años, sin diagnóstico previo de cáncer, que ingresó por disnea subaguda, con sospecha clínica inicial de tromboembolismo pulmonar (TEP. El paciente falleció al 5º día del ingreso. En la autopsia se comprobó la existencia de un tumor en pelvis renal izquierda con metástasis hepáticas y linfoganglionares múltiples y una extensa embolia pulmonar microvascular que afectaba a gran parte de los capilares y vasos sanguíneos de mediano calibre de ambos pulmones. Los ETP se consideraron responsables de la insuficiencia respiratoria progresiva y se interpretaron como la causa última de la muerte. La presentación clínica más frecuente de los ETP es la disnea, a menudo se confunden con el TEP y el diagnóstico no resulta fácil. Su pronóstico es muy malo, con una elevadísima mortalidad y su confirmación habitualmente es post-mortem.
Full Text Available Autopsy incidence of infective endocarditis during the past 50 years was analysed to review the changes in the clinico-pathologic pattern if any. 185 cases were recorded in a total of 39931 autopsies giving an average incidence of 0.46%. The cases were classified into groups I, II & III depending upon whether the endocarditis super-vened on normal hearts, diseased hearts or followed surgery, re-spectively. The fifty year period could be divided into three phases on incidence. First phase (1927-41 represented pre-antibiotic era in which group I cases predominated and causative organisms in 801" o f cases were virulent cocci such as staphylococci, haemolytic streptococci and pneumococci. In the second phase (1948-66 the general incidence was reduced by 50%. Group II cases predominat-ed and the most common etiologic agent was streptococcus viridans (40%. In the third phase (1967-76 the general incidence has reached again to preantibiotic level with coagulase positive staphy-lococci, Gram negative bacilli and fungi accounting for 90% of cases. Group III contributed significantly in this phase. The changes in incidence are primarily due to fall and rise in Group I cases. Incidence of rheumatic heart disease with endocar-ditis which mainly forms Group II is declining steadily in post-antibiotic era. There is no shift in the peak age incidence which remains in the 3rd decade. Males with rheumatic heart disease are more prone to infective endocarditis than similarly affected females. There was no change in frequency of involvement of various valves or sites of embolization.
Bancsi, Maurice J. L. M. F.; Veltrop, Marcel H. A. M.; Bertina, Rogier M.; Thompson, Jan
The endocardial vegetation which is formed in the course of bacterial endocarditis (BE) contains tissue factor (TF)-dependent procoagulant activity. Earlier studies showed that monocytes are the main source of TF in the vegetations. The TF activity (TFA) of vegetations isolated from Streptococcus sanguis-infected rabbits depended on the numbers of bacteria as well as monocytes in the vegetation. In this study, we investigated whether for Staphylococcus epidermidis, a frequent pathogen in BE, ...
Veltrop, Marcel H. A. M.; Bancsi, Maurice J. L. M. F.; Bertina, Rogier M.; Thompson, Jan
In the pathogenesis of bacterial endocarditis (BE), the clotting system plays a cardinal role in the formation and maintenance of the endocardial vegetations. The extrinsic pathway is involved in the activation of the coagulation pathway with tissue factor (TF) as the key protein. Staphylococcus aureus is a frequently isolated bacterium from patients with BE. We therefore investigated whether S. aureus can induce TF activity (TFA) on fibrin-adherent monocytes, used as an in vitro model of BE....
Full Text Available Objective: We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years. Methods: From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3% patients were male and the mean age was 39.3±14.4 (9-77 years. Twenty-seven (15.5% patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2 adding up to a total of 1030.8 patient/years. Results: Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%. In-hospital mortality occurred in 27 (15.5% cases. Postoperatively, 25 (14.4% patients had low cardiac output and 17 (9.8% heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up. Conclusion: Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low.
B S Belov
Full Text Available The present paper completes a series of papers on the current aspects of infective endocarditis (IE. It also presents detailed antibacterial treatment schemes for IE in relation of an isolated pathogen. The authors show it expedient to use of glucocorticoids in IE and give indications for their administration. The basic principles of antibiotic prevention of IE are considered in various IE risk groups.
B S Belov
Full Text Available The present paper completes a series of papers on the current aspects of infective endocarditis (IE. It also presents detailed antibacterial treatment schemes for IE in relation of an isolated pathogen. The authors show it expedient to use of glucocorticoids in IE and give indications for their administration. The basic principles of antibiotic prevention of IE are considered in various IE risk groups.
Agca, Fahriye Vatansever; Demircan, Necmiye; Peker, Tezcan; Ari, Hasan; Karaagac, Kemal; Ozluk, Ozlem Arican; YILMAZ, Mustafa; Tenekecioglu, Erhan
Introduction: We aimed to define the current characteristics of infective endocarditis (IE) in a part of Turkey. Methods: All patients who were hospitalized in our hospital with a diagnosis of IE between 2009 and 2014 were included in the study. Data were collected from archives records of all patients. Modified Duke criteria were used for diagnosis. Results: There were 85 IE cases during the study period. The mean age of patients was 52 years. Fourty eight of patients were males. Native valv...
Full Text Available An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.
Meddens, M J; Thompson, J.; Bauer, W C; van Furth, R
The role of granulocytes and monocytes during the induction and course of Escherichia coli endocarditis was investigated in rabbits by selectively depleting monocytes from the circulation with the drug VP16-213 and granulocytes and monocytes with nitrogen mustard. For induction, the number of E. coli needed to infect the vegetations in 50% of the rabbits was significantly lower in rabbits with combined granulocytopenia and monocytopenia than in those with selective monocytopenia or in control...
Mills, J; Pulliam, L; Dall, L; Marzouk, J; Wilson, W; Costerton, J. W.
Light and electron microscopy with histochemical staining were used to estimate exopolysaccharide production by strains of viridans streptococci recovered from patients with endocarditis. Six strains were selected for study because they represented a wide range of in vitro polysaccharide production. By light microscopy, there was good agreement between three polysaccharide stains (ruthenium red, periodic acid-Schiff and calcifluor white) in the amount of glycocalyx produced, which ranged from...
Jian-ling Tao; Xue-mei Li; Xue-wang Li; Jie Ma; Guang-li Ge; Li-meng Chen; Hang Li; Bao-tong Zhou; Yang Sun; Wen-ling Ye; Qi Miao
Objective To analyze the clinical features of hemodialysis patients complicated by infective endo-carditis.Methods The clinical features of six such patients admitted to Peking Union Medical College Hos-pital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular ac-cesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary cathe-ters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aor-tic valve involvement, and one with both. Five vegetations were found by transthoraeic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy-sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodi-alysis for three months after surgery.Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiogra-phy produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.
Egido, S Hernández; Ruiz, M Siller; Inés Revuelta, S; García, I García; Bellido, J L Muñoz
Small colony variants (SCV) are slow-growing subpopulations of bacteria usually associated with auxotrophism, causing persistent or recurrent infections. Enterococcus faecalis SCV have been seldom described, and only one case of Enterococcus faecium SCV has been reported, associated with sepsis in a leukaemia patient. Here we report the first case described of bacteraemia and endocarditis by SCV E. faecium in an immunocompetent patient. PMID:26862434
S. Hernández Egido
Full Text Available Small colony variants (SCV are slow-growing subpopulations of bacteria usually associated with auxotrophism, causing persistent or recurrent infections. Enterococcus faecalis SCV have been seldom described, and only one case of Enterococcus faecium SCV has been reported, associated with sepsis in a leukaemia patient. Here we report the first case described of bacteraemia and endocarditis by SCV E. faecium in an immunocompetent patient.
Kauffman, Carol A
Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents. PMID:26398531
Wałdoch, Anna; Kwiatkowska, Joanna; Dorniak, Karolina
Libman-Sacks endocarditis may be the first manifestation of systemic lupus erythematosus. The risk of its occurrence increases with the co-existence of the anti-phospholipid syndrome. Changes usually involve the mitral valve and the aortic valve. In this report, we present a case of Libman-Sacks endocarditis of the tricuspid valve in a teenage girl. PMID:25972079
Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults, with an overall mortality rate of up to 25%, but it is a rare cause of infective endocarditis. We present herein a case of N. meningitidis meningitis complicated with infective endocarditis.
Abstract Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults, with an overall mortality rate of up to 25%, but it is a rare cause of infective endocarditis. We present herein a case of N. meningitidis meningitis complicated with infective endocarditis.
Vandenbos, F; Roth, S; Montagne, N
We report a case of mitral endocarditis caused by Streptococcus pneumoniae in a 43 year old man with history of alcohol abuse and cigarette smoking. The pneumococcal endocarditis was associated with pneumonia, meningitis and brain abscess. Only transesophageal echocardiography could confirm the presence of vegetation. The patient was treated medically with good results. PMID:11887774
Balakrishnan, N; Alexander, K; Keene, B; Kolluru, S; Fauls, M L; Rawdon, I; Breitschwerdt, E B
Infective endocarditis, an inflammation of the endocardial surface due to invasion by an infectious agent, is more common in middle sized to large breed dogs. We herein report a case of mitral valve endocarditis in a 9-year-old male-castrated Weimaraner caused by an Actinomyces canis-like bacterium, not previously reported in association with infection in dogs. PMID:27364088
Boscia, J A; Kobasa, W D; Kaye, D
This study compared difloxacin administered orally, enoxacin administered orally, and cefazolin administered intramuscularly for the treatment of experimental Staphylococcus aureus endocarditis. Difloxacin significantly reduced bacterial counts of vegetations compared with enoxacin. This study demonstrated that difloxacin was significantly more effective than enoxacin and as effective as cefazolin for the treatment of S. aureus endocarditis in rabbits.
Demir, Tolga; Ergenoglu, Mehmet Umit; Ekinci, Abdurrahman; Tanrikulu, Nursen; Sahin, Mazlum; Demirsoy, Ergun
Patient: Male, 36 Final Diagnosis: Aspergillus flavus endocarditis Symptoms: Malaise • fatigue and dyspnea Medication: — Clinical Procedure: Mitral vale replacemnet Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous dr...
Durack, D T; Gilliland, B C; Petersdorf, R G
It has been asserted that humoral immunity is an important potentiating factor in pathogenesis of infective endocarditis, in that prior immunization to certain bacteria may predispose the host to endocarditis caused by those organisms. If so, possible future vaccination of humans with streptococcal antigens for the prevention of dental caries might increase the susceptibility of the population to streptococcal endocarditis. To examine this hypothesis further, we immunized rabbits with killed Streptococcus sanguis or Streptococcus mutans. After complement-fixing antibody had developed, the rabbits were tested for susceptibility to experimental infective endocarditis. Rabbits with high titers of complement-fixing antibody to the infecting organism developed streptococcal endocarditis less often (13%) than animals with lower titers (69%; P less than 0.0002). These findings do not support the hypothesis that pre-immunization predisposes to infective endocarditis and lend no credence to the concept that vaccination of human subjects against dental caries might increase their susceptibility to streptococcal endocarditis. On the contrary, the results of these experiments indicate that specific antibody can confer relative immunity to infective endocarditis. PMID:730349
Thomas, Benjamin S.; Bankowski, Matthew J.; Lau, William K. K.
Bacillus cereus is a rare cause of endocarditis, typically associated with intravenous drug abuse, rheumatic heart disease, prosthetic heart valves, pacemakers, or immunodeficiency. We present the first case of native valve Bacillus cereus endocarditis with no apparent risk factors. The patient had a fulminant course requiring emergent valve replacement.
Gao, Xinpei; Kitslaar, Pieter H; Budde, Ricardo P J; Tu, Shengxian; de Graaf, Michiel A; Xu, Liang; Xu, Bo; Scholte, Arthur J H A; Dijkstra, Jouke; Reiber, Johan H C
Extraction of the aorto-femoral vessel trajectory is important to utilize computed tomography angiography (CTA) in an integrated workflow of the image-guided work-up prior to trans-catheter aortic valve replacement (TAVR). The aim of this study was to develop a new, fully-automated technique for the extraction of the entire arterial access route from the femoral artery to the aortic root. An automatic vessel tracking algorithm was first used to find the centerline that connected the femoral accessing points and the aortic root. Subsequently, a deformable 3D-model fitting method was used to delineate the lumen boundary of the vascular trajectory in the whole-body CTA dataset. A validation was carried out by comparing the automatically obtained results with semi-automatically obtained results from two experienced observers. The whole framework was validated on whole body CTA datasets of 36 patients. The average Dice similarity indexes between the segmentations of the automatic method and observer 1 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta were 0.977 ± 0.030, 0.980 ± 0.019, 0.982 ± 0.016; the average Dice similarity indexes between the segmentations of the automatic method and observer 2 were 0.950 ± 0.040, 0.954 ± 0.031 and 0.965 ± 0.019, respectively. The inter-observer variability resulted in a Dice similarity index of 0.954 ± 0.038, 0.952 ± 0.031 and 0.969 ± 0.018 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta. The average minimal luminal diameters (MLDs) of the ilio-femoral artery were 6.03 ± 1.48, 5.70 ± 1.43 and 5.52 ± 1.32 mm for the automatic method, observer 1 and observer 2 respectively. The MLDs of the aorta were 13.43 ± 2.54, 12.40 ± 2.93 and 12.08 ± 2.40 mm for the automatic method, observer 1 and observer 2 respectively. The automatic measurement overestimated the MLD slightly in the ilio-femoral artery at the
O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica The challenge of diagnosing acute pulmonary thromboembolism in patients with chronic obstructive pulmonary disease
Sérgio Saldanha Menna-Barreto
Tromboembolia pulmonar aguda e exacerbação aguda de doença pulmonar obstrutiva crônica são doenças comuns. A doença pulmonar obstrutiva crônica é um fator clínico de risco para tromboembolia pulmonar aguda. As apresentações clínicas da tromboembolia pulmonar aguda e da exacerbação aguda da doença pulmonar obstrutiva crônica freqüentemente mimetizam-se tanto que pode ser difícil distingui-las. Anormalidades estruturais nos pulmões com doença pulmonar obstrutiva crônica tornam também difícil a ...
Marcelo del Castillo
Full Text Available Las endocarditis causadas por hongos, (Candida en particular, requieren tratamiento médico-quirúrgico, siendo la anfotericina B la droga de elección. Caspofungina es una equinocandina con gran actividad sobre Candida y Aspergillus. Se presenta un paciente con una endocarditis por Candida tropicalis resistente a fluconazol tratado con caspofungina bajo un esquema de salvataje, luego de haber presentado efectos adversos por anfotericina B. El paciente tuvo respuesta microbiológica.Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatment and amphotericin B is the drug of choice. Caspofungin is an echinocandin very effective against Candida and Aspergillus. We present a patient with Candida tropicalis endocarditis, fluconazol resistant, treated with caspofungin, on a compassional basis as a result of adverse effects with amphotericin B. The patient had a microbiological response.
Pérsio Godoy; Guilherme Milhomem Martins
E relatado o caso de uma mulher de 40 anos de idade com lupo eritematoso sistêmico, em uso de corticosterôídes, e salmonelose (Salmonella typhimurium) pulmonar grave. Associou-se ao caso cirrose septal incompleta. Os autores apontam possível papel da infecção pela salmonela na gênese de doenças por imunocomplexos.A 40-years-old ivoman witb systemic lupus eiythematosus and severe pulmonaiy nontyphoid salmonellosis (Salmonella Typhimurium), is reported In addition the patient had incomplete sep...
La enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV) en una población de pacientes con EPOC. En este estud...
L.A. Henn; R.V. Gonzaga; J. Crestani; M.R. Cerski
Schwannoma é uma neoplasia mesenquimal, usualmente solitária, encontrada no mediastino, retroperitônio ou pelve, sendo rara sua apresentação na parede torácica. OBJETIVO: Relatar o caso de um paciente masculino, tabagista, com um nódulo pulmonar direito com características de malignidade, detectado em radiografia de tórax de rotina, cujo diagnóstico anatomopatológico foi de schwannoma benigno de nervo intercostal. MÉTODOS: Revisaram-se os dados referentes ao quadro clínico, exames laboratoria...
Citro, Rodolfo; Prota, Costantina; Greco, Luigi; Mirra, Marco; Masullo, Alfonso; Silverio, Angelo; Bossone, Eduardo; Piscione, Federico
We report an unusual case of endocarditis occurring in a 74-year-old man with a history of systemic hypertension, diabetes mellitus and minor amputation for left forefoot ulcer. The patient was hospitalized for vacuum-assisted closure therapy to aid in wound healing. After the first treatment session, the patient reported abdominal pain with haematemesis and fever (40 °C). Owing to persistent fever, three blood cultures were performed, all positive for Kocuria kristinae. The identification was based on biochemical tests and automated systems. The speciation of the micro-organism was achieved with MALDI-TOF and then confirmed by 16S rRNA gene sequencing. Transthoracic echocardiographic examination showed the presence of a large vegetation (38×20 mm) on the posterior mitral leaflet and moderate mitral regurgitation. Since there are no current guidelines for the treatment of K. kristinae endocarditis, empiric antibiotic therapy with intravenous sulbactam/ampicillin (1.5 g twice daily) and gentamicin (6 mg kg(-1) per day) was started. After 7 days of hospitalization, the patient's condition suddenly worsened because of the occurrence of haemorrhagic stroke. Despite inotropic support and rifampicin infusion, the haemodynamic status progressively deteriorated. After an initial improvement, he worsened again, becoming stuporous, hypotensive and dyspnoeic. In the following days, the patient developed compartment syndrome resulting in right foot ischaemia. Unfortunately, 25 days after hospitalization, the patient died of multiple organ failure from overwhelming sepsis. To the best of our knowledge, this is the first case of K. kristinae endocarditis on a native valve that is not related to a central venous catheter but associated with diabetic foot infection. PMID:23518651
Full Text Available Since the 1960s, regular hemodialysis (HD was recognized as a risk factor for the development of infective endocarditis (IE, particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving re-gular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Sta-phylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphlococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.
Full Text Available Candida endocarditis is an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial morbidity and mortality. A 28-year-old primigravida at 32 weeks of gestation was admitted with low-grade fever and lower abdominal pain for 2 weeks. She had undergone open appendicectomy 2 months before admission. Echocardiogram showed a pedunculated 24 mm × 21 mm mass attached to the undersurface of anterior mitral leaflet near the tip and moderate mitral regurgitation. Repeated blood cultures showed growth of nonalbicans candida. She was immediately started on liposomal amphotericin and was taken up for surgery, but despite all efforts she succumbed to her illness.
Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H;
%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...... or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]). CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves...
Buchholtz, Kristine; Larsen, Carsten Toftager; Schaadt, Bente;
Objectives: The aim of this randomized study was to investigate the effects of once versus twice daily gentamicin dosing on renal function and measures of infectious disease in a population with infective endocarditis (IE). Methods: Seventy-one IE patients needing gentamicin treatment according to...... gentamicin, 20.4% (95% confidence interval 12.0–28.8). However, there was no significant difference in the GFR decrease between the once and twice daily regimens (p = 0.573). No difference in infection parameters was demonstrated between the two dosing regimens. Conclusions: A twice daily gentamicin dosing...
Pedersen, Karl; Jørgensen, J.C.; Dietz, Hans-Henrik;
Between 1998 and 2001, mortalities due to verrucous endocarditis were experienced at several mink farms. Gram-positive cocci were isolated from the endocardium of all the animals examined but not always from other internal organs. Almost all the isolates were identified as Streptococcus bovis and...... only a few isolates belonged to other Streptococcus species. Typing by pulsed-field gel electrophoresis of a selection of isolates revealed several patterns and several different clones. Attempts to reproduce disease by the injection of cultures of a field isolate into healthy mink failed....
Daudin, M; Tattevin, P; Lelong, B; Flecher, E; Lavoué, S; Piau, C; Ingels, A; Chapron, A; Daubert, J-C; Revest, M
Case series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with co-morbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococcal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched for sex and age, during the years 1991-2013, in one referral centre. Alcoholism (39.3% versus 10.7%; p endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptom onset, 14.1 ± 18.2 versus 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% versus 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most cases. PMID:27021424
Ishizaki Marcos Makoto; Ferreira Ana Maria Reis; Salomão Júnior Edgard; Nascimento Júnior Amary; Marsico Filho Firmino
O presente estudo teve como objetivo verificar a viabilidade do n-butil cianoacrilato na pneumostasia e hemostasia em lobectomia pulmonar parcial. Foram utilizadas seis gatas hígidas, adultas, com peso médio de três quilogramas. O procedimento cirúrgico consistiu na realização de toracotomia intercostal com lobectomia pulmonar parcial em que se utilizou adesivo cirúrgico para fechamento do lobo pulmonar. Após 21 dias da cirurgia, os animais foram novamente submetidos à toracotomia para a cole...
José Fernando Molina
En esta revisión se describen las diversas manifestacionespulmonares del Lupus Eritematoso Sistémico; se Incluyen tanto los cuadrosrelacionados con la enfermedad (pleuritis con o sin derrame, neumonitis lúpicaaguda, enfermedad intersticlaidifusa, hipertensión pulmonar, disfunción diafragmática,atelectasia y hemorragia pulmonar) como los asociados a ella (infección, edemapulmonar urémico, embolismo pulmonar, neumotórax, pseudolinfoma y sa...
Andre Nathan Costa
Full Text Available Pseudocistos pulmonares são lesões raras que se desenvolvem no parênquima pulmonar após traumas fechados e de grande energia, cujo diagnóstico se baseia na associação da história clínica com exames de imagem. Relata-se a seguir um pseudocisto pulmonar ocorrido no parênquima contralateral ao trauma em um homem de 31 anos que apresentou episódio de hemoptise após queda durante partida de futebol.
Garc??a, Juan J.; Sierra, Matilde; Diez, M. Jos??; Ter??n, M. Teresa
P. 105-109 En este trabajo se estudia la influencia del pulm??n en la disposici??n de la clorpromazina en el conejo, utilizando para ello el coeficiente de extracci??n pulmonar. La clorpromazina fue administrada a dosis de 7,5 y 10 mg/kg por v??a intraarterial y por. v??a intravenosa. El coeficiente de extracci??n pulmonar fue de 0,929 y 0,811 para la dosis de 7,5 y 10 mg/kg respectivamente, lo que indica que en el conejo existe una alta captaci??n pulmonar para este f??rmaco.
Luciana Friedrich; Andréa L. Corso; Marcus H Jones
OBJETIVO: O aumento da sobrevida de prematuros traz o desafio de lidar com um amplo espectro de doenças pulmonares crônicas, incluindo displasia broncopulmonar, síndrome de Wilson-Mikity e sibilância recorrente. Este artigo discute o prognóstico pulmonar clínico e funcional de prematuros na infância e na adolescência. FONTE DE DADOS: Foi realizada pesquisa no MEDLINE de publicações entre 1970 e 2004 que abordassem função e crescimento pulmonar de prematuros, bem como a evolução clínica dos me...
Stach, Christopher S.; Vu, Bao G.; Merriman, Joseph A.; Herrera, Alfa; Cahill, Michael P.; Schlievert, Patrick M.; Salgado-Pabón, Wilmara
Background Superantigens are indispensable virulence factors for Staphylococcus aureus in disease causation. Superantigens stimulate massive immune cell activation, leading to toxic shock syndrome (TSS) and contributing to other illnesses. However, superantigens differ in their capacities to induce body-wide effects. For many, their production, at least as tested in vitro, is not high enough to reach the circulation, or the proteins are not efficient in crossing epithelial and endothelial barriers, thus remaining within tissues or localized on mucosal surfaces where they exert only local effects. In this study, we address the role of TSS toxin-1 (TSST-1) and most importantly the enterotoxin gene cluster (egc) in infective endocarditis and sepsis, gaining insights into the body-wide versus local effects of superantigens. Methods We examined S. aureus TSST-1 gene (tstH) and egc deletion strains in the rabbit model of infective endocarditis and sepsis. Importantly, we also assessed the ability of commercial human intravenous immunoglobulin (IVIG) plus vancomycin to alter the course of infective endocarditis and sepsis. Results TSST-1 contributed to infective endocarditis vegetations and lethal sepsis, while superantigens of the egc, a cluster with uncharacterized functions in S. aureus infections, promoted vegetation formation in infective endocarditis. IVIG plus vancomycin prevented lethality and stroke development in infective endocarditis and sepsis. Conclusions Our studies support the local tissue effects of egc superantigens for establishment and progression of infective endocarditis providing evidence for their role in life-threatening illnesses. In contrast, TSST-1 contributes to both infective endocarditis and lethal sepsis. IVIG may be a useful adjunct therapy for infective endocarditis and sepsis. PMID:27124393
MARÍA TERESA PARADA C
Full Text Available La silicosis es una enfermedad prevalente en Chile, que es un país minero y en desarrollo. Existe escasa bibliografía sobre trasplante pulmonar, como alternativa de tratamiento en silicosis avanzada. Objetivo: Describir el tiempo y forma de exposición a la sílice y las características clínicas de enfermos silicóticos tratados con trasplante pulmonar en la Clínica Las Condes de Santiago. Pacientes y Métodos: De un total de 38 pacientes en los que se practicó trasplante pulmonar entre 1999 y 2006, cuatro de ellos fueron trasplantados por padecer de silicosis avanzada. En estos 38 enfermos la fibrosis pulmonar idiopática fue la enfermedad subyacente predominante (55%. Resultados: Los 4 pacientes silicóticos fueron trasplantados a una edad que fluctuó entre 34 y 65 años. Su período de exposición varió entre 5 y 30 años y sus síntomas comenzaron a manifestarse 4 a 30 años después de iniciada la exposición. Dos pacientes eran mineros, otro trabajó en la molienda de cuarzo y el 4º enfermo fue pulidor de prótesis dentales. La cirugía fue compleja debido a la distorsión de la anatomía pulmonar de estos enfermos. La estadía hospitalaria fue más prolongada en los trasplantados silicóticos que en los no silicóticos (41 versus 21 días, p Silicosis is a prevalent disease in Chile, a developing miner country. Scarce information about lung transplantation as an alternative for treating severe silicosis is available. Objective: To describe the time and way of exposure to silica and the clinical characteristics of silicotic patients subjected to lung transplantation at Clinica Las Condes, Santiago. Patients and Methods: From 38 patients subjected to lung transplantation between 1999 and 2006, four of them were transplanted because of severe silicosis. Ldiopathic pulmonary fibrosis was the predominant underlying disease (55% of these 38 patients. Results: The four silicotic patients were transplanted at an age ranging from 34 to 65
Aline de Marco Viott
Full Text Available Um bovino Guzerá, fêmea, adulto, com histórico de insuficiência cardíaca congestiva direita de duração de duas semanas, morreu durante o transporte ao hospital veterinário. À necropsia, o lobo pulmonar cranial esquerdo estava moderadamente aumentado de tamanho e firme. O parênquima do lobo afetado era branco e continha múltiplas áreas de 0,3 a 1,5cm de diâmetro, amareladas e caseosas. Alterações semelhantes foram observadas nos linfonodos mediastínicos e brônquicos, no pericárdio parietal, no epicárdio e na adventícia da artéria pulmonar. Histologicamente, a massa tecidual do lobo pulmonar era constituída por células epiteliais neoplásicas de padrão acinar, com duas ou mais camadas celulares, algumas com projeções papilares intraluminais. A anisocariose era acentuada, e o índice mitótico, moderado (dois a três por campo de maior aumento. Envolvendo as neoformações, observava-se abundante tecido conjuntivo fibroso. Focos de necrose e mineralização eram multifocais moderados. Alterações histológicas semelhantes foram observadas nos linfonodos brônquicos, nos mediastínicos, nos pericárdios visceral e parietal e na adventícia da artéria pulmonar. Com exceção do fígado com congestão generalizada crônica, não foram observadas alterações macro e microscópicas em outros órgãos. Os achados histológicos foram compatíveis com adenocarcinoma pulmonar, com metástases regionais. O quadro de insuficiência cardíaca congestiva direita provavelmente foi decorrente do impedimento da drenagem linfática pelas metástases.An adult Guzera cow, dysplaying for two weeks signs of right-sided congestive heart failure died during the transport to the veterinary hospital. At necropsy, the left cranial lung lobe was moderately increased in volume and firm. The parenchyma of the affected lung lobe was white and contained multiple 0.3 to 1.5cm in diameter, yellow, dry, friable nodules. Similar changes were observed in
Full Text Available Abstract Background Infective endocarditis is rarely caused by Burkholderia cepacia. This infection is known to occur particularly in immunocompromised hosts, intravenous heroin users, and in patients with prosthetic valve replacement. Most patients with Burkholderia cepacia endocarditis usually need surgical treatment in addition to antimicrobial treatment. Case Presentation Here, we report the case of a patient who developed Burkholderia cepacia-induced native valve endocarditis with consequent cerebral involvement without any predisposing factors; she was successfully treated by antimicrobial agents only. Conclusion In this report, we also present literature review of relevant cases.
Antonio Carlos Nicodemo
Full Text Available Rothia aeria is an uncommon pathogen mainly associated with endocarditis in case reports. In previous reports, endocarditis by R. aeria was complicated by central nervous system embolization. In the case we report herein, endocarditis by R. aeria was diagnosed after acute self-limited diarrhea. In addition to the common translocation of R. aeria from the oral cavity, we hypothesize the possibility of intestinal translocation. Matrix-assisted laser desorption ionization-time of flight mass spectrometry and genetic sequencing are important tools that can contribute to early and more accurate etiologic diagnosis of severe infections caused by Gram-positive rods.
Hidalgo-García, L; Hurtado-Mingo, A; Olbrich, P; Moruno-Tirado, A; Neth, O; Obando, I
Uncommon microorganisms are increasingly being recognized as causative agents of paediatric infectious endocarditis (IE). We report a 4-year old girl with congenital heart disease, who suffered from 2 IE episodes secondary to Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus) and Staphylococcus lugdunensis, both rarely reported pathogens in this age group. The patient was initially successfully treated with prolonged intravenous antibiotic courses, however removal of the Contegra valved conduit during the second episode was required due to recurrence of fever and development of pulmonary embolism despite completion of antibiotic therapy. A. aphrohilus is a member of the fastidious gram negative microorganisms of the HACEK group (Haemophilus spp., Aggregatibacter spp, Cardiobaterium hominis, Eikenella corrodens and Kingella kingae), that colonize the oropharynx and are a recognised cause of IE. Prognosis of children with IE due to HACEK group members varies, half of them suffering from complications and mortality rates of 10-12.5%. Although S. lugdunensis belongs to coagulase negative staphylococci (CONS), it behaves more like S. aureus species rather than CONS. This microorganism is a well-described cause of endocarditis in adult patients, associated with high requirements of surgical procedures and mortality (42-78%). In conclusion, paediatric IE can be caused by uncommon microorganisms associated with severe complications and potential fatality. The isolation of S. lugdunensis or A. aphrophilus in febrile patients should be considered clinically relevant and cardiac involvement must be ruled out. Those patients with proved IE will require prolonged intravenous antibiotic courses and in complicated cases surgical intervention. PMID:25751682
Piñerúa Gonsálvez, Jean Félix; Zambrano Infantinot, Rosanna del Carmen; Calcaño, Carlos; Montaño, César; Fuenmayor, Zaida; Rodney, Henry; Rodney, Marianela
Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters. PMID:23781714
Full Text Available Abstract Background There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined. Case presentation The case of a 40-year-old previously healthy man with subacute endocarditis proposed to be contributed from an occult dental abscess is described. The infection was found to be caused by B. vesicularis on blood culture results. The patient recovered without sequelae after treatment with ceftriaxone followed by subsequent ciprofloxacin therapy owing to an allergic reaction to ceftriaxone and treatment failure with ampicillin/sulbactam. Conclusion To our knowledge, this is the first report of B. vesicularis as a cause of infective endocarditis. According to an overview of the literature and our experience, we suggest that third-generation cephalosporins, piperacillin/tazobactam, and ciprofloxacin are effective in treating invasive B. vesicularis infections, while the efficacy of ampicillin-sulbactam needs further evaluation.
Full Text Available Introduction: The American Heart Association (AHA recommendations for antimicrobial prophylaxis for infective endocarditis (IE are controversial. According to the new guidelines released by the AHA now, the only patients to receive antibiotics will be those at highest risk, i.e. those with a prosthetic heart valve, a history of endocarditis, certain forms of congenital heart disease or valvulopathy after heart transplantation, and only before certain dental procedures. Unfortunately, these guidelines are still based largely on expert opinion, with very little hard evidence to show that antibiotic therapy actually prevents IE. The Hypothesis: The reported incidence of bacteremia during dental intervention ranges from 10% to 100% and, with daily brushing and flossing, from 20% to 68%. Because bacteremia also occurs during brushing and flossing of teeth, why give prophylaxis just for dental procedures? Moreover, the risks of causing adverse or anaphylactic reactions from antibiotics as well as contributing to the nationwide antibiotic resistance problem are issues not to be taken lightly. Evaluation of the Hypothesis: The hypothesis discusses the AHA recommendations for antimicrobial prophylaxis for IE, indicating some inherent limitations associated with it, and stresses upon the fact that these recommendation should also be updated, if not completely changed, to cope up with the advancements in the proper treatment plan.
杨莉; 伍卫; 王景峰; 张燕; 张小玲
Objective To discuss thepathogenesis, etiology, clinical manifestations, diagnosis, treatment and prognosis of right-sided infective endocarditis (RIE) . Methods To investigate retrospectively the clinical data of patients with RIE admitted in our hospital from Jan 1985 to Dec 2000.Results There were 17 cases of RIE (12 male, 5female, mean age 22 years), among which 7 with congenital heart disease, 1 with pacemaker implantation and 9 with a history of intravenous drug abuse but without underlying heart disease. Fever and multiple pulmonary emboli were the major clinical manifestations. Blood cultures were positive in 8 cases with Staphylococcus aureus as the predominant microorganism. Echocardiography detected right heart vegetations in all cases, with tricuspid valve as the structure most frequently affected. Most patients were successfully treated with antimicrobials. The outcome was favourable, with a mortality of 11.8 % . Conclusions The clinical features of RIE are different from that of left-sided infective endocarditis (LIE) . Echocardiography plays an important role in the diagnosis of RIE.
Giuseppe; Dattilo; Carmelo; Anfuso; Matteo; Casale; Vincenza; Giugno; Lorenzo; Camarda; Natascia; Laganà; Gianluca; Di; Bella
Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrioventricular plane and left atrium. Although we haven’t data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.
Harinstein, Matthew E; Marroquin, Oscar C
Acute coronary syndromes in the setting of infective endocarditis may be the result of coronary compression secondary to periannular aortic valve complications, coronary embolism, obstruction of the coronary ostium due to a large vegetation, coronary atherosclerosis, and severe aortic insufficiency. External coronary artery compression as a result of infective endocarditis is a rare and lethal finding with few reported cases available in the medical literature. We present a rare occurrence of an acute coronary syndrome occurring in the setting of a bioprosthetic aortic valve abscess in which there was no complete coronary occlusion visualized and given the patient's recent unremarkable catheterization and findings of diffuse tapering of the proximal left coronary system, the most likely etiology was external compression secondary to the known aortic root abscess, which caused myocardial ischemia, and was confirmed during surgery. Although uncommon, external compression should be considered in the differential diagnosis of acute coronary syndrome in this setting and coronary angiography can be diagnostic of this entity. PMID:24660223
Chahoud, Jad; Sharif Yakan, Ahmad; Saad, Hala; Kanj, Souha S
Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis. PMID:26501991
Juan Pablo Casas
Full Text Available La fibrosis pulmonar idiopática (FPI es una enfermedad que se caracteriza por presentar un compromiso pulmonar de tipo restrictivo, resultante de una reducción en la complacencia pulmonar secundaria a fibrosis difusa. En el enfisema, la pérdida de elasticidad pulmonar y el colapso de las vías aéreas periféricas generan obstrucción e hiperinflación. El efecto simultáneo que ambas enfermedades producen sobre la fisiología pulmonar no es del todo claro y se han descripto volúmenes pulmonares normales o casi normales. Presentamos 4 pacientes de sexo masculino de 64, 60, 73 y 70 años, con antecedentes de tabaquismo e historia de disnea progresiva, tres de ellos con grave limitación en su calidad de vida al momento de la consulta. En la tomografía de tórax de alta resolución todos los pacientes presentaban signos de enfermedad intersticial pulmonar avanzada, con cambios de tipo fibrótico con predominio basal y subpleural, que coexistían con enfisema centroacinar con predominio en lóbulos superiores. Uno de ellos tuvo confirmación diagnóstica de ambas condicioes por biopsia pulmonar a cielo abierto. En los cuatro pacientes la espirometría y volúmenes pulmonares fueron normales, pero tenían importante compromiso del intercambio gaseoso evaluado mediante el test de caminata de 6 minutos. Tres de los pacientes tenían hipertensión pulmonar grave diagnosticado por ecocardiograma. La presencia de volúmenes pulmonares normales no excluye un diagnóstico de fibrosis pulmonar idiopática en pacientes fumadores si coexisten evidencias tomográficas de enfisema. En estos pacientes el grado de compromiso funcional, determinado por la reducción de los volúmenes pulmonares, no debería ser considerado en la evaluación de la gravedad.Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive
Full Text Available JUSTIFICATIVA E OBJETIVOS: A endocardite é rara e grave complicação de brucelose humana. O diagnóstico é suspeito em casos de endocardite sem resposta ao tratamento comum e é confirmado com sorologia com teste de ELISA maior que 1:160. O tratamento na maioria dos casos é cirúrgico, associado a antibioticoterapia prolongada. Alguns casos são resolvidos com tratamento clínico, que inclui doxiciclina, rifampicina, ciproproxacina, gentamicina e tetraciclina. O objetivo deste estudo foi relatar um caso raro de endocardite por brucelose. RELATO DO CASO: Paciente do sexo masculino, 51 anos, trabalhador rural, admitido com quadro de febre e emagrecimento. O ecocardiograma mostrou espessamento e vegetação de válvula aórtica. Uma hemocultura foi positiva para Staphylococcus epidermidis. O tratamento foi iniciado no dia da internação com penicilina cristalina, associada com garamicina, sem melhora em três semanas. Foi suspeitada endocardite por brucelose, colhida sorologia e iniciado o tratamento. Os antibióticos usados foram rifampicina e ciprofloxacin associado à vancomicina, devido o resultado da primeira hemocultura. A sorologia de aglutinação para brucelose foi positiva com resultado de 1:360. O paciente melhorou e recebeu alta da UTI, hemodinamicamente estável e em uso de ciprofloxacin e gentamicina. CONCLUSÕES: A endocardite por brucelose não é comum, mas deve ser sempre lembrada quando o tratamento convencional de endocardite não tem boa resposta, principalmente nos pacientes com possível contato com animais e derivados de leite.BACKGROUND AND OBJECTIVES: Endocarditis is a rare and serious complication of human brucellosis. The diagnosis is suspected in cases of endocarditis without response to conservative antibiotic treatment and it is confirmed with enzyme-linked immunosorbent assay (ELISA test, titers being higher than 1:160. The treatment is usually a surgery, followed with antibiotics for long period of time. Some
Cayhl, Murat; Demir, Mesut; Yaliniz, Hafize; Ulus, Tümer; Acartürk, Esmeray
Late endocarditis after surgical repair of tetralogy of Fallot is rare. We describe a case of endocarditis following cholecystectomy in a 22-year old patient with repaired tetralogy of Fallot. After cholecystectomy, the patient was referred to a cardiology clinic with unexplained fever and suspicion of endocarditis. Echocardiography revealed a large mass at the basal level of interventricular septum. Endocarditis was diagnosed on the basis of clinical and echocardiographic findings and antibiotic treatment was initiated immediately. Nine days later, the clinical status of the patient deteriorated and urgent surgery was performed. Patch dehiscence which mimicked a large vegetation, and multiple vegetations on the patch were found during operation. The patch was removed and ventricular septum defect was repaired with a new dacron patch. Enterobacter agglomerans was isolated in the vegetation cultures. PMID:15856630
Seenivasan, M H; Yu, V L
Reported here is a successfully treated case of native mitral valve endocarditis caused by Staphylococcus lugdunensis and a review of 47 similar cases reported in the English literature. In the literature review, perineal skin flora appeared to be the source of the organism in patients with endocarditis. Staphylococcus lugdunensis is generally susceptible in vitro to beta-lactam agents. If speciation is not performed, these bacteria might be mistaken for Staphylococcus epidermidis, a relatively avirulent bacterium that is a common contaminant of cultures. Prompt speciation can lead to earlier recognition of endocarditis and possibly enable earlier surgical intervention with improved outcome for this high-mortality infection. Multiple positive blood cultures yielding coagulase-negative staphylococci should be identified to the species level; endocarditis or another intravascular source of infection should be sought. PMID:12845551
Erica E. Palys
Full Text Available Streptococcus agalactiae, commonly known as Group B streptococcus (GBS, was originally discovered as a cause of bovine mastitis. GBS colonizes the genital tract of up to 40% of women and has become a major pathogen in neonatal meningitis. GBS endocarditis is thought to be an uncommon manifestation of this infection and carries a higher mortality compared to other streptococcal pathogens. Studies have shown that endocarditis after abortion has an incidence of about one per million. However, this figure was published prior to routine use of echocardiography for diagnosis. The American Heart Association has recently declared transesophageal echocardiography the gold standard for endocarditis diagnosis. This case report illustrates that, given the potentially devastating consequences of endocarditis, there is a need for updated studies to adequately assess the true incidence of this infection. Pending the outcome of these studies, routine GBS screening and prophylactic antibiotics prior to abortion should be recommended.
Demin, A A
Key positions of Guidelines on the prevention, diagnosis, and treatment of infective endocarditis issued by the Task Force of ESC in 2009 are explained in the comments. Recent opinions on these items are presented.