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Sample records for infective endocarditis analysis

  1. Infective Endocarditis.

    Science.gov (United States)

    Klein, Michael; Wang, Andrew

    2016-03-01

    Infective endocarditis (IE) is a noncontagious infection of the endocardium and heart valves. The epidemiology of IE has shifted recently with an increase in health care-associated IE. Infective endocarditis requiring intensive care unit stay is increasing, and nosocomial IE is frequently responsible. Diagnosis of IE requires multiple clinical data points encompassing history and physical examination, microbiology, and cardiac imaging as no one test is sufficiently sensitive or specific. The modified Duke criteria algorithm is the standard of care in the clinical diagnosis of IE. Complications from IE are common, particularly so in the critical care setting, and include congestive heart failure, embolism, septic shock, invasive infection, prosthetic valve dehiscence, heart block, and mycotic aneurysm. A multidisciplinary care team of infectious disease, cardiology, and cardiac surgery physicians is recommended to reduce complications. Intravenous antibiotics are first-line therapy with cardiac surgery being reserved for certain complications of IE and/or for clinical situations in which there is a high risk of complications. Timing of surgery for IE remains controversial and depends on a variety of clinical factors. PMID:25320158

  2. Infective endocarditis

    Directory of Open Access Journals (Sweden)

    Sénior, Juan Manuel

    2015-10-01

    Full Text Available Infective endocarditis is a disease caused by colonization and proliferation of infectious agents on the endothelial surface of the heart. Its clinical presentation is variable, depending upon conditions of the patient, such as immunosuppression, presence of prosthetic material, intravenous drug use, and the etiologic agent. Diagnosis is usually established through the addition of elements such as medical history, physical examination, results of blood cultures, echocardiography and other aids. We present the case of an adult male who came to the hospital with fever and symptoms and signs of acute heart failure. The presence of a systolic murmur was documented in the aortic area, and the echocardiogram revealed severe valve regurgitation and a vegetating lesion on the bicuspid aortic valve. He required valve replacement and completed antibiotic treatment based on the sensitivity of the Streptococcus mitis strain that was demonstrated in the blood cultures.

  3. Enterococcus faecalis infective endocarditis

    DEFF Research Database (Denmark)

    Dahl, Anders; Rasmussen, Rasmus V; Bundgaard, Henning; Hassager, Christian; Bruun, Louise E; Lauridsen, Trine K; Moser, Claus; Sogaard, Peter; Arpi, Magnus; Bruun, Niels E

    2013-01-01

    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.

  4. Enterococcus faecalis infective endocarditis

    DEFF Research Database (Denmark)

    Dahl, Anders; Rasmussen, Rasmus V; Bundgaard, Henning; Hassager, Christian; Bruun, Louise E; Lauridsen, Trine K; Moser, Claus; Sogaard, Peter; Arpi, Magnus; Bruun, Niels E

    2013-01-01

    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....

  5. Shewanella putrefaciens infective endocarditis

    Scientific Electronic Library Online (English)

    Jonathan, Constant; Ivan, Chernev; Eric, Gomez.

    2014-12-01

    Full Text Available Shewanella putrefaciens rarely causes infection in humans. In the last few decades a growing number of cases have been described. The following report outlines the case of a 40-year- old immunocompetent white man with S. putrefaciens infective endocarditis. This is the first known case of infective [...] endocarditis due to an apparently monomicrobial S. putrefaciens infection, and the second known case of S. putrefaciens-related infective endocarditis worldwide.

  6. Bacterial Zoonoses and Infective Endocarditis, Algeria

    OpenAIRE

    Benslimani, Akila; Fenollar, Florence; Lepidi, Hubert; Raoult, Didier

    2005-01-01

    Blood culture–negative endocarditis is common in Algeria. We describe the etiology of infective endocarditis in this country. Samples from 110 cases in 108 patients were collected in Algiers. Blood cultures were performed in Algeria. Serologic and molecular analysis of valves was performed in France. Infective endocarditis was classified as definite in 77 cases and possible in 33. Causative agents were detected by blood cultures in 48 cases. All 62 blood culture–negative endocarditis cases we...

  7. Infective endocarditis in neonates.

    OpenAIRE

    O'CALLAGHAN, C.; McDougall, P

    1988-01-01

    Five patients with neonatal infective endocarditis were reviewed, two of whom survived. Infection was caused by Staphylococcus aureus in four and by Candida albicans in one. All cases of bacterial endocarditis had clinical signs of septicaemia, positive blood cultures, thrombocytopenia, microscopic haematuria, and heart murmurs. Three developed skin abscesses early in their illnesses. Three patients had two dimensional echocardiographic studies that showed bacterial vegetations. One of these ...

  8. Infective endocarditis, 1984 through 1993

    DEFF Research Database (Denmark)

    Benn, Marianne; Hagelskjaer, L H; Tvede, M

    1997-01-01

    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....

  9. Endocarditis infecciosa. Análisis retrospectivo de tres años (1995-1997. Infective endocarditis: a 3-year retrospective analysis (1995-97

    Directory of Open Access Journals (Sweden)

    Juana María Zulueta Fuentes

    1999-01-01

    Full Text Available Fueron analizadas retrospectivamente las historias clínicas de 24 pacientes con endocarditis infecciosa en el período comprendido entre enero de 1995 y diciembre de 1997, con el objetivo de conocer las características de este grupo. La mitad de los pacientes tenían implantados marcapasos permanentes y la tercera parte eran portadores de cardiopatías valvulares primitivas. La puerta de entrada se identificó en el 45,8 % de los pacientes y en casi las dos terceras partes de ellos fue la sepsis del bolsillo del marcapasos el inicio de la infección. Los microorganismos causales se determinaron en el 79,2 % y los gérmenes más frecuentes fueron el estafilococo coagulasa positivo, el estafilococo coagulasa negativo y el estreptococo viridans. La forma de resolución fue quirúrgica en 14 enfermos y médica en 2. Fallecieron 8 pacientes como consecuencia de complicaciones cardíacas y sépticas. Concluimos que debe realizarse una rigurosa profilaxis antibiótica a los pacientes con prótesis valvular cardíaca o con marcapasos permanentes ante cualquier instrumentación quirúrgica por el alto riesgo de que se presente la endocarditis infecciosa. A retrospective analysis of the medical histories of 24 patients suffering from infective endocarditis from January 1995 to December 1997 was made, with a view to finding out the characteristics of this group of patients. Half of the patients had permanent pacemakers and one third were carriers of native valve cardiopathies. Access route for the disease was detected in 45.8 % of them whereas pacemaker pocket sepsis was the origin of the infection in almost two-thirds of them. Microorganisms causing the sepsis were determined in 79.2 % of cases and the most commom were positive staphylococcus coagulase, negative staphylococcus coagulase and streptococcus viridans. 14 patients were treated with surgical therapy and 2 with medical treatment. Eight patients died from heart septic complications. We concluded that a strict antibiotic prophylaxis should be followed in patients having heart valve protheses or permanent pacemakers in the face of any surgical intervention because of the risks posed by infective endocarditis.

  10. Analysis of clinical features and risk factors for infective endocarditis

    International Nuclear Information System (INIS)

    Objective: To analyze the clinical features of infective endocarditis (IE) and explore the risk factors for it's prognosis. Methods: Clinical data of 65 patients with IE were acquired retrospectively, and its causes, clinical characteristics, pathogenic microorganism, clinical outcomes were analyzed. Results: The major occurring heart diseases for IE in all patients were rheumatic heart disease, congenital heart disease, and there was no any previously known heart disease. The major clinical manifestations included fever and anemia. The major pathogenic bacteria is streptococcus, but percentage of other bacteria increased gradually. Thirteen patients were refractory, in hospital. Haematoglobin and seralbumin were significantly lower, and leucocyte, hsCRP, erythrocyte sedimentation were significantly higher in refractory group. Anaemia, lower seralbumin, higher hsCRP were independent predictors for bad prognosis. Conclusion: The proportion of rheumatic heart disease is decreasing as one of the risk factors for IE in recent years. Streptococcus is major pathogen of IE, and the mortality of IE is still very high. Anaemia, lower seralbumin, higher hsCRP are independent predictors for bad prognosis. (authors)

  11. Infective endocarditis due to brucella

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    Purwar S

    2006-01-01

    Full Text Available One of the complications of brucellosis is infective endocarditis, which carries a high mortality rate if undiagnosed or misdiagnosed. We report a case of Brucella infective endocarditis, which was diagnosed serologically and by polymerase chain reaction. After Brucella specific treatment, patient showed dramatic improvement clinically, as evident by echocardiogram findings and other investigations.

  12. Infective endocarditis due to brucella.

    Science.gov (United States)

    Purwar, S; Metgud, S C; Darshan, A; Mutnal, M B; Nagmoti, M B

    2006-10-01

    One of the complications of brucellosis is infective endocarditis, which carries a high mortality rate if undiagnosed or misdiagnosed. We report a case of Brucella infective endocarditis, which was diagnosed serologically and by polymerase chain reaction. After Brucella specific treatment, patient showed dramatic improvement clinically, as evident by echocardiogram findings and other investigations. PMID:17185849

  13. Infective endocarditis due to brucella

    OpenAIRE

    Purwar S; Metgud S; Darshan A; Mutnal M; Nagmoti M

    2006-01-01

    One of the complications of brucellosis is infective endocarditis, which carries a high mortality rate if undiagnosed or misdiagnosed. We report a case of Brucella infective endocarditis, which was diagnosed serologically and by polymerase chain reaction. After Brucella specific treatment, patient showed dramatic improvement clinically, as evident by echocardiogram findings and other investigations.

  14. Serious complications after infective endocarditis

    DEFF Research Database (Denmark)

    Gill, Sabine

    2010-01-01

    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....

  15. Analysis of the Genotype and Virulence of Staphylococcus epidermidis Isolates from Patients with Infective Endocarditis? †

    OpenAIRE

    Monk, Alastair B; Boundy, Sam; Chu, Vivian H; Bettinger, Jill C.; Robles, Jaime R.; Fowler, Vance G.; Archer, Gordon L.

    2008-01-01

    Staphylococcus epidermidis is one of the most common causes of infections of prosthetic heart valves (prosthetic valve endocarditis [PVE]) and an increasingly common cause of infections of native heart valves (native valve endocarditis [NVE]). While S. epidermidis typically causes indolent infections of prosthetic devices, including prosthetic valves and intravascular catheters, S. epidermidis NVE is a virulent infection associated with valve destruction and high mortality. In order to see if...

  16. Infective Endocarditis during Pregnancy

    International Nuclear Information System (INIS)

    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)

  17. Optimal timing for early surgery in infective endocarditis: a meta-analysis†.

    Science.gov (United States)

    Liang, Fuxiang; Song, Bing; Liu, Ruisheng; Yang, Liu; Tang, Hanbo; Li, Yuanming

    2016-03-01

    To systematically review early surgery and the optimal timing of surgery in patients with infective endocarditis (IE), a search for foreign and domestic articles on cohort studies about the association between early surgery and infective endocarditis published from inception to January 2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature (CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality of the method of the included studies was assessed. Then, the meta-analysis was performed using the Stata 12.0 software. Sixteen cohort studies, including 8141 participants were finally included. The results of the meta-analysis revealed that, compared with non-early surgery, early surgery in IE lowers the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95% confidence interval (CI) (0.42, 0.77); P = 0.000, I(2) = 73.1%] and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001, I(2) = 67.4%]. Further, performing operation within 2 weeks had a more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41, 0.97); P = 0.192, I(2) = 39.4%] than non-early surgery. In different kinds of IE, we found that early surgery for native valve endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31, 0.69); P = 0.001, I(2) = 73.0%] and long-term [OR = 0.57, 95% CI (0.40, 0.81); P = 0.001, I(2) = 68.9%] mortality than the non-early surgery group. However, for prosthetic valve endocarditis (PVE), in-hospital mortality did not differ significantly [OR = 0.83, 95% CI (0.65, 1.06); P = 0.413, I(2) = 0.0%] between early and non-early surgery. We concluded that early surgery was associated with lower in-hospital and long-term mortality compared with non-early surgical treatment for IE, especially in NVE. However, the optimal timing of surgery remains unclear. Additional larger prospective clinical trials will be required to clarify the optimal timing for surgical intervention and determine its efficacy in PVE. PMID:26678152

  18. Nosocomial infective endocarditis in Hemodialysis

    International Nuclear Information System (INIS)

    There is an increased risk of infective endocarditis catheterization usedfor Hemodialysis. We report a case of a young man who had endocarditissecondary to the use of a permanent jugular catheter for hemodialysis. Bloodcultures were repeatedly negative, but vegetations were seen on the tricuspidvalve on echocardiography. A high index of suspicion is recommended for thisserious complication. (author)

  19. Metagenomic analysis for detecting pathogens in culture-negative infective endocarditis.

    Science.gov (United States)

    Fukui, Yuto; Aoki, Kotaro; Okuma, Shinnosuke; Sato, Takahiro; Ishii, Yoshikazu; Tateda, Kazuhiro

    2015-12-01

    Pathogen identification is important for proper diagnosis and optimal treatment of infective endocarditis (IE). Blood and valve cultures are the gold standard for detecting pathogens responsible for IE. However, these tests only detect culturable pathogens, and have low sensitivity, especially in patients previously treated with antibiotics. Culture-negative IE is still a major clinical problem and a diagnostic challenge. Recently, metagenomic analysis using next generation sequencing has been used to detect pathogens directly from clinical samples. However, there are very few reports of the use of metagenomic analysis for pathogen identification in culture-negative IE cases and the usefulness of this new method is unknown. Here, we report a case of successful pathogen detection with metagenomic analysis in a patient of culture-negative IE. The patient underwent valve replacement surgery and received antibiotics for 5 weeks and survived. Using metagenomic analysis of resected vegetation, we detected Abiotrophia defectiva, which is often associated with culture-negative IE due to its fastidious growth. This method may be useful for pathogen identification in future cases of culture-negative IE. PMID:26360016

  20. Diagnostic value of echocardiography in infective endocarditis

    International Nuclear Information System (INIS)

    Objective: To investigate the feature and value of echocardiography for diagnosing infective endocarditis. Methods: The shape, size, echogenicity, distribution of vegetations and valvular injury of the heart were observed in 30 patients with infective endocarditis. Results: The vegetations were located in the aortic valves (10 cases), bicuspid valves (5), tricuspid valve (1), pulmonary valve (2), main pulmonary artery with patent ductus arteriosus (2), and right ventricle with ventricular septal defect (2). The size of vegetation ranged from 2 to 27 mm and the echogenicity of vegetations was low to high. The location, size, shape and amount of vegetations observed on echocardiography correlated well with the operative findings. Echocardiography also demonstrated underlying heart disease and abnormal hemodynamics induced by infective endocarditis. Conclusion: Echocardiography can determine the location, size, shape, amount of vegetation and concomitant cardiac disease in patients with infective endocarditis. It play an important role in treatment and prognosis. (authors)

  1. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2014-07-01

    Full Text Available Three-year observation of acute tricuspid infective endocarditis in intravenous drug abused patient: diagnosis, clinical features, visceral lesions, the possibility of cardiac surgery and conservative treatment, outcome.

  2. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj; Arnous, Samer; Franzen, Olaf; Bundgaard, Henning; Søndergaard, Lars

    2013-01-01

    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....

  3. Cardiobacterium valvarum infective endocarditis and phenotypic/molecular characterization of 11 Cardiobacterium species strains

    DEFF Research Database (Denmark)

    Chen, Ming; Kemp, Michael; Bruun, Niels E; Bangsborg, Jette M; Højlyng, Niels; Hesselbjerg, Annemarie; Dargis, Rimtas; Christensen, Jens Jørgen

    2011-01-01

    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...

  4. Infective endocarditis in patients with hepatic diseases.

    Science.gov (United States)

    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

    2016-02-01

    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?analysis, factors associated with hospital-associated mortality were having an 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

  5. Hairy Cell Leukemia Masquerading as Infective Endocarditis

    OpenAIRE

    Ramasamy, Chandramohan; Dubashi, Biswajit; Rekha, J. Sree; Basu, Debdatta; Jain, Ankit; Dutta, Tarun Kumar

    2012-01-01

    Hairy cell leukemia is a chronic lymphoproliferative disorder affecting middle-aged adults, with the median age of 50–55 years. We report a case of hairy cell leukemia who presented with fever, splinter haemorrhages and moderate splenomegaly, simulating infective endocarditis. There was bicytopenia at presentation and hairy cells were seen in the peripheral blood.

  6. Complete genome and comparative analysis of Streptococcus gallolyticus subsp. gallolyticus, an emerging pathogen of infective endocarditis

    Directory of Open Access Journals (Sweden)

    Dreier Jens

    2011-08-01

    Full Text Available Abstract Background Streptococcus gallolyticus subsp. gallolyticus is an important causative agent of infectious endocarditis, while the pathogenicity of this species is widely unclear. To gain insight into the pathomechanisms and the underlying genetic elements for lateral gene transfer, we sequenced the entire genome of this pathogen. Results We sequenced the whole genome of S. gallolyticus subsp. gallolyticus strain ATCC BAA-2069, consisting of a 2,356,444 bp circular DNA molecule with a G+C-content of 37.65% and a novel 20,765 bp plasmid designated as pSGG1. Bioinformatic analysis predicted 2,309 ORFs and the presence of 80 tRNAs and 21 rRNAs in the chromosome. Furthermore, 21 ORFs were detected on the plasmid pSGG1, including tetracycline resistance genes telL and tet(O/W/32/O. Screening of 41 S. gallolyticus subsp. gallolyticus isolates revealed one plasmid (pSGG2 homologous to pSGG1. We further predicted 21 surface proteins containing the cell wall-sorting motif LPxTG, which were shown to play a functional role in the adhesion of bacteria to host cells. In addition, we performed a whole genome comparison to the recently sequenced S. gallolyticus subsp. gallolyticus strain UCN34, revealing significant differences. Conclusions The analysis of the whole genome sequence of S. gallolyticus subsp. gallolyticus promotes understanding of genetic factors concerning the pathogenesis and adhesion to ECM of this pathogen. For the first time we detected the presence of the mobilizable pSGG1 plasmid, which may play a functional role in lateral gene transfer and promote a selective advantage due to a tetracycline resistance.

  7. Timing of surgery in infective endocarditis.

    Science.gov (United States)

    Kang, Duk-Hyun

    2015-11-15

    Although early surgery is performed in approximately half of patients for the treatment of infective endocarditis (IE), the optimal timing of surgery remains unclear. Appropriate early surgery can avoid death and severe complications, but nearly one-quarter of patients with indications for surgery do not receive surgical intervention. Multidisciplinary collaborations among cardiologists, cardiac surgeons and infectious disease specialists are required for appropriate decisions about indication and timing of surgical intervention. Moreover, the potential benefits of early surgery should be weighed against its operative risks and long-term consequences. The main indications for early surgery in patients with IE are heart failure (HF), uncontrolled infection and prevention of embolism. Role of early surgery has been expanding and a recent randomised trial demonstrated that early surgery performed within 48?h after the diagnosis of IE effectively reduced systemic embolisms without increasing operative mortality or recurrence of IE. Urgent surgery is indicated in patients who have moderate to severe HF, uncontrolled infection and large vegetations associated with severe valvular disease. However, surgery should be delayed for 2-4?weeks in patients with large cerebral infarction and for at least 4?weeks in those with intracerebral haemorrhage if possible, because early surgery may pose significant risks of neurological deterioration and perioperative cerebral bleeding. The decision for surgical timing should be based on individual risk-benefit analysis, and early surgery is strongly indicated if its benefits exceed operative risks. PMID:26285598

  8. Endocarditis infecciosa activa: 152 casos / Active infective endocarditis: 152 cases

    Scientific Electronic Library Online (English)

    Lucía R., Kazelian; Luis A., Vidal; Roberto, Neme; Juan A., Gagliardi.

    2012-04-01

    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 caract [...] erísticas 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. Abstract in english 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, mortality remains very high. Our goal was to analyze the characteristics of patients with active IE and their rel [...] ationship with in-hospital mortality over 16 years. Between 1994 and 2010 we performed a prospective registry of 152 consecutive patients (64.5% male, age 45 ± 16 years) admitted with IE. Clinical characteristics, treatment and inpatient outcomes were analyzed. The most common causes of underlying heart disease were: congenital (21%) and rheumatic fever (13.2%). The reasons for hospitalization were fever (76.3%) and heart failure (40.1%). The infectious agent was identified in 69.7% of cases, and the most frequent was Streptococcus viridans. The echocardiogram showed vegetations in 80.9% of patients and 57.8% of them presented complications (the most frequent was heart failure) during hospitalization. Surgical treatment was indicated in 63.2% of cases, mainly due to heart failure. The overall hospital mortality was 30.2%. The presence of complications, requirement of surgical treatment and refractory heart failure were independent predictors of mortality whereas the single presence of vegetation showed better survival rate. The identification of these predictors could help to improve the outcomes in IE.

  9. [Management of Infective Endocarditis with Neurological Complication].

    Science.gov (United States)

    Fukuda, Wakako; Daitoku, Kazuyuki; Minakawa, Masahito; Suzuki, Yasuyuki; Fukuda, Ikuo

    2015-10-01

    Neurological complications in patients with infective endocarditis are frequent and mortality is higher in those with neurological complications than in those without. The spectrum of neurological complications includes cerebral infarction, intracranial hemorrhage, intracranial infectious aneurysm, transient ischemic attack (TIA), meningitis, encephalopathy and brain abscess. The appropriate timing of valve surgery following a cerebrovascular event remains controversial because cardiopulmonary bypass may exacerbate neurological deficits. Previous studies suggest delaying valve surgery for 2 to 4 weeks following embolic stroke and at least 4 weeks following hemorrhagic stroke however, urgent valve surgery may be needed depending on the hemodynamic state of the patient. In the event of intracranial infectious aneurysm, therapeutic management is not perfectly standardized. We retrospectively reviewed the surgical results of infective endocarditis patients with neurological complications. Current trends in surgical timing and therapeutic decision-making are discussed. PMID:26469254

  10. Infective Endocarditis in a Collegiate Wrestler

    OpenAIRE

    May, Cecilia L.; Hodde, Jason P; Badylak, Stephen F; Smith, Gerritt F.

    1995-01-01

    A 21-year-old collegiate wrestler was admitted to the hospital suffering from acute left lower quadrant abdominal pain. Blood cultures taken at the time of admission showed Staphylococcus aureus. The results of a computed tomography scan and a two-dimensional echocardiogram were consistent with a diagnosis of infective endocarditis. Therapy consisted of a 14-day hospitalization, a 28-day course of parenteral antibiotics, and subsequent follow-up visits. He returned to full participation in wr...

  11. Infective endocarditis, rheumatoid factor, and anticardiolipin antibodies.

    OpenAIRE

    Asherson, R. A.; Tikly, M; Staub, H; Wilmshurst, P T; Coltart, D J; Khamashta, M; Hughes, G R

    1990-01-01

    Serum samples from 22 patients with infective endocarditis were analysed for the presence of antibodies to cardiolipin, false positive Venereal Disease Research Laboratory (VDRL) test, and rheumatoid factor in order to determine the prevalence of anticardiolipin antibodies, their level, and to ascertain whether there was any correlation with the presence of rheumatoid factor. Although the latex test was positive in 10/22 (45%) patients, anticardiolipin antibodies, usually of a low level, were...

  12. [Mitral Valvuloplasty of Infective Endocarditis During Pregnancy].

    Science.gov (United States)

    Miyaki, Yasuko; Higami, Tetsuya; Ishikawa, Natsuya; Takagi, Nobuyuki; Tachibana, Kazutoshi; Hagiwara, Takayuki

    2015-11-01

    This report describes a case in which we treated a patient who developed infective endocarditis in the mitral valve at 28 weeks' gestation. The condition was resolved by performing mitral valvuloplasty 2 days after an emergency cesarean section. Although the patient was in a relatively stable period at 32 weeks' gestation, the mother had an extremely high risk of embolism;thus, emergency surgery was required. We believe that an accurate diagnosis in a timely manner and a valvuloplasty shortly after cesarean section saved the life of the mother and child. PMID:26555912

  13. Comparative Evaluation of Cases with Community-Acquired Infective Endocarditis and Health Care-Associated Infective Endocarditis

    Directory of Open Access Journals (Sweden)

    Ebru Kursun

    2015-03-01

    Full Text Available Purpose: The present study aimed to comparatively evaluate the cases with health care-associated infective endocarditis and the cases with community-acquired infective endocarditis. Material and Methods: Of the cases followed for infective endocarditis (IE, 21 (40 % had health care-associated infective endocarditis and 31 (60 % community-acquired infective endocarditis. Results: Comparing the cases with community acquired infective endocarditis and the cases with health care-associated infective endocarditis, it was determined that advanced age (58.0 +/- 15.1 years vs. 41.3+/- 14.4 years, P= 0.000, presence of chronic renal insufficiency (P= 0.001 and diabetes mellitus (P= 0.016 as concomitant diseases, being previously hospitalized (P= 0.0001, hemodialysis in terms of diagnostic and therapeutic interventions (P= 0.022, presence of central venous catheter (P= 0.022, and undergone intervention for gastrointestinal system (P= 0.060,as well as laboratory results including positive blood culture growth for S. aureus and Enterococcus (P= 0.037, and complications such as development of embolic event (P= 0.008, spondylodiscitis (P= 0.034 and stroke (P= 0.007 were statistically significantly more common in health care-associated infective endocarditis cases. Whilst mortality was higher in health care-associated infective endocarditis cases (28.6 %, it was determined that there was no statistically significant difference between the groups. Conclusion: Health care-associated infective endocarditis is a disease that is more common in the patients at advanced age, with concomitant disease and the history of exposing invasive procedures in the past for diagnostic and therapeutic purpose, and it is a disease with high morbidity and mortality that courses with serious complications [Cukurova Med J 2015; 40(1.000: 91-97

  14. A severe infective endocarditis successfully treated with linezolid

    Directory of Open Access Journals (Sweden)

    Graziano Antonio Minafra

    2010-03-01

    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.

  15. Infective Endocarditis: Identification of Catalase-Negative, Gram-Positive Cocci from Blood Cultures by Partial 16S rRNA Gene Analysis and by Vitek 2 Examination

    DEFF Research Database (Denmark)

    Abdul-Redha, Rawaa Jalil; Kemp, Michael; Bangsborg, Jette M; Arpi, Magnus; Christensen, Jens Jørgen

    2010-01-01

    Streptococci, enterococci and Streptococcus-like bacteria are frequent etiologic agents of infective endocarditis and correct species identification can be a laboratory challenge. Viridans streptococci (VS) not seldomly cause contamination of blood cultures. Vitek 2 and partial sequencing of the 16S rRNA gene were applied in order to compare the results of both methods. STRAINS ORIGINATED FROM TWO GROUPS OF PATIENTS: 149 strains from patients with infective endocarditis and 181 strains assessed ...

  16. Infective endocarditis in the military patient.

    Science.gov (United States)

    Gough, Andrew; Clay, K; Williams, A; Jackson, S; Prendergast, B

    2015-09-01

    Infective endocarditis (IE) is a potentially fatal cardiac infection associated with an inhospital mortality rate of up to 22%. Fifty per cent of IE cases develop in patients with no known history of valve disease. It is therefore important to remain vigilant to the possibility of the diagnosis in patients with a febrile illness and unknown source. From a military perspective, our patients are unique due to the breadth of pathogens they are exposed to, and blood-culture-negative IE is a risk. In particular, there should be awareness of Coxiella burnetii as a possible causative pathogen. In this review we incorporate the latest consensus from systematic reviews and publications identified by a literature search through Medline. We describe the diagnosis and management of IE with particular reference to the military population. PMID:26243804

  17. Complicaciones neurológicas de la endocarditis infecciosa: controversias Neurological complications of infective endocarditis: controversies

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    Federico A Silva

    2011-07-01

    Full Text Available En la endocarditis infecciosa aguda se describen complicaciones neurológicas entre 20% y 40% de los casos, lo cual representa un importante factor que predice morbimortalidad, secuelas y discapacidad. Esta entidad se caracteriza por un amplio espectro clínico debido a su compleja fisiopatología, que involucra entre otros, fenómenos inflamatorios, inmunes, infecciosos y embólicos. A pesar de la notable frecuencia de las complicaciones neurológicas en la endocarditis infecciosa, dadas especialmente por enfermedad cerebrovascular y neuroinfecciones, aun existen controversias acerca de algunos aspectos diagnósticos y terapéuticos, en parte por la poca evidencia disponible, las cuales se discuten a continuación, a partir de una serie de casos atendidos en la Fundación Cardiovascular de Colombia.Neurological complications of acute infective endocarditis are described in 20%-40% of cases, representing an important predictive factor of morbidity, mortality, sequels and disability. Acute endocarditis is characterized by a wide clinical spectrum due to its complex physiopathology that involves inflammatory, immune, infectious and embolic phenomena. Despite the remarkable frequency of neurological complications in the infective endocarditis especially by cerebrovascular disease and neuroinfections, there are still some controversies about some diagnostic and therapeutic aspects, partly because of the little evidence available. This paper describes a number of cases seen in the Fundación Cardiovascular de Colombia and discusses some aspects related with the diagnosis and treatment of the neurological complications of acute endocarditis.

  18. Infective endocarditis in chronic hemodialysis patients: Experience from Morocco

    Directory of Open Access Journals (Sweden)

    Dina Montasser

    2011-01-01

    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.

  19. Anatomical Findings in Patients with Infective Endocarditis Diagnosed at Autopsy

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    Miguel Angel Serra Valdés

    2013-12-01

    Full Text Available Background: Infective endocarditis continues to challenge modern medicine despite its rare occurrence in the general population. Its incidence depends on risk groups. Correlation of anatomical and pathological findings with clinical and epidemiological elements may explain the current features of this condition. Objective: to describe the anatomical features of patients with infective endocarditis diagnosed at autopsy. Methods: A descriptive study including cases of infective endocarditis diagnosed at autopsy between 1986 and 2008 was conducted in the Provincial Clinical-Surgical Hospital Celia Sanchez, Granma. The variables analyzed were: age, sex, previous anatomical lesions, location of vegetations, multi-organ embolic infarcts and embolic abscesses, complications, culture of lesions and direct causes of death. Results: frequency of infective endocarditis diagnosed at necropsy ranged annually from 0.4 to 1.5%. Native valve endocarditis without previous damage was the most frequent. The anatomical findings were more common in the left side of the heart. Right-sided nosocomial endocarditis accounted for almost a third of the deceased patients and risk factors were identified. Embolic lesions affecting various organs, systemic complications and direct causes of death showed acute infectious endocarditis. The most common pathogen was Staphylococcus aureus. Conclusion: knowing the anatomical findings may contribute to the understanding of the clinical and epidemiological aspects of this condition. Correlation between anatomical and clinical findings was low; therefore difficulties in establishing the diagnosis during life are inferred.

  20. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Høst, Ulla; Arpi, Magnus; Hassager, Christian; Johansen, Helle K; Korup, Eva; Schønheyder, Henrik C; Berning, Jens; Gill, Sabine; Rosenvinge, Flemming S; Fowler, Vance G; Møller, Jacob E; Skov, Robert L; Larsen, Carsten T; Hansen, Thomas F; Mard, Shan; Smit, Jesper; Andersen, Paal S; Bruun, Niels E

    2011-01-01

    Aims Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population. Methods...

  1. Mycotic aneurysm: a rare and dreaded complication of infective endocarditis

    OpenAIRE

    Singla, Vivek; Sharma, Rajni; Nagamani, A C; Manjunath, Cholenahally Nanjappa

    2013-01-01

    Mycotic cerebral aneurysm is a rare and potentially fatal complication of infective endocarditis. A young man was diagnosed with culture negative infective endocarditis of mitral valve with cerebral aneurysm. The patient was started on conservative management, but he died owing to intracerebral haemorrhage. In the absence of large randomised trials, there is a lack of consensus regarding the management of unruptured aneurysms. Since mycotic aneurysms are known to resolve or decrease in size w...

  2. Severe infective endocarditis in a healthy adult due to Streptococcus agalactiae

    OpenAIRE

    Hiroaki Fujita; Itaru Nakamura; Ayaka Tsukimori; Akihiro Sato; Kiyofumi Ohkusu; Tetsuya Matsumoto

    2015-01-01

    A case of severe endocarditis, with complications of multiple infarction, meningitis, and ruptured mitral chordae tendineae, caused by Streptococcus agalactiae in a healthy man, is reported. Emergency cardiovascular surgery was performed on the day of admission. Infective endocarditis caused by S. agalactiae is very rare, particularly in a healthy adult. In addition, microbiological analysis revealed that S. agalactiae of sequence type (ST) 19, which belongs to serotype III, was present in th...

  3. Infective endocarditis: a history of the development of its understanding

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    Stephen A. Geller

    2013-12-01

    Full Text Available Inflammation of the inner layer of the heart, especially the valvular endothelium, chordae tendinae and mural endocardium was first recognized almost 350 years ago. Over the years it has had many names, but is now generally designated infective endocarditis (IE and has an associated infectious agent. A sterile vegetative process can also affect the valves and is usually referred to as Libman-Sacks endocarditis. The developments of medical science that allowed for our understanding of this entity included refinement of the autopsy, medical microscopy, microbiology, and in recent years, molecular studies. Some observations were misleading but clarification particularly followed the reports of Morgagni, Osler and Libman. As understanding of the pathobiology of infective endocarditis grew so did the effectiveness of therapy. This paper provides a detailed history of the development of the concept of Infective endocarditis citing many key morphological observations and concludes with brief comments about current concepts of pathogenesis as well as a few remarks about therapy.

  4. Prevention of infective endocarditis in developing countries - justifiable caution?

    Scientific Electronic Library Online (English)

    Andy, Parrish; Breminand, Maharaj.

    2012-08-01

    Full Text Available The internationally accepted practice of prescribing prophylactic antibiotics to individuals at risk of infective endocarditis has come under scrutiny. There are no published high-quality randomised controlled trials of the intervention, but new insights have emerged. Bacteraemic episodes are common [...] following simple activities such as brushing teeth. Endocarditis following procedures is extremely rare, and systematic reviews of the evidence for prophylactic antibiotics have failed to demonstrate efficacy.

  5. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases

    Science.gov (United States)

    TOPAN, ADRIANA; CARSTINA, DUMITRU; SLAVCOVICI, ADRIANA; RANCEA, RALUCA; CAPALNEANU, RADU; LUPSE, MIHAELA

    2015-01-01

    Background and aims In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult. Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients. The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis. Methods We performed a prospective observational study between January 2008 – June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute . We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE. Results The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible. Conclusion Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations - bacteremia, fever and peripheral stigmata - makes the diagnosis of IE a challenge. PMID:26609264

  6. Severe infective endocarditis in a healthy adult due to Streptococcus agalactiae.

    Science.gov (United States)

    Fujita, Hiroaki; Nakamura, Itaru; Tsukimori, Ayaka; Sato, Akihiro; Ohkusu, Kiyofumi; Matsumoto, Tetsuya

    2015-09-01

    A case of severe endocarditis, with complications of multiple infarction, meningitis, and ruptured mitral chordae tendineae, caused by Streptococcus agalactiae in a healthy man, is reported. Emergency cardiovascular surgery was performed on the day of admission. Infective endocarditis caused by S. agalactiae is very rare, particularly in a healthy adult. In addition, microbiological analysis revealed that S. agalactiae of sequence type (ST) 19, which belongs to serotype III, was present in the patient's vegetation, mitral valve, and blood culture. It was therefore concluded that the endocarditis was caused by ST19, which has been reported as a non-invasive type of S. agalactiae. This was an extremely rare case in which S. agalactiae of ST19 caused very severe endocarditis in an adult patient with no underlying disease. PMID:26188131

  7. Severe infective endocarditis in a healthy adult due to Streptococcus agalactiae

    Directory of Open Access Journals (Sweden)

    Hiroaki Fujita

    2015-09-01

    Full Text Available A case of severe endocarditis, with complications of multiple infarction, meningitis, and ruptured mitral chordae tendineae, caused by Streptococcus agalactiae in a healthy man, is reported. Emergency cardiovascular surgery was performed on the day of admission. Infective endocarditis caused by S. agalactiae is very rare, particularly in a healthy adult. In addition, microbiological analysis revealed that S. agalactiae of sequence type (ST 19, which belongs to serotype III, was present in the patient's vegetation, mitral valve, and blood culture. It was therefore concluded that the endocarditis was caused by ST19, which has been reported as a non-invasive type of S. agalactiae. This was an extremely rare case in which S. agalactiae of ST19 caused very severe endocarditis in an adult patient with no underlying disease.

  8. Infective endocarditis presents as isolated splenomegaly

    OpenAIRE

    Rohani, Atoosheh; Akbari, Vahid; Homayoon, Kianoosh

    2011-01-01

    Sub acute left-sided bacterial endocarditis is a serious condition that may be overlooked due to highly variable clinical manifestations. We present the case of a 45-year-old man who presented with complaints of fullness in his abdomen and splenomegaly that referred to the surgery clinic. He underwent diagnostic splenectomy. 3 month after splenectomy endocarditis was diagnosed. We recommend echocardiography in the work up of isolated splenomegaly.

  9. Brain magnetic resonance findings in infective endocarditis with neurological complications

    International Nuclear Information System (INIS)

    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)

  10. [An exceptional case of tricuspid infective endocarditis due to Bartonella henseale revealed by an old pulmonary embolism].

    Science.gov (United States)

    Verdier-Watts, F; Peloni, J-M; Piegay, F; Gérôme, P; Aussoleil, A; Durand-de-Gevigney, G; Mioulet, D; Griffet, V

    2016-02-01

    We report a case of blood culture-negative tricuspid infective endocarditis revealed after tick bite by repeated pulmonary infection during one year due to septic pulmonary emboli in a 67-year-old farmer woman. Tricuspid vegetation and pulmonary emboli are calcified. Lyme serology is negative. Serologic test and PCR analysis are positive to Bartonella henselae. The evolution is favorable after antibiotic and anticoagulant treatment. Infective endocarditis due to B. henselae is an exceptional complication of cat scratch disease. You have to think about in case of blood culture-negative endocarditis with calcified valvular lesions even without cat bite, tick seems to be vector of the bacteria. PMID:25869466

  11. Pacemaker Related Infective Endocarditis from Staphylococcus Lugdunensis: A Case Report

    OpenAIRE

    Michael Ward; Boehm, Kevin M.

    2013-01-01

    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.

  12. Infective Endocarditis Involving the Pulmonary Valve.

    Science.gov (United States)

    Miranda, William R; Connolly, Heidi M; DeSimone, Daniel C; Phillips, Sabrina D; Wilson, Walter R; Sohail, Muhammad R; Steckelberg, James M; Baddour, Larry M

    2015-12-15

    Pulmonary valve (PV) infective endocarditis (IE) is a rare entity, accounting for 1.5% to 2% of cases of IE. Published data are limited to a few case series and reports. We sought to review the Mayo Clinic experience and describe clinical, echocardiographic, and microbiologic features. We included all patients aged ?18 years seen from 2000 to 2014 who had a diagnosis of native PV IE and unequivocal echocardiographic involvement of the PV. Nine patients with PV IE were identified. Isolated PV IE was present in 7 (78%) of 9 cases. The median age was 59 years and 22% were women. Three patients had congenital heart disease, 2 had central venous catheters, and 3 had cardiovascular implantable electronic devices. Five patients (56%) received chronic immunosuppressive therapy. Enterococcus faecalis and viridans group streptococci were the most common pathogens, isolated in 22% of cases each. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) were done in 6 and 7 patients, respectively. Four patients underwent both procedures. TTE was diagnostic in all cases, but TEE failed to detect PV involvement in 1 patient. Median follow-up was 1.8 years. Five patients (56%) underwent PV replacement. There were no operative deaths. One patient had sudden death during follow-up, unrelated to his PV IE episode. Our results suggest that PV IE is rare but carries significant morbidity. TTE and TEE provide complementary information with TEE providing better visualization of other cardiac structures. Our findings of a high prevalence of immunosuppressive therapy and cardiovascular implantable electronic devices have not been previously reported and deserve further investigation. PMID:26611123

  13. 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

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Pedersen, Line; Calum, Henrik; Nielsen, Jesper Boye; Tvede, Michael; Schønning, Kristian; Knudsen, Jenny Dahl

    2011-01-01

    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....

  14. Infective endocarditis following transcatheter aortic valve replacement-

    DEFF Research Database (Denmark)

    Loh, Poay Huan; Bundgaard, Henning; S�ndergaard, Lars

    2013-01-01

    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...

  15. Surgical treatment of active infective endocarditis: A single center experience

    Science.gov (United States)

    Aziz, Fahad; Doddi, Sujatha; Penupolu, Sudheer; Dutta, Simanta; Alok, Anshu

    2010-01-01

    Objective This study was undertaken to examine the outcomes of surgery for active infective endocarditis. Methods Fifty consecutive patients underwent surgery for active infective endocarditis in a tertiary care center between January 2000 and June 2003. Modified Duke Criteria was used to include the patients in the study. Results Mean age of the patients was 55.72 years (range 18-89 years). Underlying heart disease was the most common cause of acute infection, accounting for 30 % of all the cases. 16 % patients had a recent dental procedure and 10 % had a recent surgical procedure. The most common infective organism was staphylococcus aureus (24%), followed by streptococcus viridians (20%). The most common indications for surgery were congestive heart failure (CHF) (52%), embolic phenomenon (18%) and septic shock (10%). Most common postoperative complication was respiratory failure (30%) followed by renal failure (24%) pacemaker implantation 22%; stroke 18%, bleeding 16% and GI bleeding 2 %. Seven out of 50 patients died during hospital course that accounts for 14% of the motility rate. Conclusions Surgery for endocarditis continues to be challenging and associated with high operative mortality and morbidity. Age, shock, prosthetic valve endocarditis, impaired ventricular function, and recurrent infections adversely affect long-term survival. PMID:22263033

  16. Infective Endocarditis Presenting as Acute Renal Failure and Unusual Complications.

    Science.gov (United States)

    Pereira, Luciano; Machado, Ana; Oliveira, Jorge; Almeida, Pedro; Bettencourt, Paulo

    2015-01-01

    Infective endocarditis can be a diagnostic challenge. Few cases have so far reported infective endocarditis presenting as renal failure. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa and splenic abscess are rare complications of infective endocarditis. We herein report a case of an 80-year-old man admitted due to anorexia, malaise, edema of the legs and renal failure. A progressive degradation of the patient's renal function was documented and hemodialysis was started. Blood cultures revealed the presence of Enterococcus faecalis, and the patient was treated with ampicillin and gentamicin. The transesophageal echocardiogram findings showed pseudoaneurysms of the mitral-aortic intervalvular fibrosa and in the aortic root wall. Due to abdominal pain, an abdominal CT scan was performed and showed a cystic lesion compatible with splenic abscess. The patient received 6 weeks of antibiotic treatment. There was progressive clinical improvement and regression of the splenic abscess, but no recovery of the renal function. This report illustrates an unusual clinical presentation of infective endocarditis with unusual complications that were successfully treated with antibiotics. PMID:25986267

  17. Once versus twice daily gentamicin dosing for infective endocarditis

    DEFF Research Database (Denmark)

    Buchholtz, Kristine; Larsen, Carsten Toftager; Schaadt, Bente; Hassager, Christian; Bruun, Niels Eske

    2011-01-01

    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...

  18. Linezolid as rescue treatment for left-sided infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Bruun, L E; Rasmussen, R V; Arpi, M; Risum, N; Moser, C; Johansen, H K; Bundgaard, H; Hassager, C; Bruun, N E

    2012-01-01

    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...

  19. Enterococcal Infective Endocarditis following Periodontal Disease in Dogs

    Science.gov (United States)

    Semedo-Lemsaddek, Teresa; Tavares, Marta; São Braz, Berta; Tavares, Luís; Oliveira, Manuela

    2016-01-01

    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. PMID:26752198

  20. Endocardite infecciosa em adolescentes. Análise dos fatores de risco de mortalidade intra-hospitalar Infective endocarditis in adolescents. analysis of risk factors for in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Nádia Barreto Tenório Aoun

    1997-12-01

    Full Text Available OBJETIVO: Estudar os aspectos epidemiológicos, clínicos, terapêuticos e evolutivos da endocardite infecciosa (EI em grupo de pacientes com idade entre 12 e 20 (média de 15,5 anos. MÉTODOS: Foram estudados, retrospectivamente, 33 pacientes consecutivos (14 do sexo masculino e 19 do feminino, admitidos com diagnóstico de EI. RESULTADOS: A mortalidade da EI foi de 42%. A cardiopatia reumática predominou como condição predisponente (63% dos casos, seguida das cardiopatias congênitas (24% e próteses cardíacas (12%. A maioria dos pacientes (78% encontrava-se na admissão em CF III e IV e apresentava mortalidade significativamente maior do que os que se encontravam na CF I e II (p=0,01. Complicações embólicas foram detectadas em 51% e determinaram maior mortalidade (p=0,05. O agente etiológico mais isolado foi o Staphylococcus aureus (em 42% das hemoculturas positivas, seguido do Staphylococcus viridans (em 21%. A análise multivariada mostrou que a contagem global de leucócitos acima de 10.000/mm ³, e a CF referidos na admissão (p=0,01 e p=0,04, e a ocorrência de embolias (p=0,03 eram preditores independentes de mortalidade intra-hospitalar. CONCLUSÃO: A cardiopatia reumática permanece, semelhante à população adulta, como principal fator predisponente da EI nos adolescentes, tendo como principal agente etiológico o S.aureus, semelhante à população pediátrica. A mortalidade é elevada e representam preditores de mortalidade intra-hospitalar a CF na admissão, a ocorrência da fenômenos embólicos e a leucocitose.PURPOSE: To study the epidemiological, clinical, therapeutic and evolutive aspects of endocarditis in a group of patients aging 12 to 20 years-old ( mean 15.5. METHODS: Thirty-three consecutive patients (14 males, 19 females admitted with infective endocarditis were retrospectively studied. RESULTS: Infective endocarditismortality was 42%. Rheumatic heart disease was the predominant underlying condition in 63% of patients. Congenital heart disease (24% and cardiac prosthesis (12% were the other affections involved. The majority of patients (78% were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p=0.01. Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%. Multivariate analysis identified total leukocyte count above 10,000/mm³ and functional class, both at admission (p=0.01 and p=0.004, respectively, and the occurrence of embolic complications (p=0.03 as independent predictors of in-hospital mortality. CONCLUSION: Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S.aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

  1. Epidemiology of infective endocarditis in Chennai, South India

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    Subramaniam Senthilkumar

    2010-01-01

    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.

  2. Sweet’s syndrome in a patient with infective endocarditis: a rare clinical entity

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    Nayak, Hemanta K; Vangipuram, Deepak Rajkumar; Kumar, Suresh; Kar, Premashish; Gupta, Ankit; Kapoor, Neha; Sonika, Ujjwal

    2012-01-01

    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...

  3. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Høst, Ulla; Arpi, Magnus; Hassager, Christian; Johansen, Helle K; Korup, Eva; Schønheyder, Henrik C; Berning, Jens; Gill, Sabine; Rosenvinge, Flemming S; Fowler, Vance G; Møller, Jacob E; Skov, Robert L; Larsen, Carsten T; Hansen, Thomas F; Mard, Shan; Smit, Jesper; Andersen, Paal S; Bruun, Niels E

    2011-01-01

    Aims Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population. Methods and results From 1 January 2009 to 31 August 2010, a total of 244 patients with SAB at six Danish hospitals underwent screening echocardiography. The inclusion rate was 73% of all eligible patients (n=...

  4. Linezolid as rescue treatment for left-sided infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Bruun, L E; Rasmussen, R V; Arpi, M; Risum, N; Moser, C; Johansen, H K; Bundgaard, H; Hassager, C; Bruun, N E

    2012-01-01

    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. The objective of this study is to report our experience with linezolid from a large consecutive cohort of IE patients. In a retrospective cohort study, data on 550 consecutive IE patients were collected ...

  5. Infective endocarditis cause: fastidious agents (Agentes fastidiosos, como causa de endocarditis infecciosa

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    Carpio-Deheza Gonzalo

    2010-11-01

    Full Text Available Infective Endocarditis disease has infectious origin which affects endocardium, heart valve with vegetations and less frequently mural endocardium. The main etiology of endocarditidis infection is bacterium and next one is mycosis. Fastidious agents are inside of these one, they are bacterium with slow growth in cell culture. For its diagnosis it is necessary epidemic data, and a good anamnesis. That is the main reason to recognize its principal characteristics of presentation, diagnosis and treatment. –RESUMEN: Endocarditis Infecciosa, es una enfermedad de origen infeccioso que afecta al endocardio, que cursa con vegetaciones en las válvulas cardíacas y menos frecuentemente en el mismo endocardio mural. La principal etiología de la infección endocárdica es bacteriana, seguida por la micótica, y es dentro de estos agentes causales, que se encentran los agentes fastidiosos, los cuales, son bacterias de crecimiento lento en cultivos, por lo que, para poder diagnosticarlos, debemos de basarnos en la epidemiología de los mismos, además de realizar una buena anamnesis, y es en ese sentido que gira la importancia de saber reconocer sus características de presentación, diagnóstico y tratamiento.

  6. Tratamiento quirúrgico de la endocarditis infecciosa / Surgical treatment of infective endocarditis

    Scientific Electronic Library Online (English)

    Alain, Eusse; Mauricio, Atehortúa; Luis, Vélez; Víctor, Bucheli; Carlos, Dallos; Gerardo, Flores; Ana M, Herrera; Sergio, Franco.

    2014-02-01

    Full Text Available Objetivo: describir las características epidemiológicas y los resultados del tratamiento quirúrgico temprano de los pacientes con diagnóstico de endocarditis infecciosa intervenidos en el Departamento de Cirugía Cardiovascular de la Clínica Medellín, Colombia. Métodos: estudio observacional, descrip [...] tivo, retrospectivo, de todos los pacientes con diagnóstico de endocarditis infecciosa tratados mediante cirugía en la Clínica Medellín, entre enero de 2003 y enero de 2010. Resultados: se incluyeron en total 54 pacientes, 37 (68,5%) de ellos de género masculino. La mediana de la edad fue 57,5 años (9 - 76 años). El 77,7% tenía algún factor de riesgo para desarrollar endocarditis infecciosa; entre los más destacados insuficiencia renal crónica (IRC) en hemodiálisis (18,5%) y prótesis valvulares cardiacas (18,5%). El 66,7% de los hemocultivos fue positivo. Staphylococcus aureus fue el principal germen aislado en el 40,7% del total de pacientes. El 81,4% de las válvulas comprometidas eran nativas con predominio de la válvula mitral (44,5%) y el 7,5% presentaba compromiso de dos válvulas. En el 68,5% el motivo de consulta fue falla cardiaca y 35,3% presentaron fenómenos embólicos como manifestación inicial o asociada (cerebral 16,7%, pulmonar 13%, esplénica 5,6%). En el 83,3% de los casos se realizó cirugía temprana; 66% recibieron válvulas mecánicas. La mortalidad total a tres meses fue del 13% (muerte intraoperatoria 3,7%, mortalidad a 30 días, 9%). La mediana en el tiempo de estancia hospitalaria fue de 36 días (7 a 130 días). En este estudio se reporta una mortalidad total que se encuentra en el límite inferior de lo reportado en el mundo. Una de las razones atribuibles a este hallazgo es el manejo quirúrgico temprano que se protocoliza en el servicio. Abstract in english Objective: to describe the epidemiological characteristics and the results of early surgical treatment of patients diagnosed with infectious endocarditis who underwent surgery in the Department of Cardiovascular Surgery in the Medellin Clinic, Colombia. Methods: observational, descriptive, retrospec [...] tive study of all the patients diagnosed with infective endocarditis treated by surgery in the Medellin Clinic between January 2003 and January 2010. Results: a total of 54 patients were included. 37 (68.5%) were male. Mean age was 57.5 years (9-76 years). 77.7% had a risk factor for developing infective endocarditis; among the most prominent risk factors were chronic renal failure (CRF), patients on hemodialysis (18.5%) and heart valve prostheses (18.5%). 66.7% of the blood cultures were positive. Staphylococcus aureus was the main germ isolated in 40.7% of patients. 81.4% of the involved valves were native, with mitral valve predominance (44.5%) and 7.5% had involvement of two valves. In 68.5% the reason for the consultation was heart failure and 35.3% had embolic phenomena as the initial manifestation or associated (16.7% cerebral, pulmonary 13%, spleen 5.6%). In 83.3 % of cases early surgery was performed: 66% received mechanical valves. The three-month total mortality was 13% (3.7% intraoperative death, mortality at 30 days 9%). The median length of hospital stay was 36 days (7-130 days). In this study the total mortality reported is at the lower limit of the reported in the world. One of the reasons attributed to this finding is the early surgical management that is the protocol in the service.

  7. Aspectos históricos da endocardite infecciosa Historical aspects of infective endocarditis

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    Max Grinberg

    2011-04-01

    Full Text Available A endocardite infecciosa era fatal até há três gerações. A evolução temporal do conhecimento da doença possibilitou avanços nas técnicas diagnósticas, especialmente na ecocardiografia, a possibilidade de se realizar a cirurgia cardíaca, mesmo com o processo infeccioso em atividade, e novas recomendações de profilaxia por antibióticos antes dos procedimentos de intervenção. Hoje a endocardite infecciosa é curável. Nesta revisão são abordados os aspectos históricos da endocardite, desde as observações de Osler, no século XIX, até a transformação de doença "clinicamente possível" em "clinicamente definida".Infective endocarditis was a fatal disease three generations ago. Temporal evolution of knowledge made possible important advances in diagnostic techniques, especially in echocardiography, the possibility of cardiac surgery during the active infectious process and new guidelines for antibiotic prophylaxis before interventional procedures. Nowadays, infective endocarditis is curable. In this review, we describe historical aspects of endocarditis, from Osler´s observations in the 19th century to the change from a "clinically possible" to a "clinically defined" disease.

  8. Embolic Events And Neurological Complications In Infective Endocarditis

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    Vesna Suknjaja

    2011-06-01

    Full Text Available Infective endocarditis (IE is an infection of the endocardial surface of the heart. The intracardiac effects of this infection include severe valvular insuffi ciency, which may lead to congestive heart failure and many complications. Valvular infections have entered the era of IE caused by increased usage of intravascular devices and medical procedures. Typically, the diagnosis is made relatively late, compared to the onset of valvular infection. Complications of infective endocarditis result from embolization, slowly progressive valvular destruction and various immunological mechanisms. Complications are very frequent in IE, complicating 20–60% of cases of IE. Th e risk of embolism is the highest during the first 2 weeks of antibiotic therapy and is clearly related to the size and mobility of the vegetation. Risk is increased with large vegetations (>10 mm and particularly high with very mobile and even larger vegetations (>15 mm. Neurological complications develop in 20–40% of all patients with IE and are mainly the consequence of embolization. Rapid diagnosis and initiation of appropriate therapy especially antibiotics are of major importance to prevent a first or recurrent neurological complication.

  9. Case report: Infective endocarditis caused by Brevundimonas vesicularis

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    Chen Tun-Chieh

    2006-12-01

    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.

  10. Insufficient Living : Experiences of Recovery After Infective Endocarditis

    DEFF Research Database (Denmark)

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe

    2015-01-01

    BACKGROUND:: Infective endocarditis (IE) is a traumatic health event, and recovery is often associated with massive physical deconditioning and reduced quality of life. Patients also report reduced cognitive functioning and are at risk of developing anxiety and depression as well as posttraumatic stress disorder. Although studies have found that survivors of IE have impaired physical functioning and mental health, little is known about patient experiences contributing to these findings. OBJECTIVE:: The aim of this study was to describe patient experiences of recovery after IE. SUBJECTS AND METHODS:: Within a phenomenological-hermeneutical framework, a qualitative interview study was conducted that included 6 men and 5 women (aged 29-86 years). Patients were interviewed 3 to 6 months after discharge. Analysis consisted of 3 levels: naive reading, structured analysis, and critical interpretation and discussion. FINDINGS:: The overall concept that emerged was "Insufficient Living." Patients all experienced a life after illness, which was perceived as insufficient. The overall concept can be interpreted in terms of the following 3 themes. The first was "an altered life," where participants described a phase of adaptation to a new life situation, which some perceived as manageable and temporary, whereas others found extremely distressing and prolonged. "Shocking weakness" was experienced physically, cognitively, and emotionally, and although it subsided quickly for a few, most experienced a persisting weakness and felt frustrated about the prolonged recovery phase. In "the road to recovery," support from relatives and healthcare professionals, as well as one's own actions, was emphasized as important in facilitating recovery. CONCLUSIONS:: Recovery after IE is perceived as "Insufficient Living." Patients experience an altered life and shocking weakness, and on the road to recovery, support is needed. Research in follow-up care, supporting patients' ability to cope with potential physical and psycho-emotional consequences of IE, is encouraged as a result of these findings.

  11. A systematic review of biomarkers in the diagnosis of infective endocarditis

    DEFF Research Database (Denmark)

    Snipsøyr, Magnus G; Ludvigsen, Maja; Petersen, Eskild; Wiggers, Henrik; Honoré, Bent

    2016-01-01

    Timely diagnosis of bacterial infective endocarditis (IE) is crucial, as mortality remains high in this severe bacterial infection, currently without any distinct biological markers. Our goal was to evaluate potential diagnostic biomarkers by reviewing current literature. The MEDLINE, Embase and...

  12. Endocardite infecciosa valvar submetida a tratamento cirúrgico: análise de 64 casos Infective valve endocarditis treated by surgery: analysis of 64 cases

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    Demóstenes G. Lima Ribeiro

    2005-03-01

    Full Text Available OBJETIVO: Identificar aspectos clínico-laboratoriais da endocardite infecciosa valvar, tratada com cirurgia, no Hospital de Messejana, Fortaleza, CE, no período de 1988 a 2003. MÉTODO: Estudo observacional, retrospectivo, da fase hospitalar, de 64 pacientes portadores de endocardite infecciosa, submetidos à substituição valvar aórtica e/ou mitral, vegectomia e plastia da tricúspide e excisão da valva pulmonar, como parte do tratamento. Analisados o sexo, a idade, o tempo decorrido entre a internação e a cirurgia e entre a internação e a alta hospitalar, a valva acometida, o resultado da hemocultura, o procedimento cirúrgico efetuado e a mortalidade. RESULTADOS: A endocardite infecciosa valvar, tratada com cirurgia, preponderou na terceira década, 81,2% dos pacientes eram masculinos. O tempo decorrido entre a internamento e a cirurgia foi menor nos pacientes que faleceram. A valva aórtica, de modo isolado ou associado, foi acometida em 65% dos casos. Hemoculturas foram positivas em 42%; em 52,4% delas, isolou-se Estafilolococo aureus. Necessitaram de substituição valvar 93,7% dos pacientes. Houve mortalidade de 14,1%, não influenciada pela idade nem pelo resultado da hemocultura. CONCLUSÃO: Endocardite infecciosa valvar, submetida ao tratamento cirúrgico, foi mais freqüente em homens e na terceira década. Acometeu preferencialmente a valva aórtica. Estafilolococo aureus foi o patógeno mais comum. Na quase totalidade dos casos, procedeu-se substituição valvar e a mortalidade hospitalar foi de 14,1%.OBJECTIVE: To identify some aspects of the infective valve endocarditis treated by heart surgery, as well as antibiotic therapy, in a public hospital, in the city of Fortaleza, Ceará state, Brazil, from1988 to 2003. METHOD: A retrospective and observational study of 64 patients with Infective Valve Endocarditis who required aortic and/or mitral valve replacement, tricuspid vegectomy and repair or pulmonary valve valvulectomy, as well as antibiotic therapy, during their in-hospital stay. They were analyzed in respect to gender, age, time elapsed from hospital admission to the surgery, time elapsed from hospital admission to hospital discharge, valve lesion, blood culture result, surgical treatment and mortality. RESULTS: Infective valve endocarditis treated with heart surgery was more frequent in the third decade of life. Most of patients (81.2% were males. The patients who died spent a shorter time from hospital admission to the surgery than the patients who survived. The aortic valve was affected in 65% of cases. Positivity blood culture were seen in 42% and Staphylococcus aureus was isolated in 52.4% of these cases. Valve replacement was necessary in 93.7% of cases. The in-hospital mortality rate was 14.1% which was not influenced by the age of the patient or the blood culture result. CONCLUSION: Infective valve endocarditis treated by heart surgery was more frequent in men and in the third decade of life. It mostly affected the aortic valve. Staphylococcus aureus was the more common pathogen found. Almost all the patients needed replacement of the infected valve and the in-hospital mortality rate was 14.1%.

  13. Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically

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    Alejandro Junca

    2010-08-01

    Full Text Available La endocarditis infecciosa por Pseudomonas aeruginosa es una entidad poco frecuente, de difícil diagnóstico y alta mortalidad. Se presenta a continuación el caso de un hombre de 51 años, sin antecedentes de uso de drogas intravenosas ni enfermedad valvular, con antecedentes de colecistectomía en el mes anterior, quien se presentó a urgencias con un cuadro febril asociado a síntomas gastrointestinales, y, posteriormente mostró signos de embolismo a distancia, hemocultivos positivos para P. aeruginosa y desarrollo de múltiples complicaciones propias de la enfermedad.
    La presentación clínica de la endocarditis infecciosa es inespecífica, lo cual genera diagnósticos tardíos que impiden la instauración de un tratamiento precoz y eficaz, como el reemplazo valvular, indicado en endocarditis por hongos o por gérmenes como P. aeruginosa. Este caso es fortuito por su resolución solamente con tratamiento médico combinado, con amikacina y meropenem, ya que tuvo varias complicaciones que contraindicaron el manejo quirúrgico.Infective endocarditis due to Pseudomonas aeruginosa is a rare clinical condition, difficult to diagnose and associated with high mortality. Herein we present a case of a 51 years old male without history of intravenous drug use or valvular disease, with past medical history of cholecystectomy in the previous month, who presented to the emergency department with fever, gastrointestinal symptoms, and subsequent signs of distant embolization, positive blood cultures for P. aeruginosa and development of multiple complications of the disease. The clinical presentation of infective endocarditis is nonspecific, leading to delayed diagnosis, and preventing early and effective treatment. Valvular replacement is indicated in fungal or P. aeruginosa endocarditis. This case is notable because of the resolution with amikacin combined with meropenem, in a patient with several complications that contraindicated surgery.

  14. Kocuria kristinae endocarditis related to diabetic foot infection.

    Science.gov (United States)

    Citro, Rodolfo; Prota, Costantina; Greco, Luigi; Mirra, Marco; Masullo, Alfonso; Silverio, Angelo; Bossone, Eduardo; Piscione, Federico

    2013-06-01

    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

  15. Streptococcus intermedius causing infective endocarditis and abscesses: a report of three cases and review of the literature

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    Khalife Walid

    2008-11-01

    Full Text Available Abstract Background Streptococcus intermedius is a member of the Streptococcus anginosus group. Clinical disease with S. intermedius is characterized by abscess formation and rarely endocarditis. Identification of Streptococcus intermedius is difficult, leading to the development of molecular methods to more accurately identify and characterize this organism. Case presentation Over a period of 6 months we encountered three cases of invasive Streptococcus intermedius infection presenting as hepatic abscesses, brain abscess, and endocarditis. We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case. Conclusion Our report illustrates three different clinical manifestations due to Streptococcus intermedius infection that can be encountered in healthy individuals in a community hospital setting. To our knowledge, this is the first case of Streptococcus intermedius endocarditis confirmed by 16S sequencing analysis. The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.

  16. Acute Aortic Valve Rupture From Infective Endocarditis After Transrectal Prostate Biopsy: A Call to Revise the AHA Guidelines for Prevention of Infective Endocarditis

    OpenAIRE

    Julia Ansari; Gurkaran Singh Garcha; Henry Huang; Faisal G. Bakaeen; Salim S. Virani; Hani Jneid

    2013-01-01

    We describe the case of a 63-year-old man with a known murmur who presented with a 4-month history of intermittent fever and a progressive reduction in energy level after a transrectal prostate biopsy (TRPB). He subsequently presented with acute heart failure secondary to aortic valve cusp rupture caused by endocarditis and underwent urgent aortic valve surgery. The 2008 American College of Cardiology/American Heart Association Guideline update on infective endocarditis has narrowed the use o...

  17. Catheter-related bacteraemia and infective endocarditis caused by Kocuria species.

    Science.gov (United States)

    Lai, C C; Wang, J Y; Lin, S H; Tan, C K; Wang, C Y; Liao, C H; Chou, C H; Huang, Y T; Lin, H I; Hsueh, P R

    2011-02-01

    We describe five patients with positive blood culture for Kocuria species. Three patients had catheter-related bacteraemia and one had infective endocarditis caused by Kocuria kristinae, and one had a K. marina isolate, which was considered to be a contaminant. Identification of the isolates was further confirmed by 16S rRNA gene sequence analysis. In conclusion, Kocuria species are an unusual cause of infection in immunocompromised patients. Accurate identification with molecular methods is imperative for the diagnosis of these unusual pathogens. PMID:20218989

  18. Successful Treatment of Infective Endocarditis in Four Kidney Transplant Recipients

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    Fatemeh Pour-Reza-Gholi

    2009-04-01

    Full Text Available Infective endocarditis (IE is a serious complication in kidney transplantation, leading to graft loss and a high mortality rate. We report 4 successfully managed cases of IE in kidney transplant recipients. Blood culture revealed Enterococcus in 2 patients, group D Streptococcus in 1, and no bacteria in 1. All of the patients were diagnosed based on at least 2 major Duke criteria for diagnosis of IE. Although a mild increase in the serum creatinine level was observed in 3 out of 4 patients, no graft rejection occurred during the follow-up. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft. Studies on previous recurrent infections and simultaneous diseases such as cytomegalovirus in these patients are warranted.

  19. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases

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    Serap ?im?ek-Yavuz

    2015-01-01

    Conclusions: In Turkey, IE occurs in relatively young patients and Brucella spp should always be taken into consideration as a cause of this infection. We should first consider streptococci as the causative agents of IE in young patients, those with CRHD or congenital heart valve disease, and cases of community-acquired IE. Staphylococci should be considered first in the case of pacemaker lead IE, when there are high levels of creatinine, and in cases of healthcare-associated IE. Enterococci could be the most probable causative agent of IE particularly in patients aged >50 years, those on dialysis, those with late prosthetic valve IE, and those with a perivalvular abscess. The early diagnosis and treatment of IE before complications develop is crucial because the mortality rate is high among cases with serious complications. The prevention of bacteraemia with the measures available among chronic haemodialysis patients should be a priority because of the higher mortality rate of subsequent IE among this group of patients.

  20. Infective endocarditis and phlebotomies may have killed mozart.

    Science.gov (United States)

    Lee, Simon Jong-Koo

    2010-12-01

    Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock. PMID:21267381

  1. Endocarditis infecciosa por Streptococcus bovis asociada a instrumentación gastrointestinal / Infective endocarditis caused by Streptococcus bovis

    Scientific Electronic Library Online (English)

    Rafael, Pila Pérez; Victor Adolfo, Holguín Prieto; Ever, Cetina Lozada; Rafael, Pila Peláez; Leandro, Segura Pujal.

    2012-12-01

    Full Text Available La endocarditis por Streptococcus bovis representa el 10% de los casos de endocarditis bacteriana, siendo frecuente su asociación con enfermedades intestinales y hepáticas. Se presenta el caso de una mujer de 36 años con antecedentes de fiebre reumática en la niñez, quien hace un año comenzó con sin [...] tomatología digestiva, para la cual fue sometida a estudios clínicos invasivos como endoscopia y colonoscopia, desarrollando posteriormente una endocarditis con aislamiento microbiológico de Streptococcus bovis. Se detalla la fisiopatología, clínica, diagnóstico y los aspectos terapéuticos de esta entidad. Además se discuten las posibles relaciones de las enfermedades intestinales, las instrumentaciones del tubo digestivo y las hepatopatías con la bacteriemia por Streptococcus bovis biotipo I. Esta asociación sugiere un posible mecanismo de adherencia biotipo-específica que aún no ha sido fehacientemente demostrado. Por último se resalta la conveniencia de someter a exploración digestiva y ecocardiografía a todo paciente con hemocultivos positivos a este tipo de germen. (MÉD.UIS. 2012;25(3):251-8). Abstract in english Endocarditis caused by Streptococcus bovis represents 10% of the cases of bacterial endocarditis and is frequently associated with intestinal and liver diseases. We present the case of a 36-year old female patient with a history of rheumatic fever in childhood. The gastrointestinal symptomatology be [...] gan one year before the bacterial endocarditis. Several invasive clinical investigations as endoscopy and colonoscopy, were performed and subsequently she developed endocarditis. Streptococcus bovis was isolated in microbiological studies. Pathophysiology, clinical manifestations, diagnosis, and treatment are detailed. The association between bacteremia from Streptococcus bovis biotype I and intestinal diseases, instrumentation of the digestive tract, and hepatopathy is reviewed. This association suggests a possible mechanism of bacteremia and endocarditis associated with biotype I but this has not been definitely confirmed. We have highlighted the importance of performing echocardiography in all patients with blood cultures positive for Streptococcus bovis who have had invasive studies of the gastrointestinal tract.(MÉD.UIS. 2012;25(3)251-8).

  2. Radiologic manifestations of extra-cardiac complications of infective endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Colen, Teran W.; Gunn, Martin; Cook, Erin; Dubinsky, Theodore [University of Washington Medical Center, Department of Radiology, 1959 NE Pacific Ave, Box 357115, Seattle, WA (United States)

    2008-11-15

    Infective endocarditis (IE) is a disease with high morbidity and a mortality rate of 9-30%, even with appropriate diagnosis and therapy. Septic emboli, caused by IE, can affect any organ or tissue in the body with an arterial supply and occur in 12-40% of IE cases. The most common extra-cardiac organ system involved in IE is the central nervous system. Other organs frequently involved are the lungs (especially in right-sided IE), spleen, kidneys, liver, and the musculoskeletal system. In addition, the arterial system itself is susceptible to the development of potentially fatal mycotic aneurysms. As extra-cardiac complications often antedate the clinical diagnosis of IE, it is important that the diagnosis is suggested when characteristic findings are encountered during imaging. In addition, imaging is often used to monitor the extent of complications in patients with a known diagnosis of IE. (orig.)

  3. Infective endocarditis detection through SPECT/CT images digital processing

    Science.gov (United States)

    Moreno, Albino; Valdés, Raquel; Jiménez, Luis; Vallejo, Enrique; Hernández, Salvador; Soto, Gabriel

    2014-03-01

    Infective endocarditis (IE) is a difficult-to-diagnose pathology, since its manifestation in patients is highly variable. In this work, it was proposed a semiautomatic algorithm based on SPECT images digital processing for the detection of IE using a CT images volume as a spatial reference. The heart/lung rate was calculated using the SPECT images information. There were no statistically significant differences between the heart/lung rates values of a group of patients diagnosed with IE (2.62+/-0.47) and a group of healthy or control subjects (2.84+/-0.68). However, it is necessary to increase the study sample of both the individuals diagnosed with IE and the control group subjects, as well as to improve the images quality.

  4. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus Vinther; Høst, Ulla; Arpi, Rolf Magnus; Hassager, Christian; Johansen, Helle Krogh; Korup, Eva; Schønheyder, Henrik Carl; Berning, Jens; Gill, Sabine; Rosenvinge, Flemming S; Fowler, Vance G; Møller, Jacob; Skov, Robert L; Larsen, Carsten Toftager; Hansen, Thomas F; Mard, Shan; Smit, Jesper; Andersen, Paal S; Bruun, Niels Eske

    2011-01-01

    Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population.

  5. Prognostic criteria for the development of infective endocarditis in children with heart pathology

    Directory of Open Access Journals (Sweden)

    Porokhnya N.G.

    2014-09-01

    Full Text Available To determine the most informative prognostic signs of infectious endocarditis development in children with heart pathology on the background of bacterial infections clinical course of 15 cases of infective endocarditis in children aged from 1 month to 17 years was performed. The comparison group consisted of 40 children aged 5 - 17 years with mitral valve prolapse. Of 19 analyzed clinical-anamnestic predictive diagnostic features for the development of infective endocarditis in children, presence of febrile fever during infusion therapy, the operated congenital heart disease, treatment in an intensive therapy unit with mechanical ventilation, intravenous infusions through a catheter lasting more than three days, a positive blood culture during the disease course, diagnostic catheterization of large vessels were of high informative value. In a positive prognosis of infective endocarditis development with a probability of 95% and more, children underwent complex of therapeutic measures with the following observation of pediatric cardio-rheumatologist.

  6. Clinical Profile and Outcome of Infective Endocarditis at the Aga Khan University Hospital

    OpenAIRE

    Smego, Raymond A.; Mehnaz Atiq; Mahboob Alam; Sohail Abrar Khan; Muhammad Tariq; Bilal Karim Siddiqui; Atif Jadoon

    2009-01-01

    Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan. Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic crite...

  7. Endovascular Treatment of Intracerebral Mycotic Aneurysm before Surgical Treatment of Infective Endocarditis

    OpenAIRE

    Erdogan, Hasan Basri; Erentug, Vedat; Bozbuga, Nilgun; Goksedef, Deniz; AKINCI, Esat; Yakut, Cevat

    2004-01-01

    Mycotic aneurysms are rarely seen in patients who have infective endocarditis, and the management of these patients remains controversial. We present the case of a patient who had infective endocarditis complicated by a mycotic aneurysm of the left middle cerebral artery. There was substantial mitral regurgitation, and Streptococcus viridans was isolated from the blood samples. Dysarthria appeared during the 4th week of the antibiotic therapy, but resolved completely 8 hours after onset. The ...

  8. Clinical Practice Guidelines Infective Endocarditis Treatment. Guía de práctica clínica para el tratamiento de la endocarditis infecciosa.

    Directory of Open Access Journals (Sweden)

    Pablo Rodríguez Díaz

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Infective Endocarditis Treatment. Infectious disease affecting the endocardium produces vegetations and could also affect the septum, the chordae tendinae or mural endocardium. It includes concept, risk factors, classification (and special groups and an update and review of the main clinical aspects, complications and treatment stressing the antibiotic therapy. It includes assessment guidelines focused on the most important aspects to be accomplished.Guía de práctica clínica para el tratamiento de la endocarditis infecciosa. Enfermedad de origen infeccioso que afecta al endocardio, cursa con vegetaciones y también lo puede hacer a los septos, las cuerdas tendinosas o el endocardio mural. Incluye concepto, factores de riesgo, clasificación y dentro de esta grupos especiales; revisa y actualiza los aspectos clínicos fundamentales, complicaciones y tratamiento, con énfasis en la antibioticoterapia. Concluye con su guía de evaluación, enfocada en los aspectos más importantes a cumplir.

  9. Genome Sequence of Staphylococcus capitis QN1, Which Causes Infective Endocarditis

    OpenAIRE

    Qin, Nan; Ding, Wenchao; YAO, JIAN; Su, Kunkai; Wu, LingJiao; LI, LANJUAN

    2012-01-01

    Staphylococcus capitis is a subtype of coagulase-negative staphylococci (CoNS) which could emerge as a significant pathogen causing infective endocarditis, prosthetic valve endocarditis, and late-onset sepsis. We isolated S. capitis strain QN1 from the skin swab sample of a female. Here we prepared a genome sequence for this strain consisting of 30 contigs totaling 2,430,101 bases and a GC content of 32.76%.

  10. Staphylococcus aureus Bloodstream Infection and Endocarditis - A Prospective Cohort Study

    Science.gov (United States)

    Le Moing, Vincent; Alla, François; Doco-Lecompte, Thanh; Delahaye, François; Piroth, Lionel; Chirouze, Catherine; Tattevin, Pierre; Lavigne, Jean-Philippe; Erpelding, Marie-Line; Hoen, Bruno; Vandenesch, François; Duval, Xavier

    2015-01-01

    Objectives To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE). Methods All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. Results SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%). Conclusion SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions. PMID:26020939

  11. Imaging of the neurological complications of infective endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S.J.; Lee, J.Y.; Kim, T.H.; Kim, S.C.; Choi, Y.H. [Department of Radiology, Dankook University College of Medicine, Chungnam (Korea, Republic of); Pai, H. [Department of Internal Medicine, Dankook University College of Medicine, Chungnam (Korea, Republic of); Choi, W.S. [Department of Radiology, Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    1998-02-01

    We describe the findings on CT or MRI in five patients with neurological symptoms and underlying infective endocarditis (IE). We noted the size, number, and distribution of lesions, the presence or absence of haemorrhage, and contrast enhancement patterns. The number of lesions ranged from 4 to more than 10 in each patient. Their size varied from punctate to 6 cm; they were distributed throughout the brain. The lesions could be categorized into four patterns based on imaging features. A cortical infarct pattern was seen in all patients. Patchy lesions, which did not enhance, were found in the white matter or basal ganglia in three. Isolated, tiny, nodular or ring-enhancing white matter lesions were seen in three patients, and parenchymal haemorrhages in four. In addition to the occurrence of multiple lesions with various patterns in the same patient, isolated, tiny, enhancing lesions in the white matter seemed to be valuable features which could help to differentiate the neurological complications of IE from other thromboembolic infarcts. (orig.) With 4 figs., 2 tabs., 11 refs.

  12. Infective endocarditis of a rare etiology: Serratia marcescens

    Directory of Open Access Journals (Sweden)

    ?oki? Milomir

    2004-01-01

    Full Text Available Infective endocarditis (IE is a unique diagnostic and therapeutic challenge. It is a severe disease, fatal before penicillin discovery. Atypical presentations frequently led to delayed diagnosis and poor outcome. There was little information about the natural history of the vegetations during medical treatment or the relation of morphologic changes in vegetation to late complications. Application of a new diagnostic criteria and echocardiography, increased the number of definite diagnosis. Trans-thoracic and trans-esophageal echocardiography had an established role in the management of patients with IE. The evolution of vegetation size, its mobility, and consistency, the extent of the disease, and the severity of valvular regurgutation were related to late complications. With therapeutic options including modern antibiotic treatment and early surgical intervention IE turned out to be a curable disease. Reduction in mortality also depended on prevention. Antibiotic prophylaxis of IE was important, but low mortality was also the result of early treatment, especially in the event of early recognition of symptoms and signs of the disease.

  13. Infective endocarditis caused by Staphylococcus aureus in a patient with atopic dermatitis: a case report

    Directory of Open Access Journals (Sweden)

    Mohiyiddeen Gadha

    2008-05-01

    Full Text Available Abstract Introduction- Atopic dermatitis (AD is a common condition in the United Kingdom with the prevalence varying from 21% in infants aged 0–6 months to 6.4% at the age of 16 years. Patients with AD experience high rates of colonization of their skin surfaces by Staphylococcus aureus (S. aureus. In severe AD there is a potential risk of staphylococcal bacteremia and invasive infection such as acute endocarditis. Case presentation- We report a case of acute endocarditis with mitral valve destruction caused by S. aureus in a 30-year-old man with severe AD. The patient received intensive inpatient treatment with antibiotics and underwent successful mitral valve replacement and skin treatment for AD. Conclusion- Patients with severe AD are at higher risk of staphylococcal bacteremia and endocarditis. Staphylococcal endocarditis has to be considered in the differential diagnosis of febrile illness in patients with uncontrolled atopic dermatitis.

  14.  Tricuspid Endocarditis and Septic Pulmonary Embolism in an Intravenous Drug User with advanced HIV Infection

    Directory of Open Access Journals (Sweden)

    Gonul Sengoz

    2011-09-01

    Full Text Available  Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD4 count are associated with increased risk of death. This report presents a case of isolated tricuspid valve endocarditis with advanced HIV infection who was also an IVDU.

  15. Tricuspid Endocarditis and Septic Pulmonary Embolism in an Intravenous Drug User with advanced HIV Infection

    Science.gov (United States)

    Yasar, Kadriye Kart; Pehlivanoglu, Filiz; Gursoy, Sevtap; Sengoz, Gonul

    2011-01-01

    Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU) with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD4 count are associated with increased risk of death. This report presents a case of isolated tricuspid valve endocarditis with advanced HIV infection who was also an IVDU. PMID:22125735

  16. Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Masmoudi Sayda

    2000-01-01

    Full Text Available Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

  17. Non-typeable Haemophilus influenzae infective endocarditis in a renal transplant recipient: compromised host or virulent strain?

    OpenAIRE

    Bertelle-Ibrahim, Lauren A; Murphy, Timothy F; Kirkham, Charmaine; Parameswaran, Ganapathi I; Berenson, Charles S

    2013-01-01

    Non-typeable Haemophilus influenzae (NTHI) rarely cause endocarditis. Of the limited reports of H influenzae endocarditis, most have been due to encapsulated organisms or have had limited bacterial characterisation. We encountered a transplant recipient with native valve NTHI endocarditis and were intrigued to find no previous descriptions of this entity. Although it was tempting to ascribe this infection to our patient's immunocompromised status, we investigated his pathogen further and foun...

  18. [Splenic abscess in the course of infective endocarditis--report of a case].

    Science.gov (United States)

    Ryczak, Elzbieta; Mosiewicz, Jerzy; Bi?an, Andrzej; Wallner, Grzegorz; Zinkiewicz, Krzysztof; Prystupa, Andrzej; Ignatowicz, Andrzej; Bie?ko-Baka, Grazyna

    2004-11-01

    Infective endocarditis is the most common condition predisposing a patient to splenic abscess. We report the case of man aged 65 who was admitted to the Internal Medicine Department to diagnose the fever of unknown origin. The fever lasted longer than one year. Clinical status and executed diagnostics, among others: echocardiography, blood cultures, abdominal ultrasonography, abdominal computed tomography allowed to give the diagnosis splenic abscess caused by Acinetobacter Baumanii in the course of infective endocarditis. Patient was treated by splenectomy and antibiotics. As a result of the treatment normalization of temperature and recovery was obtained. PMID:15773518

  19. Infective endocarditis (IE) first diagnosed at autopsy: analysis of 31 cases in Ribeirão Preto, Brazil Endocardite infecciosa (EI) com diagnóstico feito apenas à necrópsia: análise de 31 casos ocorridos entre 1992 e 1997, em Ribeirão Preto, Brasil

    OpenAIRE

    Figueiredo, Luiz Tadeu M.; RUIZ-JUNIOR Everaldo; SCHIRMBECK Tarciso

    2001-01-01

    Thirty one infective endocarditis (IE) fatal cases whose diagnosis was first obtained at autopsy were studied. The clinical data of these patients (Group 1) showed significant differences compared to other 141 IE cases (Group 2). The average age of 53 years in Group 1 patients was 18 years higher than that of Group 2. The Group 1 patients had a low frequency of IE predisposing heart disease. Both patient groups presented fever (about 87%), but a significant low frequency of cardiac murmur (25...

  20. Aortocavitary fistula as a complication of infective endocarditis and subsequent complete heart block in a patient with severe anemia

    Directory of Open Access Journals (Sweden)

    Jose N. Galeas

    2015-12-01

    Full Text Available Infective endocarditis has different presentations depending on the involvement of valvular and perivalvular structures, and it is associated with high morbidity and mortality. Aortocavitary fistula is a rare complication. We introduce the case of a 48-year-old female with native valve endocarditis, complicated by aortocavitary fistula to the right atrium, and consequently presented with syncope.

  1. Un brote epidémico de endocarditis por Pseudomonas aeruginosa secundario a angiografía coronaria / An outbreak of Pseudomonas aeruginosa infective endocarditis subsequent to coronary angiography

    Scientific Electronic Library Online (English)

    Derya, Seyman; Dilara, Inan; Nevgun, Sepin Ozen; Dilara, Ogunc.

    2014-06-01

    Full Text Available Objetivos: Describir un brote de endocarditis por Pseudomonas aeruginosa que afectó a tres pacientes tras habérseles efectuado una coronariografía en el Centro Médico de Cardiología y de Cirugía Cardiovascular (CMC-CCV) de un hospital privado. Métodos: Después de reconocer la aparición de un brote e [...] n un periodo de un mes, este hecho fue comunicado al Departamento de Salud de Antalya, iniciándose una exhaustiva investigación para precisar la más probable causa y/o fuente de las endocarditis nosocomiales. Se extrajo de los registros médicos los datos clínicos de los pacientes y se efectuaron entrevistas a los pacientes o sus familiares. Se extrajo 36 muestras medioambientales de vigilancia en busca de P. aeruginosa de diversos sitios dentro de la unidad de coronariografía. Un team que investigó el brote revisó los procedimientos en uso para la prevención de infecciones en el CMC-CCV. Se estudió la epidemiología de la P. aeruginosa mediante análisis de su fenotipos, incluyendo el perfil de susceptibilidad in vitro a antimicrobianos. Resultados: La auditoria comprobó el quiebre de diversas normas de control de infecciones. Sólo 1/36 de las muestras ambientales arrojó el cultivo de P. aeruginosa, a partir de una solución de medio radio-opaco dentro de una bomba inyectora empleada en las angiografías. Los aislados de P. aeruginosa desde la solución del medio radio-opaco tenían idéntico patrón de susceptibilidad antimicrobiana que las cepas recuperadas de los pacientes. Ambos tipos de muestras eran susceptibles a todos los antimicrobianos con actividad anti-pseudomonas. El brote pudo evitarse si se hubieran instaurado una serie de medidas de control de infecciones. Conclusiones: Este brote enfatiza la importancia de adherir a los estándares y prácticas de control de infecciones para la cateterización cardiaca, así como la necesidad de una estrecha colaboración entre el Comité de Control de Infecciones y el personal involucrado en el procedimiento de coronariografía. Abstract in english Objectives: To describe an endocarditis outbreak affecting three patients due to Pseudomonas aeruginosa infection post coronary angiography performed in the Cardiovascular Surgery and Cardiology Medical Center of a private hospital. Methods: After recognition of an infection cluster within a onemont [...] h period, the outbreak was reported to Antalya Department of Health and a broad investigation was initiated in order to determine the most probable cause and/or source of nosocomial pseudomonal endocarditis. Patient data were obtained by medical record review as well as interviews with patients or their next of kin. Thirty-six surveillance samples for P. aeruginosa were collected from various locations within the coronary angiography unit. The outbreak research team reviewed the private hospital's Cardiovascular Surgery and Cardiology Medical Center's infection control procedures. The epidemiology of P. aeruginosa was studied through analysis of phenotypic markers, including antimicrobial sensitivity profiles. Results: The infection control audit revealed multiple breaches of infection control procedures. Only 1/36 environmental samples yielded, which was isolated from a radio-opaque solution within an angiography injector pump. P. aeruginosa from the radio-opaque solution had an identical antimicrobial susceptibility pattern to the strain isolated from patients. Both samples were susceptible to all antipseudomonal agents. This outbreak could have been successfully controlled by instituting combined infection control measures. Conclusions: This outbreak emphasizes the important of adherence to infection control standards and practices for cardiac catheterization, as well as the need for closer collaboration between the Infection Control Committee and coronary angiography personnel.

  2. K2 Serotype Klebsiella pneumoniae Causing a Liver Abscess Associated with Infective Endocarditis?

    OpenAIRE

    Rivero, Andres; Gomez, Eric; Alland, David; Huang, David B; Chiang, Tom

    2009-01-01

    Klebsiella pneumoniae primary liver abscess (KPLA) is an emerging disease that is associated with distant septic complications. We report the first case of KPLA associated with infective endocarditis. The K. pneumoniae strain was a hypermucoid K2 serotype carrying the rmpA virulence-associated gene.

  3. K2 serotype Klebsiella pneumoniae causing a liver abscess associated with infective endocarditis.

    Science.gov (United States)

    Rivero, Andres; Gomez, Eric; Alland, David; Huang, David B; Chiang, Tom

    2010-02-01

    Klebsiella pneumoniae primary liver abscess (KPLA) is an emerging disease that is associated with distant septic complications. We report the first case of KPLA associated with infective endocarditis. The K. pneumoniae strain was a hypermucoid K2 serotype carrying the rmpA virulence-associated gene. PMID:20007381

  4. Awareness of infective endocarditis prophylaxis in parents of children with congenital heart disease: A prospective survey

    International Nuclear Information System (INIS)

    A prospective survey of parents of the children with congenital heart disesease was conducted to determine their awareness as regards the importance of oral hygiene and prophylaxis against infective endocarditis (IE). The results of this study demonstrated that only 8% of the parents were aware of the importance of good oro-dental hygiene and need for IE prophylaxis

  5. Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars; Buchholtz, Kristine; Larsen, Carsten T; Hassager, Christian; Bruun, Niels E

    2009-01-01

    OBJECTIVES: To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE). METHODS: A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset of...

  6. Infective Endocarditis and Chronic Kidney Disease: How to Deal with Complications.

    Science.gov (United States)

    Habib Khan, Yusra; Sarriff, Azmi; Hayat Khan, Amer; Azreen Syazril, Adnan; Mallhi, Tauqeer Hussain

    2015-01-01

    Infective endocarditis (IE) is the one of the most important causes of increased mortality and morbidity among haemodialysis patients. The reason for this increasing prevalence of infection among these patients is the use of haemodialysis catheters during dialysis, as these patients are highly susceptible to infections that are easily transmitted via blood access points. The present case was a geriatric end stage renal disease (ESRD) patient who was readmitted to the hospital two days after her scheduled haemodialysis session with symptoms of nosocomial endocarditis. Her concurrent medical complications were hypertension, non-insulin dependent diabetes mellitus, and ischemic heart disease. Based on her previous medical history and current examination, the patient was suspected to have IE due to catheter related infection. The goal of therapy is to manage the comorbidities and infection by provision of appropriate treatment based on close monitoring of the patient condition. PMID:26715911

  7. Necrotizing fasciitis and infective endocarditis caused by Escherichia coli in a hemodialysis patient.

    Science.gov (United States)

    Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei; Hsieh, Shih-Chung

    2015-10-01

    Patients with uremia are often immunocompromised and uremia patients undergoing maintenance dialysis are often vulnerable to uncommon infections. We report a 40-year-old man who was undergoing maintenance hemodialysis and was initially diagnosed with monomicrobal necrotizing fasciitis of the lower limbs, based on blood and pus cultures that yielded Escherichia coli. His condition improved after surgical debridement and antibiotic therapy. However, he eventually died of intracranial hemorrhage related to septic emboli. Concurrent infective endocarditis was diagnosed based on an echocardiogram that indicated vegetation in the left ventricular region. Escherichia coli-related necrotizing fasciitis and infective endocarditis is rarely seen in clinical practice. There should be a high index of suspicion for multiple infections when a hemodialysis patient presents with an uncommon infection. PMID:25582556

  8. Infectivity of Lactobacillus rhamnosus and Lactobacillus paracasei isolates in a rat model of experimental endocarditis.

    Science.gov (United States)

    Vankerckhoven, Vanessa; Moreillon, Philippe; Piu, Stéphane; Giddey, Marlyse; Huys, Geert; Vancanneyt, Marc; Goossens, Herman; Entenza, José M

    2007-08-01

    The potential pathogenicity of selected (potentially) probiotic and clinical isolates of Lactobacillus rhamnosus and Lactobacillus paracasei was investigated in a rat model of experimental endocarditis. In addition, adhesion properties of the lactobacilli for fibrinogen, fibronectin, collagen and laminin, as well as the killing activity of the platelet-microbicidal proteins fibrinopeptide A (FP-A) and connective tissue activating peptide 3 (CTAP-3), were assessed. The 90 % infective dose (ID(90)) of the L. rhamnosus endocarditis isolates varied between 10(6) and 10(7) c.f.u., whereas four of the six (potentially) probiotic L. rhamnosus isolates showed an ID(90) that was at least 10-fold higher (10(8) c.f.u.) (P0.05). Importantly, these two probiotic isolates shared the same fluorescent amplified fragment length polymorphism cluster type as the clinical isolate showing the lowest ID(90) (10(6) c.f.u.). L. paracasei tended to have a lower infectivity than L. rhamnosus (ID(90) of 10(7) to > or =10(8) c.f.u.). All isolates had comparable bacterial counts in cardiac vegetations (P>0.05). Except for one L. paracasei strain adhering to all substrates, all tested lactobacilli adhered only weakly or not at all. The platelet peptide FP-A did not show any microbicidal activity against the tested lactobacilli, whereas CTAP-3 killed the majority of the isolates. In general, these results indicate that probiotic lactobacilli display a lower infectivity in experimental endocarditis compared with true endocarditis pathogens. However, the difference in infectivity between L. rhamnosus endocarditis and (potentially) probiotic isolates could not be explained by differences in adherence or platelet microbicidal protein susceptibility. Other disease-promoting factors may exist in these organisms and warrant further investigation. PMID:17644707

  9. Endocarditis infecciosa por Rhizobium radiobacter: Reporte de un caso / Infective endocarditis by Rhizobium radiobacter: A case report

    Scientific Electronic Library Online (English)

    Jean Félix, Piñerúa Gonsálvez; Rosanna del Carmen, Zambrano Infantino; Carlos, Calcaño; César, Montaño; Zaida, Fuenmayor; Henry, Rodney; Marianela, Rodney.

    2013-03-01

    Full Text Available Rhizobium radiobacter es una bacteria Gram-negativa, fijadora de nitrógeno que se encuentra principalmente en el suelo. Rara vez causa infecciones en humanos. Ha sido asociada a bacteriemia secundaria a colonización de catéteres intravasculares en pacientes inmunocomprometidos. El objetivo de este t [...] rabajo es informar un caso de endocarditis infecciosa por R. radiobacter. Se trata de paciente masculino, de 47 años de edad, con diagnóstico de enfermedad renal crónica estadio 5 en tratamiento sustitutivo con hemodiálisis, quien acude a centro asistencial por presentar fiebre de dos semanas de evolución. Es hospitalizado, se toman muestras de sangre periférica para hemocultivo y se inicia antibioticoterapia empírica con cefotaxime más vancomicina. El ecocardiograma transtorácico revelo vegetación fusiforme en válvula tricúspide con regurgitación grado III-IV/IV. Al séptimo día del inicio de la antibioterapia el paciente presenta mejoría clínica y paraclínica. La bacteria identificada por hemocultivo es Rhizobium radiobacter resistente a ceftriaxona y sensible a imipenem, amikacina, ampicilina y ampicilina/sulbactam. Debido a la mejoría clínica se decide continuar tratamiento con vancomicina y se anexa imipenem. A los 14 días de iniciada la antibioterapia el paciente es dado de alta con tratamiento ambulatorio con imipenen hasta cumplir seis semanas de tratamiento. En el ecocardiograma control se evidencio ausencia de la vegetación en la válvula tricúspide. Este caso sugiere que R. radiobacter puede ser una causa de endocarditis en pacientes portadores de catéteres intravasculares. Abstract in english 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 r [...] eport 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.

  10.  Tricuspid Endocarditis and Septic Pulmonary Embolism in an Intravenous Drug User with advanced HIV Infection

    OpenAIRE

    Gonul Sengoz; Sevtap Gursoy; Filiz Pehlivanoglu; Kadriye Kart Yasar

    2011-01-01

     Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU) with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD4 count are associated with increased risk of death. This report presents a case of isolated tricusp...

  11. NICE guideline on antibiotic prophylaxis against infective endocarditis: attitudes to the guideline and implications for dental practice in Ireland.

    LENUS (Irish Health Repository)

    2009-03-28

    To investigate attitudes of Irish dental practitioners, cardiologists and patients with cardiac lesions to the new NICE guideline for antibiotic prophylaxis against infective endocarditis and to determine the implications of this guideline for dental practice in Ireland.

  12. Successful recovery of infective endocarditis-induced rapidly progressive glomerulonephritis by steroid therapy combined with antibiotics: a case report

    OpenAIRE

    Kikkawa Ryuichi; Shibuya Kazuyuki; Koya Daisuke; Haneda Masakazu

    2004-01-01

    Abstract Background The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined. Ca...

  13. Infective endocarditis caused by methicillin-resistant Staphylococcus aureus in a young woman after ear piercing: a case report

    OpenAIRE

    Kim Mijeong; Durey Areum; Park Jae; Chung Moon-Hyun; Nah So-Yun; Lee Jin-Soo

    2011-01-01

    Abstract Introduction Ear piercing is a common practice among Korean adolescents and young women and usually is performed by nonmedical personnel, sometimes under suboptimal hygienic conditions. Consequently, ear piercing has been associated with various infectious complications, including fatal infective endocarditis. We report a case of infective endocarditis that was caused by community-associated methicillin-resistant Staphylococcus aureus after ear piercing and that was accompanied by a ...

  14. Infective endocarditis due to Bartonella spp. and Coxiella burnetii: experience at a cardiology hospital in Sao Paulo, Brazil.

    Science.gov (United States)

    Siciliano, Rinaldo Focaccia; Strabelli, Tânia Mara; Zeigler, Rogério; Rodrigues, Cristhieni; Castelli, Jussara Bianchi; Grinberg, Max; Colombo, Silvia; da Silva, Luiz Jacintho; Mendes do Nascimento, Elvira Maria; Pereira dos Santos, Fabiana Cristina; Uip, David Everson

    2006-10-01

    Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis. PMID:17114712

  15. Isolated Pulmonary Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Hatamizadeh

    2009-06-01

    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.

  16. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis

    DEFF Research Database (Denmark)

    2009-01-01

    The aim of this study was to investigate in-hospital mortality and 12-month mortality in patients with coagulase-negative Staphylococcus (CoNS) compared to Staphylococcus aureus (S. aureus) infective endocarditis (IE). We used a prospective cohort study of 66 consecutive CoNS and 170 S. aureus IE patients, collected at 2 tertiary university hospitals in Copenhagen (Denmark) and at 1 tertiary university hospital in Gothenburg (Sweden). Median (range) C-reactive protein at admission was higher in ...

  17. Radiolabeled antibody in the detection of infection using endocarditis as a model

    International Nuclear Information System (INIS)

    The authors have examined a method to detect infections using radiolabeled antibodies. Staphylococcal endocarditis was chosen as a model because it poses a common clinical diagnostic problem. The experiments demonstrate that biologically active antibodies may be extracted and efficiently labeled by a relatively simple process. This has the potential to make the specificity of the in vivo antigen-antibody reaction available through the use of autologously extracted, labeled γ-globulin

  18. MRI visualization of Staphyloccocus aureus-induced infective endocarditis in mice

    OpenAIRE

    Ring, J.; Hoerr, V. (Verena); Tuchscherr, L; Kuhlmann, M.T. (Michael); Löffler, B; Faber, C.

    2014-01-01

    Infective endocarditis (IE) is a severe and often fatal disease, lacking a fast and reliable diagnostic procedure. The purpose of this study was to establish a mouse model of Staphylococcus aureus-induced IE and to develop a MRI technology to characterize and diagnose IE. To establish the mouse model of hematogenous IE, aortic valve damage was induced by placing a permanent catheter into right carotid artery. 24 h after surgery, mice were injected intravenously with either iron particle-label...

  19. Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

    OpenAIRE

    Gambarati Gianpaolo; Mestres Carlos A; Colli Andrea; Chesi Giuseppe; Boni Fabrizio; Gherli Tiziano

    2006-01-01

    Abstract Background Methicillin-resistant S. aureus (MRSA) with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE) by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There w...

  20. Mitral valve replacement in a patient with infective endocarditis and aneurysm of the cerebral artery: A case report

    Directory of Open Access Journals (Sweden)

    Senka Mesihovi?-Dinarevi?

    2014-11-01

    Full Text Available Objective. Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. Case report. This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. Conclusion. Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

  1. An unusual case of infective endocarditis presenting as acute myocardial infarction.

    Science.gov (United States)

    Chen, Zhong; Ng, Francesca; Nageh, Thuraia

    2009-01-01

    A 39-year-old Zimbabwean man presented with a 1 week history of fever, general malaise and acute onset chest pain. He had a urethral stricture, which had been managed with an indwelling supra-pubic catheter. The electrocardiography on admission showed inferior ST-T segments elevation. His chest pain and electrocardiography changes resolved subsequent to thrombolysis, and he remained haemodynamically stable. The 12 h troponin I was increased at 10.5 µg/l (NR mobile vegetation. Enterococci faecalis were grown on blood cultures. A diagnosis of enterococci infective endocarditis with concomitant acute myocardial infarction due to possible septic emboli was made. Despite the successful outcome from thrombolysis in the setting of acute myocardial infarction with infective endocarditis, the case highlights the current lack of definitive data on the optimal acute management of such an unusual clinical scenario. Although there is serious concern that thrombolytic treatment for myocardial infarction in the setting of infective endocarditis may be associated with higher risk of cerebral haemorrhage, there is little documented evidence supporting the safety of primary percutaneous coronary intervention with these patients. PMID:21686364

  2. Endocarditis infecciosa en pacientes con daño hepático crónico: Serie de 4 casos clínicos Infective endocarditis in patients with chronic hepatic failure: A four cases series

    Directory of Open Access Journals (Sweden)

    Dan Oksenberg R

    2009-06-01

    Full Text Available La asociación entre daño hepático y endocarditis infecciosa es infrecuente. Para analizar los factores predisponentes de esta asociación, la etiología microbiana y evolución clínica, se efectuó un análisis retrospectivo de los egresos por endocarditis infecciosa en pacientes con cirrosis hepática desde 1995 a junio de 2008. Se identificaron cuatro casos, asociados a categoría Child A en tres y en todos había una cardiopatía predisponente. Las manifestaciones clínicas fueron clásicas excepto en un caso que se presentó como descompensación hepática. Sólo un caso se asoció a un agente típico, otros a un agente nosocomial y Corynebacterium diphtheriae. En un caso no se identificó la etiología. Uno de los pacientes requirió cirugía de reemplazo valvular. Tres pacientes se recuperaron (Child A y el paciente en categoría Child C falleció. Aunque infrecuente, la asociación cirrosis y endocarditis ocurre en la práctica clínica, se puede asociar a agentes inhabituales y tener manifestaciones encubiertas.Infective endocarditis and liver cirrhosis is an infrequent association. A retrospective study was performed in order to characterize predisposing factors, microbial causes and evolution. Medical records between 1995 and 2008 (June were searched. Four cases were identified. In three cases liver cirrhosis was in stage Child A, and in all 4 there was a predisposing cardiac disease. Clinical manifestations were classical in 3 cases and in one presented as hepatic failure. Only in one case a typical agent was recovered. Other cases were associated to a nosocomial agent or Corynebacterium diphtheriae, and in one no agent was identified. One patient required valve replacement. Three patients recovered satisfactorily, all of them in Child A stage. One died of non-infectious causes (Child C. Infective endocarditis and liver cirrhosis is an infrequent association in clinical practice, it can be associated to unusual agents or clinical manifestations.

  3. Lead-dependent infective endocarditis and pocket infection – similarities and differences

    Directory of Open Access Journals (Sweden)

    Anna Polewczyk

    2016-01-01

    Full Text Available Introduction : Infectious complications in patients with implanted pacemakers are divided into infections of the generator pocket (PI and lead-dependent infective endocarditis (LDIE. Aim of the research: Identification of risk factors for developing different types of infections and evaluation of the extent of infectious complications. Material and methods : We compared two groups of patients with infectious complications, who underwent transvenous lead extraction (TLE in the Reference Centre between March 2006 and July 2013. The groups consisted of 414 patients with LDIE and 205 with PI. We analysed risk factors, clinical manifestations, inflammatory markers, microbiology, and echocardiography results. Results : The coexistence of LDIE and PI was observed in 62.1% patients. There were no significant differences in the presence of host-dependent risk factors. Patients with LDIE significantly more frequently had abrasion of leads (35.1.% vs. 21.0%; p = 0.0001 connected with other procedural risk factors: a larger number of the leads (2.2 vs. 2.0; p = 0.004 lead loops (24.6% vs. 13.2%; p = 0.001, and longer time interval from the last procedure prior to TLE (28.7 vs. 22.6 months; p = 0.005. Fever and pulmonary infections, higher level of erythrocyte sedimentation rate, C-reactive protein, procalcitonin, vegetation presence, and higher pulmonary systolic pressure were also revealed in patients with LDIE. Positive blood and leads culture were observed in 34.5% and 46.4% patients with LDIE. Conclusions: The frequent coexistence of LDIE and PI confirms their common pathogenesis, but the phenomenon of abrasion suggests also another mechanism for the development of LDIE. Intensity of clinical syndromes, high inflammatory parameters, echocardiography, and microbiology findings are helpful in assessment of the extensity of the infection.

  4. Niveles de péptido natriurético tipo B y su asociación con la morbimortalidad en endocarditis infecciosa / Association Levels of brain natriuretic peptide with morbidity and mortality in infective endocarditis

    Scientific Electronic Library Online (English)

    Oddir, Jáuregui Ruiz; Eduardo, Galván García; Cyntia Zulema, Machain Leyva.

    2013-12-01

    Full Text Available La endocarditis infecciosa (EI) es una infección con alta morbimortalidad. Identificar a los pacientes con mayor riesgo de presentar complicaciones proporciona la oportunidad de establecer una terapéutica agresiva. El péptido natriurético tipo B es un estudio rápido y disponible, y se ha relacionado [...] a los niveles elevados con una mala evolución en la EI. Objetivos: Determinar la asociación entre los niveles de péptido natriurético tipo B y la morbimortalidad en pacientes con EI. Material y métodos: Se incluyeron pacientes ?15 años, durante el periodo de julio de 2010 a julio de 2012. Se dividieron en distintos grupos con base en los niveles de péptido natriurético tipo B: grupo 1, péptido natriurético tipo B Abstract in english Infective endocarditis (IE) is an infection with high morbidity and mortality. Identify patients with increased risk for complications, provides the opportunity to establish an aggressive therapeutic. B-type natriuretic peptide is a quick, available and high levels has been linked with poor outcome [...] in IE. Objectives: To determine the association between B-type natriuretic peptide levels and morbidity and mortality in patients with infective endocarditis. Material and methods: We included patients ? 15 years, during the period July 2010 to July 2012. They were divided into groups based on the levels of B-type natriuretic peptide, group 1 B-type natriuretic peptide

  5. From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection

    Directory of Open Access Journals (Sweden)

    Raoult Didier

    2007-04-01

    Full Text Available Abstract Background Most patients with infectious endocarditis (IE due to Bartonella henselae have a history of exposure to cats and pre-existing heart valve lesions. To date, none of the reported patients have had a history of typical cat scratch disease (CSD which is also a manifestation of infection with B. henselae. Case presentation Here we report the case of a patient who had CSD and six months later developed IE of the mitral valve caused by B. henselae. Conclusion Based on this unique case, we speculate that CSD represents the primary-infection of B. henselae and that IE follows in patients with heart valve lesions.

  6. Severe infective endocarditis with systemic embolism due to community associated methicillin-resistant Staphylococcus aureus ST630

    Scientific Electronic Library Online (English)

    Beiwen, Zheng; Saiping, Jiang; Zemin, Xu; Yonghong, Xiao; Lanjuan, Li.

    2015-02-01

    Full Text Available Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly causing infective endocarditis over the past decade. Here we report a healthy man who developed a severe acute infective endocarditis with systemic embolism caused by CA- MRSA. The strain was recovered from r [...] epeated blood cultures and was characterized using molecular detection and genotyping. The S. aureus isolate was typed as ST630 SCCmecV with spa-type t4549, agrI/IV and was PVL-negative. This is the only case report, to our knowledge, of CA-MRSA infective endocarditis in China. This case highlights the emergence and geographical spread of life-threatening CA-MRSA infection within China.

  7. Cirurgia conservadora de próteses aórtica e mitral na endocardite infecciosa Conservative surgery for aortic and mitral prosthesis in infective endocarditis

    Directory of Open Access Journals (Sweden)

    Kanim Kalil KASSAB

    2001-03-01

    Full Text Available A endocardite infecciosa (EI acometendo próteses valvares é uma complicação freqüente, sendo tratada geralmente com cirurgia, devido ao seu difícil controle clínico e má resposta à antibioticoterapia. Este relato descreve o caso de uma paciente com EI, acometendo simultaneamente as biopróteses aórtica (Ao e mitral (Mi após vinte e quatro meses de cirurgia de implantes valvares, submetida a tratamento cirúrgico conservador, e com resultado favorável. Discutem-se as vantagens deste procedimento em situações específicas.Infective endocarditis is a frequent complication for valvar prosthesis currently treated with surgery, orving to its difficult control and poor response to therapy with antibiotics. Although conservative surgery for infective endocarditis of prosthesis is not a procedure of choice, this report shows a case of infective endocarditis of aortic and mitral prosthesis, after 24 months of implantation, treated by conservative surgery with favorable outcome.

  8. Cirurgia conservadora de próteses aórtica e mitral na endocardite infecciosa / Conservative surgery for aortic and mitral prosthesis in infective endocarditis

    Scientific Electronic Library Online (English)

    Kanim Kalil, KASSAB; José Antônio Garcia, MENEGOLI; Vera Lúcia A. M., PICARDI; Marcos Cesar V. de, ALMEIDA; Emil, SABINO; Edgard, SAN JUAN; Ricardo Gomes, CAMACHO; César Morioki, OGIDO; Enoch Brandão de Souza, MEIRA.

    2001-03-01

    Full Text Available A endocardite infecciosa (EI) acometendo próteses valvares é uma complicação freqüente, sendo tratada geralmente com cirurgia, devido ao seu difícil controle clínico e má resposta à antibioticoterapia. Este relato descreve o caso de uma paciente com EI, acometendo simultaneamente as biopróteses aórt [...] ica (Ao) e mitral (Mi) após vinte e quatro meses de cirurgia de implantes valvares, submetida a tratamento cirúrgico conservador, e com resultado favorável. Discutem-se as vantagens deste procedimento em situações específicas. Abstract in english Infective endocarditis is a frequent complication for valvar prosthesis currently treated with surgery, orving to its difficult control and poor response to therapy with antibiotics. Although conservative surgery for infective endocarditis of prosthesis is not a procedure of choice, this report show [...] s a case of infective endocarditis of aortic and mitral prosthesis, after 24 months of implantation, treated by conservative surgery with favorable outcome.

  9. Primer reporte en Cuba de endocarditis infecciosa a consecuencia de brucelosis First report of infective endocarditis in Cuba as a result of brucellosis

    Directory of Open Access Journals (Sweden)

    Gloria Sofía García González

    2012-04-01

    Full Text Available Introducción: las manifestaciones clínicas por brucelosis han sido muy poco investigadas y no se profundiza en los síntomas y las posibles complicaciones que puede causar. Objetivo: reportar por primera vez en Cuba un caso de endocarditis infecciosa a consecuencia de brucelosis. Métodos: hombre blanco, de 57 años, campesino, remitido desde Vertientes, que ingresó en diciembre de 2009 en el Hospital Provincial "Manuel Ascunce Domenech" de Camagüey, con diagnóstico presuntivo de endocarditis infecciosa por Brucella e insuficiencia aórtica moderada, que refirió presentar fiebre, malestar general, decaimiento, dolores musculares, articulares, artritis, astenia marcada, anorexia, signos neurológicos, sudoración y fuerte dolor en el pecho. En anteriores ingresos fue tratado con antimicrobianos, indicándole entre los complementarios, serología lenta en busca de brucelosis, pero por no disponibilidad de reactivos no se realizaron estas pruebas hasta enero de 2010. Se precisaron como antecedentes epidemiológicos el contacto directo con ganado vacuno y porcino y la presencia de heridas y microtraumatismos en manos y pies, propios de su labor. Su finca colinda con otra donde hay ganado afectado de brucelosis. Resultados: los exámenes de laboratorio resultaron positivos con elevados títulos serológicos, y aunque no fue posible el aislamiento del agente etiológico mediante el cultivo, se confirmó serológicamente la enfermedad y la endocarditis infecciosa como complicación sobreañadida; esto llevó tratamiento con antimicrobianos y medicamentos para la afección cardíaca. Se diagnostican muy poco estas complicaciones a consecuencia de brucelosis en la literatura internacional, este es el primer reporte para Cuba. Conclusiones: la descripción de este caso, constituye una alerta en el diagnóstico de las endocarditis infecciosas quizá asociadas a antecedentes epidemiológicos de brucelosis.Introduction: the clinical manifestations of brucellosis have been poorly researched on and the symptoms and possible complications have not been deeply studied either. Objective: to report a case of infective endocarditis caused by brucellosis for the first time in Cuba. Methods: a Caucasian male farmer aged 57 years was referred from Vertientes municipality to be admitted at "Manuel Ascunce Domenech" provincial hospital in Camaguey province in December,2009. He had been presumptively diagnosed with infectious endocarditis caused by Brucella and with moderate aortic failure since he presented with fever, general malaise, fatigue, muscle and joint pains, arthritis, marked asthenia, anorexia, neurological signs, sweating and strong chest pain. In his previous hospitalization, he had been treated with antimicrobials after indication of supplementary tests such as slow serology for brucellosis; however, specific reagents were not available,so these tests were not performed until January 2010.The epidemiological history of this case included his direct contact with cows and pigs as well as wounds and minor traumas inflicted on his hands and feet resulting from his type of work. His farm is next to another farm where the cattle is also affected with brucellosis. Results: the lab tests were positive with high serological titres, and although it was not possible to isolate the etiologic agent through culturing, the disease and the infective endocarditis were serologically confirmed as additional complication; this required antimicrobial treatment and drugs for the heart disease. These complications from brucellosis are barely diagnosed in the international literature, and in Cuba, this is the first report of the disease. Conclusions: the description of this case is an alert to diagnosis of infective endocarditis that may be associated with epidemiological history of brucellosis.

  10. Primer reporte en Cuba de endocarditis infecciosa a consecuencia de brucelosis / First report of infective endocarditis in Cuba as a result of brucellosis

    Scientific Electronic Library Online (English)

    Gloria Sofía, García González; Iraida María, Saborido Pérez; Lázaro, Ramírez Lana; Isabel, Ponce de León Ávila.

    2012-04-01

    Full Text Available Introducción: las manifestaciones clínicas por brucelosis han sido muy poco investigadas y no se profundiza en los síntomas y las posibles complicaciones que puede causar. Objetivo: reportar por primera vez en Cuba un caso de endocarditis infecciosa a consecuencia de brucelosis. Métodos: hombre blan [...] co, de 57 años, campesino, remitido desde Vertientes, que ingresó en diciembre de 2009 en el Hospital Provincial "Manuel Ascunce Domenech" de Camagüey, con diagnóstico presuntivo de endocarditis infecciosa por Brucella e insuficiencia aórtica moderada, que refirió presentar fiebre, malestar general, decaimiento, dolores musculares, articulares, artritis, astenia marcada, anorexia, signos neurológicos, sudoración y fuerte dolor en el pecho. En anteriores ingresos fue tratado con antimicrobianos, indicándole entre los complementarios, serología lenta en busca de brucelosis, pero por no disponibilidad de reactivos no se realizaron estas pruebas hasta enero de 2010. Se precisaron como antecedentes epidemiológicos el contacto directo con ganado vacuno y porcino y la presencia de heridas y microtraumatismos en manos y pies, propios de su labor. Su finca colinda con otra donde hay ganado afectado de brucelosis. Resultados: los exámenes de laboratorio resultaron positivos con elevados títulos serológicos, y aunque no fue posible el aislamiento del agente etiológico mediante el cultivo, se confirmó serológicamente la enfermedad y la endocarditis infecciosa como complicación sobreañadida; esto llevó tratamiento con antimicrobianos y medicamentos para la afección cardíaca. Se diagnostican muy poco estas complicaciones a consecuencia de brucelosis en la literatura internacional, este es el primer reporte para Cuba. Conclusiones: la descripción de este caso, constituye una alerta en el diagnóstico de las endocarditis infecciosas quizá asociadas a antecedentes epidemiológicos de brucelosis. Abstract in english Introduction: the clinical manifestations of brucellosis have been poorly researched on and the symptoms and possible complications have not been deeply studied either. Objective: to report a case of infective endocarditis caused by brucellosis for the first time in Cuba. Methods: a Caucasian male f [...] armer aged 57 years was referred from Vertientes municipality to be admitted at "Manuel Ascunce Domenech" provincial hospital in Camaguey province in December,2009. He had been presumptively diagnosed with infectious endocarditis caused by Brucella and with moderate aortic failure since he presented with fever, general malaise, fatigue, muscle and joint pains, arthritis, marked asthenia, anorexia, neurological signs, sweating and strong chest pain. In his previous hospitalization, he had been treated with antimicrobials after indication of supplementary tests such as slow serology for brucellosis; however, specific reagents were not available,so these tests were not performed until January 2010.The epidemiological history of this case included his direct contact with cows and pigs as well as wounds and minor traumas inflicted on his hands and feet resulting from his type of work. His farm is next to another farm where the cattle is also affected with brucellosis. Results: the lab tests were positive with high serological titres, and although it was not possible to isolate the etiologic agent through culturing, the disease and the infective endocarditis were serologically confirmed as additional complication; this required antimicrobial treatment and drugs for the heart disease. These complications from brucellosis are barely diagnosed in the international literature, and in Cuba, this is the first report of the disease. Conclusions: the description of this case is an alert to diagnosis of infective endocarditis that may be associated with epidemiological history of brucellosis.

  11. Infective endocarditis caused by Scedosporium prolificans infection in a patient with acute myeloid leukemia undergoing induction chemotherapy.

    Science.gov (United States)

    Ochi, Yotaro; Hiramoto, Nobuhiro; Takegawa, Hiroshi; Yonetani, Noboru; Doi, Asako; Ichikawa, Chihiro; Imai, Yukihiro; Ishikawa, Takayuki

    2015-06-01

    Disseminated Scedosporium prolificans infection occurs mainly in immunocompromised patients. The mortality rate is high, as the fungus is resistant to most antifungal agents. Here, we present the case of a 66-year-old female with acute myeloid leukemia who developed infective endocarditis caused by S. prolificans infection during induction chemotherapy. Her 1,3-?-D-glucan levels were elevated and computed tomography revealed bilateral sinusitis and disseminated small nodular masses within the lungs and spleen; it nonetheless took 6 days to identify S. prolificans by blood culture. The patient died of multi-organ failure despite the combined use of voriconazole and terbinafine. Autopsy revealed numerous mycotic emboli within multiple organs (caused by mitral valve vegetation) and endocarditis (caused by S. prolificans). The geographic distribution of this infection is limited to Australia, the United States, and southern Europe, particularly Spain. The first Japanese case was reported in 2011, and four cases have been reported to date, including this one. Recently, the incidence of S. prolificans-disseminated infection in immunocompromised patients has increased in Japan. Therefore, clinicians should consider S. prolificans infection as a differential diagnosis when immunocompromised patients suffer disseminated infections with elevated 1,3-?-D-glucan levels. PMID:25630434

  12. Infective endocarditis: a continuous challenge. The recent experience of a European tertiary center

    DEFF Research Database (Denmark)

    Knudsen, Jane B; Fuursted, Kurt; Petersen, Eskild; Wierup, Per; Mølgaard, Henning; Poulsen, Steen H; Egeblad, Henrik

    2009-01-01

    BACKGROUND AND AIM OF THE STUDY: The study aim was to monitor infective endocarditis (IE) before and after the condition was brought into focus in hospitals in the Aarhus region of Denmark. METHODS: A total of 172 patients with IE, all of whom had been referred to the regional tertiary center during 2000-2001 or during 2005-2006, was included prospectively into the study. RESULTS: Between 2000-1 (n = 51) and 2005-6 (n = 121), a very large (137%) increase occurred in the number of IE patients ref...

  13. Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II

    Directory of Open Access Journals (Sweden)

    B S Belov

    2008-09-01

    Full Text Available Infective endocarditis (IE is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

  14. Radioimmunoimaging of subacute infective endocarditis using a technetium-99m monoclonal granulocyte-specific antibody

    Energy Technology Data Exchange (ETDEWEB)

    Munz, D.L.; Sandrock, D.; Emrich, D. (Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin); Morguet, A.J.; Heim, A.; Sold, G.; Figulla, H.R.; Kreuzer, H. (Goettingen Univ. (Germany). Abt. fuer Kardiologie und Pulmonologie)

    1991-12-01

    Immunoscintigraphy with a technetium-99m murine monoclonal IgG{sub 1} antibody directed against non-specific cross-reacting antigen (NCA-95) and carcinoembryonic antigen was performed with 20 patients with suspected subacute infective endocarditis (SIE) and 6 controls with suspected inflammatory/infectious disease elsewhere in the body. Immunoscintigraphy and echocardiography localised SIE in 11 of 15 patients in whom the disease could be confirmed. In 4 patients with validated SIE, the immunoscan was abnormal, and the echocardiogram was normal. In another 4 patients, the result was exactly the opposite. These findings suggest that the combination of immunoscintigraphy and echocardiography improves diagnostic efficacy in patients with suspected SIE. (orig.).

  15. Pathogenesis of Streptococcus infantarius subspecies coli Isolated from Sea Otters with Infective Endocarditis.

    Science.gov (United States)

    Counihan, Katrina L; Gill, Verena A; Miller, Melissa A; Burek-Huntington, Kathleen A; LeFebvre, Rance B; Byrne, Barbara A

    2015-06-01

    The Gram positive bacterial coccus Streptococcus infantarius subspecies coli is increasingly linked with development of fatal vegetative infective endocarditis and septicemia in humans, sea otters (Enhydra lutris) and other animals. However, the pathogenesis of these infections is poorly understood. Using S. infantarius subsp. coli strains isolated from sea otters with infective endocarditis, this study evaluated adherence and invasion of epithelial and endothelial cells, adherence to extracellular matrix components, and macrophage survival. Significant adherence to endothelial-derived cells was observed for 62% of isolates, 24% adhered to epithelial cell lines, and 95% invaded one or both cell types in vitro. The importance of the hyaluronic acid capsule in host cell adherence and invasion was also evaluated. Capsule removal significantly reduced epithelial adherence and invasion for most S. infantarius subsp. coli isolates, suggesting that the capsule facilitates attachment to and invasion of epithelium. Enzyme-linked immunosorbent assay testing revealed that all isolates adhered significantly to the extracellular matrix components collagen IV, fibronectin, laminin and hyaluronic acid. Finally, significant bacterial survival following phagocytosis by macrophages was apparent for 81% of isolates at one or more time points. Taken collectively these findings indicate that S. infantarius subsp. coli has multiple pathogenic properties that may be important to host colonization, invasion and disease. PMID:25838157

  16. Clinical presentation of infective endocarditis caused by different groups of non-beta haemolytic streptococci.

    Science.gov (United States)

    Nilson, B; Olaison, L; Rasmussen, M

    2016-02-01

    Streptococci are common causes of infective endocarditis (IE) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has provided a practical tool for their species determination. We aimed to investigate if particular groups of non-beta heamolytic streptococci were associated with IE or to specific presentations thereof. The Swedish Registry of Infective Endocarditis was used to identify cases of IE caused by streptococci and a local database to identify cases of streptococcal bacteremia. The bacteria were grouped using MALDI-TOF MS and the clinical characteristics of IE caused by different groups were compared. We identified a group of 201 streptococcal IE isolates: 18 isolates belonged to the anginosus, 19 to the bovis, 140 to the mitis, 17 to the mutans, and seven to the salivarius groups. The mitis and mutans groups were significantly more common and the anginosus group less common among IE cases as compared to all cause bacteremia. Patients infected with the bovis group isolates were older, had more cardiac devices, and had more commonly prosthetic valve IE compared to IE caused by streptococci of the other groups. Twenty-one percent of patients needed surgery, and in-hospital mortality was 8% with no significant differences between the groups. Grouping of non-beta haemolytic streptococci using MALDI-TOF MS can provide a basis for decision-making in streptococcal bacteremia. IE caused by bovis group isolates have clinical characteristics distinguishing them from IE caused by other groups of Streptococcus. PMID:26610338

  17. Complicaciones posoperatorias y mortalidad en pacientes operados por endocarditis infecciosa / Postoperative complications and mortality observed in patients operated on from infective endocarditis

    Scientific Electronic Library Online (English)

    Joaquín, Gómez Armando Gonga; Milvio B, Ramírez López; Horacio E, Pérez López; Fidel Manuel, Cáceres Loriga; José R, Llanes.

    2013-03-01

    Full Text Available Objetivo: describir las causas de morbilidad y mortalidad perioperatorias en los pacientes afectos de endocarditis infecciosa activa y significar cómo pueden ser disminuidas. Métodos: se realizó un estudio retrospectivo de las complicaciones posoperatorias y mortalidad en 139 pacientes operados por [...] presentar endocarditis infecciosa en un período de 16 años. Se efectuaron 147 operaciones a los 139 pacientes de las cuales 83 (57,1 %) fueron electivas y 64 (42,9 %) fueron de urgencia. El 24 % de los pacientes fueron remitidos de otros centros en los que habían sido sometidos a tratamiento médico no exitoso por más de 4 semanas. Resultados: las operaciones efectuadas fueron: Sustituciones valvulares aórticas,mitrales y tricuspídeas 75 (41,1 %), extracción de electrodos de marcapasos o desfibriladores automáticos implantables del ventrículo derecho 57 (41 %) , otras operaciones en número de 7 (4,9 %)y 8 reintervenciones. La complicación más frecuente fue la sepsis generalizada (10,07 % p Abstract in english Objective: To describe the causes of perioperative morbidity and mortality of patients suffering active infectious endocarditis and to explain how both aspects can be reduced. Methods: A retrospective study of postoperative complications and mortality observed in 139 patients operated on from infect [...] ious endocarditis in 16 years. One hundred forty seven surgeries were performed, of which 83 (57.1 %) were elective and 64 (42.9 %) were emergency surgeries. In this group, 24 % had been referred from other medical centers where they had been unsuccessfully treated for 4 weeks. Results: The performed surgeries comprised 15 aortic, mitral and tricuspid valve replacements, 57 (41 %) removals of pacemaker electrodes or of implanted automatic defibrillators in the right ventricle, seven other types of surgeries and 8 reoperations. The most frequent complication was generalized sepsis ((10.07 % p

  18. Endocarditis infecciosa por S. aureus en la Argentina: EIRA 2. Análisis comparativo luego de 10 años de los estudios EIRA 1 y 2 / S. aureus Infective Endocarditis in Argentina: A Comparative Analysis after 10 Years of EIRA-1 and EIRA-2 Surveys

    Scientific Electronic Library Online (English)

    Ernesto R., Ferreirós; José H., Casabé; Francisco, Nacinovich; Sandra, Swieszkowski; Hernán, Cohen Arazi; Claudia, Cortés; Juan Carlos, Modenesi; Sergio, Varini.

    2006-02-01

    Full Text Available Objetivo Comparar el perfil y la evolución de la endocarditis infecciosa (EI) en nuestro país a lo largo de 10 años, a través de los registros EIRA-1 y EIRA-2. Determinar las características clínicas y epidemiológicas y la evolución hospitalaria de la EI por Staphylococcus aureus (EISA) en la Argent [...] ina. Métodos El estudio EIRA-2 fue un registro prospectivo multicéntrico conducido en 82 hospitales de 16 provincias de la Argentina. En el presente análisis se incluyeron pacientes con EI definidas (clasificación de Duke) relevados en un período de 18 meses. Resultados Se registraron 390 episodios de EI definidas (108 EISA y 282 no EISA); edad media 58,5 ± 17,3 años, sexo masculino 70%. No existieron diferencias estadísticamente significativas entre las 108 EISA y las 282 no EISA con respecto a edad, sexo, endocarditis de válvula protésica, enfermedad valvular degenerativa, presencia de insuficiencia cardíaca y frecuencia de tratamiento quirúrgico. La comparación de los registros EIRA-2 y EIRA-1 demostró cambios importantes en el perfil de la enfermedad en la última década, actualmente caracterizada por pacientes de mayor edad (58 versus 51 años), mayor prevalencia de cardiopatía subyacente 67% versus 55% (en particular prótesis valvulares 19,2% versus 8,5%, enfermedades valvulares degenerativas 12,4% versus 4,8% y cardiopatías congénitas 9,5% versus 4,2%), mayor frecuencia de infección causada por S. aureus (30% versus 26%) y menor por Streptococcus viridans (30,8% versus 26,8%), con una reducción del tiempo hasta el diagnóstico definitivo (21,5 versus 33 días). No se encontraron modificaciones en la tasa de mortalidad de la enfermedad. Se observó una diferencia estadísticamente significativa (p Abstract in english Work Objective To analyze the evolution and profile of infective endocarditis (IE) in Argentina during the last 10 years through the comparison of EIRA-1 and EIRA-2 surveys. To determine the epidemiological and clinical characteristics, and in-hospital evolution of S. aureus IE (SAIE) in Argentina. [...] Research Design and Methods The EIRA-2 survey was a prospective, multicentric study performed in 82 hospitals belonging to 16 of the 24 Argentinean provinces. Patients with definitive diagnosis of IE (Duke criteria) were followed-up during an 18-month period. Results Three hundred and ninety episodes of definitive IE were reported (108 SAIE and 282 non-SAIE); mean age was 58.5±17.3 years, male sex 70%. No statistically significant differences were observed between SAIE and non-SAIE regarding mean age, sex, prosthetic valve IE, degenerative valve IE, prevalence of heart failure and surgical treatment. The comparison of the EIRA-2 and EIRA-1 surveys showed that IE profile has changed in the last decade in Argentina. Currently, patients are older (58 vs. 51 years), and have a higher prevalence of underlying heart disease (67% vs. 55%) particularly prosthetic valve (19.2% vs. 8.5%), degenerative valve disease (12.4% vs. 4.8%), and congenital heart disease (9.5% vs. 4.2%); infections were more frequently caused by S. aureus (30% vs. 26%) and less by S. viridans (30.8% vs. 26.8%) with a decreased time until final diagnosis (21.5 vs. 33 days). No significant changes were observed in the overall mortality rate. Patients with SAIE showed a significantly (p

  19. Staphylococcus aureus infective endocarditis versus bacteremia strains: Subtle genetic differences at stake.

    Science.gov (United States)

    Bouchiat, Coralie; Moreau, Karen; Devillard, Sébastien; Rasigade, Jean-Philippe; Mosnier, Amandine; Geissmann, Tom; Bes, Michèle; Tristan, Anne; Lina, Gérard; Laurent, Frédéric; Piroth, Lionel; Aissa, Nejla; Duval, Xavier; Le Moing, Vincent; Vandenesch, François

    2015-12-01

    Infective endocarditis (IE)((1)) is a severe condition complicating 10-25% of Staphylococcus aureus bacteremia. Although host-related IE risk factors have been identified, the involvement of bacterial features in IE complication is still unclear. We characterized strictly defined IE and bacteremia isolates and searched for discriminant features. S. aureus isolates causing community-acquired, definite native-valve IE (n=72) and bacteremia (n=54) were collected prospectively as part of a French multicenter cohort. Phenotypic traits previously reported or hypothesized to be involved in staphylococcal IE pathogenesis were tested. In parallel, the genotypic profiles of all isolates, obtained by microarray, were analyzed by discriminant analysis of principal components (DAPC)((2)). No significant difference was observed between IE and bacteremia strains, regarding either phenotypic or genotypic univariate analyses. However, the multivariate statistical tool DAPC, applied on microarray data, segregated IE and bacteremia isolates: IE isolates were correctly reassigned as such in 80.6% of the cases (C-statistic 0.83, P<0.001). The performance of this model was confirmed with an independent French collection IE and bacteremia isolates (78.8% reassignment, C-statistic 0.65, P<0.01). Finally, a simple linear discriminant function based on a subset of 8 genetic markers retained valuable performance both in study collection (86.1%, P<0.001) and in the independent validation collection (81.8%, P<0.01). We here show that community-acquired IE and bacteremia S. aureus isolates are genetically distinct based on subtle combinations of genetic markers. This finding provides the proof of concept that bacterial characteristics may contribute to the occurrence of IE in patients with S. aureus bacteremia. PMID:26318542

  20. 67Ga imaging in the patients with infective endocarditis after surgery for congenital heart disease

    International Nuclear Information System (INIS)

    67Ga imaging was performed in sixteen patients (age: 8 m.-18 y.) who had persistent fever and positive acute phase reactants after surgery for congenital heart disease. Abnormal uptake of 67Ga over the heart and the lungs was evaluated with a computer. Abnormal uptake of 67Ga was observed in seven patients. Of them, three showed it in the area of peripheral pulmonary artery and the other four showed it in the area of artificial vessels for pulmonary artery reconstruction. In six patients with positive blood cultures, five showed abnormal uptake of 67Ga and in ten patients with negative blood cultures, two showed it. Vegetation was detected with 2D-echocardiography in four patients and all of them showed abnormal uptake of 67Ga, while in 12 patients without vegetation three showed it. In conclusion, 67Ga imaging was useful to detect the foci of infective endocarditis or pulmonary embolism caused by the vegetation in infective endocarditis in the patients after surgery for congenital heart disease, especially in the peripheral pulmonary arteries and artificial vessels which could not be detected with 2D-echo. (author)

  1. sup 67 Ga imaging in the patients with infective endocarditis after surgery for congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Kohata, Tohru; Ono, Yasuo; Kamiya, Tetsuro; Nishimura, Tsunehiko; Takamiya, Makoto; Yagihara, Toshikatsu (National Cardiovascular Center, Suita, Osaka (Japan))

    1991-11-01

    {sup 67}Ga imaging was performed in sixteen patients (age: 8 m.-18 y.) who had persistent fever and positive acute phase reactants after surgery for congenital heart disease. Abnormal uptake of {sup 67}Ga over the heart and the lungs was evaluated with a computer. Abnormal uptake of {sup 67}Ga was observed in seven patients. Of them, three showed it in the area of peripheral pulmonary artery and the other four showed it in the area of artificial vessels for pulmonary artery reconstruction. In six patients with positive blood cultures, five showed abnormal uptake of {sup 67}Ga and in ten patients with negative blood cultures, two showed it. Vegetation was detected with 2D-echocardiography in four patients and all of them showed abnormal uptake of {sup 67}Ga, while in 12 patients without vegetation three showed it. In conclusion, {sup 67}Ga imaging was useful to detect the foci of infective endocarditis or pulmonary embolism caused by the vegetation in infective endocarditis in the patients after surgery for congenital heart disease, especially in the peripheral pulmonary arteries and artificial vessels which could not be detected with 2D-echo. (author).

  2. Cases of active infective endocarditis in a university hospital during a 10-year period

    International Nuclear Information System (INIS)

    Objective: To determine the features of patients with active infective endocarditis, and to identify causative microorganisms in blood and/or valve cultures. Methods: The retrospective study was conducted at the Surgical Intensive Care Unit of Istanbul University Cardiology Institute, Istanbul, Turkey, and comprised 22 patients with clinical evidence of the affliction who underwent operation between January 2001 and December 2010. Modified Duke Criteria was used for the diagnosis of the condition. Frequencies and percentages were calculated. Results: The mean age of the patients was 46.68+-18 years, and 12 (54.5%) were male. Native valve endocarditis was present in 13 (59.1%) cases and prosthetic valve endocarditis was present in 9 (40.9%). Rheumatic heart disease was the commonest underlying heart disease (n=12; 54.5%). None of patient was intravenous drug abuser and positive for human immunodeficiency virus. Operative mortality was 18% (n=4). Vegetation and abscess formation were detected in 19 (86.3%) cases. Blood culture positivity was 50% (n=11). Staphylococci was the most common causative micro-organism (n=4; 36.3%), followed by Streptococci (n=3; 27.3%), and 1 (9.1%) each for Enterococci, Brucella species, Candida albicans and Stenotrophomonas maltophilia. Positive cultures from vegetations and tissue retrieved at the operation was not detected. Conclusion: Active IE remains a severe disease affecting the young population in our study and rheumatic heart disease continues to be the most underlying heart disease. Culture negativity was found to be very high and prior antibiotic therapy may be the prime reason. (author)

  3. Infective endocarditis caused by methicillin-resistant Staphylococcus aureus in a young woman after ear piercing: a case report

    Directory of Open Access Journals (Sweden)

    Kim Mijeong

    2011-08-01

    Full Text Available Abstract Introduction Ear piercing is a common practice among Korean adolescents and young women and usually is performed by nonmedical personnel, sometimes under suboptimal hygienic conditions. Consequently, ear piercing has been associated with various infectious complications, including fatal infective endocarditis. We report a case of infective endocarditis that was caused by community-associated methicillin-resistant Staphylococcus aureus after ear piercing and that was accompanied by a noticeable facial rash. Case presentation A 29-year-old Korean woman underwent ear piercing six days before hospitalization. On admission, she had fever, erythematous maculopapular rashes on her face, signs of generalized emboli, vegetation in her mitral valve, and methicillin-resistant S. aureus bacteremia. On the basis of the blood culture results, she was treated with vancomycin in combination with gentamicin. On day six of hospitalization, a rupture of the papillary muscle of her mitral valve developed, and emergency cardiac surgery replacing her mitral valve with a prosthetic valve was performed. After eight weeks of antibiotic therapy, she was treated successfully and discharged without significant sequelae. Conclusions Numerable cases of body piercing-related infective endocarditis have been reported, and since ear piercing is commonplace nowadays, the importance of risk recognition cannot be overemphasized. In our report, a patient developed infective endocarditis that was caused by methicillin-resistant S. aureus after ear piercing and that was accompanied by an interesting feature, namely facial rash.

  4. Endocarditis infecciosa por Listeria monocytogenes: revisión de la literatura a partir de un caso clínico / Infective endocarditis caused by Listeria monocytogenes: review of the literature and a case report

    Scientific Electronic Library Online (English)

    Arnaldo, Marín; Nicole, Lustig; Ricardo, Cruz; Samuel, Córdova.

    2013-08-01

    Full Text Available La endocarditis infecciosa por Listeria monocytogenes es una enfermedad extremadamente infrecuente, pero usualmente agresiva. Se ha observado en los últimos años un aumento en la edad de presentación y una predilección por pacientes con enfermedad valvular, especialmente válvula protésica. El tratam [...] iento de elección es ampicilina combinada con un aminoglucósido para obtener sinergismo. Aun con un tratamiento adecuado, la mortalidad es elevada y mayor que en otros tipos de endocarditis bacteriana. Con una terapia óptima, incluyendo la resolución quirúrgica, la mortalidad ha disminuido significativamente en los últimos años. Se presenta una revisión de la literatura científica a partir de un caso clínico de un paciente con un síndrome febril en el que se diagnosticó una endocarditis por L. monocytogenesque fue tratada en forma médica con un resultado exitoso. Abstract in english Infective endocarditis caused by Listeria monocytogenesis an extremely rare but usually aggressive disease. We have seen in recent years an increase in age of onset of this disease and a predilection for patients with valvular disease, especially prosthetic valve. The treatment of choice is ampicill [...] in, which is combined with gentamicin for synergy. It is known that even with treatment the mortality is very high and higher than in other types of bacterial endocarditis. With optimal therapy, that is medical-surgical, mortality has declined significantly in recent years. We presents a review of the literature and a clinical case of a patient with a febrile syndrome diagnosed as a infective endocarditis caused by L. monocytogenestreated medically with successful outcome to date.

  5. Endocardite infecciosa: 12 anos de tratamento cirúrgico / Infective endocarditis: 12 years of surgical treatment

    Scientific Electronic Library Online (English)

    Antoninho Sanfins, ARNONI; Josué de, CASTRO NETO; Renato Tambellini, ARNONI; Antonio Flávio Sanches de, ALMEIDA; Camilo, ABDULMASSIH NETO; Jarbas J., DINKHUYSEN; Mario, ISSA; Paulo, CHACCUR; Paulo P., PAULISTA.

    2000-12-01

    Full Text Available INTRODUÇÃO: A endocardite é uma doença de tratamento difícil e que freqüentemente necessita da participação cirúrgica. CASUÍSTICA E MÉTODOS: Entre janeiro de 1987 e janeiro de 1999, 159 pacientes foram operados em nosso Serviço, sendo 64,7% do sexo masculino. Este grupo apresentou idade média de 39, [...] 2 anos (2 a 78 anos), com peso médio de 57,1 kg. O acometimento valvar aórtico foi o mais freqüente (66 pacientes), sendo na valva nativa em 47 casos e em próteses em 19 (8 metálicas e 11 biológicas): a lesão mitral verificou-se em 53 pacientes, sendo mais comum em portadores de prótese (28 biológicas e 2 metálicas). O comprometimento das duas valvas esteve presente em 28 casos. Os demais pacientes eram portadores de defeitos congênitos ou de marcapasso definitivo. A operação foi indicada por refratariedade ao tratamento clínico, insuficiência cardíaca, quadro infeccioso levando a disfunção valvar ou de prótese, vazamento periprotético, ou ainda por arritmia. RESULTADOS: O estudo microbiológico evidenciou maior prevalência de infecção por Streptococcus viridans e Staphilococcus aureus. A operação realizada nos portadores de endocardite infecciosa em valva nativa propiciou a conservação da valva em 3 pacientes do grupo mitral e em 1 do grupo aórtico; nos demais pacientes empregaram-se próteses (a maioria metálica em aórticos e biológica em mitrais). As reoperações foram freqüentes, tendo pacientes com até quarta operação. A lesão congênita responsável pela maioria dos casos foi a comunicação interventricular (3 casos) e 4 pacientes apresentavam a endocardite em eletrodo de marcapasso. A mortalidade global foi de 16,3%, com maior incidência em portadores de prótese mitral e aórtica submetidos a reoperação. A presença de abscesso como complicação da endocardite infecciosa verificou-se em 18,2% dos pacientes, utilizando-se pericárdio bovino na reconstrução da maioria, com mortalidade de 17,2%. CONCLUSÃO: Concluímos que o tratamento cirúrgico da endocardite infecciosa representa um desafio para o cirurgião, apesar de todo o progresso adicionado ao arsenal diagnóstico e terapêutico desta patologia. Abstract in english BACKGROUND: Infective endocarditis is a disease of difficult and multidisciplinar treatment that frequently needs the surgical participation. MATERIAL AND METHODS: Between January 1987 and January 1999, 159 patients were operated on in our Service for infective endocarditis. Male group represented 6 [...] 4.7%. The mean age was 39.2 yr. (2 to 78 yr.) and the mean weight 57.1 kg. The aortic valve was affected most frequently (66 patients), the native valve was affected in 47 cases and the prostheses in 19 (11 bioprostheses and 8 mechanic valves). The mitral valve was affected in 53 patients, most commonly in prostheses (28 bioprostheses and 2 mechanical). Aortic and mitral valves were together affected in 28 cases. The other patients had congenital defects or definitive pacemaker. Surgical treatment was indicated in cases of heart failure, refractory to medical treatment, valvar or prosthesis dysfunction secondary to infection, leak or arrhythmia. RESULTS: Cultures revealed that Streptococcus viridans and Staphilococcus aureus were the most prevalent microorganisms. Valve repair was possible in 3 patients of mitral group and one of aortic group. For the others, prostheses were used (mechanical for aortic valve and bioprostetic for mitral valve in the majority of the cases). Reoperation was frequent. Ventricular septal defect was the most common congenital pathology (3 cases) and 4 patients presented infective endocarditis in pacemaker wire. The global mortality was 16.3%. Abscess as a complication was presented in 18.2% of the patients. We used bovine pericardium for reconstruction with a surgical mortality of 17.2%. CONCLUSION: We concluded that the treatment for infective endocarditis represents a surgical challenge, in spite of the progress added to the diagnostic and therapeutic armamentarium of this pathology.

  6. Infective Endocarditis of the Aortic Valve caused by Pseudomonas aeruginosa and Treated Medically in a Patient on Haemodialysis

    Directory of Open Access Journals (Sweden)

    Kowthar S. Hassan

    2012-02-01

    Full Text Available Infective endocarditis (IE in patients on dialysis is a serious infection with a high mortality rate. It is usually caused by Gram positive bacteria with Gram negative organisms being relatively rare as a cause. Recommended treatment usually involves surgical valve replacement and the extended use of antibiotics. Successful treatment with antibiotics alone is rare. We report a case of IE caused by Pseudomonas aeruginosa in a patient on dialysis treated solely with antibiotics.

  7. Endocardite infecciosa num recém-nascido pré-termo / Infective endocarditis in a preterm newborn

    Scientific Electronic Library Online (English)

    Cristiana, Ribeiro; Marta, Rios; Luísa, Lopes; Sílvia, Álvares; Elisa, Proença; Ana, Guedes.

    Full Text Available Introdução: A endocardite infecciosa é uma situação rara mas grave no período neonatal. Caso clínico: Os autores descrevem o caso clínico de um recém-nascido, pré-termo de 31 semanas que ao 15º dia de vida apresentou quadro séptico pelo que iniciou antibioticoterapia. Nas hemoculturas efectuadas iso [...] lou-se Staphylococus aureus, sensível aos antibióticos prescritos e o cateter epicutâneo-cava introduzido no sexto dia de vida foi nesta altura substituído. Ao 25º dia detectou-se sopro sistólico grau II/VI, tendo o ecocardiograma mostrado imagem sugestiva de vegetação na válvula tricúspide (dimensões-8,5x4mm). Por suspeita de endocardite bacteriana, efectuou tratamento com vancomicina, gentamicina e rifampicina. As hemoculturas posteriores foram estéreis e não se verificou aumento do tamanho da vegetação. Em ambulatório manteve-se clinicamente bem e actualmente, com nove meses de idade corrigida apresenta vegetação de 3x3mm. Conclusão: A suspeita de endocardite bacteriana deve ser considerada nos recém-nascidos com sépsis hospitalar, internados numa Unidade de Cuidados Intensivos, com colocação de cateter venoso central, sobretudo se os agentes envolvidos são o Staphylococcus aureus ou fungos. A base do tratamento é um curso prolongado de antibioticoterapia com um regime bactericida apropriado. Contudo a mortalidade permanece elevada. Abstract in english Background: Infective endocarditis is a rare but serious illness in neonatal period. Case report: The authors describe the case of a preterm newborn, 31 weeks of gestation who presented at 15th day of life a condition consistent with neonatal sepsis and antibiotic therapy was administered. Staphyloc [...] ocus aureus, sensitive to antibiotics that were prescribed, were detected in blood cultures and the central venous line introduced at 6th day of life was replaced at this point. At 25th day an II/VI grade blowing systolic murmur was heard and the echocardiography showed a suggestive image of vegetation (size-8,5x4mm) in the tricuspid valve. Bacterial endocarditis was suspected and the newborn was treated with vancomycin, gentamicin and rifampicin. The subsequent blood cultures were negative and no increase on vegetation size was observed. In ambulatory, he remained clinically well and actually, with nine months of corrected age, the size of vegetation is 3x3mm. Conclusion: Suspicion of infective endocarditis must be considered in newborns with hospital sepsis in an intensive care setting, with an indwelling catheter, especially if the agents involved are Staphylococcus aureus or fungi. The cornerstone of treatment is a prolonged course of antibiotic treatment with an appropriate bactericidal regimen. However mortality remains high.

  8. Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus

    Science.gov (United States)

    AOKI, Takuma; SUNAHARA, Hiroshi; SUGIMOTO, Keisuke; ITO, Tetsuro; KANAI, Eiichi; FUJII, Yoko

    2014-01-01

    Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight loss, pyrexia (40.4°C) and lameness. A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions. Corynebacterium spp. and Bacillus subtilis were isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the PDA was subsequently surgically corrected. After a series of treatments, the dog showed long-term improvement in clinical status. PMID:25391395

  9. Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities

    DEFF Research Database (Denmark)

    Axelsson, Anna; Søholm, Helle; Dalsgaard, Morten; Helweg-Larsen, Jannik; Ihlemann, Nikolaj; Bundgaard, Henning; Køber, Lars; Iversen, Kasper

    2014-01-01

    attending a supervised injection facility. We performed transthoracic echocardiographic examinations on-site in the injection facilities. A total of 206 IDUs (mean age 43 ± 9 years, 23% women) with a median injection drug abuse of 18 years (interquartile range 10 to 26) were included. Fourteen IDUs (14 of......Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs...... 206, 7%, 95% confidence interval [CI] 4% to 11%) had a previous history of IE. IDUs with a history of IE were significantly older than IDUs without a history of IE (48 ± 8 vs 42 ± 9 years, respectively, p = 0.03) and had a longer duration of injection drug use (27 [18 to 36] vs 17 years [10 to 25], p...

  10. From Recussitation to Birth: Double Valve Replacement Due to Infective Endocarditis in Pregnant Woman

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    Vedat Y?ld?r?m

    2012-01-01

    Full Text Available Pregnancy carries an increased risk for mother and the fetus in patients with cardiac disease. In this case we represent a woman with gestational age of 16 weeks, who was resuscitated and underwent double valve replacement with longer cardiopulmonary bypass times (112 minutes of cross clamping and 133 minutes of perfusion time due to infective endocarditis and decompensed heart failure. After the surgery at 38th gestational weeks, she gave birth uneventfully to a healthy child whose Apgar score was 9 at first and fifth minutes of the delivery. Heart surgery during pregnancy can be performed with acceptable maternal and fetal mortality rates. These rates may even be lower if strict protocols performed during every step of surgery and after.

  11. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars; Andersson, Rune; Buchholtz, Kristine; Larsen, Carsten T; Hansen, Thomas Fritz; Køber, Lars; Hassager, Christian; Bruun, Niels E

    The aim of this study was to investigate in-hospital mortality and 12-month mortality in patients with coagulase-negative Staphylococcus (CoNS) compared to Staphylococcus aureus (S. aureus) infective endocarditis (IE). We used a prospective cohort study of 66 consecutive CoNS and 170 S. aureus IE...... patients, collected at 2 tertiary university hospitals in Copenhagen (Denmark) and at 1 tertiary university hospital in Gothenburg (Sweden). Median (range) C-reactive protein at admission was higher in patients with S. aureus IE (150 mg/l (1-521) vs 94 mg/l (6-303); p<0.001), which may suggest a more......% of patients with S. aureus IE (p =0.05). In conclusion, CoNS IE was associated with a long diagnostic delay and high in-hospital mortality, whereas post-discharge prognosis was better in this group of patients compared to patients with IE due to S. aureus....

  12. Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011

    Directory of Open Access Journals (Sweden)

    Oslan Francischetto

    2014-10-01

    Full Text Available Background: Healthcare-associated infective endocarditis (HCA-IE, a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011 in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE were included. There were 26 (49% males (mean age of 47 ± 18.7 years, 27 (51% females (mean age of 42 ± 20.1 years. IE was acute in 37 (70% cases and subacute in 16 (30% cases. The mitral valve was affected in 19 (36% patients and the aortic valve in 12 (36%; prosthetic valves were affected in 23 (43% patients and native valves in 30 (57%. Deep intravenous access was used in 43 (81% cases. Negative blood cultures were observed in 11 (21% patients, Enterococcus faecalis in 10 (19%, Staphylococcus aureus in 9 (17%, and Candida sp. in 7 (13%. Fever was present in 49 (92% patients, splenomegaly in 12 (23%, new regurgitation murmur in 31 (58%, and elevated C-reactive protein in 44/53 (83%. Echocardiograms showed major criteria in 46 (87% patients, and 34 (64% patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%. Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

  13. Endocarditis infecciosa de alto riesgo embolígeno durante el embarazo: ¿manejo conservador o quirúrgico? / High risk infective endocarditis embolism during pregnancy: Medical or surgical management?

    Scientific Electronic Library Online (English)

    Luis Eduardo, Echeverría; Antonio, Figueredo; Juan Carlos, Gómez; Leonardo Alberto, Salazar; Jaime Alberto, Rodriguez; Camilo Ernesto, Pizarro; Carlos Eduardo, Riaño; Addy, Perroni; Alba Lucía, Cuadros; María Cristina, Villamizar; Edwin Uriel, Suárez.

    2013-09-01

    Full Text Available Presentamos el caso de una paciente de 22 años de edad con embarazo de 14 semanas y endocarditis infecciosa de válvula mitral nativa con una vegetación de 15 mm con amplia movilidad, acompañada de insuficiencia valvular severa. Inicialmente, y pese al riesgo embolígeno, se dio tratamiento antibiótic [...] o durante 4 semanas. Por persistencia del tamaño de la vegetación se decide llevar a cirugía para reparación mitral y remoción de la lesión en la semana 18 de gestación, considerando que el balance entre el riesgo fetal y materno estaba a favor del procedimiento quirúrgico. Se usaron técnicas de protección fetal intraoperatoria y se colocó una prótesis biológica previo intento de reparación. La evolución postintervención fue satisfactoria, lográndose parto por cesárea a las 30 semanas. Abstract in english A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to pe [...] rsistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.

  14. Apuntes sobre la fisiopatología, etiología, diagnóstico, tratamiento y profilaxis de la endocarditis infecciosa / Notes on the physiopathology, etiology, diagnosis, treatment and prophylaxis of infective endocarditis

    Scientific Electronic Library Online (English)

    Hiram, Tápanes Daumy; Elsa, Fleitas Ruisanchez; Eliobert, Díaz Bertot; Andrés, Savío Benavides; Maylin, Peña Fernández.

    2014-09-01

    Full Text Available La endocarditis infecciosa es una afección de difícil diagnóstico en Cardiología, con características clínicas muy variadas y una epidemiología cambiante en los últimos años. En la presente revisión se tratan aspectos novedosos sobre su clasificación, etiología y fisiopatología; además, se presentan [...] las herramientas fundamentales para su diagnóstico, punto de partida para su tratamiento médico basado primordialmente en la terapia antimicrobiana, así como los criterios quirúrgicos y la conducta actual en la profilaxis antimicrobiana de esta compleja entidad. Abstract in english Infective endocarditis is a disease of difficult diagnosis in cardiology, with highly variable clinical characteristics and changing epidemiology in the last few years. The present review dealt with novel aspects on classification, etiology and physiopathology of the disease in addition to the prese [...] ntation of the fundamental tools for diagnosis, which is the starting point for the medical treatment basically supported on the antimicrobial therapy. It also set forth the surgical criteria and the present performance in the antimicrobial prophylaxis of this complex disease.

  15. Corynebacterium propinquum as the first cause of infective endocarditis in childhood.

    Science.gov (United States)

    Kawasaki, Yu; Matsubara, Kousaku; Ishihara, Haruko; Nigami, Hiroyuki; Iwata, Aya; Kawaguchi, Koji; Fukaya, Takashi; Kawamura, Yoshiaki; Kikuchi, Ken

    2014-05-01

    We here present a 7-year-old girl with ventricular septum defect and ventriculoatrial communication, who developed infective endocarditis (IE) due to Corynebacterium propinquum in the tricuspid valve. The patient was admitted because of an 8-day history of fever. Transthoracic echocardiogram showed non-pedunculated vegetation on the septal leaflet of the tricuspid valve. Gram-positive coryneform bacteria grew from three consecutive sets of blood cultures taken on admission. C. propinquum was confirmed by 3 microbiological approaches; (i) biochemical testing using API Coryne panels, (ii) a sequence-based method using the 16S rRNA gene and partial rpoB sequencing, and (iii) matrix-assisted laser desorption ionization-time of flight mass spectrometry. The isolates were susceptible to a wide variety of ?-lactams and vancomycin. The patient was successfully treated with antimicrobial agents without surgical intervention. There have only been available of clinical details of two adult cases of invasive C. propinquum infections; one of which was presented as IE, and the other was pleuritis in a patient with lung cancer. To the best of our knowledge, this is the first report to describe C. propinquum as a cause of IE as well as that of invasive infections in a pediatric population. Multiple methods that reliably differentiated related species helped us to establish this rare organism. Our report expanded the clinical spectrum of C. propinquum infections. PMID:24486166

  16. Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014

    Scientific Electronic Library Online (English)

    Renato, Mello; Marisa da Silva, Santos; Wilma, Golebiosvki; Clara, Weksler; Cristiane, Lamas.

    2015-04-01

    Full Text Available Background: Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. Objectives: To describe aspects of S. bovis endocarditis. Methods: This is a case series of patients admitted to a cardiac surgery refer [...] ral center, during the years 2005-2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. Results: Nine patients with S. bovis endocarditis were included; all cases ful?lled the modi?ed Duke criteria. Incidence was 8/220 (4%) in years 2006-2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal ?ndings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. Conclusions: S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.

  17. {sup 18}F-FDG PET/CT for early detection of embolism and metastatic infection in patients with infective endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Riet, Jelle van; Gheysens, Olivier; Mortelmans, Luc [University Hospital KU Leuven, Department of Nuclear Medicine, Leuven (Belgium); Hill, Evelyn E.; Herregods, Marie-Christine [University Hospital KU Leuven, Department of Cardiology, Leuven (Belgium); Dymarkowski, Steven [University Hospital KU Leuven, Department of Radiology, Leuven (Belgium); Herijgers, Paul [University Hospital KU Leuven, Department of Cardiac Surgery, Leuven (Belgium); Peetermans, Willy E. [University Hospital KU Leuven, Department of Internal Medicine, Leuven (Belgium)

    2010-06-15

    In the acute setting of endocarditis it is very important to assess both the vegetation itself, as well as potential life-threatening complications, in order to decide whether antibiotic therapy will be sufficient or urgent surgery is indicated. A single whole-body scan investigating inflammatory changes could be very helpful to achieve a swift and efficient assessment. In this study we assessed whether {sup 18}F-FDG can be used to detect and localize peripheral embolism or distant infection. Twenty-four patients with 25 episodes of endocarditis, enrolled between March 2006 and February 2008, underwent {sup 18}F-FDG PET/CT imaging on a dedicated PET/CT scanner. PET/CT imaging revealed a focus of peripheral embolization and/or metastatic infection in 11 episodes (44%). One episode had a positive PET/CT scan result for both embolism and metastatic infection. PET/CT detected seven positive cases (28%) in which there was no clinical suspicion. Valve involvement of endocarditis was seen only in three patients (12%). PET/CT may be an important diagnostic tool for tracing peripheral embolism and metastatic infection in the acute setting of infective endocarditis, since a PET/CT scan detected a clinically occult focus in nearly one third of episodes. (orig.)

  18. Nosocomial vs. community-acquired infective endocarditis in Greece: changing epidemiological profile and mortality risk.

    Science.gov (United States)

    Giannitsioti, E; Skiadas, I; Antoniadou, A; Tsiodras, S; Kanavos, K; Triantafyllidi, H; Giamarellou, H

    2007-08-01

    Current epidemiological trends of infective endocarditis (IE) in Greece were investigated via a prospective cohort study of all cases of IE that fulfilled the Duke criteria during 2000-2004 in 14 tertiary and six general hospitals in the metropolitan area of Athens. Demographics, clinical data and outcome were compared for nosocomial IE (NIE) and community-acquired IE (CIE). NIE accounted for 42 (21.5%) and CIE for 153 (78.5%) of 195 cases. Intravenous drug use was associated exclusively with CIE, while co-morbidities (cardiovascular disease, diabetes mellitus, chronic renal failure requiring haemodialysis and malignancies) were more frequent in the NIE group (p 50% of NIE cases had a history of vascular intervention. Coagulase-negative staphylococci and enterococci were more frequent in cases of NIE than in cases of CIE (26.2% vs. 5.2%, p <0.01, and 30.9% vs. 16.3%, p 0.05, respectively). Enterococci accounted for 19.5% of total IE cases and were the leading cause of NIE. Staphylococcus aureus IE was hospital-acquired in only 11.9% of cases. In-hospital mortality was higher for NIE than for CIE (39.5% vs. 18.6%, p 0.02). Cardiac failure (New York Heart Association grade III-IV; OR 13.3, 95% CI 4.9-36.1, p <0.001) and prosthetic valve endocarditis (OR 3.7, 95% CI 1.3-10.6, p 0.01) were the most important predictors of mortality. PMID:17488327

  19. First reported case of infective endocarditis caused by community-acquired methicillin-resistant Staphylococcus aureus not associated with healthcare contact in Brazil

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    Claudio Querido Fortes

    2008-12-01

    Full Text Available We report here the first case of endocarditis due to CA-MRSA not associated with healthcare contact in Brazil in Brazil. A previously healthy patient presented with history of endocarditis following a traumatic wound infection. Patient had multiple positive blood cultures within 72 h of admission and met modified Duke's criterion for infective endocarditis. The isolate was typed as Staphylococcal cassette chromosome (SCC mec type IV and was positive for presence of Panton-Valentine leukocidin (PVL. Increased incidence of CA-MRSA endocarditis is a challenge for the internist to choose the best empirical therapy. Several authors have suggested an empirical therapy with both a beta-lactam and an anti-MRSA agent for serious S. aureus infections. Our patient was treated with Vancomycin and made complete recovery in 3 months.

  20. Fatores determinantes da letalidade após cirurgia para endocardite infecciosa Postoperative mortality in infective endocarditis: determinant factors

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    Charles André

    1997-06-01

    Full Text Available Estudamos a influência de dados demográficos, fatores predisponentes, aspectos clínicos, variáveis operatórias sobre a evolução em 39 pacientes operados por endocardite infecciosa (EI. Utilizamos os testes t de Student, X²ou exato de Fisher em análises univariadas, regressão logística para determinação de fatores adversos independentes. O impacto do número destes fatores sobre a evolução foi estudado pelo teste exato de Fisher. Valvas mais afetadas: aórtica (20 e mitral (16; germes mais comuns: Staphylococcus aureus (12 e Streptococcus sp (10. Cirurgia de emergência e a presença de coma seis horas após a operação elevaram a letalidade (p=0,001 e p=0,0015, bem como infecção pelo S.aureus (p=0,023 e presença de complicações neurológicas (p=0,097. A concomitância de dois ou três destes fatores elevou particularmente a letalidade (>76,9%. Pacientes com EI devem receber cuidadosa avaliação quanto a indicação cirúrgica nas fases iniciais da doença, já que a concomitância de variáveis adversas e cirurgias em caráter de emergência elevam fortemente a letalidade por EI.The factors leading to high postoperative mortality in active infectious endocarditis (IE are poorly defined. We studied patients operated at an University Hospital between March 1978 and April 1992. We hipothesized that the summation of potential adverse factors would strongly increase mortality after surgery. We studied 39 patients (28 men, age range 13-70 years (mean±SD =32±16 operated during active IE (time from onset 52+48 days. Predisposing factor: rheumatic valvar disease in 14 cases, intravenous drug use in 5. Affected valves: aortic in 14, mitral in 10, tricuspid in 8, multiple structures in 7. In most cases, S aureus (12 or Streptoccocus sp (10 was isolated in blood cultures. Surgery was indicated in most patients because of heart failure (30, multiple embolic complications (17 or treatment failure (14. The possible adverse influence of specific demographic characteristics, clinical features and surgical variables was assessed by the Student t test or the %² test. Also, multple regression analysis was performed in order to identify independent adverse factors for increased mortality. Positive correlations were further investigated with the X² test to assess whether an increasing number of adverse factors could identify a special subset of patients with markedly elevated death risk. Fourteen patients (36% died after surgery. Emergency surgery (p = 0.001, the presence of coma 6 hours after surgery (p = 0.0015 and S. aureus infection (p = 0.023 were all associated with increased mortality. The presence of neurological complications was correlated with a high mortality (54% vs. 27%. However this increase was of dubious statistical significance (p = 0.097. Multiple regression analysis confirmed S. aureus and emergency surgery as independent adverse factors for increased mortality. When put together, an increasing number of adverse factors was highly predictive of a fatal outcome, even after exclusion of that evaluated after surgery (level of consciousness. Patients with two or three adverse factors had a very high mortality rate (>76.9%. Mortality following surgery for active IE is increased in patients operated on an emergency basis especially if the infection is caused by S. aureus. The presence of neurological complications may also be associated with worse outcome. Early consideration of surgery should reduce the high mortality in patients with active IE.

  1. Outcome of Patients with Infective Endocarditis who were Treated with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

    OpenAIRE

    Santhosh G. John; Preethi William; Sangeetha Murugapandian; Bijin Thajudeen

    2014-01-01

    Infective endocarditis is a potentially life threatening condition. It is associated with high mortality and morbidity resulting mostly due to cardiorespiratory failure. Extracorporeal membrane oxygenation is a modality of treatment used to support hypoxic respiratory failure especially in patients who are already on mechanical ventilation. Continuous renal replacement therapy is added mainly for maintaining fluid and electrolyte balance. Here we report a case series of patients diagnosed wit...

  2. Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report

    OpenAIRE

    Gamma Reto; Showkathali Refai; Luther Vishal

    2011-01-01

    Abstract Introduction Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. Case presentation A 73-year...

  3. Successful recovery of infective endocarditis-induced rapidly progressive glomerulonephritis by steroid therapy combined with antibiotics: a case report

    Directory of Open Access Journals (Sweden)

    Kikkawa Ryuichi

    2004-12-01

    Full Text Available Abstract Background The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined. Case presentation Patient was a 24-years old man who presented to our hospital with fever, fatigue, and rapidly progressive glomerulonephritis. He had a history of ventricular septum defect (VSD. A renal biopsy specimen revealed crescentic glomerulonephritis and echocardiogram revealed VSD with vegetation on the tricuspid valve. Specimens of blood demonstrated Propionibacterium Acnes. The intensive antibiotic therapy with penicillin G was started without clinical improvement of renal function or resolution of fever over the next 7 days. After the short-term treatment of low dose of corticosteroid combined with continuous antibiotics, high fever and renal insufficiency were dramatically improved. Conclusion Although renal function in our case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure. We suggest that the patients with rapidly progressive glomerulonephritis associated with infective endocarditis might be treated with a short-term and low dose of corticosteroid successfully.

  4. A systematic review of biomarkers in the diagnosis of infective endocarditis.

    Science.gov (United States)

    Snipsøyr, Magnus G; Ludvigsen, Maja; Petersen, Eskild; Wiggers, Henrik; Honoré, Bent

    2016-01-01

    Timely diagnosis of bacterial infective endocarditis (IE) is crucial, as mortality remains high in this severe bacterial infection, currently without any distinct biological markers. Our goal was to evaluate potential diagnostic biomarkers by reviewing current literature. The MEDLINE, Embase and Scopus databases were searched for articles published from 1980 through June 2015 restricted to English, Norwegian, Danish and Swedish. Eighteen studies qualified, providing a review of the most promising candidates for future studies. Several studies are inconclusive, since they are characterized by using improper control groups. Patients with IE have bacteremia, and control groups should therefore be patients with bacteremia without IE. Based on current research, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) alone or in combination with Cystatin C (Cys C), lipopolysaccharide-binding protein (LBP), troponins, aquaporin-9 (AQP9), S100 calcium binding protein A11 (S100A11), E-selectin (CD62E) and VCAM-1 (CD54) and interleukin-6 (IL-6) are potential biomarkers for future studies. PMID:26447663

  5. Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

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    Gambarati Gianpaolo

    2006-07-01

    Full Text Available Abstract Background Methicillin-resistant S. aureus (MRSA with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin. Conclusion The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin

  6. ENDOCARDITIS WITH AN UNCOMMON GERM

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    M. Gharouni

    2006-07-01

    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.

  7. Gemella morbillorum Endocarditis

    OpenAIRE

    Ural, Serap; Gul Yurtsever, Sureyya; Ormen, Bahar; Turker, Nesrin; Kaptan, Figen; El, Sibel; Akyildiz, Zehra Ilke; Coskun, Nejat Ali

    2014-01-01

    Infective endocarditis caused by Gemella morbillorum is a rare disease. In this report 67-year-old male patient with G. morbillorum endocarditis was presented. The patient was hospitalized as he had a fever of unknown origin and in the two of the three sets of blood cultures taken at the first day of hospitalization G. morbillorum was identified. The transthoracic echogram revealed 14 × 10?mm vegetation on the aortic noncoronary cuspis. After 4 weeks of antibiotic therapy, the case was referr...

  8. Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography

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    Embil John M

    2007-05-01

    Full Text Available Abstract Background Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE, systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE as compared to transesophageal echocardiography (TEE in patients with an intermediate likelihood of native valve IE. Methods Between 2004 and 2005, 36 consecutive inpatients with an intermediate likelihood of disease were prospectively evaluated by hTTE and TEE. Results Of 36 patients (21 males with a mean age of 57 ± 15 years, range 32 to 86 years, 19 patients had definite IE by TEE. The sensitivity for the detection of vegetations by hTTE was 84%, specificity of 88%, positive predictive value (PPV of 89% and negative predictive value (NPV of 82%. The association between hTTE and TTE interpretation for the presence and absence of vegetations were high (kappa = 0.90 and 0.85 respectively. Conclusion In patients with an intermediate likelihood of native valve IE, TTE with harmonic imaging provides diagnostic quality images in the majority of cases, has excellent concordance with TEE and should be recommended as the first line test.

  9. Balloon aortic valvuloplasty in pregnancy with severe aortic stenosis and infective endocarditis

    Directory of Open Access Journals (Sweden)

    Vinotha

    2012-12-01

    Full Text Available Twenty seven year old lady, previously diagnosed to have aortic stenosis, presented to the obstetric outpatient department at 19 weeks of gestation with fever and breathlessness, NYHA class 4, for one week. Two D Echo revealed left ventricular hypertrophy, a severely stenosed, calcified bicuspid aortic valve, with vegetations on aortic and mitral valves and severe mitral regurgitation. Blood cultures grew nutrionally variant streptococci and she was treated with crystalline penicillin and gentamicin. She stabilised clinically by 21 weeks, by which time, the risk of termination of pregnancy was comparable to continuing the pregnancy. She underwent balloon aortic valvuloplasty. Post balloon aortic valvuloplasty, she was stable. At 34+2 weeks, she underwent emergency LSCS, the indication being intrauterine growth restriction with fetal compromise and breech presentation. She delivered a baby girl, 1.6 kg, Apgar 9 & 10. Our case report highlights the fact that a timely, balloon aortic valvuloplasty can be life saving for patients with pregnancy complicated by severe aortic stenosis and infective endocarditis. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000: 69-71

  10. The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis

    International Nuclear Information System (INIS)

    Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T2*-weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring >10 mm. For these patients, we performed preoperative MRI and MRA. Males comprised 67% of the subjects, with average age 53±15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15; of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred. MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes. (author)

  11. Infective endocarditis complicated by splenic rupture and fatal intra-abdominal haemorrhage

    OpenAIRE

    Khan, Muhammad Fayaz; Ghani, Saqib

    2009-01-01

    This case report describes a rare presentation of Streptococcus mitis endocarditis of the aortic and mitral valves, complicated by spontaneous splenic rupture due to splenic infarction, which led to massive intra-abdominal bleeding and ultimately death.

  12. [Infective endocarditis due to high level aminoglycoside resistant Enterococcus faecalis and methicillin resistant coagulase-negative staphylococci presenting with rheumatic manifestations].

    Science.gov (United States)

    Pi?kin, Nihal; Akduman, Deniz; Aydemir, Hande; Celebi, Güven; Oztoprak, Nefise; Akta?, Elif

    2008-07-01

    Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12th day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 x 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20th day of ampicillin therapy showed waning of the vegetation. On 42nd day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified. PMID:18822897

  13. Identity of streptococcal blood isolates and oral isolates from two patients with infective endocarditis

    DEFF Research Database (Denmark)

    Fiehn, N E; Gutschik, E; Larsen, Tove; Bangsborg, Jette Marie

    1995-01-01

    The purpose of this study was to isolate streptococcal strains from the oral cavities of streptococcal endocarditis patients and compare these strains biochemically and genetically with the corresponding streptococcal blood isolates. Total identity was observed between the blood and oral cavity...

  14. Echocardiographic findings suggestive of infective endocarditis in asymptomatic Danish injection drug users attending urban injection facilities

    DEFF Research Database (Denmark)

    Axelsson, Anna; SØholm, Helle

    2014-01-01

    Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs attending a supervised injection facility. We performed transthoracic echocardiographic examinations on-site in the injection facilities. A total of 206 IDUs (mean age 43 ± 9 years, 23% women) with a median injection drug abuse of 18 years (interquartile range 10 to 26) were included. Fourteen IDUs (14 of 206, 7%, 95% confidence interval [CI] 4% to 11%) had a previous history of IE. IDUs with a history of IE were significantly older than IDUs without a history of IE (48 ± 8 vs 42 ± 9 years, respectively, p = 0.03) and had a longer duration of injection drug use (27 [18 to 36] vs 17 years [10 to 25], p = 0.008). In the subgroup of IDUs with a history of IE, 4 subjects (4 of 14, 29%, 95% CI 11% to 55%) had persistentor relapse vegetations. Of the remaining 10 IDUs with a history of IE, 5 (5 of 10, 50%, 95% CI 24% to 76%) had moderate-to-severe regurgitation. In the subgroup of IDUs without a history of IE, vegetations were seen in 9 subjects (9 of 192, 5%, 95% CI 2% to 9%). This group of IDUs with possibly unrecognized IE was older than IDUs without vegetations (48 ± 12 vs 42 ± 9, respectively, p = 0.04). Among the IDUs without a history of IE who did not have vegetations, 30 IDUs (30 of 183, 16%, 95% CI 11% to 22%) had moderate-to-severe regurgitation with or without concomitant thickening of leaflets. Thus, in IDUs without a history of IE, some extent of valvular abnormalities was seen in 20% (39 of 192, 95% CI 15% to 27%) of subjects. None of the IDUs with valvular vegetations had current symptoms consistent with active IE. In conclusion, valvular abnormalities assessed by echocardiography were prevalent in asymptomatic IDUs without a medical history of IE, and vegetations were seen in 5% of subjects.

  15. Small Colony variants of Staphylococcus aureus isolated from a patient with infective endocarditis: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Sayan Bhattacharyya

    2012-06-01

    Full Text Available Staphylococcus aureus produces a particular morphological variant called small colony variant(SCV which is responsible for persistent subclinical infections in predisposed individuals and is usually resistant to aminoglycosides and cell wall active antibiotics. Infections by SCV of S. aureus is an upcoming problem due to difficulty in laboratory diagnosis and resistance to antimicrobial chemotherapy. We here report a case of infective endocarditis caused by SCV of Staphylococcus aureus in a pediatric patient.

  16. Achromobacter species endocarditis: A Case Report and Literature Review

    OpenAIRE

    Derber, Catherine; Elam, Kara; Forbes, Betty A; Bearman, Gonzalo

    2011-01-01

    Endocarditis due to Achromobacter species is a rare, yet serious, endovascular infection. Achromobacter species infective endocarditis is associated with underlying immunodeficiencies or prosthetic heart valves and devices. A case of prosthetic pulmonary valve endocarditis secondary to Achromobacter xylosoxidans subspecies denitrificans is described in the present report. This life-threatening infection was successfully treated with combined valve replacement and prolonged antibiotic therapy....

  17. Morbimortalidad de la endocarditis infecciosa asociada a dispositivos electrónicos implantables permanentes / Morbimortality of infective endocarditis associated with permanent cardiovascular implantable electronic devices

    Scientific Electronic Library Online (English)

    Gabriel, Pérez-Baztarrica; Flavio, Salvaggio; Norberto, Blanco; Héctor, Mazzetti; Ricardo, Levin; Alejandro, Botbol; Rafael, Porcile.

    2013-12-01

    Full Text Available La endocarditis infecciosa (EI) asociada a dispositivos electrónicos implantables permanentes (DEIP) es una complicación de baja frecuencia pero alta mortalidad sin el tratamiento adecuado. El avance sobre el conocimiento de esta patología y el desarrollo de estrategias terapéuticas como el diagnóst [...] ico precoz, manejo de antibióticos, técnicas de extracción, entre otras, han mejorado el pronóstico de estos pacientes. Los objetivos de este estudio fueron evaluar la morbimortalidad intrahospitalaria y alejada y analizar algunos factores que justifican las diferencias con los datos de la mortalidad publicada. Se estudiaron en forma retrospectiva pacientes entre marzo/2002 y marzo/2011 con diagnóstico de EI asociada a DEIP. Se analizaron características basales, diagnósticas, terapéuticas, evolución intrahospitalaria y alejada. Se incluyeron 26 casos atendidos en nuestro hospital, 23 de los cuales fueron remitidos desde otros centros para su diagnóstico y tratamiento. La edad promedio fue de 67,5 años. Todos los pacientes recibieron antibióticos durante seis semanas y se les retiró el sistema en forma completa; en el 95% de los pacientes por vía percutánea y en 2 pacientes se requirió estereotomía mediana, atriotomía y colocación de marcapasos epicardíaco. La mortalidad fue del 4% y en el seguimiento fue nula. La morbilidad intrahospitalaria fue del 31%. En el seguimiento alejado no hubo reinfecciones u otra complicación. Como conclusión la EI es un cuadro grave que presenta una morbilidad elevada con estadías hospitalarias prolongadas, pero la mortalidad es baja. La explicación podría estar en las técnicas percutáneas, experiencia, extracción completa, el tiempo del reimplante del nuevo dispositivo y el tratamiento precoz, entre otros factores. Abstract in english Infective endocarditis (IE) associated with permanent cardiovascular implantable electronic devices (CIEDs) is a complication of low frequency, but high mortality without adequate treatment. Progress on the knowledge of this disease and the development of therapeutic strategies such as early diagnos [...] is, antibiotic management and better extraction techniques, among others, have improved the prognosis of these patients. The objectives of this study were to evaluate the in-hospital and out-of-hospital morbidity, and analyze some factors that explain the differences among the published mortality data. Patients diagnosed with IE associated with CIEDs were studied, retrospectively, between March/2002 and March/2011. We analyzed baseline, diagnostic and therapeutic characteristics, and in-hospital and out-of-hospital courses of the disease. We included 26 cases treated in our hospital, 23 of whom were referred from other centers for diagnosis and treatment. The average age of the patients was 67.5 years. All patients received antibiotics for six weeks and underwent complete removal of the device system, in 95% of patients by percutaneous extraction and 2 patients required a median sternotomy, atriotomy and epicardial pacemaker placement. Mortality was 4% and the follow up mortality was zero. The in-hospital morbidity was 31%. In the follow-ups there were no reinfections or other complications. In conclusion, IE is a serious condition that has a high morbidity with prolonged hospital stays, but with a low mortality. The explanation may lie in the use percutaneous extraction techniques, experience, complete extraction of the device system, the time of reimplantation of the new device and early treatment, among other factors.

  18. Cirurgia conservadora da valva tricúspide na endocardite infecciosa Conservative operation of tricuspide valve for the treatment of infective endocarditis

    Directory of Open Access Journals (Sweden)

    Pablo M. A Pomerantzeff

    1993-12-01

    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.

  19. Meningite como complicação de endocardite infecciosa / Meningitis as a complication of infective endocarditis

    Scientific Electronic Library Online (English)

    Viviane Cordeiro, Veiga; Júlio César de, Carvalho; Luis Enrique Campodonico, Amaya; Marcos Sérgio, Martins; Salomón Soriano Ordinola, Rojas.

    2012-09-01

    Full Text Available As complicações neurológicas estão presentes em aproximadamente 30% dos pacientes com endocardite infecciosa; no entanto, a meningite apresenta-se como uma complicação rara. Apresenta-se aqui o caso de paciente do gênero feminino com quadro de meningite decorrente de endocardite em valva mitral, que [...] necessitou de procedimento cirúrgico em razão de quadro agudo de insuficiência cardíaca por ruptura de cordoalha valvar. Abstract in english Although approximately 30% of patients with endocarditis present with neurological complications, the development of meningitis in these patients is rare. This case report describes a female patient who developed meningitis as a complication of mitral valve endocarditis, and surgery was required for [...] this patient due to acute heart failure resulting from the rupture of the chordae tendineae.

  20. Endocarditis in a dog due to infection with a novel Bartonella subspecies.

    OpenAIRE

    Breitschwerdt, E.B.; Kordick, D L; Malarkey, D E; Keene, B; Hadfield, T. L.; Wilson, K.

    1995-01-01

    Vegetative valvular endocarditis involving the aortic and, to a lesser extent, mitral valves was diagnosed echocardiographically in a 3-year-old spayed female Labrador retriever. Historically, the dog had been treated with tetracycline hydrochloride and prednisolone for positive seroreactivity to Ehrlichia canis and antinuclear antigens. Although three aerobic and anaerobic blood cultures failed to grow bacteria, blood cultured simultaneously by the lysis centrifugation technique grew a fasti...

  1. Meningite como complicação de endocardite infecciosa Meningitis as a complication of infective endocarditis

    OpenAIRE

    Viviane Cordeiro Veiga; Júlio César de Carvalho; Luis Enrique Campodonico Amaya; Marcos Sérgio Martins; Salomón Soriano Ordinola Rojas

    2012-01-01

    As complicações neurológicas estão presentes em aproximadamente 30% dos pacientes com endocardite infecciosa; no entanto, a meningite apresenta-se como uma complicação rara. Apresenta-se aqui o caso de paciente do gênero feminino com quadro de meningite decorrente de endocardite em valva mitral, que necessitou de procedimento cirúrgico em razão de quadro agudo de insuficiência cardíaca por ruptura de cordoalha valvar.Although approximately 30% of patients with endocarditis present with neurol...

  2. Awareness of Iranian’s General Dentists Regarding the Latest Prophylaxis Guideline for Prevention of Infective Endocarditis

    Directory of Open Access Journals (Sweden)

    Ghaderi F.

    2013-03-01

    Full Text Available Statement of Problem: Dental procedures leading to oral tissue injuries may provoke bacterial release to the blood stream causing infective endocarditis (IE in vulnerable patients. The guideline which was proposed by AHA has been updated 9 times having the last update published in 2007. This study was endeavored to uncover the level of knowledge of general dental practitioners in Shiraz, concerning the 2007 AHA guidelines for endocarditis prophylaxis in patients with cardiac problems receiving dental treatments.Materials and Method: This cross- sectional and descriptive analytical study included 150 dentists as participants. All practitioners were given a self –report questionnaire which consisted of three sections. Questions were designed to assess their knowledge of antibiotic prophylaxis in patients with cardiac disease. Results: Almost all participants (93% were aware of antibiotic prophylaxis to be essential for tooth extraction. Most participants did not believe in prophylaxis for noninvasive procedures (such as shedding of primary teeth, impression, intraoral radiography. From all of the respondents, 75% considered Amoxicillin to be the anti-biotic of choice and 57% were acquainted with the correct dose of Amoxicillin for high risk patients.Conclusion: The study identified a potential for under/over prescription of antibiotic prophylaxis under the current guideline. Burden of IE necessitates more accurate knowledge of antibiotic prophylaxis in the undergraduate curriculum and continuing education programs of dentistry.

  3. Surgical treatment for infective endocarditis and hospital mortality in a Brazilian single-center Tratamento cirúrgico para endocardite infecciosa e mortalidade hospitalar em centro único brasileiro

    Directory of Open Access Journals (Sweden)

    Maurício Nassau Machado

    2013-03-01

    Full Text Available OBJECTIVE: We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality. METHODS: We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP, Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis, evaluating perioperative clinical outcomes and 30-day all cause mortality. RESULTS: In our series, 64 patients (8% underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%, greater need for dialysis (9% and higher 30-day mortality (17% compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively. In a Cox regression analysis, age (P = 0.007, acute kidney injury (P = 0.004, dialysis (P = 0.026, redo surgery (P = 0.026, re-exploration for bleeding (P = 0.013, tracheal reintubation (P OBJETIVO: Avaliamos pacientes submetidos à cirurgia valvar em vigência de endocardite infecciosa na tentativa de identificar preditores independentes de mortalidade intrahospitalar em 30 dias. MÉTODOS: Foram avaliados 837 pacientes consecutivamente submetidos à cirurgia valvar, no período de janeiro de 2003 a maio de 2010, em um hospital terciário de São José do Rio Preto, SP, Brasil. O Grupo de Estudo compreendeu indivíduos submetidos à intervenção em vigência de endocardite infecciosa e foi comparado ao Grupo Controle, considerando complicações clínicas perioperatórias e óbito por todas as causas em 30 dias. RESULTADOS: Em nossa casuística, 64 (8% pacientes foram submetidos à cirurgia valvar em vigência de endocardite infecciosa, sendo 37,5% deles com indicação de intervenção cirúrgica em múltiplas valvas. O Grupo de Estudo apresentou maior permanência em Unidade de Terapia Intensiva (16%, necessidade de diálise (9% e maior mortalidade em 30 dias (17% comparado ao Grupo Controle (7%, P=0,020; 2%, P=0,002 e 9%, P=0,038; respectivamente. A análise de regressão de Cox confirmou idade (P=0,007, lesão renal aguda (P=0,004, diálise (P=0,026, reoperação (P=0,026, reintervenção por sangramento (P=0,013, reintubação orotraqueal (P<0,001 e lesão neurológica tipo I (P<0,001 como preditores independentes para óbito. Embora a manifestação de endocardite infecciosa influencie na mortalidade na análise univariada, a regressão de Cox não confirmou tal variável como preditor independente de óbito em nossa casuística. CONCLUSÃO: Idade e complicações perioperatórias destacam-se como preditores de mortalidade hospitalar em população brasileira. Cirurgia valvar em vigência de infecção ativa não se confirma como preditor independente de óbito nesta casuística.

  4. Gemella morbillorum Endocarditis.

    Science.gov (United States)

    Ural, Serap; Gul Yurtsever, Sureyya; Ormen, Bahar; Turker, Nesrin; Kaptan, Figen; El, Sibel; Akyildiz, Zehra Ilke; Coskun, Nejat Ali

    2014-01-01

    Infective endocarditis caused by Gemella morbillorum is a rare disease. In this report 67-year-old male patient with G. morbillorum endocarditis was presented. The patient was hospitalized as he had a fever of unknown origin and in the two of the three sets of blood cultures taken at the first day of hospitalization G. morbillorum was identified. The transthoracic echogram revealed 14 × 10?mm vegetation on the aortic noncoronary cuspis. After 4 weeks of antibiotic therapy, the case was referred to the clinic of cardiovascular surgery for valve surgery. PMID:25544914

  5. Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral Infected aneurysm of brachial artery after mitral valve infective endocarditis

    Directory of Open Access Journals (Sweden)

    Heraldo Guedis Lobo Filho

    2011-03-01

    Full Text Available Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

  6. Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report

    Directory of Open Access Journals (Sweden)

    Gamma Reto

    2011-08-01

    Full Text Available Abstract Introduction Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. Case presentation A 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died. Conclusion Clinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed.

  7. Complicaciones posoperatorias y mortalidad en pacientes operados por endocarditis infecciosa Postoperative complications and mortality observed in patients operated on from infective endocarditis

    Directory of Open Access Journals (Sweden)

    Joaquín Gómez Armando Gonga

    2013-03-01

    Full Text Available Objetivo: describir las causas de morbilidad y mortalidad perioperatorias en los pacientes afectos de endocarditis infecciosa activa y significar cómo pueden ser disminuidas. Métodos: se realizó un estudio retrospectivo de las complicaciones posoperatorias y mortalidad en 139 pacientes operados por presentar endocarditis infecciosa en un período de 16 años. Se efectuaron 147 operaciones a los 139 pacientes de las cuales 83 (57,1 % fueron electivas y 64 (42,9 % fueron de urgencia. El 24 % de los pacientes fueron remitidos de otros centros en los que habían sido sometidos a tratamiento médico no exitoso por más de 4 semanas. Resultados: las operaciones efectuadas fueron: Sustituciones valvulares aórticas,mitrales y tricuspídeas 75 (41,1 %, extracción de electrodos de marcapasos o desfibriladores automáticos implantables del ventrículo derecho 57 (41 % , otras operaciones en número de 7 (4,9 %y 8 reintervenciones. La complicación más frecuente fue la sepsis generalizada (10,07 % pObjective: To describe the causes of perioperative morbidity and mortality of patients suffering active infectious endocarditis and to explain how both aspects can be reduced. Methods: A retrospective study of postoperative complications and mortality observed in 139 patients operated on from infectious endocarditis in 16 years. One hundred forty seven surgeries were performed, of which 83 (57.1 % were elective and 64 (42.9 % were emergency surgeries. In this group, 24 % had been referred from other medical centers where they had been unsuccessfully treated for 4 weeks. Results: The performed surgeries comprised 15 aortic, mitral and tricuspid valve replacements, 57 (41 % removals of pacemaker electrodes or of implanted automatic defibrillators in the right ventricle, seven other types of surgeries and 8 reoperations. The most frequent complication was generalized sepsis ((10.07 % p< 0.01, followed by the low heart output and postoperative bleeding. The main causes of death were congestive heart failure in 13 patients (9.3 %, p< 0. 02 and generalized sepsis in 5 patients (3.6 %. The mortality rates presented in this study (16.4 % were associated to several factors such as functional class, since 12.2 % of patients were classified into the functional class III-IV of the New York Heart Association. The mortality rate was higher in those patients who had been unsuccessfully treated for over 4 years (n= 13, 56.5 %. Low mortality is noticeable (2.1 % in patients with infectious endocarditis as a result of pacemaker electrodes or cables, or of implanted automatic defibrillators. Conclusions: Early diagnosis, implementation of an intensive antibiotic treatment, early performance of surgery together with rigorous homeostasis results in a stagger reduction of mortality and morbidity in infectious endocarditis surgeries.

  8. Vancomycin AUC24/MIC Ratio in Patients with Complicated Bacteremia and Infective Endocarditis Due to Methicillin-Resistant Staphylococcus aureus and Its Association with Attributable Mortality during Hospitalization

    OpenAIRE

    Brown, Jack; Brown, Kristen; FORREST, Alan

    2012-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of complicated bacteremia (CB) and infective endocarditis (IE). The gold standard treatment for these infections is vancomycin. A vancomycin area under the concentration-time curve from 0 to 24 h (AUC24)/MIC ratio of >400 has been suggested as a target to achieve clinical effectiveness, and yet to date no study has quantitatively investigated the AUC24/MIC ratio and its association with attributable mortality (AM). We perfor...

  9. Septal endocarditis, bone infection and severe leg ischemia detected in Tc-99m labelled monoclonal anti granulocyte scan

    International Nuclear Information System (INIS)

    Patient 28 years old has continued to have a persistent fever (39.2OC), despite ten days treatment by specific antibiotics for bacterial endocarditis associated to a recent claudication of the right lower leg. The persistent fever has motivated a 99mTc-labelled monoclonal anti granulocyte scan which has showed an important uptake in the myocardial septum, and other infection locations in temporal bone and in right tibial arteries. Two days after, a nanocolloids-99mTc WBS showed no uptake in the heart area, a total absence of uptake of the nanocolloids in the bone marrow of right tibia b and cranial SPECT views confirmed the infectious site in the right temporal bone. New antibiotic strategy was adopted successfully associated with surgical amputation of the right lower leg (au)

  10. [The echocardiographic aspects of infectious endocarditis].

    Science.gov (United States)

    Romero Cárdenas, A; Espínola Zavaleta, N; Rijlaarsdam, M; Vargas Barrón, J

    1998-01-01

    Infective endocarditis is a severe disease observed frequently in cardiologic centers. The importance of echocardiography in the diagnosis, the morphological criteria of vegetations, abscesses and periaortic complications were analyzed. The use of transesophageal echocardiography in patients with surgical indication is assessed. The significance of clinical symptoms of infective endocarditis in the echocardiographic interpretation must be always taken into consideration. PMID:9810365

  11. Actinobacillus endocarditis associated with hypertrophic cardiomyopathy

    OpenAIRE

    Jorge, Vanda Cristina; Araújo, Ana Carolina; Grilo, Ana; Noronha, Carla; Panarra, António; Riso, Nuno; Vaz Riscado, Manuel

    2012-01-01

    Infective endocarditis can be associated with complex clinical presentations, sometimes with a difficult multi-disciplinary management. Actinobacillus actinomycetemcomitans belongs to the Haemophilus species, Actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella species group, responsible for 5% to 10% of infective endocarditis in native heart valves. These organisms have slow fastidious growth pattern, often associated with negative cultures, and cause systemic emb...

  12. A case of culture-negative endocarditis due to Streptococcus tigurinus.

    Science.gov (United States)

    Kanamori, Hajime; Kakuta, Risako; Yano, Hisakazu; Suzuki, Tomoyuki; Gu, Yoshiaki; Oe, Chihiro; Inomata, Shinya; Aoyagi, Tetsuji; Hatta, Masumitsu; Endo, Shiro; Tokuda, Koichi; Weber, David J; Nakamura, Yasuhiro; Saiki, Yoshikatsu; Kaku, Mitsuo

    2015-02-01

    Culture-negative endocarditis remains a diagnostic and therapeutic challenge despite recent medical advances. Streptococcus tigurinus, a novel member of the Streptococcus mitis group, was first identified in Zurich. S. tigurinus possesses virulence determinants and causes invasive infections. We report a case of culture-negative endocarditis with serious complications due to S. tigurinus, which was identified by 16S ribosomal RNA gene sequence analysis of excised valve tissue specimens. This technique is useful for identification of the causative microorganism in patients with culture-negative endocarditis and may facilitate early diagnosis and appropriate antimicrobial treatment. PMID:25240269

  13. Endocardite infecciosa por Haemophilus aphrophilus: relato de caso Infective endocarditis due to Haemophilus aphrophilus: a case report

    Directory of Open Access Journals (Sweden)

    Ricardo M. Pereira

    2008-04-01

    Full Text Available OBJETIVO: Descrever o caso de uma criança com endocardite infecciosa causada por Haemophilus aphrophilus. DESCRIÇÃO: Menino com febre e calafrios há 20 dias. À internação, apresentava-se febril, descorado e sem sinais de instabilidade hemodinâmica; à ausculta cardíaca, tinha sopro holosistólico em foco mitral. Os exames laboratoriais identificaram anemia (hemoglobina = 9,14 g/dL, leucócitos totais de 11.920 mm³, plaquetas de 250.000 mm³, velocidade de sedimentação das hemácias e proteína C reativa elevadas. O ecocardiograma revelou imagem em válvula mitral, sugestiva de vegetação. Com a hipótese de endocardite, foi iniciada antibioticoterapia com penicilina cristalina (200.000 UI/kg/dia associada à gentamicina (4 mg/kg/dia. No terceiro dia de tratamento, foi identificado Haemophilus aphrophilus em hemoculturas, sendo então trocado o esquema antibiótico para ceftriaxona (100 mg/kg/dia. No 20º dia de internação, encontrava-se pálido, mas sem febre e sem outras queixas. Os exames mostravam hemoglobina = 7,0 g/dL, leucócitos = 2.190 mm³, plaquetas = 98.000 mm³, razão normatizada internacional = 1,95 e R = 1,89. Foi feita hipótese de reação adversa ao ceftriaxona, que foi substituído por ciprofloxacina, 20 mg/kg/dia, até completar 6 semanas de tratamento. Após 72 horas da troca, houve normalização dos exames. Durante seguimento ambulatorial, apresentou insuficiência mitral grave, sendo submetido a troca de válvula por prótese metálica 9 meses após quadro agudo. Há 3 anos encontra-se bem, em acompanhamento ambulatorial. COMENTÁRIOS: É rara a identificação de agentes do grupo HACEK (Haemophilus ssp, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens e Kingella kingae em crianças com endocardite infecciosa. O caso apresentado, sem fatores de risco relacionados a esses agentes, reafirma a necessidade de tentar sempre identificar o agente etiológico das endocardites para adequação do tratamento.OBJECTIVE: To report the case of a child with infective endocarditis caused by Haemophilus aphrophilus. DESCRIPTION: Boy with 20 days of fever and chills. On admission, he was febrile, pale and with no signs of hemodynamic instability; on cardiac auscultation, a mitral-related holosystolic murmur was observed. Laboratory examination identified anemia (hemoglobin = 9.14 g/dL, total leukocytes of 11,920 mm³, platelets of 250,000 mm³, elevated sedimentation velocity of red cells and elevated C-reactive protein. The echocardiogram revealed image on mitral valve, resembling vegetation. Considering endocarditis, antibiotic therapy was started with crystalline penicillin (200,000 UI/kg/day in association with gentamicin (4 mg/kg/day. On the third day of treatment, Haemophilus aphrophilus was identified in the blood cultures and the antibiotic scheme was replaced with ceftriaxone (100 mg/kg/day. On the 20th day of evolution, the patient was pale but with no fever or other complaints. Examinations showed hemoglobin = 7.0 g/dL, leukocytes = 2,190 mm³, platelets = 98,000 mm³, international normalized ratio = 1.95 and R = 1.89. Considering the hypothesis of adverse reaction to ceftriaxone, a 6-week replacement treatment with ciprofloxacin (20 mg/kg/day was started. Examination results normalized after 72 hours of the replacement therapy. During ambulatory follow-up, patient presented with severe mitral regurgitation, undergoing a valve replacement with a metallic prosthetic valve 9 months after acute event. Patient has done well throughout the 3-year ambulatory follow-up. COMMENTS: Identification of agents of the HACEK group (Haemophilus ssp, Actinobacillus actinomycetemcomitans,Cardiobacterium hominis, Eikenella corrodens and Kingella kingae in children with infective endocarditis is rare. This case report, with no HACEK agent-related risk factors, reinforces the need for identification of the etiological agent of endocarditis to ensure adequate treatment.

  14. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis.

    Science.gov (United States)

    Orvin, K; Goldberg, E; Bernstine, H; Groshar, D; Sagie, A; Kornowski, R; Bishara, J

    2015-01-01

    The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease. PMID:25636930

  15. Utilidad diagnóstica de los nódulos de Osler en la endocarditis infecciosa en usuarios de drogas por vía parenteral (UDVP) / Diagnostic utility of Osler´s nodes in the infective endocarditis in intravenous drug users

    Scientific Electronic Library Online (English)

    F. J., Espinosa Parra; J. M., Ramos Rincón; F., Herrero Huerta; L., Pretel Serrano; A. A., Lorenzo.

    2002-06-01

    Full Text Available Fundamento: Se describen los datos clínicos, microbiológicos e histológicos de cinco episodios de endocarditis infecciosa (EI) con nódulos de Osler en usuarios de drogas por vía parenteral (UDVP). Pacientes y métodos: Se han estudiado de forma prospectiva 43 casos de EI en UDVP. En 4 pacientes se re [...] alizó punción aspiración y en otro biopsia de un nódulo de Osler, con tinción de Gram y cultivo de la muestra. Resultados: De los 43 episodios de EI 33 fueron derechas, 9 izquierdas y 1 mixta. Cinco de los 10 (50%) pacientes con endocarditis izquierda o mixta presentaron nódulos de Osler, pero no se encontraron en ninguno de los pacientes con EI derecha. En todas las muestras tomadas por punción aspiración se observaron cocos grampositivos en racimos en la tinción de Gram y se obtuvo crecimiento de Staphylococcus aureus con el mismo antibiotipo que los aislados en los hemocultivos. En el único caso en el que se realizo biopsia del nódulo se apreciaba trombos sépticos en la microcirculación. Conclusiones: La tinción de Gram y el cultivo del material aspirado de los nódulos de Osler tiene una alta rentabilidad en el diagnóstico etiológico de la EI en los usuarios a drogras por vía parenteral. La presencia de nódulos de Osler en un paciente con EI nos debe sugerir que la localización es izquierda. Estos datos sugieren que los nódulos de Osler, en la EI por S. aureus en los UDVP se origina como consecuencia de embolismos sépticos microvasculares. Abstract in english Background: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users . Patients y methods: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a as [...] pirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. Results: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases grampositive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. Conclusions: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

  16. Nuclear medicine imaging in endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Ivancevic, V.; Munz, D.L. (Univ. Hospital Charite' , Humboldt Univ., Berlin (Germany). Clinic for Nuclear Medicine)

    1999-03-01

    Infective endocarditis is a serious disease which requires early diagnosis and adequate therapy. Echocardiography plays a key role in diagnosis and follow-up. Subacute infective endocarditis, however, is often difficult to prove echocardiographically due to its more subtle morphological changes. Also, echocardiography cannot reliably differentiate florid vegetations from residual structural changes of the affected valves in cured patients. Therefor, scintigraphy of infection and inflammation has been investigated as a complementary tool in diagnosis and follow-up of infective endocarditis. Immunoscintigraphy with the [sup 99m]Tc labelled anti granulocyte antibody in SPECT technique is complementary to echocardiography and seems to assess the floridity of the underlying inflammatory process. The combined use of both imaging modalities allows detection of virtually all cases of subacute infective endocarditis. SPECT immunoscintigraphy with the anti granulocyte antibody seems useful in doubtful cases of infective endocarditis, especially, if echocardiography is non-diagnostic and valve pathology pre-existing. the method may be used for follow-up and monitoring antibiotic therapy.

  17. A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis--the CopenHeartIE trial protocol

    DEFF Research Database (Denmark)

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe; Sibilitz, Kirstine Lærum; Risom, Signe Stelling; Bundgaard, Henning; Gluud, Christian Nyfeldt; Moons, Philip; Winkel, Per; Thygesen, Lau Caspar; Hansen, Jane Lindschou; Norekvål, Tone Merete; Berg, Selina Kikkenborg

    2012-01-01

    INTRODUCTION: Infective endocarditis (IE) is among the most serious infectious diseases in the western world. Treatment requires lengthy hospitalisation, high-dosage antibiotic therapy and possible valve replacement surgery. Despite advances in treatment, the 1-year mortality remains at 20-40%. Studies indicate that patients experience persisting physical symptoms, diminished quality of life and difficulties returning to work up to a year postdischarge. No studies investigating the effects of re...

  18. Molecular imaging in Libman-Sacks endocarditis

    DEFF Research Database (Denmark)

    Dahl, Anders; Schaadt, Bente K; Santoni-Rugiu, Eric; Bruun, Niels E

    2015-01-01

    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...

  19. Endocarditis caused by nonhemolytic group B streptococcus.

    OpenAIRE

    Miranda, C.; Gámez, M I; Navarro, J. M.; Rosa-Fraile, M.

    1997-01-01

    We report a case of bacterial endocarditis caused by nonhemolytic group B streptococcus (GBS) in a 67-year-old man with no predisposing risk factors. Nonhemolytic GBS strains rarely cause illness and are usually detected in perinatal infections. We believe this to be the first reported case of endocarditis caused by a nonhemolytic strain of GBS.

  20. Unusual case of Aeromonas hydrophila endocarditis.

    OpenAIRE

    Ong, K R; Sordillo, E; Frankel, E.

    1991-01-01

    We describe a case of Aeromonas hydrophila endocarditis in a 66-year-old man with myelodysplastic syndrome and non-A, non-B hepatitis, The infection resolved with antibiotic therapy, but the patient succumbed to complications of his underlying illness. This is the second case of Aeromonas endocarditis reported in the world literature.

  1. The role of oral bacteria in the pathogenesis of infective endocarditis.

    Science.gov (United States)

    Knox, K W; Hunter, N

    1991-08-01

    Various micro-organisms have been implicated as causative agents for bacterial endocarditis, including lactobacilli and in particular the viridans streptococci which are more commonly associated with dental caries. Of these, the most frequently isolated one has the descriptive name Streptococcus sanguis. The disease is characterized by growth of micro-organisms within a platelet-fibrin thrombus protruding from a valve leaflet. An understanding of the pathogenesis involves knowledge of the mechanisms of conversion of the normal vascular surface to a thrombogenic one and the adhesion of micro-organisms to such surfaces. Model systems to study this interaction include experimental animals, mammalian epithelial cells and platelets, and proteins such as fibronectin and fibrinogen. Microbial protein surface components (adhesins) and lipoteichoic acid have also been implicated. Capsular polysaccharides may be involved, but the role of dextrans formed from sucrose has been over-emphasized as the polymers are not formed in situ. Antibiotic prophylaxis for patients at risk is based on bacteriostatic or bactericidal action. However, bacterial cell surface components involved in adhesion may also be affected, and knowledge of such reactions could provide a more rational basis for antibiotic prophylaxis. PMID:1789762

  2. [Surgical Treatment of Prosthetic Valve Endocarditis;Tips of Complete Resection of Infective Tissue and Valve Replacement].

    Science.gov (United States)

    Irie, Yoshihito; Kondo, Shunichi; Tsuboi, Eitoshi; Rokkaku, Kyu; Nakanowatari, Hitoshi; Takano, Hiroshi; Yokoyama, Hitoshi

    2015-10-01

    Fifteen consecutive prosthetic valve endocarditis (PVE) patients were operated from March 2009 to September 2014. The average age of patients was 68 years ( range 49 to 82) and 7 patients were male. The interval between initial surgery and reoperation was 62.4 months(range 2.6 to 340.9). Seven of these cases(47%) developed PVE within the 1st year after surgery were defined as early PVE. All microorganisms isolated from blood cultures in early PVE were Staphylococcus species. Generally, the infective prosthetic valve was removed 1st, then all infective tissues were excised from the periannular cavity. A new prosthetic valve was replaced in supra-annular fashion. One patient who had a severe discontinuity between the most part of left ventricle and aorta necessitated a root replacement. One patient in aortic PVE, needed an additional patch-plasty of anterior mitral leaflet. The mean cardiopulmonary bypass and aortic clamping times were 250 minutes( range 132 to 426) and 165 minutes( range 117 to 309), respectively. Four patients needed permanent pacemaker implanted for complete A-V block. Five patients had transient acute renal failure, and 1 required dialysis could be weaned at 40 post operative day. Average postoperative hospital stay was 39 days (range 21 to 108), and the operative mortality was 0%. The postoperative follow up was 3.1 years( range 0.6 to 6.0), all patients were doing well without re-infection and heart failure except 1 patient died by non-cardiac disease. PMID:26469259

  3. Maternal understanding of infective endocarditis after hospitalization: assessing the knowledge of mothers of children with congenital heart disease and the practical implications.

    Science.gov (United States)

    Knöchelmann, Anja; Geyer, Siegfried; Grosser, Urte

    2014-02-01

    This study aimed to examine the knowledge of mothers of children with congenital heart disease as well as the association of cardiological factors and maternal characteristics with maternal understanding. Mothers of 135 children (?2 years old) were interviewed to assess maternal knowledge of infective endocarditis (IE) using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease. Two subscales, endocarditis and risk factors, were used. Cardiological data as well as maternal characteristics were collected. Two-thirds of the mothers achieved only low scores, answering 0-20 % of the questions correctly (endocarditis = 64.4 %; risk factors = 71.1 %). Mothers with higher education recalled the correct definition of IE (P = 0.001) and the importance of dental hygiene (P = 0.004) more often. Mothers with only one child were more likely to know the most typical symptom (P = 0.007). The severity of the heart disease and the requirement of endocarditis prophylaxis did not influence maternal understanding. Yet, mothers assessing the heart disease as severe showed better knowledge (typical symptom P = 0.021; importance of dental hygiene P = 0.007). If mothers learned the diagnosis before their child's birth, they remembered relevant information more often. Mothers receiving information by the medical staff and from the Internet showed better knowledge (definition P = 0.014; importance of dental hygiene P = 0.001). Due to low levels of knowledge, more efforts must be put into the education of mothers. Educational programs should take maternal characteristics into account, providing written material and thereby keeping the instruction of lower-educated persons in mind. Furthermore, education should be focused on mothers of children requiring IE prophylaxis. PMID:23982219

  4. Endocarditis in Greenland with special reference to endocarditis caused by Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Madsen, Rasmus Gaarde; Ladefoged, Karin; Kjaergaard, Jens Jørgen; Andersen, Peter Stemann; Clemmesen, Christopher

    2009-01-01

    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...... 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...

  5. Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system

    Directory of Open Access Journals (Sweden)

    Buonfrate Dora

    2011-02-01

    Full Text Available Abstract Background Few population-based studies provide epidemiological data on infective endocarditis (IE. Aim of the study is to analyze incidence and outcomes of IE in the Veneto Region (North-Eastern Italy. Methods Residents with a first hospitalization for IE in 2000-2008 were extracted from discharge data and linked to mortality records to estimate 365-days survival. Etiology was retrieved in subsets of this cohort by discharge codes and by linkage to a microbiological database. Risk factors for mortality were assessed through logistic regression. Results 1,863 subjects were hospitalized for IE, with a corresponding crude rate of 4.4 per 100,000 person-years, increasing from 4.1 in 2000-2002 to 4.9 in 2006-2008 (p = 0.003. Median age was 68 years; 39% of subjects were hospitalized in the three preceding months. 23% of patients underwent a cardiac valve procedure in the index admission or in the following year. Inhospital mortality was 14% (19% including hospital transfers; 90-days and 365-days mortality rose through the study years. Mortality increased with age and the Charlson comorbidity index, in subjects with previous hospitalizations for heart failure, and (in the subcohort with microbiological data in IE due to Staphylococci (40% of IE. Conclusions The study demonstrates an increasing incidence and mortality for IE over the last decade. Analyses of electronic archives provide a region-wide picture of IE, overcoming referral biases affecting single clinic or multicentric studies, and therefore represent a first fundamental step to detect critical issues related to IE.

  6. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis

    DEFF Research Database (Denmark)

    Asmar, Ali; Ozcan, Cengiz; Diederichsen, Axel C P; Thomassen, Anders; Gill, Sabine

    2014-01-01

    OBJECTIVE: The purpose of this study was to assess the clinical importance of (18)F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND: IE is a serious condition with a significant mortality. Besides the degree of valvular involvement, the prognosis relies crucially on the presence of systemic infectious embolism. METHODS: Seventy-two patients (71% males and mean age 63 ± 17 years) with IE were evaluated with (18)F-FDG-PET/CT in addition to stan...

  7. Endocarditis associated with Comamonas acidovorans.

    OpenAIRE

    Horowitz, H.; Gilroy, S.; Feinstein, S; G. Gilardi

    1990-01-01

    A case of endocarditis caused by Comamonas acidovorans (Pseudomonas acidovorans) in a 42-year-old intravenous-drug abuser is described. This article appears to be the first detailed report of the isolation of this organism from a systemic clinical infection and its identification as a pathogen.

  8. Endocarditis caused by Abiotrophia defectiva

    Directory of Open Access Journals (Sweden)

    Asma M Al-Jasser

    2007-01-01

    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.

  9. Native valve infective endocarditis due to Achromobacter xylosoxidans in an apparently immunocompetent individual

    OpenAIRE

    Storey, Anna; Wilson, Anne; McWilliams, Eric

    2010-01-01

    A 79-year-old woman presented with fever, lethargy and weight loss. Clinically, the patient was confused, frail and had a systolic murmur. Her temperature was 38 °C and she remained persistently febrile. Initial investigations revealed neutrophilia with an elevated C reactive protein level. Multiple peripheral blood cultures grew Achromobacter xylosoxidans, a Gram-negative rod, which is a very rare cause of infection in patients who are immunocompetent. Subsequent transoesophageal echocardiog...

  10. Erysipelothrix rhusiopathiae endocarditis and presumed osteomyelitis.

    Science.gov (United States)

    Romney, M; Cheung, S; Montessori, V

    2001-07-01

    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

  11. The impact of cardiac surgery in native valve infective endocarditis: Can euroSCORE guide patient selection?

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Bruun, Louise E; Lund, Jens; Larsen, Carsten T; Hassager, Christian; Bruun, Niels E

    2010-01-01

    BACKGROUND: Decision making regarding surgical intervention in native valve endocarditis (NVE) is often complex and surgery is withheld in a number of patients either because medical treatment is considered the best treatment or because the risk of operation is considered too high. The objective of...

  12. [Infective endocarditis caused by Erysipelothrix rhusiopathie.Report of one case].

    Science.gov (United States)

    Vázquez, Limay; De Los Santos, Carolina; Cichero, María; Frantchez, Victoria; Batista, Noelia; Palacio, Rosario; Seija, Verónica; Vignolo, Washington; Sosa, Leonardo; Silvariño, Ricardo

    2015-12-01

    Erysipelothrix rhusiopathie is an immobile, not sporulated, gram positive bacillus. Man is an accidental host. Infection is acquired through wounds on contact with sick animals or carriers, their products or objects contaminated with their waste. We report a 40 years old tannery male worker, presenting in the emergency room with fever lasting one month. An echocardiogram showed a vegetation and perforation of the aortic valve with severe aortic regurgitation. Blood cultures gave growth to E. rhusiopathiae. The patient was treated with penicillin. After three weeks of treatment an aortic valve replacement with a mechanical valve was performed. At six weeks, he was discharged from the hospital. PMID:26928623

  13. Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Habets, Jesse; Mali, Willem P.T.M. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Tanis, Wilco [Haga Teaching Hospital, Department of Cardiology, The Hague (Netherlands); Reitsma, Johannes B. [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Brink, Renee B.A. van den [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Chamuleau, Steven A.J. [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Budde, Ricardo P.J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands)

    2015-07-15

    Multimodal non-invasive imaging plays a key role in establishing a diagnosis of PHV endocarditis. The objective of this study was to provide a systematic review of the literature and meta-analysis of the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected) PHV endocarditis. Studies published between 1985 and 2013 were identified via search and cross-reference of PubMed/Embase databases. Studies were included if (1) they reported on the non-invasive index tests TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the condition of interest; and (3) imaging results were verified against either surgical inspection/autopsy or clinical follow-up reference standards, thereby enabling the extraction of 2-by-2 tables. Twenty articles (including 496 patients) met the inclusion criteria for PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled sensitivity/specificity for vegetations of 29/100 %; 82/95 %, and 88/94 %, respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT + TEE for periannular complications was 36/93 %, 86/98 %, and 100/94 %, respectively. TEE showed good sensitivity and specificity for establishing a diagnosis of PHV endocarditis. Although MDCT data are limited, this review showed that MDCT in addition to TEE may improve sensitivity in detecting life-threatening periannular complications. (orig.)

  14. Rhabdomyolysis in a child secondary to Staphylococcus aureus endocarditis

    OpenAIRE

    Srinivas Bandi; Ashish Chikermane

    2009-01-01

    Rhabdomyolysis secondary to bacterial infection has only rarely been investigated, and there are case reports of the same mainly in adults. This article describes the first reported case of rhabdomyolysis in a child secondary to Staphylococcus aureus endocarditis. A 12-year-old child presented with myalgia, pyrexia and dark urine and was found to have infective endocarditis due to S. aureus.

  15. Successfully treated infective endocarditis caused by methicillin-resistant Staphylococcus Aureus in extremely low birth weight infant

    Science.gov (United States)

    Jung, Sehwa; Jeong, Kyung Uk; Jung, Jo Won; Park, Moon Sung

    2016-01-01

    Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for microorganisms during the course of septicemia. Herein, we report a case of persistent bacteremia due to methicillin-resistant Staphylococcus aureus in an extremely low birth weight (ELBW) infant, along with vegetation observed on an echocardiogram, the findings which are compatible with a diagnosis of endocarditis. The endocarditis was successfully treated with antibiotic therapy, and the patient recovered without major complications. We suggest a surveillance echocardiogram for ELBW infants within a few days of birth, with regular follow-up studies when clinical signs of sepsis are observed.

  16. Listeria monocytogenes endocarditis.

    Science.gov (United States)

    Sheinman, B D; Evans, T; Sage, R

    1985-01-01

    A fatal case of endocarditis due to Listeria monocytogenes is reported. Case reports of endocarditis due to this organism are rare but indicate a higher mortality than with many other causes of bacterial endocarditis. The size of the problem may be underestimated because the organism has a "diphtheroid' appearance and may be incorrectly dismissed as a contaminant. PMID:3991406

  17. Listeria monocytogenes endocarditis.

    OpenAIRE

    Sheinman, B D; Evans, T; Sage, R.

    1985-01-01

    A fatal case of endocarditis due to Listeria monocytogenes is reported. Case reports of endocarditis due to this organism are rare but indicate a higher mortality than with many other causes of bacterial endocarditis. The size of the problem may be underestimated because the organism has a "diphtheroid' appearance and may be incorrectly dismissed as a contaminant.

  18. Prosthetic valve sewing-ring sealing with antibiotic and fibrin glue in infective endocarditis. A prospective clinical study.

    Science.gov (United States)

    Farhat, Fadi; Durand, Marion; Delahaye, François; Jegaden, Olivier

    2007-02-01

    To analyze the benefits of prosthetic valve sewing ring sealing with antibiotic and fibrin glue in endocarditis, a prospective study was undertaken in 16 consecutive patients. Valvular lesions concerned aortic valve in seven patients, mitral valve in three and both in six. Preoperative antibiotic treatment was started 15+/-15 days before surgery. Peroperative findings showed six isolated valvular lesions and ten perivalvular extensions. Before the prostheses were sutured to the annulus, the Dacron sewing rings were covered with antibiotic and fibrin glue. The antibiotic was chosen according to the micro-organism identified preoperatively. We didn't have any peroperative mortality or paravalvular leakage (PVL). One patient died suddenly on postoperative day (POD) nine (non-contributive autopsy). Another patient was reoperated on POD 31 for PVL. Peroperative local bacteriological examinations were sterile. Mean follow-up was of 9.3+/-6.8 months and was completed in all cases. Actuarial survival rate was 94+/-6% and freedom from reoperation was 92+/-7%. Antibiotic treatment was stopped after 59+/-64 days for 10 patients. None of them had recurrence of endocarditis or PVL. Prosthetic valve sewing ring sealing with adapted antibiotic and fibrin glue can constitute a good weapon in the armamentarium of surgical treatment of active endocarditis. PMID:17669758

  19. Aspergillus niger endocarditis in an immunocompetent patient: an unusual course

    OpenAIRE

    Kreiss, Y.; Vered, Z; Keller, N.; Kochva, I.; Sidi, Y.; H. Gur

    2000-01-01

    Aspergillus is an opportunistic nosocomial fungus generally associated with a high mortality rate. A niger has been rarely associated with infection, and most cases have occurred in patients who have recently undergone heart surgery or in immunocompromised patients. We present a case of an immunocompetent patient with A niger endocarditis which illustrates the difficulties in diagnosis and the possible insidious course of fungal endocarditis.


Keywords: endocarditis; Aspergillus niger; trans...

  20. Acute myocardial infarction in infectious endocarditis. Report of one case

    International Nuclear Information System (INIS)

    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

  1. Endocarditis bacteriana: reporte de caso / Bacterial endocarditis: case report

    Scientific Electronic Library Online (English)

    Roberto, Dávila F; Miguel, Marroquín A.

    2014-04-01

    Full Text Available La endocarditis bacteriana es una inflamación del endocardio donde hay colonización bacteriana que genera vegetaciones en alguna válvula del corazón, las cuales alteran la función cardiaca generando regurgitaciones y alteraciones hemodinámicas. Además, puede producir cuadros propios de la infección [...] como tromboembolismo séptico y alteraciones inflamatorias como complejos inmunes. En el presente estudio se describe el caso de un canino hembra de 2.5 años, que presentó fiebre, decaimiento, anorexia y un soplomarcado(IV/VI) en elladoizquierdodeltórax.Losexámenesdelaboratorioevidenciaron leucocitosis con desviación a la izquierda e insuficiencia renal aguda. Además, la ecocardiografía mostró un crecimiento a nivel de la válvula aórtica que alteraba el flujo sanguíneo produciendo un jet regurgitante diastólico. Se concluye que la lesión era compatible con una endocarditis bacteriana Abstract in english Bacterial endocarditis is an inflammation of the endocardium, where a bacterial colonization produces vegetation in the cardiac valve, which can alter its normal function causing regurgitations and hemodynamic alterations. Also, this infection can cause septic thromboembolism or inflammatory alterat [...] ions like immune complexes. The present study describes the case of a female canine of 2.5 years of age that presented fever, depression, anorexia and a severe murmur (IV/VI) on the left side of the thorax. Laboratory exams revealed leukocytosis with left shift and renal failure. Besides, the echocardiography showed vegetation at the aortic valve that altered the hemodynamics producing a diastolic regurgitation jet. It was concluded that the lesion was compatible with bacterial endocarditis

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

    DEFF Research Database (Denmark)

    Larsen, Tove; Fiehn, Nils-Erik; Gutschik, Ernö; Bangsborg, Jette Marie

    1999-01-01

    OBJECTIVE: Infective endocarditis is frequently caused by oral streptococci, especially Streptococcus sanguis. In this group, many strains have recently been reclassified on the basis of new taxonomic schemes. The purpose of this study was to classify oral streptococci from patients with infective...... endocarditis and, further, to assess the importance of specific virulence factors for the development of streptococcal endocarditis. METHODS: Twenty-eight previously identified and 10 new streptococcal isolates from infective endocarditis were classified according to Kilian et al (1989) and compared to 30...... streptococcal isolates from the oral cavities of periodontal patients without endocarditis. Subsequently, surface hydrophobicity was assessed by hydrophobic interaction chromatography, production of extracellular dextran was determined by precipitation, and non-specific proteolytic activity was evaluated by...

  3. What Is Infective Endocarditis?

    Science.gov (United States)

    ... you have heart disease or have had a stroke, members of your family also may be at higher risk. It’s very important for them to make changes now to lower their risk. Call ... disease. For information on stroke, call 1-888-4-STROKE (1-888-478- ...

  4. A Complicated Case of Triple Valve Infective Endocarditis in an IV Drug User with a Bicuspid Aortic Valve Requiring Three Separate Salvage Operations: A Case Report and Literature Review

    OpenAIRE

    Khan, Shahzad; Smyrlis, Athanasios; Yaranov, Dmitry; Oelberg, David; Jimenez, Eric

    2015-01-01

    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 vasc...

  5. Partial oral treatment of endocarditis

    DEFF Research Database (Denmark)

    Iversen, Kasper; Høst, Nis; Bruun, Niels Eske; Elming, Hanne; Pump, Bettina; Christensen, Jens Jørgen; Gill, Sabine; Rosenvinge, Flemming Schønning; Wiggers, Henrik; Fuursted, Kurt; Holst-Hansen, Claus; Korup, Eva; Schønheyder, Henrik Carl; Hassager, Christian; Høfsten, Dan Eik; Helweg-Larsen, Jannik; Moser, Claus; Ihlemann, Nikolaj; Bundgaard, Henning

    2013-01-01

    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...... hospital stay. Evidence supporting partial oral therapy as an alternative to the routinely recommended continued parenteral therapy is scarce, although observational data suggest that this strategy may be safe and effective.......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...

  6. Coxiella burnetii Endocarditis in a Child Caused by a New Genotype.

    Science.gov (United States)

    Briggs, Benjamin J; Raoult, Didier; Hijazi, Ziyad M; Edouard, Sophie; Angelakis, Emmanouil; Logan, Latania K

    2016-02-01

    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

  7. [Linezolid therapy for infectious endocarditis].

    Science.gov (United States)

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Bruun, Niels Eske

    2010-04-19

    In Denmark enterococci causes 15 to 20% of all endocarditis (IE) cases. The development of multi-resistant bacterial strains has increased the need for new antibiotics. Linezolid is an alternative to conventional treatment of infections with gram positive cocci. In this case report linezolid was used to treat IE in a patient, who was allergic to penicillin and where conventional treatment caused development of acute renal failure. No side effects were observed and the patient responded well to the treatment. PMID:20423667

  8. Perfil clínico-epidemiológico de pacientes con endocarditis infecciosa, período 2003-2010 en el hospital de Temuco, Chile Profile of patients with infective endocarditis admitted to a Chilean regional hospital

    Directory of Open Access Journals (Sweden)

    Benjamín Stockins

    2012-10-01

    Full Text Available Background: Mortality due to infective endocarditis (IE in Chile is close to 30%. Aim: To report the experience with patients admitted with the diagnosis of IE in a regional tertiary hospital. Material and Methods: Retrospective study of 107 patients aged 50 ± 16years (75% males discharged with a definitive diagnosis of IE according to modified DUKE criteria, between years 2003 and 2010. Demographic variables, severity scores, clinical characteristics, bacteriology and hospital evolution were recorded. Results: Fifty nine percent of patients had concomitant cardiovascular problems. APACHE II and Sequential Organ Failure Assessment (SOFA scores on admission were 8.4 ± 4.7 and 2.7 ± 2.8 respectively. Native valves were affected in 91% of cases (aortic and mitral valves in 62% and 50% of cases respectively. Prosthetic valves were affected in 9.3% of cases. Rheumatic heart disease was the predominant primary lesion in 10% of patients. Antibiotics were used in 45.1% before blood cultures were performed. In 68% of patients blood cultures were positive. S. viridans (30.8%, S.aureus (18.6% and coagulase negative Streptocicci (5.6% were the identified microorganisms. Intensive care unit admission was required in 48% of patients. Renal, heart and neurological deterioration was observed in 53, 34 and 14% of patients, respectively. Twenty percent of patients developed systemic embolism and 37% required heart surgery. Mean hospital stay was 28.3 ± 19.1 days and 27% of patients died. Conclusions: In this series of patients, IE has a high mortality. Most patients studied were admitted in bad conditions.

  9. Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario Infective endocarditis: short and long term results in 261 cases managed by a multidiciplinary approach

    Directory of Open Access Journals (Sweden)

    Sandra Braun J

    2000-07-01

    Full Text Available Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke. S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%. Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20.

  10. Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario / Infective endocarditis: short and long term results in 261 cases managed by a multidiciplinary approach

    Scientific Electronic Library Online (English)

    Sandra, Braun J; Alex, Escalona P; Gastón, Chamorro S; Ramón, Corbalán H; Carlos, Pérez C; Jaime, Labarca L; Manuel José, Irarrázaval L; Ricardo, Zalaquett S; José Antonio, Rodríguez V; Pablo, Casanegra P.

    2000-07-01

    Full Text Available [...] Abstract in english Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de [...] Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20).

  11. Technetium 99m-labeled annexin v scintigraphy of platelet activation in vegetations of experimental endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Rouzet, F.; Sarda-Mantel, L.; Le Guludec, D. [Nucl Med Serv, Grp Hosp Bichat Claude Bernard, AP-HP, Paris (France); Rouzet, F.; Sarda-Mantel, L.; LeGuludec, D. [Univ Denis Diderot Paris 7, UMR S773, Paris (France); Rouzet, F.; Sarda-Mantel, L.; Le Guludec, D. [INSERM, U773, Paris (France); Hernandez, M.D.; Louedec, L.; Michel, J.B. [Univ Paris 07, CHU Xavier Bichat, INSERM, U698, Paris (France); Hervatin, F. [CEA, DSV, DRM, SHFJ, Orsay (France); Lefort, A.; Fantin, B. [Univ Denis Diderot Paris 7, EA 3964, Paris (France); Duval, X. [Univ Denis Diderot Paris 7, INSERM, CIC 007, Paris (France); Duval, X. [Univ Denis Diderot Paris 7, AP-HP, Grp Hosp Bichat Claude Bernard, Ctr Invest Clin, Paris (France); Hernandez, M.D. [Univ Guadalajara, DeptPathol, Guadalajara 44430, Jalisco (Mexico)

    2008-07-01

    Background: The pathophysiology of infective endocarditis involves a pathogen/host tissue interaction, leading to formation of infected thrombotic vegetations. Annexin V is a ligand of phosphatidyl-serines exposed by activated platelets and apoptotic cells. Because vegetations are platelet-fibrin clots in which platelet pro-aggregant activity is enhanced by bacterial colonization, we investigated the ability of annexin V labeled with technetium {sup 99m}Tc ({sup 99m}Tc-ANX) to provide functional imaging of these vegetations in experimental models of infective endocarditis. This ability was assessed in rabbits and rats because of the different interest of these 2 species in preclinical analysis. Methods and Results: Non-bacterial thrombotic endocarditis was induced with the use of a catheter left indwelling through the aortic or tricuspid valve, and animals were injected with either a bacterial inoculum or saline. Scintigraphic investigations were performed 5 days later and showed a higher {sup 99m}Tc-ANX uptake by vegetations in infected versus non-infected animals (ratio,1.3 for in vivo acquisitions and 2 for autoradiography; P {<=} 0.0001 for all), whereas no significant uptake was present in controls. Right-sided endocarditis was associated with pulmonary uptake foci corresponding to emboli. Histological analysis of vegetations showed a specific uptake of {sup 99m}Tc-ANX at the interface between circulating blood and vegetation. In parallel, underlying myocardial tissue showed myocyte apoptosis and mucoid degeneration, without extracellular matrix degradation at this stage. Conclusions: {sup 99m}Tc-ANX is suitable for functional imaging of platelet-fibrin vegetations in endocarditis, as well as embolic events. {sup 99m}Tc-ANX uptake reflects mainly platelet activation in the luminal layer of vegetations. This uptake is enhanced by bacterial colonization. (authors)

  12. Endocarditis por Abiotrophia defectiva en paciente adulto Endocarditis caused by Abiotrophia defectiva in an adult patient

    Directory of Open Access Journals (Sweden)

    Lorena Porte T.

    2004-06-01

    Full Text Available Abiotrophia defectiva es una cocácea grampositiva considerada anteriormente como parte del grupo de los estreptococos nutricionalmente variables. Es parte de la microbiota oral y puede ser causante de endocarditis bacteriana con cultivo negativo. Se reporta el caso de un paciente varón de 37 años de edad, alérgico a penicilina, con endocarditis infecciosa causada por A. defectiva y se realiza revisión de la literatura sobre las alternativas terapéuticas y el estado actual del diagnóstico microbiológico de este agenteAbiotrophia defectiva, formerly designated as a member of nutritionally variant streptococci, is part of normal oral flora and may be a cause of culture-negative endocarditis. We report a case of infective endocarditis caused by A. defectiva in a 37-year-old man, allergic to penicillin. We also review the literature for antibiotic treatment alternatives and the microbiological diagnostic possibilities at present

  13. Endocarditis por Abiotrophia defectiva en paciente adulto / Endocarditis caused by Abiotrophia defectiva in an adult patient

    Scientific Electronic Library Online (English)

    Lorena, Porte T.; Juanita, Zamorano R.; Daniela, Pavéz A.; Gustavo, Monckeberg F.; Carmen, Varela A.; Patricia, González A.; M. Teresa, Ulloa F.; Carolina, Sepúlveda R..

    2004-06-01

    Full Text Available Abiotrophia defectiva es una cocácea grampositiva considerada anteriormente como parte del grupo de los estreptococos nutricionalmente variables. Es parte de la microbiota oral y puede ser causante de endocarditis bacteriana con cultivo negativo. Se reporta el caso de un paciente varón de 37 años de [...] edad, alérgico a penicilina, con endocarditis infecciosa causada por A. defectiva y se realiza revisión de la literatura sobre las alternativas terapéuticas y el estado actual del diagnóstico microbiológico de este agente Abstract in english Abiotrophia defectiva, formerly designated as a member of nutritionally variant streptococci, is part of normal oral flora and may be a cause of culture-negative endocarditis. We report a case of infective endocarditis caused by A. defectiva in a 37-year-old man, allergic to penicillin. We also revi [...] ew the literature for antibiotic treatment alternatives and the microbiological diagnostic possibilities at present

  14. Candida albicans isolated from human fungaemia induces apoptosis in an experimental endocarditis model

    Scientific Electronic Library Online (English)

    Iván, Hernández-Cañaveral; Gerardo, Becerra; Alberto, Jiménez-Cordero; Jean-Baptiste, Michel; Arturo, Plascencia; Miguel, Domínguez-Hernández.

    2009-09-01

    Full Text Available Candida albicans is the most common fungal pathogen known to cause endovascular infections, such as vascular catheter sepsis, infections of vascular prostheses and infective endocarditis. A C. albicans isolate was used to determine the apoptotic potential of the fungus in a rat endocarditis model. T [...] his study confirms the ability of C. albicans to induce apoptosis in myocardial tissue.

  15. Spondylodiscitis and endocarditis caused by S. vestibularis.

    Science.gov (United States)

    Tufan, Muge Aydin; Hamide, Kart-Koseoglu; Duygu, Ersozlu-Bozkirli; Ozlem, Azap; Kadir, Tufan; Eftal, Yucel Ahmet

    2010-01-01

    Streptococcus vestibularis is a recently described member of the viridans group that was first isolated from the vestibular mucosa of the human oral cavity and described as a new species in 1988. It has been rarely associated with human infections. In few papers, it has been reported as a causal agent of systemic infection in immunosupressed adults and in those with other severe underlying diseases, like coronary valve diseases. A 65-year-old woman was admitted to the hospital with complaints of fever for three months, general malaise, effort dyspnea, weight loss, back pain and myalgia. Both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis were detected. The patient was successfully treated with intravenous potassium penicillin G and gentamicin for six weeks, followed by oral amoxicillin for three months, in addition to aortic valve replacement. In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. Cardiac valve replacement surgery should be performed if the course of fever and inflammatory syndrome is unfavorable after appropriate antibiotic treatment. We report the first case with both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis. PMID:20963324

  16. Spondylodiscitis and endocarditis caused by S. vestibularis

    Scientific Electronic Library Online (English)

    Muge Aydin, Tufan; Kart-Koseoglu, Hamide; Ersozlu-Bozkirli, Duygu; Azap, Ozlem; Tufan, Kadir; Yucel Ahmet, Eftal.

    2010-08-01

    Full Text Available Streptococcus vestibularis is a recently described member of the viridans group that was first isolated from the vestibular mucosa of the human oral cavity and described as a new species in 1988. It has been rarely associated with human infections. In few papers, it has been reported as a causal age [...] nt of systemic infection in immunosupressed adults and in those with other severe underlying diseases, like coronary valve diseases. A 65-year-old woman was admitted to the hospital with complaints of fever for three months, general malaise, effort dyspnea, weight loss, back pain and myalgia. Both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis were detected. The patient was successfully treated with intravenous potassium penicillin G and gentamicin for six weeks, followed by oral amoxicillin for three months, in addition to aortic valve replacement. In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. Cardiac valve replacement surgery should be performed if the course of fever and inflammatory syndrome is unfavorable after appropriate antibiotic treatment. We report the first case with both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis.

  17. Spondylodiscitis and endocarditis caused by S. vestibularis

    Directory of Open Access Journals (Sweden)

    Muge Aydin Tufan

    2010-08-01

    Full Text Available Streptococcus vestibularis is a recently described member of the viridans group that was first isolated from the vestibular mucosa of the human oral cavity and described as a new species in 1988. It has been rarely associated with human infections. In few papers, it has been reported as a causal agent of systemic infection in immunosupressed adults and in those with other severe underlying diseases, like coronary valve diseases. A 65-year-old woman was admitted to the hospital with complaints of fever for three months, general malaise, effort dyspnea, weight loss, back pain and myalgia. Both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis were detected. The patient was successfully treated with intravenous potassium penicillin G and gentamicin for six weeks, followed by oral amoxicillin for three months, in addition to aortic valve replacement. In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. Cardiac valve replacement surgery should be performed if the course of fever and inflammatory syndrome is unfavorable after appropriate antibiotic treatment. We report the first case with both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis.

  18. A Misinterpreted Case of Aorta Prosthesis Endocarditis

    DEFF Research Database (Denmark)

    Lerche, Christian Johann; Haugan, Ketil Jørgen; Reimers, Jesper Irving; Ihlemann, Nikolaj

    2013-01-01

    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...

  19. Serological diagnosis of experimental Enterococcus faecalis endocarditis

    DEFF Research Database (Denmark)

    Kjerulf, A; Espersen, F; Gutschik, E; Majcherczyk, P A; Hougen, H P; Rygaard, J; Høiby, N

    1998-01-01

    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...

  20. Achados clínico-laboratoriais de uma série de casos com endocardite infecciosa Clinical and laboratory findings in a series of cases of infective endocarditis

    Directory of Open Access Journals (Sweden)

    Carla A.Z. Pereira

    2003-10-01

    Full Text Available OBJETIVO: Descrever os achados clínico-laboratoriais da endocardite infecciosa (EI em 28 crianças, em Vitória/ES. MÉTODO: Estudo retrospectivo dos prontuários de 28 crianças, com idade abaixo de 18 anos e diagnóstico de endocardite infecciosa, internadas no serviço de infectologia do Hospital Infantil Nossa Senhora da Glória, em Vitória - Espírito Santo, no período de janeiro de 1993 a dezembro de 2001. Os critérios para diagnóstico de endocardite infecciosa foram os do Duke Endocarditis Service (Duke University, Durham, North Carolina - USA: critérios maiores (hemoculturas e ecocardiograma positivos e critérios menores (febre, doença cardíaca prévia, sopro cardíaco recente, fenômenos vasculares e imunológicos. Através de protocolo específico, preenchido pelos médicos-residentes e acadêmicos do serviço de infectologia, e revisados pelos médicos da equipe, foram anotadas as idades, sexo, achados clínicos e laboratoriais, e os resultados da ecocardiografia transtorácica das 28 crianças que preenchiam os critérios clínicos e laboratoriais. Em todos os casos, as hemoculturas foram realizadas com coleta do sangue (três amostras, sob condições assépticas e com inoculação em meios aeróbicos e anaeróbicos, incubados a uma temperatura de 37ºC e testados com sistema automatizado Vitec System® (Biolab. RESULTADOS: Das 28 crianças, 16 eram do sexo masculino, com idade entre 3 e 180 meses (média 70,6±59,2 m, e a maioria (68% era procedente da região metropolitana de Vitória. Metade apresentava cardiopatia prévia. Os achados clínicos mais freqüentes que levaram à suspeita de EI foram: febre prolongada (100%, sopro cardíaco (67,9%, dispnéia (57,1%, hepatomegalia (57,1%, fenômenos vasculares (32,2%, esplenomegalia (28,6% e nódulos de Osler (7,1%. Foram colhidas hemoculturas dos 28 casos, sendo 16 (57,1% positivas. O S. aureus adquirido na comunidade foi o germe mais freqüentemente isolado (9/16-56,6%. Houve persistência da febre, apesar do tratamento, duração da febre de 2,5 a 30 dias, mediana de 18,0 dias. O valor médio de leucócitos à internação foi de 11.657±7.085mm³. O ecocardiograma transtorácico, realizado em todos os pacientes, evidenciou vegetações, principalmente nas válvulas tricúspide (25,0%, mitral (25,0% e na borda de CIV (28,6%. Treze (46,4% crianças apresentaram sepse concomitante, e três (10,7% infecção hospitalar. Houve um óbito (3,6%. CONCLUSÕES: A endocardite infecciosa em nosso meio é freqüente em crianças abaixo de dois anos de idade e com uma cardiopatia congênita. O S. aureus de origem comunitária foi o microorganismo isolado mais freqüentemente, e em crianças sem lesão cardíaca prévia. Endocardite infecciosa aguda, endocardite bacteriana, Staphylococcus aureus, ecocardiografia transtorácica.OBJECTIVE: To describe clinical and laboratory data of infective endocarditis (IE in 28 children from Vitória, state of Espírito Santo, Brazil. METHODS: We reviewed the medical records of 28 children aged 18 years and under admitted to the Infectious Diseases Unit of Nossa Senhora da Glória Children's Hospital with a diagnosis of IE from January 1993 to December 2001. The diagnosis of IE was based on the criteria established by the Duke Endocarditis Service (Duke University, Durham, North Carolina, USA: positive blood cultures and echocardiogram (primary criteria; and fever, history of heart disease, recent heart murmur, and vascular and immunological phenomena (secondary criteria. A specific protocol was filled out by interns and medical students and revised by physicians from the hospital medical team to obtain the following data: age, sex, clinical and laboratory findings, and results of transthoracic echocardiography. In all cases, three blood samples were collected under aseptic conditions and inoculated in aerobic and anaerobic environments. The samples were then incubated at 37º C and tested with the VITEC SYSTEM® automatized system (BIOLAB. RESULTS: Among 28 patients, 16 were boys. Age w

  1. An Unusual Case of Early Onset Persistent Escherichia coli Septicemia Associated with Endocarditis

    Directory of Open Access Journals (Sweden)

    Sachin K. Gupta

    2013-10-01

    Full Text Available Escherichia coli infection is very common cause of early onset septicemia especially in very low-birth-weight newborns, but E. coli endocarditis has not been described in newborns. E. coli endocarditis, even in the adult population, is a rare and not well-characterized disease and is associated with high mortality. We report a very unusual presentation of persistent E. coli infection associated with endocarditis.

  2. Staphylococcus aureus Endocarditis with Multivalvular Involvement Secondary to an Atrial Septal Defect

    Science.gov (United States)

    Daruwalla, Vistasp Jimmy; Sagi, Jahnavi; Tahir, Hassan; Penumetsa, Srikanth

    2016-01-01

    Infective endocarditis is usually diagnosed using modified Duke's criteria. Our patient had a subacute presentation and a low suspicion for endocarditis during admission, unfortunately leading to her death. Despite advances in diagnostic and therapeutic measures including antibiotic therapy and surgical techniques, morbidity and mortality with staphylococcal infective endocarditis remain high. Hence, we stress the significance of having a low threshold for TEE in patients with multisystem involvement due to Staphylococcus aureus that have evidence of persistent infection despite antibiotic treatment, even if the suspicion for endocarditis is low based on Duke's criteria. TEE substantially improves the sensitivity of diagnosis but may not be readily available in many medical centers. Presence of an ASD has been noted to have increased the risk of left sided endocarditis even with conditions that predispose to right sided endocarditis, particularly in patients with hemodialysis and diabetes as morbid risk factors. PMID:26989519

  3. Fusobacterium necrophorum causing infective endocarditis and liver and splenic abscesses / Fusobacterium necrophorum causando endocardite infecciosa e abscesso hepático e esplênico

    Scientific Electronic Library Online (English)

    Marc Zac, Handler; Benjamin, Miriovsky; Howard E., Gendelman; Uriel, Sandkovsky.

    2011-06-01

    Full Text Available Homem de 25 anos de idade, sem antecedentes mórbidos foi admitido ao hospital com bacteremia por Fusobacterium necrophorum e abscessos no fígado e no baço. Avaliação posterior com ecografia revelou válvula aórtica bicúspide com insuficiência severa e vegetação de 1,68 x 0,86 cm. Foi feita drenagem d [...] os abscessos, terapia antimicrobiana intravenosa e substituição da válvula aórtica. Resolução completa da infecção foi conseguida após substituição valvular e curso prolongado de terapêutica intravenosa antimicrobiana. É apresentada breve análise do curso clínico do paciente e revisão da literatura. Abstract in english A 25-year-old male without prior co-morbidities was admitted to hospital with Fusobacterium necrophorum bacteremia, where he was found to have liver and splenic abscesses. Further evaluation with echocardiography revealed a bicuspid aortic valve with severe insufficiency and a 1.68 x 0.86 cm vegetat [...] ion. The patient required abscess drainage, intravenous antimicrobial therapy and aortic valve replacement. Complete resolution of the infection was achieved after valve replacement and a prolonged course of intravenous antimicrobial therapy. A brief analysis of the patient's clinical course and review of the literature is presented.

  4. The first reported case of Bartonella endocarditis in Thailand

    Directory of Open Access Journals (Sweden)

    Orathai Pachirat

    2011-06-01

    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.

  5. Native valve endocarditis due to Streptococcus vestibularis and Streptococcus oralis.

    Science.gov (United States)

    Doyuk, Elif; Ormerod, Oliver J; Bowler, Ian C J W

    2002-07-01

    Viridans streptococci are the commonest cause of native valve infective endocarditis (IE). The taxonomy of this group is evolving allowing new disease associations to be made. Streptococcus vestibularis is a recently described member of the viridans group, first isolated from the vestibular mucosa of the human oral cavity. It has rarely been associated with human disease. Streptococcus oralis, another member of the viridans group resident in the human oral cavity is a well known cause of IE and bacteraemia in neutropenic patients. We report the first case of native mitral valve endocarditis due to S. vestibularis in a patient with co-existing S. oralis endocarditis. PMID:12217730

  6. Neisseria meningitidis endocarditis: A case report and review of the literature.

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-04-08

    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.

  7. Neisseria meningitidis endocarditis: a case report and review of the literature.

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2012-02-01

    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.

  8. Molecular imaging in Libman-Sacks endocarditis

    DEFF Research Database (Denmark)

    Dahl, Anders; Schaadt, Bente K

    2015-01-01

    We present a 54-year-old woman with systemic lupus erythematosus (SLE), fever, pericardial effusion and a mitral valve vegetation. (18)F-Fluorodesoxyglucose positron emission tomography CT ((18)F-FDG-PET-CT) showed very high accumulation of the isotope at the mitral valve. The patient underwent 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.

  9. The fibronectin-binding protein EfbA contributes to pathogenesis and protects against infective endocarditis caused by Enterococcus faecalis.

    Science.gov (United States)

    Singh, Kavindra V; La Rosa, Sabina Leanti; Somarajan, Sudha R; Roh, Jung Hyeob; Murray, Barbara E

    2015-12-01

    EfbA is a PavA-like fibronectin adhesin of Enterococcus faecalis previously shown to be important in experimental urinary tract infection. Here, we expressed and purified the E. faecalis OG1RF EfbA and confirmed that this protein binds with high affinity to immobilized fibronectin, collagen I, and collagen V. We constructed an efbA deletion mutant and demonstrated that its virulence was significantly attenuated (P infection, likely by interfering with bacterial adherence. PMID:26351286

  10. Endocarditis and risk of cancer

    DEFF Research Database (Denmark)

    Thomsen, Reimar Wernich; Farkas, Dóra Körmendiné; Friis, Søren; Sværke, Claus; Ording, Anne Gulbech; Nørgaard, Mette; Sørensen, Henrik Toft

    2013-01-01

    Endocarditis may be a marker for bacteremia-associated occult cancer. Intensive antibiotic treatment in endocarditis is suggested to reduce long-term cancer risk. We examined these hypotheses in a nationwide cohort study.......Endocarditis may be a marker for bacteremia-associated occult cancer. Intensive antibiotic treatment in endocarditis is suggested to reduce long-term cancer risk. We examined these hypotheses in a nationwide cohort study....

  11. Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

    Directory of Open Access Journals (Sweden)

    Engblom Erik

    2008-04-01

    Full Text Available Abstract Background Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE. Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery. Methods A total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients. Results The mean (SD follow-up time for the 1-year survivors was 11.5 (7.3 years (range 25 days to 25.5 years. The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003 and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010 or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005 as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p Conclusion Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

  12. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis

    DEFF Research Database (Denmark)

    Asmar, Ali; Ozcan, Cengiz

    2014-01-01

    OBJECTIVE: The purpose of this study was to assess the clinical importance of (18)F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND: IE is a serious condition with a significant mortality. Besides the degree of valvular involvement, the prognosis relies crucially on the presence of systemic infectious embolism. METHODS: Seventy-two patients (71% males and mean age 63 ± 17 years) with IE were evaluated with (18)F-FDG-PET/CT in addition to standard work-up including patient history, physical examination, conventional imaging modalities, and weekly interdisciplinary conferences. When previous unknown lesions detected by (18)F-FDG-PET/CT were confirmed by succeeding examinations, they were considered true positive new findings and were further assessed for their clinical importance. Number needed to investigate was calculated as the number of patients who needed to undergo (18)F-FDG-PET/CT to find at least one clinical important true positive new finding, not identified by standard work-up prior to (18)F-FDG-PET/CT. RESULTS: (18)F-FDG-PET/CT detected 114 lesions and 64 were true positive, of which 25 were new findings and detected in 17 patients. In 11 patients, the lesions were considered to have a clinical importance; osteomyelitis (n = 7), iliopsoas abscess (n = 1), gastrointestinal lesions (n = 2), and vascular prosthetic graft (n = 1). Number needed to investigate was 7 (11 of 72 patients). CONCLUSIONS: (18)F-FDG-PET/CT detected lesions of clinical importance in one of seven IE patients and may be a substantial imaging technique for tracing peripheral infectious embolism due to IE. Thus, (18)F-FDG-PET/CT may help to guide adequate therapy and thereby improve the prognosis of patients with IE.

  13. Permanent pacemaker-associated actinomycetemcomitans endocarditis: A case report.

    Science.gov (United States)

    Li, Zhenhong; Madeo, Jennifer; Ahmed, Shadab; Vidal, Alex; Makaryus, Amgad; Mejia, Jose; Yasmin, Tabassum

    2013-09-01

    Aggregatibacter actinomycetemcomitans is a Gram-negative bacillus, member of the HACEK group of bacteria, and it is a very rare cause of endocarditis. It is also an extremely rare cause of device-associated infection of the heart. We describe the case of a 25 year-old man who presented with pacemaker-associated endocarditis due to Aggregatibacter actinomycetemcomitans and also discuss the implications and treatment of this organism. PMID:24432293

  14. IMMUNOPROTEOMICS OF INFECTIOUS ENDOCARDITIS OF NATIVE HEARTVALVES

    Directory of Open Access Journals (Sweden)

    A. A. Rumbesht

    2014-07-01

    Full Text Available Abstract. The aim of present study was to analyze the most commonly detected blood plasma immune proteins, that reflect molecular pathways in development of infectious endocarditis of native valves, together with analysis of marker proteins of disease on the base of modern technological platform for clinical proteomics. Ninety-nine patients with infectious endocarditis of native heart valves were included into the study. All the patients were examined according to hospital assessment protocol, including clinical, laboratory and instrumental methods of evaluation. Separation and identification of proteins of microorganisms in blood and materials taken at surgery, detection of proteins related to functioning of immune system, were carried out using new methods of clinical proteomics. We have revealed same proteins, that are specific of pathogens causing infectious endocarditis, that thus representing immunogenic determinants and defining a systemic immune response in the patients.

  15. Endocarditis por Streptococcus equi subsp. zooepidemicus / Streptococcus equi subsp. Zooepidemicus endocarditis

    Scientific Electronic Library Online (English)

    Iago, Villamil; Marta, Serrano; Elisabeth, Prieto.

    2015-04-01

    Full Text Available Las especies Streptococcus equi subsp. equi y S. equi subsp. zooepidemicus son especies zoonóticas típicamente patógenas de animales, especialmente en caballos. Es una causa excepcional de enfermedad en humanos. Presentamos un caso de endocarditis por S. equi subsp. zooepidemicus tras un contacto co [...] n equinos, con buena evolución con tratamiento antibiótico. Abstract in english Zoonotic infections with S. equi subsp. zooepidemicus have been reported occasionally in individuáis with exposure to farm animals, especially horses. They exceptionally present as a human pathogen. We present a S. equi subsp. zooepidemicus well documented endocarditis after a horse's female genital [...] tract contact, and excellent surveillance with exclusive antibiotic management.

  16. A case of Kingella kingae endocarditis complicated by native mitral valve rupture

    OpenAIRE

    Mohammad Bagherirad; Damoon Entesari-Tatafi; Sam Mirzaee; Allan Appelbe; Chenghon Yap; Eugene Athan

    2013-01-01

    We report a case of Kingella kingae endocarditis in a patient with a history of recent respiratory tract infection and dental extraction. This case is remarkable for embolic and vasculitic phenomena in association with a large valve vegetation and valve perforation. Kingella kingae is an organism known to cause endocarditis, however early major complications are uncommon. Our case of Kingella endocarditis behaved in a virulent fashion necessitating a combined approach of intravenous antibioti...

  17. Mycobacterial endocarditis: a comprehensive review / Endocardite micobacteriana: uma revisão abrangente

    Scientific Electronic Library Online (English)

    Shi-Min, Yuan.

    2015-02-01

    Full Text Available Objetivo: Uma análise sistemática foi feita considerando epidemiologia, quadro clínico, diagnóstico, tratamento e principais resultados da endocardite micobacteriana. Métodos: Foi realizada uma pesquisa bibliográfica abrangente no MEDLINE, Highwire Press e no Google para publicações sobre endocardi [...] te micobacteriana, publicados entre 2000 e 2013. Resultados: As micobactérias de crescimento rápido tornam-se os patógenos predominantes, com Mycobacterium chelonae sendo a mais comum. Essa condição se alterou significativamente em termos de epidemiologia, desde o início do século 21, abrangendo faixa etária mais ampla, maior latência, prevalecendo infecções da valva mitral e melhor prognóstico. Conclusão: Endocardite micobacteriana é rara e os patógenos causadores são predominantemente as micobactérias de crescimento rápido. Amicacina, ciprofloxacina e claritromicina são os agentes antimicrobianos mais frequentemente utilizados, mas muitas vezes apresentam respostas pobres. Pacientes com infecções profundas podem justificar um procedimento cirúrgico ou retirada de linha. Com a poliquimioterapia periódica guiada por testes de sensibilidade às drogas, e abordagens cirúrgicas, os pacientes podem obter bons resultados terapêuticos. Abstract in english Objective: A systematic analysis was made in view of the epidemiology, clinical features, diagnosis, treatment and main outcomes of mycobacterial endocarditis. Methods: The data source of the present study was based on a comprehensive literature search in MEDLINE, Highwire Press and Google search e [...] ngine for publications on mycobacterial endocarditis published between 2000 and 2013. Results: The rapidly growing mycobacteria become the predominant pathogens with Mycobacterium chelonae being the most common. This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis. Conclusion: Mycobacterial endocarditis is rare and the causative pathogens are predominantly the rapidly growing mycobacteria. Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses. Patients with deep infections may warrant a surgical operation or line withdrawal. With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results.

  18. Stenotrophomonas maltophilia prosthetic valve endocarditis: a case report

    Directory of Open Access Journals (Sweden)

    Bayle Sophie

    2008-05-01

    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.

  19. Prevención de la Endocarditis Bacteriana :: Revisión de la Literatura

    Scientific Electronic Library Online (English)

    Patricia R, Guzmán H; Sonia M, Corte F; Mónica P., Delgado O..

    2000-09-01

    Full Text Available La endocarditis infecciosa es una infección del revestimiento de las cavidades del corazón y de las válvulas cardíacas, causadas por bacterias, hongos virus u otros microorganismos. La endocarditis bacteriana se refiere específicamente a la infección por agentes bacterianos. La mayoría de las person [...] as que desarrollan la endocarditis han padecido una enfermedad cardíaca previa. El origen de la infección podría ser una bacteremia transitoria, la cual es común durante diagnósticos y procedimientos quirúrgicos; ya sean dentales, urológicos, del tracto respiratorio o gastrointestinal. La endocarditis es una enfermedad que amenaza a la vida a pesar de ser poco frecuente, por lo que la prevención es lo más importante. La Asociación Americana del Corazón, realizó algunos cambios en las pautas a seguir para la prevención de esta enfermedad, como son: una reducción de la antibioticoterapia para la protección del paciente, tanto bajando la dosis de ataque como eliminando la dosis posterior al tratamiento. De igual forma se limitaron los tratamientos que ameritan la profilaxis antibiótica. Estas nuevas recomendaciones definen mejor a los pacientes en riesgo y los procedimientos dentales que requieren protección con antibióticos. Abstract in english Infective endocarditis is an infection of the lining of the heart and heart valves. Caused by bacterias, fungus, viruses or other micro-organisms. Bacterial endocarditis is refered especially to infection for bacterial agents. The most people that developes endocarditis has sufered a prior cardiac d [...] isease. Cardiac source may be a transient bacteremia, common during diagnosis and surgical procedures, such dental, genitourinary, upper respiratory tract or gastrointestinal. Endocarditis is a life-threatening disease, although it is relatively uncommon so prevention is the most important. The American Heart Association, made some changes in guidelines for prevention of this disease: an antibioticoterapy decrease for pacients’cover, as much as lowering attack dosis and eliminating the follow doses to treatment. This new recommendations define better pacients at risk and dental procedures that require antibiotic cover.

  20. Medical dental prophylaxis of endocarditis

    Scientific Electronic Library Online (English)

    Regina C., Basilio; Francisco E., Loducca; Paulo C., Haddad.

    2004-10-01

    Full Text Available Antibiotics have long been the main reason for the increase in man's longevity. Since their discovery, man has tried to reduce the level of infection by treating with antibiotics. At the same time, prophylactic use has been suggested, although this is controversial. Their routine use is not recommen [...] ded, and empirical treatments at non-therapeutic doses, and indiscriminately, should be avoided, because they may become dangerous and harmful, causing among other things, the prevalence of resistant microorganisms and the eventual potentiation of an increase in morbid states. Infectious endocarditis is a systemic pathology that can start with a bacteremia, which comes either from dental procedures or/and chronic processes that already existed. Its etiopathogeny consists of a combination of bacteremia and two other factors: Cardiac injury, which can be congenital or/and acquired, and a debilitated immunological system (patients who have transplanted organs, or those who have auto-immune diseases, such as pemphigus vulgaris, systemic lupus erythematosus). The main goal is to prevent or to fight against the transient bacteremia, reducing its intensity and duration, and also to kill the bacteria in at-risk patients. In this way, infectious endocarditis can be prevented; the dental surgeon plays an important role in the prevention of this condition, which joins medical and dental aspects. This can be done by antibiotic prophylaxis. The dentist needs to be acquainted with the medical protocols of the heart health societies.

  1. Medical dental prophylaxis of endocarditis

    Directory of Open Access Journals (Sweden)

    Regina C. Basilio

    2004-10-01

    Full Text Available Antibiotics have long been the main reason for the increase in man's longevity. Since their discovery, man has tried to reduce the level of infection by treating with antibiotics. At the same time, prophylactic use has been suggested, although this is controversial. Their routine use is not recommended, and empirical treatments at non-therapeutic doses, and indiscriminately, should be avoided, because they may become dangerous and harmful, causing among other things, the prevalence of resistant microorganisms and the eventual potentiation of an increase in morbid states. Infectious endocarditis is a systemic pathology that can start with a bacteremia, which comes either from dental procedures or/and chronic processes that already existed. Its etiopathogeny consists of a combination of bacteremia and two other factors: Cardiac injury, which can be congenital or/and acquired, and a debilitated immunological system (patients who have transplanted organs, or those who have auto-immune diseases, such as pemphigus vulgaris, systemic lupus erythematosus. The main goal is to prevent or to fight against the transient bacteremia, reducing its intensity and duration, and also to kill the bacteria in at-risk patients. In this way, infectious endocarditis can be prevented; the dental surgeon plays an important role in the prevention of this condition, which joins medical and dental aspects. This can be done by antibiotic prophylaxis. The dentist needs to be acquainted with the medical protocols of the heart health societies.

  2. Relapse of Enterococcus hirae Prosthetic Valve Endocarditis?

    OpenAIRE

    Talarmin, J. P.; Pineau, S.; Guillouzouic, A.; Boutoille, D; Giraudeau, C.; Reynaud, A.; Lepelletier, D; Corvec, S.

    2011-01-01

    Enterococcus hirae, a Gram-positive bacterium, is a rare isolate in clinical specimens. We report an unusual case of a relapse of prosthetic valve endocarditis due to E. hirae 6 months after the initial episode. Clonal relationship was proven by genomic analysis.

  3. A case of Kingella kingae endocarditis complicated by native mitral valve rupture

    Directory of Open Access Journals (Sweden)

    Mohammad Bagherirad

    2013-04-01

    Full Text Available We report a case of Kingella kingae endocarditis in a patient with a history of recent respiratory tract infection and dental extraction. This case is remarkable for embolic and vasculitic phenomena in association with a large valve vegetation and valve perforation. Kingella kingae is an organism known to cause endocarditis, however early major complications are uncommon. Our case of Kingella endocarditis behaved in a virulent fashion necessitating a combined approach of intravenous antibiotic therapy and a valve replacement. It highlights the importance of expedited investigation for endocarditis in patients with Kingella bacteraemia.

  4. Endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide / Nocardia endocarditis in aortic and tricuspid native valves

    Scientific Electronic Library Online (English)

    Sergio, Chain; Héctor, Luciardi; Gabriela, Feldman; Sofía, Berman; Cristina, Estrella.

    2007-06-01

    Full Text Available La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrob [...] iana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses. Abstract in english Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-year-old man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In [...] 6 month follow up the patient remained asymptomatic with good clinical evolution.

  5. A Misinterpreted Case of Aorta Prosthesis Endocarditis

    DEFF Research Database (Denmark)

    Lerche, Christian Johann; Haugan, Ketil Jørgen; Reimers, Jesper Irving; Ihlemann, Nikolaj

    2013-01-01

    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 following the movement of the mechanical heart valve (MHV), which eventually proved to be a product of degassing microbubbles (MB).

  6. Role of {sup 18}F-FDG PET/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Graziosi, Maddalena; Lorenzini, Massimiliano; Diemberger, Igor; Pasquale, Ferdinando; Ziacchi, Matteo; Biffi, Mauro; Martignani, Cristian; Boriani, Giuseppe; Rapezzi, Claudio [Alma Mater-University of Bologna, and S. Orsola-Malpighi Hospital, Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Bologna (Italy); Nanni, Cristina; Bonfiglioli, Rachele; Fanti, Stefano [Alma Mater-University of Bologna, and S. Orsola-Malpighi Hospital, Nuclear Medicine Unit, Department of Experimental, Diagnostic and Specialty Medicine, Bologna (Italy); Bartoletti, Michele; Tumietto, Fabio; Viale, Pier Luigi [Alma Mater-University of Bologna, and S. Orsola-Malpighi Hospital, Infectious Diseases Unit, Department of Medical and Surgical Sciences, Bologna (Italy)

    2014-08-15

    Infective endocarditis (IE) is widely underdiagnosed or diagnosed after a major delay. The diagnosis is currently based on the modified DUKE criteria, where the only validated imaging technique is echocardiography, and remains challenging especially in patients with an implantable cardiac device. The aim of this study was to assess the incremental diagnostic role of {sup 18}F-FDG PET/CT in patients with an implanted cardiac device and suspected IE. We prospectively analysed 27 consecutive patients with an implantable device evaluated for suspected device-related IE between January 2011 and June 2013. The diagnostic probability of IE was defined at presentation according to the modified DUKE criteria. PET/CT was performed as soon as possible following the clinical suspicion of IE. Patients then underwent medical or surgical treatment based on the overall clinical evaluation. During follow-up, we considered: lead cultures in patients who underwent extraction, direct inspection and lead cultures in those who underwent surgery, and a clinical/instrumental reevaluation after at least 6 months in patients who received antimicrobial treatment or had an alternative diagnosis and were not treated for IE. After the follow-up period, the diagnosis was systematically reviewed by the multidisciplinary team using the modified DUKE criteria and considering the new findings. Among the ten patients with a positive PET/CT scan, seven received a final diagnosis of ''definite IE'', one of ''possible IE'' and two of ''IE rejected''. Among the 17 patients with a negative PET/CT scan, four were false-negative and received a final diagnosis of definite IE. These patients underwent PET/CT after having started antibiotic therapy (≥48 h) or had a technically suboptimal examination. In patients with a cardiac device, PET/CT increases the diagnostic accuracy of the modified Duke criteria for IE, particularly in the subset of patients with possible IE in whom it may help the clinician manage a challenging situation. (orig.)

  7. Haemophilus segnis endocarditis

    DEFF Research Database (Denmark)

    Bangsborg, Jette Marie; Tvede, M; Skinhøj, P

    1988-01-01

    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...

  8. Mycobacterium neoaurum causing prosthetic valve endocarditis: a case report and review of the literature

    Scientific Electronic Library Online (English)

    Anupam, Kumar; George S., Pazhayattil; Aparna, Das; Harry A., Conte.

    2014-04-01

    Full Text Available Mycobacterium neoaurum is a rare cause of bacteremia, and infection usually occurs in an immunocompromised host in the setting of an indwelling catheter. Prosthetic valve endocarditis due to non-tuberculous mycobacteria typically carries a dismal prognosis; we report a case ofM. neoaurum prosthetic [...] valve endocarditis with favorable response to antimicrobial therapy without surgical intervention.

  9. The Role of Endocarditis, Myocarditis and Pericarditis in Qualitative and Quantitative Data Analysis

    OpenAIRE

    Groneberg, David A; David Quarcoo; Stefanie Mache; Norman Schöffel; Karin Vitzthum

    2009-01-01

    The current study is the first scientometric analysis of research activity and output in the field of inflammatory disorders of the heart (endo-, myo- and pericarditis). Scientometric methods are used to compare scientific performance on national and on international scale to identify single areas of research interest. Interest and research productivity in inflammatory diseases of the heart have increased since 1990. The majority of publications about inflammatory heart disorders were publish...

  10. Achados clínico-laboratoriais de uma série de casos com endocardite infecciosa Clinical and laboratory findings in a series of cases of infective endocarditis

    OpenAIRE

    Carla A.Z. Pereira; Scheila C.G.P. Rocio; Maria-Fátima R. Ceolin; Ana-Paula N.B. Lima; Felippe Borlot; Roberto S.T. Pereira; Moreira-Silva, Sandra F.

    2003-01-01

    OBJETIVO: Descrever os achados clínico-laboratoriais da endocardite infecciosa (EI) em 28 crianças, em Vitória/ES. MÉTODO: Estudo retrospectivo dos prontuários de 28 crianças, com idade abaixo de 18 anos e diagnóstico de endocardite infecciosa, internadas no serviço de infectologia do Hospital Infantil Nossa Senhora da Glória, em Vitória - Espírito Santo, no período de janeiro de 1993 a dezembro de 2001. Os critérios para diagnóstico de endocardite infecciosa foram os do Duke Endocarditis Ser...

  11. Actualización sobre endocarditis infecciosa en válvula protésica / UP-Date in prosthetic valve endocarditis

    Scientific Electronic Library Online (English)

    Nathalia, Badilla A; Ricardo, Zalaquett S.

    2009-12-01

    Full Text Available Prosthetic valve endocarditis is still a matter of controversy especially the type of treatment that should be chosen for an individual patient. Since the current knowledge of this patology is based mainly on the literature and in its many and varied exponents (clinical experience, sistematic review [...] , practice guideslines of cardiology associations, observational studies, etc), it is necessary to update the information continuously This review is focused mainly in the incidence, etiology diagnostics and treatment of prosthetic endocarditis. The principal microroganisms related to this patology are Staphylococcus aureus and coagulase-negative Staphyloccoco. Risk factors were identified for witch surgery is mandatory, such us Staphylococcus aureus infection and a complicated prosthetic valve endocarditis (cardiac failure, conduction abnormalities, abscess formation and recurrent embolism). With this information, patients that could have a medical treatment option can be recognized, as well as those who will require surgery. In order to present in a better way our conclusions, easily reading diagrams were included to facilitate the decisión process when facing up a prosthetic valve endocarditis. Abstract in english La endocarditis en válvulas protésicas es aún tema de controversia, en especial en referencia al tipo de tratamiento que se debe elegir. Debido a que los conocimientos actuales sobre esta patología están basados principalmente en la literatura y por ende, en sus variados exponentes (experiencias clí [...] nicas, revisiones sistemáticas, guía clínicas de diferentes sociedades de cardiología, estudios observacionales, entre otros), es necesario hacer una actualización continua de la información. Esta revisión bibliográfica se centra en la incidencia, etiología, diagnóstico y tratamiento de la endocarditis protésica. En ella se llega la conclusión de que los principales microorganismos productores de esta patología son el Estafilococo aureus y el Estafilococo coagulasa-negativo. También se reconocen aquellos factores de riesgo para los cuales la cirugía es mandatoria, entre los que destacan las infecciones por S. aureus y la endocarditis protésica complicada, ya sea por insuficiencia cardíaca, alteración de la conducción, formación de abscesos y/o embolias recurrentes. De esta manera, con la información recopilada, se identificaron aquellos pacientes con opción a tratamiento médico, y aquellos con indicación de manejo quirúrgico. Para presentar mejor nuestras conclusiones, se construyeron esquemas de fácil consulta y lectura, para apoyar la decisión del tipo de manejo frente a una endocarditis en válvulas protésicas.

  12. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas; Frimodt-Møller, Niels; Bruun, Niels Eske

    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...

  13. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Arpi, Magnus

    2011-01-01

    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 for the correct diagnosis and treatment.

  14. First case of infectious endocarditis caused by Parvimonas micra.

    Science.gov (United States)

    Gomez, Carlos A; Gerber, Daniel A; Zambrano, Eduardo; Banaei, Niaz; Deresinski, Stan; Blackburn, Brian G

    2015-12-01

    P. micra is an anaerobic Gram-positive cocci, and a known commensal organism of the human oral cavity and gastrointestinal tract. Although it has been classically described in association with endodontic disease and peritonsillar infection, recent reports have highlighted the role of P. micra as the primary pathogen in the setting of invasive infections. In its most recent taxonomic classification, P. micra has never been reported causing infectious endocarditis in humans. Here, we describe a 71 year-old man who developed severe native valve endocarditis complicated by aortic valvular destruction and perivalvular abscess, requiring emergent surgical intervention. Molecular sequencing enabled identification of P. micra. PMID:26485192

  15. An Isolated Congenital Left Ventricular Diverticulum with Mitral Valve Endocarditis.

    Science.gov (United States)

    Jiang, Bo; Yang, Yi-Feng; Wang, Xi; Xiong, Lian; Huang, Can; Gong, Liang-Hui

    2016-03-01

    Congenital left ventricular diverticulum is a rare cardiac malformation, which could result in rupture, thrombosis, congestive heart failure, infective endocarditis, ventricular arrhythmia and aortic insufficiency. Most authors propose that patients who are symptomatic and have a higher risk for major complications should undergo surgical treatment. We present a case of isolated congenital left ventricular diverticulum with mitral valve infective endocarditis and anomalous single coronary artery observed intra-operatively. The patient underwent successful surgical repair of the diverticulum by continuous suture of the internal opening inside the left ventricle. PMID:26572256

  16. Pacing lead endocarditis due to Aspergillus fumigatus

    Directory of Open Access Journals (Sweden)

    Kothari A

    2010-01-01

    Full Text Available Invasive aspergillosis is an opportunistic infection with a high mortality rate that usually occurs in the immunocompromised host. Several cases of fungal infections have been reported after cardiac surgery. We present here a case of Aspergillus fumigatus tricuspid valve endocarditis associated with permanent pacemaker leads. Tricuspid valve vegetectomy was done and the pacing leads were also removed. Culture from the excised vegetation grew Aspergillus fumigatus. The patient was started on IV Amphotericin B for eight weeks. The patient was subsequently followed up in the out-patient clinic, and remains afebrile after one year, with no evidence of any vegetation.

  17. Evaluación de 61 episodios de endocarditis infecciosa en pacientes adictos a drogas intravenosas e infección por el virus de la inmunodeficiencia humana tipo-1 Evaluation of 61 episodes of infective endocarditis in intravenous drug abusers and human immunodeficiency tipe-1 virus infection

    Directory of Open Access Journals (Sweden)

    M.E. Corti

    2004-06-01

    Full Text Available Se evaluaron las características clínicas y de laboratorio de 61 episodios de endocarditis infecciosa (EI en adictos a drogas intravenosas (ADIV infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1. Cuarenta y nueve hombres y 6 mujeres con edades comprendidas entre 15 y 55 años. La totalidad de los pacientes estudiados presentó 61 episodios de EI, los que tuvieron fiebre y soplo cardíaco. Cuarenta y tres (70,4% presentaron hepatomegalia y 29 (47,5% esplenomegalia. Treinta y ocho (62,3% tuvieron tos, que en 9 (14,7% resultó hemoptoica. En 25 casos (41% se observó disnea y en 5 (8,2% ingurgitación yugular. El fondo de ojo mostró alteraciones en 3 pacientes (4,9%. La confirmación bacteriológica se obtuvo en 41 episodios (67,2%. Se identificaron por hemocultivos: Staphylococcus aureus en 30 casos (73,1%, Streptococcus viridans en 8 (19,5%, Staphylococcus epidermidis en 1 (2,4%, Staphylococcus hominis en 1 (2,4% y Streptococcuspneumoniae en 1 (2,4%. Se comprobó compromiso de la válvula tricúspide en 51 episodios (83,6%, aórtica en 6 (9,8%, mitral en 3 (4,9% y pulmonar en 1 (1,6%. En 3 pacientes la afectación fue bivalvular: en 2 (3,2% de la tricúspide y pulmonar y en 1 (1,6% de la tricúspide y mitral. En 19 episodios (31,1% se detectó derrame pericárdico. En la etapa aguda de la enfermedad fallecieron 6 (10,9% pacientes.We conducted a retrospective evaluation to determine the clinical and microbiological characteristics of 61 episodes of infective endocarditis (IE in intravenous drug abusers (IDA, HIV seropositive patients. Forty-nine males and 6 females between 15 and 42 years of age were included in the study. All the included patients presented 61 episodes of IE. Fever and cardiac murmur were present in all episodes; 43 (70,4% had hepatomegaly; 29 (47,5% had splenomegaly. Thirty-eight (62,3% presented cough (9 with hemoptysis; 25 (41% had dyspnea, and 5 (8,2% had jugular ingurgitation. Fundoscopy showed alterations in 3 patients (4,9%. Bacteriological confirmation was obtained in 41 episodes (67,2%; blood cultures revealed Staphylococcus aureus in 30 cases (73,1%, Streptococcus viridans in 8 (19,5% patients, Staphylococcus epidermidis in 1 (2,4%, Staphylococcus hominis in 1 (2,4% and Streptococcuspneumoniae in one case (2,4%. The tricuspid valve was involved in 51 episodes (83,6%, the aorta in 6 (9,8%, the mitral valve in 3 (4,9% and the pulmonary valve in one (1,6%. There was evidence of right bivalvular involvement in 2 patients (3,2% and tricuspid and mitral involvement in another (1,6%. Pericardial effusion was detected in 19 episodes (31,1%. Six patients (10,9% died during the acute episode of IE.

  18. A rare case of fungal endocarditis caused by Candida glabrata after completion of antibiotic therapy for Streptococcus endocarditis.

    Science.gov (United States)

    Tsugu, Toshimitsu; Murata, Mitsushige; Iwanaga, Shiro; Kitamura, Yohei; Inoue, Soushin; Fukuda, Keiichi

    2015-04-01

    We present the rare case of a 76-year-old female with infective endocarditis (IE) caused by Candida glabrata. Immediately before developing the present infection, she developed IE with vegetation on the mitral annular calcification, which was caused by Streptococcus mitis and successfully treated with penicillin-G and gentamicin. However, her fever recurred, and she developed disseminated intravascular coagulation. Blood culture revealed C. glabrata, and echocardiography revealed new vegetation on the mitral valve. After 4 weeks of treatment with micafungin, prosthetic valve replacement was performed, followed by additional administration of micafungin for 4 weeks (total of 8 weeks). No relapse at 9 months after surgery has been observed. C. glabrata endocarditis is extremely rare and difficult to manage. Our case and review of past reported cases suggest that early diagnosis and initiation of treatment contribute to good prognosis of C. glabrata endocarditis. PMID:26576579

  19. Endocarditis de Libman-Sacks

    Directory of Open Access Journals (Sweden)

    Carolina Saldarriaga

    2015-05-01

    Full Text Available La endocarditis de Libman-Sacks es una manifestación cardiaca bien reconocida del lupus eritematoso sistémico en la que se observan vegetaciones valvulares estériles, con predominio en el lado izquierdo del corazón, especialmente en la válvula mitral. La mayoría de los pacientes son asintomáticos; sin embargo, en la presentación clínica la forma aguda puede imitar a la de una endocarditis infecciosa (endocarditis pseudoinfecciosa y complicar tanto el diagnóstico diferencial como el tratamiento. Se reporta el caso de un paciente de género masculino, de 63 años, quien manifestó signos y síntomas compatibles con endocarditis infecciosa, y cuyos diferentes estudios demostraron una endocarditis de Libman-Sacks que respondió de forma favorable al tratamiento inmunosupresor.

  20. Neisseria elongata endocarditis of a native aortic valve.

    Science.gov (United States)

    Samannodi, Mohammed; Vakkalanka, Sujit; Zhao, Andrew; Hocko, Michael

    2016-01-01

    Neisseria elongata is a part of the common bacterial flora of the oropharynx but has caused sepsis, osteomyelitis and infective endocarditis on rare occasions. We report the case of a 56-year-old Caucasian woman who was admitted to hospital with a 5-week history of fever, malaise and fatigue. Two blood cultures grew Gram-negative rods which were confirmed to be N. elongata subspecies nitroreducens via bacterial DNA sequence analysis. An echocardiogram showed a large mobile vegetation on the right and non-coronary cusps of the aortic valve. The patient underwent aortic valve replacement and antibiotic therapy for 6?weeks. We suggest that clinicians should consider extended antibiotic treatment and early surgical evaluation based on the nature and aggressiveness of N. elongata. PMID:26917793

  1. A case of native valve endocarditis caused by Burkholderia cepacia without predisposing factors

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    Han Seong

    2011-05-01

    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.

  2. Stenotrophomonas maltophilia prosthetic valve endocarditis: a case report

    OpenAIRE

    Bayle Sophie; Rovery Clarisse; Sbragia Pascal; Raoult Didier; Brouqui Philippe

    2008-01-01

    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 endocar...

  3. Use of autologous pericardium for mitral leaflet reconstruction in a child with endocarditis

    Directory of Open Access Journals (Sweden)

    Olcay Murat Disli

    2013-06-01

    Full Text Available We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period was uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.

  4. Early detection of infantile endocarditis by gallium-67 scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Hardoff, R.; Luder, A.S.; Lorber, A.; Dembo, L.

    1989-04-01

    An infant with suspected soft tissue infection of the knee was studied by /sup 67/Ga-scintigraphy. In addition to knee and hip joint increased activity, heart uptake was also demonstrated prior to the development of clinical signs of endocarditis. The early detection and treatment resulted in satisfactory clinical resolution.

  5. Endocarditis infecciosa en la Unidad de Medicina Intensiva Infectious endocarditis in the intensive care unit

    Directory of Open Access Journals (Sweden)

    S. Miranda-Montero

    2012-10-01

    Full Text Available Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Universitario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37% ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002 y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041. La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011, así como la proporción de cirugías urgentes (45,8 vs 5,9%, pObjective: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. Design: A prospective, observational cohort study of patients admitted due to infectious endocarditis. Setting: Nuestra Señora de Candelaria University Hospital, a third - level center with a recruitment population of 493,145. Patients: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. Study variables: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. Results: Out of 102 patients diagnosed with endocarditis, 38 (37% were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002 and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041. In turn, mortality was greater (42.1% vs 18.8%, p= 0.011, as was the proportion of emergency surgeries (45.8% vs 5.9%, p<0.001. The identified mortality predictors were Staphylococcus aureus infection (OR= 3.49; 95%CI 1.02-11.93; p=0.046, heart failure (OR=4.18; 95%CI: 1.17-14.94; p=0.028, cerebral embolism (OR= 8.45; 95%CI: 1.89-37.74; p=0.005 and the SAPS II upon admission (OR=1.09; 95%CI: 1.04-1.15; p<0.001. Conclusions: A large proportion of patients with endocarditis require admission to the Intensive Care Unit, presenting a much poorer prognosis. Staphylococcus aureus infection, heart failure, cerebral embolism and SAPS II scores are independent predictors of hospital mortality.

  6. BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Ebrahim Nematipour

    1995-06-01

    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.

  7. Endocarditis por Streptococcus pneumoniae en niños: Presentación de un caso clínico y revisión de la literatura Endocarditis caused by Streptococcus pneumoniae in children: Case report and review

    Directory of Open Access Journals (Sweden)

    M. Alejandra Prado S

    2005-12-01

    Full Text Available La endocarditis causada por Streptococcus pneumoniae es una patología muy poco frecuente en niños, correspondiendo sólo a 3 - 7% de los casos. Sin embargo, su importancia radica en que se puede presentar de forma muy agresiva, con complicaciones como destrucción valvular y abscesos, y con una mortalidad reportada hasta 61%, de no mediar tratamiento antimicrobiano precoz y muchas veces cardiocirugía. En más del 50% se puede asociar a otros focos infecciosos, como meningitis, neumonía, sinusitis o mastoiditis. Se describe el caso de una lactante de 10 meses que presentó una meningitis asociada a endocarditis debidas a S. pneumoniae, con grave compromiso cardíaco, y que requirió reemplazo valvular. Se realizó una revisión de la literatura médica acerca de endocarditis por S. pneumoniae en niñosEndocarditis caused by Streptococcus pneumoniae in children is an infrequent disease, corresponding to 3-7% of all cases of endocarditis. However, it is highly relevant because of its severity with the possibility of producing valvular ring abscesses and destruction, and high mortality that reaches up to 61% if medical and surgical treatment are not started early in the course of the illness. Over 50% of cases are associated to other sites of infection such as meningitis, pneumonia, sinusitis or mastoiditis. We report a 10-months-old infant who was admitted with meningitis and endocarditis due to S. pneumoniae, who presented with severe heart failure and required aortic valve replacement. A review of the literature of endocarditis caused by S. pneumoniae in pediatrics is presented

  8. Infectious endocarditis due to Streptococcus pneumoniae in a cardiac surgery patient: a new form of clinical presentation.

    Science.gov (United States)

    Lacalzada, Juan; Padilla, Marta; de la Rosa, Alejandro; Laynez, Ignacio

    2016-02-01

    High mortality associated with pneumococcal endocarditis is due to late diagnosis and the frequency of complications, which usually require early diagnostic and intensive therapeutic measures. We present the first reported case of pneumococcal endocarditis with simultaneous infection of an aortic prosthetic valve, native tricuspid valve, and permanent pacemaker lead. PMID:26862407

  9. [Endocarditis due to an alga of the genus Prototheca sp. A saprophyte of water and of tree sap?].

    Science.gov (United States)

    Buendía, A; Patiño, E; Rijlaarsdam, M; Loredo, M L; Rivera, E; Ramírez, S; Attie, F

    1998-01-01

    We report a case of a preterm neonate with very low birth weight (775 grs), He stayed 77 days in a neonatal care unit due to respiratory distress syndrome, with respiratory support for 27 days, and complications in gastrointestinal and nervous systems. In a structural normal heart, he developed infective endocarditis that was treated with good bacteriologic results. An echocardiogram showed the persistence of a mass in the right atrium, the mass was a thrombus and it was resected. Histopathological analysis and cultures of the thrombus reported Prototheca sp. that is an algae. The patient received medical treatment with amphothericin B with satisfactory clinical evolution. He is doing well 6 months later. This is the first report of literature of an algae causing endocarditis. PMID:9810371

  10. Endocarditis by Kocuria rosea in an immunocompetent child

    Scientific Electronic Library Online (English)

    Jorge Salomão, Moreira; Adriana Gut Lopes, Riccetto; Marcos Tadeu Nolasco da, Silva; Maria Marluce dos Santos, Vilela.

    2015-02-01

    Full Text Available Kocuria rosea belongs to genus Kocuria (Micrococcaceae family, suborder Micrococcineae, order Actinomycetales) that includes about 11 species of bacteria. Usually, Kocuria sp are commensal organisms that colonize oropharynx, skin and mucous membrane; Kocuria sp infections have been described in the [...] last decade commonly affecting immunocompromised patients, using intravenous catheter or peritoneal dialysis. These patients had mainly bacteremia/recurrent sepsis. We hereby describe the case of a 10-year-old girl, immunocompetent, who had endocarditis/sepsis by K. rosea which was identi?ed in ?ve different blood cultures by Vitek2 ID-GPC card (BioMérieux, France). Negative HIV serology, blood count within normal range of leukocytes/neutrophils and lymphocytes, normal fractions of the complement, normal level of immunoglobulins for the age; lymphocyte immunophenotyping was also within the expected values. Thymus image was normal at chest MRI. No catheters were required. Identi?cation of K. rosea was essential to this case, allowing the differentiation of coagulase-negative staphylococci and use of an effective antibiotic treatment. Careful labo- ratory analysis of Gram-positive blood-born infections may reveal more cases of Kocuria sp infections in immunocompetent patients, which may collaborate for a better understanding, prevention and early treatment of these infections in pediatrics.

  11. Implantable cardioverter defibrillator lead-related methicillin resistant Staphylococcus aureus endocarditis: Importance of heightened awareness

    Directory of Open Access Journals (Sweden)

    Obiora F Anusionwu

    2012-01-01

    Full Text Available Methicillin resistant Staphylococcus aureus (MRSA septicemia is associated with high morbidity and mortality especially in patients with immunosuppression, diabetes, renal disease and endocarditis. There has been an increase in implantation of cardiac implantable electronic devices (CIED with more cases of device-lead associated endocarditis been seen. A high index of suspicion is required to ensure patient outcomes are optimized. The excimer laser has been very efficient in helping to ensure successful lead extractions in patients with CIED infections. We present an unusual case report and literature review of MRSA septicemia from device-lead endocarditis and the importance of early recognition and prompt treatment.

  12. Rothia aeria endocarditis in a patient with a bicuspid aortic valve: case report

    Scientific Electronic Library Online (English)

    Antonio Carlos, Nicodemo; Luiz Guilherme, Gonçalves; Fatuma Catherine Atieno, Odongo; Marines Dalla Valle, Martino; Jorge Luiz Mello, Sampaio.

    2014-09-01

    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 a [...] ddition 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.

  13. Native valve endocarditis and femoral embolism due to Granulicatella adiacens: a rare case report

    Scientific Electronic Library Online (English)

    KE, Vandana; C, Mukhopadhyay; NR, Rau; V, Ajith; P, Rajath.

    2010-12-01

    Full Text Available The fastidious Gram-positive cocci Granulicatella adiacens, previously known as nutritionally variant streptococci (NVS) are unusual but significant cause of endocarditis due to increased mortality and morbidity. Difficulties in reaching correct bacteriological identification, increased resistance t [...] o beta-lactam antibiotics and macrolides and complicated clinical course have contributed to problems in management of cases of infective endocarditis caused by this bacterium. We present the first Indian case of endocarditis with arterial embolus by G. adiacens in an elderly male with no preexisting cardiac abnormality

  14. Native valve endocarditis and femoral embolism due to Granulicatella adiacens: a rare case report.

    Science.gov (United States)

    Vandana, K E; Mukhopadhyay, C; Rau, N R; Ajith, V; Rajath, P

    2010-01-01

    The fastidious Gram-positive cocci Granulicatella adiacens, previously known as nutritionally variant streptococci (NVS) are unusual but significant cause of endocarditis due to increased mortality and morbidity. Difficulties in reaching correct bacteriological identification, increased resistance to beta-lactam antibiotics and macrolides and complicated clinical course have contributed to problems in management of cases of infective endocarditis caused by this bacterium. We present the first Indian case of endocarditis with arterial embolus by G. adiacens in an elderly male with no preexisting cardiac abnormality. PMID:21340307

  15. Rothia aeria endocarditis in a patient with a bicuspid aortic valve: case report

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nicodemo

    2014-10-01

    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.

  16. Native Valve Streptococcus bovis Endocarditis and Refractory Transfusion Dependent Iron Deficiency Anaemia Associated with Concomitant Carcinoma of the Colon: A Case Report and Review of the Literature

    Science.gov (United States)

    Ahamed Riyaaz, Abdul Azeez; Samarasinghe, Randula; Sellahewa, Kolitha; Sivakumaran, Sabaratnam; Tampoe, Manjula Sri

    2016-01-01

    Streptococcus bovis is found as a commensal organism in human gut and may become opportunistically pathogenic. Infective endocarditis is one of the commonest modes of presentation of this infection. The association between Streptococcus bovis endocarditis and colorectal cancer is well recognized. We report a case of Streptococcus bovis endocarditis along with a refractory iron deficiency anaemia associated with concomitant carcinoma of ascending colon in a 63-year-old male. Cooccurrence of these two conditions may cause a challenge in the management. Considering the strong association of colon cancer with Streptococcus bovis endocarditis, a detailed screening colonoscopy is mandatory following the diagnosis of the latter.

  17. Tricuspid Valve Endocarditis With Group B Streptococcus After an Elective Abortion: The Need for New Data

    Directory of Open Access Journals (Sweden)

    W. David Hardy

    2006-11-01

    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.

  18. Tricuspid Valve Endocarditis With Group B Streptococcus After an Elective Abortion: The Need for New Data

    OpenAIRE

    W. David Hardy; Gaut, Paula L.; John Li; Palys, Erica E.

    2006-01-01

    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. Howev...

  19. Isolation of Bartonella washoensis from a Dog with Mitral Valve Endocarditis

    OpenAIRE

    Chomel, Bruno B.; Wey, Aaron C.; Kasten, Rickie W

    2003-01-01

    We report the first documented case of Bartonella washoensis bacteremia in a dog with mitral valve endocarditis. B. washoensis was isolated in 1995 from a human patient with cardiac disease. The main reservoir species appears to be ground squirrels (Spermophilus beecheyi) in the western United States. Based on echocardiographic findings, a diagnosis of infective vegetative valvular mitral endocarditis was made in a spayed 12-year-old female Doberman pinscher. A year prior to presentation, the...

  20. Blood in, blood out: left ventricular pseudoaneurysm following mitral valve endocarditis

    OpenAIRE

    Sartipy, Ulrik; Ivert, Torbjörn; Ugander, Martin

    2013-01-01

    A 76-year old male on warfarin due to atrial fibrillation was admitted with Staphylococcus aureus septicaemia. Echocardiography demonstrated mitral valve endocarditis, and shortly thereafter, he suffered an intracranial haemorrhage as a result of septic embolism. Four weeks later, cardiac magnetic resonance imaging revealed a newly formed pseudoaneurysm. A left ventricular pseudoaneurysm caused by infective endocarditis is very rare, but awareness of this unusual complication may allow surger...

  1. Staphylococcus saprophyticus native valve endocarditis in a diabetic patient with neurogenic bladder: A case report.

    Science.gov (United States)

    Magarifuchi, Hiroki; Kusaba, Koji; Yamakuchi, Hiroki; Hamada, Yohei; Urakami, Toshiharu; Aoki, Yosuke

    2015-09-01

    A 61-year-old man was admitted to our hospital with 2-day history of malaise and dyspnea. He had mitral prolapse and type II diabetes mellitus with neurogenic bladder, which was cared for by catheterization on his own. On arrival the patient was in septic condition with hypoxemia, and physical examination revealed systolic murmur at the apex. Transthoracic echocardiography revealed vegetation of the mitral and the aortic valve. The presence of continuous bacteremia was confirmed by multiple sets of blood culture, whereby gram-positive cocci was retrieved and identified as Staphylococcus saprophyticus (S. saprophyticus) both phenotypically and genetically. Because two major criteria of the Modified Duke Criteria were met, the patient was diagnosed with native valve endocarditis due to S. saprophyticus. The urine culture was also positive for gram-positive cocci, phenotypically identified as Staphylococcus warneri, which was subsequently identified as S. saprophyticus with the use of 16S rRNA gene sequence analysis and MALDI-TOF MS (matrix-assisted laser desorption ionization time of flight mass spectrometry), indicating strongly that the intermittent catheterization-associated urinary tract infection resulted in bacteremia that eventually lead to infective endocarditis. This patient was treated with vancomycin and clindamycin. Because of multiple cerebral infarctions, the patient underwent mitral and aortic valve replacement on hospital day 5. Blood culture turned negative at 6th hospital day. Antibiotic therapy was continued for six weeks after surgery. The patient's clinical course was uneventful thereafter, and was discharged home. This is the first case report of native valve endocarditis caused by S. saprophyticus of confirmed urinary origin. PMID:26184852

  2. Cardiac imaging in infectious endocarditis

    DEFF Research Database (Denmark)

    Bruun, Niels Eske; Habib, Gilbert; Thuny, Franck; Sogaard, Peter

    2014-01-01

    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....... The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts...... computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in...

  3. Endocarditis por Streptococcus pneumoniae resistente a penicilina en niños: Report of a case due to penicillin resistant Streptococcus pneumoniae Pneumococcal endocarditis in children

    Directory of Open Access Journals (Sweden)

    M. Soledad Wenzel A

    2006-09-01

    Full Text Available Streptococcus pneumoniae es el principal agente de infección bacteriana invasora en niños; sin embargo, es extremadamente infrecuente como causa de endocarditis. Esta entidad clínica se manifiesta generalmente como una enfermedad aguda y grave con alta mortalidad, que requiere tratamiento médico-quirúrgico precoz, afectando con mayor frecuencia la válvula mitral. Presentamos el caso de una niña de 6 años 4 meses, de extrema ruralidad, que presentó endocarditis infecciosa (EI de válvula mitral asociada a meningitis, aislándose en hemocultivos S. pneumoniae resistente a penicilina y se discute las estrategias terapéuticasDespite S. pneumoniae is one of main etiologies of invasive bacterial infection in children, it rarely causes infectious endocarditis in children. Pneumococcal endocarditis is a serious condition that affects mainly the mitral valve, with a rapidly destructive nature and a high fatality rate, demanding prompt medical and surgical treatment. We report a case of pneumococcal endocarditis in a school girl coming from extreme rurality who presented both meningitis and endocarditis, and whose blood cultures isolated penicillin resistant S. pneumoniae

  4. GLOMERULONEFRITIS POR INMUNOCOMPLEJOS EN LA ENDOCARDITIS INFECCIOSA

    Scientific Electronic Library Online (English)

    Rommer Alex, Ortega Martínez; Paola Cecilia, Rodríguez Gil; Ricardo, Silvestre Arze; Luis, Mercado Maldonado; Juan Pablo, Barrenechea.

    Full Text Available Los pacientes con endocarditis infecciosa pueden desarrollar tres diferentes formas de enfermedad renal: Glomerulonefritis postinfecciosa mediada por complejos inmunes, nefritis intersticial aguda inducida por drogas o necrosis tubular aguda por aminoglucósidos y la enfermedad embólica renal. La glo [...] merulonefritis mediada por inmunocomplejos es similar a la glomerulonefritis post Estreptocócica o la glomerulonefritis membranoproliferativa con antigenemia larga y persistente. Las manifestaciones clínicas son similares a las de aquellos pacientes con otras formas de glomerulonefritis aguda. Presentamos el caso de una paciente que cumplió los requisitos para entrar dentro el grupo de glomerulonefritis por complejos inmunes, destacando el hecho de presentar alteraciones en la función renal y sedimento urinario disipadas con la resolución de la patología de base. Abstract in english Patients with infective endocarditis can develop three different forms of renal disease: post infectious immune complex mediated glomerulonephritis, drug induced acute intersticial nephritis or acute tubular necrosis due to aminoglucoside toxicity and renal embolic disease. Inmune complex glomerulon [...] ephritis is similar to post estreptococal glomerulonephritis or membrano proliferative glomerulonephritis with long standing and persistent antigenemia. The clinical manifestations are similar to those of other forms of glomerulonephritis. We present the case of a patient who fulfilled most criteria of immune complex mediated glomerulonephritis. emphasizing the fact that the alterations in renal function and urinary sediment resolved with the resolution of the primary disease.

  5. A RARE CASE: SLE WITH LIBMAN - SACKS ENDOCARDITIS

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    Chakrandhar Rao

    2015-01-01

    Full Text Available Libman - Sacks endocarditis is the characteristic cardiac manifestation of autoimmune disease Systemic Lupus Erythematosus. The condition most commonly involves the mitral and aortic valves, but all the four cardiac valves and the endocardial surfa ces can be involved 1 . Persons with Libman - Sacks endocarditis are usually asymptomatic., but become symptomatic due to cardiac failure, cerebrovascular embolism, systemic thromboembolism and secondary infective endocarditis. 2D Echocardiography should be pe rformed when it is suspected. With introduction of steroid therapy for SLE, improved longevity of patients appears to have changed the spectrum of valvular disease. Herewith, we are reporting a 35 year old female who presented at Department of General Medi cine, GGH, Guntur with seven day history of anasarca, shortness of breath, cough and fever of long duration. ECHO was suggestive of Libman - Sachs endocarditis and further investigations revealed SLE. On addition of steroids, there was good response and the patient was improving, but she had sudden cardio - respiratory arrest 5 days later.

  6. Aortic Root Pseudoaneurysm Following Surgery for Aortic Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    Kuei-Ton Tsai

    2002-02-01

    Full Text Available Prosthetic aortic valve replacement for aortic valve endocarditis remains a primarypractice of most cardiac surgeons. Usually it cures endocarditis and restores cardiac function.However, in advanced aortic valve endocarditis with complex annular destruction,complications following prosthetic aortic valve replacement do occur and present a formidablechallenge for reoperation.Herein, we describe a case of an adult man who was operated on initially for advancedaortic valve endocarditis with a large periannular abscess cavity and who developed congestiveheart failure 3 months later. Furthermore, he was diagnosed with a giant pseudoaneurysmaround the aortic root without evidence of recurrent infection or aortic prostheticincompetence. During his reoperation, a cryopreserved aortic homograft as a root replacementthat included reimplantation of bilateral coronary artery buttons was used to exteriorizethis pseudoaneurysm and reconstruct a left ventricular outflow tract. The postoperativecourse was unremarkable, and the patient, during a follow-up of 2 years, remained in NewYork Heart Association functional class I.Aortic root pseudoaneurysm following prosthetic aortic valve replacement for infectiveendocarditis is rare in clinical practice and can cause rapid hemodynamic deteriorationwhich requires imminent reoperation. Homograft aortic root replacement has proven to be aversatile treatment option of this complex disease.

  7. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Sirio Hassem Sobrinho

    2010-04-01

    Full Text Available A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.La endocarditis bacteriana es una severa enfermedad infecciosa cuyo tratamiento se hace tradicionalmente con el paciente internado, recibiendo medicación intravenosa. La posibilidad de tratamiento domiciliar o clínico, en casos estrictamente seleccionados, es atractivo desde el punto de vista social como del económico. Presentamos el caso clínico de 6 pacientes con diagnóstico de endocarditis bacteriana por streptococcus, tratados parcial o integralmente en régimen ambulatorio. Todos evolucionaron sin complicaciones y con resolución completa del cuadro infeccioso.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

  8. Dexamethasone as Adjuvant Therapy to Moxifloxacin Attenuates Valve Destruction in Experimental Aortic Valve Endocarditis Due to Staphylococcus aureus?

    OpenAIRE

    Skiadas, Ioannis; Pefanis, Angelos; Papalois, Apostolos; Kyroudi, Aspasia; Triantafyllidi, Helen; Tsaganos, Thomas; Giamarellou, Helen

    2007-01-01

    Although the beneficial effects of dexamethasone have frequently been investigated in various serious-infection settings, insufficient data on valve histology and cardiac function for infective endocarditis are available. The efficacy of moxifloxacin for the treatment of experimental aortic valve endocarditis due to methicillin-susceptible Staphylococcus aureus and the long-term effects of dexamethasone were evaluated in the current study. Sixty-eight rabbits were randomly assigned to four gr...

  9. Endocarditis infecciosa: Análisis de 5 años (1997-2001 en el Hospital "Hermanos Ameijeiras"

    Directory of Open Access Journals (Sweden)

    José Eugenio Negrín Expósito

    2003-10-01

    Full Text Available Se revisaron 50 historias clínicas de pacientes con endocarditis infecciosa atendidos entre los años 1997 y 2001 para conocer sus características clínicas en un centro terciario y analizar los factores que influyen en la mortalidad. Se recogieron datos generales, válvula afectada, cardiopatía de base, gérmenes causales, complicaciones, antibióticos empleados, hallazgos ecocardiográficos y evolución final, cada variable se relacionó con la mortalidad. Se halló que la edad promedio fue de 51,5 años, predominó la valvulopatía degenerativa (24 %; el germen más aislado fue el Estafilococo coagulasa negativa (22 % y se hallaron vegetaciones en el 52 %. Las variables que se relacionaron con la mortalidad fueron: toma del sistema nervioso central (p = 0,01, infarto pulmonar (p = 0,001, endocarditis de válvula nativa aguda (p = 0,001 y endocarditis de válvula protésica precoz (p = 0,003. Se concluyó que la endocarditis infecciosa es una enfermedad fatal si no se sigue una atención agresiva de los casos agudos o precoces.50 medical histories from patients with infective endocarditis that recieved medical attention between 1997 and 2001 were reviewed to know their clinical characteristics in an institute and to analyze those factors influencing mortality. General data, affected valve, base heart disease, causal germs, complications, antibiotics used, echocardiographic findings and final evolution were collected. Each variable was related to mortality. It was found that the average age was 51.5 years old. There was a predominance of the degenerative valvulopathy (24 %. The negative Staphilococcus coagulase was the most isolated germ (22 % and vegetations were observed in 52 %. The variables connected with mortality were: taking of the central nervous system (p=0.01, lung infarction (p=0.001, endocarditis of acute native valve (p=0.001 and endocarditis of early prosthetic valve (p=0.003. It was concluded that infective endocarditis may be a fatal disease if the acute or early cases do not receive an aggressive attention .

  10. Enterococcus faecium small colony variant endocarditis in an immunocompetent patient

    Directory of Open Access Journals (Sweden)

    S. Hernández Egido

    2016-01-01

    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.

  11. Cardiac imaging in infectious endocarditis

    DEFF Research Database (Denmark)

    Bruun, Niels Eske; Habib, Gilbert

    2014-01-01

    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. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts 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 computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.

  12. Pacemaker endocarditis caused by Propionibacterium acnes in an adult patient with Ebstein's anomaly: a report of a rare case.

    Science.gov (United States)

    Santo, Karla R E; Franceschi, Vinicius; Campos, André C B; Monteiro, Thaíssa S; Barbosa, Giovanna I F; Dantas, Angela; Lamas, Cristiane C

    2014-10-01

    We report a rare case of a Brazilian adult woman with Ebstein's Anomaly who presented with pacemaker endocarditis caused by Propionibacterium acnes. Ebstein's Anomaly is a rare congenital malformation of the heart. Infective endocarditis is defined as an infection of heart valves, of the mural endocardium, of a septal defect, or of a cardiac electronic implantable device. Propionibacterium acnes is a skin commensal bacterium, that is usually considered as a contaminant, but can, on rare occasions, cause serious infections including endocarditis of prosthetic valves, native valves and cardiac electronic implantable devices. Diagnosis was made after nearly two years of investigation by identification of the organism by the MALDI-TOF technique and transoesophageal echocardiogram. The patient was successfully treated with daptomycin and device removal. She remains free of endocarditis after 32 months of follow-up. PMID:25047281

  13. Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011 / Endocardite Infecciosa Associada aos Cuidados de Saúde: Série de Casos em Hospital de Referência entre 2006 e 2011

    Scientific Electronic Library Online (English)

    Oslan, Francischetto; Luciana Almenara Pereira da, Silva; Katia Marie Simões e, Senna; Marcia Regina, Vasques; Giovanna Ferraiuoli, Barbosa; Clara, Weksler; Rosana Grandelle, Ramos; Wilma Felix, Golebiovski; Cristiane da Cruz, Lamas.

    2014-10-01

    Full Text Available Fundamento: A endocardite infecciosa associada aos cuidados de saúde (EI-ACS) é uma complicação grave associada aos cuidados médico-hospitalares, com uma incidência crescente na população. Objetivo: Avaliar a EI-ACS com relação à sua epidemiologia, etiologia, fatores de risco de aquisição, compli [...] cações, tratamento cirúrgico e quadro clínico. Métodos: Este estudo de caráter observacional e prospectivo avaliou uma série de casos reportados entre 2006 e 2011 em um hospital público no Rio de Janeiro. Resultados: Cinquenta e três pacientes com EI-ACS de um total de 151 casos de endocardite infecciosa (EI) foram incluídos no estudo, dos quais 26 (49%) eram do sexo masculino (idade média de 47 ± 18,7 anos), e 27 (51%) eram sexo feminino (idade média de 42 ± 20,1 anos). Quadros clínicos agudos de EI ocorreram em 37 casos (70%) e quadros subagudos em 16 casos (30%). A válvula mitral foi afetada em 19 casos (36%), e a valva aórtica em 12 casos (36%). As válvulas cardíacas protéticas foram afetadas em 23 casos (43%), e as válvulas cardíacas nativas em 30 casos (57%). O acesso venoso profundo foi usado em 43 pacientes (81%). Hemoculturas negativas foram observadas em amostras de 11 pacientes (21%). Nas hemoculturas positivas, Enterococcus faecalis foi identificado em 10 casos (19%), Staphylococcus aureus em 9 casos (17%) e Candida sp. em 7 casos (13%). Febre ocorreu em 49 pacientes (92%), esplenomegalia em 12 pacientes (23%), novo sopro de regurgitação valvar em 31 pacientes (58%) e proteína C reativa elevada em 44 pacientes (83%). O ecocardiograma apresentou critérios principais em 46 casos (87%). Trinta e quatro pacientes (64%) foram submetidos à cirurgia cardíaca. A mortalidade ocorreu em 17 casos (32%). Conclusão: EI-ACS afeta pacientes mais jovens no Brasil. As válvulas cardíacas protéticas e nativas foram afetadas em proporção semelhante. A cirurgia não cardíaca foi um fator predisponente pouco frequente, ao passo que o acesso intravenoso foi um fator predisponente comum. Infecções por S. aureus foram significativamente mais frequentes em casos de EI-ACS envolvendo a válvula cardíaca nativa. A mortalidade por EI-ACS é elevada. Abstract in english Background: Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Obse [...] rvational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

  14. Histologic and bacteriologic findings in valvular endocarditis of slaughter-age pigs

    DEFF Research Database (Denmark)

    Jensen, Henrik E.; Gyllensten, Johanna; Hofman, Carolina; Leifsson, Páll S.; Agerholm, Jørgen S.; Boye, Mette; Aalbæk, Bent

    2010-01-01

    Endocarditis lesions from 117 slaughter pigs were examined pathologically and etiologically in addition to 90 control hearts with cardiac valves. Lesions were located on the valves; however, the lesions had extended to the walls in 21 cases (18%). Lesions predominated on the mitral valve (59%). A...... 10 cases of endocarditis due to S. suis and E. rhusiopathiae were disclosed. Within lesions, streptococci predominated (53%) followed by E. rhusiopathiae (30%). Distinct features of both the lesions and the shape and localization of bacterial colonies were related to streptococci and E. rhusiopathiae....... The propensity for streptococci to be localized on more than 1 valve in single hearts may be because S. suis-infected pigs tend to have been infected for a longer period compared with E. rhusiopathiae. Mineralization of endocarditis lesions was significantly associated with infection by streptococci...

  15. Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Greub Gilbert

    2010-08-01

    Full Text Available Abstract Introduction The main clinical manifestations of Whipple's disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement. Case presentation We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple's disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year. Conclusion Tropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline and should be given over a prolonged period of time (a minimum of one year.

  16. Candida tropicalis causing Prosthetic Valve Endocarditis

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    Nagaraja P

    2005-01-01

    Full Text Available The incidence of endocarditis produced by the so-called "opportunists" as a complication of prosthetic valve surgery is progressively increasing in frequency and gradually transforming the clinical picture habitually associated with this disease. Candida endocarditis is an unusual but severe complication caused by Candida albicans or other fungal species. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that late recurrent Candida endocarditis, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.

  17. Prosthetic ball valve endocarditis due to Gemella species.

    Science.gov (United States)

    Ukimura, A; Nishihara, S; Suwa, M; Hirota, Y; Kitaura, Y; Kawamura, K; Sasaki, S

    1998-08-01

    A case is presented of endocarditis that was affecting a prosthetic ball valve (Starr-Edwards) and which was caused by Gemella species. A 57-year-old man was admitted with a 3-day history of abdominal pain with fever. At the time of admission, his temperature was 37.7 degrees C and laboratory tests showed elevated inflammatory parameters and an increased neutrophil count. However, transthoracic echocardiogram showed no vegetation. During hospitalization, Gemella spp. were detected by blood culture, and a transesophageal echocardiogram showed vegetation on the prosthetic valve. He was treated with intravenous ampicillin and astromycin, and also underwent valve replacement. This is the first case in Japan of infective endocarditis of a prosthetic valve due to Gemella spp. PMID:9741744

  18. Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient

    Directory of Open Access Journals (Sweden)

    Shailee Y. Shah

    2015-01-01

    Full Text Available Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be C. burnetii by PCR (polymerase chain reaction sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.

  19. Cardiac Surgery in Patients Infected with Human Immunodeficiency Virus

    OpenAIRE

    Abad, Cipriano; Cárdenes, Miguel Angel; Jiménez, Pedro Conrado; Armas, Mario-Vicente; Betancor, Pedro

    2000-01-01

    From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade.

  20. Reemplazo de válvula mitral consecutivo a endocarditis micótica Mitral valve replacement due to mycotic endocarditis

    Directory of Open Access Journals (Sweden)

    Yalili Pouymiró Brooks

    2011-07-01

    Full Text Available Se presenta el caso clínico de un niño de 15 meses de edad, el cual experimentó varias infecciones en la etapa neonatal (entre ellas por Candida albicans y otras complicaciones; sin embargo, no pudo recibir el esquema terapéutico completo contra la candidiasis sistémica por habérsele diagnosticado un daño funcional hepático. Posteriormente, al detectársele una endocarditis micótica, se le reemplazó la válvula mitral. En su último ingreso padecía, además, broncoespasmo asociado a neumonía bacteriana, anemia carencial, deshidratación isotónica moderada, acidosis metabólica e inmunodeficiencia mixta, causantes de una insuficiencia multiorgánica que le produjo la muerte al día siguiente de su admisión hospitalaria.A case report of a child aged 15 months who underwent several infections (i.e. due to Candida albicans and other complications during the neonatal stage is presented. However, he could not receive the complete treatment against systemic candidiasis because of an impairment of liver function. Subsequently, mitral valve was replaced when detecting mycotic endocarditis. In addition, while being hospitalized for the last time, he underwent bronchial spasm associated with bacterial pneumonia, deficiency anemia, mild isotonic dehydration, non-respiratory acidosis, and mixed immunodeficiency which caused multiple organ failure and death the day after his hospital admission.

  1. Granulicatella infection: diagnosis and management.

    Science.gov (United States)

    Cargill, James S; Scott, Katharine S; Gascoyne-Binzi, Deborah; Sandoe, Jonathan A T

    2012-06-01

    Granulicatella species, along with the genus Abiotrophia, were originally known as 'nutritionally variant streptococci'. They are a normal component of the oral flora, but have been associated with a variety of invasive infections in man and are most noted as a cause of bacterial endocarditis. It is often advised that Granulicatella endocarditis should be treated in the same way as enterococcal endocarditis. We review here the published data concerning diagnosis and treatment of Granulicatella infection, and include some observations from local cases, including four cases of endocarditis. PMID:22442291

  2. Afasia post acv de acm unilateral por embolia infecciosa en endocarditis bacteriana / Aphasia post unilateral cerebral media stroke associated to infectious embolism in acute bacterial endocarditis

    Scientific Electronic Library Online (English)

    Germán, Cantillo Mackenzie; Andersson L, Rozo A.; Juan Camilo, Suárez-Escudero.

    2014-04-01

    Full Text Available Se reporta el caso de un paciente con endocarditis infecciosa que sufre un accidente cerebro vascular (ACV) isquémico a nivel parieto-occipital e ínsula posterior izquierda, con manifestaciones afásicas de rasgos mixtos, donde prima la fluidez y los problemas de repetición, agresividad, agrafia y di [...] ficultades de lectura. Es un caso llamativo por la singularidad de los hallazgos y la mejoría funcional posterior al evento. Son escasos reportes en la literatura que muestren una complicación afásica por una endocarditis infecciosa con vegetaciones aórticas por Streptococo mitis versus S. oralis. El origen de la endocarditis infecciosa fue atribuido a procedimiento de endodoncia, y justificado en hallazgos de RMN, punción lumbar y ECO-TE. En la actualidad, el paciente posee un lenguaje funcional, con ciertas dificultades a nivel del lenguaje expresivo y de la comprensión. Abstract in english We present a clinical report of a patient with infective endocarditis who suffered an ischemic stroke at the parietal occipital and posterior insula, with aphasic demonstrations including mixed features, primordially exhibiting fluency and repetition problems, aggression, dysgraphia, and reading dif [...] ficulties. It is a striking case because of the uniqueness of the findings and the functional improvement after the event. There are few previous reports describing an association between these bacteria and this injury and the patient's improvement. The cause of the endocarditis was attributed to an endodontic procedure because other paraclinical tests made during medical care showed no other apparent cause. Currently the patient only has difficulty with expressive language and understanding certain commands.

  3. The Uptake of Apoptotic Cells Drives Coxiella burnetii Replication and Macrophage Polarization: A Model for Q Fever Endocarditis

    OpenAIRE

    Benoit, Marie; Ghigo, Eric; Capo, Christian; Raoult, Didier; Mege, Jean-Louis

    2008-01-01

    Patients with valvulopathy have the highest risk to develop infective endocarditis (IE), although the relationship between valvulopathy and IE is not clearly understood. Q fever endocarditis, an IE due to Coxiella burnetii, is accompanied by immune impairment. Patients with valvulopathy exhibited increased levels of circulating apoptotic leukocytes, as determined by the measurement of active caspases and nucleosome determination. The binding of apoptotic cells to monocytes and macrophages, th...

  4. Streptococcus tigurinus is highly virulent in a rat model of experimental endocarditis.

    Science.gov (United States)

    Veloso, Tiago Rafael; Zbinden, Andrea; Andreoni, Federica; Giddey, Marlyse; Vouillamoz, Jacques; Moreillon, Philippe; Zinkernagel, Annelies Sophie; Entenza, José Manuel

    2013-12-01

    Streptococcus tigurinus is responsible for systemic infections in humans including infective endocarditis. We investigated whether the invasive trait of S. tigurinus in humans correlated with an increased ability to induce IE in rats. Rats with catheter-induced aortic vegetations were inoculated with 10? CFU/ml of either of four S. tigurinus strains AZ_3a(T), AZ_4a, AZ_8 and AZ_14, isolated from patients with infective endocarditis or with the well known IE pathogen Streptococcus gordonii (Challis). Aortic infection was assessed after 24 h. S. tigurinus AZ_3a(T), AZ_4a and AZ_14 produced endocarditis in ?80% of rats whereas S. gordonii produced endocarditis in only 33% of animals (P<0.05). S. tigurinus AZ_8 caused vegetation infection in 56% of the animals. The capacity of S. tigurinus to induce aortic infection was not related to their ability to bind extracellular matrix proteins (fibrinogen, fibronectin or collagen) or to trigger platelet aggregation. However, all S. tigurinus isolates showed an enhanced resistance to phagocytosis by macrophages and two of them had an increased ability to enter endothelial cells, key attributes of invasive streptococcal species. PMID:23856340

  5. Austrian syndrome in the context of a fulminant pneumococcal native valve endocarditis

    Directory of Open Access Journals (Sweden)

    Manuel Wilbring

    2012-10-01

    Full Text Available This is the case of a young male suffering from Austrian syndrome, which is the triad of endocarditis, meningitis, and pneumonia due to invasive S. pneumoniae infection. He reported recurrent fever for six months without any antibiotic treatment, which may have determined the further course of the syndrome. Echocardiography revealed massive native valve endocarditis, and the patient was considered for ultima-ratio cardiac surgery. Intraoperative aspect presented extensive affection of the aortic root with full destruction of aortic valve, mitral valve, and aortomitral continuity. The myocardium showed a phlegmonlike infiltration. Microbiologic testing of intraoperatively collected specimens identified penicillin-sensitive Streptococcus pneumoniae. S. pneumoniae is a very uncommon cause for infective infiltrative endocarditis and is associated with severe clinical courses. Austrian syndrome is even more rare, with only a few reported cases worldwide. In those patients, only early diagnosis, immediate antibiotic treatment, and emergent cardiac surgery can save lives.

  6. Austrian syndrome in the context of a fulminant pneumococcal native valve endocarditis

    Scientific Electronic Library Online (English)

    Manuel, Wilbring; Sems-Malte, Tugtekin; Klaus, Matschke; Utz, Kappert.

    2012-10-01

    Full Text Available This is the case of a young male suffering from Austrian syndrome, which is the triad of endocarditis, meningitis, and pneumonia due to invasive S. pneumoniae infection. He reported recurrent fever for six months without any antibiotic treatment, which may have determined the further course of the s [...] yndrome. Echocardiography revealed massive native valve endocarditis, and the patient was considered for ultima-ratio cardiac surgery. Intraoperative aspect presented extensive affection of the aortic root with full destruction of aortic valve, mitral valve, and aortomitral continuity. The myocardium showed a phlegmonlike infiltration. Microbiologic testing of intraoperatively collected specimens identified penicillin-sensitive Streptococcus pneumoniae. S. pneumoniae is a very uncommon cause for infective infiltrative endocarditis and is associated with severe clinical courses. Austrian syndrome is even more rare, with only a few reported cases worldwide. In those patients, only early diagnosis, immediate antibiotic treatment, and emergent cardiac surgery can save lives.

  7. Community-associated Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis among HIV Patients: A cohort study

    Directory of Open Access Journals (Sweden)

    Stine Oscar C

    2011-10-01

    Full Text Available Abstract Background HIV patients are at increased risk of development of infections and infection-associated poor health outcomes. We aimed to 1 assess the prevalence of USA300 community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA among HIV-infected patients with S. aureus bloodstream infections and. 2 determine risk factors for infective endocarditis and in-hospital mortality among patients in this population. Methods All adult HIV-infected patients with documented S. aureus bacteremia admitted to the University of Maryland Medical Center between January 1, 2003 and December 31, 2005 were included. CA-MRSA was defined as a USA300 MRSA isolate with the MBQBLO spa-type motif and positive for both the arginine catabolic mobile element and Panton-Valentin Leukocidin. Risk factors for S. aureus-associated infective endocarditis and mortality were determined using logistic regression to calculate odds ratios (OR and 95% confidence intervals (CI. Potential risk factors included demographic variables, comorbid illnesses, and intravenous drug use. Results Among 131 episodes of S. aureus bacteremia, 85 (66% were MRSA of which 47 (54% were CA-MRSA. Sixty-three patients (48% developed endocarditis and 10 patients (8% died in the hospital on the index admission Patients with CA-MRSA were significantly more likely to develop endocarditis (OR = 2.73, 95% CI = 1.30, 5.71. No other variables including comorbid conditions, current receipt of antiretroviral therapy, pre-culture severity of illness, or CD4 count were significantly associated with endocarditis and none were associated with in-hospital mortality. Conclusions CA-MRSA was significantly associated with an increased incidence of endocarditis in this cohort of HIV patients with MRSA bacteremia. In populations such as these, in which the prevalence of intravenous drug use and probability of endocarditis are both high, efforts must be made for early detection, which may improve treatment outcomes.

  8. Brucella endocarditis on double valvular prosthesis.

    OpenAIRE

    Lezaun, R.; Teruel, J.; Maître, M. J.; Artaza, M

    1980-01-01

    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.

  9. Fungal Prosthetic Valve Endocarditis by Candida parapsilosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Tahereh Shokohi

    2014-03-01

    Full Text Available Introduction: Fungal prosthetic valve endocarditis (PVE is rare but serious complication of valve replacement surgery. Candida species, particularly Candida albicans is the most common isolated pathogen in fungal PVE (1–6%of cases. Case Presentation: We describe a 35-year-old woman who underwent mechanical mitral valve replacement about 3 years ago. She was admitted with neurological symptoms and later with dyspnea and hypotension. Transesophageal echocardiography showed large and mobile prosthetic valve vegetation. She underwent mitral valve surgery. The explanted valve and vegetation revealed lots of budding yeasts and the isolated yeast was identified as C. parapsilosis. Amphotericin B and broad spectrum antibiotic were started immediately. Unfortunately, the patient died two days after surgery, due to sepsis probably related to the candidemia. Conclusions: Fungal endocarditis is uncommon infection, but it is a serious problem in patients with prosthetic valve. Fungal PVE can occur years after the surgery, thus long-term follow-up is essential. Keywords: Candida; Fungi; Endocarditis; Prosthetic valve

  10. Hand infections: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Tolga Türker

    2014-09-01

    Full Text Available Purpose. Hand infections are common, usually resulting from an untreated injury. In this retrospective study, we report on hand infection cases needing surgical drainage in order to assess patient demographics, causation of infection, clinical course, and clinical management. Methods. Medical records of patients presenting with hand infections, excluding post-surgical infections, treated with incision and debridement over a one-year period were reviewed. Patient demographics; past medical history; infection site(s and causation; intervals between onset of infection, hospital admission, surgical intervention and days of hospitalization; gram stains and cultures; choice of antibiotics; complications; and outcomes were reviewed. Results. Most infections were caused by laceration and the most common site of infection was the palm or dorsum of the hand. Mean length of hospitalization was 6 days. Methicillin-resistant Staphylococcus aureus, beta-hemolytic Streptococcus and methicillin-susceptible Staphylococcus aureus were the most commonly cultured microorganisms. Cephalosporins, clindamycin, amoxicillin/clavulanate, penicillin, vancomycin, and trimethoprim/sulfamethoxazole were major antibiotic choices. Amputations and contracture were the primary complications. Conclusions. Surgery along with medical management were key to treatment and most soft tissue infections resolved without further complications. With prompt and appropriate care, most hand infection patients can achieve full resolution of their infection.

  11. Endocarditis infecciosa activa: 152 casos

    Directory of Open Access Journals (Sweden)

    Lucía R. Kazelian

    2012-04-01

    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.

  12. Culture-Negative Endocarditis Due to Houston Complex Bartonella henselae Acquired in Noumea, New Caledonia

    OpenAIRE

    Rodrick, Dani; Dillon, Belinda; Dexter, Mark; Nicholson, Ian; Marcel, Sebastien; Dickeson, David; Iredell, Jon

    2004-01-01

    A 44-year-old man with a bioprosthetic aortic valve suffered destructive endocarditis with severe embolic disease due to Bartonella henselae infection. Multilocus sequence typing was successfully performed with crude preparations of operative tissue as templates, and the infecting organism was determined to be typical of the Houston clonal group, although it was never cultured from blood or tissue. This is the first report of B. henselae infection in the South Pacific, and it reminds one that...

  13. Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replacement with an aortic valve homograft

    OpenAIRE

    Kim, Min-Seok; Chang, Hyoung Woo; Lee, Seung-Pyo; Kang, Dong Ki; Kim, Eui-Chong; Kim, Ki-Bong

    2015-01-01

    Eleven years ago, a 27-year-old non-drug abuser woman was admitted to the hospital due to a burn injury. During the treatment, she was diagnosed with tricuspid valve infective endocarditis caused by multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). She underwent tricuspid valve replacement (TVR) using a bioprosthetic valve, followed by 6 weeks of meropenem antibiotic therapy. Ten years later, she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P...

  14. Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review

    OpenAIRE

    Orme, Joseph; Rivera-Bonilla, Tomas; Loli, Akil; Blattman, Negin N.

    2015-01-01

    Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.

  15. Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis

    OpenAIRE

    Jorge D. Machicado

    2014-01-01

    Infective endocarditis (IE) is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC) joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.

  16. Septicemia and Aortic Valve Endocarditis due to Erysipelothrix rhusiopathiae in a Homeless Man

    OpenAIRE

    Dean Campbell; Mark Cowan

    2013-01-01

    We report a case of bacterial endocarditis due to Erysipelothrix rhusiopathiae in a homeless man with no animal exposure. His course was complicated by an allergic reaction to ampicillin, urinary bladder infection, respiratory failure, and acute kidney injury. He recovered completely after aortic valve replacement and a 6-week course of intravenous ceftriaxone.

  17. Detection of microbial diversity in endocarditis usingcultivation-independent molecular techniques

    DEFF Research Database (Denmark)

    Wolf, T. Y.; Moser, C.; Bundgaard, H.; Høiby, N.; Nielsen, Per Halkjær; Thomsen, Trine Rolighed

    Background: The aim of this study was to investigate whether the diagnosis of infective endocarditis (IE) could be improved using molecular tools in addition to standard microscopy and cultivation methods. Methods: Cultivation was performed on blood or tissue samples as recommended in the modified...

  18. Staphylococcus aureus endocarditis with fast development of aortic root abscess despite relevant antibiotics

    DEFF Research Database (Denmark)

    Dahl, Anders; Hansen, Thomas Fritz; Bruun, Niels Eske

    2013-01-01

    We present a case of Staphylococcus aureus endocarditis in which a large abscess was formed in only 4 days, despite specific intravenous antibiotics and only few vague signs of disease progression. Our case seems to be the first to show echocardiographic documentation of how quickly an intracardiac...... abscess can develop despite relevant antibiotics. Clinically, the patient is remarkably unaffected, and thus even small signs of progression should lead to considerations about repeating the diagnostic imaging workup. This case illustrates how aggressive an infection S. aureus endocarditis may be, and...

  19. Late prosthetic valve endocarditis due to Cardiobacterium hominis, an unusual complication

    Directory of Open Access Journals (Sweden)

    Shivaprakasha S

    2007-01-01

    Full Text Available We report a case of prosthetic valve endocarditis caused by Cardiobacterium hominis in a patient who had undergone atrial septal defect closure and mitral valve replacement of the heart in 1978. He presented with pyrexia of unknown origin and congestive cardiac failure. Investigations revealed infective endocarditis of prosthetic valve in mitral portion. Blood culture samples grew C. hominis . The patient was empirically started on vancomycin and gentamicin intravenously and ceftriaxone was added after isolation of the organism. Though subsequent blood cultures were negative, patient remained in congestive cardiac failure and died due to complications.

  20. Endocarditis bacteriana por Kocuria kristinae en paciente inmunocompetente: Reporte de un caso / Bacterial endocarditis by Kocuria kristinae in an inmunocompetent patient: Case report

    Scientific Electronic Library Online (English)

    Alirio R, Bastidas; Carlos A, Vélez; Carol V, Gutiérrez M; Nancy J, Bahamón.

    2013-09-01

    Full Text Available Las infecciones por microorganismos del género Kocuria spp. han sido descritas con mayor frecuencia en pacientes con enfermedades crónicas y estados de inmunosupresión. Comúnmente, no se ha reportado su aislamiento como causa de endocarditis en pacientes jóvenes e inmunocompetentes. Se deben diferen [...] ciar de las infecciones producidas por Staphylococcus spp. ya que su evolución clínica puede ser similar y sólo el aislamiento y tipifi cación en cultivos permite hacer el diagnóstico etiológico defi nitivo y dirigir la terapia antibiótica adecuada. Se describe el caso de un paciente joven e inmunocompetente que cursó con endocarditis bacteriana, aislándose Kocuria kristinae en hemocultivos. Abstract in english Infections by microorganisms of the genus Kocuria spp. have been reported more frequently in patients with chronic diseases and immunosuppression. Its isolation has not been reported as cause of endocarditis in young and immunocompetent patients. It should be differentiated from infections caused by [...] Staphylococcus spp. given that their clinical course may be similar and that only the isolation and typification in cultures allows definitive etiologic diagnosis and direct appropriate antibiotic therapy. We describe the case of an immunocompetent young patient who presented bacterial endocarditis and in whose blood cultures kristinae Kocuria was isolated.

  1. Aneurisma micótico abdominal e embolia cerebral associados à endocardite infecciosa em paciente com doença valvar reumática crônica Abdominal mycotic aneurysm and cerebral embolic event associated with infective endocarditis in a patient with chronic rheumatic valvar disease

    Directory of Open Access Journals (Sweden)

    Bernadete Lourdes Liphaus

    2007-01-01

    Full Text Available Relatamos o caso de uma menina com doença valvar crônica devido à febre reumática que apresentou endocardite infecciosa e duas complicações: acidente vascular cerebral devido à embolia e aneurisma micótico da artéria mesentérica superior.We report the case of a girl with chronic rheumatic valvar heart disease who developed infeccious endocarditis and two complications, ischemic stroke due to cerebral embolic event and mycotic aneurysm of the superior mesenteric artery.

  2. Aneurisma micótico abdominal e embolia cerebral associados à endocardite infecciosa em paciente com doença valvar reumática crônica Abdominal mycotic aneurysm and cerebral embolic event associated with infective endocarditis in a patient with chronic rheumatic valvar disease

    OpenAIRE

    Bernadete Lourdes Liphaus; Cláudia Goldenstein-Schainberg; Letícia Monteiro Kitamura; Clóvis Artur Almeida Silva

    2007-01-01

    Relatamos o caso de uma menina com doença valvar crônica devido à febre reumática que apresentou endocardite infecciosa e duas complicações: acidente vascular cerebral devido à embolia e aneurisma micótico da artéria mesentérica superior.We report the case of a girl with chronic rheumatic valvar heart disease who developed infeccious endocarditis and two complications, ischemic stroke due to cerebral embolic event and mycotic aneurysm of the superior mesenteric artery.

  3. Tricuspid endocarditis in hyper-IgE syndrome

    Directory of Open Access Journals (Sweden)

    Gupta S

    2010-01-01

    Full Text Available Hyper-IgE syndrome is a congenitally acquired primary immune deficiency condition. We report a case of possible hyper-IgE syndrome who presented with multiple cold skin abscesses and chest infection due to Staphylococcus aureus and hyper-IgE findings. Patient also had tricuspid valve acute bacterial endocarditis with purulent pericarditis which is very rare. This case is presented to highlight that early diagnosis and treatment in such cases decreases the mortality and morbidity in phagocytic disorders.

  4. [Surgical Treatment of Prosthetic Valve Endocarditis].

    Science.gov (United States)

    Kaminishi, Yuichiro; Akutsu, Hirohiko; Sugaya, Akira; Kurumisawa, Soki; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Aizawa, Kei; Ohki, Shinichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-11-01

    Between 2003 and 2014, at Jichi Medical University Hospital, 11 patients with prosthetic valve endocarditis (PVE) underwent re-operation. There was 1 in-hospital death and 2 late deaths. The cause of death was cirrhosis, heart failure and sepsis, respectively. Emergency surgery, previous double valve replacement (DVR) and Staphylococcus infection were common risk factors for all 3 cases. Two cases of patients that survived who underwent mitral valve replacement (MVR) and DVR for PVE after DVR were treated with multiple antibiotic courses for bacteremia associated with hemodialysis and colon cancer. One patient who underwent DVR after mitral valve plasty which was complicated with cerebral hemorrhage, had survived and was discharged. Of the aortic PVE patients, 2 cases of aortic valve replacement (AVR) using a mechanical valve, 1 case of aortic root replacement (ARR) using a mechanical valve, and 1 ARR using the homograft, were considered cured and never relapsed. A patient with aortic PVE, who underwent AVR after cesarean section for heart failure in birth period, has received ARR twice with the mechanical valve for recurrent pseudo-aneurysm of the left ventricular outflow tract. Since hemodialysis and colon cancer is a risk factor for recurrent PVE, it is necessary to consider the long-term administration of antibiotics after surgery. PMID:26469256

  5. Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replacement with an aortic valve homograft.

    Science.gov (United States)

    Kim, Min-Seok; Chang, Hyoung Woo; Lee, Seung-Pyo; Kang, Dong Ki; Kim, Eui-Chong; Kim, Ki-Bong

    2015-01-01

    Eleven years ago, a 27-year-old non-drug abuser woman was admitted to the hospital due to a burn injury. During the treatment, she was diagnosed with tricuspid valve infective endocarditis caused by multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). She underwent tricuspid valve replacement (TVR) using a bioprosthetic valve, followed by 6 weeks of meropenem antibiotic therapy. Ten years later, she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She underwent redo-TVR with a bioprosthetic valve and was treated with colistin and ciprofloxacin. Ten months later, she was again diagnosed with prosthetic valve infective endocarditis with MDR P. aeruginosa as a pathogen. She underwent a second redo-TVR with a tissue valve and was treated with colistin. Two months later, her fever recurred and she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She eventually underwent a third redo-TVR using an aortic valve homograft and was discharged from the hospital after additional 6 weeks' of antibiotic therapy. All the strains of P. aeruginosa isolated from each event of infective endocarditis were analyzed by repetitive deoxyribonucleic acid sequence-based polymerase chain reaction (rep-PCR) deoxyribonucleic acid (DNA) strain typing to determine the correlation of isolates. All of the pathogens in 11 years were similar enough to be classified as the same strain, and this is the first case report of TVR using an aortic valve homograft to treat relapsing endocarditis. PMID:26051245

  6. Prevention of Infective (Bacterial) Endocarditis: Wallet Card

    Science.gov (United States)

    ... has approved this statement as it relates to dentistry. National Center 7272 Greenville Avenue Dallas, Texas 75231- ... second generation oral cephalosporin in equivalent adult or pediatric dosage. † Cephalosporins should not be used in an ...

  7. Brucella Endocarditis Caused By Brucella Melitensis

    Directory of Open Access Journals (Sweden)

    Suzan Saçar

    2008-01-01

    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.

  8. Estudos sobre thrombose cardiaca e endocardite parietal de origem não valvular On thrombosis of heart and on mural endocarditis of non-valvular origin

    Directory of Open Access Journals (Sweden)

    C. Magarinos Torres

    1928-01-01

    Full Text Available 1.-Since the parietal endocarditis represents a chapter generally neglected, owing to the relative lack of cases, and somewhat confused because there various terms have been applied to a very same morbid condition, it justifies the work which previously we tried to accomplish, of nosographic classification. Taking into account the functional disturbances and the anatomical changes, all cases of parietal endocarditis referred to in the litterature were distributed by the following groups: A-Group-Valvulo-parietal endocarditis. 1st . type-Valvulo-parietal endocarditis per continuum. 2nd. type-Metastatic valvulo-parietal endocarditis. 3rd. type-Valvulo-parietal endocarditis of the mitral stenosis. B-Group-Genuine parietal endocarditis. a with primary lesions in the myocardium. b with primary lesions in the endocardium. 4th type-Fibrous chronic parietal endocarditis (B A Ü M L E R, « endocarditis parietalis simplex». 5th type-Septic acute parietal endocarditis (LESCHKE, «endocarditis parietalis septica». 6th type-Subacute parietal endocarditis (MAGARINOS TORRES, «endocarditis muralis lenta». 2.-Studying a group of 14 cases of fibrous endomyocarditis with formation of thrombi, and carrying together pathological and bacteriological examinations it has been found that some of such cases represent an infectious parietal endocarditis, sometimes post-puerperal, of subacute or slow course, the endocardic vegetations being contamined by pathogenic microörganisms of which the most frequent is the Diplococcus pneumoniae, in most cases of attenuated virulence. Along with the infectious parietal endocarditis, there occur arterial and venous thromboses (abdominal aorta, common illiac and femural arteries and external jugular veins. The case 5,120 is a typical one of this condition which we name subacute parietal endocarditis (endocarditis parietalis s. muralis lenta. 3.-The endocarditis muralis lenta encloses an affection reputed to be of rare occurrence, the «myocardite subaigüe primitive», of which JOSSERAND and GALLAVARDIN published in 1901 the first cases, and ROQUE and LEVY, another, in 1914. The «myocardite subaigüe primitive» was, wrongly, in our opinion, included by WALZER in the syndrome of myocardia of LAUBRY and WALZER, considering that, in the refered cases of JOSSERAND and GALLAVARDIN and in that of ROQUE and LEVY, there are described rather considerable inflammatory changes in the myocardium and endocardium. The designation «myocardia» was however especially created by LAUBRY and WALZER for the cases of heart failure in which the most careful aetiologic inquiries and the most minucious clinical examination were unable to explain, and in which, yet, the post-mortem examination did not reveal any anatomical change at all, it being forcible to admit, then, a primary functional change of the cardiac muscle fibre. This special cardiac condition is thoroughly exemplified in the observation that WALZER reproduces on pages 1 to 7 of his book. 4.-The clinical picture of the subacute parietal endocarditis is that of heart failure with oedemas, effusion in the serous cavities and passive chronic congestion of the lungs, liver, kideys and spleen associated, to that of an infectious disease of subacute course. The fever is rather transient oscillating around 99.5 F., being intersected with apyretic periods of irregular duration; it is not dependent on any evident extracardiac septic infection. In other cases the fever is slight, particularly in the final stage of the disease, when the heart failure is well established. The rule is to observe then, hypothermy. The cardiac-vascular signs consist of enlargement of the cardiac dullness, smoothing of the cardiac sounds, absence of organic murmurs and accentuated and persistent tachycardia up to a certain point independent of fever. The galloprhythm is present, in most cases. The signs of the pulmonary infarct are rather expressed by the aspect of the sputum, which is foamy and blood-streaked than by the classic signs. Cerebral embolism was a terminal accid

  9. Estudos sobre thrombose cardiaca e endocardite parietal de origem não valvular / On thrombosis of heart and on mural endocarditis of non-valvular origin

    Scientific Electronic Library Online (English)

    C. Magarinos, Torres.

    Full Text Available [...] Abstract in english 1.-Since the parietal endocarditis represents a chapter generally neglected, owing to the relative lack of cases, and somewhat confused because there various terms have been applied to a very same morbid condition, it justifies the work which previously we tried to accomplish, of nosographic classif [...] ication. Taking into account the functional disturbances and the anatomical changes, all cases of parietal endocarditis referred to in the litterature were distributed by the following groups: A-Group-Valvulo-parietal endocarditis. 1st . type-Valvulo-parietal endocarditis per continuum. 2nd. type-Metastatic valvulo-parietal endocarditis. 3rd. type-Valvulo-parietal endocarditis of the mitral stenosis. B-Group-Genuine parietal endocarditis. a) with primary lesions in the myocardium. b) with primary lesions in the endocardium. 4th type-Fibrous chronic parietal endocarditis (B A Ü M L E R), « endocarditis parietalis simplex». 5th type-Septic acute parietal endocarditis (LESCHKE), «endocarditis parietalis septica». 6th type-Subacute parietal endocarditis (MAGARINOS TORRES), «endocarditis muralis lenta». 2.-Studying a group of 14 cases of fibrous endomyocarditis with formation of thrombi, and carrying together pathological and bacteriological examinations it has been found that some of such cases represent an infectious parietal endocarditis, sometimes post-puerperal, of subacute or slow course, the endocardic vegetations being contamined by pathogenic microörganisms of which the most frequent is the Diplococcus pneumoniae, in most cases of attenuated virulence. Along with the infectious parietal endocarditis, there occur arterial and venous thromboses (abdominal aorta, common illiac and femural arteries and external jugular veins). The case 5,120 is a typical one of this condition which we name subacute parietal endocarditis (endocarditis parietalis s. muralis lenta). 3.-The endocarditis muralis lenta encloses an affection reputed to be of rare occurrence, the «myocardite subaigüe primitive», of which JOSSERAND and GALLAVARDIN published in 1901 the first cases, and ROQUE and LEVY, another, in 1914. The «myocardite subaigüe primitive» was, wrongly, in our opinion, included by WALZER in the syndrome of myocardia of LAUBRY and WALZER, considering that, in the refered cases of JOSSERAND and GALLAVARDIN and in that of ROQUE and LEVY, there are described rather considerable inflammatory changes in the myocardium and endocardium. The designation «myocardia» was however especially created by LAUBRY and WALZER for the cases of heart failure in which the most careful aetiologic inquiries and the most minucious clinical examination were unable to explain, and in which, yet, the post-mortem examination did not reveal any anatomical change at all, it being forcible to admit, then, a primary functional change of the cardiac muscle fibre. This special cardiac condition is thoroughly exemplified in the observation that WALZER reproduces on pages 1 to 7 of his book. 4.-The clinical picture of the subacute parietal endocarditis is that of heart failure with oedemas, effusion in the serous cavities and passive chronic congestion of the lungs, liver, kideys and spleen associated, to that of an infectious disease of subacute course. The fever is rather transient oscillating around 99.5 F., being intersected with apyretic periods of irregular duration; it is not dependent on any evident extracardiac septic infection. In other cases the fever is slight, particularly in the final stage of the disease, when the heart failure is well established. The rule is to observe then, hypothermy. The cardiac-vascular signs consist of enlargement of the cardiac dullness, smoothing of the cardiac sounds, absence of organic murmurs and accentuated and persistent tachycardia up to a certain point independent of fever. The galloprhythm is present, in most cases. The signs of the pulmonary infarct are rather expressed by the aspect of the sputum, which is foamy and blood-streaked than by the classic signs

  10. Indium-111 leukocyte localization in infected prosthetic graft

    International Nuclear Information System (INIS)

    Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection

  11. Indium-111 leukocyte localization in infected prosthetic graft

    Energy Technology Data Exchange (ETDEWEB)

    Purnell, G.L.; Walker, C.W.; Allison, J.W.; Dalrymple, G.V. (Univ. of Arkansas for Medical Sciences, Little Rock (USA))

    1990-08-01

    Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.

  12. Prosthetic valve endocarditis caused by Staphylococcus capitis: report of 4 cases

    Directory of Open Access Journals (Sweden)

    Wada Yuko

    2011-10-01

    Full Text Available Abstract Although Staphylococcus capitis is considered to be a rare causative organism for prosthetic valve endocarditis, we report 4 such cases that were encountered at our hospital over the past 2 years. Case 1 was a 79-year-old woman who underwent aortic valve replacement with a bioprosthetic valve and presented with fever 24 days later. Transesophageal echocardiography revealed an annular abscess in the aorto-mitral continuity and mild perivalvular regurgitation. We performed emergency surgery 5 days after the diagnosis of prosthetic valve endocarditis was made. Case 2 was a 79-year-old woman presenting with fever 40 days after aortic valve replacement with a bioprosthesis. Transesophageal echocardiography showed vegetation on the valve, and she underwent urgent surgery 2 days after prosthetic valve endocarditis was diagnosed. In case 3, a 76-year-old man presented with fever 53 days after aortic valve replacement with a bioprosthesis. Vegetation on the prosthetic leaflet could be seen by transesophageal echocardiography. He underwent emergency surgery 2 days after the diagnosis of prosthetic valve endocarditis was made. Case 4 was a 68-year-old woman who collapsed at her home 106 days after aortic and mitral valve replacement with bioprosthetic valves. Percutaneous cardiopulmonary support was started immediately after massive mitral regurgitation due to prosthetic valve detachment was revealed by transesophageal echocardiography. She was transferred to our hospital by helicopter and received surgery immediately on arrival. In all cases, we re-implanted another bioprosthesis after removal of the infected valve and annular debridement. All patients recovered without severe complications after 2 months of antibiotic treatment, and none experienced re-infection during 163 to 630 days of observation. Since the time interval between diagnosis of prosthetic valve endocarditis and valve re-replacement ranged from 0 to 5 days, early surgical removal of the infected prosthesis and an appropriate course of antibiotics were attributed to good clinical outcomes in our cases.

  13. Serological evaluation of O fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis.

    OpenAIRE

    Peacock, M G; Philip, R. N.; Williams, J. C.; Faulkner, R. S.

    1983-01-01

    Serological parameters were compared in 15 cases of Coxiella burnetii infection comprising 5 cases each of primary Q fever, chronic granulomatous hepatitis, and endocarditis. The diagnosis was made on the basis of clinical history and serology and on the isolation of C. burnetii phase I from biopsy specimens of liver and bone marrow from two patients with granulomatous hepatitis and from the aortic valve vegetations of five patients with endocarditis. The temporal sequences of immunoglobulin ...

  14. {sup 18}F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Bonfiglioli, Rachele; Nanni, Cristina; Morigi, Joshua James; Ambrosini, Valentina; Fanti, Stefano [Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Nuclear Medicine, Bologna (Italy); Graziosi, Maddalena; Rapezzi, Claudio [Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Cardiology, Bologna (Italy); Trapani, Filippo; Bartoletti, Michele; Tumietto, Fabio; Viale, Pier Luigi [Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Infective Diseases, Bologna (Italy); Ferretti, Alice; Rubello, Domenico [Azienda Ospedaliera S. Maria della Misericordia, Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Rovigo (Italy)

    2013-08-15

    Acute infective endocarditis is a potentially life-threatening disease. Its outcome strongly depends on systemic embolization and extracardiac infections. When present, these conditions usually lead to a more aggressive therapeutic approach. However, the diagnosis of peripheral septic embolism is very challenging. {sup 18}F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has proven to be accurate for the detection of inflammatory diseases and occult infections. The aim of this study was to assess the added value of {sup 18}F-FDG PET/CT in the detection of extracardiac embolisms in the evaluation of patients with suspected valvular endocarditis (VE). Seventy-one patients with suspected infective endocarditis, enrolled between June 2010 and December 2012, underwent {sup 18}F-FDG PET/CT with the standard procedure on a dedicated PET/CT scanner. Extracardiac findings were subsequently evaluated with other imaging procedures. Of the 71 patients with suspicion of infective endocarditis, we found unexpected extracardiac findings in 17 patients (24 %) without any clinical suspicion. Extracardiac findings were subsequently evaluated with other imaging procedures. PET/CT detected unexpected extra sites of infection in 24 % of cases, leading to changes in therapeutic management in a very relevant percentage of patients. These findings may have important therapeutic implications. (orig.)

  15. [Fever, malaise and new onset mitral valve insufficiency. Subacute Streptococcus bovis mitral valve endocarditis ].

    Science.gov (United States)

    Burri, E; Laffer, R; Steuerwald, M; Cathomas, G; Zimmerli, W

    2004-05-01

    A 62-year-old patient with low grade fever, fatigue, arthralgia and newly discovered mitral regurgitation was diagnosed with subacute endocarditis. Streptococcus bovis grew from all six blood culture bottles. Streptococcus bovis is known to be associated with gastrointestinal neoplasias. Therefore a colonoscopy was performed and two polyps were removed. Histological analysis revealed a tubulovillous adenoma and a serrated adenoma. Colonoscopy is mandatory for all patients with Streptococcus bovis endocarditis even without any symptoms for colorectal neoplasia. The significance of Streptococcus bovis for the carcinogenesis of colorectal neoplasias and the possible alternative pathway for colorectal carcinomas through serrated adenomas will be discussed. PMID:15185488

  16. Antiphospholipid Syndrome and Libman-Sacks Endocarditis in a Bioprosthetic Mitral Valve.

    Science.gov (United States)

    Sladek, Eric H; Accola, Kevin D

    2016-02-01

    This report describes one the first cases of antiphospholipid syndrome and Libman-Sacks endocarditis in a bioprosthetic valve. A redo mitral valve replacement was carried out owing to early deterioration of the prior valve. Initially it was considered secondary to rheumatic heart disease; however, pathology analysis and autoimmune workup revealed antiphospholipid syndrome with Libman-Sacks endocarditis. We believe certain populations with mitral valve stenosis may have an underlying antiphospholipid syndrome. As a result, there needs to be a lower threshold for identifying this disease. PMID:26777966

  17. / Endocarditis por Bordetella holmesii en un paciente asplénico

    Scientific Electronic Library Online (English)

    Rolando N, Soloaga; Natalia A, Carrion; Marisa, Almuzara; Claudia, Barberis; Juan C, Pidone; Liliana I, Guelfand; Carlos, Vay.

    2013-06-01

    Full Text Available Se presenta el caso de una paciente de 52 años portadora de estenosis aórtica crítica, esplenectomizada, hipotiroidea, que tenía como antecedente linfoma de Hodgkin diagnosticado en 2004. En abril de 2011 ingresó al Servicio de Cardiología por insuficiencia cardíaca global y registros febriles, con [...] respuesta tórpida al tratamiento diurético-vasodilatador. El ecocardiograma transesofágico mostró imágenes ecodensas en válvulas aórtica, pulmonar y mitral compatibles con vegetaciones, por lo que el cuadro se interpretó como probable endocarditis infecciosa. En dos muestras de hemocultivos desarrolló un cocobacilo gram negativo que fue identificado como Bordetella holmesii. Se realizó tratamiento con ceftriaxona 1 g cada 12 h durante 28 días, y se observó una evolución favorable. Abstract in english The case of a 52-year-old female patient with a history of critical aortic stenosis, hypothyroidism and splenectomy as treatment for her Hodgkin's lymphoma is herein presented. In April 2011, the patient was admitted to the cardiology service due to global heart failure, fever and poor response to d [...] iuretic and vasodilator therapy. A transesophageal echocardiogram showed images compatible with vegetations in the aortic, pulmonary, and mitral valves. A diagnosis of infective endocarditis was made. Growth of gram-negative coccobacilli was observed in two blood culture sets. The microorganism was finally identified as Bordetella holmesii.The patient was treated with ceftriaxone 1 g every 12 hours for 28 days with favorable outcome.

  18. The use of technetium-99m hexamethylpropylene amine oxime labelled granulocytes with single-photon emission tomography imaging in the detection and follow-up of recurrence of infective endocarditis complicating transvenous endocardial pacemaker

    Energy Technology Data Exchange (ETDEWEB)

    Ramackers, J.M. [Department of Nuclear Medicine, CHU E. Herriot, Lyon (France); Kotzki, P.O. [Department of Nuclear Medicine, CHU Lapeyronie et A. de Villeneuve, Montpellier (France); Couret, I. [Department of Nuclear Medicine, CHU Lapeyronie et A. de Villeneuve, Montpellier (France); Messner-Pellenc, P. [Department of Cardiology, CHU Lapeyronie et A. Villeneuve, Montpellier (France); Davy, J.M. [Department of Cardiology, CHU Lapeyronie et A. Villeneuve, Montpellier (France); Rossi, M. [Department of Nuclear Medicine, CHU Lapeyronie et A. de Villeneuve, Montpellier (France)

    1995-11-01

    In this case report we present a patient with a recurrence of subacute bacterial infectious endocarditis (IE) complicating a transvenous endocardial pacemaker. Technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO) labelled granulocytes were used for diagnosis and follow-up under medical treatment only, since surgical removal of the pacemaker lead was ruled out because of the general condition of the patient. Single-photon emission tomography (SPET) imaging displayed the active lesion previously suspected on echography. At the end of antibiotic therapy, SPET indicated a favourable disease outcome whereas echocardiographic abnormalities remained nearly unchanged. The medical treatment had eradicated the IE, and the patient did well for more than 1 year thereafter. (orig.)

  19. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas; Frimodt-Møller, Niels; Bruun, Niels Eske

    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...

  20. [Transthoracic and transesophageal echocardiography in the study of adults with congenital cardiopathy and infectious endocarditis].

    Science.gov (United States)

    Vargas Barrón, J; Espínola Zavaleta, N; Romero Cárdenas, A; Loredo Mendoza, M L; Rijlaarsdam, M; Crespo Serje, L

    1998-01-01

    Twenty-four adults (average age 28 years) patients with congenital heart disease were examined; infective endocarditis was diagnosed in all of them by Duke criteria and was confirmed in 18 by surgery and/or pathology. Patients were divided into 2 groups. Group A was made up of 13 patients with left ventricular outflow obstruction, including ten with bicuspid aorta. Group B was made up of 11 patients with shunts (PDA or VSD), either isolated or associated with other abnormalities. The principal alterations associated with the infectious processes were trauma to the endocardium or vascular endothelium from accelerated turbulent flow (jet lesion) and valvular deformities. The principally transesophageal echocardiographic recordings showed infective vegetations on the four cardiac valves, mural endocarditis in both ventricles and right atrium, perivalvular abscesses and fistulae. The echocardiographic information aided in selecting the type of treatment in this group of patients with high intrahospital mortality (25%). PMID:9810366

  1. Endocarditis and meningitis associated to nape piercing in a young female: a case report.

    Science.gov (United States)

    Mariano, Andrea; Pisapia, Raffaella; Abdeddaim, Amina; Taibi, Chiara; Rianda, Alessia; Vincenzi, Laura; D'Offizi, Gianpiero

    2015-09-01

    Body piercing is a social phenomenon on the rise especially among young people. This procedure may be complicated by serious bacterial and viral infections. We report a case of Staphylococcus aureus infective endocarditis and meningitis arising from the site of a nape piercing, after its removal. A 21-year-old Italian female was admitted to hospital with neurological impairment and sepsis. A diagnosis of endocarditis associated with meningitis by S. aureus, complicated by septic emboli in the brain, retina, skin and kidney, was formulated on the basis of modified Duke's criteria. The likely port-of-entry was the site of a nape piercing, removed two months before. In view of the widespread practice of body piercing, provision of correct and timely information concerning the associated serious risks is now imperative. Such information should emphasise the option for antibiotic prophylaxis, and the importance of careful local hygiene, even after piercing removal. PMID:26397300

  2. Prosthetic Valve Endocarditis Due to Neisseria skkuensis, a Novel Neisseria Species

    OpenAIRE

    Park, So Yeon; Kang, Seung Ji; Joo, Eun-Jeong; Ha, Young Eun; Baek, Jin Yang; Wi, Yu Mi; Kang, Cheol-In; Chung, Doo Ryeon; Peck, Kyong Ran; Lee, Nam Young; Song, Jae-Hoon

    2012-01-01

    We describe the first reported case of endocarditis due to Neisseria skkuensis. The organism from the blood cultures taken on admission day was identified initially as unidentified Gram-negative cocci by Vitek2. Finally, it was identified as Neisseria skkuensis by 16 rRNA gene sequence analysis.

  3. Endocarditis por Coxiella burnetii: fiebre Q Coxiella burnetii endocarditis: Q fever

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Betancur

    2012-01-01

    Full Text Available La fiebre Q es una zoonosis causada por Coxiella burnetii; más frecuente en Europa pero reportada en otros continentes, puede cursar en forma aguda o crónica. La endocarditis es una forma de presentación crónica con curso insidioso y se asocia frecuentemente a fenómenos embólicos, representa 1% de todos los casos de endocarditis en el mundo. El diagnóstico se realiza por la sospecha clínica, cultivos negativos para patógenos convencionales y la confirmación serológica. Este artículo describe el caso clínico de un paciente con endocarditis causada por Coxiella burnetii y se revisa la literatura. (Acta Med Colomb 2012: 37: 31-33.Q fever is a zoonosis caused by Coxiella burnetii. Q fever may present as subacute or chronic endocarditis, has a high incidence of embolic phenomena and is often fatal, representing 1% of all cases of endocarditis worldwide. Q fever most commonly presents an insidious course. The diagnosis is made by clinical suspicion after serial blood cultures for conventional pathogens are negative and by serological confirmation. This article describes the clinical case of a patient with endocarditis caused Coxiella burnetii and updated review of the literature. (Acta Med Colomb 2012: 37: 31-33.

  4. Endocarditis por Coxiella burnetii: fiebre Q / Coxiella burnetii endocarditis: Q fever

    Scientific Electronic Library Online (English)

    Carlos Alberto, Betancur; Ana G, Múnera.

    2012-01-01

    Full Text Available La fiebre Q es una zoonosis causada por Coxiella burnetii; más frecuente en Europa pero reportada en otros continentes, puede cursar en forma aguda o crónica. La endocarditis es una forma de presentación crónica con curso insidioso y se asocia frecuentemente a fenómenos embólicos, representa 1% de t [...] odos los casos de endocarditis en el mundo. El diagnóstico se realiza por la sospecha clínica, cultivos negativos para patógenos convencionales y la confirmación serológica. Este artículo describe el caso clínico de un paciente con endocarditis causada por Coxiella burnetii y se revisa la literatura. (Acta Med Colomb 2012: 37: 31-33). Abstract in english Q fever is a zoonosis caused by Coxiella burnetii. Q fever may present as subacute or chronic endocarditis, has a high incidence of embolic phenomena and is often fatal, representing 1% of all cases of endocarditis worldwide. Q fever most commonly presents an insidious course. The diagnosis is made [...] by clinical suspicion after serial blood cultures for conventional pathogens are negative and by serological confirmation. This article describes the clinical case of a patient with endocarditis caused Coxiella burnetii and updated review of the literature. (Acta Med Colomb 2012: 37: 31-33).

  5. Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients

    Directory of Open Access Journals (Sweden)

    Ruotsalainen Eeva

    2006-09-01

    Full Text Available Abstract Background Endocarditis is a common complication in Staphylococcus aureus bacteremia (SAB. We compared risk factors, clinical manifestations, and outcome in a large, prospective cohort of patients with S. aureus endocarditis in injection drug users (IDUs and in nonaddicts. Methods Four hundred and thirty consecutive adult patients with SAB were prospectively followed up for 3 months. Definite or possible endocarditis by modified Duke criteria was found in 74 patients: 20 patients were IDUs and 54 nonaddicts. Results Endocarditis was more common in SAB among drug abusers (46% than in nonaddicts (14% (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65–9.91; P P P P = 0.03, and their SAB was more often community-acquired (95% vs 39%, P P P = 0.70. Arterial thromboembolic events and severe sepsis were also equally common in both groups. There was no difference in mortality between the groups at 7 days, but at 3 months it was lower among IDUs (10% compared with nonaddicts (39% (OR, 5.73; 95% CI, 1.20–27.25; P = 0.02. Conclusion S. aureus endocarditis in IDUs was associated with as high complication rates including extracardiac deep infections, thromboembolic events, or severe sepsis as in nonaddicts. Injection drug abuse in accordance with younger age and lack of underlying diseases were associated with lower mortality, but after adjusting by age and underlying diseases injection drug abuse was not significantly associated with mortality.

  6. A Misinterpreted Case of Aorta Prosthesis Endocarditis : Remember The Phenomenon of Microbubbles

    DEFF Research Database (Denmark)

    Lerche, Christian Johann; Haugan, Ketil JØrgen

    2013-01-01

    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 following the movement of the mechanical heart valve (MHV), which eventually proved to be a product of degassing microbubbles (MB).

  7. Cardiac device-related endocarditis: Epidemiology, pathogenesis, diagnosis and treatment – a review

    OpenAIRE

    Edelstein, Shimon; Yahalom, Malka

    2009-01-01

    Cardiac device-related endocarditis (CDE) is a phenomenon for which incidence is on the rise; it presents difficult management problems to the clinician. On one hand, there is the patient who needs the implanted device, and the potential morbidity and mortality associated with its removal. On the other hand, there is the problem of a persistent infection – usually acquired during insertion of an electrical device – that is resistant to many antibiotics, has a high recurrence rate, and necessi...

  8. Tricuspid valve endocarditis associated with intravenous nyoape use: A report of 3 cases

    Scientific Electronic Library Online (English)

    R, Meel; F, Peters; M R, Essop.

    2014-12-01

    Full Text Available We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South A [...] frica. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery.

  9. A Widely Used In Vitro Biofilm Assay Has Questionable Clinical Significance for Enterococcal Endocarditis

    OpenAIRE

    Leuck, Anne-Marie; Johnson, James R; Dunny, Gary M.

    2014-01-01

    Biofilm formation may play an important role in the pathogenesis of infections caused by Enterococcus faecalis, including endocarditis. Most biofilm studies use a polystyrene dish assay to quantify biofilm biomass. However, recent studies of E. faecalis strains in tissue and animal models suggest that polystyrene dish results need to be interpreted with caution. We evaluated 158 clinical E. faecalis isolates using a polystyrene dish assay and found variation in biofilm formation, with many is...

  10. Daptomycin-nonsusceptible, vancomycin-intermediate, methicillin-resistant Staphylococcus aureus endocarditis

    OpenAIRE

    Yu, Ryan; Dale, Suzanne E.; Yamamura, Deborah; Stankus, Vida; Lee, Christine

    2012-01-01

    Due to the emergence of Staphylococcus aureus with reduced vancomycin susceptibility, newer antibiotics, including daptomycin, have been used to treat methicillin-resistant S aureus infections. Daptomycin is a cyclic lipopeptide that is approved to treat S aureus bacteremia and right-sided endocarditis, and reports of S aureus with reduced susceptibility to daptomycin are infrequent. To our knowledge, the present report describes the first Canadian case of daptomycin-nonsusceptible, vancomyci...

  11. Complication of nasal piercing by Staphylococcus aureus endocarditis: a case report and a review of literature

    OpenAIRE

    Giuliana, Battagin; Loredana, Sarmati; Pasquale, Sordillo; Giovanna, Picchi; Giorgio, Calisti; Laura, Ceccarelli; Pellegrino, Antonio; Paolo, Nardi; Luigi, Chiariello; Massimo, Andreoni

    2010-01-01

    Body piercing, a growing trend especially in young people, is often complicated by severe infections. We present a case of acute bacterial endocarditis by Staphylococcus aureus complicated by multiple cerebral, kidney, spleen embolisms in a young girl, with no known previous cardiac abnormalities, following the piercing of nasal septum. This case highlights the importance of education of patients with and without structural heart disease to the potential dangerous and even life threatening in...

  12. Endocardite por lactococcus garvieae: primeiro relato de caso da América Latina / Lactococcus garvieae endocarditis: first case report in Latin America / Endocarditis por lactococcus garvieae: primer relato de caso de América Latina

    Scientific Electronic Library Online (English)

    Tatiana Franco, Hirakawa; Fernando Augusto Alves da, Costa; Marcos Cairo, Vilela; Micheli, Rigon; Henry, Abensur; Maria Rita Elmor de, Araújo.

    2011-11-01

    Full Text Available Lactococcus garvieae, patógeno zoonótico emergente, é responsável por mastite em ruminantes e septicemia em peixes. Embora seja considerado oportunista e raramente causar infecções em humanos, sua incidência deve estar subestimada devido à dificuldade do diagnóstico. Há pouquíssimos relatos de osteo [...] mielite, abscesso hepático e peritonite, e apenas nove casos descritos na literatura mundial de endocardite. Relatamos o primeiro caso de endocardite por Lactococcus garvieae da América Latina em paciente portadora de prótese valvar metálica, com quadro de febre diária, calafrios, nodos de Osler e seis hemoculturas positivas para Lactococcus garvieae, que preenchiam os critérios de Duke para o diagnóstico de "endocardite infecciosa definitiva" Abstract in spanish Lactococcus garvieae, patógeno zoonótico emergente, es responsable por mastitis en rumiantes y septicemia en peces. Aunque sea considerado oportunista y raramente cause infecciones en humanos, su incidencia debe estar subestimada debido a la dificultad del diagnóstico. Hay poquísimos relatos de oste [...] omielitis, absceso hepático y peritonitis, y apenas nueve casos descriptos en la literatura mundial de endocarditis. Relatamos el primer caso de endocarditis por Lactococcus garvieae de América Latina en paciente portadora de prótesis valvar metálica, con cuadro de fiebre diaria, escalofríos, nódulos de Osler y seis hemocultivos positivos para Lactococcus garvieae, que llenaban los criterios de Duke para el diagnóstico de "endocarditis infecciosa definitiva" Abstract in english Lactococcus garvieae, an emerging zoonotic pathogen, is responsible for mastitis in rodents and sepsis in fish. Although deemed opportunistic and hardly ever causing infections in humans, its incidence is probably underestimated due to the difficulty in diagnosis. There are very few reports of osteo [...] myelitis, liver abscess, and peritonitis, and only nine cases of endocarditis described in worldwide literature. We describe the first case of Lactococcus garvieae endocarditis in Latin America, in a female patient with metallic prosthetic heart valve who presented with daily fever, chills, Osler nodes and six positive blood cultures for Lactococcus garvieae, which met Duke's criteria for the diagnosis of "definitive infective endocarditis"

  13. Endocarditis por Trichoderma longibrachiatum en paciente con nutrición parenteral domiciliaria / Endocarditis caused by Trichoderma longibrachiatum and parenteral nutrition

    Scientific Electronic Library Online (English)

    Laura I., Rodríguez Peralta; M.ª Reyes, Mañas Vera; Manuel J., García Delgado; Antonio J., Pérez De la Cruz.

    2013-06-01

    Full Text Available La modalidad domiciliaria de la nutrición parenteral (NPD) mejora la calidad de vida de los pacientes, pero tiene complicaciones como infecciones asociadas a catéter (IAC) y complicaciones mecánicas. Presentamos el caso de un paciente con NPD por intestino corto que desarrolla una endocarditis sobre [...] catéter con matices especiales: asentar sobre un catéter abandonado en aurícula derecha y tratarse de una infección con participación de un microorganismo no descrito hasta el momento en esta patología, Trichoderma longibrachiatum. El catéter se extrajo mediante cirugía convencional. En la pieza quirúrgica se aislaron Staphylococcus epidermidis, Ochrobactrum anthropi y Trichoderma longibrachiatum. Combinando el tratamiento antibiótico y la eliminación del foco infeccioso se consiguió la recuperación completa. Ochrobactrum anthropi y Trichoderma longibrachiatum son microorganismos poco habituales, pero que cada vez adquieren mayor relevancia. Aunque no existe acuerdo en el manejo de los catéteres intravasculares "abandonados", es recomendable el seguimiento y eliminarlos en caso de complicación. Abstract in english Home parenteral nutrition (HPN) improves the quality of life of the patients although it has complications. Catheter-related infections and mechanical complications are the most frequent ones. We report the case of endocarditis over catheter in a man suffering from short bowel and receiving HPN. The [...] special features of the case are firstly the catheter was a remaining fragment on the right atrial and secondly the infection was caused by Trichoderma longibrachiatum, an isolated fact regarding this pathology so far. Conventional surgery was applied to take the catheter out. Staphylococcus epidermidis, Ochrobactrum anthropi and Trichoderma longibrachiatum were isolated from the surgical specimen. The extraction of the infected catheter along with antibiotic therapy led to the complete recovery of the subject. Ochrobactrum anthropi and Trichoderma longibrachiatum are unusual microorganisms but they are acquiring more relevance. Although there is no agreement about intravascular retained catheter management, the most recommended approach consists on monitoring them and removing the device in case of complications.

  14. Löffler endocarditis with multiple cerebral embolism.

    Science.gov (United States)

    Wang, Shuzhen; Wang, Aiqin; Guo, Bin; Zhu, Shaowei; Chi, Zhaofu; Zhao, Xiuhe

    2014-07-01

    Idiopathic hypereosinophilic syndrome is an uncommon leukoproliferative systemic disorder characterized by the sustained eosinophilia and target organ damage. We report the case of a 56-year-old man presenting with multiple cerebral embolism, Löffler endocarditis, and hypereosinophilia. This patient also had pleural, bone marrow, and skin involvement. The unique feature was multifocal embolisms in the brain. PMID:24529355

  15. Nocardial endocarditis of an aortic valve prosthesis.

    OpenAIRE

    Ertl, G.; Schaal, K P; Kochsiek, K

    1987-01-01

    The organism responsible for endocarditis of a prosthetic aortic valve was identified as Nocardia asteroides. The patient was treated with intravenous amikacin (250 mg four times a day) and intravenous imipenem (1.5 g four times a day). The valve was replaced under this new antibiotic regimen. This is the first report of survival after prosthetic valve nocardiosis.

  16. Endocarditis por Streptococcus equi subsp. zooepidemicus

    Directory of Open Access Journals (Sweden)

    Iago Villamil

    2015-04-01

    Full Text Available Las especies Streptococcus equi subsp. equi y S. equi subsp. zooepidemicus son especies zoonóticas típicamente patógenas de animales, especialmente en caballos. Es una causa excepcional de enfermedad en humanos. Presentamos un caso de endocarditis por S. equi subsp. zooepidemicus tras un contacto con equinos, con buena evolución con tratamiento antibiótico.

  17. Trombosis de vena cava inferior y endocarditis en un paciente prematuro: Caso clínico / Inferior vena cava thrombosis and endocarditis in a premature patient: Case report

    Scientific Electronic Library Online (English)

    Andrea, Parra Buitrago; Natalia Andrea, Valencia Zuluaga; Andrés Felipe, Uribe Murillo.

    2014-12-01

    Full Text Available La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. Objetivos: Cara [...] cterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, dada evolución favorable, se decidió continuar manejo médico con terapia anticoagulante por 4-6 semanas, y al alta manejo con aspirina. Conclusiones: El neonato pretérmino con endocarditis infecciosa y trombo intracardiaco presentan un dilema interesante de manejo, por lo cual se debe individualizar el tratamiento según la evolución clínica y el perfil de seguridad de los agentes trombolíticos y/o anticoagulantes. La disponibilidad y las ventajas de la heparina de bajo peso molecular ha dado lugar a su uso como una alternativa de tratamiento en neonatos y niños con trombosis venosa profunda. Abstract in english Thrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. Objectiv [...] es: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis.

  18. Probabilidad diagnóstica de endocarditis infecciosa antes de la realización del ecocardiograma.: Sobreutilización del ecocardiograma transesofágico

    Scientific Electronic Library Online (English)

    GUSTAVO, VIGNOLO; RAúL, CENTURIóN; ANíBAL, MANFREDI; ALEJANDRO, FERREIRO; RUBEN, CANO; MARCELA, VALENTINI; ROSANA, SCARPELLI; CARLOS, CODINA; VIRGINIA, MICHELIS; CARLOS, ROMERO.

    2004-04-01

    Full Text Available RESUMEN El ecocardiograma es una herramienta ampliamente utilizada y de elevado valor para el diagnóstico de endocarditis infecciosa (EI). En nuestro centro hospitalario se indica en forma rutinaria el ecocardiograma transesofágico (ETE) para valorar este diagnóstico y sólo en caso de contraindicaci [...] ón se limita la valoración al ecocardiograma transtorácico (ETT). Objetivo: individualizar criterios clínicos y microbiológicos que permitan identificar una población en la que el ETE aporte información diagnóstica útil, racionalizando su uso. Material y método: registro prospectivo de 116 pacientes referidos para diagnóstico de EI por medio de ETE por el médico tratante. Se comparó el resultado ecocardiográfico con el diagnóstico de cierre de la historia clínica y con el que resultó de la aplicación en los criterios de Duke. Se realizó análisis univariado y multivariado para detectar condiciones clínicas asociadas con el diagnóstico de EI. Resultados: se comprobaron 23 casos de EI como diagnóstico de cierre de la historia clínica, de los cuales 14 fueron EI definida (EID), ocho posibles (EIP) en ausencia de hemocultivos (HC) positivos y uno rechazada, que fue excluida del resto del análisis. El ETE fue positivo en 20 casos (17,2%), que coincidieron con 20 de los casos positivos por cierre de la historia (90,9%). Los dos casos no diagnosticados por ETE fueron diagnosticados por ETT, por lo que el ecocardiograma en conjunto fue positivo en 100% de las EID y de las EI por cierre de la historia. El análisis multivariado mostró que la presencia de cardiopatía predisponente pre ETE, dos o más HC positivos y la ausencia de un foco no endovascular, implica una probabilidad de 88% de EID, en tanto que la ausencia de estos tres elementos implica una probabilidad de 0% de EID o 7,8% de EIP. Conclusiones: existe una sobreindicación de ETE para el diagnóstico de EI. La ausencia dos o más HC positivos, la existencia de cardiopatía predisponente y la ausencia de un foco infeccioso no endovascular podrían implicar la no realización de ETE. Si se hubiera limitado la realización de ETE a los pacientes que cumplieran con estos criterios se hubieran realizado 68 (58,6%) estudios menos inicialmente. Abstract in english SUMMARY Transesophage echocardiogram (ETE) is an efficient tool for infective endocarditis (EI). Objective: to individualize clinical criteria to identify populations in which ETE is efficient to diagnosis. Methods: a prospective study of 116 patients suspected of EI who underwent ETE. Echocardiogra [...] phic results were compared to those obtained by clinical history analysis and Duke criteria. Uni and multivaried analysis were used to determine clinical conditions associated with EI. Results: 23 cases of EI were found as conclusion of clinical history analysis, among them 14 were definitive (EID). ETE was positive in 22 cases (18.96%) included in the 23 cases above-mentioned; ETE was positive for suspected infective endocarditis (EIP) in 8 cases, without positive blood cultures (HC). Multivariate analysis showed that presence of cardiopathy prior to ETE, 2 or more positive HC and lack of non-endovascular focus implies an 88% probability of EID. Lack of these criteria indicates 0% probability of EID and 7.8% probability of EIP. Conclusions: there is an overindicated use of ETE for EI. Lack of 2 or more positive HC, predispositional cardiopathy and lack of infectious non-endovascular focus might imply no use of ETE. If ETE would have been limitated to these criteria, 67.9 (58.5%) could have been saved.

  19. Scintigraphic detection of acute experimental endocarditis with the technetium-99m labelled glycoprotein IIb/IIIa receptor antagonist DMP444

    International Nuclear Information System (INIS)

    Bacterial endocarditis is an important clinical problem that may result in persistent bacteraemia and irreversible cardiac damage. Since endocarditis is characterized by aggregation of activated platelets, fibrin and bacteria, we studied DMP444, a technetium-99m labelled high-affinity antagonist of the GP IIb/IIIa receptor that is expressed on activated platelets. In seven Beagle dogs (11-15 kg), the left ventricle was catheterized via the right carotid artery. One hour later, 5 x 107 colony forming units of Staphylococcus aureus were injected intracardially. Half an hour later, the catheter was removed. Two extra dogs underwent a complete sham procedure. One day after the intervention, five infected and the two non-infected dogs were injected with 37 MBq/kg 99mTc-DMP444 and two infected dogs with 37 MBq/kg 99mTc-IgG (used as a non-specific control agent) and imaged up to 4 h after injection. Samples were obtained for tissue counting, microbiology and histology. From 1 to 2 h post injection onward, there was clear focal accumulation of DMP444 in the aortic valve region when endocarditis was present, and this accumulation increased with time. The non-infected and the 99mTc-IgG injected dogs showed only persisting blood pool activity without any focal abnormality. At 4 h post injection, the in vivo valve-to-blood pool ratios were 1.87±0.18 in endocarditis, 1.01±0.05 in non-infected controls and 1.09±0.02 in 99mTc-IgG injected dogs (P99mTc-labelled GP IIb/IIIa antagonist DMP444 allows a final diagnosis of experimental bacterial endocarditis within 4 h owing to high, specific and fast in vivo uptake. (orig.)

  20. Scintigraphic detection of acute experimental endocarditis with the technetium-99m labelled glycoprotein IIb/IIIa receptor antagonist DMP444

    Energy Technology Data Exchange (ETDEWEB)

    Oyen, W.J.G.; Boerman, O.C.; Corstens, F.H.M. [Department of Nuclear Medicine, University Hospital Nijmegen, Nijmegen (Netherlands); Brouwers, F.M. [Department of Nuclear Medicine, University Hospital Nijmegen, Nijmegen (Netherlands); Department of Internal Medicine, University Hospital Nijmegen, Nijmegen (Netherlands); Barrett, J.A. [DuPont Pharmaceutical Company, Radiopharmaceutical Division, North Billerica, MA (United States); Verheugt, F.W.A. [Department of Cardiology, University Hospital Nijmegen, Nijmegen (Netherlands); Ruiter, D.J. [Department of Pathology, University Hospital Nijmegen, Nijmegen (Netherlands); Meer, J.W.M. van der [Department of Internal Medicine, University Hospital Nijmegen, Nijmegen (Netherlands)

    2000-04-01

    Bacterial endocarditis is an important clinical problem that may result in persistent bacteraemia and irreversible cardiac damage. Since endocarditis is characterized by aggregation of activated platelets, fibrin and bacteria, we studied DMP444, a technetium-99m labelled high-affinity antagonist of the GP IIb/IIIa receptor that is expressed on activated platelets. In seven Beagle dogs (11-15 kg), the left ventricle was catheterized via the right carotid artery. One hour later, 5 x 10{sup 7} colony forming units of Staphylococcus aureus were injected intracardially. Half an hour later, the catheter was removed. Two extra dogs underwent a complete sham procedure. One day after the intervention, five infected and the two non-infected dogs were injected with 37 MBq/kg {sup 99m}Tc-DMP444 and two infected dogs with 37 MBq/kg {sup 99m}Tc-IgG (used as a non-specific control agent) and imaged up to 4 h after injection. Samples were obtained for tissue counting, microbiology and histology. From 1 to 2 h post injection onward, there was clear focal accumulation of DMP444 in the aortic valve region when endocarditis was present, and this accumulation increased with time. The non-infected and the {sup 99m}Tc-IgG injected dogs showed only persisting blood pool activity without any focal abnormality. At 4 h post injection, the in vivo valve-to-blood pool ratios were 1.87{+-}0.18 in endocarditis, 1.01{+-}0.05 in non-infected controls and 1.09{+-}0.02 in {sup 99m}Tc-IgG injected dogs (P<0.05). It is concluded that targeting activated platelets with the {sup 99m}Tc-labelled GP IIb/IIIa antagonist DMP444 allows a final diagnosis of experimental bacterial endocarditis within 4 h owing to high, specific and fast in vivo uptake. (orig.)

  1. Low efficacy of tobramycin in experimental Staphylococcus aureus endocarditis

    DEFF Research Database (Denmark)

    Lerche, Christian Johann; Christophersen, L J; Trøstrup, H; Thomsen, K; Jensen, P Ø; Hougen, H P; Bundgaard, H; Høiby, N; Moser, C

    2015-01-01

    The empiric treatment of infective endocarditis (IE) varies widely and, in some places, a regimen of penicillin in combination with an aminoglycoside is administered. The increasing incidence of Staphylococcus aureus IE, poor tissue penetration by aminoglycosides and low frequency of penicillin......-susceptible S. aureus may potentially lead to functional tobramycin monotherapy. Therefore, this study aimed to evaluate tobramycin monotherapy in an experimental S. aureus IE rat model. Catheter-induced IE at the aortic valves were established with S. aureus (NCTC 8325-4) and rats were randomised into...... was observed at 2 DPI (p ≤ 0.001) but not at 3 DPI. Tobramycin as functional monotherapy only reduced bacterial load and inflammation transiently, and was insufficient in most cases of S. aureus IE....

  2. An atypical temporal sequence for right heart endocarditis: case report.

    Science.gov (United States)

    Manea, Paloma

    2013-06-01

    In 2010, an 82-year-old patient received a diagnosis of stage IV chronic obstructive pulmonary disease, ischemic dilated cardiomyopathy, severe secondary pulmonary hypertension, atrial fibrillation with slow ventricular response, and severe tricuspid regurgitation. In December 2011, he was hospitalized for exacerbation of chronic obstructive pulmonary disease. The patient received antibiotics via injections (for 2 weeks through a peripheral venous catheter). In February 2012, he returned to the hospital with congestive heart failure and vascular purpura skin lesions. The echocardiography examination revealed a rupture of cordage afferent to the septal tricuspid valve. Because blood cultures were sterile after 10 days and no vegetation was revealed, the Duke criteria were not fulfilled. In March 2012, the patient returned with congestive heart failure, fatigue, and anorexia. Echocardiography evaluation then revealed attached septal tricuspid valve vegetation. The Duke criteria were now satisfied. The patient received antibiotics at doses recommended for infective endocarditis, with a favorable outcome. PMID:23803237

  3. Induction of experimental endocarditis by continuous low-grade bacteremia mimicking spontaneous bacteremia in humans.

    Science.gov (United States)

    Veloso, T R; Amiguet, M; Rousson, V; Giddey, M; Vouillamoz, J; Moreillon, P; Entenza, J M

    2011-05-01

    Transient high-grade bacteremia following invasive procedures carries a risk of infective endocarditis (IE). This is supported by experimental endocarditis. On the other hand, case-control studies showed that IE could be caused by cumulative exposure to low-grade bacteremia occurring during daily activities. However, no experimental demonstration of this latter possibility exists. This study investigated the infectivity in animals of continuous low-grade bacteremia compared to that of brief high-grade bacteremia. Rats with aortic vegetations were inoculated with Streptococcus intermedius, Streptococcus gordonii or Staphylococcus aureus (strains Newman and P8). Animals were challenged with 10(3) to 10(6) CFU. Identical bacterial numbers were given by bolus (1 ml in 1 min) or continuous infusion (0.0017 ml/min over 10 h). Bacteremia was 50 to 1,000 times greater after bolus than during continuous inoculation. Streptococcal bolus inoculation of 10(5) CFU infected 63 to 100% vegetations compared to 30 to 71% infection after continuous infusion (P > 0.05). When increasing the inoculum to 10(6) CFU, bolus inoculation infected 100% vegetations and continuous infusion 70 to 100% (P > 0.05). S. aureus bolus injection of 10(3) CFU infected 46 to 57% valves. This was similar to the 53 to 57% infection rates produced by continuous infusion (P > 0.05). Inoculation of 10(4) CFU of S. aureus infected 80 to 100% vegetations after bolus and 60 to 75% after continuous infusion (P > 0.05). These results show that high-level bacteremia is not required to induce experimental endocarditis and support the hypothesis that cumulative exposure to low-grade bacteremia represents a genuine risk of IE in humans. PMID:21321073

  4. Induction of Experimental Endocarditis by Continuous Low-Grade Bacteremia Mimicking Spontaneous Bacteremia in Humans ?

    Science.gov (United States)

    Veloso, T. R.; Amiguet, M.; Rousson, V.; Giddey, M.; Vouillamoz, J.; Moreillon, P.; Entenza, J. M.

    2011-01-01

    Transient high-grade bacteremia following invasive procedures carries a risk of infective endocarditis (IE). This is supported by experimental endocarditis. On the other hand, case-control studies showed that IE could be caused by cumulative exposure to low-grade bacteremia occurring during daily activities. However, no experimental demonstration of this latter possibility exists. This study investigated the infectivity in animals of continuous low-grade bacteremia compared to that of brief high-grade bacteremia. Rats with aortic vegetations were inoculated with Streptococcus intermedius, Streptococcus gordonii or Staphylococcus aureus (strains Newman and P8). Animals were challenged with 103 to 106 CFU. Identical bacterial numbers were given by bolus (1 ml in 1 min) or continuous infusion (0.0017 ml/min over 10 h). Bacteremia was 50 to 1,000 times greater after bolus than during continuous inoculation. Streptococcal bolus inoculation of 105 CFU infected 63 to 100% vegetations compared to 30 to 71% infection after continuous infusion (P > 0.05). When increasing the inoculum to 106 CFU, bolus inoculation infected 100% vegetations and continuous infusion 70 to 100% (P > 0.05). S. aureus bolus injection of 103 CFU infected 46 to 57% valves. This was similar to the 53 to 57% infection rates produced by continuous infusion (P > 0.05). Inoculation of 104 CFU of S. aureus infected 80 to 100% vegetations after bolus and 60 to 75% after continuous infusion (P > 0.05). These results show that high-level bacteremia is not required to induce experimental endocarditis and support the hypothesis that cumulative exposure to low-grade bacteremia represents a genuine risk of IE in humans. PMID:21321073

  5. Comparison of heart valve culture between two Danish endocarditis centres

    DEFF Research Database (Denmark)

    Voldstedlund, Marianne; Fuursted, Kurt; Bruun, Niels Eske; Arpi, Rolf Magnus

    2012-01-01

    Background: 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. Methods: The study included 223 patients with definitive endocarditis undergoing heart valve surgery at 2 Danish endocarditis centres (96 at the East centre and 127 at the West centre). The following data related to the sample...

  6. Subacute bacterial endocarditis (SBE due to Streptococcus gordonii

    Directory of Open Access Journals (Sweden)

    Raffaella Battista

    2009-12-01

    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.

  7. Coxiella burnetii infection.

    Science.gov (United States)

    Kazar, Jan

    2005-12-01

    Coxiella burnetii is an obligate intracellular bacterium that causes a worldwide zoonosis, Q fever, and can be misused as a biological warfare agent. Infection in animals (coxiellosis) is mostly persistent. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia, or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic fatigue syndrome). C. burnetii infection in pregnant women may result in abortions, premature deliveries, and stillbirths. Infection in nature is maintained and transmitted by ticks as the principal vector and reservoir. Cattle, sheep, and goats are the most important source of human infections. Humans contract C. burnetii infection mostly by aerosol in contact with contaminated environs, wind playing an important factor in spreading the infection. The wide distribution of C. burnetii contributes to a high resistance of its extracellular small cell variant to environmental conditions. Its intracellular large cell variant, adapted to survive under harsh conditions of phagolysosomes, enables long-term survival and persistence of C. burnetii, namely in monocytes/macrophages. Host factors such as underlying disease and cell-mediated immunity play a decisive role in the clinical expression of C. burnetii infection. Complete genome analysis of C. burnetii will certainly contribute to better understanding of the pathogenesis of C. burnetii infection and will improve Q fever diagnosis and immunoprophylaxis. PMID:16481501

  8. Native-valve endocarditis due to Candida pulcherrima

    Directory of Open Access Journals (Sweden)

    Antonella D’Andria

    2009-09-01

    Full Text Available Fungal endocarditis (FE is an uncommon disease, an while accounting for only 1.3-6% of all cases of infectious endocarditis, it carries a high mortality risk. Usually occurring in intravenous-drug abusers and prosthetic valve recipients, native-valve endocarditis is rarely reported. Fungal endocarditis in commonly complicated by systemic embolization, and the difficulty in isolating the fungi with routine blood cultures complicates the diagnostic process. In these culture-negative cases of endocarditis, etiologic diagnosis is made with histolopathologic examination of the cardiac valve, embolic materials, and systemic ulcers.The fungal endocarditis is considered an absolute indication for valve replacement.Although Candida albicans represents the main etiology of fungal endocarditis, Candida parapsilosis is the most common non-albicans species. The incidence of endocarditis produced by the so-called “opportunists” is progressively increasing in frequency and gradually transforming the clinical picture habitually associated with this disease. We describe a first case of Candida pulcherrima endocarditis involving the aortic valves, with the patient not survived.

  9. Surgical management of tricuspid valve endocarditis in the current era: A review.

    Science.gov (United States)

    Yong, Matthew S; Coffey, Sean; Prendergast, Bernard D; Marasco, Silvana F; Zimmet, Adam D; McGiffin, David C; Saxena, Pankaj

    2016-01-01

    The incidence of isolated tricuspid valve infective endocarditis is increasing. Medical management is the mainstay of treatment but surgical intervention is required in a subset of patients. Surgical treatment options include valve excision and replacement or valve reconstruction. We searched PubMed and the Cochrane library to identify articles to be included in this review of surgical outcomes. References of selected articles were crosschecked for other relevant studies. Surgical management of tricuspid valve endocarditis can be achieved with satisfactory outcomes. However, the optimal indication and timing of surgery remain unclear, and the frequent association with intravenous drug use complicates management. Repair techniques are preferable though there is no clear evidence supporting one method over another. PMID:26386918

  10. Occult systemic lupus erythematosus with active lupus nephritis presenting as Libman-Sacks endocarditis

    Directory of Open Access Journals (Sweden)

    Pankajkumar Ashok Kasar

    2012-01-01

    Full Text Available The diagnosis of systemic lupus erythematosus (SLE depends on clinical evidence of renal, rheumatologic, cutaneous, and neurologic involvement, supported by serological markers. A previously healthy 14-year-old girl presented with Libman-Sacks endocarditis involving the aortic valve as the first manifestation of SLE. Even though she did not satisfy the American College of Rheumatology criteria for diagnosing SLE, she had anemia, proteinuria, elevated erythrocyte sedimentation rate, low complement 4 (C4 levels, and strongly positive antinuclear antibody titer. A renal biopsy showed stage IV lupus nephritis. Treatment was initiated with immunosuppressants and steroids. This type of presentation may be misdiagnosed as infective endocarditis missing the underlying collagen vascular disease.

  11. [Necrotising endocarditis of mitral valve due to Staphylococcus lugdunensis].

    Science.gov (United States)

    Celebi, Güven; Büyükate?, Mustafa; Do?an, Sait Mesut; Pi?kin, Nihal; Aydemir, Hande; Oztoprak, Nefise; Akta?, Elif; Bekta?, Sibel; Keskin, Ay?egül; Akduman, Deniz

    2009-04-01

    Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis. PMID:19621620

  12. Endocarditis infecciosa, experiencia de diez años en un centro de referencia nacional / Infectious endocarditis, 10 years of experience in a national reference center

    Scientific Electronic Library Online (English)

    Elsa, Fleitas Ruisánchez; Andrés, Savío Benavides; Jorge, Ponce Bittar; Carlos, García Guevara; Xiomara, Calzadilla Mesa.

    2011-12-01

    Full Text Available Objetivo: estudiar las características clínicas, epidemiológicas y microbiológicas, así como el tratamiento médico quirúrgico de los pacientes ingresados con el diagnóstico de endocarditis infecciosa, con el propósito de profundizar en su estudio y contribuir a un mejor tratamiento a estos pacientes [...] . Métodos: se estudiaron 24 pacientes procedentes de todo el país, egresados con el diagnóstico de endocarditis infecciosa. Los datos fueron recogidos de las historias clínicas procedentes del archivo del Hospital "William Soler", y de la base de datos del servicio de cirugía del cardiocentro. Se determinó la frecuencia de las diferentes manifestaciones de la endocarditis infecciosa según: grupos etarios, factores de riesgo, y los datos clínicos, de laboratorio y microbiológicos más frecuentes. Además, se determinó la toma valvular predominante, la etiología y su respuesta a los antibióticos. Resultados: el grupo de edad más afectado fue entre 5 y 18 años; la cardiopatía previa fue el factor de riesgo predominante; los síntomas y signos más frecuentes fueron la fiebre, la anorexia y la pérdida de peso. La insuficiencia cardiaca y el embolismo pulmonar fueron complicaciones frecuentes. La mayoría de los pacientes tuvo una eritrosedimentación acelerada, y la cuarta parte de los casos presentaron hemocultivos negativos. Las válvulas aórtica y mitral resultaron las más afectadas, y el curso clínico que predominó fue el subagudo. En casi la mitad de los pacientes la infección tuvo un origen nosocomial. Los antimicrobianos más utilizados fueron la amikacina, la vancomicina y la ceftriaxona. Conclusiones: la endocarditis infecciosa es poco frecuente en nuestra institución, ocurre más a menudo en relación con las cardiopatías congénitas. Los hechos clínicos más constantes fueron la fiebre y el antecedente de cardiopatía previa. Abstract in english Objective: to study the clinical, epidemiological and microbiological characteristics as well as the surgical medical treatment of patients admitted diagnosed with infectious endocarditis to deepen in its study and to contribute to a better treatment for these patients. Methods: twenty four patients [...] from whole country, discharged with the diagnosis of infectious endocarditis. Data were collect from the medical records of the "William Soler" Children Hospital files and from the database of surgery service of heart center. The frequency of different manifestations of infectious endocarditis was determined according to: age groups, risk factors and the more frequent clinical, laboratory and microbiologic data. Also, the predominant valvular take, the etiology and the response to antibiotics were determined. Results: the more involved age group was between 5 and 18 years; the previous heart disease was the more predominant factor; the more frequent symptoms and signs were: fever, anorexia and weight loss. The heart failure and the pulmonary embolism were frequent complications. Most of patients had an accelerated erythrosedimentation and the fourth of cases had negative blood cultures. The aortic and mitral valves were the more involved and the predominant clinical course was the subacute. In almost the half of patients the infection had a nosocomial origin. The more used antimicrobial agents were amikacin, vancomycin and ceftriaxone. Conclusions: the infectious endocarditis is uncommon in our institution occurs more often in relation to congenital heart diseases. The more constant clinical facts were fever and a history of previous heart disease.

  13. Endocarditis infecciosa, experiencia de diez años en un centro de referencia nacional Infectious endocarditis, 10 years of experience in a national reference center

    Directory of Open Access Journals (Sweden)

    Elsa Fleitas Ruisánchez

    2011-12-01

    Full Text Available Objetivo: estudiar las características clínicas, epidemiológicas y microbiológicas, así como el tratamiento médico quirúrgico de los pacientes ingresados con el diagnóstico de endocarditis infecciosa, con el propósito de profundizar en su estudio y contribuir a un mejor tratamiento a estos pacientes. Métodos: se estudiaron 24 pacientes procedentes de todo el país, egresados con el diagnóstico de endocarditis infecciosa. Los datos fueron recogidos de las historias clínicas procedentes del archivo del Hospital "William Soler", y de la base de datos del servicio de cirugía del cardiocentro. Se determinó la frecuencia de las diferentes manifestaciones de la endocarditis infecciosa según: grupos etarios, factores de riesgo, y los datos clínicos, de laboratorio y microbiológicos más frecuentes. Además, se determinó la toma valvular predominante, la etiología y su respuesta a los antibióticos. Resultados: el grupo de edad más afectado fue entre 5 y 18 años; la cardiopatía previa fue el factor de riesgo predominante; los síntomas y signos más frecuentes fueron la fiebre, la anorexia y la pérdida de peso. La insuficiencia cardiaca y el embolismo pulmonar fueron complicaciones frecuentes. La mayoría de los pacientes tuvo una eritrosedimentación acelerada, y la cuarta parte de los casos presentaron hemocultivos negativos. Las válvulas aórtica y mitral resultaron las más afectadas, y el curso clínico que predominó fue el subagudo. En casi la mitad de los pacientes la infección tuvo un origen nosocomial. Los antimicrobianos más utilizados fueron la amikacina, la vancomicina y la ceftriaxona. Conclusiones: la endocarditis infecciosa es poco frecuente en nuestra institución, ocurre más a menudo en relación con las cardiopatías congénitas. Los hechos clínicos más constantes fueron la fiebre y el antecedente de cardiopatía previa.Objective: to study the clinical, epidemiological and microbiological characteristics as well as the surgical medical treatment of patients admitted diagnosed with infectious endocarditis to deepen in its study and to contribute to a better treatment for these patients. Methods: twenty four patients from whole country, discharged with the diagnosis of infectious endocarditis. Data were collect from the medical records of the "William Soler" Children Hospital files and from the database of surgery service of heart center. The frequency of different manifestations of infectious endocarditis was determined according to: age groups, risk factors and the more frequent clinical, laboratory and microbiologic data. Also, the predominant valvular take, the etiology and the response to antibiotics were determined. Results: the more involved age group was between 5 and 18 years; the previous heart disease was the more predominant factor; the more frequent symptoms and signs were: fever, anorexia and weight loss. The heart failure and the pulmonary embolism were frequent complications. Most of patients had an accelerated erythrosedimentation and the fourth of cases had negative blood cultures. The aortic and mitral valves were the more involved and the predominant clinical course was the subacute. In almost the half of patients the infection had a nosocomial origin. The more used antimicrobial agents were amikacin, vancomycin and ceftriaxone. Conclusions: the infectious endocarditis is uncommon in our institution occurs more often in relation to congenital heart diseases. The more constant clinical facts were fever and a history of previous heart disease.

  14. The Abilities of a Staphylococcus epidermidis Wild-Type Strain and Its Slime-Negative Mutant To Induce Endocarditis in Rabbits Are Comparable

    OpenAIRE

    Perdreau-Remington, Francoise; Sande, Merle A; Peters, Georg; Chambers, Henry F.

    1998-01-01

    The abilities of a parent and mutant pair of Staphylococcus epidermidis strains, the slime-producing parent RP62A and its slime-negative mutant, to establish endocarditis in a rabbit model of aortic valve endocarditis and to accumulate and adhere to surfaces in vitro were compared. Vegetation titer and infection rate depended on the presence or absence of a catheter (P = 0.020) and on inoculum size (P < 0.001) but not on the infecting strain. The ability of the parent strain vis-à-vis its mut...

  15. Propionibacterium acnes prosthetic valve endocarditis with abscess formation: a case report

    Science.gov (United States)

    2014-01-01

    Background Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery. Case presentation We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment. Conclusion To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria. PMID:24568204

  16. Endocardite por Streptococcus gallolyticus em portadora de lúpus eritematoso sistêmico: avaliação pelo ecocardiograma tridimensional / Streptococcus gallolyticus infective endocarditis in a patient with systemic lupus erythematosus: a three-dimensional echocardiography evaluation

    Scientific Electronic Library Online (English)

    Rudyney Eduardo Uchôa de, Azevedo; Ana Clara Tude, Rodrigues; Lucas Arraes de, França; Maria Luciana Zacarias Hannouche da, Trindade; Marcelo Luiz Campos, Vieira; Claudio Henrique, Fischer; Samira Saady, Morhy.

    2013-09-01

    Full Text Available Mulher de 42 anos foi encaminhada ao hospital com história de febre e queda do estado geral há 30 dias. À admissão, apresentava taquicardia e sopro sistólico na região apical. Os exames de laboratório mostraram leucocitose com 13.100/mL, hemoglobina 8,4g/dL e anticorpos positivos para lúpus eritemat [...] oso sistêmico (anti-Ro/SSA, anti-La/SSB, anticardiolipina e anticorpo antinuclear); hemocultura foi positiva para Streptococcus gallolyticus. Foi realizado um ecocardiograma transesofágico tridimensional, que mostrou múltiplas vegetações na valva mitral, com perfuração do folheto e refluxo importante, além de grande vegetação aórtica com perfuração valvar e refluxo importante adicionalmente. Pequena vegetação foi identificada na valva tricúspide, com um refluxo significativo. O emprego da ecocardiografia transesofágica tridimensional proporcionou o diagnóstico de complicações decorrentes de endocardite infecciosa. Abstract in english A 42 year-old woman was referred to our hospital with a history of fever and poor general status for the last 30 days. She presented tachycardia and a systolic apical murmur. Laboratory tests revealed leukocytosis of 13,100/mL, hemoglobin of 8.4g/dL and positive systemic lupus erythematosus antibodi [...] es (anti-Ro/SSA, anti-La/SSB, anticardiolipin, and antinuclear antibodies); blood culture was positive for Streptococcus gallolyticus. Three-dimensional transesophageal echocardiography was performed and revealed multiple mitral valve vegetations, with leaflet perforation and important mitral regurgitation, as well as large aortic vegetation, with cusp perforation and severe regurgitation. Additionally, a small vegetation was observed on the tricuspid valve, which presented moderate regurgitation. Threedimensional transesophageal echocardiography provides appropriate visualization of complications resulting from infectious endocarditis.

  17. Haemophilus aphrophilus Endocarditis after Tongue Piercing

    OpenAIRE

    Akhondi, Hossein; Rahimi, Ali R.

    2002-01-01

    Piercing invades subcutaneous areas and has a high potential for infectious complications. The number of case reports of endocarditis associated with piercing is increasing. We studied a 25-year-old man with a pierced tongue, who arrived at Memorial Health University Medical Center with fever, chills, rigors, and shortness of breath of 6 days duration and had an aortic valvuloplasty for correction of congenital aortic stenosis.

  18. Endocarditis infecciosa en la Unidad de Medicina Intensiva / Infectious endocarditis in the intensive care unit

    Scientific Electronic Library Online (English)

    S., Miranda-Montero; M., Rodríguez-Esteban; L., Álvarez-Acosta; S., Lubillo-Montenegro; H., Pérez-Hernández; R., Llorens-León.

    2012-10-01

    Full Text Available Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Univers [...] itario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37%) ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002) y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041). La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011), así como la proporción de cirugías urgentes (45,8 vs 5,9%, p Abstract in english Objective: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. Design: A prospective, observational cohort study of patients admitted due to infectious endocarditis. Setting: Nuestra Señora de Candelaria Unive [...] rsity Hospital, a third - level center with a recruitment population of 493,145. Patients: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. Study variables: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. Results: Out of 102 patients diagnosed with endocarditis, 38 (37%) were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002) and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041). In turn, mortality was greater (42.1% vs 18.8%, p= 0.011), as was the proportion of emergency surgeries (45.8% vs 5.9%, p

  19. [Infectious endocarditis in a patient with multiple sclerosis--case report].

    Science.gov (United States)

    Prystupa, Andrzej; Mosiewicz, Jerzy

    2003-01-01

    Multiple sclerosis is chronic demyelination disease associated with complex immunological disorders, resulting in increased susceptibility to different infections. A case of woman, aged 40 with multiple sclerosis who was admitted to the Internal Medicine Ward because of severe general state, fever of seven-day duration and systolic murmur in apex area is discussed in this paper. Clinical status and performed diagnostics, among others; echocardiography, blood cultures, abdominal ultrasonography, allowed to diagnose infective endocarditis caused by Enterococcus faecalis. Antibiotics as follows: augmentin, cefuroxim, cefotaxim and vancomycin were administered parenterally. As a result of the treatment normalization of temperature and complete recovery were obtained. PMID:15058172

  20. [Early and Mid-term Outcomes of Prosthetic Valve Endocarditis].

    Science.gov (United States)

    Kin, Hajime; Takanashi, Shuichiro

    2015-10-01

    Prosthetic valve endocarditis (PVE) is associated with high mortality and reoperation rates despite diagnostic and therapeutic improvements. We retrospectively analyzed the data of 35 patients who had undergone reoperative cardiac surgery for PVE in our hospital between January 1, 2005 and December 31, 2014. The mean age of the patients was 68±12 years, and 15( 42%) of those patients were women. Early PVE was defined as PVE that occurred within 1 year after the surgery;12 (34%) patients showed early PVE. The aortic valve was affected in 25;the mitral valve, in 18;and the tricuspid valve, in 2 patients. Streptococcal, staphylococcal, and other infections were observed in 4, 20, and 7 patients, respectively. Aortic valve replacement, mitral valve replacement, double valve replacement, and aortic root reconstruction was performed in 9, 10, 6, and 10, patients, respectively. The 30-day operative and hospital mortality occurred in 4 (11%) patients. All patients who died had developed early PVE and staphylococci infection. The overall 7-year survival and freedom from valve-related reoperation were 63% and 78%, respectively. Surgical management of PVE remains a challenge and is associated with remarkably high morbidity and mortality rates. In our series, early PVE and staphylococcal infection were associated with very poor prognosis. PMID:26469257

  1. Bacterial endocarditis due to eikenella corrodens: A case report

    Directory of Open Access Journals (Sweden)

    Mahapatra A

    2003-01-01

    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.

  2. Acute endocarditis of a percutaneously placed pulmonary valve

    Science.gov (United States)

    Ramakrishnan, Karthik V; Olivieri, Laura; Jonas, Richard A

    2015-01-01

    Endocarditis of percutaneously placed pulmonary valve is increasingly being recognized and reported as a potentially life-threatening complication. In this report, we discuss a 17-year-old male who presented with septic shock secondary to staphylococcal endocarditis of a percutaneously placed pulmonary valve.

  3. Polymicrobial Q Fever and enterococcal aortic prosthetic valve endocarditis with aortic root abscess.

    Science.gov (United States)

    Yahav, Dafna; Kuznitz, Israel; Reisfeld, Sharon; Eliakim-Raz, Noa; Bishara, Jihad

    2015-05-01

    Polymicrobial endocarditis is uncommon. We present a case of polymicrobial endocarditis caused by Enterococcus faecalis and Coxiella burnetii and review previous cases of polymicrobial endocarditis involving Coxiella burnetii. Testing for Q fever should be considered in any patient with endocarditis living in an endemic area. PMID:25988443

  4. Radionuclide Imaging of Cardiovascular Infection.

    Science.gov (United States)

    Ahmed, Fozia Zahir; James, Jackie; Memmott, Matthew J; Arumugam, Parthiban

    2016-02-01

    Owing to expanding clinical indications, cardiac implantable electronic devices (CIEDs) are being increasingly used. Despite improved surgical techniques and the use of prophylactic antimicrobial therapy, the rate of CIED-related infection is also increasing. Infection is a potentially serious complication, with clinical manifestations ranging from surgical site infection and local symptoms in the region of the generator pocket to fulminant endocarditis. The utility of radionuclide imaging as a stand-alone noninvasive diagnostic imaging test in patients with suspected endocarditis has been less frequently examined. This article summarizes the recent advances in radionuclide imaging for evaluation of patients with suspected cardiovascular infections. PMID:26590786

  5. Endocarditis de válvula protésica por Salmonella no tifoidea / Prosthetic Valve Endocarditis due to Non-Typhoid Salmonella

    Scientific Electronic Library Online (English)

    Marta E., Cardús; Romina E., Trossero; Jorge, Curotto Grasiosi; Antonio, Abdala; María J., Torres.

    2013-02-01

    Full Text Available Existen varios factores predisponentes para el desarrollo de endocarditis infecciosa; entre ellos se destacan el antecedente de haber padecido endocarditis infecciosa y el recambio valvular con válvula protésica. La endocarditis infecciosa de válvula protésica producida por Salmonella es una entidad [...] de muy baja incidencia. En esta presentación se describe el caso de una paciente con antecedente de doble recambio valvular, mitral y aórtico, que ingresó con un cuadro de sepsis grave. Se llegó al diagnóstico etiológico de endocarditis infecciosa por Salmonella enteritidis a través de hemocultivos. La paciente tuvo una evolución fulminante y falleció antes de las 24 horas. Abstract in english There are several predisposing factors for the development of infectious endocarditis, among them, the history of infectious endocarditis and prosthetic valve replacement. Infectious endocarditis in prosthetic valve caused by Salmonella is an unusual entity. We report the case of a female patient wi [...] th a history of double-valve mitral and aortic replacement, who was admitted due to severe sepsis. The etiological diagnosis of infectious endocarditis by Salmonella enteritidis was reached through blood cultures. The clinical course was fulminant and she died within the first 24 hours.

  6. Q Fever Endocarditis in Romania: The First Cases Confirmed by Direct Sequencing

    Directory of Open Access Journals (Sweden)

    Monica Straut

    2011-12-01

    Full Text Available Infective endocarditis (IE is a serious, life-threatening disease with highly variable clinical signs, making its diagnostic a real challenge. A diagnosis is readily made if blood cultures are positive, but in 2.5 to 31% of all infective endocarditis cases, routine blood cultures are negative. In such situations, alternative diagnostic approaches are necessary. Coxiella burnetii and Bartonella spp. are the etiological agents of blood culture-negative endocarditis (BCNE most frequently identified by serology. The purpose of this study is to investigate the usefulness of molecular assays, as complementary methods to the conventional serologic methods for the rapid confirmatory diagnostic of Q fever endocarditis in patients with BCNE. Currently, detection of C. burnetii by culture or an antiphase I IgG antibody titers >800 represents a major Duke criterion for defining IE, while a titers of >800 for IgG antibodies to either B. henselae or B. quintana is used for the diagnosis of endocarditis due to Bartonella spp. We used indirect immunofluorescence assays for the detection of IgG titers for C. burnetii, B. henselae and B. quintana in 57 serum samples from patients with clinical suspicion of IE. Thirty three samples originated from BCNE patients, whereas 24 were tested before obtaining the blood cultures results, which finally were positive. The results of serologic testing showed that nine out of 33 BCNE cases exhibited antiphase I C. burnetii IgG antibody titer >800, whereas none has IgG for B. henselae or B. quintana. Subsequently, we used nested-PCR assay for the amplification of C. burnetii DNA in the nine positive serum samples, and we obtained positive PCR results for all analyzed cases. Afterwards we used the DNA sequencing of amplicons for the repetitive element associated to htpAB gene to confirm the results of nested-PCR. The results of sequencing allowed us to confirm that C. burnetii is the causative microorganism responsible for BCNE. In conclusion, the nested PCR amplification followed by direct sequencing is a reliable and accurate method when applied to serum samples, and it may be used as an additional test to the serological methods for the confirmatory diagnosis of BCNE cases determined by C. burnetii.

  7. Clindamycin therapy of experimental Staphylococcus aureus endocarditis.

    OpenAIRE

    Scheld, W. M.; Johnson, M.L.; Gerhardt, E B; Sande, M A

    1982-01-01

    The efficacy of clindamycin in the treatment of experimental endocarditis in rabbits was compared with that of nafcillin. Both drugs were administered intramuscularly three times daily for 5 days, clindamycin at doses of 6.25, 12.5, 25, or 50 mg/kg and nafcillin at a dose of 200 mg/kg. The minimum inhibitory and bactericidal concentrations (0.125 microgram/ml) of clindamycin for the test strain of Staphylococcus aureus were very similar to the corresponding concentrations (0.25 microgram/ml) ...

  8. Is it safe to perform coronary angiography during acute endocarditis?

    Science.gov (United States)

    Kung, Victor W S; Jarral, Omar A; Shipolini, Alex R; McCormack, David J

    2011-08-01

    A best evidence topic was written according to a structured protocol. The question addressed was 'Is it safe to perform coronary angiography (CA) in acute endocarditis?' Three hundred and ninety-seven papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, key results and limitations of these papers are tabulated. One of the papers is a case report, which reported a fatal vegetation embolism from an infected aortic valve into the left main coronary artery 14 h after angiography. The remaining five papers are cohort studies. Four of these studies were performed between 1970 and 1980 before the era of echocardiography and were aimed at quantifying the severity of valvular regurgitation. No embolic complications or dislodgement of vegetations occurred in any of the five studies (186 patients). Guidelines published by the European Society of Cardiology (ESC) in 2009 recommended CA in the context of infective endocarditis (IE) for men >40 years old, postmenopausal women, and patients with at least one cardiovascular risk factor or a history of coronary artery disease. Exceptions include patients with large aortic vegetations which may be dislodged during catheterisation, and when emergency surgery is necessary - 1) native aortic or mitral IE with severe acute regurgitation or valve obstruction, or prosthetic valve IE with severe prosthetic dysfunction (dehiscence or obstruction) causing refractory pulmonary oedema or cardiogenic shock; 2) native aortic, mitral, or prosthetic valve IE with fistula into a cardiac chamber or pericardium causing refractory pulmonary oedema or shock. This is reiterated by the guidelines on the management of valvular heart disease published by the ESC in 2007. From the findings of the six papers, it can be concluded that coronary angiography can be performed safely in IE and should be performed if deemed necessary, unless the patients are haemodynamically unstable requiring emergency surgery, or have large vegetations of the aortic valve. This is consistent with the ESC guidelines. PMID:21602418

  9. Beneficial Influence of Platelets on Antibiotic Efficacy in an In Vitro Model of Staphylococcus aureus-Induced Endocarditis

    OpenAIRE

    Mercier, Renee-Claude; Dietz, Robert M.; Mazzola, Jory L.; Arnold S. Bayer; Yeaman, Michael R.

    2004-01-01

    Platelets contribute to antimicrobial host defense against infective endocarditis (IE) by releasing platelet microbicidal proteins (PMPs). We investigated the influence of thrombin-stimulated human platelets on the evolution of simulated IE in the presence and absence of vancomycin or nafcillin. Staphylococcus aureus strains differing in intrinsic susceptibility to PMPs or antibiotics were studied: ISP479C (thrombin-induced PMP-1 [tPMP-1] susceptible; nafcillin and vancomycin susceptible), IS...

  10. Tratamento clínico de endocardite em prótese valvar complicada por abscesso para-protético / Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess

    Scientific Electronic Library Online (English)

    Maria do Carmo Pereira, Nunes; Claudio Leo, Gelape; Felipe Batista Lima, Barbosa; Luciano Ribeiro, Leduc; Christiano Gonçalves de, Araújo; Lucas Fabel, Chalup; Marcela Ferreira, Nicoliello; Teresa Cristina Abreu, Ferrari.

    2009-09-01

    Full Text Available O presente artigo relata o caso de um paciente do sexo masculino, 44 anos, com endocardite em prótese aórtica complicada por abscesso para-protético. Evoluiu com melhora do processo infeccioso apenas com o tratamento clínico. História prévia de doença reumática, submetido a três cirurgias cardíacas [...] para troca valvar por disfunção de prótese e endocardite prévia. Neste relato de caso, discutiremos as características principais do abscesso para-protético como complicação de endocardite Abstract in english We present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valv [...] e replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditis

  11. Tratamento clínico de endocardite em prótese valvar complicada por abscesso para-protético Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Pereira Nunes

    2009-09-01

    Full Text Available O presente artigo relata o caso de um paciente do sexo masculino, 44 anos, com endocardite em prótese aórtica complicada por abscesso para-protético. Evoluiu com melhora do processo infeccioso apenas com o tratamento clínico. História prévia de doença reumática, submetido a três cirurgias cardíacas para troca valvar por disfunção de prótese e endocardite prévia. Neste relato de caso, discutiremos as características principais do abscesso para-protético como complicação de endocarditeWe present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valve replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditis

  12. Use of extracellular matrix materials in patients with endocarditis.

    Science.gov (United States)

    Sündermann, Simon Harald; Rodriguez Cetina Biefer, Héctor; Emmert, Maximilian Y; Falk, Volkmar

    2014-02-01

    Tissue replacement is sometimes necessary during surgery for endocarditis. Commonly used materials are Dacron, expanded polytetrafluoroethlyene, or bovine pericardium. Those materials have no potential for bioresorption and cannot restore regional functionality. Extracellular matrices became available lately as patch material. Here we present two cases of patients with endocarditis. CorMatrix ECM (CorMatrix Cardiovascular, Inc., Atlanta, Georgia, United States) was used to repair intracardiac structures with good results in follow-up up to 3 months. CorMatrix ECM may be an adequate alternative to foreign material for patients with endocarditis. PMID:23143861

  13. Endocarditis-associated Brain Lesions in Slaughter Pigs

    DEFF Research Database (Denmark)

    Karstrup, C.C.; Jensen, H.E.; Aalbæk, B.; Leifsson, P.S.; Boye, Mette; Agerholm, J.S.

    2011-01-01

    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...

  14. Endocardite infecciosa: uma suspeita sempre presente / Infectious endocarditis: an ever-present suspicion

    Scientific Electronic Library Online (English)

    Ana Santos, Ferreira.

    2013-01-01

    Full Text Available Introdução: O diagnóstico de endocardite infecciosa requer um elevado grau de suspeição para ser estabelecido atempadamente. O médico de família, conhecendo os fatores de risco de cada doente, está numa posição privilegiada para a suspeita clínica de endocardite, podendo desempenhar um papel fulcral [...] no diagnóstico desta patologia. Descrição do Caso: Manuel, utente de 59 anos acompanhado na nossa consulta desde 2007, tem como antecedentes pessoais 3 episódios prévios de endocardite infecciosa, dois dos quais associados a prótese valvular colocada na sequência do primeiro episódio. Foi acompanhado na nossa consulta por um quadro de síndrome febril indeterminado, associado a parâmetros inflamatórios elevados, com dois ecocardiogramas negativos realizados a nível hospitalar. Por se tratar de um utente de risco elevado para recorrência de endocardite infecciosa, a médica de família nunca abandonou esta hipótese diagnóstica. Perante o quadro, pediu hemoculturas em ambulatório, que foram positivas para Enterococos faecalis. O doente foi novamente enviado ao hospital, desta vez realizando um ecocardiograma que revelou vegetação, tendo-se estabelecido o diagnóstico definitivo de endocardite infecciosa 20 dias após o início do quadro clínico. Foi internado e cumpriu antibioterapia. Contudo, no início do segundo mês de internamento, teve um episódio de AVC hemorrágico, tendo como consequências hemiparesia direita e disartria a longo prazo. Comentário: Apesar de se tratar de uma doença rara, a endocardite infecciosa associada a próteses valvulares está associada a elevada morbimortalidade. A forma de apresentação é variável, estando o médico dependente de um elevado grau de suspeição para conseguir estabelecer o diagnóstico atempadamente, minimizando as sequelas a longo prazo. Os critérios de Duke facilitam o estabelecimento adequado do diagnóstico; no entanto a sensibilidade destes critérios diminui em doentes com próteses valvulares. Trata-se de um quadro subagudo de endocardite, necessitando de 20 dias para se estabelecer o diagnóstico final, após o resultado de hemoculturas positivas. Foi a persistência da suspeita diagnóstica que permitiu o diagnóstico atempado. Abstract in english Introduction: An elevated level of suspicion is required to make a timely diagnosis of infective endocarditis. The family physician with knowledge of the risk factors of each patient is in a privileged position to diagnose this disease. Case Description: A 59 year-old male patient with a history of [...] 3 previous episodes of infective endocarditis has been treated in our practice since 2007. Two episodes were associated with a prosthetic valve (a consequence of the first episode). He was seen recently for an episode of fever of unknown origin associated with high serum levels of markers of inflammation. Two echocardiograms performed in hospital were non-diagnostic. The family physician retained a suspicion of infective endocarditis in this high-risk patient. Ambulatory blood cultures were positive for Enterococcus faecalis. The patient was again sent to the hospital and the echocardiogram now revealed a cardiac vegetation, confirming the diagnosis of infective endocarditis, 20 days after the initial onset of symptoms. At the beginning of the second month of his stay at the hospital, the patient suffered a hemorrhagic stroke, leaving him with dysarthria and a right hemiparesis. Discussion: Although infective endocarditis is a rare disease, it has high morbidity and mortality when associated with prosthetic heart valves. The presentation of the disease is variable, so the physician needs a high level of suspicion to make a prompt diagnosis and prevent long-term consequences. The Duke criteria may help with diagnosis. However, the sensitivity of the criteria is reduced in patients with prosthetic valves. This is a sub-acute case of endocarditis, in which the diagnosis was made with positive blood cultures after 20 days of symptoms. Persistent suspicion of endocardit

  15. Molecular characterization of a Streptococcus gallolyticus genomic island encoding a pilus involved in endocarditis.

    OpenAIRE

    Danne, Camille; Entenza, José M; Mallet, Adeline,; Briandet, Romain; Débarbouillé, Michel; Nato, Farida; Glaser, Philippe; Jouvion, Grégory,; Moreillon, Philippe; Trieu-Cuot, Patrick; Dramsi, Shaynoor

    2011-01-01

    BACKGROUND: Streptococcus gallolyticus is a causative agent of infective endocarditis associated with colon cancer. Genome sequence of strain UCN34 revealed the existence of 3 pilus loci (pil1, pil2, and pil3). Pili are long filamentous structures playing a key role as adhesive organelles in many pathogens. The pil1 locus encodes 2 LPXTG proteins (Gallo2178 and Gallo2179) and 1 sortase C (Gallo2177). Gallo2179 displaying a functional collagen-binding domain was referred to as the adhesin, whe...

  16. Failure of vancomycin continuous infusion against experimental endocarditis due to vancomycin-intermediate Staphylococcus aureus.

    Science.gov (United States)

    Entenza, J M; Veloso, T R; Vouillamoz, J; Giddey, M; Moreillon, P

    2011-01-01

    Continuous infusion of vancomycin was evaluated against experimental endocarditis due to heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and VISA. Animals were infected with hVISA PC1 (vancomycin MIC, 2 mg/liter) or VISA PC3 (vancomycin MIC, 8 mg/liter) and treated for 5 days with constant serum levels of 20 or 40 mg/liter. Vancomycin continuous infusion was unsuccessful, as 20 mg/liter was barely active against PC1 (6 of 13 sterile vegetations) and 40 mg/liter failed against PC3 (2 of 9 sterile vegetations). PMID:20956604

  17. Failure of Vancomycin Continuous Infusion against Experimental Endocarditis Due to Vancomycin-Intermediate Staphylococcus aureus ?

    Science.gov (United States)

    Entenza, J. M.; Veloso, T. R.; Vouillamoz, J.; Giddey, M.; Moreillon, P.

    2011-01-01

    Continuous infusion of vancomycin was evaluated against experimental endocarditis due to heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and VISA. Animals were infected with hVISA PC1 (vancomycin MIC, 2 mg/liter) or VISA PC3 (vancomycin MIC, 8 mg/liter) and treated for 5 days with constant serum levels of 20 or 40 mg/liter. Vancomycin continuous infusion was unsuccessful, as 20 mg/liter was barely active against PC1 (6 of 13 sterile vegetations) and 40 mg/liter failed against PC3 (2 of 9 sterile vegetations). PMID:20956604

  18. Ciprofloxacin and rifampin, alone and in combination, for therapy of experimental Staphylococcus aureus endocarditis.

    OpenAIRE

    Kaatz, G.W.; Seo, S.M.; Barriere, S L; Albrecht, L M; Rybak, M. J.

    1989-01-01

    The therapeutic activities of ciprofloxacin (25 mg/kg every 8 h), rifampin (10 mg/kg every 24 h), ciprofloxacin plus rifampin, and vancomycin (17.5 mg/kg every 6 h) were compared by using the rabbit model of Staphylococcus aureus endocarditis. Animals infected with one of two test strains (SA1199 or SA487) were randomized into treatment groups and received 6 days of therapy. For SA1199, ciprofloxacin plus rifampin was most effective at reducing vegetation bacterial counts. For SA487, ciproflo...

  19. [Treatment with caspofungin of Candida tropicalis endocarditis resistant to fluconazol].

    Science.gov (United States)

    del Castillo, Marcelo; Wainsztein, Nestor; Klein, Francisco; Manganello, Silvana; Orellana, Nora

    2004-01-01

    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. PMID:15628305

  20. Infected total knee arthroplasty treatment outcome analysis

    Directory of Open Access Journals (Sweden)

    Radoi?i? Dragan

    2012-01-01

    Full Text Available Background/Aim. Infected total knee arthroplasty (TKA is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA in Belgrade. A total of 654 primary and revised TKAs were performed in the said period. We registered and surgically treated 28 infected TKAs (primary TKAs: MMA - 22, other institutions - 6. The incidence of TKA infection in the MMA was 3.36%. The most common pathogens were: Staphylococcus aureus - 14 (50% cases, and Staph. epidermidis - 3 (10.7% cases. Other isolated pathogens were: Enterococcus faecalis, Klebsiella pneum., Klebsiella spp., Streptoccocus viridans, Seratia spp, Micrococcus luteus and Peptostreptococcus spp. In one case we had mixed anaerobic flora, and in 3 cases cultures were negative. We analyzed diagnostic challenges, risk factors (such as age and previous viscosupplementation and treatment outcomes in our series of infected TKAs. Results. In our series 2 infections healed after iv antibiotics and debridement, 1 patient responded to open debridement with component retention, 4 patients responded fully to one-stage reimplantation, 10 cases responded fully to two-stage reimplantation, 11 patients ended with arthrodesis and we had 1 patient with above knee amputation. Conclusion. Two-stage reimplantation remains gold standard for treatment of infected TKA, and we recommend it as treatment of choice for eradication of infection. The antibiotic loaded spacer prothesis concept in most cases allows infection eradication, good function and high patient satisfaction.

  1. Victim of fashion: Endocarditis after oral piercing.

    Science.gov (United States)

    Dubose, Joseph; Pratt, Jerry W

    2004-01-01

    A case report of endocarditis after tongue piercing is presented. Body piercing is a form of self-expression that is achieving greater acceptance and wider practice in modern society. Even in healthy individuals, significant health risks exist with this type of physical adornment. Despite this fact, no significant regulatory mechanisms are currently in place to guide practitioners of this craft or to protect the recipients of body piercing. Medical professionals should join the American Dental Association in their opposition of the practice of intraoral/perioral piercing and should call for the development of legislation protecting the recipients of such practices, particularly the population of young people in whom this type of body art is becoming increasingly prevalent. PMID:15475098

  2. Septic sacroiliitis revealing an infectious endocarditis.

    Science.gov (United States)

    Mahfoudhi, Madiha; Hariz, Anis; Turki, Sami; Kheder, Adel

    2014-01-01

    We report the case of a 43-year-old man admitted for right hip ache and fever. Physical examination revealed a fever, an ache at the manipulation of the sacroiliac joint and a limitation of abduction and external rotation of the right hip. There was no murmur in cardiac auscultation. No anomaly was found at the conventional radiographs of the sacroiliac joint, while the pelvic MRI confirmed a right sacroiliitis. A sacroiliac puncture with a study of synovial fluid demonstrated the presence of Streptococcus viridans. The blood culture revealed the same germ. Transthoracic and transoesophageal echocardiography confirmed infectious endocarditis with vegetation in the mitral valve. He received penicillin G and gentamicin relayed by pristinamycin because of an allergy to penicillin G with a total duration of treatment of 40?days. His symptoms and the laboratory and radiological tests abnormalities resolved totally with no recurrence. PMID:25123569

  3. Endocarditis infecciosa producida por Bartonella quintana / Infective endocarditis due to Bartonella quintana

    Scientific Electronic Library Online (English)

    Luis, Garré; Walter, Guaraglia; Daniel, Cuatz; Sara, Kaufman; Horacio, Gil; Antonio F., De Rosa.

    2008-04-01

    Full Text Available Presentamos el caso de un hombre de 68 años que ingresó por mareos y sensación de pérdida de la conciencia. El examen clínico reveló una temperatura de 37.5 °C y un soplo de regurgitación mitral. El ecocardiograma mostró una insuficiencia mitral grave con dilatación de las cavidades izquierdas, y el [...] ecocardiograma transesofágico una vegetación en la valva anterior de la mitral. Los hemocultivos demostraron una bacteria Gram-negativa que luego se identificó como Bartonella spp. La PCR demostró que se trataba de una Bartonella quintana. Se trató con gentamicina, doxiciclina y ceftriaxona, evolucionando satisfactoriamente. La insuficiencia mitral remanente espera el tratamiento quirúrgico. Abstract in english We present the clinical case of a man of 68 years who was admitted for dizziness and sensation of loss of conscience. The clinical examination revealed a body temperature of 37.5 °C and a murmur of mitral regurgitation. The echocardiogram showed a severe mitral regurgitation and left cavitie's dilat [...] ation; transesophageal echocardiogram showed a vegetation in the anterior leaflet of the mitral valve. In blood cultures grew a Gram-negative bacteria identified as Bartonella spp. A PCR demonstrated that it was a Bartonella quintana. The patient was treated with gentamicin, doxiciclin and ceftriaxone with satisfactory evolution. The remaining mitral insufficiency awaits surgical treatment.

  4. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis

    Science.gov (United States)

    Makdisi, George; Casciani, Thomas; Wozniak, Thomas C.; Roe, David W.

    2016-01-01

    Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient’s condition, and he was ultimately able to undergo definitive surgery.

  5. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine K; Park, Lawrence; Tong, Steven Y C; Selton-Suty, Christine; Peterson, Gail; Cecchi, Enrico; Afonso, Luis; Habib, Gilbert; Paré, Carlos; Tamin, Syahidah; Dickerman, Stuart; Bayer, Arnold S; Johansson, Magnus C; Chu, Vivian H; Samad, Zainab; Bruun, Niels E; Fowler, Vance G; Crowley, Anna Lisa

    2015-01-01

    BACKGROUND: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS.......001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and...... fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality....

  6. Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis

    OpenAIRE

    Feridoun Sabzi; Reza Faraji

    2016-01-01

    The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium ...

  7. Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

    Directory of Open Access Journals (Sweden)

    Jayashree Purkayastha

    2015-09-01

    Full Text Available Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 0-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicansEchocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and upportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3: 142-145

  8. Identification of clinically relevant nonhemolytic Streptococci on the basis of sequence analysis of 16S-23S intergenic spacer region and partial gdh gene

    DEFF Research Database (Denmark)

    Nielsen, Xiaohui Chen; Justesen, Ulrik Stenz; Dargis, Rimtas; Kemp, Michael; Christensen, Jens Jørgen

    2009-01-01

    Nonhemolytic streptococci (NHS) cause serious infections, such as endocarditis and septicemia. Many conventional phenotypic methods are insufficient for the identification of bacteria in this group to the species level. Genetic analysis has revealed that single-gene analysis is insufficient for the identification of all species in this group of bacteria. The aim of the present study was to establish a method based on sequence analysis of the 16S-23S intergenic spacer (ITS) region and the partial...

  9. Identification of Clinically Relevant Nonhemolytic Streptococci on the Basis of Sequence Analysis of 16S-23S Intergenic Spacer Region and Partial gdh Gene?

    OpenAIRE

    Nielsen, Xiaohui Chen; Justesen, Ulrik Stenz; Dargis, Rimtas; Kemp, Michael; Christensen, Jens Jørgen

    2009-01-01

    Nonhemolytic streptococci (NHS) cause serious infections, such as endocarditis and septicemia. Many conventional phenotypic methods are insufficient for the identification of bacteria in this group to the species level. Genetic analysis has revealed that single-gene analysis is insufficient for the identification of all species in this group of bacteria. The aim of the present study was to establish a method based on sequence analysis of the 16S-23S intergenic spacer (ITS) region and the part...

  10. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

    Directory of Open Access Journals (Sweden)

    F. Compain

    2015-11-01

    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.

  11. Efficacy of clarithromycin versus that of clindamycin for single-dose prophylaxis of experimental streptococcal endocarditis.

    OpenAIRE

    Vermot, D; Entenza, J.M.; Vouillamoz, J.; Glauser, M. P.; Moreillon, P.

    1996-01-01

    Clarithromycin is compared with clindamycin for single-dose prophylaxis of streptococcal endocarditis in rats. Human-like kinetics of the two antibiotics prevented endocarditis in animals challenged with both small and large amounts of bacterial inocula. Clarithromycin was marginally superior to clindamycin against small amounts of inocula. Clarithromycin may be considered for endocarditis chemoprophylaxis in human.

  12. Clinical analysis of deep neck space infections

    International Nuclear Information System (INIS)

    Deep neck space infections, which affect soft tissues and fascial compartments of the head and neck, can lead to lethal complications unless treated carefully and quickly, even with the advanced antibiotics available. We reviewed our seventeen patients with deep neck abscesses, analyzed their location by reviewing CT images, and discussed the treatment. Deep neck space infections were classified according to the degree of diffusion of infection diagnosed by CT images. Neck space infection in two cases was localized to the upper neck space above the hyoid bone (Stage I). Neck space infection in 12 cases extended to the lower neck space (Stage II), and further extended to the mediastinum in one case (Stage III). The two cases of Stage I and the four cases of Stage II were managed with incision and drainage through a submental approach. The seven cases of Stage II were managed with incision and drainage parallel to the anterior border of the sternocleidomastoid muscle, the ''Dean'' approach. The one case of Stage III received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphodal incision. The parapharyngeal space played an important role in that the inflammatory change can spread to the neck space inferiorly. The anterior cervical space in the infrahyoid neck was important for mediastinal extension of parapharyngeal abscesses. It is important to diagnose deep neck space infections promptly and treat them adequately, and contrast-enhanced CT is useful and indispensable for diagnosis. The point is which kind of drainage has to be performed. If the surgical method of drainage is chosen according to the level of involvement in the neck space and mediastinum, excellent results may be obtained in terms of survival and morbidity. (author)

  13. Tratamento cirúrgico da endocardite infecciosa Surgical treatment of infeccious endocarditis

    Directory of Open Access Journals (Sweden)

    Antoninho S Arnoni

    1992-06-01

    Full Text Available De janeiro de 1987 a janeiro de 1992, 105 pacientes portadores de endocardite foram submetidos a tratamento cirúrgico. Sessenta e quatro eram do sexo masculino e 41 do feminino. A idade média foi de 35,7 anos e o peso médio de 55,45 kg. Quarenta e cinco pacientes apresentavam acometimento da valva aórtica, sendo 32 na nativa e 12 em próteses anteriormente implantadas (6 metálicas e 6 biológicas. Na correção, foram utilizadas sete próteses biológicas e 37 metálicas. O caso restante foi de plastia da valva. Doze pacientes necessitaram correção de abcessos que comprometiam o anel e as estruturas adjacentes. A endocardite na mitral foi tratada em 34 pacientes, sendo 18 na valva nativa e 16 em próteses artificiais, com um deles apresentando abcesso, que destruiu parte do anel valvar, e necessitando correção com pericárdio bovino, para posterior implante da prótese. Nesses pacientes fizemos 2 plastias e utilizamos 24 próteses biológicas e 8 metálicas. Em 18 pacientes, tanto a mitral como a aórtica estavam comprometidas, sendo 11 vezes nas valvas nativas, 6 em prótese biológica mitral com metálica aórtica e 1 vez com portador de prótese biológica mitral e aorta nativa. Em 11 deles usou-se prótese biológica mitral e metálica aórtica, em 4 prótese metálica em ambas as posições, em 1 prótese biológica nas 2 posições e, nos 2 casos restantes, plastia de 1 valva associada à prótese da outra. Em 1 dos pacientes que apresentava abcesso tanto na mitral como na aórtica, usou-se retalho único de pericárdio bovino, para corrigir os abcessos, e as próteses foram implantadas parcialmente nesse retalho. Os 8 restantes apresentavam endocardite em cardiopatias congênitas (6 casos, em fio de marcapasso endovitário (1 caso e nas 3 valvas (mitro-aórtico-tricuspídeo 1 caso. A mortalidade cirúrgica foi de 18,09%, a maioria por síndrome de baixo débito ou septicemia. As endocardites em posição mitral tiveram o maior índice de mortalidade (23,5% e as da posição aórtica o menor (15,5%, com os mitro-aórticos tendo uma mortalidade de 16,6%. A cirurgia para endocardite tem apresentado melhoria nos resultados, principalmente depois que os cirurgiões tornaram-se mais agressivos, retirando todo o tecido infectado, com amplas ressecções e corrigindo todos os defeitos adicionais, procurando restaurar a integridade do coração e a função valvar.From January 1987 to January 1992,105 patients (64 males; age x 35.7 years were referred to surgery due to valvar edocarditis. Forty-five patients had the aortic valve involved (32 in the native valve and 12 in a prosthesis previously implanted (6 metalic and 6 biological and 1 case of previous valve suture. Twelve patients needed removal of abscess on the valve which was compromising the valvar ring and contiguous structures. Endocarditis in the mitral valve was treated in 34 patients (18 in native valve and 16 in artificial prosthesis. In such patients we performed 2 sutures of the valves and implanted 24 biological and 8 metalic valves. Involvement of both mitral and aortic apparatus, was present in 18 cases. In such patients, 11 received biological prosthesis in mitral position, and metalic prosthesis in aortic position. One of these cases, that presented an abscess in both mitral and aortic valve, received a single patch of bovinum pericardium and the prosthesis were partially implanted in such patch. The remained 8 cases presented endocarditis in congenital heart disease (6 cases, in pacemaker electrode (1 case and 1 case in the 3 valves (aortic, mitral and tricuspid. The in-hosipital mortality rate was: 18% (23.5% to mitral; 15.5% to aortic and 16.6% to mitral-aortic valves endocarditis. We concluded that surgery for endocarditis has improved the results, mainly after surgeons became more aggressive pulling out the infected tissue with great resections and correcting the additional deffects, in an attempt to restore the heart integrity and valvular function.

  14. Genome Sequence of Streptococcus gallolyticus: Insights into Its Adaptation to the Bovine Rumen and Its Ability To Cause Endocarditis ▿ †

    OpenAIRE

    Rusniok, Christophe; Couvé, Elisabeth; Da Cunha, Violette; El Gana, Rachida; Zidane, Nora; Bouchier, Christiane; Poyart, Claire; Leclercq, Roland; Trieu-Cuot, Patrick,; Glaser, Philippe

    2010-01-01

    Streptococcus gallolyticus (formerly known as Streptococcus bovis biotype I) is an increasing cause of endocarditis among streptococci and frequently associated with colon cancer. S. gallolyticus is part of the rumen flora but also a cause of disease in ruminants as well as in birds. Here we report the complete nucleotide sequence of strain UCN34, responsible for endocarditis in a patient also suffering from colon cancer. Analysis of the 2,239 proteins encoded by its 2,350-kb-long genome reve...

  15. Endocarditis por Brucella abortus: Reporte del primer caso en C.R / Brucella abortus Endocarditis

    Scientific Electronic Library Online (English)

    Manuel Antonio, Villalobos-Zúñiga; Edith, Barrantes-Valverde; Patricia, Monge-Ortega.

    2011-09-01

    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 v [...] álvula 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. Abstract in english 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.

  16. Endocarditis por Brucella abortus: Reporte del primer caso en C.R Brucella abortus Endocarditis

    Directory of Open Access Journals (Sweden)

    Manuel Antonio Villalobos-Zúñiga

    2011-09-01

    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.

  17. Endocarditis infecciosa sobre electrodo de marcapasos permanente Infectious Endocarditis on electrode of permanent pacemaker

    Directory of Open Access Journals (Sweden)

    Raúl Reyes Sánchez

    2010-12-01

    Full Text Available Se presenta el caso clínico de un anciano de 84 años, con antecedentes de cardiopatía isquémica crónica, que fue remitido a la consulta de cardiología (para atender a los pacientes con marcapasos y arritmias del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, donde se le diagnosticó una disfunción sinusal y se le colocó un marcapasos permanente. Un mes después comenzó a presentar fiebre y otras manifestaciones clínicas de modo que reingresó por sospecha de endocarditis infecciosa aguda en la cavidad derecha, relacionada con la implantación del dispositivo intracardíaco, lo cual fue confirmado con los resultados de los hemocultivos y ecocardiogramas efectuados. El paciente evolucionó desfavorablemente y falleció.The case report of a 84 year-old elderly is presented, with history of chronic ischemic heart disease that was referred to the cardiology visit (to assist the patients with pacemakers and arrhythmias of "Saturnino Lora" Teaching Provincial Hospital in Santiago de Cuba, where he was diagnosed a sinusal dysfuntion and he was inserted a permanent pacemaker. One month later he began to present fever and other clinical manifestations so that he was readmitted due to suspicion of acute infectious endocarditis in the right cavity, related to the placing of the intracardiac device, which was confirmed with the results of the hemoculture and echocardiograms. The clinical course of the patient was unfavorable and he died.

  18. The uptake of apoptotic cells drives Coxiella burnetii replication and macrophage polarization: a model for Q fever endocarditis.

    Science.gov (United States)

    Benoit, Marie; Ghigo, Eric; Capo, Christian; Raoult, Didier; Mege, Jean-Louis

    2008-05-01

    Patients with valvulopathy have the highest risk to develop infective endocarditis (IE), although the relationship between valvulopathy and IE is not clearly understood. Q fever endocarditis, an IE due to Coxiella burnetii, is accompanied by immune impairment. Patients with valvulopathy exhibited increased levels of circulating apoptotic leukocytes, as determined by the measurement of active caspases and nucleosome determination. The binding of apoptotic cells to monocytes and macrophages, the hosts of C. burnetii, may be responsible for the immune impairment observed in Q fever endocarditis. Apoptotic lymphocytes (AL) increased C. burnetii replication in monocytes and monocyte-derived macrophages in a cell-contact dependent manner, as determined by quantitative PCR and immunofluorescence. AL binding induced a M2 program in monocytes and macrophages stimulated with C. burnetii as determined by a cDNA chip containing 440 arrayed sequences and functional tests, but this program was in part different in monocytes and macrophages. While monocytes that had bound AL released high levels of IL-10 and IL-6, low levels of TNF and increased CD14 expression, macrophages that had bound AL released high levels of TGF-beta1 and expressed mannose receptor. The neutralization of IL-10 and TGF-beta1 prevented the replication of C. burnetii due to the binding of AL, suggesting that they were critically involved in bacterial replication. In contrast, the binding of necrotic cells to monocytes and macrophages led to C. burnetii killing and typical M1 polarization. Finally, interferon-gamma corrected the immune deactivation induced by apoptotic cells: it prevented the replication of C. burnetii and re-directed monocytes and macrophages toward a M1 program, which was deleterious for C. burnetii. We suggest that leukocyte apoptosis associated with valvulopathy may be critical for the pathogenesis of Q fever endocarditis by deactivating immune cells and creating a favorable environment for bacterial persistence. PMID:18483547

  19. Bartonella (Rochalimaea) quintana infections.

    OpenAIRE

    Maurin, M; Raoult, D.

    1996-01-01

    Bartonella (formerly Rochalimaea) quintana is the etiological agent of trench fever, a disease extensively reported during the World Wars. Recent molecular biology approaches have allowed dramatic extension of the spectrum of Bartonella infections. B. quintana is now also recognized as an etiological agent of fever and bacteremia, endocarditis, bacillary angiomatosis, and chronic lymphadenopathy. Human immunodeficiency virus-infected patients and/or homeless people are the most vulnerable to ...

  20. Systems analysis of West Nile virus infection

    OpenAIRE

    Suthar, Mehul S.; Pulendran, Bali

    2014-01-01

    Emerging and re-emerging mosquito-borne viruses continue to pose a significant threat to human health throughout the world. Over the past decade, West Nile virus (WNV), Dengue virus (DENV), and Chikungunya virus (CHIKV), have caused annual epidemics of virus-induced encephalitis, hemorrhagic fever\\shock syndromes, and arthritis, respectively. Currently, no specific antiviral therapies or vaccines exist for use in humans to combat or prevent these viral infections. Thus, there is a pressing ne...

  1. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H; Vejlstrup, Niels; Bundgaard, Henning; Søndergaard, Lars; Ihlemann, Nikolaj

    2015-01-01

    BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural......%) 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...

  2. Comparison of heart valve culture between two Danish endocarditis centres

    DEFF Research Database (Denmark)

    Voldstedlund, Marianne; Fuursted, Kurt; Bruun, Niels Eske; Arpi, Rolf Magnus

    2012-01-01

    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....

  3. Pulmonary infections after kidney transplantation: analysis of CT findings

    International Nuclear Information System (INIS)

    Objective: To review the CT findings in patients with pulmonary infection after kidney transplantation and to determine the characteristic features in different infections. Methods: The medical records were reviewed in 446 patients with pulmonary infection after kidney transplantation and 121 patients who had pulmonary thin-section CT were included in this study. The pattern and distribution of the pulmonary abnormalities were interpreted independently by two thoracic radiologists. Statistical analysis was performed using the ?2 test and the Fisher's exact test. Results: (1) Time course: 65 (14.6%) patients initially had pulmonary infection in the first 30 days, 147 (32.9%) between 1 and 3 months, 91 (20.4%) between 3 and 6 months, 23 (5.2%) between 6 and 12 months, 120 (26.9%)after 12 months of transplantation. In the first month after procedure, bacterial infection (4/5,80.0%) was the most common infection, bacterial (34/41,82.9%), mixed (19/41,46.3%) and vires infections (11/41,26.8%) were seen commonly 1 to 6 months following transplant, the incidence of fungal (14/38, 36.8%) and mycobacterial (5/38,13.2%) infections was increased after 12 months of transplantation. (2)Pathogens: Bacterial (34,28%) and mixed infections (34,28%) were the most common, followed by fungus infection (9, 7%), TB(7,6%)and cytomegalovims (5,4%). (3)CT findings: Ground-glass attenuations (69,57.0%) was the most common findings of pneumonia, followed by reticular or linear opacities (68,56.2%), nodules (66,54.5%), pleural thickening (41,33.9%), consolidations (31,25.6%), tree-in-bud patterns (24, 19.8%), pleural effusion (22,18.2%), and bronchovascular bundle thickening (16,13.2%). Ground-glass attenuation was commonly seen in cytomegalovims pneumonia (4,80.0%), and nodule was commonly observed in bacterial infection (23,67.6%), tree-in-bud pattern was the most common finding in pulmonary tuberculosis(4, P=0.049). There were no statistically significant differences in the prevalence of other CT patterns (P>0.05). Conclusions: The peak incidence of pulmonary infection is in the 3 month after renal transplantation and bacterial infection is the most common. The CT diagnosis of infection can be made by combining the time course of infection, clinical laboratory data and lesion distribution. (authors)

  4. Meta-analysis of Chicken – Salmonella infection experiments

    Directory of Open Access Journals (Sweden)

    te Pas Marinus FW

    2012-04-01

    Full Text Available Abstract Background Chicken meat and eggs can be a source of human zoonotic pathogens, especially Salmonella species. These food items contain a potential hazard for humans. Chickens lines differ in susceptibility for Salmonella and can harbor Salmonella pathogens without showing clinical signs of illness. Many investigations including genomic studies have examined the mechanisms how chickens react to infection. Apart from the innate immune response, many physiological mechanisms and pathways are reported to be involved in the chicken host response to Salmonella infection. The objective of this study was to perform a meta-analysis of diverse experiments to identify general and host specific mechanisms to the Salmonella challenge. Results Diverse chicken lines differing in susceptibility to Salmonella infection were challenged with different Salmonella serovars at several time points. Various tissues were sampled at different time points post-infection, and resulting host transcriptional differences investigated using different microarray platforms. The meta-analysis was performed with the R-package metaMA to create lists of differentially regulated genes. These gene lists showed many similarities for different chicken breeds and tissues, and also for different Salmonella serovars measured at different times post infection. Functional biological analysis of these differentially expressed gene lists revealed several common mechanisms for the chicken host response to Salmonella infection. The meta-analysis-specific genes (i.e. genes found differentially expressed only in the meta-analysis confirmed and expanded the biological functional mechanisms. Conclusions The meta-analysis combination of heterogeneous expression profiling data provided useful insights into the common metabolic pathways and functions of different chicken lines infected with different Salmonella serovars.

  5. Use of autologous pericardium for mitral leaflet reconstruction in a child with endocarditis / Uso de pericárdio autólogo para reconstrução de folheto mitral em criança com endocardite

    Scientific Electronic Library Online (English)

    Olcay Murat, Disli; Cemsit, Karakurt; Nevzat, Erdil; Bektas, Battaloglu.

    2013-06-01

    Full Text Available Apresentamos um caso de reparo bem-sucedido da valva mitral decorrente de endocardite infecciosa ativa. Reparo da valva mitral foi acompanhado de desbridamento da vegetação e do abscesso, ressecção e plastia do folheto mitral posterior, e anuloplastia posterior com pericárdio autólogo. Pós-operatóri [...] o sem evidências de infecção recorrente, e ecocardiograma demonstrou competência da valva mitral com regurgitação mitral trivial. Concluímos que o reparo valvar é uma escolha viável em caso de endocardite ativa nas crianças. Abstract in english We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period w [...] as uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.

  6. Infective Endocarditis and Phlebotomies May Have Killed Mozart

    OpenAIRE

    Lee, Simon Jong-Koo

    2010-01-01

    Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fe...

  7. Neuralgic amyotrophy as a presenting feature of infective endocarditis

    OpenAIRE

    English, P; Maciver, D

    2000-01-01

    A 35 year old man presented to his general practitioner with severe right shoulder pain and subsequent weakness and wasting of the muscles in the affected shoulder girdle three weeks after a dental filling. His symptoms persisted despite standard treatment. He developed malaise, night sweats, weight loss, a petechial rash and a microcytic anaemia. On admission to hospital three months after the start of his symptoms he had also developed splenomegaly and the murmur of aortic regurgitation. In...

  8. Bacterial infections complicating tongue piercing

    OpenAIRE

    Yu, Catherine HY; Minnema, Brian J.; Gold, Wayne L

    2010-01-01

    Tongue piercing has become an increasingly popular form of body art. However, this procedure can occasionally be complicated by serious bacterial infections. The present article reports a case of prosthetic valve endocarditis caused by a Gemella species in a patient with a pierced tongue, and reviews 18 additional cases of local and systemic bacterial infections associated with tongue piercing. Infections localized to the oral cavity and head and neck region included molar abscess, glossal ab...

  9. Efficacy of ciprofloxacin in experimental aortic valve endocarditis caused by a multiply beta-lactam-resistant variant of Pseudomonas aeruginosa stably derepressed for beta-lactamase production.

    OpenAIRE

    Bayer, A S; Lindsay, P; Yih, J; Hirano, L; LEE, D.; Blomquist, I K

    1986-01-01

    The emergence of multi-beta-lactam resistance is a limiting factor in treating invasive Pseudomonas infections with newer cephalosporins. The in vivo efficacy of ciprofloxacin, a new carboxy-quinolone, was evaluated in experimental aortic valve endocarditis caused by a strain of Pseudomonas aeruginosa which is stably derepressed for beta-lactamase production and is resistant to ceftazidime and multiple other beta-lactam agents. A total of 51 catheterized rabbits with aortic catheters in place...

  10. Endocarditis fatal con localización mitral producida por Erysipelothrix rhusiopathiae / Fatal mitral valve endocarditis by Erysipelothrix rhusiopathiae

    Scientific Electronic Library Online (English)

    G.V., Vallespi; D.A., Pipet; S.A., Mattoni; H.A., Lopardo.

    2005-06-01

    Full Text Available Se describe un caso fatal de endocarditis en válvula mitral por Erysipelothrix rhusiopathiae, en un paciente varón de 45 años con antecedentes de etilismo crónico y sin contacto previo con animales. Presentaba un síndrome febril prolongado con poliartralgias, pérdida de peso y dolor en región lumbar [...] y miembros inferiores. Los hemocultivos (2/2) fueron positivos a las 48 hs. de incubación y en el examen directo se observaron bacilos gram-positivos pleomórficos. En el subcultivo en agar sangre ovina al 5% desarrollaron colonias puntiformes con alfa hemólisis, catalasa y oxidasa negativas, PYR y LAP positivas y con producción de H2S en medio TSI. La cepa aislada fue identificada como E. rhusiopathiae de acuerdo a la metodología convencional y confirmada con API Coryne. El cuadro se asumió como una probable endocarditis demostrada mediante un ecocardiograma transtorácico. Se comenzó el tratamiento endovenoso con ampicilina y gentamicina. El paciente evolucionó favorablemente y se tornó afebril, sin embargo falleció a los 19 días de internación por edema agudo de pulmón. La prueba de sensibilidad por E-test demostró resistencia a vancomicina y gentamicina y sensibilidad a penicilina y cefotaxima. Es importante valorar los aislamientos de bacilos gram-positivos pleomórficos, catalasa y oxidasa negativos y realizar la prueba de producción de SH2 en el medio TSI. La resistencia a vancomicina ayuda a la identificación y permite establecer una correcta terapia antimicrobiana. Si bien se considera que las infecciones por E. rhusiopathiae son de carácter ocupacional, el contacto con cerdos u otros animales puede no ser evidente. Abstract in english A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis is described in a 45 years old male, with a history of chronic alcohol abuse and without animals contact. He presented intermittent fever, polyarthralgia, weight loss, and low back pain. In blood cultures (2 bottles), gram-positi [...] ve pleomorphic rods grew after 48 hours of incubation. The subculture on blood agar media showed a small, alpha-hemolytic colony, catalase and oxidase negative, PYR and LAP positive and the production of H2S in triple sugar iron agar, was demonstrated. The isolate was initially identified as E. rhusiopathiae, and confirmed by API Coryne (BioMérieux). On the basis of these findings and a transthoracic echocardiogram, an endocarditis was confirmed. Intravenous ampicillin and gentamicin treatment was initiated. The patient became afever, nevertheless he died on day 19 after admission as a consequence of acute pulmonary edema. Susceptibility testing by E-test showed that the microorganism was resistant to vancomycin and gentamicin, and susceptible to penicillin and cefotaxime. We emphasize the importance to consider the isolates of gram-positive pleomorphic rods, catalase and oxidase negative, and the addition of H2S production test in TSI medium. Vancomycin-resistance helps in the identification, and to establish the correct antimicrobial therapy. Although E. rhusiopathiae is usually reported as an occupational pathogen, the contact with pigs and other farm animals may be underestimated.

  11. A case of infectious endocarditis due to BCG

    Directory of Open Access Journals (Sweden)

    Alice Fournier

    2015-06-01

    Full Text Available The occurrence of bacillus Calmette–Guérin (BCG disease following instillation for bladder cancer is commonly documented. The intravesical administration of BCG is generally safe, but may present severe complications. A fatal case of native aortic valve infectious endocarditis with septicemia due to BCG in a patient treated with intravesical instillation is reported herein.

  12. A case of infectious endocarditis due to BCG.

    Science.gov (United States)

    Fournier, Alice; Gouriet, Frédérique; Fournier, Pierre-Edouard; Casalta, Jean-Paul; Saby, Ludivine; Habib, Gilbert; Drancourt, Michel; Raoult, Didier

    2015-06-01

    The occurrence of bacillus Calmette-Guérin (BCG) disease following instillation for bladder cancer is commonly documented. The intravesical administration of BCG is generally safe, but may present severe complications. A fatal case of native aortic valve infectious endocarditis with septicemia due to BCG in a patient treated with intravesical instillation is reported herein. PMID:25869076

  13. Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

    DEFF Research Database (Denmark)

    Pedersen, Karl; Jørgensen, J.C.; Dietz, Hans-Henrik; Andersen, T.H.

    2003-01-01

    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...

  14. Speech Analysis of Throat Infected People Using DSO

    Directory of Open Access Journals (Sweden)

    Dr.S.R. Chaudhari,

    2013-09-01

    Full Text Available There are various ways of communication. Two people may communicate with each other through speech, gestures or graphical symbols. Man’s most natural way of communication is through speech. Though writing seems to be important means of communication and written words, appear to be more efficient means of transmitting intelligence, the amount of intelligence exchanged by speech is beyond comparison. Considering the importance of speech ,the speech analysis is carried out .Speech analysis is used in innovative way to find out parameters like Amplitude, frequency, energy and power, when throat gets infected because of viral infections or due to any other cause. Speech quality changes which changes the parameters. An experiment is carried out with the instrument DSO (Digital signal oscilloscope. Speech analysis of normal and infected throat that is performed without any treatment. The word “Hello” pronounced by 4 different persons in Normal health condition and when person when has infected throat. The main aim of this project is to compare signals of speech of normal throat person and infected throat person by analyzing Amplitude and frequency parameters which are obtained from DSO.The instrument set up consist of Input Module with Microphone (ST2108, DSO( Agilent Infiniti Vision 2000 X-Series oscilloscope. FFT software installed in computer for speech recording.

  15. Use of a human-like low-grade bacteremia model of experimental endocarditis to study the role of Staphylococcus aureus adhesins and platelet aggregation in early endocarditis.

    Science.gov (United States)

    Veloso, Tiago Rafael; Chaouch, Aziz; Roger, Thierry; Giddey, Marlyse; Vouillamoz, Jacques; Majcherczyk, Paul; Que, Yok-Ai; Rousson, Valentin; Moreillon, Philippe; Entenza, José Manuel

    2013-03-01

    Animal models of infective endocarditis (IE) induced by high-grade bacteremia revealed the pathogenic roles of Staphylococcus aureus surface adhesins and platelet aggregation in the infection process. In humans, however, S. aureus IE possibly occurs through repeated bouts of low-grade bacteremia from a colonized site or intravenous device. Here we used a rat model of IE induced by continuous low-grade bacteremia to explore further the contributions of S. aureus virulence factors to the initiation of IE. Rats with aortic vegetations were inoculated by continuous intravenous infusion (0.0017 ml/min over 10 h) with 10(6) CFU of Lactococcus lactis pIL253 or a recombinant L. lactis strain expressing an individual S. aureus surface protein (ClfA, FnbpA, BCD, or SdrE) conferring a particular adhesive or platelet aggregation property. Vegetation infection was assessed 24 h later. Plasma was collected at 0, 2, and 6 h postinoculation to quantify the expression of tumor necrosis factor (TNF), interleukin 1? (IL-1?), IL-1?, IL-6, and IL-10. The percentage of vegetation infection relative to that with strain pIL253 (11%) increased when binding to fibrinogen was conferred on L. lactis (ClfA strain) (52%; P = 0.007) and increased further with adhesion to fibronectin (FnbpA strain) (75%; P < 0.001). Expression of fibronectin binding alone was not sufficient to induce IE (BCD strain) (10% of infection). Platelet aggregation increased the risk of vegetation infection (SdrE strain) (30%). Conferring adhesion to fibrinogen and fibronectin favored IL-1? and IL-6 production. Our results, with a model of IE induced by low-grade bacteremia, resembling human disease, extend the essential role of fibrinogen binding in the initiation of S. aureus IE. Triggering of platelet aggregation or an inflammatory response may contribute to or promote the development of IE. PMID:23250949

  16. [A case of Streptococcus suis endocarditis, probably bovine-transmitted, complicated by pulmonary embolism and spondylitis].

    Science.gov (United States)

    Ishigaki, Kazuyoshi; Nakamura, Akira; Iwabuchi, Sentaro; Kodera, Satoshi; Ooe, Kenji; Kataoka, Yasushi; Aida, Yuka

    2009-09-01

    Streptococcus suis, a major global porcine pathogen, is an emerging zoonosis in Southeast Asia that triggered a 2005 outbreak in China. S. suis causes meningitis, sepsis, and endocarditis in both pigs and humans and involves significant mortality. We report the case of a previously healthy 50-year-old dairy farmer who developed S. suis type 2 endocarditis complicated by pulmonary embolism and spondylitis. He experienced a high fever, chills, fatigue, and worsening low back pain in the 6 weeks prior to admission. On physical examination, he had lumbar spine tenderness and weakness of the left leg. Blood culture identified penicillin-sensitive S. suis type 2. Echocardiography showed vegetation on the tricuspid valve, and magnetic resonance imaging (MRI) showed signs of spondylitis. The man reported sudden chest pain several days after admission, which computed tomography (CT) showed what was diagnosed as a septic pulmonary embolism. He was treated with penicillin G for 4 weeks and gentamicin for the first 2 weeks, followed by 2 weeks of oral amoxicillin, after which his symptoms gradually improved. The infection source was probably his dairy herd, since calves often bit his fingers while feeding and S. suis was found in their oral mucus. Over 400 cases of human S. suis infection have been reported globally, but this is, to our knowledge, the first known case of bovine transmission. All of Japan's 8 other cases involved occupational swine exposure, 5 of whom had injuries to their fingers. This emerging situation should be made known to all possibly involved in unprotected direct contact with swine and cattle, particularly when the skin could be compromised by cuts or abrasions. PMID:19860257

  17. Bacterial infection and Alzheimer's disease: a meta-analysis.

    Science.gov (United States)

    Maheshwari, Priya; Eslick, Guy D

    2015-01-01

    The possibility of an infectious etiology for Alzheimer's disease (AD) has been repeatedly postulated over the past three decades. We provide the first meta-analysis to address the relationship between bacterial infection and AD. Studies examining the association between AD and spirochetal bacteria or Chlamydophila pneumoniae (Cpn) were identified through a systematic search of the databases MEDLINE, EMBASE, PubMed, and Google Scholar. Data combined from 25 relevant, primarily case-control studies demonstrated a statistically significant association between AD and detectable evidence of infection of either bacterial group. We found over a ten-fold increased occurrence of AD when there is detectable evidence of spirochetal infection (OR: 10.61; 95% CI: 3.38-33.29) and over a four-fold increased occurrence of AD in a conservative risk estimate (OR: 4.45; 95% CI: 2.33-8.52). We found over a five-fold increased occurrence of AD with Cpn infection (OR: 5.66; 95% CI: 1.83-17.51). This study shows a strongly positive association between bacterial infection and AD. Further detailed investigation of the role of bacterial infection is warranted. PMID:25182736

  18. Dexamethasone as adjuvant therapy to moxifloxacin attenuates valve destruction in experimental aortic valve endocarditis due to Staphylococcus aureus.

    Science.gov (United States)

    Skiadas, Ioannis; Pefanis, Angelos; Papalois, Apostolos; Kyroudi, Aspasia; Triantafyllidi, Helen; Tsaganos, Thomas; Giamarellou, Helen

    2007-08-01

    Although the beneficial effects of dexamethasone have frequently been investigated in various serious-infection settings, insufficient data on valve histology and cardiac function for infective endocarditis are available. The efficacy of moxifloxacin for the treatment of experimental aortic valve endocarditis due to methicillin-susceptible Staphylococcus aureus and the long-term effects of dexamethasone were evaluated in the current study. Sixty-eight rabbits were randomly assigned to four groups: A, B, C, and D. Group A consisted of 18 animals and functioned as a control group. Groups B and C consisted of 11 and 23 subjects, respectively, which received moxifloxacin for 5 days in a human-like pharmacokinetic simulation. Group D consisted of 16 animals that were administered moxifloxacin plus dexamethasone (0.25 mg/kg of body weight twice a day intravenously). The group B animals were sacrificed a day after the completion of treatment, and group C and D animals were sacrificed after 12 days in order to monitor any possible relapse and allow microbiological, histopathological, and echocardiographic evaluation of the long-term effects of glucocorticoids. No differences in survival, sterilization rates, or inflammatory infiltration and calcification of valve tissue were observed among the treated groups. However, the degrees of valve damage and collagenization were significantly worse, the fibroblast content was higher, and fractional shortening of the left ventricle fluctuated significantly in group C compared to group D (all groups, P < 0.05). We concluded that dexamethasone treatment for experimental S. aureus endocarditis attenuates valve destruction and preserves overall cardiac function without impeding the efficacy of moxifloxacin. PMID:17562794

  19. Non-Invasive Imaging of Prosthetic Heart Valves with a Focus on Endocarditis

    OpenAIRE

    Budde, Ricardo PJ

    2016-01-01

    Prosthetic heart valve (PHV) implantation can be a life-saving intervention. However, it does provide the patient with a lifelong chronic condition. Prosthetic heart valves can become dysfunctional due to various causes. The most dreaded complication is PHV endocarditis. Patients with a PHV are at higher risk to develop endocarditis because of the exposure of foreign material to the bloodstream. The reported incidence of PHV endocarditis varies considerably in the literature [1], probably bec...

  20. Successful Medical Treatment of Prosthetic Mitral Valve Endocarditis Caused by Brucella abortus

    OpenAIRE

    Lee, Seung-Ah; KIM, KYUNG-HEE; Shin, Hyo-Sun; Lee, Hee-Sun; Choi, Hong-Mi; Kim, Hyung-Kwan

    2014-01-01

    Although Brucella endocarditis is a rare complication of human brucellosis, it is the main cause of the mortality in this disease. Traditionally, the therapeutic approach to endocarditis caused by Brucella species requires a combination of antimicrobial therapy and valve replacement surgery. In the literature, only a few cases of mitral prosthetic valve endocarditis caused by Brucella species have been successfully treated without reoperation. We present a case of a 42-year-old man with a pro...

  1. Penicillin-sensitive Moraxella prosthetic endocarditis. Near disaster caused by failure to treat with penicillin.

    OpenAIRE

    Chen, W.; Lee, P K; Chau, P. Y.

    1982-01-01

    A patient with late prosthetic endocarditis resulting from Moraxella non-liquefaciens is reported. Correct laboratory indentification is of therapeutic importance as Moraxella is often highly sensitive to penicillin. Because of suspected penicillin sensitivity, antibiotics other than penicillin were used, but failed to control the endocarditis. Prompt response occurred when penicillin was given. Penicillin remains by far the most effective antibiotic for the treatment of endocarditis, particu...

  2. Coxiella burnetii Survives in Monocytes from Patients with Q Fever Endocarditis: Involvement of Tumor Necrosis Factor

    OpenAIRE

    Dellacasagrande, Jérôme; Ghigo, Eric; Capo, Christian; Raoult, Didier; Mege, Jean-Louis

    2000-01-01

    Endocarditis is the most frequent form of chronic Q fever, an infectious disease caused by Coxiella burnetii. As this obligate intracellular bacterium inhabits monocytes and macrophages, we wondered if pathogenesis of Q fever endocarditis is related to defective intracellular killing of C. burnetii by monocytes. Monocytes from healthy controls eliminated virulent C. burnetii within 3 days. In contrast, monocytes from patients with ongoing Q fever endocarditis were unable to eliminate bacteria...

  3. Oral antibiotic treatment of left-sided infectious endocarditis verified by 16S-PCR

    DEFF Research Database (Denmark)

    Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz; Bruun, Niels Eske

    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....

  4. Tandem Repeat Analysis for Surveillance of Human Salmonella Typhimurium Infections

    DEFF Research Database (Denmark)

    Torpdahl, Mia; Sørensen, Gitte; Lindstedt, Bjørn-Arne; Nielsen, Eva Møller

    2007-01-01

    In Denmark, as part of the national laboratory-based surveillance system of human enteric infections, all Salmonella enterica serotype Typhimurium isolates are currently subtyped by using phage typing, antimicrobial resistance profiles, and pulsed-field gel electrophoresis (PFGE). We evaluated the...... value of real-time typing that uses multiple-locus variable-number tandem-repeats analysis (MLVA) of S. Typhimurium to detect possible outbreaks. Because only a few subtypes identified by PFGE and phage typing account for most infections, we included MLVA typing in the routine surveillance in a 2-year...... outbreak investigations of S. Typhimurium....

  5. Analysis of prognostic factors for infantile rotavirus infection.

    Science.gov (United States)

    Zhou, R; Xu, J L; Wu, D; Tang, J L

    2015-01-01

    In this study, we investigated the prognostic factors of infantile rotavirus (RV) infection. A total of 102 infants with RV enteritis were divided into 2 groups according to the standards of improvement and cure at the time of discharge from the hospital: improvement group (N = 58; 47 males and 11 females with an average age of 15.19 ± 5.03 months) and the cure group (N = 44; 34 males and 10 females with an average age of 10.02 ± 4.92 months). Both groups were phlebotomized for the detection of serum glutamic oxaloacetic aminotransferase, creatine kinase-MB, and lactate dehydrogenase. Prognostic factors and clinical data were analyzed by univariate and multivariate logistic analysis. Among the 102 cases of RV infection, 58 were cured and 44 were improved. Univariate analysis showed that the 2 groups were significantly different in age, feeding pattern, concentrations of serum glutamic oxaloacetic aminotransferase, creatine kinase-MB, and lactate dehydrogenase, and central nervous system damage. Logistic regression analysis showed that age, feeding, and central nervous system damage were significant independent prognostic factors for RV enteritis (P < 0.05). There were no statistical differences in gender, course of disease, and respiratory infection (P < 0.05). Both myocardial and hepatic damages presented a temporary feature in the infants and had no significant influence on prognosis. Age, feeding pattern, and central nervous system damage are significant independent prognostic factors for RV infection. These factors should be carefully considered in clinical practice. PMID:25730018

  6. Pulmonary valve endocarditis associated to a septal interventricular defect and infundibular and pulmonary valve Stenosis

    International Nuclear Information System (INIS)

    Ventricular septal defects generate 10% of all adult congenital cardiopathies. 4% to 8% of patients to whom the defect has not been corrected are in risk of developing endocarditis. Pulmonary valve endocarditis is a rare event (1.5% to 2% of all endocarditis cases) and its mean etiology is intravenous drug abuse. The most frequently isolated microorganism in these cases is staphylococcus aurous. We report a case of pulmonary valve endocarditis associated with ventricular septal defect and valvular and infundibular pulmonary stenosis caused by streptococcus sp. in a patient without past medical history of drug abuse, alcoholism or previous invasive procedures

  7. Spondylodiscitis and endocarditis caused by S. vestibularis

    OpenAIRE

    Muge Aydin Tufan; Kart-Koseoglu Hamide; Ersozlu-Bozkirli Duygu; Azap Ozlem; Tufan Kadir; Yucel Ahmet Eftal

    2010-01-01

    Streptococcus vestibularis is a recently described member of the viridans group that was first isolated from the vestibular mucosa of the human oral cavity and described as a new species in 1988. It has been rarely associated with human infections. In few papers, it has been reported as a causal agent of systemic infection in immunosupressed adults and in those with other severe underlying diseases, like coronary valve diseases. A 65-year-old woman was admitted to the hospital with complaints...

  8. Hypereosinophilic Syndrome: A Case of Fatal Löffler Endocarditis

    Science.gov (United States)

    Baltazares-Lipp, Mario Enrique; Soto-González, Juan Ignacio; Aboitiz-Rivera, Carlos Manuel; Carmona-Ruíz, Héctor A.; Ortega, Benito Sarabia; Blachman-Braun, Ruben

    2016-01-01

    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/?L). 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. PMID:26904305

  9. An investigation on the level of dental senior students knowledge about endocarditis prophylaxis incases with cardiac disease receiving dental treatment

    Directory of Open Access Journals (Sweden)

    Fakhraee AH

    2004-02-01

    Full Text Available Dental practices such as oral, periodontal and endodontic surgeries cause damages to"nthe intraoral tissues, so having knowledge of the dental procedures that necessiciate endocarditis prophylaxis"nis of high importance."nPurpose: The aim of the present study was to determine the knowledge level of dental senior students in"nTehran dental faculties about endocarditis,"nMaterials and Methods: In this cross- sectional descriptive- analytic study, 253 senior students of four"ndentistry faculties in Tehran took part as follows: Tehran University: 71 students (M:42, F:29, Shahid"nBeheshti University: 74 students (M:40, F:34, Shahed University: 35 students (M:35, F:38, Azad University:"n73 students (M:35, F:38. The questionnaire used in this research consisted of three parts as follows: part one:"ninformation on cardiac diseases, part two: dental procedures requiring endocarditis prophylaxis, part three:"nantibiotic diet in endocarditis prophylaxis. Sex and place of education of the students were also studied in"ndetail. For statistical analysis, Chi-square test was used."nResults: On the basis of the sex, the correct answers of the female respondents of different universities were"nranked as: Azad University: 72.5%, Tehran University: 71.1%, Shahid Beheshti: 57%, ShahedUniversity:"n55.7%. In the same way, the male respondents were reported as: Tehran Universitys: 71.6%, Azad University:"n66.2%, Shahed University: 57.3%, Shahid Behesti University: 52.1%, On the basis of the place of education,"nthe following results were reported: Tehran University students managed to answer 71.3% , Azad University,"nShahed University and Shahid Beheshti University students could answer 69.5%, 56.5% and 54.6%,"nrespectively. All these differences were statistically significant, indicating that first ranked students have more"ninformation than the students of other schools."nConclusion: It is recommended to develop more practical training programme in dental schools on cardiac"ndiseases, dental procedures requiring endocarditis prophylaxis and antibiotic diets.

  10. Bacterial concentration correlations in experimental endocarditis caused by Staphylococcus epidermidis.

    OpenAIRE

    Baddour, L. M.; Christensen, G D; Bisno, A L

    1987-01-01

    Using 13 strains of Staphylococcus epidermidis to produce catheter-induced experimental endocarditis in rats, we found that bacterial concentrations in blood cultures obtained at the time of sacrifice correlated significantly with the number of organisms per gram of endocardial vegetation (P less than 0.001) and the total number of organisms per vegetation (P less than 0.001). Furthermore, blood culture concentrations correlated with vegetation weights (P less than 0.001) and sizes of infecti...

  11. Natural history of aortic valve endocarditis in rats.

    OpenAIRE

    Héraïef, E; Glauser, M.P.; Freedman, L. R.

    1982-01-01

    Sterile aortic vegetations were produced in rats by introducing a polyethylene catheter through the right carotid artery. The catheter was either left in place throughout the experiments or removed before bacterial challenge. Bacterial endocarditis was uniformly produced by intravenous injection of 10(7) colony-forming units of Staphylococcus aureus or Streptococcus intermedius, whether the catheter was left in place or removed. However, in rats with the catheter left in place, bacterial mult...

  12. Diphtheroids as a cause of endocarditis in a haemodialysis patient

    OpenAIRE

    Nagassar, Rajeev Peeyush; Nicholson, Alison Merle; Williams, Winston; Bridgelal-Nagassar, Roma Jaanki

    2012-01-01

    The authors report a fatal case of Corynebacterium sp. endocarditis. Corynebacterium spp. are non-sporulating, pleomorphic Gram-positive bacilli. In particular the authors have identified a species of Corynebacterium very closely related to C striatum. This is C simulans. The authors were able to identify the genus and species using various phenotypic tests. Highlighted here is the importance of identifying diphtheroids as a significant pathogen in the appropriate setting and the need to star...

  13. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis.

    OpenAIRE

    Daly, J.S.; Worthington, M G; Brenner, D.J.; Moss, C W; Hollis, D G; Weyant, R S; Steigerwalt, A G; Weaver, R. E.; Daneshvar, M I; O'Connor, S P

    1993-01-01

    A Rochalimaea-like organism (strain F9251) was isolated from a patient with endocarditis after blood drawn for culture before antimicrobial therapy was subcultured onto blood and chocolate agars and incubated for 2 weeks in 5% CO2. The strain was phenotypically similar to known Rochalimaea species. The cellular fatty acid composition of strain F9251 was close to but distinct from those of the three known Rochalimaea species and was most similar to that of R. vinsonii. Labeled DNA from strain ...

  14. Loeffler's endocarditis presenting with acute abdominal aortic obstruction.

    Science.gov (United States)

    Seol, Sang-Hoon; Song, Pil-Sang; Kim, Dong-Kie; Kim, Ki-Hun; Kim, Doo-Il; Han, Yang-Chun

    2013-11-01

    Loeffler's endocarditis is a complication of diseases associated with the idiopathic hypereosinophilic syndrome, which is characterised by persistently elevated blood eosinophil counts with symptoms and signs of organ involvement especially in the heart, vascular system, nervous system and bone marrow. We report the involvements of the endocardium and aorta, without endomyocardial fibrosis and the complete resolution of the endocardial eosinophilic infiltration with steroids and anticoagulation therapy. PMID:23548334

  15. Löffler endocarditis: a rare cause of acute cardiac failure

    OpenAIRE

    Niemeijer Nicolasine D; van Daele Paul LA; Caliskan Kadir; Oei Frans BS; Loosveld Olaf JL; van der Meer Nardo JM

    2012-01-01

    Abstract We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow- and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was ...

  16. Surgical treatment of aortic valve endocarditis: a 26-year experience

    Directory of Open Access Journals (Sweden)

    Taylan Adademir

    2014-03-01

    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.

  17. In vivo effect of flucloxacillin in experimental endocarditis caused by mecC-positive staphylococcus aureus showing temperature-dependent susceptibility in vitro.

    Science.gov (United States)

    Mancini, Stefano; Laurent, Frédéric; Veloso, Tiago R; Giddey, Marlyse; Vouillamoz, Jacques; Vandenesch, François; Moreillon, Philippe; Entenza, José M

    2015-04-01

    Methicillin-resistant Staphylococcus aureus (MRSA) carrying the mecC gene (mecC-MRSA) exhibited at 37°C MICs of oxacillin close to those of methicillin-susceptible S. aureus (MSSA). We investigated whether at this temperature, mecC-MRSA strains respond to flucloxacillin treatment like MSSA strains, using a rat model of endocarditis. Flucloxacillin (human-like kinetics of 2 g intravenously every 6 h) cured 80 to 100% of aortic vegetations infected with five different mecC-MRSA strains. These results suggest that mecC-MRSA infections may successfully respond to treatment with ?-lactams. PMID:25605361

  18. Detecting Infected Botnet Machines by Using the Traffic Behavior Analysis

    OpenAIRE

    Fahimeh Hasani; Ebrahime Mehdipour

    2015-01-01

    Despite the increase in attacks and other security challenges in cyberspace, we require new methods of detection and to develop new techniques for the new generations of attacks. One of these new threats are botnets. This article presents the means for identifying infected machines with botnets by using a behavioral analysis method. Work with botnets as a tool intended to carry out criminal activities has increased with large area in computer networks against large targets. The pattern of beh...

  19. Reducing bias in bacterial community analysis of lower respiratory infections

    OpenAIRE

    Rogers, Geraint B.; Cuthbertson, Leah; Hoffman, Lucas R.; Wing, Peter A.C.; Pope, Christopher; Hooftman, Danny A. P.; Lilley, Andrew K.; Oliver, Anna; Carroll, Mary P; Bruce , Kenneth D.; van der Gast, Christopher J.

    2012-01-01

    High-throughput pyrosequencing and quantitative PCR (Q-PCR) analysis offer greatly improved accuracy and depth of characterisation of lower respiratory infections. However, such approaches suffer from an inability to distinguish between DNA derived from viable and non-viable bacteria. This discrimination represents an important step in characterising microbial communities, particularly in contexts with poor clearance of material or high antimicrobial stress, as non-viable bacteria...

  20. In vivo synergism of ceftobiprole and vancomycin against experimental endocarditis due to vancomycin-intermediate Staphylococcus aureus.

    Science.gov (United States)

    Entenza, J M; Veloso, T R; Vouillamoz, J; Giddey, M; Majcherczyk, P; Moreillon, P

    2011-09-01

    The efficacy of ceftobiprole combined with vancomycin was tested against two vancomycin-intermediate Staphylococcus aureus (VISA) strains, PC3 and Mu50, in rats with experimental endocarditis. Animals with infected aortic vegetations were treated for 3 days with doses simulating the kinetics after intravenous administration in humans of (i) the standard dose of ceftobiprole of 500 mg every 12 h (b.i.d.) (SD-ceftobiprole), (ii) a low dose of ceftobiprole of 250 mg b.i.d. (LD-ceftobiprole), (iii) a very low dose of ceftobiprole of 125 mg b.i.d. (VLD-ceftobiprole), (iv) SD-vancomycin of 1 g b.i.d., or (v) LD- or VLD-ceftobiprole combined with SD-vancomycin. Low dosages of ceftobiprole were purposely used to highlight positive drug interactions. Treatment with SD-ceftobiprole sterilized 12 of 14 (86%) and 10 of 13 (77%) vegetations infected with PC3 and Mu50, respectively (P 0.05 versus controls). VLD-ceftobiprole and SD-vancomycin alone were ineffective against both strains (?8% sterile vegetations). In contrast, the combination of VLD-ceftobiprole and SD-vancomycin sterilized 7 of 9 (78%) and 6 of 14 (43%) vegetations infected with PC3 and Mu50, respectively, and the combination of LD-ceftobiprole and SD-vancomycin sterilized 5 of 6 (83%) vegetations infected with Mu50 (P < 0.05 versus controls and monotherapy). Thus, ceftobiprole monotherapy simulating standard therapeutic doses was active against VISA experimental endocarditis. Moreover, subtherapeutic LD- and VLD-ceftobiprole synergized with ineffective vancomycin to restore efficacy. Hence, combining ceftobiprole with vancomycin broadens the therapeutic margin of these two compounds against VISA infections. PMID:21730114

  1. In Vivo Synergism of Ceftobiprole and Vancomycin against Experimental Endocarditis Due to Vancomycin-Intermediate Staphylococcus aureus?

    Science.gov (United States)

    Entenza, J. M.; Veloso, T. R.; Vouillamoz, J.; Giddey, M.; Majcherczyk, P.; Moreillon, P.

    2011-01-01

    The efficacy of ceftobiprole combined with vancomycin was tested against two vancomycin-intermediate Staphylococcus aureus (VISA) strains, PC3 and Mu50, in rats with experimental endocarditis. Animals with infected aortic vegetations were treated for 3 days with doses simulating the kinetics after intravenous administration in humans of (i) the standard dose of ceftobiprole of 500 mg every 12 h (b.i.d.) (SD-ceftobiprole), (ii) a low dose of ceftobiprole of 250 mg b.i.d. (LD-ceftobiprole), (iii) a very low dose of ceftobiprole of 125 mg b.i.d. (VLD-ceftobiprole), (iv) SD-vancomycin of 1 g b.i.d., or (v) LD- or VLD-ceftobiprole combined with SD-vancomycin. Low dosages of ceftobiprole were purposely used to highlight positive drug interactions. Treatment with SD-ceftobiprole sterilized 12 of 14 (86%) and 10 of 13 (77%) vegetations infected with PC3 and Mu50, respectively (P 0.05 versus controls). VLD-ceftobiprole and SD-vancomycin alone were ineffective against both strains (?8% sterile vegetations). In contrast, the combination of VLD-ceftobiprole and SD-vancomycin sterilized 7 of 9 (78%) and 6 of 14 (43%) vegetations infected with PC3 and Mu50, respectively, and the combination of LD-ceftobiprole and SD-vancomycin sterilized 5 of 6 (83%) vegetations infected with Mu50 (P < 0.05 versus controls and monotherapy). Thus, ceftobiprole monotherapy simulating standard therapeutic doses was active against VISA experimental endocarditis. Moreover, subtherapeutic LD- and VLD-ceftobiprole synergized with ineffective vancomycin to restore efficacy. Hence, combining ceftobiprole with vancomycin broadens the therapeutic margin of these two compounds against VISA infections. PMID:21730114

  2. Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report

    Directory of Open Access Journals (Sweden)

    Cavazzi Emma

    2008-05-01

    Full Text Available Abstract Background Even though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet. Case presentation We describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1. After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared. Conclusion As this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.

  3. Bartonella spp. and Coxiella burnetii Associated with Community-Acquired, Culture-Negative Endocarditis, Brazil.

    Science.gov (United States)

    Siciliano, Rinaldo Focaccia; Castelli, Jussara Bianchi; Mansur, Alfredo Jose; Pereira dos Santos, Fabiana; Colombo, Silvia; do Nascimento, Elvira Mendes; Paddock, Christopher D; Brasil, Roosecelis Araújo; Velho, Paulo Eduardo Neves Ferreira; Drummond, Marina Rovani; Grinberg, Max; Strabelli, Tania Mara Varejao

    2015-08-01

    We evaluated culture-negative, community-acquired endocarditis by using indirect immunofluorescent assays and molecular analyses for Bartonella spp. and Coxiella burnetii and found a prevalence of 19.6% and 7.8%, respectively. Our findings reinforce the need to study these organisms in patients with culture-negative, community-acquired endocarditis, especially B. henselae in cat owners. PMID:26197233

  4. Subacute bacterial endocarditis and subsequent shunt nephritis from ventriculoatrial shunting 14?years after shunt implantation

    DEFF Research Database (Denmark)

    Burström, Gustav; Andresen, Morten; Bartek, Jiri; Fytagoridis, Anders

    2014-01-01

    of causing subacute bacterial endocarditis and subsequent shunt nephritis. The patient was successfully treated with antibiotics combined with ventriculoatrial shunt removal and endoscopic third ventriculocisternostomy (VCS). This case illustrates the nowadays rare, but potentially severe...... complication of subacute bacterial endocarditis and shunt nephritis. It also exemplifies the VCS as an alternative to implanting foreign shunt systems for CSF diversion....

  5. Global analysis of viral infection in an archaeal model system

    Directory of Open Access Journals (Sweden)

    JosephSteffens

    2012-12-01

    Full Text Available The origin and evolutionary relationship of viruses is poorly understood. This makes archaeal virus-host of particular interest because the hosts generally root near the base of phylogenetic trees, while some of the viruses have clear structural similarities to those that infect prokaryotic and eukaryotic cells. Despite the advantageous position for use in evolutionary studies, little is known about archaeal viruses or how they interact with their hosts, compared to viruses of bacteria and eukaryotes. In addition, many archaeal viruses have been isolated from extreme environments and present a unique opportunity for elucidating factors that are important for existence at the extremes.. In this article we focus on virus-host interactions using a proteomics approach to study Sulfolobus Turreted Icosahedral Virus (STIV infection of Sulfolobus solfataricus P2. Using cultures grown from the ATCC cell stock, a single cycle of STIV infection was sampled 6 times over a 72 hr period. More than 700 proteins were identified throughout the course of the experiments. Seventy one host proteins were found to change by nearly two-fold (p<0.05 with 40 becoming more abundant and 31 less abundant. The modulated proteins represent 30 different cell pathways and 14 COG groups. 2D gel analysis showed that changes in post translational modifications were a common feature of the affected proteins. The results from these studies showed that the prokaryotic antiviral adaptive immune system CRISPR associated proteins (CAS proteins were regulated in response to the virus infection. It was found that regulated proteins come from mRNAs with a shorter than average half-life. In addition, activity-based protein profiling (ABPP profiling on 2D gels showed caspase, hydrolase and tyrosine phosphatase enzyme activity labeling at the protein isoform level. Together, this data provides a more detailed global view of archaeal cellular responses to viral infection, demonstrates the power of qua

  6. Sensitivity, specificity and predictive value of blood cultures from cattle clinically suspected of bacterial endocarditis

    DEFF Research Database (Denmark)

    Houe, Hans; Eriksen, L.; Jungersen, Gregers; Pedersen, D.; Krogh, H. V.

    1993-01-01

    This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis of the...... isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied...... the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases....

  7. Root cause analysis to support infection control in healthcare premises.

    Science.gov (United States)

    Venier, A-G

    2015-04-01

    Infection control teams (ICTs) seek to prevent healthcare-associated infections (HCAIs). They undertake surveillance and prevention, promote safety and quality of care, and evaluate and manage risk. Root cause analysis (RCA) can support this work but is not widely used by ICTs. This paper describes how ICTs can use RCA to enhance their day-to-day work. Many different tools and methods exist for RCA. Its primary aim is to identify the factors that have led to HCAI, but RCA can also be used for near-misses. A team effort and multidisciplinary work are usually required. Published accounts and personal experience in the field indicate that an ICT that correctly uses RCA implements more effective prevention measures, improves practice and collaborative working, enhances teamwork, and reduces the risk of HCAI. RCA should be promoted among ICTs because it adds value to their work and helps to develop a hospital culture that anticipates and pre-empts problems. PMID:25634490

  8. Infected Abdominal Aortic Aneurysm with Helicobacter cinaedi

    Science.gov (United States)

    Iwasawa, Takamasa; Tamura, Atsushi; Lefor, Alan T.

    2016-01-01

    Helicobacter cinaedi is a rare human pathogen which has various clinical manifestations such as cellulitis, bacteremia, arthritis, meningitis, and infectious endocarditis. We report an abdominal aortic aneurysm infected with Helicobacter cinaedi, treated successfully with surgical repair and long-term antimicrobial therapy. PMID:26885430

  9. Autoimmunity as a possible predisposing factor for Stenotrophomonas maltophilia endocarditis / Autoinmunidad como posible factor predisponente para endocarditis por Stenotrophomonas maltophilia

    Scientific Electronic Library Online (English)

    Jorge R., Carrillo-Córdova; Luis M., Amezcua-Guerra.

    2012-09-01

    Full Text Available Actualmente sólo existen 40 casos descritos de endocarditis por Stenotrophomonas maltophilia (S. maltophilia), ninguno de los cuales tenía una enfermedad autoinmune subyacente. Una mujer de 23 años con imbricación de lupus eritematoso sistémico (LES) y artritis reuma-Artritis reumatoide; toide (AR), [...] ingresó a nuestro Instituto por endocarditis de la válvula tricúspide adquirida en México comunidad. La paciente presentó como complicaciones tromboembolia pulmonar y neumonía, se encontraron anticuerpos contra péptidos cíclicos citrulinados (anti-CCP), antinucleares, anti-Sm, anti-Ro/SSA, anti-cardiolipina y anti-(?2 glucoproteína 1, factor reumatoide (FR), complementopenia, linfopenia y proteína C reactiva (PCR) de 425 mg/L. Se observó crecimiento de S. maltophilia en hemocultivos seriados y el tratamiento antimicrobiano empírico no fue efectivo, sino hasta que se incluyó trimetoprim/sulfametoxazol (TMP/SMX). Después de un mes de hospitalización, la paciente fue sometida a remplazo quirúrgico de la válvula tricúspide y la evolución clínica subsecuente fue satisfactoria, permitiendo su egreso 14 días después. Actualmente, la paciente se encuentra asintomática y su función cardiaca, renal y pulmonar es estable. Llama la atención que todos los autoanticuerpos han permanecido elevados a través del tiempo. Presentamos una recopilación de la información disponible acerca de la endocarditis por S. maltophilia, y proponemos que la autoinmunidad podría ser incluida como un nuevo factor de predisposición para esta entidad. Abstract in english Only 40 cases of Stenotrophomonas maltophilia (S. maltophilia) endocarditis have been reported to date, and there is no description in patients with underlying autoimmunity. A 23-year-old woman with systemic lupus erythematosus (SLE) overlapping rheumatoid arthritis (RA) and no risk factors for endo [...] carditis was admitted in our hospital because of community-acquired tricuspid valve endocarditis. During hospitalization, she was complicated with pulmonary thromboembolism and pneumonia. Laboratory showed autoimmune diathesis featured by anti-cyclic citrullinated peptide (anti-CCP), anti-Sm, anti-Ro/SSA, anti-cardiolipin, anti-(?2 glycoprotein 1, and antinuclear antibodies, rheumatoid factor (RF), low complement, lymphopenia and C-reactive protein (CRP) of 425 mg/L. S. maltophilia grew in serial blood culture sets. Empirical broad-spectrum antimicrobials were ineffective until trimethoprim/sulfamethoxazole (TMP/SMX) was added to therapy. One month after admission, the patient underwent successful surgical replacement of the tricuspid valve and the subsequent course was satisfactory, allowing her to be discharged 14 days after. Nowadays, she remains free of complaints and her cardiac, renal and pulmonary functioning is stable. Noteworthy is that all auto-antibodies have been persistently raised over time. Here, we present a compilation of the available information about S. maltophilia endocarditis, and suggest that autoimmunity could be included as a novel predisposing factor for S. maltophilia endocarditis.

  10. Endocarditis trombótica no bacteriana bivalvular asociada a cáncer y ecocardiograma transesofágico Bivalvular non bacterial thrombotic endocarditis associated with cancer and transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Marcelo Zylberman

    2006-06-01

    Full Text Available La endocarditis trombótica no bacteriana es la causa más frecuente de accidente cerebrovascular isquémico en pacientes con cáncer. En estos pacientes se hallaron vegetaciones valvulares hasta en el 9% de las autopsias. Sin embargo, la afección bivalvular es poco frecuente, observándose en el 9% de las endocarditis trombóticas. Se presenta una paciente con cáncer de ovario que presentó afasia e imágenes compatibles con isquemia cerebral. El ecocardiograma transtorácico fue normal. El ecocardiograma transesofágico evidenció vegetaciones en las válvulas aórtica y mitral. Se enfatiza la importancia de sospechar endocarditis trombótica no bacteriana en enfermos con cáncer y embolismo sistémico y en la escasa frecuencia de afección bivalvular.Non bacterial thrombotic endocarditis is the most frequent cause of ischemic stroke in cancer patients. Up to 9% of autopsies of cancer patients show non infectious valvular masses. However, bivalvular involvement is not frequently occurring in 9% of non bacterial thrombotic endocarditis. We report a patient with ovarian cancer who presented aphasia. The MRI was compatible with cerebral ischemia. The transthoracic echocardiogram was normal and a transesophageal echocardiogram showed vegetations in aortic and mitral valves. We emphasize the importance of suspecting non bacterial thrombotic endocarditis in patients with cancer and systemic embolism and the low frequency of bivalvular involvement.

  11. Endocarditis trombótica no bacteriana bivalvular asociada a cáncer y ecocardiograma transesofágico / Bivalvular non bacterial thrombotic endocarditis associated with cancer and transesophageal echocardiography

    Scientific Electronic Library Online (English)

    Marcelo, Zylberman; Fernando A., Díaz Couselo; Flavio, Sánchez; Daniel, Santos; Adrián, Nervo.

    2006-06-01

    Full Text Available La endocarditis trombótica no bacteriana es la causa más frecuente de accidente cerebrovascular isquémico en pacientes con cáncer. En estos pacientes se hallaron vegetaciones valvulares hasta en el 9% de las autopsias. Sin embargo, la afección bivalvular es poco frecuente, observándose en el 9% de l [...] as endocarditis trombóticas. Se presenta una paciente con cáncer de ovario que presentó afasia e imágenes compatibles con isquemia cerebral. El ecocardiograma transtorácico fue normal. El ecocardiograma transesofágico evidenció vegetaciones en las válvulas aórtica y mitral. Se enfatiza la importancia de sospechar endocarditis trombótica no bacteriana en enfermos con cáncer y embolismo sistémico y en la escasa frecuencia de afección bivalvular. Abstract in english Non bacterial thrombotic endocarditis is the most frequent cause of ischemic stroke in cancer patients. Up to 9% of autopsies of cancer patients show non infectious valvular masses. However, bivalvular involvement is not frequently occurring in 9% of non bacterial thrombotic endocarditis. We report [...] a patient with ovarian cancer who presented aphasia. The MRI was compatible with cerebral ischemia. The transthoracic echocardiogram was normal and a transesophageal echocardiogram showed vegetations in aortic and mitral valves. We emphasize the importance of suspecting non bacterial thrombotic endocarditis in patients with cancer and systemic embolism and the low frequency of bivalvular involvement.

  12. Congenital TORCH infections of the brain--CT manifestation (with analysis of 7 cases)

    International Nuclear Information System (INIS)

    To study the neuropathologic changes and CT manifestations in congenital TORCH infection of the brain. Analysis of 7 cases of congenital TORCH infection of the neonates and infants demonstrated by serum examination was performed. There were congenital toxoplasmosis 3 cases, congenital syncytial virus infection 1 case, congenital rubella virus infection 1 case, congenital cytomegalovirus infection 2 cases, and congenital herpes simplex virus infection 1 case. Cerebral hypoplasia, ventricular dilatation or hydrocephalus, subependymal and parenchymal calcifications, microcephalic focal cortical migration anomalies, schizencephaly polymicrogyria, et al, were demonstrated by CT with congenital TORCH infection. The earlier the infection, the more severe the brain developmental anomalies. The extent and appearance of calcification in brain were related to the degree, extent and course of TORCH infection. Basal ganglia calcification of unknown cause in infant was suggestive of congenital TORCH infection. Typical CT manifestations together with clinical picture may suggest congenital TORCH infection, while serological test can be diagnostic

  13. Endocarditis infecciosa asociada con dispositivos electrónicos implantables intracardíacos. Nuestra experiencia

    Directory of Open Access Journals (Sweden)

    Fabián Salmo

    2007-01-01

    Full Text Available IntroducciónLa endocarditis infecciosa es una patología con una morbimortalidad elevada. En esta comunicación se presentan 17 casos de endocarditis infecciosa (EI asociada con dispositivos electrónicos implantables (DEI, que representaron el 6% de las endocarditis entre 1992 y 2005.ObjetivoAnalizar las características clínicas, evolutivas y anatomopatológicas de un subgrupo de pacientes con EI portadores de DEI.Material y métodosDe un total de 263 pacientes con EI admitidos en nuestra institución entre 1992 y 2005, se analizaron 17 con EI asociada con DEI.Las EI asociadas con DEI se clasificaron en: 1 temprana, la ocurrida dentro de los 12 meses del posquirúrgico, y 2 tardía, la producida luego de ese lapso. En todos los pacientes se obtuvieron muestras para hemocultivos, se efectuó el cultivo de todo material extraído durante la cirugía y se realizaron ecocardiogramas por vía transtorácica (ETT y transesofágica (ETE.ResultadosDe los 17 pacientes, 13 (73% eran hombres; la edad promedio fue de 60 años y el tiempo entre el implante y el diagnóstico fue de 344 días. Dieciséis pacientes presentaron fiebre y bacteriemia; el germen predominante fue Staphylococcus aureus en el 70% de los casos. En todos se extrajo el sistema. La mortalidad fue del 17%.ConclusionesLa EI asociada con el DEI, que debe sospecharse siempre en ausencia de otro foco infeccioso, constituye un subgrupo que con diagnóstico y tratamiento precoz tiene una mortalidad menor que la global descripta. Al igual que para la EI sin DEI, los hemocultivos y la ecocardiografía son los pilares para el diagnóstico.

  14. Diphtheroids as a cause of endocarditis in a haemodialysis patient

    Science.gov (United States)

    Nagassar, Rajeev Peeyush; Nicholson, Alison Merle; Williams, Winston; Bridgelal-Nagassar, Roma Jaanki

    2012-01-01

    The authors report a fatal case of Corynebacterium sp. endocarditis. Corynebacterium spp. are non-sporulating, pleomorphic Gram-positive bacilli. In particular the authors have identified a species of Corynebacterium very closely related to C striatum. This is C simulans. The authors were able to identify the genus and species using various phenotypic tests. Highlighted here is the importance of identifying diphtheroids as a significant pathogen in the appropriate setting and the need to start antibiotic therapy if this is suspected. PMID:22605849

  15. Löffler endocarditis: a rare cause of acute cardiac failure

    Directory of Open Access Journals (Sweden)

    Niemeijer Nicolasine D

    2012-10-01

    Full Text Available Abstract We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis. At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow- and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient’s condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprosthesis.

  16. Löffler endocarditis: a rare cause of acute cardiac failure.

    Science.gov (United States)

    Niemeijer, Nicolasine D; van Daele, Paul L A; Caliskan, Kadir; Oei, Frans B S; Loosveld, Olaf J L; van der Meer, Nardo J M

    2012-01-01

    We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow- and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient's condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprosthesis. PMID:23046536

  17. La endocarditis infecciosa sigue desafiando a la clínica moderna

    Directory of Open Access Journals (Sweden)

    Miguel Serra Valdés

    2011-09-01

    Full Text Available Ante el desafío que mantiene la endocarditis infecciosa a pesar del desarrollo de la medicina contemporánea, merece la pena revisar y comentar aspectos del tema, de los últimos años, que inviten a la reflexión en los profesionales médicos y que beneficiará, sin dudas, el grado de competencia y desempeño. El extraer conclusiones universales de las publicaciones revisadas se hace difícil por la baja incidencia de la enfermedad comparada con otras infecciosas y la diversidad de factores económicos, sociales e institucionales de las poblaciones que han sido objeto de estudio.

  18. Analysis of the SUMO2 Proteome during HSV-1 Infection.

    Science.gov (United States)

    Sloan, Elizabeth; Tatham, Michael H; Groslambert, Marine; Glass, Mandy; Orr, Anne; Hay, Ronald T; Everett, Roger D

    2015-07-01

    Covalent linkage to members of the small ubiquitin-like (SUMO) family of proteins is an important mechanism by which the functions of many cellular proteins are regulated. Sumoylation has roles in the control of protein stability, activity and localization, and is involved in the regulation of transcription, gene expression, chromatin structure, nuclear transport and RNA metabolism. Sumoylation is also linked, both positively and negatively, with the replication of many different viruses both in terms of modification of viral proteins and modulation of sumoylated cellular proteins that influence the efficiency of infection. One prominent example of the latter is the widespread reduction in the levels of cellular sumoylated species induced by herpes simplex virus type 1 (HSV-1) ubiquitin ligase ICP0. This activity correlates with relief from intrinsic immunity antiviral defence mechanisms. Previous work has shown that ICP0 is selective in substrate choice, with some sumoylated proteins such the promyelocytic leukemia protein PML being extremely sensitive, while RanGAP is completely resistant. Here we present a comprehensive proteomic analysis of changes in the cellular SUMO2 proteome during HSV-1 infection. Amongst the 877 potentially sumoylated species detected, we identified 124 whose abundance was decreased by a factor of 3 or more by the virus, several of which were validated by western blot and expression analysis. We found many previously undescribed substrates of ICP0 whose degradation occurs by a range of mechanisms, influenced or not by sumoylation and/or the SUMO2 interaction motif within ICP0. Many of these proteins are known or are predicted to be involved in the regulation of transcription, chromatin assembly or modification. These results present novel insights into mechanisms and host cell proteins that might influence the efficiency of HSV-1 infection. PMID:26200910

  19. Transcriptome analysis of resistant soybean roots infected by Meloidogyne javanica

    Scientific Electronic Library Online (English)

    Maria Eugênia Lisei de, Sá; Marcus José Conceição, Lopes; Magnólia de Araújo, Campos; Luciano Vilela, Paiva; Regina Maria Santos de, Amorim; Magda Aparecida, Beneventi; Alexandre Augusto Pereira, Firmino; Maria Fátima Grossi de, Sá.

    Full Text Available Soybean is an important crop for Brazilian agribusiness. However, many factors can limit its production, especially root-knot nematode infection. Studies on the mechanisms employed by the resistant soybean genotypes to prevent infection by these nematodes are of great interest for breeders. For thes [...] e reasons, the aim of this work is to characterize the transcriptome of soybean line PI 595099-Meloidogyne javanica interaction through expression analysis. Two cDNA libraries were obtained using a pool of RNA from PI 595099 uninfected and M. javanica (J2) infected roots, collected at 6, 12, 24, 48, 96, 144 and 192 h after inoculation. Around 800 ESTs (Expressed Sequence Tags) were sequenced and clustered into 195 clusters. In silico subtraction analysis identified eleven differentially expressed genes encoding putative proteins sharing amino acid sequence similarities by using BlastX: metallothionein, SLAH4 (SLAC1 Homologue 4), SLAH1 (SLAC1 Homologue 1), zinc-finger proteins, AN1-type proteins, auxin-repressed proteins, thioredoxin and nuclear transport factor 2 (NTF-2). Other genes were also found exclusively in nematode stressed soybean roots, such as NAC domain-containing proteins, MADS-box proteins, SOC1 (suppressor of overexpression of constans 1) proteins, thioredoxin-like protein 4-Coumarate-CoA ligase and the transcription factor (TF) MYBZ2. Among the genes identified in non-stressed roots only were Ser/Thr protein kinases, wound-induced basic protein, ethylene-responsive family protein, metallothionein-like protein cysteine proteinase inhibitor (cystatin) and Putative Kunitz trypsin protease inhibitor. An understanding of the roles of these differentially expressed genes will provide insights into the resistance mechanisms and candidate genes involved in soybean-M. javanica interaction and contribute to more effective control of this pathogen.

  20. Diagnosis and management of bacterial infections in decompensated cirrhosis

    OpenAIRE

    Manuel de la Mata; Jose Luis Montero; Jose Manuel Benitez; Maria Pleguezuelo; Juan Jurado

    2013-01-01

    Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis a...