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Sample records for infective endocarditis analysis

  1. Infective endocarditis.

    Ferro, José M; Fonseca, Ana Catarina

    2014-01-01

    Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated. PMID:24365290

  2. Enterococcus faecalis infective endocarditis

    Dahl, Anders; Rasmussen, Rasmus V; Bundgaard, Henning;

    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....

  3. Enterococcus faecalis infective endocarditis

    Dahl, Anders; Bruun, Niels Eske

    2013-01-01

    Enterococcus faecalis infective endocarditis (IE) is a disease of increasing importance, with more patients infected, increasing frequency of health-care associated infections and increasing incidence of antimicrobial resistances. The typical clinical presentation is a subacute course with fever...... ceftriaxone. E. faecalis infective endocarditis continues to be a very serious disease with considerable percentages of high-level gentamicin resistant strains and in-hospital mortality around 20%. Strategies to prevent E. faecalis IE, improve diagnostics, optimize treatment and reduce morbidity will be...

  4. Infective endocarditis, 1984 through 1993

    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....

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

    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)

  6. Serious complications after infective endocarditis

    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....

  7. An analysis of clinical characteristics,etiologies and prognosis of 218 patients with infective endocarditis

    谢红梅

    2014-01-01

    Objective To describe the profile of patients with infective endocarditis(IE)and assess prognostic factors of IE.Methods Clinical and etiology data of 218 patients with IE were collected retrospectively from January 2011to January 2013.The distribution and antimicrobial susceptibilities of pathogens causing IE were evaluated.Prognostic factors associated with IE were determined by univariate and multivariate regression analysis.Results

  8. Infective Endocarditis during Pregnancy

    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)

  9. What Is Infective Endocarditis?

    ... from IE include: • artificial (prosthetic) heart valves or heart valves repaired with artificial material • a history of endocarditis • some kinds of congenital heart defects • abnormality of the heart valves after a ...

  10. Infective endocarditis caused by Streptococcus tigurinus-like organisms.

    Peuchant, O; Wirth, G; Tixier, R; Dijos, M; Camou, F; Greib, C; Mégraud, F; Ménard, A

    2016-09-01

    Streptococcus species are important causes of infective endocarditis but species identification remains challenging. We report two cases of infective endocarditis due to Streptococcus tigurinus-like organisms, which were first identified by 16S ribosomal RNA gene sequence analysis and subsequently confirmed using phylogeny based on the analysis of the shetA gene encoding exfoliative toxin. PMID:27408744

  11. Immunologic evaluation in infective endocarditis

    Wilma C. Neves Forte

    2001-01-01

    Full Text Available OBJECTIVE: To analyze the immune response in peripheral blood of patients with infective endocarditis. METHODS: We studied 10 patients with infective endocarditis, age range from 20 to 50 years-old, males and females, and 20 healthy subjects in the same age range. The diagnosis of the disease was based on the clinical picture, echocardiogram, and hemoculture based upon samples drawn and tested before the treatment started. The were no history of atopy or malnutrition, no autoimmune disease, and they were not using any immunosuppressant or antibiotic medication. RESULTS: The patients with endocarditis had significantly higher T and B lymphocyte, CD4+ and CD8+ cell counts, IgM and IgG serum levels, and C4 component of the complement than the control group; no significant difference concerning serum IgA and neutrophil oxidative metabolism; a significant decrease in C3, chemotaxis, and monocyte phagocytosis;cryoglobulins were detected in 66.6% of patients and they were formed by IgG, IgM, IgA, C3, and C4. CONCLUSION: The patients with infective endocarditis were immunocompetent in most sectors of immune response and, at a certain moment, an autoimmune component may be present.

  12. The teeth and infective endocarditis.

    Bayliss, R.; Clarke, C.; Oakley, C.; Somerville, W; Whitfield, A. G.

    1983-01-01

    During 1981 and 1982 544 cases of infective endocarditis were investigated retrospectively by means of a questionnaire. Only 13.7% had undergone any dental procedure within three months of the onset of the illness, and in 42.5% there was no known cardiac abnormality before the onset of the disease. Furthermore, the number of cases occurring annually was about the same as or more than it was before the introduction of penicillin. The mouth and nasopharynx were the most likely sources of the co...

  13. Infective endocarditis following percutaneous pulmonary valve replacement

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj;

    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....

  14. Infective endocarditis in patients with hepatic diseases.

    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 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

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

    Chen, Ming; Kemp, Michael; Bruun, Niels E;

    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...

  16. Infective endocarditis-experience in Nigeria.

    Falase, A O; Jaiyesimi, F; Iyun, A O; Attah, E B

    1976-03-01

    Ninety cases of infective endocarditis seen over a 10-year-period at University College Hospital, Ibadan, are reviewed. The peak incidence was in the third decade and rheumatic heart disease was the commonest pre-existing lesion in 59 cases with subacute endocarditis. In most cases the source of infection was not known. In 41 of the 90 cases (44%) the diagnosis was made only at autopsy. The bacterial isolation rate was low, the commonest organisms being staphylococci, streptococci, micrococci and gramnegative bacilli. The overall mortality was 70%. A plea is made for increasing awareness of the disease and prompt institution of effective treatment. PMID:941246

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

    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.

  18. Endocarditis infecciosa activa: 152 casos Active infective endocarditis: 152 cases

    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.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

  19. INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST'S PRACTICE

    E. Yu. Ponomareva; Andrei Petrovich Rebrov

    2012-01-01

    Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE) and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the p...

  20. Left-sided infective endocarditis: analysis of in-hospital and medium-term outcome and predictors of mortality

    Ferreira, J.; Gomes, F.; Rodrigues, P.; Araújo Abreu, M.; Maia, J.; Bettencourt, P.; Luz, A; Torres, S.; Araújo Correia, J.

    2013-01-01

    Abstract Introduction: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a challenging and potentially lethal disease. The prognosis of IE remains poor; in the last 30 years, its incidence and mortality have only been marginally reduced. Early identification of high-risk patients can change the course of the disease and improve outcomes. Objectives and methods: To describe and investigate predictors of mortality during hospital stay and in the ...

  1. Polymicrobial infective endocarditis caused by Neisseria sicca and Haemophilus parainfluenzae

    Nikoloz Koshkelashvili

    2016-01-01

    Full Text Available Infective endocarditis is a common clinical problem in industrialized countries. Risk factors include abnormal cardiac valves, a history of endocarditis, intracardiac devices, prosthetic valves and intravenous drug use. We report a case of polymicrobial infective endocarditis in a 33 year-old female with a history chronic heroin use caused by Neisseria sicca and Haemophilus parainfluenzae. We believe the patient was exposed to these microbes by cleansing her skin with saliva prior to injection. Pairing a detailed history with the consideration of atypical agents is crucial in the proper diagnosis and management of endocarditis in patients with high-risk injection behaviors.

  2. Polymicrobial infective endocarditis caused by Neisseria sicca and Haemophilus parainfluenzae.

    Koshkelashvili, Nikoloz; Shah, Mahek; Codolosa, J Nicolas; Climaco, Antonette

    2016-01-01

    Infective endocarditis is a common clinical problem in industrialized countries. Risk factors include abnormal cardiac valves, a history of endocarditis, intracardiac devices, prosthetic valves and intravenous drug use. We report a case of polymicrobial infective endocarditis in a 33 year-old female with a history chronic heroin use caused by Neisseria sicca and Haemophilus parainfluenzae. We believe the patient was exposed to these microbes by cleansing her skin with saliva prior to injection. Pairing a detailed history with the consideration of atypical agents is crucial in the proper diagnosis and management of endocarditis in patients with high-risk injection behaviors. PMID:27051571

  3. 感染性心内膜炎的临床分析%Clinical analysis of infective endocarditis

    夏勇

    2012-01-01

    Objective To investigate the clinical features and treatment of infective endocarditis.Methods The clinical data of 30 cases of infective endocarditis from January 2009 to December 2011 were retrospectively analyzed.Results All patients underwent medical treatment,cured or improved in 23 cases after active treatment,and automatic discharged in 4 cases,3 cases of death (1 case died of heart failure,1 case died of multiple organ failure,1 case died of cerebrovascular accident).Conclusions Early diagnosis and combined treatment of surgery and medicine therapy is the key to treatment of infective endocarditis.%目的 探讨感染性心内膜炎的临床特征及治疗情况.方法 对2009年1月至2011年12月河南科技大学第三附属医院收治的30例感染性心内膜炎患者的临床资料进行回顾性分析.结果 所有患者均内科治疗,经积极治疗后痊愈或好转23例,自动出院4例,死亡3例(死于心力衰竭1例、多器官功能衰竭1例、脑血管意外1例).结论 感染性心内膜炎进行治疗的关键在于及早确诊,并进行内、外科的联合治疗.

  4. Man's best friend? Infective endocarditis due to Capnocytophaga canimorsus.

    Hayani, Omar; Higginson, Lyall A J; Toye, Baldwin; Burwash, Ian G

    2009-04-01

    Infective endocarditis caused by zoonotic microorganisms is an uncommon clinical entity. A 55-year-old man was diagnosed with endocarditis due to Capnocytophaga canimorsus, a commensal bacterium contained in the saliva of dogs, that involved the aortic and tricuspid valves and was complicated by a para-aortic valve abscess and aorta-to-right atrial fistula. The patient was successfully treated with antibiotic therapy and surgical intervention. C canimorsus endocarditis should be considered in patients with culture-negative endocarditis, particularly in immunosuppressed, asplenic or alcoholic individuals who have recently suffered a dog bite or have had close contact with dogs. PMID:19340358

  5. A severe infective endocarditis successfully treated with linezolid

    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.

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

    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.

  7. Infective Endocarditis Analysis of Clinical Observation and Treatment%感染性心内膜炎的临床观察与治疗分析

    邓惠

    2012-01-01

    目的:观察与分析感染性心内膜炎的临床表现、病原菌、治疗效果等,以期早期诊断、早期治疗、促进患者康复.方法:选取60例感染性心内膜炎患者且对其临床表现、治疗方法和效果及生存质量等进行观察与相关数据记录和统计分析.结果:感染性心内膜炎临床表现多样、而以发热为首发症状最为常见,病原菌为草绿色链球菌、表皮葡萄球菌、金黄色葡萄球菌、大肠杆菌、白色念珠菌、铜绿假单胞菌且本次治疗死亡率为3.33%.结论:感染性心内膜炎的诊断应综合患者临床症状、体征、辅助检查等及早做出判断,从而早期给予合理治疗,方能降低死亡率和致残率、改善患者生存质量.%Objective:The clinical manifestations of infective endocarditis,pathogens,treatment effects were observed and analyzed in order to achieve early diagnosis,early treatment,the purpose of promoting the rehabilitation of patients.Methods:60 cases of infective endocarditis patients were selected and their clinical manifestations,treatment,effectiveness and quality of life to observe and record data and statistical analysis.Results:The various clinical manifestations of infective endocarditis,and fever as the first symptom of the most common pathogens were Streptococcus viridans,Staphylococcus epidermidis,Staphylococcus aureus,Escherichia coli,Candida albicans,Pseudomonas aeruginosa and the treatment mortality rate was 3.33%.Conclusion:The diagnosis of infective endocarditis should be integrated clinical symptoms,signs,laboratory examinations and other early to judge,to give proper treatment can only reduce early mortality and morbidity,improve patient quality of life.

  8. Uncertainties in managing myocardial infarction associated with infective endocarditis

    Overend, Louise; Rose, Edward

    2012-01-01

    Embolic myocardial infarction is an uncommon but increasingly recognised complication of infective endocarditis. This complication has a high mortality rate and is deemed a relative contraindication to thrombolytic therapy. The present article describes an episode of acute myocardial infarction associated with infective endocarditis. Systemic thrombolytic therapy was administered, which resulted in resolution of cardiac ischemia but was complicated by a fatal intracerebral bleed. There are a ...

  9. Infective endocarditis with Lactococcus garvieae in Japan: a case report

    Isonuma Hiroshi

    2011-08-01

    Full Text Available Abstract Introduction Lactococcus garvieae is a well-recognized fish pathogen, and it is considered a rare pathogen with low virulence in human infection. We describe the 11th case of L. garvieae infective endocarditis reported in the literature, and the first reported case in Japan. Case presentation We report a case of a 55-year-old Japanese woman who had native valve endocarditis with L. garvieae. The case was complicated by renal infarction, cerebral infarction, and mycotic aneurysms. After anti-microbial treatment, she was discharged from the hospital and is now well while being monitored in the out-patient clinic. Conclusion We encountered a case of L. garvieae endocarditis that occurred in a native valve of a healthy woman. The 16S ribosomal RNA gene sequencing was useful for the identification of this pathogen. Although infective endocarditis with L. garvieae is uncommon, it is possible to treat high virulence clinically.

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

    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)

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

    Michael Ward

    2013-01-01

    Full Text Available Staphylococcus lugdunensis is a common skin flora not typically associated with infection. There are, however, several cases reported in the literature of Staphylococcus lugdunensis as a causative bacterium of various infections. This paper reports an additional case of pacemaker associated endocarditis with Staphylococcus lugdunensis as the causative bacterium.

  12. Using MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis: a case report of a patient with mitral valve infective endocarditis caused by Abiotrophia defectiva

    Holler, Jon Gitz; Pedersen, Line; Calum, Henrik;

    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....

  13. INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST'S PRACTICE

    E Yu Ponomareva

    2012-12-01

    Full Text Available Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the presence of rheumatic heart disease. Results. Locomotor apparatus lesion was noted in 44.8% of the patients with IE, cutaneous hemorrhagic vasculitis in 18%, pericarditis in 10%, pleurisy in 19%, glomerulonephritis in 60%, leukopenia in 9%, thrombocytopenia in 32%, elevated C-reactive protein levels in 92%, circulating immune complexes in 72%. Glomerulonephritis and hemorrhagic vasculitis more frequently develop in injection drug users (p < 0.0001. Rheumatic heart disease was pre-ceded by IE in 24 patients (13% among the all patients and 27% among those with secondary IE. In the patients with secondary IE evolving in the presence of prior rheumatic heart disease, pulmonary artery systolic pressure (PASP and cardiac arrhythmia rates were significantly higher than those in primary IE (62.5 and 53 mm Hg; p < 0.05; 62 and 32%; p < 0.025. Conclusion. The «rheumatic» manifestations were common in patients with IE and require their differential diagnosis with rheumatic diseases. Their degree correlates with systemic in-flammatory disease activity. In the patients with IE and prior rheumatic heart involvement, PASP and the frequency of arrhythmias are higher than in those with primary IE.

  14. Clinico-pathological characteristics of infective endocarditis associated with congenital heart disease:an analysis of 74 cases in single center

    李莉

    2013-01-01

    Objective To assess the changing profile of infective endocarditis(IE) in patients with congenital heart disease(CHD) from 1998 to 2009 in our hospital. Methods Clinical characteristics of IE patients with CHD under-went surgical treatment during 1998-2009 in our hospital

  15. Infective endocarditis following transcatheter aortic valve replacement-

    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...... be atypical causing a delay in the diagnosis and treatment. The management is also complicated by their comorbidities, and surgical treatment may not be feasible leading to a significant morbidity and mortality. We describe a case of an 85-year-old man with TAVI prosthetic valve endocarditis...

  16. Infective endocarditis in intravenous drug abusers: an update.

    Sousa, C; Botelho, C; Rodrigues, D; Azeredo, J; Oliveira, R

    2012-11-01

    Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts. PMID:22714640

  17. ACTINOMYCES NAESLUNDII, A PREVIOUSLY UNDOCUMENTED CAUSE OF INFECTIVE ENDOCARDITIS; WITH LITERARY REVIEW

    Loren Garrison Morgan

    2014-01-01

    Full Text Available Actinomycotic endocarditis is a rare disease with only 18 documented cases to date. Most of these cases are sub-acute or chronic infections and usually lack the stigmata of classic endocarditis. This article reviews the details of previously published reports of endocarditis due to various species of actinomyces, along with consensus opinion on diagnosis and treatment. We also present our unique case of Actinomyces naeslundii infective endocarditis, the first case ever attributed to this organism in medical literature.

  18. ACTINOMYCES NAESLUNDII, A PREVIOUSLY UNDOCUMENTED CAUSE OF INFECTIVE ENDOCARDITIS; WITH LITERARY REVIEW

    Loren Garrison Morgan; Ashley L. Davis; Paul Poommipanit; Yasir Ahmed

    2014-01-01

    Actinomycotic endocarditis is a rare disease with only 18 documented cases to date. Most of these cases are sub-acute or chronic infections and usually lack the stigmata of classic endocarditis. This article reviews the details of previously published reports of endocarditis due to various species of actinomyces, along with consensus opinion on diagnosis and treatment. We also present our unique case of Actinomyces naeslundii infective endocarditis, the first case ever attributed to this orga...

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

    Lauridsen, Trine Kiilerich; Bruun, Louise E; Rasmussen, R V;

    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...

  20. Surgical management for active infective endocarditis: a single hospital 10 years experience

    To examine the outcome of surgery for active infective endocarditis (IE) in a cohort of patients. One hundred sixty-four consecutive patients who underwent valve surgery for active IE (diagnosis according to Duke criteria) in Madani Heart Center, Tabriz, Iran from 1996 to 2006 were studied. The mean age of patients was 36.3+-16 years overall: 34.6+-17.5 years for native valve endocarditis and 38.6+-15.2 yrs for prosthetic valve endocarditis (p=0.169). Ninety one (55.5%) patients were men. The infected valve was native in 112 (68.7%) of patients and prosthetic in 52(31.3%). In 61 (37%) patients, no predisposing heart disease was found. The aortic valve was infected in 78 (47.6%), mitral valve in 69 (42.1%), and multiple valves in 17 (10.3%) of patients. Active culture positive endocarditis was present in 81 (49.4%) whereas 83 (50.6%) patients had culture-negative endocarditis. Staphylococcus aureus was the most common isolated microorganism. Ninety patients (54.8%) were in NYHA classes III and IV. Mechanical valves were implanted in 69 patients (42.1%) and bioprostheses in 95 (57.9%), including a homograft in 19 (11.5%). There were 16 (9%) operative deaths, but there was only 1 death in patients that underwent aortic homograft replacement. Reoperation was required in 18 (10.9%) of cases. On multivariate logistic regression analysis, Staphylococcus aureus infection (p=0.008), prosthetic valve endocarditis (p=0.01), paravalvular abscess (p=0.001) and left ventricular ejection fraction less than 40% (p=0.04) were independent predictors of in-hospital mortality. Surgery for infective endocarditis continues to be challenging and associated with high operative mortality and morbidity. Prosthetic valve endocarditis, impaired ventricular function, paravalvular abscess and Staphylococcus aureus infection adversely affect in-hospital mortality. Also we found that aortic valve replacement with an aortic homograft can be performed with acceptable in hospital mortality and

  1. Enterococcal Infective Endocarditis following Periodontal Disease in Dogs.

    Teresa Semedo-Lemsaddek

    Full Text Available In humans, one of the major factors associated with infective endocarditis (IE is the concurrent presence of periodontal disease (PD. However, in veterinary medicine, the relevance of PD in the evolution of dogs' endocarditis remains poorly understood. In order to try to establish a correlation between mouth-associated Enterococcus spp. and infective endocarditis in dogs, the present study evaluated the presence and diversity of enterococci in the gum and heart of dogs with PD. Samples were collected during necropsy of 32 dogs with PD and visually diagnosed with IE, which died of natural causes or euthanasia. Enterococci were isolated, identified and further characterized by Pulsed-Field Gel Electrophoresis (PFGE; susceptibility to antimicrobial agents and pathogenicity potential was also evaluated. In seven sampled animals, PFGE-patterns, resistance and virulence profiles were found to be identical between mouth and heart enterococci obtained from the same dog, allowing the establishment of an association between enterococcal periodontal disease and endocarditis in dogs. These findings represent a crucial step towards understanding the pathogenesis of PD-driven IE, and constitute a major progress in veterinary medicine.

  2. Selection of dental procedures for antibiotic prophylaxis against infective endocarditis.

    Tan, S Y; Gill, G

    1992-12-01

    A dental source of infection remains the most common identifiable risk factor in infective endocarditis and this may be particularly important in patients at 'high risk'. We therefore performed a questionnaire survey of dental practitioners to assess acceptance of The British Society of Antimicrobial Chemotherapy (BSAC) recommendations, especially with regards to selection of dental procedures for antibiotic prophylaxis. The results showed that the dental practitioners surveyed treated the 'high risk' patient group differently by extending the range of dental procedures covered by antibiotics but the BSAC only recommend that they be treated differently by hospital treatment and/or parenteral antibiotics. This must be an area of concern and deserves further attention, especially with regards to the need for wider publicity and the range of dental procedures that should be covered in the 'high risk' group where morbidity and mortality from infective endocarditis are higher. PMID:1452880

  3. Diagnosis and Treatment of Infective Endocarditis in Chronic Hemodialysis Patients

    Jian-ling Tao; Xue-mei Li; Xue-wang Li; Jie Ma; Guang-li Ge; Li-meng Chen; Hang Li; Bao-tong Zhou; Yang Sun; Wen-ling Ye; Qi Miao

    2010-01-01

    Objective To analyze the clinical features of hemodialysis patients complicated by infective endo-carditis.Methods The clinical features of six such patients admitted to Peking Union Medical College Hos-pital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular ac-cesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary cathe-ters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aor-tic valve involvement, and one with both. Five vegetations were found by transthoraeic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy-sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodi-alysis for three months after surgery.Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiogra-phy produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.

  4. Epidemiology of infective endocarditis in Chennai, South India

    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.

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

    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...

  6. INFECTIVE ENDOCARDITIS: TREATMENT AND PREVENTIVE MAINTENANCE (part III

    B S Belov

    2008-01-01

    Full Text Available The present paper completes a series of papers on the current aspects of infective endocarditis (IE. It also presents detailed antibacterial treatment schemes for IE in relation of an isolated pathogen. The authors show it expedient to use of glucocorticoids in IE and give indications for their administration. The basic principles of antibiotic prevention of IE are considered in various IE risk groups.

  7. INFECTIVE ENDOCARDITIS: TREATMENT AND PREVENTIVE MAINTENANCE (part III

    B S Belov

    2008-12-01

    Full Text Available The present paper completes a series of papers on the current aspects of infective endocarditis (IE. It also presents detailed antibacterial treatment schemes for IE in relation of an isolated pathogen. The authors show it expedient to use of glucocorticoids in IE and give indications for their administration. The basic principles of antibiotic prevention of IE are considered in various IE risk groups.

  8. Infective endocarditis: a tertiary referral centre experience from Turkey

    Agca, Fahriye Vatansever; Demircan, Necmiye; Peker, Tezcan; Ari, Hasan; Karaagac, Kemal; Ozluk, Ozlem Arican; YILMAZ, Mustafa; Tenekecioglu, Erhan

    2015-01-01

    Introduction: We aimed to define the current characteristics of infective endocarditis (IE) in a part of Turkey. Methods: All patients who were hospitalized in our hospital with a diagnosis of IE between 2009 and 2014 were included in the study. Data were collected from archives records of all patients. Modified Duke criteria were used for diagnosis. Results: There were 85 IE cases during the study period. The mean age of patients was 52 years. Fourty eight of patients were males. Native valv...

  9. 20例感染性心内膜炎的临床分析%Clinical Analysis of 20 Cases of Infective Endocarditis

    高媛

    2015-01-01

    Objective To investigate the clinical antibiotic treatment of infectious endocarditis patients. Methods Clinical data 20 cases of infectious endocarditis patients were analyzed. Results All patients who were clinically cured, average follow-up ifve months without subacute endocarditis. Conclusion The treatment of infection control, antibiotic treatment is extremely important, including early treatment of antibiotic therapy, treatment and prevention of recurrence.%目的:探讨感染性心内膜炎患者临床抗生素治疗。方法选取临床20例感染性心膜炎患者资料进行分析。结果所有患者均获临床痊愈,平均随访5个月无亚急性心内膜炎发生。结论控制感染治疗,抗生素治疗极为重要,抗生素治疗包括早期治疗、复发的治疗及预防。

  10. Antimicrobial susceptibility of enterococci from Italian patients with infective endocarditis

    Claudio Farina

    2010-03-01

    Full Text Available The epidemiological and clinical study “Studio Endocarditi Italiane” (SEI evaluated 947 cases of infective endocarditis in 2004-2008. Enterococcal aethiology was described in 11% cases.The aim of our study was to evacuate the in vitro activity of twelve antibiotics alone and in association against 20 strains (15 E. faecalis, 5 E. faecium. Results show the in vitro activity of tigecyicline, daptomicine and linezolid. Synergism is appreciated for ceftriaxone-fosfomycin (FICindex50=0.34, FICindex90=0.56 against E. faecalis and for imipenem-fosfomycin against E. faecium.The majority of the tested strains show addition using ampicillin-ceftriaxone (FICindex50=0.85, FICindex90=1.01 and moxifloxacin- tigecycline (FICindex50=0.77, FICindex90=1.96.

  11. Infective endocarditis- (a survey of the past 50 years

    Mehta Ajita

    1978-01-01

    Full Text Available Autopsy incidence of infective endocarditis during the past 50 years was analysed to review the changes in the clinico-pathologic pattern if any. 185 cases were recorded in a total of 39931 autopsies giving an average incidence of 0.46%. The cases were classified into groups I, II & III depending upon whether the endocarditis super-vened on normal hearts, diseased hearts or followed surgery, re-spectively. The fifty year period could be divided into three phases on incidence. First phase (1927-41 represented pre-antibiotic era in which group I cases predominated and causative organisms in 801" o f cases were virulent cocci such as staphylococci, haemolytic streptococci and pneumococci. In the second phase (1948-66 the general incidence was reduced by 50%. Group II cases predominat-ed and the most common etiologic agent was streptococcus viridans (40%. In the third phase (1967-76 the general incidence has reached again to preantibiotic level with coagulase positive staphy-lococci, Gram negative bacilli and fungi accounting for 90% of cases. Group III contributed significantly in this phase. The changes in incidence are primarily due to fall and rise in Group I cases. Incidence of rheumatic heart disease with endocar-ditis which mainly forms Group II is declining steadily in post-antibiotic era. There is no shift in the peak age incidence which remains in the 3rd decade. Males with rheumatic heart disease are more prone to infective endocarditis than similarly affected females. There was no change in frequency of involvement of various valves or sites of embolization.

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

    Abdul-Redha, Rawaa Jalil; Kemp, Michael; Bangsborg, Jette M;

    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 16...... obtained identical species identifications by the two methods. Most VS strains belonging to the groups of salivarius, anginosus, and mutans obtained agreeing species identifications with the two methods, while this only was the case for 13 of the 21 bovis strains. Pyogenic strains (n=10), Enterococcus...

  13. Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C.

    Kamar, Fareed B; Hawkins, T Lee-Ann

    2016-01-01

    While antineutrophil cytoplasmic antibody (ANCA) is often used as a diagnostic marker for certain vasculitides, ANCA induction in the setting of infection is much less common. In the case of infective endocarditis, patients may present with multisystem disturbances resembling an autoimmune process, cases that may be rendered even trickier to diagnose in the face of a positive ANCA. Though not always straightforward, distinguishing an infective from an inflammatory process is pivotal in order to guide appropriate therapy. We describe an encounter with a 43-year-old male with chronically untreated hepatitis C virus infection who featured ANCA positivity while hospitalized with acute bacterial endocarditis. His case serves as a reminder of two of the few infections known to uncommonly generate ANCA positivity. We also summarize previously reported cases of ANCA positivity in the context of endocarditis and hepatitis C infections. PMID:27366166

  14. Once versus twice daily gentamicin dosing for infective endocarditis

    Buchholtz, Kristine; Larsen, Carsten Toftager; Schaadt, Bente;

    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...... gentamicin, 20.4% (95% confidence interval 12.0–28.8). However, there was no significant difference in the GFR decrease between the once and twice daily regimens (p = 0.573). No difference in infection parameters was demonstrated between the two dosing regimens. Conclusions: A twice daily gentamicin dosing...

  15. Successful treatment of mitral valve endocarditis in a dog associated with 'Actinomyces canis-like' infection.

    Balakrishnan, N; Alexander, K; Keene, B; Kolluru, S; Fauls, M L; Rawdon, I; Breitschwerdt, E B

    2016-09-01

    Infective endocarditis, an inflammation of the endocardial surface due to invasion by an infectious agent, is more common in middle sized to large breed dogs. We herein report a case of mitral valve endocarditis in a 9-year-old male-castrated Weimaraner caused by an Actinomyces canis-like bacterium, not previously reported in association with infection in dogs. PMID:27364088

  16. 感染性心内膜炎75例临床分析%Infective endocarditis:a clinical analysis of 75 cases

    刘发琼

    2013-01-01

    Objective To summarize the clinical features and treatment methods of infective endocarditis and to improve the treatment outcomes for infective endocarditis. Methods The clinical data of 75 patients with infective endocarditis who were admitted to our hospital from May 2003 to December 2012 were retrospectively analyzed to summarize the clinical characteristics of this condition and discuss treatment methods. Results Fever was the major clinical symptom of infective endocarditis, accounting for 89.33% of all symptoms. Echocardiography revealed the presence of neoplasms in nearly 80% of patients. Fifty-two patients were positive for bacterial blood culture, accounting for 69.33%. A total of 41 patients developed vascular complications, including mesenteric artery embolization in 21 patients, cerebral embolism in 15 patients, splenic embolization in 3 patients, and other complications in 2 patients. Sixty-eight patients were cured and discharged from the hospital, with none experiencing late deaths. Three patients died in hospital and four gave up treatment. Conclusion Despite a lack of definite diagnostic criteria for infective endocarditis, the combination of fever monitoring, echocardiography, and blood culture can contribute to early detection of this disease, hence resulting in improved outcomes.%目的:总结感染性心内膜炎的临床特点、治疗方法,以提高感染性心内膜炎的治疗效果。方法对我院2003年5月-2012年12月收治并确诊的感染性心内膜炎患者共75例临床资料进行回顾性分析,以总结有关的临床特点,同时讨论治疗方法。结果发热为感染性心内膜炎的主要临床症状,占比为89.33%。超声心动图检查,发现有近80%的患者有赘生物。血培养细菌阳性患者有52例,占比为69.33%。本组患者共有41人发生血管并发症。其中:肠系膜动脉栓塞21例,脑栓塞15例,脾栓塞3例,其他并发症2例。治愈出院68例,出院患者

  17. Case report: Infective endocarditis caused by Brevundimonas vesicularis

    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.

  18. Man’s best friend? Infective endocarditis due to Capnocytophaga canimorsus

    Hayani, Omar; Higginson, Lyall AJ; Toye, Baldwin; Burwash, Ian G.

    2009-01-01

    Infective endocarditis caused by zoonotic microorganisms is an uncommon clinical entity. A 55-year-old man was diagnosed with endocarditis due to Capnocytophaga canimorsus, a commensal bacterium contained in the saliva of dogs, that involved the aortic and tricuspid valves and was complicated by a para-aortic valve abscess and aorta-to-right atrial fistula. The patient was successfully treated with antibiotic therapy and surgical intervention. C canimorsus endocarditis should be considered in...

  19. Infective endocarditis due to Bacillus cereus in a pregnant female: A case report and literature review

    Mahek Shah; Soumya Patnaik; Supakanya Wongrakpanich; Yaser Alhamshari; Talal Alnabelsi

    2015-01-01

    Incidence of infective endocarditis during pregnancy is around 0.006% with high maternal and fetal mortality. Bacillus cereus is an extremely rare cause for endocarditis in intravenous drug abusers (IVDA) or those with valvular disease or devices such as pacemakers. We report a case of B. cereus endocarditis, which, to the best of our knowledge, has never been reported in pregnancy. A 30-year-old, 25-week pregnant female presented with right shoulder pain, swelling and erythema on the lateral...

  20. [Infective endocarditis by Rhizobium radiobacter. A case report].

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

    2013-03-01

    Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters. PMID:23781714

  1. Clinical Features of Right-sided Infective Endocarditis

    杨莉; 伍卫; 王景峰; 张燕; 张小玲

    2002-01-01

    Objective To discuss thepathogenesis, etiology, clinical manifestations, diagnosis, treatment and prognosis of right-sided infective endocarditis (RIE) . Methods To investigate retrospectively the clinical data of patients with RIE admitted in our hospital from Jan 1985 to Dec 2000.Results There were 17 cases of RIE (12 male, 5female, mean age 22 years), among which 7 with congenital heart disease, 1 with pacemaker implantation and 9 with a history of intravenous drug abuse but without underlying heart disease. Fever and multiple pulmonary emboli were the major clinical manifestations. Blood cultures were positive in 8 cases with Staphylococcus aureus as the predominant microorganism. Echocardiography detected right heart vegetations in all cases, with tricuspid valve as the structure most frequently affected. Most patients were successfully treated with antimicrobials. The outcome was favourable, with a mortality of 11.8 % . Conclusions The clinical features of RIE are different from that of left-sided infective endocarditis (LIE) . Echocardiography plays an important role in the diagnosis of RIE.

  2. Right-Sided Infective Endocarditis and Pulmonary Infiltrates: An Update.

    Chahoud, Jad; Sharif Yakan, Ahmad; Saad, Hala; Kanj, Souha S

    2016-01-01

    Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis. PMID:26501991

  3. Novel Tissue Level Effects of the Staphylococcus aureus Enterotoxin Gene Cluster Are Essential for Infective Endocarditis

    Stach, Christopher S.; Vu, Bao G.; Merriman, Joseph A.; Herrera, Alfa; Cahill, Michael P.; Schlievert, Patrick M.; Salgado-Pabón, Wilmara

    2016-01-01

    Background Superantigens are indispensable virulence factors for Staphylococcus aureus in disease causation. Superantigens stimulate massive immune cell activation, leading to toxic shock syndrome (TSS) and contributing to other illnesses. However, superantigens differ in their capacities to induce body-wide effects. For many, their production, at least as tested in vitro, is not high enough to reach the circulation, or the proteins are not efficient in crossing epithelial and endothelial barriers, thus remaining within tissues or localized on mucosal surfaces where they exert only local effects. In this study, we address the role of TSS toxin-1 (TSST-1) and most importantly the enterotoxin gene cluster (egc) in infective endocarditis and sepsis, gaining insights into the body-wide versus local effects of superantigens. Methods We examined S. aureus TSST-1 gene (tstH) and egc deletion strains in the rabbit model of infective endocarditis and sepsis. Importantly, we also assessed the ability of commercial human intravenous immunoglobulin (IVIG) plus vancomycin to alter the course of infective endocarditis and sepsis. Results TSST-1 contributed to infective endocarditis vegetations and lethal sepsis, while superantigens of the egc, a cluster with uncharacterized functions in S. aureus infections, promoted vegetation formation in infective endocarditis. IVIG plus vancomycin prevented lethality and stroke development in infective endocarditis and sepsis. Conclusions Our studies support the local tissue effects of egc superantigens for establishment and progression of infective endocarditis providing evidence for their role in life-threatening illnesses. In contrast, TSST-1 contributes to both infective endocarditis and lethal sepsis. IVIG may be a useful adjunct therapy for infective endocarditis and sepsis. PMID:27124393

  4. Kocuria kristinae endocarditis related to diabetic foot infection.

    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

  5. 感染性心内膜炎的临床护理分析%Clinical Nursing Analysis of Infective Endocarditis

    郭莉莉

    2015-01-01

    目的:探讨感染性心肌膜炎的临床护理。方法选取2014年3月~2015年4月收治的感染性心内膜炎患者24例的临床护理方法和资料进行分析。结果24例感染性心内膜炎患者的临床治疗及护理均获临床痊愈。结论通过临床治疗及护理使患者的体温恢复至正常范围。患者自诉疼痛减轻或消失;心排血量恢复,血压正常,脉搏有力,无并发症发生或被及时发现并得到妥善处理,焦虑减轻或消失。%Objective To investigate the clinical nursing care of patients with infectious myocardial membrane. Methods The clinical nursing methods and data of 24 patients with infective endocarditis treated in our hospital from April2014 to March 2015 were analyzed. Results The clinical treatment and nursing of 24 patients with infective endocarditis were al cured. Conclusion The body temperature returned to normal range through clinical treatment and nursing care. The patient reported pain relieved or disappeared,recovery of cardiac output,blood pressure is normal,strong pulse. No complications occurred or were found to be treated in time,anxiety or loss was relieved or disappeared.

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

    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

  7. Antibiotic prophylaxis in infective endocarditis: Use or abuse?

    Nisha Thakur

    2012-01-01

    Full Text Available Introduction: The American Heart Association (AHA recommendations for antimicrobial prophylaxis for infective endocarditis (IE are controversial. According to the new guidelines released by the AHA now, the only patients to receive antibiotics will be those at highest risk, i.e. those with a prosthetic heart valve, a history of endocarditis, certain forms of congenital heart disease or valvulopathy after heart transplantation, and only before certain dental procedures. Unfortunately, these guidelines are still based largely on expert opinion, with very little hard evidence to show that antibiotic therapy actually prevents IE. The Hypothesis: The reported incidence of bacteremia during dental intervention ranges from 10% to 100% and, with daily brushing and flossing, from 20% to 68%. Because bacteremia also occurs during brushing and flossing of teeth, why give prophylaxis just for dental procedures? Moreover, the risks of causing adverse or anaphylactic reactions from antibiotics as well as contributing to the nationwide antibiotic resistance problem are issues not to be taken lightly. Evaluation of the Hypothesis: The hypothesis discusses the AHA recommendations for antimicrobial prophylaxis for IE, indicating some inherent limitations associated with it, and stresses upon the fact that these recommendation should also be updated, if not completely changed, to cope up with the advancements in the proper treatment plan.

  8. Infective endocarditis in Ethiopian children: a hospital based review of cases in Addis Ababa

    Moges, Tamirat; Gedlu, Etsegenet; Isaakidis, Petros; Kumar, Ajay; Den, Rafael Van; Khogali, Mohammed; Mekasha, Amha; Hinderaker, Sven Gudmund

    2015-01-01

    Introduction Infective endocarditis is an infection of the endocardial lining of the heart mainly associated with congenital and rheumatic heart disease. Although it is a rare disease in children, it is associated with high morbidity and mortality; death due to infective endocarditis has been reported to be as high as 26% in sub-Saharan Africa. Methods This was a retrospective review of routinely collected data from patient records. Results A total of 40 children (71% female) with 41 episodes...

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

    Serap Şimşek-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.

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

    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.

  11. Rare case of simultaneous enterococcal endocarditis and prosthetic joint infection.

    Tracy, Sean I; Brown, Sherry-Ann; Ratelle, John T; Bhagra, Anjali

    2016-01-01

    A 59-year-old man was admitted with a 3-month history of daily fevers as well as bilateral knee pain and swelling. Medical history was significant for bilateral knee arthroplasties 4 years prior to admission. Two sets of peripheral blood cultures as well as bilateral knee synovial fluid grew Enterococcus faecalis within 10 hours. Transoesophageal echocardiography revealed aortic and mitral valve vegetations suggestive of infectious endocarditis, with severe regurgitation secondary to large size. The patient's hospitalisation was complicated by acute heart failure, necessitating emergent mitral valve repair and aortic valve replacement, followed shortly thereafter by bilateral total knee arthroplasty resection with placement of antibiotic spacers. He was treated with intravenous penicillin and gentamicin for 4 months and recovered fully. He underwent repeat bilateral knee arthroplasties and was placed on amoxicillin for 6 months postoperatively, with no further evidence of infection. PMID:27207984

  12. Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis.

    Nichols, Kristen R; Israel, Emily N; Thomas, Christopher A; Knoderer, Chad A

    2016-05-01

    The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise in antibiotic dosing to the panel would be beneficial for future updates. PMID:26917819

  13. THE INFECTIVE ENDOCARDITIS (PREVENTION, DIAGNOSIS CRITERIA AND TREATMENT): KEY POINTS 2010

    Demin, A A

    2016-01-01

    Key positions of Guidelines on the prevention, diagnosis, and treatment of infective endocarditis issued by the Task Force of ESC in 2009 are explained in the comments. Recent opinions on these items are presented.

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

    Rasmussen, Rasmus V; Høst, Ulla; Arpi, Magnus;

    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...

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

    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.

  16. Effectiveness of Thrombolytic Therapy in Acute Embolic Stroke due to Infective Endocarditis

    Sontineni, Siva P.; Mooss, Aryan N.; Andukuri, Venkata G.; Susan Marie Schima; Dennis Esterbrooks

    2009-01-01

    Objective. To identify the role of thrombolytic therapy in acute embolic stroke due to infective endocarditis. Design. Case report. Setting. University hospital. Patient. A 70-year-old male presented with acute onset aphasia and hemiparesis due to infective endocarditis. His head computerized tomographic scan revealed left parietal sulcal effacement. He was given intravenous tissue plasminogen activator with significant resolution of the neurologic deficits without complications. Main Outcome...

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

    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 ...

  18. HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.

    Stephen T Chambers

    Full Text Available The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species are rare causes of infective endocarditis (IE. The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4% had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001, a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008 and stroke (25% vs. 17% p = 0.05 but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004, death in-hospital (4% vs. 18%; p = 0.001 or after 1 year follow-up (6% vs. 20%; p = 0.01 than IE due to other pathogens (n = 5514. On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01 and younger age (OR 0.62; CI 0.49-0.90; p<0.01. The overall outcome of HE was excellent with the in-hospital mortality (4% significantly better than for non-HE (18%; p<0.001. Prosthetic valve endocarditis was more common in HE (35% than non-HE (24%. The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

  19. INFECTIVE ENDOCARDITIS: AETIOLOGY, CLINICAL FEATURES, PRINCIPLES OF TREATMENT AND PREVENTION

    Coralia Bleotu

    2012-03-01

    Full Text Available Infective endocarditis (IE is characterized by pathogen colonization and endocardium invasion, causing the formation of vegetations - amorphous aggregates, composed of platelets, fibrin, microorganisms and inflammatory cells. IE microbiological aspects are variable from country to country, reason for which, the purpose of this review was to integrate some original data concerning the etiology and antimicrobial resistance markers in microbial strains isolated from infections occurred in patients with underlying cardiovascular diseases in the general microbiological picture IE (i.e. diagnosis, etiology and treatment. In our hospital, the etiology of positive blood cultures and prosthetic devices associated infections occurred in patients with cardiovascular diseases is dominated by Gram-positive cocci, especially S. aureus and coagulase-negative staphylococci (CNS, followed by Gram-negative fermentative and non-fermentative bacilli. The major concerns regarding the resistance markers of the isolated strains are the methicillin and macrolides lincosamides streptogramines resistance exceeding 50%, both in S. aureus and CNS and the aminoglycosides high level resistance (30% in E. faecium strains.

  20. Impact of Early Valve Surgery on Outcome of Staphylococcus aureus Prosthetic Valve Infective Endocarditis: Analysis in the International Collaboration of Endocarditis–Prospective Cohort Study

    Chirouze, Catherine; Alla, François; Fowler, Vance G.; Sexton, Daniel J.; Corey, G. Ralph; Chu, Vivian H.; Wang, Andrew; Erpelding, Marie-Line; Durante-Mangoni, Emanuele; Fernández-Hidalgo, Nuria; Giannitsioti, Efthymia; Hannan, Margaret M.; Lejko-Zupanc, Tatjana; Miró, José M.; Muñoz, Patricia; Murdoch, David R.; Tattevin, Pierre; Tribouilloy, Christophe; Hoen, Bruno; Clara, Liliana; Sanchez, Marisa; Nacinovich, Francisco; Oses, Pablo Fernandez; Ronderos, Ricardo; Sucari, Adriana; Thierer, Jorge; Casabé, José; Cortes, Claudia; Altclas, Javier; Kogan, Silvia; Spelman, Denis; Athan, Eugene; Harris, Owen; Kennedy, Karina; Tan, Ren; Gordon, David; Papanicolas, Lito; Eisen, Damon; Grigg, Leeanne; Street, Alan; Korman, Tony; Kotsanas, Despina; Dever, Robyn; Jones, Phillip; Konecny, Pam; Lawrence, Richard; Rees, David; Ryan, Suzanne; Feneley, Michael P.; Harkness, John; Jones, Phillip; Ryan, Suzanne; Jones, Phillip; Ryan, Suzanne; Jones, Phillip; Post, Jeffrey; Reinbott, Porl; Ryan, Suzanne; Gattringer, Rainer; Wiesbauer, Franz; Andrade, Adriana Ribas; de Brito, Ana Cláudia Passos; Guimarães, Armenio Costa; Grinberg, Max; Mansur, Alfredo José; Siciliano, Rinaldo Focaccia; Strabelli, Tania Mara Varejao; Vieira, Marcelo Luiz Campos; de Medeiros Tranchesi, Regina Aparecida; Paiva, Marcelo Goulart; Fortes, Claudio Querido; de Oliveira Ramos, Auristela; Ferraiuoli, Giovanna; Golebiovski, Wilma; Lamas, Cristiane; Santos, Marisa; Weksler, Clara; Karlowsky, James A.; Keynan, Yoav; Morris, Andrew M.; Rubinstein, Ethan; Jones, Sandra Braun; Garcia, Patricia; Cereceda, M; Fica, Alberto; Mella, Rodrigo Montagna; Barsic, Bruno; Bukovski, Suzana; Krajinovic, Vladimir; Pangercic, Ana; Rudez, Igor; Vincelj, Josip; Freiberger, Tomas; Pol, Jiri; Zaloudikova, Barbora; Ashour, Zainab; El Kholy, Amani; Mishaal, Marwa; Rizk, Hussien; Aissa, Neijla; Alauzet, Corentine; Alla, Francois; Campagnac, Catherine; Doco-Lecompte, Thanh; Selton-Suty, Christine; Casalta, Jean-Paul; Fournier, Pierre-Edouard; Habib, Gilbert; Raoult, Didier; Thuny, Franck; Delahaye, François; Delahaye, Armelle; Vandenesch, Francois; Donal, Erwan; Donnio, Pierre Yves; Michelet, Christian; Revest, Matthieu; Tattevin, Pierre; Violette, Jérémie; Chevalier, Florent; Jeu, Antoine; Sorel, Claire; Tribouilloy, Christophe; Bernard, Yvette; Chirouze, Catherine; Hoen, Bruno; Leroy, Joel; Plesiat, Patrick; Naber, Christoph; Neuerburg, Carl; Mazaheri, Bahram; Naber, Christoph; Neuerburg, Carl; Athanasia, Sofia; Giannitsioti, Efthymia; Mylona, Elena; Paniara, Olga; Papanicolaou, Konstantinos; Pyros, John; Skoutelis, Athanasios; Sharma, Gautam; Francis, Johnson; Nair, Lathi; Thomas, Vinod; Venugopal, Krishnan; Hannan, Margaret; Hurley, John; Gilon, Dan; Israel, Sarah; Korem, Maya; Strahilevitz, Jacob; Rubinstein, Ethan; Strahilevitz, Jacob; Casillo, Roberta; Cuccurullo, Susanna; Dialetto, Giovanni; Durante-Mangoni, Emanuele; Irene, Mattucci; Ragone, Enrico; Tripodi, Marie Françoise; Utili, Riccardo; Cecchi, Enrico; De Rosa, Francesco; Forno, Davide; Imazio, Massimo; Trinchero, Rita; Tebini, Alessandro; Grossi, Paolo; Lattanzio, Mariangela; Toniolo, Antonio; Goglio, Antonio; Raglio, Annibale; Ravasio, Veronica; Rizzi, Marco; Suter, Fredy; Carosi, Giampiero; Magri, Silvia; Signorini, Liana; Baban, Tania; Kanafani, Zeina; Kanj, Souha S.; Yasmine, Mohamad; Abidin, Imran; Tamin, Syahidah Syed; Martínez, Eduardo Rivera; Soto Nieto, Gabriel Israel; van der Meer, Jan T.M.; Chambers, Stephen; Holland, David; Morris, Arthur; Raymond, Nigel; Read, Kerry; Murdoch, David R.; Dragulescu, Stefan; Ionac, Adina; Mornos, Cristian; Butkevich, O.M.; Chipigina, Natalia; Kirill, Ozerecky; Vadim, Kulichenko; Vinogradova, Tatiana; Edathodu, Jameela; Halim, Magid; Lum, Luh-Nah; Tan, Ru-San; Lejko-Zupanc, Tatjana; Logar, Mateja; Mueller-Premru, Manica; Commerford, Patrick; Commerford, Anita; Deetlefs, Eduan; Hansa, Cass; Ntsekhe, Mpiko; Almela, Manuel; Armero, Yolanda; Azqueta, Manuel; Castañeda, Ximena; Cervera, Carlos; del Rio, Ana; Falces, Carlos; Garcia-de-la-Maria, Cristina; Fita, Guillermina; Gatell, Jose M.; Marco, Francesc; Mestres, Carlos A.; Miró, José M.; Moreno, Asuncion; Ninot, Salvador; Paré, Carlos; Pericas, Joan; Ramirez, Jose; Rovira, Irene; Sitges, Marta; Anguera, Ignasi; Font, Bernat; Guma, Joan Raimon; Bermejo, Javier; Bouza, Emilio; Fernández, Miguel Angel Garcia; Gonzalez-Ramallo, Victor; Marín, Mercedes; Muñoz, Patricia; Pedromingo, Miguel; Roda, Jorge; Rodríguez-Créixems, Marta; Solis, Jorge; Almirante, Benito; Fernandez-Hidalgo, Nuria; Tornos, Pilar; de Alarcón, Arístides; Parra, Ricardo; Alestig, Eric; Johansson, Magnus; Olaison, Lars; Snygg-Martin, Ulrika; Pachirat, Orathai; Pachirat, Pimchitra; Pussadhamma, Burabha; Senthong, Vichai; Casey, Anna; Elliott, Tom; Lambert, Peter; Watkin, Richard; Eyton, Christina; Klein, John L.; Bradley, Suzanne; Kauffman, Carol; Bedimo, Roger; Chu, Vivian H.; Corey, G. Ralph; Crowley, Anna Lisa; Douglas, Pamela; Drew, Laura; Fowler, Vance G.; Holland, Thomas; Lalani, Tahaniyat; Mudrick, Daniel; Samad, Zaniab; Sexton, Daniel; Stryjewski, Martin; Wang, Andrew; Woods, Christopher W.; Lerakis, Stamatios; Cantey, Robert; Steed, Lisa; Wray, Dannah; Dickerman, Stuart A.; Bonilla, Hector; DiPersio, Joseph; Salstrom, Sara-Jane; Baddley, John; Patel, Mukesh; Peterson, Gail; Stancoven, Amy; Afonso, Luis; Kulman, Theresa; Levine, Donald; Rybak, Michael; Cabell, Christopher H.; Baloch, Khaula; Chu, Vivian H.; Corey, G. Ralph; Dixon, Christy C.; Fowler, Vance G.; Harding, Tina; Jones-Richmond, Marian; Pappas, Paul; Park, Lawrence P.; Redick, Thomas; Stafford, Judy; Anstrom, Kevin; Athan, Eugene; Bayer, Arnold S.; Cabell, Christopher H.; Chu, Vivian H.; Corey, G. Ralph; Fowler, Vance G.; Hoen, Bruno; Karchmer, A. W.; Miró, José M.; Murdoch, David R.; Sexton, Daniel J.; Wang, Andrew; Bayer, Arnold S.; Cabell, Christopher H.; Chu, Vivian; Corey, G. Ralph; Durack, David T.; Eykyn, Susannah; Fowler, Vance G.; Hoen, Bruno; Miró, José M.; Moreillon, Phillipe; Olaison, Lars; Raoult, Didier; Rubinstein, Ethan; Sexton, Daniel J.

    2015-01-01

    Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis–Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non–S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39–1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE. PMID:25389255

  1. A Clinical Analysis of 36 Cases of Infective Endocarditis%感染性心内膜炎36例临床分析

    陈方军

    2007-01-01

    目的:探讨感染性心内膜炎(infective endocarditis,IE)的临床特点、治疗方法及转归.方法:回顾性分析安庆卫校附属医院自1997年1月~2006年5月间确诊的36例IE的临床资料.结果:临床主要表现发热(100%)为首发症状,超声心动图(UCG)赘生物检出25例.7例IE 经过单纯抗感染治疗痊愈,13/14例经过抗感染治疗联合外科手术治愈.另15例未接受手术治疗,其中院内死亡8 例,放弃治疗、自动出院7 例.结论:对不明原因长期发热患者应想到IE的可能,血培养和超声心动图检查有助于IE 的诊断.基础心脏病是IE常见病因之一,及时手术治疗,效果较好.

  2. Infective endocarditis in children in the Guinea savannah of Nigeria.

    Ifere, O A; Masokano, K A

    1991-01-01

    Thirty-two children with 33 episodes of infective endocarditis were admitted into the paediatric unit of Ahmadu Bello University Teaching Hospital, Zaria during an 8-year period (January 1982-December 1989). Thirty (94%) had underlying heart disease. Rheumatic heart disease was the pre-existing anomaly in 21 (66%) while congenital cardiac anomalies were detected in nine (28%). Cardiac failure, changing murmur or persisting fever drew attention to the disease. Bacterial isolation was achieved in 19 patients (58%), staphylococci in 11, and salmonella was found in three children. Others included Acinetobacter spp. in two patients, one of whom had a mixed infection involving alpha haemolytic streptococcus whereas three children had Klebsiella, pseudomonas or alpha haemolytic Streptococcus, respectively. Only six patients (18%) recovered. Abscondment rates were high (28%) and overall hospital mortality was 47%. Intractable cardiac failure and neurological complications were the most important events heralding death. There is a need for increased awareness and improved facilities for prompt and effective treatment. PMID:1719922

  3. Infective endocarditis of a rare etiology: Serratia marcescens

    Đokić 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.

  4. Streptococcus agalactiae mural infective endocarditis in a structurally normal heart.

    Ariyoshi, Nobuhiro; Miyamoto, Keisuke; Bolger, Dennis T

    2016-01-01

    A 38-year-old Caucasian man with uncontrolled diabetes mellitus type 2 was admitted with a 1-week duration of fevers, chills, and a non-productive cough. He had a left ischiorectal abscess 1 month prior to admission. Physical examination revealed caries on a left upper molar and a well-healed scar on the left buttock, but no heart murmur or evidence of micro-emboli. Blood cultures grew Streptococcus agalactiae. A transesophageal echocardiogram revealed a mobile mass in the right ventricle that attached to chordae tendineae without valvular disease or dysfunction. A computed tomography (CT) with contrast revealed the mass within the right ventricle, a left lung cavitary lesion, and a splenic infarction. He was initially treated with penicillin G for a week. Subsequently, ceftriaxone was continued for a total of 8 weeks. A follow-up CT showed no evidence of right ventricular mass 8 weeks after discharge. This is the first reported case of S. agalactiae mural infective endocarditis in a structurally normal heart. PMID:27124171

  5. Is there a role for Tc-99m HMPAO leucocyte scintigraphy in patients with infective endocarditis?

    Aim: Infective endocarditis is still an important disease in developing countries. Due to the difficult diagnosis, treatment is often delayed or inappropriate. A combination of clinical findings and echocardiography are used most often, but have a low sensitivity. As Tc-99m HMPAO labelled leucocyte scintigraphy is used routinely to evaluate patients with suspected infectious processes, it was postulated that this technique may also aid in the diagnosis of acute infective endocarditis in patients with rheumatic heart disease. Materials and Methods: Six patients who presented with clinical signs and symptoms of infective endocarditis, were referred for Tc-99m HMPAO labelled leucocyte scintigraphy. The white blood cells were labelled according to standard procedures. Whole body planar imaging, and single photon emission tomography of the chest area, with imaging at 30 minutes, 3 hours and 24 hours after the administration of the labelled leucocytes, were performed on all patients. Results: All the scintigrams were negative. No abnormal concentration of leucocytes could be detected in the region of the heart. This was in spite of clinical findings indicative of active infective endocarditis. Conclusion: Vegetations mainly consist of masses of clotted blood and blood cell debris, containing the causative organisms. Leucocytes do not play a major role in the pathologic process. Although only six patients were studied, it appears that Tc-99m HMPAO leucocyte scintigraphy is of no value in the evaluation of patients with infective endocarditis. A study after the administration of radiolabelled antibiotics may be of greater value and should be considered in these patients

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

    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.

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

    Masmoudi Sayda; Frikha Imed; Trigui Walid; Karoui Abdelhamid; Daoud Moncef; Sahnoun Youssef

    2000-01-01

    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.

  8. Donor-Derived Coccidioides immitis Endocarditis and Disseminated Infection in the Setting of Solid Organ Transplantation.

    Nelson, Joanna K; Giraldeau, Genevieve; Montoya, Jose G; Deresinski, Stan; Ho, Dora Y; Pham, Michael

    2016-09-01

    Background.  Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant. Methods.  We present a unique case of donor-derived Coccidioides immitis endocarditis and disseminated infection in a heart transplant patient. We also conducted a review of the literature to identify other cases of donor-derived coccidioidomycosis in solid organ transplant recipients and reviewed their clinical characteristics. Results.  Fifteen prior cases of donor-derived coccidioidomycosis were identified. A majority of these cases were diagnosed by positive culture (83%). Mortality was high at 58%. Conclusions.  Clinicians should maintain a high index of suspicion for disseminated coccidioidomycosis in patients who received transplants with organs from donors with a history of residing in endemic regions. PMID:27413765

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

    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.

  10. 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

    Nádia Barreto Tenório Aoun

    1997-12-01

    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.

  11. Takayasu Arteritis with Rheumatic Heart Disease with Congestive Cardiac Failure mimicking as having Infective Endocarditis

    Upadhyay, Piyush

    2013-01-01

    Takayasu Arteritis (TA) is a chronic, idiopathic and granulomatous vasculitis of the large arteries. It involves primarily the aorta, especially aortic proximal branches, and occasionally the pulmonary arteries. We report a 10 year old boy with Takayasu arteritis with Rheumatic heart disease who developed congestive heart failure with valvular heart disease mimicking as having infective endocarditis. Complete aortogram revealed narrowing of abdominal aorta, superior ...

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

    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

  13. Turning 18 with congenital heart disease : prediction of infective endocarditis based on a large population

    Verheugt, Carianne L.; Uiterwaal, Cuno S. P. M.; van der Velde, Enno T.; Meijboom, Folkert J.; Pieper, Petronella G.; Veen, Gerrit; Stappers, Jan L. M.; Grobbee, Diederick E.; Mulder, Barbara J. M.

    2011-01-01

    Aims The risk of infective endocarditis (IE) in adults with congenital heart disease is known to be increased, yet empirical risk estimates are lacking. We sought to predict the occurrence of IE in patients with congenital heart disease at the transition from childhood into adulthood. Methods and re

  14. New Tricks from an Old Cow: Infective Endocarditis Caused by Streptococcus dysgalactiae subsp. dysgalactiae

    Jordal, Stina; Glambek, Marte; Oppegaard, Oddvar

    2014-01-01

    We present a case of infective endocarditis caused by Streptococcus dysgalactiae subsp. dysgalactiae, a major cause of bovine mastitis and previously thought to be an animal-restricted pathogen. The patient reported no direct contact with animals, and the clinical course was severe and complicated. PMID:25472489

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

    Nath Parrimala

    2008-01-01

    Full Text Available 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.

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

    Nath Parrimala; Kiran V; Maheshwari Sunita

    2008-01-01

    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.

  17. Infective endocarditis due to Bacillus cereus in a pregnant female: A case report and literature review.

    Shah, Mahek; Patnaik, Soumya; Wongrakpanich, Supakanya; Alhamshari, Yaser; Alnabelsi, Talal

    2015-01-01

    Incidence of infective endocarditis during pregnancy is around 0.006% with high maternal and fetal mortality. Bacillus cereus is an extremely rare cause for endocarditis in intravenous drug abusers (IVDA) or those with valvular disease or devices such as pacemakers. We report a case of B. cereus endocarditis, which, to the best of our knowledge, has never been reported in pregnancy. A 30-year-old, 25-week pregnant female presented with right shoulder pain, swelling and erythema on the lateral aspect of deltoid muscle from large abscess over her deltoid muscle. She was found to have a vegetation on the native tricuspid valve. Cultures from abscess fluid and blood cultures grew B. cereus, she was appropriately treated with antimicrobials and had favorable outcomes. There are cereus endocarditis reported but none during pregnancy. When cultures grow unusual organisms the case must be thoroughly investigated. This case illustrates a rare situation (endocarditis in pregnancy) with an unusual outcome (B. cereus) on an uncommon valve (tricuspid valve). PMID:26793477

  18. Infective endocarditis due to Bacillus cereus in a pregnant female: A case report and literature review

    Mahek Shah

    2015-01-01

    Full Text Available Incidence of infective endocarditis during pregnancy is around 0.006% with high maternal and fetal mortality. Bacillus cereus is an extremely rare cause for endocarditis in intravenous drug abusers (IVDA or those with valvular disease or devices such as pacemakers. We report a case of B. cereus endocarditis, which, to the best of our knowledge, has never been reported in pregnancy. A 30-year-old, 25-week pregnant female presented with right shoulder pain, swelling and erythema on the lateral aspect of deltoid muscle from large abscess over her deltoid muscle. She was found to have a vegetation on the native tricuspid valve. Cultures from abscess fluid and blood cultures grew B. cereus, she was appropriately treated with antimicrobials and had favorable outcomes. There are <20 cases of B. cereus endocarditis reported but none during pregnancy. When cultures grow unusual organisms the case must be thoroughly investigated. This case illustrates a rare situation (endocarditis in pregnancy with an unusual outcome (B. cereus on an uncommon valve (tricuspid valve.

  19. Case report: Infective endocarditis caused by Brevundimonas vesicularis

    Chen Tun-Chieh; Chen Yen-Hsu; Yang Mei-Li; Lin Wei-Ru; Lin Chun-Yu; Lu Po-Liang

    2006-01-01

    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...

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

    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.

  1. The relationship between cerebrovascular complications and previously established use of antiplatelet therapy in left-sided infective endocarditis

    Snygg-Martin, Ulrika; Rasmussen, Rasmus Vedby; Hassager, Christian;

    2011-01-01

    Cerebrovascular complications (CVC) in infective endocarditis (IE) are common. The only established treatments to reduce the incidence of CVC in IE are antibiotics and in selected cases early cardiac surgery. Potential effects of previously established antiplatelet therapy are under debate....

  2. Analysis on the influential factors for prognosis of 81 patients with infective endocarditis%感染性心内膜炎81例预后影响因素分析

    虞燕波; 邢云利; 梁金锐

    2016-01-01

    Objective To analyze the influential factors for prognosi of patients with infective endocarditis. Methods The clinical data of 81 patients with infective endocarditis in Beijing Friendship Hospital during January 1992 to October 2013 were retrospectively reviewed and ana-lyzed. Results Among these 81 patients with infective endocarditis,the male gender was predominated with a sex ratio of 2. 1:1,48 patients (59. 3% )had basic heart diseases,70 patients(87. 4% )had fever and 60. 5% patients had anemia. The bacterial cultures were positive in 38. 3% of patients,and 22. 2% patients accepted surgical treatment. Conclusion The data in this study showed that the clinical manifestations of infective endocarditis are complex with high mortality rate. Rheumatic heart disease is the basic disease for this infection and renal impairment is the risk factor for the poor prognosis of these patients.%目的:分析感染性心内膜炎(IE)的预后影响因素。方法调查1992年1月至2013年10月北京友谊医院确诊的81例 IE 患者病例资料,对其临床特点进行回顾性分析,并对可能的相关因素进行单因素统计学分析。结果81例患者中单因素分析显示,风湿性心脏病对于感染性心内膜炎患者的 OR =5.387(95% CI 1.626-8.425),肾脏损伤对于感染性心内膜炎患者的 OR =4.233(95% CI 1.607~10.494),外科治疗对于感染性心内膜炎患者的 OR =1.153(95% CI 1.121~1.440),具有统计学意义。结论 IE 临床表现复杂,是一种危害大、病死率较高的心脏疾病;风湿性心脏基础疾病以及肾脏损伤是患者预后不良的危险因素。

  3. 感染性心内膜炎患者血培养病原菌及其耐药性分析%Analysis of Pathogenic Bacteria and Drug Resistance in Patients with Endocarditis Infected Blood Culture

    邱宗利

    2014-01-01

    目的:分析感染性心内膜炎患者血培养病原菌及其耐药性,为临床提供参考。方法:通过对52例2003年9月-2013年9月本院收治的感染性心内膜炎患者进行血培养实验和病原菌耐药性实验,分析感染性心内膜炎患者血培养病原菌及其耐药性。结果:52例患者共筛选出32株病原菌,感染率为61.54%,其中革兰阳性菌株28株,占87.50%,主要为金黄色葡萄球菌、草绿色链球菌、粪肠球菌、牛链球菌、口腔链球菌和表皮葡萄球菌,革兰阳性菌对环丙沙星和庆大霉素耐药性较强,对万古霉素耐药性较差;革兰阴性菌4株,占12.50%,主要为铜绿假单胞、产气肠杆菌和大肠埃希菌,革兰阴性菌对庆大霉素耐药性较强,对头孢哌酮和环丙沙星耐药性较差。结论:金黄色葡萄球菌和草绿色链球菌是感染性心内膜炎的主要致病菌,而这两株菌对万古霉素的耐药性均较差,所以临床上可以用万古霉素作为预防和治疗感染性心内膜炎的主要抗生素,这对临床治疗感染性心内膜炎有重要的指导意义。%Objective:To analyze pathogenic bacteria and drug resistance in blood of patients with infective endocarditis,and to provide reference for clinical.Method:52 cases of patients with infective endocarditis were obtained from 2003 September to 2013 September in our hospital,which were used to do pathogen resistance experiment and blood culture experiment,and the endocarditis culture and drug resistance of pathogens were analyzed.Result:32 strains of pathogenic bacteria were screened from 52 patients,the infection rate was 61.54%,of which 28 strains were gram positive strains,accounting for 87.50%,mainly included Staphylococcus aureus,Streptococcus viridans,Enterococcus faecalis,Streptococcus bovis,oral Streptococcus and Staphylococcus epidermidis,the resistance of gram positive bacteria to ciprofloxacin and gentamicin was strong,but the

  4. Staphylococcus aureus β-Toxin Mutants Are Defective in Biofilm Ligase and Sphingomyelinase Activity, and Causation of Infective Endocarditis and Sepsis.

    Herrera, Alfa; Vu, Bao G; Stach, Christopher S; Merriman, Joseph A; Horswill, Alexander R; Salgado-Pabón, Wilmara; Schlievert, Patrick M

    2016-05-01

    β-Toxin is an important virulence factor of Staphylococcus aureus, contributing to colonization and development of disease [Salgado-Pabon, W., et al. (2014) J. Infect. Dis. 210, 784-792; Huseby, M. J., et al. (2010) Proc. Natl. Acad. Sci. U.S.A. 107, 14407-14412; Katayama, Y., et al. (2013) J. Bacteriol. 195, 1194-1203]. This cytotoxin has two distinct mechanisms of action: sphingomyelinase activity and DNA biofilm ligase activity. However, the distinct mechanism that is most important for its role in infective endocarditis is unknown. We characterized the active site of β-toxin DNA biofilm ligase activity by examining deficiencies in site-directed mutants through in vitro DNA precipitation and biofilm formation assays. Possible conformational changes in mutant structure compared to that of wild-type toxin were assessed preliminarily by trypsin digestion analysis, retention of sphingomyelinase activity, and predicted structures based on the native toxin structure. We addressed the contribution of each mechanism of action to producing infective endocarditis and sepsis in vivo in a rabbit model. The H289N β-toxin mutant, lacking sphingomyelinase activity, exhibited lower sepsis lethality and infective endocarditis vegetation formation compared to those of the wild-type toxin. β-Toxin mutants with disrupted biofilm ligase activity did not exhibit decreased sepsis lethality but were deficient in infective endocarditis vegetation formation compared to the wild-type protein. Our study begins to characterize the DNA biofilm ligase active site of β-toxin and suggests β-toxin functions importantly in infective endocarditis through both of its mechanisms of action. PMID:27015018

  5. Infective endocarditis 1973-1984 at the Bergen University Hospital: clinical feature, treatment and prognosis.

    Lien, E A; Solberg, C O; Kalager, T

    1988-01-01

    During the period 1973-1984, 72 patients with infective endocarditis (IE) were hospitalized in the medical department, Bergen University Hospital. The male/female ratio was 1.25/1, the mean age 55.3 years. 35 infections were caused by streptococci, 18 by staphylococci, 6 by other microorganisms and in 13 cases no causal organism was found. Only 13 patients had rheumatic heart disease. The overall mortality was 35%, and the mean age of the patients who died was 65 years. The case fatality rates for staphylococcal and streptococcal endocarditis were 61 and 24% respectively. In the period 1973-1978 the case fatality rate was 50% compared to 26% during 1979-1984. The proportion of patients with culture-negative endocarditis was reduced from 31 to 11% from the first to the second half of the study and the percentage of patients who received antibiotics before diagnosis decreased from 81 to 58%. Valve replacement was performed in 4 patients with staphylococcal and 15 with streptococcal infections. Seven cases (mean age 73.4 years) were diagnosed at necropsy; 3 with staphylococcal infections. With increased clinical awareness of IE, liberal use of blood cultures, better diagnostic tools and earlier surgical intervention, especially in staphylococcal infections, a further reduction in mortality should be possible. PMID:3406663

  6. Recurrent infective endocarditis due to Aggregatibacter aphrophilus and Staphylococcus lugdunensis.

    Hidalgo-García, L; Hurtado-Mingo, A; Olbrich, P; Moruno-Tirado, A; Neth, O; Obando, I

    2015-03-01

    Uncommon microorganisms are increasingly being recognized as causative agents of paediatric infectious endocarditis (IE). We report a 4-year old girl with congenital heart disease, who suffered from 2 IE episodes secondary to Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus) and Staphylococcus lugdunensis, both rarely reported pathogens in this age group. The patient was initially successfully treated with prolonged intravenous antibiotic courses, however removal of the Contegra valved conduit during the second episode was required due to recurrence of fever and development of pulmonary embolism despite completion of antibiotic therapy. A. aphrohilus is a member of the fastidious gram negative microorganisms of the HACEK group (Haemophilus spp., Aggregatibacter spp, Cardiobaterium hominis, Eikenella corrodens and Kingella kingae), that colonize the oropharynx and are a recognised cause of IE. Prognosis of children with IE due to HACEK group members varies, half of them suffering from complications and mortality rates of 10-12.5%. Although S. lugdunensis belongs to coagulase negative staphylococci (CONS), it behaves more like S. aureus species rather than CONS. This microorganism is a well-described cause of endocarditis in adult patients, associated with high requirements of surgical procedures and mortality (42-78%). In conclusion, paediatric IE can be caused by uncommon microorganisms associated with severe complications and potential fatality. The isolation of S. lugdunensis or A. aphrophilus in febrile patients should be considered clinically relevant and cardiac involvement must be ruled out. Those patients with proved IE will require prolonged intravenous antibiotic courses and in complicated cases surgical intervention. PMID:25751682

  7. Isolated Pulmonary Valve Endocarditis

    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.

  8. [Simultaneous operation of WPW syndrome combined with mitral regurgitation caused by infective endocarditis].

    Sueda, T; Nakashima, Y; Hamanaka, Y; Ishihara, H; Matsuura, Y; Isobe, F

    1990-03-01

    A case of WPW syndrome combined with mitral regurgitation caused by infective endocarditis underwent surgical division of accessory pathway and mitral valve replacement preserving posterior leaflet simultaneously. A 56-years old woman suffered atrial fibrillation with pseudo VT and cardiac failure caused by mitral regurgitation. Electro-physiological study (EPS) revealed accessory pathway in postero-lateral wall in left atrium and atrio-fascicular pathway like James bundle in AV node. ECHO cardiography showed mitral valve prolapse and severe regurgitation. Accessory pathway was divided surgically and deep freeze coagulation was followed. Perforation of anterior leaflet and chordal rupture of posterior leaflet caused by infective endocarditis were repaired by annuloplasty (Kay and McGoon method) at first, but regurgitation retained moderately. After re-clamping of aorta, mitral valve was replaced with prosthesis (SJM 29 mm) preserving posterior leaflet. Postoperative examination revealed division of accessory pathway and no regurgitation of mitral prosthesis. PMID:2348136

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

    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

  10. Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa

    Nkomo, Vuyisile T.

    2007-01-01

    Valvular heart diseases in Africa affect mainly children and young adults and are a result of rheumatic fever. Rheumatic fever is a preventable disease, but in Africa the combination of a lack of resources, lack of infrastructure, political, social and economic instability, poverty, overcrowding, malnutrition and lack of political will contributes to the persistence of a high burden of rheumatic fever, rheumatic valvular heart diseases and infective endocarditis. Combating and eradicating rhe...

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

    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...

  12. Outcome of Infective Endocarditis: Improved Results Over 18 Years (1990–2007)

    Pachirat O; Limwattananon S; Tantisirin C; Tatsanavivat P

    2008-01-01

    Background: High morbidity and mortality characterize patients suffering infective endocarditis (IE). The treatment of IE has undergone significant changes within ten years but it is not known whether mortality has decreased and which factors are determinant of the outcome.Objectives: Our aim was to evaluate the prognostic significance of clinical characteristics and outcomes of IE.Methods and Results: 312 definite cases of IE diagnosed using the Duke criteria were evaluated. Overall in-hospi...

  13. Value of brain MRI in infective endocarditis: a narrative literature review.

    Champey, J; Pavese, P; Bouvaist, H; Kastler, A; Krainik, A; Francois, P

    2016-02-01

    The nervous system is frequently involved in patients with infective endocarditis (IE). A systematic review of the literature was realized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). This study sought to systematically evaluate the published evidence of the contribution of brain magnetic resonance imaging (MRI) in IE. The aim was to identify studies presenting the incidence and type of MRI brain lesions in IE. Fifteen relevant studies were isolated using the Medline, Embase, and Cochrane databases. Most of them were observational studies with a small number of patients. MRI studies demonstrated a wide variety and high frequency of cerebral lesions, around 80 % of which were mostly clinically occult. This review shows MRI's superiority compared to brain computed tomography (CT) for the diagnosis of neurologic complications. Recent developments of sensitive MRI sequences can detect microinfarction and cerebral microhemorrhages. However, the clinical significance of these microhemorrhages, also called cerebral microbleeds (CMBs), remains uncertain. Because some MRI neurological lesions are a distinctive IE feature, they can have a broader involvement in diagnosis and therapeutic decisions. Even if cerebral MRI offers new perspectives for better IE management, there is not enough scientific proof to recommend it in current guidelines. The literature remains incomplete regarding the impact of MRI on concerted decision-making. The long-term prognosis of CMBs has not been evaluated to date and requires further studies. Today, brain MRI can be used on a case-by-case basis based on a clinician's appraisal. PMID:26585337

  14. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data.

    Loupa, C; Mavroidi, N; Boutsikakis, I; Paniara, O; Deligarou, O; Manoli, H; Saroglou, G

    2004-06-01

    The epidemiology, and clinical and microbiological spectrum, of infective endocarditis (IE) in Greece was analysed in a prospective 4-year study in a tertiary hospital and a heart surgery centre in Athens. In total, 101 cases of IE (71 men, 30 women, aged 54.4 +/- 17.1 years) were studied, with a follow-up period of 3 months. Seventy-seven cases were definite and 24 possible; 59 involved native valves (native valve endocarditis; NVE), 31 prosthetic valves (prosthetic valve endocarditis; PVE), of which nine were early and 22 late, and 11 permanent pacemakers (pacemaker endocarditis; PME). There was a predominant involvement of aortic (48/101) and mitral (40/101) valves. Seven patients had rheumatic valvular disease, two had mitral valve prolapse, and eight had a previous history of IE. Thirteen and six patients had undergone dental and endoscopic procedures, respectively. In 13 patients, intravenous catheters were used within the 3 months before diagnosis of IE. There were three intravenous drug users among the patients. Staphylococcus aureus was the most important pathogen, isolated in 22% of cases, followed by viridans streptococci (19%) and coagulase-negative staphylococci (16%). Enterococcus spp. were responsible for 3%, HACEK group for 2%, and fungi for 6% of cases. Viridans streptococci were the leading cause of NVE (29%), Staphylococcus epidermidis of PVE (16%), and S. aureus of PME (54.5%). Six of 22 S. aureus and ten of 16 S. epidermidis isolates were methicillin-resistant. Surgical intervention, including total pacemaker removal, was performed in 51.5% of patients. Overall mortality was 16%, but was 29% with PVE, and was significantly higher with medical than with combined surgical and medical therapy (24.5% vs. 8%). Compared with previous studies, there were changing trends in the epidemiology, microbiology, treatment and prognosis of IE in Greece. PMID:15191385

  15. Draft Genome Sequence of Erythromycin-Resistant Streptococcus gallolyticus subsp. gallolyticus NTS 31106099 Isolated from a Patient with Infective Endocarditis and Colorectal Cancer

    Kambarev, Stanimir; Caté, Clément; Corvec, Stéphane; Pecorari, Frédéric

    2015-01-01

    Streptococcus gallolyticus subsp. gallolyticus is known for its close association with infective endocarditis and colorectal cancer in humans. Here, we report the draft genome sequence of highly erythromycin-resistant strain NTS 31106099 isolated from a patient with infective endocarditis and colorectal cancer.

  16. Clinical Analysis on Atypical Ultrasound Diagnosis of Infective Endocarditis%不典型感染性心内膜炎超声诊断的临床分析

    窦新萍; 张利

    2015-01-01

    Objective:To analyze atypical infective endocarditis by ultrasonic diagnosis.Method:From April 2012 to April 2014 50 patients admitted in our hospital with atypical infective endocarditis and 50 patients with infective endocarditis were involved in clinical research,both for echocardiography,blood culture,examination,serum immunology examination, electrocardiogram inspection diagnosis,to compare two groups of patients with infective endocarditis and relevant test results. Result:Echocardiography in atypical patients with infective endocarditis diagnosed rate (98.0%) was significantly higher, blood culture to check,the positive rate of serum immunology examination,ECG (76.0%,58.0%,34.0%) (P0.05).Two groups patients with blood culture showed positive ratio was 76.0% and 32.0% respectively (P<0.05);Two groups patients circulating immune complex (CIC) content showed the proportion of overweight was 58.0% and 80.0% respectively (P<0.05).Two groups patients T wave change was 4.0% and 60.0%,respectively (P<0.05). Conclusion:Ultrasound diagnosis for atypical clinical diagnosis of infective endocarditis accuracy is higher,which is important for the differential diagnosis of these patients.%目的:对不典型感染性心内膜炎超声诊断进行临床分析。方法:对2012年4月-2014年4月在本院接受治疗的50例不典型感染性心内膜炎患者和50例非感染性心内膜炎患者进行临床研究,均分别进行超声心动图检查、血培养检查、血清免疫学检查、心电图检查诊断,研究比较不典型感染性心内膜炎患者的检出情况及两组患者的相关检查结果。结果:不典型感染性心内膜炎患者的超声心动图检查的确诊率(98.0%)明显高于血培养检查、血清免疫学检查、心电图检查的确诊率(76.0%、58.0%、34.0%),比较差异有统计学意义(P<0.05)。不典型的感染性心内膜炎患者与非感染性心内膜炎患者存在赘生物的比例分别为98

  17. Bartonella henselae endocarditis in Laos - 'the unsought will go undetected'.

    Sayaphet Rattanavong

    2014-12-01

    Full Text Available Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos, probably because people have neglected to look.We conducted a retrospective (2006-2012, and subsequent prospective study (2012-2013, at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for

  18. [Infective endocarditis due to Bartonella henselae following a rupture of a cerebral aneurysm].

    de La Blanchardière, A; Fournier, P-E; Haustraete, E; du Cheyron, D; Lepage, O; Verdon, R

    2009-06-01

    We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200mg/day and intravenous gentamycin at 90mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis. PMID:19097835

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

    Raoult Didier; Collart Frédéric; Habib Gilbert; Lepidi Hubert; Gouriet Frédérique

    2007-01-01

    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 uniq...

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

    B S Belov

    2008-01-01

    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.

  1. Complex tricuspid valve repair for infective endocarditis: leaflet augmentation, chordae and annular reconstruction.

    Tarola, Christopher L; Losenno, Katie L; Chu, Michael W A

    2015-01-01

    Surgical treatment of tricuspid valve (TV) endocarditis remains a challenge because of extensive valve destruction, high risk of reinfection, poor outcomes with valve replacement and complex patient compliance issues. Reconstruction of the TV is certainly favoured over replacement; however, diffuse, multifocal vegetations and complete debridement often leave insufficient building materials necessary for repair. We describe our surgical reconstructive technique that relies upon extensive autologous pericardial patch augmentation of the destroyed TV leaflets to establish leaflet coaptation, supplemented with expanded polytetrafluoroethylene neo-chordae and annular reconstruction. We report our outcomes in a series of patients with grossly infected TVs with more than 50% of valvular destruction. PMID:25989809

  2. Clinicomicrobiological profile of infective endocarditis in a tertiary care center of Nepal

    M Ghimire

    2013-09-01

    Full Text Available Background Infective endocarditis is a common problem and data regarding its clinical and microbiological pattern from developing countries are sparse. We studied clinical features and the microbiological pathogens in patients with Infective Endocarditis in our Hospital. Objective To study the clinical profile and microbiological pathogens involved in patients with Infective Endocarditis, admitted under Department of Internal Medicine of B.P Koirala Institute of Health Sciences. Materials and methods A total of 54 patients with history of fever and underlying heart disease were studied. It was a hospital based cross sectional descriptive study done in patients with infective endocarditis presented to us from March 2007 to February 2008 in B.P Koirala Institute of Health Sciences. Results Out of 54 patients, 11 (20.4% had Dukes definite IE. The male: female ratio was 1.2:1. The mean age of the study group was 27.3 years (range=16-55. In IE group, fever was present in 100% cases (n=11 as it was the inclusion criteria of the study, followed by SOB 81.8% (n=9. History of antibiotic therapy prior to the presentation was present in 36.7 % (n=4 patients. Pallor was the most common sign 63.6% (n=7. Splenomegaly was seen in 18.2% (n=2. Anaemia (Hb<10gm % in 36.4% (n=4 and microscopic haematuria in 72.3% (n=8 cases. Blood culture positivity was seen in 36.4 %. The most common pathogens were Staphylococcus aureus in 27.3% (n=3 and Acinetobacter species in 9.1% (n=1. Conclusion In our study we found that the clinical spectrum of IE was different from the west in that the majority of patients being young in our study. However, RHD still is the commonest underlying heart disease and Staphylococcus aureus being the commonest isolate. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 34-41 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8698  

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

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars;

    2009-01-01

    -hospital mortality was 23% (95% CI: 17-29%), and there was no significant difference between those with or without anticoagulation. CONCLUSIONS: We found no increased risk of cerebral haemorrhage in S. aureus IE patients receiving anticoagulation. Anticoagulation was associated with a reduced risk of cerebral events...... before initiation of antibiotics. Data support the continuance of anticoagulation in S. aureus IE patients when indicated.......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...

  4. Multiple Embolism in a Female Patient with Infective Endocarditis: Low Back Pain and Hematuria as the Initial Clinical Manifestations

    Vieira Marcelo Luiz Campos

    2002-01-01

    Full Text Available A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

  5. Hospital acquired native valve endocarditis: analysis of 22 cases presenting over 11 years

    Lamas, C; Eykyn, S

    1998-01-01

    Objective—To analyse hospital acquired infective endocarditis cases with respect to age, sex, clinical, laboratory, and echocardiographic features, predisposition, complications, surgery, mortality, and diagnostic criteria.
Design—Prospective cohort study.
Setting—Teaching hospital.
Patients—A series of 200 patients with infective endocarditis presenting over 11 years, 168 with native valve infective endocarditis, of whom 22 acquired this infection in hospital.
Results—22 (14%) of the 168 cas...

  6. Successful treatment of Candida parapsilosis and Pseudomonas aeruginosa infection using medical and surgical management in an injecting drug user with mitral and aortic valve endocarditis: a case report

    Daas Hanady

    2009-05-01

    Full Text Available Abstract Introduction Polymicrobial endocarditis is a well-recognized problem in intravenous drug users and it accounts for 1 to 3% of endocarditis cases overall and up to 9% in other series. The most common combinations of organisms include Staphylococcus aureus and Streptococcus pneumoniae followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida parapsilosis endocarditis carries a mortality rate of 45%, and each infection with Candida or Pseudomonas endocarditis per se carries a very high mortality rate approaching 85% and 80%, respectively. The combination of P. aeruginosa and C. parapsilosis has never been encountered and there have been no earlier reports of the combination of C. parapsilosis and P. aeruginosa in adult intravenous drug users as a cause of endocarditis. Case presentation We present a 49-year-old man with bivalvular endocarditis with P. aeruginosa and C. parapsilosis. He had a prior bivalvular replacement in 2005 that became infected with the above microorganisms and he was treated with intravenous antibiotics. Because of ongoing intravenous drug use, a second valve replacement was denied. A few days later, the patient presented with septic shock secondary to P. aeruginosa and C. parapsilosis recurrent endocarditis. The infection was cured with a second bivalvular replacement and extended therapy with antibiotics and antifungals. Conclusion This is the first time a patient has presented with P. aeruginosa and C. parapsilosis endocarditis. Relapsing polymicrobial endocarditis can be cured with medical and surgical therapy.

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

    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

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

    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

  9. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae.

    Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Astushi

    2016-01-01

    BACKGROUND Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). CASE REPORT A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient's heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient's condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. CONCLUSIONS This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular extension of the infection, which can lead to fatal heart block. PMID:27604147

  10. 67Ga imaging in the patients with infective endocarditis after surgery for congenital heart disease

    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)

  11. A Case of Subacute Combined Degeneration of the Spinal Cord with Infective Endocarditis

    Xiao-Jiang Huang

    2015-01-01

    Full Text Available Background. Subacute combined degeneration (SCD is a rare cause of demyelination of the dorsal and lateral columns of spinal cord and is a neurogenic complication due to cobalamin deficiency. Anemia of chronic disease (ACD occurs in patients with acute or chronic immune activation, including infective endocarditis. It remains to be elucidated whether ACD patients are more sensitive to suffer from SCD. Little cases about SCD patients accompanied with ACD have been reported till now. Here we reported a 36-year-old man with SCD with a medical history of mitral inadequacy over 20 years, who was admitted and transported from another hospital to our hospital due to an 8-month history of gait disturbance, lower limb weakness and paresthesia, and loss of proprioception. Significant laboratory results and echocardiography suggest iron deficiency anemia and infective endocarditis (IE. The SCD diagnosis was confirmed by MRI, which showed selective demyelination in the dorsal and lateral columns of spinal cord. In conclusion, the ACD patients may suffer from SCD, which can be diagnosed by 3 Tesla magnetic resonance imaging.

  12. An update on the epidemiology, pathogenesis and management of infective endocarditis with emphasis on Staphylococcus aureus.

    Tak, Tahir; Reed, Kurt D; Haselby, Ray C; McCauley, Charles S; Shukla, Sanjay K

    2002-01-01

    The incidence of infective endocarditis (IE) is thought to be around 4/100,000 person years in the general population, and 15/100,000 over the age of 50 years. The risk of acquiring IE is higher among patients with valvular heart disease (e.g., rheumatic valves, bicuspid aortic valves, myxomatous degeneration, etc.), congenital heart disease (e.g., coarctation, patent ductus arteriosus, ventricular septal defect, etc.), prosthetic cardiac valves, and among intravenous drug abusers. Staphylococcus aureus is one of the most common infective agents of IE, and most commonly originates from nosocomial sources, e.g., intravenous and arterial catheters, pacemaker leads, and prosthetic valves. Endocarditis caused by S aureus has a mortality rate of approximately 20% to 40%. In up to 40% of patients, IE caused by S aureus is associated with embolic complications. The risk of death increases with the development of complications. The epidemiology and microbiology of S aureus are changing rapidly, and resistance to antibiotics, especially methicillin, is becoming more widespread. In this review we will focus on the epidemiology, microbiology, and pathogenesis of S aureus IE, and also summarize the current guidelines for diagnosis, treatment, and prophylaxis of this clinical condition. PMID:12426917

  13. Aerococcus urinae, a rare cause of infective endocarditis.

    Melnick, Stephen; Nazir, Salik; Hingorani, Rittu; Wexler, Philip

    2016-01-01

    We present the case of an elderly male who was initially seen in our hospital for a urinary tract infection that was treated with oral ciprofloxacin. He was admitted 2 weeks later with altered mental status and fever, and was found to have bacteraemia with Aerococcus urinae Owing to altered mental status a brain MRI was performed which showed evidence of embolic stroke. Following this, a transesophageal echocardiogram showed severe mitral regurgitation and a vegetation >1 cm involving the mitral valve with associated destruction of posterior valve leaflets. The patient was started on antibiotics intravenous penicillin G and intravenous gentamicin for a total duration of 6 weeks. He underwent mitral valve replacement on day 4 of hospitalisation. The postoperative course was complicated by ventilator-dependent respiratory failure, requiring tracheostomy and eventual transfer to a skilled nursing facility. Unfortunately, he died after 2 weeks of stay at the facility. PMID:27440847

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

    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)

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

    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.

  16. Bartonella quintana Endocarditis in Dogs

    Kelly, Patrick; Rolain, Jean-Marc; Maggi, Ricardo; Sontakke, Sushama; Keene, Bruce; Hunter, Stuart; Lepidi, Hubert; Breitschwerdt, Kyle T.; Breitschwerdt, Edward B.; Raoult, Didier

    2006-01-01

    We provide the first evidence that Bartonella quintana can infect dogs and cause typical signs of endocarditis. Using PCR and sequencing, we identified B. quintana in the blood of a dog from the United States with aortic valve endocarditis and probably also in the mitral valve of a dog from New Zealand with endocarditis.

  17. Infective endocarditis: long-term reversibility of kidney function impairment. A 1-y post-discharge follow-up study

    Buchholtz, Kristine; Larsen, Carsten T; Hassager, Christian;

    2010-01-01

    The aim of this study was to quantify the long-term reversibility of kidney function decrease occurring during hospitalization and treatment for infective endocarditis (IE). A prospective observational cohort study was performed at a tertiary university hospital in Copenhagen from October 2002...

  18. Clinical analysis of right-side infective endocarditis in intravenous drug users with HIV-positive%HIV抗体阳性静脉药瘾者右心感染性心内膜炎临床分析

    郑其岳; 朱炜; 欧家满; 叶广宁

    2009-01-01

    Objectives To investigate the clinical features of the intravenous drugs users who have infected the right-sided infective endocarditis (RIE) with human immunodeficiency virus (HIV)-positive. Methods We retrospectively analyzed the clinical data of 21 patients infected the RIE with HIV-positive. Results Most part of them were unemployed young men who had no heart-disease, they had something in common such as they have shared and repeated to use the unsterilized syringes; the time of intravenous drug abuse was about 0.5-5 years; and HIV-positive. Clinical manifestations: all of them got fever and lung damage and so on. Heart damage was mainly in the tricuspid valve. Laboratory examination showed that most of them had anaemia, high white blood cell count, hypoproteinemia and so on; the positive rate of blood culture was 61.9% , it was staphylococcus aureus in the majority. Eehocardiography detected tricuspid valve vegetation in 100% patients. Conclusions Intravenous drug abuse is the cause of the RIE and HIV infected, and the RIE and HIV can be infected in the same time, they influenced each other and the HIV infection can increase the seriousness and refractoriness of RIE, the clinical symptoms will be heavy. Relatively, it has poor prognosis.%目的 探讨静脉药瘾者右心感染性心内膜炎(right-sided infective endocarditis,RIE)并人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体阳性的临床特点.方法 回顾性分析21例HIV抗体阳性的RIE患者临床资料,着重分析患者的检查结果 和治疗情况.结果 ①无业男青年居多,无基础心脏病,静脉吸毒时间0.5年~5年不等;②均有发热、浅表静脉炎性反应及肺损害等;③心脏损害以三尖瓣受损为主,部分有肺动脉瓣受损,少数并发二尖瓣受累;④实验室检查多有贫血,白细胞升高及低蛋白血症,血培养阳性率达61.9%,以金黄色葡萄球菌居多;⑤超声心动图检出三尖瓣赘生物达100%,符合右心感染

  19. Histoplasma capsulatum Endocarditis

    Riddell, James; Kauffman, Carol A.; Smith, Jeannina A.; Assi, Maha; Blue, Sky; Buitrago, Martha I.; Deresinski, Stan; Wright, Patty W.; Drevets, Douglas A.; Norris, Steven A.; Vikram, Holenarasipur R.; Carson, Paul J.; Vergidis, Paschalis; Carpenter, John; Seidenfeld, Steven M.

    2014-01-01

    Abstract Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was...

  20. Legionella longbeachae and Endocarditis

    Leggieri, Nicola; Gouriet, Frédérique; Thuny, Frank; Habib, Gilbert; Raoult, Didier; Casalta, Jean-Paul

    2012-01-01

    We report a case of infectious endocarditis attributable to Legionella longbeachae. L. longbeachae is usually associated with lung infections. It is commonly found in composted waste wood products. L. longbeachae should be regarded as an agent of infectious endocarditis, notably in the context of gardening involving handling of potting soils.

  1. A Clinical Analysis of 11 Patients with Drug Addiction and Infective Endocarditis%静脉药瘾者心内膜炎11例临床分析

    颜景信

    2006-01-01

    目的探讨静脉药瘾并发感染性心内膜炎(infective endocarditis IE)的特征.方法回顾分析11例静脉药瘾并发IE的临床资料.结果静脉药瘾并发IE者多为青年男性,男女比例10:1,平均年龄26岁,无基础心脏病.临床特点起病为发热,体温38~40℃,为不规则发热,全身乏力,面色苍白,咳嗽气促,合并肺感染(91%);血细菌培养阳性以金黄色葡萄球菌多见(45.3%);超声心动图显示右心系统感染(三尖瓣受累)最为常见(81%),其次二尖瓣(18%).结论静脉药瘾并发IE者临床特征为发热、咳嗽、气促,心脏杂音,血细菌培养阳性合并肺感染,超声心动图检查对右心感染有重要价值.

  2. Role of the serine-rich surface glycoprotein Srr1 of Streptococcus agalactiae in the pathogenesis of infective endocarditis.

    Ho Seong Seo

    Full Text Available The binding of bacteria to fibrinogen and platelets are important events in the pathogenesis of infective endocarditis. Srr1 is a serine-rich repeat glycoprotein of Streptococcus agalactiae that binds directly to the Aα chain of human fibrinogen. To assess the impact of Srr1 on the pathogenesis of endocarditis due to S. agalactiae, we first examined the binding of this organism to immobilized human platelets. Strains expressing Srr1 had significantly higher levels of binding to human platelets in vitro, as compared with isogenic Δsrr1 mutants. In addition, platelet binding was inhibited by pretreatment with anti-fibrinogen IgG or purified Srr1 binding region. To assess the contribution of Srr1 to pathogenicity, we compared the relative virulence of S. agalactiae NCTC 10/84 strain and its Δsrr1 mutant in a rat model of endocarditis, where animals were co-infected with the WT and the mutant strains at a 1:1 ratio. At 72 h post-infection, bacterial densities (CFU/g of the WT strain within vegetations, kidneys, and spleens were significantly higher, as compared with the Δsrr1 mutant. These results indicate that Srr1 contributes to the pathogenesis of endocarditis due to S. agalactiae, at least in part through its role in fibrinogen-mediated platelet binding.

  3. [Microbiological approach to a possible infective endocarditis case caused by Aggregatibacter actinomycetemcomitans].

    Gürcan, Şaban; Ünlü, Selahattin; Kuloğlu, Figen; Karadenizli, Aynur; Kuşkucu, Mert Ahmet

    2016-04-01

    Aggregatibacter (Actinobacillus) actinomycetemcomitans, a small, gram-negative coccobacillus that grows slow and fastidious, is generally colonized in the oral cavity. It is a rarely seen bacterium because of the difficulty of isolation but it can be a causative agent for dental infections and infective endocarditis (IE) particularly in the persons having prosthetic heart valves. In this report, a possible IE case caused by A.actinomycetemcomitans in a patient with aortic valve replacement has been presented. A 36-year-old man has admitted to Trakya University Hospital, Health Center for Medical Research and Practice, with the complaints of chills, malaise, intermittent fever, severe arthralgia and weight loss (20 kg). During his follow-up period, the blood cultures that were obtained three week intervals yielded the identical gram-negative coccobacilli morphology. The patient was then diagnosed as possible IE on the basis of having one major (growth of the typical microorganisms that may cause IE in two different blood cultures) and two minor (presence of prosthetic valve and high fever) criterias. The isolate could not be identified with conventional methods, while it was identified as Francisella tularensis with VITEK 2 (bioMerieux, France) system. Hence this identification was not confirmed by real-time Taqman polymerase chain reaction, so MALDI-TOF mass spectrometry was used to identify this bacteria. In the first run of the study, the isolate was named as Shigella dysenteriae initially, however when it was retested the next day it was identified as A.actinomycetemcomitans. In order to enlighten these conflicting results, 16S and 23S ribosomal DNA sequence analysis was performed, and consequently the bacterium was identified as A.actinomycetemcomitans. Doxycycline (2 x 100 mg po, 20 days) and streptomycin (2 x 10 mg/kg im, 10 days) therapy were initiated, considering the initial suspicious identification (F.tularensis), and on the fifth day of therapy the

  4. Infective Endocarditis

    ... were born with). You had rheumatic fever or rheumatic heart disease as a child, which scarred your heart valves. ... and if you have a history of congenital heart disease, rheumatic fever, or valve disease. Doctors may also look ...

  5. Infective Endocarditis

    ... the past, patients with nearly every type of congenital heart defect needed to receive antibiotics one hour before dental procedures or operations on the mouth, throat, gastrointestinal genital, or urinary tract. However, in 2007 the American Heart Association simplified ...

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

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars;

    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 patients with S. aureus IE (150 mg/l (1-521) vs 94 mg/l (6-303); p...% 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....

  7. INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST’S PRACTICE: ISSUES OF ITS CLINICAL PRESENTATION AND DIAGNOSIS

    B. S. Belov

    2015-01-01

    Full Text Available At present, the problem of infective endocarditis (IE remains relevant for clinicians of different specialties, including rheumatologists. The distinctive feature of present-day IE is its polyetiological pattern due to a broad spectrum of pathogens. The lecture highlights in detail clinical picture of the disease, laboratory and instrumental findings. It presents current international diagnostic criteria for IE. The obvious clinical polymorphism, subtle symptoms, and monosyndromic onset as masks, all increases the significance of differential diagnosis of IE, in early disease stages in particular. Main approaches to differentiating IE from diseases posing the greatest differentially diagnostic challenges are set forth.

  8. Infective endocarditis in bicuspid aortic valve: atrioventricular block as sign of perivalvular abscess.

    Bacchion, Francesco; Cukon, Sonja; Rizzoli, Giulio; Gerosa, Gino; Daliento, Luciano; Thiene, Gaetano; Basso, Cristina

    2007-01-01

    A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the emergency department. Electrocardiogram showed sinus tachycardia and first-degree atrioventricular block. Transesophageal echocardiogram showed infective endocarditis in bicuspid aortic valve, complicated with severe aortic regurgitation, ring abscess, and sinus-of-Valsalva aneurysm extending to mitroaortic fibrous continuity. The patient, who was unaware of his bicuspid aortic valve condition, reported having undergone an orthodontic procedure complicated with dental abscess 1 month prior, which was treated with combined clavulanate-amoxicillin antibiotic therapy. Blood cultures were positive for Bacteroides fragilis resistant to metronidazole. Intravenous antibiotic therapy was undertaken, with rapid resolution of fever. He eventually underwent successful aortic homograft implantation and mitral valve repair with residual first-degree atrioventricular block. PMID:17637435

  9. Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

    Pedro; A; Villablanca; Shashvat; Sukhal; Oscar; Maitas; Afiachuukwu; Onuegbu; Juan; M; Muoz-Pea; Ajay; Joseph; Carlos; Requena; Divyanshu; Mohananey

    2014-01-01

    Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.

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

    Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Fujii, Yoko

    2015-03-01

    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

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

    Axelsson, Anna; Søholm, Helle; Dalsgaard, Morten;

    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...

  12. Misdiagnosis analysis and literature review of left ventricle-right atrium communication complicated with infective endocarditis vegetation%左心室右心房通道并感染性心内膜炎赘生物误诊分析及文献回顾

    孙琪青; 孙力安; 徐灵敏

    2016-01-01

    Objective To investigate the misdiagnosis reason and clinical features of left ventricle-right atrium communication complicated with infective endocarditis vegetation.Methods The clinical features,the process of diagnosis and misdiagnosis of 1 child with left ventricle-right atrium communication complicated with infective endocarditis vegetation on August 9,2013 were retrospectively analyzed.The related related literature was reviewed.Results Fever was the early performance of the child;physical examination found a heart murmur;blood cultures was positive;echocardiography showed left ventricle-right atrium communication,slight hyperechoic mass in right atrium.The temperature reduced after anti-infective treatment,while stomach,face and feet edema occurred;then the surgery was performed.It was confirmed as right atrium purulent endocarditis by postoperative pathology.The child was discharged after standardized anti-infection treatment.After 1 year of follow-up,no recurrence was observed.Conclusion Left ventricle-right atrium communication complicated with infective endocarditis vegetation is rare,timely standard echocardiography and comprehensive clinical analysis are helpful to the diagnosis.%目的 分析左心室有心房通道并感染性心内膜炎赘生物的误诊原因和临床特点.方法 回顾性分析2013年8月9日郑州市儿童医院收治的1例左心室右心房通道并感染性心内膜炎患儿的临床特点、诊疗及误诊过程,并进行相关文献复习.结果 该患儿早期表现为发热,体格检查发现心脏有杂音,血培养阳性,心脏彩色超声示左心室有心房通道,右心房内略强回声团块;抗感染治疗体温好转后出现腹胀、面部及双足水肿,行手术治疗.病理证实:右心房化脓性心内膜炎,给予规范抗感染治疗后痊愈出院.随访1年,无复发.结论 左心室右心房通道合并感染性心内膜炎赘生物罕见,及时规范的心脏超声检查、综合临床分析有助于明确诊断.

  13. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases.

    Vogkou, Christiana T; Vlachogiannis, Nikolaos I; Palaiodimos, Leonidas; Kousoulis, Antonis A

    2016-08-01

    Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term "infective endocarditis". All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3 % of studies (N = 57) (and in 55.4 % of studies using Duke's criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and diagnostic strategies. PMID:27170145

  14. Infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm: a case report.

    Ikeda, Akihiko; Nakajima, Tomomi; Konishi, Taisuke; Matsuzaki, Kanji; Sugano, Akinori; Fumikura, Yuko; Nishina, Hidetaka; Jikuya, Tomoaki

    2016-12-01

    Asymptomatic rupture of a sinus of Valsalva aneurysm is rare. A fistula following rupture of a sinus of Valsalva aneurysm may cause infective endocarditis. Here, we report a case of infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm. A 45-year-old male, who was first diagnosed with a heart murmur at the age of 37 years, presented with fever. Blood culture was positive for Streptococcus gordonii. Ultrasound echocardiography revealed an aorto-right atrial fistula caused by rupture of a sinus of Valsalva aneurysm. After the infective endocarditis was healed by antibiotics, we successfully performed surgical repair of the aorto-right atrial fistula. Although asymptomatic rupture of a sinus of Valsalva aneurysm is uncommon, it should be recognized as a possible cause of infective endocarditis. PMID:27180251

  15. sup(99m)Tc-labeled antibacterial antibody scan for the diagnosis of infective endocarditis (in rabbit)

    The mortality of infective endocarditis is high and the results of blood cultures and clinical manifestations may be unreliable in its diagnosis. A technique has been developed using the specific antigen-antibody reaction against sup(99m)Tc-labelled antibacterial antibody. The antibody, tagged by an electrolytic method, remained very active and was not denatured since 99% of the sup(99m)Tc-antibody was able to react with antigen. The labelled antibody was injected intravenously into rabbits with experimental aortic endocarditis. The radioactivity of the infected aortic valves was about four times greater than that in the uninfected valves. A scintillation scan was able to detect the infected valves in vivo. (U.K.)

  16. DISTINGUISHED CHARACTERISTICS OF INFECTIVE ENDOCARDITIS IN HIV/AIDS AMONG INTRAVENOUS DRUGS ABUSED

    E. Y. Ponomareva

    2014-07-01

    Full Text Available The aim – definition of distinguished characteristics of the right-sided infective endocarditis (IE inintravenous drugs abused with human immunodeficiency virus (HIV/acquired immunodeficiency syndrome (AIDS.Materials and methods. The study included 10 patients with right-sided IE in conjunction with HIV/AIDS. All patients were male, age – from 28to 36 years.Results. Course of the IE in HIV/AIDS among intravenous drugs abused in general corresponds to features specific to IE in intravenous drug users without HIV infection. Distinctive features of IE in these patients are a large burden of lung disease, its disseminated character, more tissue oxygenation disorders and marked pulmonary hypertension and haematological disorders (lymphopenia, anemia, and late diagnosis of IE.Conclusion. Features of the current right-sided IE in intravenous drugs abused with HIV/AIDS are distinguished . Difficulties in diagnosis of IE inHIV infection are due to variety of causes of prolonged fever, which should guide doctors to more frequent use of transthoracic echocardiography during prolonged fever in HIV-infected patients.

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

    Janine Ring

    Full Text Available 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-labeled or unlabeled S. aureus (strain 6850. To distinguish the effect of IE from mere tissue injury or recruited macrophages, subgroups of mice received sham surgery prior to infection (n = 17, received surgery without infection (n = 8, or obtained additionally injection of free iron particles to label macrophages (n = 17. Cardiac MRI was performed 48 h after surgery using a self-gated ultra-short echo time (UTE sequence (TR/TE, 5/0.31 ms; in-plane/slice, 0.125/1 mm; duration, 12∶08 min to obtain high-resolution, artifact-free cinematographic images of the valves. After MRI, valves were either homogenized and plated on blood agar plates for determination of bacterial titers, or sectioned and stained for histology. In the animal model, both severity of the disease and mortality increased with bacterial numbers. Infection with 105 S. aureus bacteria reliably caused endocarditis with vegetations on the valves. Cinematographic UTE MRI visualised the aortic valve over the cardiac cycle and allowed for detection of bacterial vegetations, while mere tissue trauma or labeled macrophages were not detected. Iron labeling of S. aureus was not required for detection. MRI results were consistent with histology and microbial assessment. These data showed that S. aureus-induced IE in mice can be detected by MRI. The established mouse model allows for investigation of the pathophysiology of IE, testing of novel drugs and may serve for the development of a clinical

  18. 感染性心内膜炎的超声诊断%Ultrasonic Diagnosis for Infective Endocarditis

    周爱云; 蒋筑丽; 邓林云

    2000-01-01

    :探讨超声在感染性心内膜炎的诊断价值。方法:超声检查37例心内膜炎患者。结果:检出赘生物31例,阳性率84%。赘生物多见于左心系统,为26/31(二尖瓣者15/31、主动脉瓣者11/31);其它部位较少为5/31。赘生物致心衰病例仅见于左心系统(二尖瓣赘生物致心衰6例,主动脉瓣赘生物致心衰9例)。而彩色多普勒血流显像(CDFI)可进一步评估心内膜炎所并发的瓣膜关闭不全及血流动力学改变。结论:超声对诊断心内膜炎有明显指导意义,应为首选。%To assess the diagnostic value of ultrasonology in infective endocarditis. Methods: 37 patients with infective endocarditis were examined by ultrasonology. Results: 31patients were found with vegetation in total 37 cases. Most of the vegetations existed in the left heart (26/31 ,among which 15 at bicuspid valve and 11 at aortic valve). The heart failure was present only in the case with left heart vegetations (15/26, among which 6 at bicuspid vale and 9 at aortic vale). CDFI could further estimate the degree of valvular regurgitation caught by infective endocarditis. Conclusion: Ultrasonology should be chosen first in the diagnosis of infective endocarditis.

  19. Tuberculous endocarditis.

    Liu, Alexander; Nicol, Edward; Hu, Yanmin; Coates, Anthony

    2013-08-10

    Mycobacterium tuberculosis (TB) is a major cause of death globally. TB is capable of infecting every organ in the body, and the heart is no exception. Tuberculous endocarditis (TBE) was first reported in 1892 and subsequently many other cases have been described, highlighting the significant morbidity and mortality associated with this manifestation of TB. TBE usually presents with miliary tuberculosis and most early cases were diagnosed on autopsy. With increasing application of prosthetic valve replacements in the treatment of infective endocarditis (IE), TB infections have begun to affect these as well as native valves. With the introduction of TB culture methods and drug therapy, the prognosis has improved. HIV and drug resistance are likely to make the management of TBE more difficult in the future. Large scale studies, both prospective and retrospective, are required to ascertain the true incidence of TBE whilst development of novel anti-TB therapy is also required to combat resistance. We present the first extensive literature review on TBE in over 75 years. PMID:23021600

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

    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

  1. 感染性心内膜炎的临床护理分析%Clinical Nursing Analysis of Infectious Endocarditis

    窦玉红

    2014-01-01

    Objective Infectious endocarditis clinical nursing and health education are to be discussed. Methods The clinical nursing data of 36 patients with infective endocarditis admitted in this hospital during October of 2012 to October of 2013 are selected for analysis. Results There are 18 cases with rheumatic heart disease,8 cases with congenital heart disease and 6 cases with idiopathic mitral valve prolapsed and insufficiency. Al 36 patients saw clinical recovery. Conclusion Through intensive care for patients with infectious endocarditis,the therapeutic effect has improved with preventing and reducing incidence of subacute endocarditis.%目的:探讨感染性心内膜炎患者临床护理与健康教育。方法选取临床2012年10月至2013年10月收治的感染性心膜炎患者36例临床护理资料进行分析。结果风湿性心脏病18例,先天性心脏病8例,特发性二尖瓣脱垂及关闭不全6例,36例患者均获临床痊愈。结论通过对感染性心内膜炎患者精心护理,提高治疗效果,预防和减少亚急性心内膜炎的发生。

  2. ENDOCARDITIS WITH AN UNCOMMON GERM

    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.

  3. Activated human valvular interstitial cells sustain interleukin-17 production to recruit neutrophils in infective endocarditis.

    Yeh, Chiou-Yueh; Shun, Chia-Tung; Kuo, Yu-Min; Jung, Chiau-Jing; Hsieh, Song-Chou; Chiu, Yen-Ling; Chen, Jeng-Wei; Hsu, Ron-Bin; Yang, Chia-Ju; Chia, Jean-San

    2015-06-01

    The mechanisms that underlie valvular inflammation in streptococcus-induced infective endocarditis (IE) remain unclear. We previously demonstrated that streptococcal glucosyltransferases (GTFs) can activate human heart valvular interstitial cells (VIC) to secrete interleukin-6 (IL-6), a cytokine involved in T helper 17 (Th17) cell differentiation. Here, we tested the hypothesis that activated VIC can enhance neutrophil infiltration through sustained IL-17 production, leading to valvular damage. To monitor cytokine and chemokine production, leukocyte recruitment, and the induction or expansion of CD4(+) CD45RA(-) CD25(-) CCR6(+) Th17 cells, primary human VIC were cultured in vitro and activated by GTFs. Serum cytokine levels were measured using an enzyme-linked immunosorbent assay (ELISA), and neutrophils and Th17 cells were detected by immunohistochemistry in infected valves from patients with IE. The expression of IL-21, IL-23, IL-17, and retinoic acid receptor-related orphan receptor C (Rorc) was upregulated in GTF-activated VIC, which may enhance the proliferation of memory Th17 cells in an IL-6-dependent manner. Many chemokines, including chemokine (C-X-C motif) ligand 1 (CXCL1), were upregulated in GTF-activated VIC, which might recruit neutrophils and CD4(+) T cells. Moreover, CXCL1 production in VIC was induced in a dose-dependent manner by IL-17 to enhance neutrophil chemotaxis. CXCL1-expressing VIC and infiltrating neutrophils could be detected in infected valves, and serum concentrations of IL-17, IL-21, and IL-23 were increased in patients with IE compared to healthy donors. Furthermore, elevated serum IL-21 levels have been significantly associated with severe valvular damage, including rupture of chordae tendineae, in IE patients. Our findings suggest that VIC are activated by bacterial modulins to recruit neutrophils and that such activities might be further enhanced by the production of Th17-associated cytokines. Together, these factors can amplify

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

    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

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

    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.

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

    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)

  7. Transcatheter Aortic Valve Implantation Infective Endocarditis: Current Data and Implications on Prophylaxis and Management.

    Ben-Shoshan, Jeremy; Amit, Sharon; Finkelstein, Ariel

    2016-01-01

    During the last decade, transcatheter aortic valve implantation (TAVI) has become a widespread procedure for the treatment of symptomatic severe aortic stenosis in patients with high surgical risk. In conjunction with the growing experience, the adverse outcomes of TAVI have arisen, including transcatheter aortic valve infective endocarditis (TAVIE). Although rare, TAVIE has been shown as a major etiology of transcatheter aortic valve failure and its magnitude is expected to increase as TAVI will become more frequent, and long term follow-ups will accumulate. To date, large scale TAVI cohorts have restrictively addressed TAVIE-related data and details regarding TAVIE course and management are available only in sporadic case reports, which have been recently collected and published. In this review, we present a case of TAVIE from our institution and analyze the available data regarding prevalence, clinical presentation and microbiology of TAVIE, as depicted from the current literature. We discuss TAVIE treatment and prophylaxis strategies, which are expected to gain growing attention in the years to come, as TAVI will be established as a key procedure in aortic stenosis management. PMID:26710943

  8. Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

    Marwa Sayed Meshaal

    Full Text Available Infective endocarditis (IE is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs. These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention.The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%. Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32% had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%. The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.Routine brain CT/CTA resulted in changes in the treatment plan in a significant

  9. Late infective endocarditis after cholecystectomy in a patient with repaired tetralogy of Fallot: a case report.

    Cayhl, Murat; Demir, Mesut; Yaliniz, Hafize; Ulus, Tümer; Acartürk, Esmeray

    2004-12-01

    Late endocarditis after surgical repair of tetralogy of Fallot is rare. We describe a case of endocarditis following cholecystectomy in a 22-year old patient with repaired tetralogy of Fallot. After cholecystectomy, the patient was referred to a cardiology clinic with unexplained fever and suspicion of endocarditis. Echocardiography revealed a large mass at the basal level of interventricular septum. Endocarditis was diagnosed on the basis of clinical and echocardiographic findings and antibiotic treatment was initiated immediately. Nine days later, the clinical status of the patient deteriorated and urgent surgery was performed. Patch dehiscence which mimicked a large vegetation, and multiple vegetations on the patch were found during operation. The patch was removed and ventricular septum defect was repaired with a new dacron patch. Enterobacter agglomerans was isolated in the vegetation cultures. PMID:15856630

  10. Endocarditis Due to Rare and Fastidious Bacteria

    Brouqui, P; Raoult, D

    2001-01-01

    The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, ...

  11. International guideline changes and the incidence of infective endocarditis: a systematic review

    Khan, Omeair; Shafi, Ahmed Mohamed Abdel; Timmis, Adam

    2016-01-01

    The objective of this study was to determine the impact on incident infective endocarditis (IE) of guideline recommendations to restrict indications for antibiotic prophylaxis. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. PubMed and EMBASE databases were searched for articles published between 2007 and 2015 using mesh terms relevant to the research question. Included were English language articles published after 2009 that provided estimates of IE incidence before-and-after major international guideline changes. Seven studies were identified: 1 conducted in France, 4 in the USA and 2 in the UK. Only 1 study reported an increase in the rate of incident IE following guideline modification, and the remainder showed no change in upward (2 studies) or downward (4 studies) incidence trends. Study quality was generally poor for answering the question posed in this review, with serious risk of bias related to diagnostic ascertainment and unavailability of population risk data to adjust the incidence estimates. Moreover, the studies were often small, and relevant bacteriological data were not always available. Only 2 reported changes in antibiotic prescriptions, but these data were not linked to health records making it impossible to determine causal relations to changes in incident IE. The studies in this review were heterogenous in their design and variably limited by study size, duration of follow-up, diagnostic ascertainment, and absence of relevant prescription and bacteriological data. The studies were inconsistent in their conclusions and it remains uncertain what, if any, has been the impact of antibiotic prophylaxis guideline changes on the incidence of IE.

  12. Gender-Based Long-Term Surgical Outcome in Patients with Active Infective Aortic Valve Endocarditis.

    Dohmen, Pascal M; Binner, Christian; Mende, Meinhart; Daviewala, Piroze; Etz, Christian D; Borger, Michael Andrew; Misfeld, Martin; Eifert, Sandra; Mohr, Friedrich Wilhelm

    2016-01-01

    BACKGROUND The aim of this observational, single-center study was to evaluate the impact of gender on surgical outcome in patients with active infective endocarditis (AIE) of the aortic valve. MATERIAL AND METHODS Between October 1994 and January 2011, 755 patients (558 men and 297 women) underwent surgery for AIE at the Leipzig Heart Center, Germany, according to the modified Duke criteria. Data were collected before surgery and as the study was ongoing. Gender influence on survival was evaluated (Kaplan-Meier curves). Cox proportional models were used to evaluate gender differences in relation to early mortality (within 30 days) and late mortality (up to 10 years). RESULTS The early mortality rate was 15.0% among men and 23.0% among women, which was statistically significant different (p=0.01). In male patients, variables associated with overall mortality were age (HR 1.63, 95% CI 1.43-1.86; pClass IV (OR 1.56, 95% CI 1.12-2.15; p=0.008), and involvement of multiple valves (OR 1.65, 95% CI 1.24-2.19; p=0.001) had a statistically significant influence on the late mortality. Focus identification (OR 1.75, 95% CI 1.08-2.77; p=0.023), involvement of multiple valves (OR 1.52, 95% CI 1.02-2.26; p=0.040), preoperative dialysis (OR 3.65, 95% CI 1.96-6.77; pgender-based differences in risk of mortality in patients with AIE (who were undergoing surgical treatment) with different early and long-term outcomes. PMID:27427831

  13. Vancomycin treatment of infective endocarditis is linked with recently acquired obesity.

    Franck Thuny

    Full Text Available BACKGROUND: Gut microbiota play a major role in digestion and energy conversion of nutrients. Antibiotics, such as avoparcin (a vancomycin analogue, and probiotics, such as Lactobacillus species, have been used to increase weight in farm animals. We tested the effect of antibiotics given for infective endocarditis (IE on weight gain (WG. METHODOLOGY/PRINCIPAL FINDINGS: Forty-eight adults with a definite diagnosis of bacterial IE (antibiotic group were compared with forty-eight age-matched controls without IE. Their body mass index (BMI was collected at one month before the first symptoms and one year after hospital discharge. The BMI increased significantly and strongly in vancomycin-plus-gentamycin-treated patients (mean [+/-SE] kg/m(2, +2.3 [0.9], p = 0.03, but not in controls or in patients treated with other antibiotics. Seventeen patients had a BMI increase of >or=10%, and five of the antibiotic group developed obesity. The treatment by vancomycin-plus-gentamycin was an independent predictor of BMI increase of >or=10% (adjusted OR, 6.7; 95% CI, 1.37-33.0; p = 0.02, but not treatment with other antibiotics. Weight gain was particularly high in male patients older than 65 who did not undergo cardiac surgery. Indeed, all three vancomycin-treated patients with these characteristics developed obesity. CONCLUSIONS/SIGNIFICANCE: A major and significant weight gain can occur after a six-week intravenous treatment by vancomycin plus gentamycin for IE with a risk of obesity, especially in males older than 65 who have not undergone surgery. We speculate on the role of the gut colonization by Lactobacillus sp, a microorganism intrinsically resistant to vancomycin, used as a growth promoter in animals, and found at a high concentration in the feces of obese patients. Thus, nutritional programs and weight follow-up should be utilized in patients under such treatment.

  14. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

    Robert Sogomonian

    2016-04-01

    Full Text Available Background: Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE or transesophageal echocardiography (TEE in patients with a body mass index (BMI greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods: A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results: Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65% were discovered to have native valve vegetations on TEE and 58 (35% with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions: Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.

  15. Infective endocarditis: long-term reversibility of kidney function impairment. A 1-y post-discharge follow-up study

    Buchholtz, Kristine; Larsen, Carsten T; Hassager, Christian;

    2010-01-01

    The aim of this study was to quantify the long-term reversibility of kidney function decrease occurring during hospitalization and treatment for infective endocarditis (IE). A prospective observational cohort study was performed at a tertiary university hospital in Copenhagen from October 2002...... through May 2008; 223 consecutive IE patients were included. Forty patients died in hospital and 38 within 1 y of discharge. Of the 145 patients called in for the 1-y follow-up, 111 accepted. Kidney function was assessed by estimated endogenous creatinine clearance (EECC). Statistical correlation between...

  16. Significado de la fiebre persistente o recurrente durante el tratamiento de la endocarditis infecciosa Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis

    José Carena

    2004-06-01

    Full Text Available Se evaluaron 81 pacientes con endocarditis infecciosa con el objeto de establecer la significación clínica de la presencia de fiebre persistente (FP y/o fiebre recurrente (FR durante el tratamiento. Un total de 46 pacientes (56.8% (Grupo 1 tuvieron FP y/o FR durante el tratamiento: 35 FP y 16 FR, que se compararon con 35 sin FP/FR (Grupo 2. No hubo diferencias en la edad, sexo, permanencia hospitalaria, origen nosocomial, demora diagnóstica y comorbilidad asociada. El compromiso aórtico (47.8 vs 34.2% y tricuspídeo (21.7 vs 11.4% y la infección por Staphylococcus aureus (55.5 vs 28% fueron más frecuentes en el Grupo 1, aunque no significativamente. El S. aureus meticilino resistente (SAMR (22.2 vs 4%, las complicaciones (95.6 vs 65.7%, la disfunción renal (58.6 vs 31.4%, el embolismo mayor (60.8 vs 34%, los fenómenos microvasculares (43.4 vs 17.1% y la cirugía valvular (34.7 vs 11.4% ocurrieron significativamente en el Grupo 1 (pPatients with infective endocarditis (IE were studied to assess incidence, clinical features and mortality in a population with either persistent (PF or recurrent fever (RF during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8% had fever during treatment: 35 had PF and 16 had RF (Group 1. This group was compared with 35 patients with IE without fever (Group 2. Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly. However, the development of complications (95.6 vs. 65.7%, renal dysfunction (58.6 vs. 31.4%, major vessel embolization (60.8 vs. 34%, microvascular phenomena (43.4 vs. 17.1%, infections with MRSA (22.2 vs. 4% and valvular surgery (34.7 vs. 11.4% were significantly higher in Group 1(p<0.05. The most common causes of PF were microvascular phenomena (14

  17. Antiphospholipid syndrome associated with non-infective mitral valve endocarditis: a case report

    Dragan Stevanović

    2014-04-01

    Full Text Available We present a rare case of antiphospholipid syndrome associated with non-infectious thrombotic endocarditis of the mitral valve. The patient was admitted to hospital for examination because of skin lesions manifested through a discoid skin rash. During the hospitalization antiphospholipid syndrome was diagnosed along with ultrasound verification of vegetations on the mitral valve, including both leaflets, with moderate to severe mitral regurgitation. Adequate and opportunely introduced therapy led to regression of all symptoms, including endocarditis of the mitral valve on checkup ultrasound verifications, with a prevention of arterial and/or venous thrombosis in patient's future.

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

    Fiehn, N E; Gutschik, E; Larsen, Tove;

    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...

  19. Incidence, risk factors and prediction of post-operative acute kidney injury following cardiac surgery for active infective endocarditis: an observational study

    Legrand, Matthieu; Pirracchio, Romain; Rosa, Anne; Petersen, Maya L.; van der Laan, Mark; Fabiani, Jean-Noël; Fernandez-gerlinger, Marie-paule; Podglajen, Isabelle; Safran, Denis; Cholley, Bernard; Mainardi, Jean-Luc

    2013-01-01

    Abstract Introduction Cardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. The purpose of the study was to determine the risk factors for post-operative AKI in patients operated on for IE. Methods A retrospective, non-interventional study of prospectively collected data (2000–2010) included ...

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

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe; Sibilitz, Kirstine Lærum;

    2012-01-01

    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...

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

    Asmar, Ali; Ozcan, Cengiz; Diederichsen, Axel C P;

    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...

  2. Candida tropicalis infection in a term neonate with gall bladder masses and infective endocarditis

    Mamta Jajoo; Vishal Kumar; Vishnu K Goyal; Amit Garg

    2012-01-01

    ABSTRACT Candidaendocarditis is extremely rare in term neonates, and gall bladder involvement due to candidemia has never been reported amongst neonates and infants. A term, appropriate for gestational age neonate developedCandidatropicalis blood stream infection in second week of life. He was started on conventional amphotericin B. However, he failed to show any clinical improvement, and candidemia keep on persisting. Repeat sanctuary sites screening revealed multiple echogenic masses in heart (vegetations) and gall bladder. On changing the treatment to liposomal amphotericin B and fluconazole, he recovered clinically, echogenic masses in gall bladder disappeared, and intracardiac vegetations decreased in size.

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

    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.

  4. Molecular technique identifies the pathogen responsible for culture negative infective endocarditis

    SHIN, G. Y.; Manuel, R J; Ghori, S; Brecker, S; Breathnach, A. S.

    2005-01-01

    A case of culture negative endocarditis complicated by immune complex glomerulonephritis and severe aortic regurgitation necessitated aortic valve replacement. Empirical treatment with penicillin and gentamicin according to UK guidelines was started. The pathogen, Streptococcus sanguis, was later identified by polymerase chain reaction amplification and sequencing of bacterial 16S ribosomal RNA. This molecular technique is likely to be of increasing importance in determining the aetiology of ...

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

    Larsen, Tove; Fiehn, Nils-Erik; Gutschik, Ernö;

    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...... non-endocarditis isolates. CONCLUSIONS: The present study showed that infective endocarditis may be caused by a variety of oral streptococcal species. The possible virulence factors investigated were found in the same proportions in endocarditis and non-endocarditis isolates, and thus did not seem to...

  6. Early Surgical Intervention in Infective Endocarditis:Pros over Cons%早期外科干预感染性心内膜炎:利大于弊

    王超

    2013-01-01

    Albeit the morbidity of infective endocarditis is not very high,the mortality in clinical is very high. With the use of antibiotics, the recovery rate of infective endocarditis has been a significant improvement, but when vegetations or valvular dysfunction appear,the mortality rate is still high,and simple use of drugs often fails to achieve the desired result. With the deepening of understanding of the natural outcome and pathophysiology of infective endocarditis, currently, the effect of surgical treatment of infective endocarditis has been widely recognized. However,the timing of the surgery remains controversial. Through reviewing relat ed literatures,it's considered that the short and long term results of early surgical intervention of infective endocarditis is significantly better than the conventional drug treatment.%感染性心内膜炎的发病率虽然不是很高,但在临床上其病死率却很高.随着抗生素的使用,感染性心内膜炎的治愈率虽有了明显提高,但出现赘生物形成或瓣膜功能损害时,其病死率仍然居高不下,单纯使用药物往往很难达到理想的效果.随着对感染性心内膜炎自然转归、病理生理等认识的深入,目前外科手术治疗感染性心内膜炎已经得到广泛认可,但是手术时机的选择仍然存在争议.通过回顾相关文献报告,认为早期外科干预感染性心内膜炎的近远期效果明显优于传统的药物治疗.

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

    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.

  8. Presenting features and clinical course of 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis

    Liu Shuang; Xie Jiang; Chen Yong; Yang Jinghua; Zhang Jianqun; Meng Xu; Liu Yinglong

    2014-01-01

    Backgroud Misdiagnosis and missed diagnosis of septic pulmonary embolism (SPE),a rare disease,occurs among the patients with right heart infective endocarditis.The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.Methods We retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1,2002 to June 1,2013.We reviewed the medical records and radiological images of these cases and extracted the following information:age,gender,and symptoms,physical examination,laboratory findings,transthoracic echocardiography (TTE) results,treatment information,comorbid medical conditions,and outcomes.Microbiological samples were collected and processed according to well-established and published guidelines.Results We identified basic heart disease in 97.1% of the patients.A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4%); predominantly,ventricular septal defects.Clinical symptoms were fever (97.1%),cardiac murmurs (94.1%) and fatigue (88.2%).Respiratory symptoms included cough (58.8%),pleuritic chest pain (47.1%) and hyoxemia (52.9%).Positive blood cultures were grown from 35.2% of patients and 50.0% were caused by staphylococcal species.Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases.Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases.Parenteral antibiotics were administered for all,and cardiac surgery was carried out for 76.5% of patients with an effective rate of 82.3%.Conclusions SPE lacks characteristic clinical manifestation.Congenital heart disease is a common risk of SPE.Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided.

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

    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.

  10. Validity, reliability and responsiveness of the Body Image Quality of Life Inventory in patients treated for infective endocarditis

    Rasmussen, Trine Bernholdt; Konradsen, Hanne; Dixon, Jane;

    2016-01-01

    RATIONALE AND OBJECTIVES: Suffering through infective endocarditis (IE) can drastically alter a person's physical appearance, and body image-related concerns have been reported by patients. The extent and severity of the phenomenon has not previously been explored, as no quantitative measure has...... been validated in this patient population. The purpose of this study was thus to assess the validity, reliability and responsiveness of the Danish Body Image Quality of Life Inventory (BIQLI-DA) on patients treated for IE. METHODS: We evaluated the psychometric properties of the BIQLI-DA on data...... correlations to other measures, including body mass index, Medical Outcome Short Form 36 and Hospital Anxiety and Depression Scale. In addition, we examined internal consistency on item and scale level and performed anova group-by-time interaction to test for responsiveness. RESULTS AND STUDY LIMITATION...

  11. Usefulness of New-Onset Atrial Fibrillation, as a Strong Predictor of Heart Failure and Death in Patients With Native Left-Sided Infective Endocarditis.

    Ferrera, Carlos; Vilacosta, Isidre; Fernández, Cristina; López, Javier; Sarriá, Cristina; Olmos, Carmen; Vivas, David; Sáez, Carmen; Sánchez-Enrique, Cristina; Ortiz-Bautista, Carlos; San Román, José Alberto

    2016-02-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and has been independently related to increased morbidity and mortality. AF is a frequent arrhythmia in infective endocarditis (IE). Nevertheless, there are no data on how AF affects the clinical outcome of patients with endocarditis. Our purpose was to investigate patient characteristics, microbiology, echocardiographic findings, in-hospital course, and prognosis of patients with IE who develop new-onset AF (NAF) and compare them with those who remained in sinus rhythm (SR) or had previous AF (PAF). From 1997 to 2014, 507 consecutive patients with native left-sided IE were prospectively recruited at 3 tertiary care centers. We distinguished 3 groups according to the type of baseline heart rhythm during hospitalization and previous history of AF: NAF group (n = 52), patients with no previous history of AF and who were diagnosed as having NAF during hospitalization; SR group (n = 380), patients who remained in SR; and PAF group (n = 75), patients with PAF. Patients with NAF were older than those who remained in SR (68.3 vs 59.6 years, p <0.001). At admission, heart failure was more common in NAF group (53% vs 34.3%, p <0.001), whereas stroke (p = 0.427) was equally frequent in all groups. During hospitalization, embolic events occurred similarly (p = 0.411). In the multivariate analysis, NAF was independently associated with heart failure (odds ratio 3.56, p <0.01) and mortality (odds ratio 1.91, p = 0.04). In conclusion, the occurrence of NAF in patients with IE was strongly associated with heart failure and higher in-hospital mortality independently from other relevant clinical variables. PMID:26762724

  12. Bartonella henselae endocarditis in an immunocompetent adult.

    Holmes, A H; Greenough, T C; Balady, G J; Regnery, R L; Anderson, B E; O'Keane, J C; Fonger, J D; McCrone, E L

    1995-10-01

    We describe a case of aggressive Bartonella henselae endocarditis in an immunocompetent man who owned a cat. Aortic valve replacement was required, and his infection was diagnosed by histology, serology, and polymerase chain reaction analysis. The manifestations of his disease included mediastinal lymphadenopathy, glomerulonephritis, myocarditis, and a petechial rash; the unusual finding of a positive titer of c-antineutrophil cytoplasmic antibodies was noted. Serological titers were markedly elevated for > 1 year despite clinical improvement. PMID:8645787

  13. Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

    Said, Salah A M; Mariani, Massimo A

    2016-01-01

    AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas (ACF) secondary to iatrogenic or infectious disorders. METHODS From a PubMed search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case - an adult male who presented with ACF between commissures of the right and non-coronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV - is added, the world literature is briefly reviewed. RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital (47%) or acquired (53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea (21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23 (60%), single method in 14 (37%) (echocardiography in 12 and catheterization in 2), and at autopsy in 2 (3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12 (30%) with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24 (63%). CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.

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

    Charles André

    1997-06-01

    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.

  15. Observation on therapeatic effect of surgical treatment for infective endocarditis%外科手术治疗原发性感染性心内膜炎疗效观察

    姚青; 徐东; 刘燕晖; 李洪利

    2014-01-01

    Objective To evaluate the impact of surgical treatment for infective endocarditis in short and long term period.Analysis the risk facts of in hospital mortality .Methods From January 2002 to June 2013, consecutive 16 cases who meets Duke diagnostic criteria and treated with primary infective endocarditis were studied retrospectively .The primary end-point events with infective endocarditis -related include death, reoperation, and infective endocarditis recurrence .Results 16 patients included 12 males and 4 females, male to female ratio was 3∶1, age 25.0 -60.6 (46.7 ±13.9) years old, mitral valve replacement in 9 patients, 4 cases of aortic valve replacement , mitral combined aortic valve replacement with three ca -ses, 30 d mortality rate was 18.8% (3 /16).Follow-up of 12 cases, follow-up time 0 -137 (42.3 ±5.0) months, the 5-year survival rate was 80.0%, the main cause of late death was heart failure , infective endocarditis recurrence .Conclusion Infective endocarditis is still a high mortality disease , heart color ultrasound can improve the diagnosis rate of early surgical help to improve the long-term effects.%目的:探讨手术治疗原发性感染性心内膜炎的近远期效果。方法对2002年1月-2013年6月连续收治的符合 Duke 诊断标准的原发性感染性心内膜炎患者16例进行回顾性研究。主要终点事件为与感染性心内膜炎相关性死亡、二次手术、感染性心内膜炎复发。结果16例患者中男12例,女4例,男女比为3∶1,年龄25.0~60.6(46.7±13.9)岁,行二尖瓣置换术9例,主动脉瓣置换术4例,二尖瓣主动脉瓣联合置换术3例,30 d 内病死率为18.8%(3/16)。随访12例,随访时间0~137(42.3±5.0)月,5年生存率为80.0%,远期死亡原因主要为心功能不全、感染性心内膜炎复发。结论感染性心内膜炎仍是高病死率疾病,心脏彩色超声可以提高其诊断率,早期手术有利于提高远期效果。

  16. 感染性心内膜炎患者临床特征与预后影响因素分析%Clinical characteristics and influencing factors of prognosis of infective endocarditis

    张苑; 任鹏涛; 杨婧; 刘婷婷; 闫庆辉; 张国建

    2016-01-01

    OBJECTIVE To investigate the clinical characteristics and prognostic factors of infective endocarditis ,so as to provide basis for improving the prognosis of patients with endocarditis .METHODS A total of 900 patients with infective endocarditis in the hospital from Jan .2010 to Dec .2014 were selected ,and their clinical data were retrospectively analyzed .Clinical characteristics of the patients and their performance were analyzed .The prognos‐tic factors were analyzed by univariate and multivariate logistic regression analyses ,the results were statistically analyzed by using SPSS 20 .0 software .RESULTS Totally 869 patients had underlying heart diseases among the 900 patients with infective endocarditis ,accounting for 96 .56% .The univariate analysis showed artificial valve , fever ≥39 ℃ ,hypersensitive C‐reactive protein ≥60 mg/L ,hemoglobin <90 g/L ,serum albumin <30 g/L and surgical treatment were the related prognostic factors (P< 0 .05) .The multivariate logistic regression analysis showed that hemoglobin <90 g/L ,serum albumin <30g/L and surgical treatment were the independent prognos‐tic factors (P<0 .05) .CONCLUSION The results show that most patients with infective endocarditis have under‐lying heart diseases ,the majority of patients have normal ECG .Levels of hemoglobin and serum albumin as well as surgical treatment are prognostic risk factors in infective endocarditis .%目的:探讨感染性心内膜炎患者的临床特征及预后影响因素,为提高心内膜炎患者预后提供参考依据。方法回顾性分析2010年1月-2014年12月医院收治的900例感染性心内膜炎患者临床资料,分析患者的临床特征及表现,预后影响因素进行单因素及多因素logistic回归分析,结果采用SPSS 20.0软件进行统计分析。结果900例感染性心内膜炎患者中有基础心脏疾病患者869例占96.56%;单因素分析显示,人工瓣膜、发热≥39

  17. Two-component system response regulators involved in virulence of Streptococcus pneumoniae TIGR4 in infective endocarditis.

    Trihn, My; Ge, Xiuchun; Dobson, Alleson; Kitten, Todd; Munro, Cindy L; Xu, Ping

    2013-01-01

    Streptococci resident in the oral cavity have been linked to infective endocarditis (IE). While other viridans streptococci are commonly studied in relation to IE, less research has been focused on Streptococcus pneumoniae. We established for the first time an animal model of S. pneumoniae IE, and examined the virulence of the TIGR4 strain in this model. We hypothesized that two-component systems (TCS) may mediate S. pneumoniae TIGR4 strain virulence in IE and examined TCS response regulator (RR) mutants of TIGR4 in vivo with the IE model. Thirteen of the 14 RR protein genes were mutagenized, excluding only the essential gene SP_1227. The requirement of the 13 RRs for S. pneumoniae competitiveness in the IE model was assessed in vivo through use of quantitative real-time PCR (qPCR) and competitive index assays. Using real-time PCR, several RR mutants were detected at significantly lower levels in infected heart valves compared with a control strain suggesting the respective RRs are candidate virulence factors for IE. The virulence reduction of the ΔciaR mutant was further confirmed by competitive index assay. Our data suggest that CiaR is a virulence factor of S. pneumoniae strain TIGR4 for IE. PMID:23342132

  18. Molecular Identification of Gemella Species from Three Patients with Endocarditis

    La Scola, Bernard; Raoult, Didier

    1998-01-01

    Gemella morbillorum and Gemella haemolysans are opportunistic pathogens which cause endocarditis and other severe infections. We report on three patients with endocarditis, one with endocarditis caused by G. haemolysans and two with endocarditis caused by G. morbillorum. The paucity of reports concerning these bacteria is probably related to the difficulties associated with their identification. For example, one of the strains reported in this study was originally sent to our laboratory with ...

  19. C-reactive protein, Rheumatoid factor and circulatory immune complex as markers for monitoring treatment of infective endocarditis

    Objectives: To evaluate the diagnostic usefulness of serum C-reactive protein (CRP), rheumatoid factor (RF) and circulatory immune complex (CIC) determinations in monitoring the outcome of infective endocarditis (IE). Methodology: In this prospective analytic descriptive study CRP, RF and CIC were measured on admission and 4 weeks after initiation of standard antibiotic regimen in 30 hospitalized patients with IE in an educational hospital between 2006 and 2007 in Ahvaz a city south west Iran . Duke criteria were used for diagnosis of IE. CRP and RF were examined using quantitative neflometry (Binding site kit, UK) and CIC was detected by semi quantitative immune diffusion (Baharafshan SIRD kit, Iran). Data were evaluated using statistical analyses in SPSS (version 12, USA) software for windows. Results: The fall in serum C-reactive protein or RF was significant (P=0.05). Only two of the 30 patients, who had elevated CRP, RF and CIC week four failed to response and one needed cardiac surgery. Conclusions: The C-reactive protein proved to be a good tool for monitoring the treatment of IE. Also RF proved useful in the assessment of patients with IE, but the value of CIC was negligible. (author)

  20. Bacteremia with the bovis group streptococci: species identification and association with infective endocarditis and with gastrointestinal disease.

    Marmolin, Ea S; Hartmeyer, Gitte N; Christensen, Jens J; Nielsen, Xiaohui C; Dargis, Rimtas; Skov, Marianne N; Knudsen, Elisa; Kemp, Michael; Justesen, Ulrik S

    2016-06-01

    DNA sequencing of the intergenic spacer (ITS) region was used to identify 53 blood culture isolates that had previously been designated to the bovis group streptococci and clinical data was collected retrospectively from patients' records using a standardized protocol. ITS sequencing identified 19 (35.8%) isolates as Streptococcus gallolyticus subsp. gallolyticus, 12 (22.6%) as S. gallolyticus subsp. pasteurianus, two (3.8%) as S. gallolyticus subsp. macedonicus, seven (13.2%) as S. infantarius subsp. infantarius, 12 (22.6%) as S. lutetiensis and one (1.9%) as S. equinus. The association of S. gallolyticus subsp. gallolyticus with colorectal neoplasia and with infective endocarditis and the association between S. gallolyticus subsp. pasteurianus and pancreatic cancer were found to be clinically important. Also, a very high 1-year mortality rate with S. lutetiensis (66.7%) and S. gallolyticus subsp. pasteurianus (58.7%) bacteremia calls for intensive investigation for underlying disease focusing on the pancreas and the hepatobiliary system. PMID:27117515

  1. Research Progress on Infected Endocarditis in Dogs%犬感染性心内膜炎研究进展

    雍康; 张传师; 杨庆稳

    2014-01-01

    感染性心内膜炎(Infective Endocarditis,IE)是犬的一种致命性疾病,由病原微生物侵入心脏瓣膜或心内膜内皮细胞所引发.细菌是从病变瓣膜和壁内膜组织中分离的主要病原体,因此也称细菌性心内膜炎.临床上,犬患IE并不常见,但一旦发生,死亡率极高.IE由于病情发展迅速,缺乏特异性的临床症状,因此早期诊断比较困难.文章主要从发病机制、临床症状、诊断、治疗等方面对犬IE进行了综述,为有效防治该病提供依据.

  2. Pulmonary Valve Infective Endocarditis in an Adult Patient with Severe Congenital Pulmonary Stenosis and Ostium Secundum Atrial Septal Defect

    Juan Lacalzada

    2010-01-01

    Full Text Available A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD, confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE. The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting.

  3. Streptococcus agalactiae infective endocarditis complicated by large vegetations at aortic valve cusps along with intracoronary extension: An autopsy case report.

    Ro, Ayako

    2016-01-01

    Streptococcus agalactiae infective endocarditis is a rare condition with high mortality owing to complications of large vegetations and systemic emboli. A 49-year-old man was found dead in his house. He had a history of hepatic cirrhosis and had been diagnosed with type 2 diabetes 2years previously. He had presented with a high fever 10days before his death. An autopsy revealed 50mL of purulent pericardial effusion, and S. agalactiae was detected from the culture of this pericardial effusion. Two slender rope-like vegetations were present at the right aortic valve cusp and noncoronary aortic valve cusp. The vegetation at the right aortic valve cusp extended into the right coronary artery. The right coronary artery was broadly occluded by white rod-like material. The mitral valves were also affected, and the posterior papillary muscle was ruptured. Myocardial infarction was not observed. Systemic microscopic Gram-positive bacterial masses were observed in several organs. The death was attributed to acute myocardial ischemia caused by occlusive intracoronary extension of the vegetation at the proximal right coronary artery. PMID:26926519

  4. Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: an open cohort study.

    Lepur, Dragan; Barsić, Bruno

    2009-01-01

    The objective of this open cohort study was to assess the association between neurological complications in patients with definite native-valve infective endocarditis (IE) and cerebral microembolism (MES). MES detection was performed with 1-h, bilateral middle cerebral arteries (MCA) insonation using a transcranial Doppler ultrasound (TCD) machine. Thirty patients with definite native-valve IE were stratified into 2 groups based upon the presence of MES. The most striking difference between the 2 groups of patients was the incidence of clinically evident neurological complications. Neurological complications of IE occurred in 10 (83.3%) patients with positive MES and in 6 (33.3%) MES-negative patients (p=0.021). Ischaemic stroke was the most common complication, occurring in 11 of 16 patients, followed by meningitis in 4 patients and cerebritis in 1 patient. There was a trend towards greater in-hospital mortality in patients with recorded MES than in the MES-negative, although this was not statistically significant (33.3% vs 16.6%; p=0.392). Our results reveal a significant association between MES and neurological complications in patients with native-valve IE. TCD is a promising tool in predicting individual patient risk for neurological complications of IE. PMID:19685379

  5. Scedosporium apiosermum infection of the “Native” valve: Fungal endocarditis in an orthotopic heart transplant recipient

    Clement, Meredith E.; Eileen K. Maziarz; Schroder, Jacob N.; Patel, Chetan B.; Perfect, John R.

    2015-01-01

    Scedosporium apiospermum is an increasingly appreciated pathogen in immunosuppressed patients. We present a case of S. apiospermum endocarditis in a 70-year-old male who had undergone orthotopic heart transplant. Echocardiogram demonstrated a 1.4 cm tricuspid valve vegetation. He underwent valve replacement, complicated by fatal massive post-operative haemorrhage. Valve cultures grew S. apiospermum. To our knowledge, our case is the first reported instance of endocarditis caused by S. apiospe...

  6. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients.

    Mzabi, A; Kernéis, S; Richaud, C; Podglajen, I; Fernandez-Gerlinger, M-P; Mainardi, J-L

    2016-07-01

    Although many international guidelines exist for the management of infective endocarditis (IE), recommendations are lacking on the opportunity of switching antibiotics from the intravenous (IV) to oral route during treatment. We present a cohort study of 426 cases of IE over a period of 13 years (2000-2012), including 369 cases of definite IE according to the Duke criteria. Predictors of mortality were identified using the Cox proportional hazard analysis. The median (range) age at diagnosis was 64.5 (7-98) years. One hundred six patients (25%) had healthcare-associated IE. Oral streptococci (n = 99, 23%) and Staphylococcus aureus (n = 81, 19%) were the predominant microorganisms. Ninety-two patients (22%) died during follow-up. After an initial phase of IV antibiotherapy, 214 patients (50%) were switched to oral route a median (range) of 21 (0-70) days after diagnosis of IE. Patients in the oral group had fewer comorbidities, and criteria of severity at inclusion and were less frequently infected by S. aureus. Oral antibiotics were amoxicillin alone in 109 cases or a combination therapy of clindamycin, fluoroquinolone, rifampicin and/or amoxicillin in 46 cases, according to the susceptibility of the microorganisms. In the multivariate analysis, a switch to oral route was not associated with an increased risk of mortality. During follow-up, only two relapses and four reinfections were observed in the oral group (compared to nine and eight in the IV group, respectively). In this study, switching to oral administration was not associated with an increased risk of relapse or reinfection. These promising results need to be confirmed by prospective studies. PMID:27091094

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

    Ricardo M. Pereira

    2008-04-01

    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

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

    Madsen, Rasmus Gaarde; Ladefoged, Karin; Kjaergaard, Jens Jørgen;

    2009-01-01

    in studies on Caucasian populations, where pneumococcal infection was seen in 1-3% of endocarditis cases. The overall mortality rate was 12%. Pneumococcal endocarditis (PE) had the clinical characteristics of fulminant disease with frequent heart failure, complications and need for surgery. Among......OBJECTIVES: The aim of this retrospective study was to determine the incidence and outcome of infectious endocarditis in Greenland with an emphasis on pneumococcal endocarditis. STUDY DESIGN: Retrospective, non-interventional study. METHODS: Review of files and medical history of all patients with...... infectious endocarditis from the Patient Registry in Greenland in the 11-year period 1995-2005. RESULTS: There were 25 cases of endocarditis, giving an incidence rate of 4.0/100,000 per year. Twenty-four percent of these cases were caused by Streptoccous pneumonia, which is significantly more frequent than...

  9. 42例感染性心内膜炎的外科治疗%The surgical treatment of infective endocarditis in 42 cases

    张林; 罗昭全; 赵雄飞; 张伟

    2012-01-01

    目的 探讨感染性心内膜炎(infective endocarditis,IE)的诊断及外科治疗时机,提高近远期疗效.方法 回顾分析2001年1月~2010年1月手术治疗感染性心内膜炎患者42例,均在体外循环下行毁损瓣膜置换、畸形矫正和赘生物清除术.结果 42例患者术后早期成功39例,死亡3例,近远期效果良好.结论 外科治疗感染性心内膜炎效果良好,能明显降低病死率.而正确把握手术时机、手术方式以及围术期的正确处理是提高感染性心内膜炎治愈率的关键.%Objective To investigate the diagnosis and the surgical opportunity of infective endocarditis (infective endocarditis , IE) . Methods The data of 42 cases of IE treated by surgery were analyzed retrospectively from January 2001 to Januar-y 2010. The damaged valve replacement and deformity correction and vegetation removal were performed on cardiopulmonary bypass on these patients. Results Three cases were death soon after operation. Thirty-nine cases were achieved good results on the long term follow-up. Conclusion Satisfied effects could be obtained and the rate of mortality could be reduced significantly by surgery on IE patients. It was very important to grasp the timing of surgery correctly and to select the surgical approach as well as to treat correctly on IE patients in perioperative period.

  10. Partial oral treatment of endocarditis

    Iversen, Kasper; Høst, Nis; Bruun, Niels Eske;

    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...

  11. Endocarditis caused by Abiotrophia defectiva

    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.

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

    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...

  13. Erysipelothrix rhusiopathiae endocarditis and presumed osteomyelitis.

    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

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

    Rasmussen, Rasmus V; Bruun, Louise E; Lund, Jens;

    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...

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

    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.)

  16. Awareness and knowledge of prophylaxis for infective endocarditis in patients with severe rheumatic heart disease.

    Maharaj, B; Vayej, A C

    2013-03-01

    Prevention of infective endocardit s (IE) is mportant because it has a high mortalty rate.This study sets out to to gather information from patients who were at risk of developing IE of their knowledge of the need for prophylaxis for the disease. Forty-one black patients suffering from severe rheumatic heart disease (RHD) were interviewed. Only one patient (2.4%) was regularly visiting a dentist to maintain good oral health and only five (12.2%) had received advice about the need for antibiotic cover prior to dental extraction. The vast majority of patients (97.5%) visited a dentist only when driven by dental pain, 36.6 % had to travel for more than an hour to reach their nearest dentist, and 87.8% indicated that they brushed their teeth. It may be concluded that in this group of black patients with severe RHD there was a lack of knowledge of the need for and of measures recommended for prophylaxs against IE. In addition, attempts by the health care team to ensure good oral health and access to dental care for these patients were inadequate, if not non-existent. PMID:23951767

  17. Molecular imaging in Libman-Sacks endocarditis

    Dahl, Anders; Schaadt, Bente K; Santoni-Rugiu, Eric;

    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...... 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....

  18. 感染性心内膜炎赘生物及常见并发症的超声诊断分析%Ultrasound diagnosis of vegetations and common complications in patients with infective endocarditis

    郑浙悦; 朱海宏; 周余旺

    2014-01-01

    OBJECTIVE To discuss the accuracy of ultrasound diagnosis of vegetations and common complications in patients with infective endocarditis so as to improve the accurate rate of ultrasound diagnosis .METHODS The clinical data were collected from 42 patients with infective endocarditis who underwent the ultrasound diagnosis and surgical procedures from Aug 2009 to Feb 2012 ,then the results of the ultrasound diagnosis and surgical treatment were analyzed ,and the statistical analysis was performed with the use of SPSS 18 .0 software .RESULTS Of the 42 patients with infective endocarditis , the result of the ultrasound diagnosis showed that 40 cases were with confirmed vegetations and 1 case was with suspected vegetations .The surgical procedures found 42 cases of vege-tations .Totally 30 cases of valve lesions were confirmed by the ultrasound diagnosis ;32 cases of valve lesions were confirmed by the surgical procedures .The pseudoaneurysm was confirmed in 2 cases through the ultrasound diagnosis and in 3 cases through the surgical procedures .The ultrasound diagnosis could confirm larger number of cases of vegetations ,valve lesions ,or pseudoaneurysm than the surgical procedures ,however ,the difference between the two was not statistically significant .The size of the vegetation was confirmed as (18 .1 ± 1 .5)mm by the ultrasound diagnosis ,(20 .6 ± 0 .5)mm by the surgical procedures ,the difference between the two was statisti-cally significant(P<0 .05) .CONCLUSION The ultrasound diagnosis plays a certain role in diagnosis of the vegeta-tions and common complications in the patients with infective endocarditis ,which may provide evidence for the diagnosis of the disease .%目的:探讨超声诊断感染性心内膜炎赘生物及常见并发症的准确性,提高临床超声诊断的准确率。方法搜集医院2009年8月-2012年2月收治的感染性心内膜炎经超声诊断及手术治疗42例患者的临床资料,分析超声诊断与手术结果

  19. [Mitral valve endocarditis after Turkish "Festival of Sacrifice"].

    Blaich, A; Fasel, D; Kaech, C; Frei, R

    2011-09-01

    Erysipelothrix rhusiopathiae is the causative agent of swine erysipelas. Systemic infections caused by E. rhusiopathiae are rare, but often (90%) associated with endocarditis. In about 60% of cases endocarditis develops on normal heart valves, and despite appropriate antibiotic therapy about one-third of the patients requires valve replacement. We report the case of a housewife, who developed a mitral valve endocarditis due to E. rhusiopathiae after preparing meat for the Turkish "Festival of Sacrifice". PMID:21152883

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

    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. Proteus endocarditis in an intravenous drug user.

    Goel, Rohan; Sekar, Baskar; Payne, Mark N

    2015-01-01

    Infective endocarditis (IE) is a life-threatening condition with adverse consequences and increased mortality, despite improvements in treatment options. Diagnosed patients usually require a prolonged course of antibiotics, with up to 40-50% requiring surgery during initial hospital admission. We report a case of a 42-year-old intravenous drug user who presented feeling generally unwell, with lethargy, rigours, confusion and a painful swollen right leg. He was subsequently diagnosed with Proteus mirabilis endocarditis (fulfilling modified Duke criteria for possible IE) and deep vein thrombosis (DVT). He was successfully treated with single antibiotic therapy without needing surgical intervention or requiring anticoagulation for his DVT. Proteus endocarditis is extremely uncommon, with a limited number of case reports available in the literature. This case illustrates how blood cultures are invaluable in the diagnosis of IE, especially that due to unusual microorganisms. Our case also highlights how single antibiotic therapy can be effective in treating Proteus endocarditis. PMID:26611486

  2. Right-sided infective endocarditis with a ruptured sinus of Valsalva and multiple septic pulmonary emboli in a patient with atopic dermatitis.

    Horimoto, Koshin; Kubo, Toshihiko; Matsusaka, Hidenori; Baba, Hironori; Umesue, Masayoshi

    2015-01-01

    We herein report the case of 34-year-old woman with acute tricuspid valve infective endocarditis (IE) associated with a ruptured sinus of Valsalva and multiple septic pulmonary emboli. She had no history of medical problems, except for atopic dermatitis (AD). Blood cultures identified methicillin-sensitive Staphylococcus aureus. Despite the administration of two months of antibiotic therapy, the patient experienced recurrent pulmonary emboli and developed heart failure due to a left-to-right shunt, whereas the area of vegetation did not change in size. She subsequently underwent surgery for shunt closure and tricuspid valve replacement. The AD was thought to be the cause of the patient's bacteremia, which consequently resulted in aggressive right-sided IE. PMID:25832944

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

    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

  4. A Clinical Research of 55 Cases of Infective Endocarditis%55例感染性心内膜炎临床研究

    齐永乐

    2011-01-01

    Objective:In infective endocarditis in heart disease,and analyze its fundamental cause,pathogenic microorganisms and clinical manifestations of the change rule.Methods:Our records of 55 cases of infective endocarditis in heart patients were retrospectively analysed.Results:55 patients in the reasonable application of antimicrobial drugs,corresponding temperature is normal,symptoms disappeared;After the end of the period of treatment were different period blood culture,the blood culture negative.Do the inspection found heart vegetations,through the corresponding antibiotic treatment,42 patients were cured after hospital discharge,9 cases of surgical treatment.Conclusion:According to the reasonable application of the corresponding bacteria species antibiotic treatment,all can make an illness control effectively.%目的:针对感染性心内膜炎病症,归纳分析其基础病因、致病微生物及临床表现的变化规律.方法:对我院收治的55例感染性心内膜炎患者的临床资料进行回顾性分析.结果:55例患者在合理应用相应抗菌药物后,体温正常、症状消失;疗程结束后的不同时间段分别做血培养,血培养阴性.行心超检查发现赘生物,经过相应抗生素治疗后,42例治愈出院,9例行手术治疗.结论:根据细菌种类合理应用相应的抗生素治疗,均能使病情得到有效控制.

  5. Streptococcus dysgalactiae endocarditis presenting as acute endophthalmitis

    Angelina Su-Min Yong

    2012-02-01

    Full Text Available Endogenous endophthalmitis is a rare ocular infection affecting the vitreous and/or aqueous humours. It is associated with poor visual prognosis and its commonest endogenous aetiology is infective endocarditis. The causative organisms of endogenous endophthalmitis complicating endocarditis are mainly Group A or B streptococci. The identification of Group C and G streptococci such as Streptococcus dysgalactiae is comparatively uncommon and has only been reported in a few case reports or series. We therefore report a case of infective endocarditis caused by Streptococcus dysgalactiae first presenting with endogenous endophthalmitis, the most likely source being bilateral feet osteomyelitis in a patient with type I diabetes. The patient was treated with a course of intravenous benzylpenicillin, intravitreal antibiotics, bilateral below knee amputations and mitral valve replacement. She survived all surgical procedures and regained partial visual acuity in the affected eye.

  6. Acute Haemophilus parainfluenzae endocarditis: a case report

    Christou Leonidas

    2009-07-01

    Full Text Available Abstract Introduction Numerous pathogens can cause infective endocarditis, including Haemophilus parainfluenzae. H. parainfluenzae is part of the H. aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae group that may cause about 3% of the total endocarditis cases, and is characterized by a subacute course and large vegetations. Case presentation Acute H. parainfluenzae endocarditis developed in a 54-year-old woman, with no underlying predisposing factors. The patient presented with fever of 3 days duration and a severe headache. Magnetic resonance imaging of the brain revealed multiple cerebral emboli with hemorrhagic foci. Upon suspicion of endocarditis, cardiac transesophageal ultrasonography was performed and revealed massive vegetations. The patient underwent emergency mitral valve replacement, and was further treated with ceftriaxone. Blood cultures grew H. parainfluenzae only after valve replacement, and a 6-week course of ceftriaxone was prescribed. Conclusion We underline the typical presentation of large vegetations in H. parainfluenzae endocarditis, which are associated with embolic phenomena and resulting severity. Although the majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that H. parainfluenzae endocarditis may develop rapidly. Thus, awareness of the imaging characteristics of the pathogen may enhance early appropriate diagnosis and therapeutic response.

  7. Clinical characteristics of elderly patients with infective endocarditis and causes of hospitalized death%老年感染性心内膜炎患者的临床特点及死亡相关因素分析

    梁玉芝; 赵辉; 沈志方; 常国栋

    2013-01-01

    目的 探讨老年感染性心内膜炎患者的临床特点,分析影响死亡的相关因素,以制定干预对策,提高治愈率.方法 回顾性分析104例老年感染性心内膜炎住院患者的临床资料,对可能与死亡的相关因素通过统计软件进行单因素及多因素分析.结果 104例住院患者中死亡25例,病死率24.0%;单因素分析显示,性别、发热、肝脏肿大、脾脏肿大、血尿素氮、谷丙转氨酶、营养、心功能为影响患者死亡的危险因素;多因素分析显示,脾肿大在诸多指标中影响最大(OR=18.7),其余依次为肝肿大(OR=14.5)、心功能分级(OR=5.0)、营养不良(OR=4.1)、发热(OR=2.9)、血尿素氮高(0R=2.2)、性别(OR=2.0)、谷丙转氨酶(OR=1.8).结论 老年感染性心内膜炎患者其早期死亡率高,且与多种因素关系密切,临床应注意针对性制定干预措施.%OBJECTIVE To study the clinical characteristics of the elderly patients with infective endocarditis and analyze the causes of hospitalized death so as to develop intervention measures and improve the cure rate.METHODS The clinical data of 104 cases of elderly patients with infective endocarditis were retrospectively analyzed,then the univariate analysis and multivariate analysis were performed for the causes of hospitalized death through the statistics software.RESULTS Of totally 104 cases of patients,25 cases died in the hospital with the mortality of 24.0 %.The univariate analysis showed that the sex,fever,hepatomegaly,splenomegaly,blood urea nitrogen,cereal third transaminase,nutrition,and cardiac function were the risk factors of the hospitalized death;while the multivariate analysis showed that the splenomegaly (OR=18.7) was the most influential factor,followed by the hepatomegaly (OR=14.5),cardiac function classification (OR=5.0),malnutrition (OR=4.1),fever (OR=2.9),blood urea nitrogen (OR =2.2),gender (OR =2.0),and cereal third transaminase (OR =1.8).CONCLUSION The early

  8. A Rare Case of Streptococcus alactolyticus Infective Endocarditis Complicated by Septic Emboli and Mycotic Left Middle Cerebral Artery Aneurysm.

    Almeida, Patricia; Railsback, Jaclyn; Gleason, James Benjamin

    2016-01-01

    To date, S. alactolyticus endocarditis complicated by middle cerebral artery aneurysm has not been reported. We describe the case of a 65-year-old female with a history of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction presenting with confusion and a apical holosystolic murmur. Angiography of the brain identified new bilobed left middle cerebral artery aneurysm. Serial blood cultures grew S. alactolyticus, and aortic and mitral valve vegetation were discovered on transesophageal echocardiography. The patient was treated with antimicrobial therapy, mitral and aortic valve replacements, and microsurgical clipping of cerebral aneurysm. This case serves to highlight the pathogenicity of a sparsely described bacterium belonging to the heterogenous S. bovis complex. PMID:27525136

  9. Value of Echocardiogram Diagnosing to Infective Endocarditis Vegetation%超声心动图用于感染性心内膜炎赘生物的诊断价值

    白松峰

    2013-01-01

      目的:超声心动图对于感染性心内膜炎赘生物诊断的临床应用价值。方法:选取本院2011年3月-2012年3月收治的符合感染性心内膜炎诊断依据的患者共64例,入选患者进行手术治疗,在手术前需要进行超声心动图检查,并且与手术结果进行对比。结果:超声心电图能够准确诊断出感染性心内膜赘生物的赘生部位以及瓣膜损伤情况。与手术结果对比,两者结果差异无统计学意义(P>0.01)。结论:超声心动图能够较为准确地诊断出感染性心内膜炎赘生物,具有较高的诊断价值。%Objective:To observe the clinic application value of echocardiogram diagnosing infective endocarditis vegetation. Method:64 patients with infective endocarditis vegetation treated in our hospital from March 2011 to March 2012 were selected. All the patients received surgical treatment. The patients needed to be given echocardiogram examination before operation which was compared with the surgical result. Result:Echocardiogram could accurately diagnose neoplasitc part of infective endocarditis vegetation and the condition of valve damag. There was no evident difference between the two results(P>0.01). Conclusion:Echocardiogram can accurately diagnose infective endocarditis vegetation,which has high diagnostic value.

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

    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.

  11. 儿童感染性心内膜炎临床表现与治疗对策%Clinical characteristics and treatment of infective endocarditis in children

    罗丽娟; 曹清; 周云芳; 潘淑华; 王希华

    2015-01-01

    目的:分析儿童感染性心内膜炎的临床特征、治疗和预后。方法回顾性分析1998—2012年收治的83例感染性心内膜炎患儿的临床资料。结果共83例患儿,男53例、女30例,平均年龄(6.8±4.6)岁,临床特征以发热(77.1%)、轻中度贫血(71.1%)、C反应蛋白升高(67.5%)、红细胞沉降率增高(60.2%)、白细胞增高(47.0%)为主;出现栓塞症状20例(24.1%);血培养阳性56例(67.5%),以革兰阳性菌为主,链球菌属及葡萄球菌属占89.3%;万古霉素等敏感抗生素治疗有效;超声检查检出赘生物68例(82%)。55例(66.2%)患儿接受心脏手术,最终死亡7例(8.4%)。结论近年来感染性心内膜炎的病原菌变迁,缓症链球菌及金黄色葡萄球菌成为主要病原菌,需万古霉素等敏感抗生素治疗;心脏超声检出赘生物阳性率较高。%Objective To study the clinical characteristics, treatment and prognosis of infective endocarditis in children. Methords Clinical data from 83 patients of infective endocarditis admitted from 1998 to 2012 were retrospectively analyzed. Results In a total of 83 patients, there were 53 males and 30 females, and the average age was 6.8±4.6 years. The main clinical characteristics were fever (77.1%) and mild to moderate anemia (71.1%). The C-reaction protein (67.5%), erythrocyte sedimen-tation rate (60.2%), and white blood cell (47.0%) were elevated. Twenty (24.1%) patients had embolism. Blood culture was pos-itive in 56 (67.5%) cases with bacteria mainly being Gram-positive and Streptococcus and Staphylococcus accounted for 89.3%. Vancomycin and other sensitive antibiotics were effective. Neoplasm was detected in 68 cases (82%) by transthoracic echocar-diograerphy. Fifty-ifve (66.2%) patients underwent cardio surgery. Seven patients (8.4%) died. Conclusion In recent years, the distribution of pathogenic bacteria in infective endocarditis had changed. Streptococcus mitis and Staphylococcus aureus has

  12. 20例感染性心内膜炎病原菌及耐药性分析%Pathogenic Bacteria Distribution in 20 Cases with Infective Endocarditis and their Drug Sensitivity Test Results

    熊祝嘉; 岳志刚; 李小瑛

    2013-01-01

    目的 通过对20例感染性心内膜炎患者的培养结果进行回顾性研究,为临床合理使用抗生素提供依据.方法 回顾性分析煤炭总医院2010年20例感染性心内膜炎病原菌的分布及其对抗生素的敏感性.结果 革兰阳性球菌19株,占到95%,其中链球菌9株(占45%),主要为化脓性链球菌;葡萄球菌7株(占35%),主要为金黄色葡萄球菌;肠球菌3株(占15%),均为屎肠球菌.此外大肠埃希菌检出1株(占5%).不同的病原菌有其自身的耐药特点,金黄色葡萄球菌的耐药较严重,所有阳性菌对万古霉素敏感.结论 感染性心内膜炎病原菌以链球菌为主.不同的病原菌有其自身的耐药特点,对感染性心内膜炎患者应及早进行细菌培养和耐药检测,以指导临床正确用药,防止耐药株的出现.%Objective To detect the distribution of pathogenic bacteria in 20 cases with infective endocarditis and their resistance to antimicrobial drugs, and to provide the reference for selecting antimicrobial drugs rationally in clinical treatment. Methods To analysis the pathogenic bacteria distribution and their sensitivity to antibiotics from 20 cases with infective endocarditis conformed by bacterial culture. Results The proportion of Gram-positive cocco bacterium was 95% (Streptococcus account for 45% ,the most was Streptococcus pyogenes; Staphylococcus account for 35% ,the most was Staphylococcus aureus; Enterococ-cus account for 15% ,all was Enterococcus faecium) ;the proportion of Gram-necgative bacillus was 5% ( Escherichia coli). Different pathogens had its own characteristics of resistance, and the drug resistance of staphylococcus aureus was serious. The Gram-positive cocco bacterium were found to be all sensitive to vancomycin. Conclusion Streptococcus is still the primary pathogen among patients with Infective Endocarditis. Different pathogens had its own characteristics of resistance, and we should carry out cultivation

  13. 感染性心内膜炎患者超声心动图诊断价值分析%The Clinical Diagnosis Value of Echocardiography in Patients with Infective Endocarditis

    李洪琳; 王丽

    2015-01-01

    Objective:To investigate the clinical diagnosis value of echocardiogram in patients with in-fective endocarditis .Method: The data of 64 patients with suspected infective endocarditis treated in our hospital between January 2009 and January 2015 were retrospectively analyzed , the detection of infective en-docarditis -associated complications and excrescences was compared by transthoracic echocardiography (TTE) and by transesophageal echocardiography (TEE), and the sensitivities and specificities of TTE and TEE in diagnosis of various pathological changes in patients with endocardium involved were compared .Re-sult:Excrescences were detected by TTE in 31 patients (48.44%) and by TEE in 49 patients (76.56%), and the difference in detection rate between the two detection methods was statistically significant ( P0.05); when taking TEE as the diagnostic criterion of infective endocarditis, the sensitivity and specificity of TTE detection were 63.27%and 86.67%, respectively.Con-clusion:Echocardiography has important clinical significances in diagnosis of infective endocarditis .TEE is more sensitive for the detection of infective endocarditis , but TTE can also provide positive evidence , and TTE is the first choice for diagnosis of infective endocarditis currently .%目的:探讨分析超声心动图对感染性心内膜炎患者临床诊断价值。方法:回顾性分析2009年1月至2015年1月我院收治的疑似为感染性心内膜炎患者64例,比较经胸超声心动图( TTE)以及经食管超声心动图( TEE )对感染性心内膜相关并发症以及赘生物的检出情况,比较TTE与TEE诊断患者心内膜受累各种病理变化的特异性以及敏感性。结果:TTE 检出赘生物31例(48.44%)、TEE检出赘生物49例(76.56%),两种检测方式对赘生物的检出率具有统计学差异(P<0.05);TTE检出平均赘生物的大小显著低于TEE检出赘生物的大小( P<0.05);在瓣周脓肿

  14. Native valve Escherichia coli endocarditis following urosepsis

    Rangarajan, D.; Ramakrishnan, S.; Patro, K. C.; Devaraj, S.; V Krishnamurthy; Kothari, Y.; Satyaki, N.

    2013-01-01

    Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure.

  15. 感染性心内膜炎临床研究(附136例临床病例)%Clinical Study of 136 Cases of Infective Endocarditis

    李迎宾; 伍黎明

    2014-01-01

    目的:探讨感染性心内膜炎的临床特点,并探讨其临床治疗的方法。方法选取该院在2012年6月-2013年6月期间收治的136例感染性心内膜炎患者,对其临床资料进行回顾性分析。结果感染性心内膜炎血培养的阳性率为57.7%,主要的致病菌为表皮葡萄球菌以及草绿色链球菌;其基础病因中先天性心脏病、风湿性心脏病以及无基础性心脏病所占的比例分别为34.9%、30.2%以及16.7%;主要的临床表现为发热,其次是贫血和脏器栓塞。患者住院期间有14例患者死亡,死亡的原因主要是脑血管意外和心力衰竭。结论感染性心内膜炎的致病菌以及基础病因都发生了较明显的变化,且早期人工瓣膜心内膜炎的致死率较高,应该尽早进行手术治疗。%Objective To investigate the clinical characteristics of infective endocarditis and the method of clinical treatment. Methods The clinical data of 136 cases of patients with infective endocarditis admitted in our hospital from June, 2012 to June, 2013 were analyzed retrospectively. Results The positive rate of infective endocarditis blood culture was 57.7%, the main pathogens were Staphylococcus epidermidis and Streptococcus viridans; of the primary etiologies of the disease, congenital heart disease, rheumatic heart disease and heart disease accounted for 34.9%, 30.2% and 16.7%, respectively; the main clinical mani-festations were fever, followed by anemia and organ thrombosis. During hospitalization, 14 patients died, the causes of death were mainly cerebrovascular accidents and heart failure. Conclusion The pathogens and primary etymologies of infective endocarditis have undergone obvious changes, and the mortality of early prosthetic valve endocarditis is high, so surgical treatment should be carried out as soon as possible.

  16. A Misinterpreted Case of Aorta Prosthesis Endocarditis

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

    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...

  17. Surgical treatment of infective endocarditis%感染性心内膜炎62例外科治疗分析

    袁忠祥; 刘健; 王利民

    2010-01-01

    目的 总结感染性心内膜炎(infective endocarditis,IE)的外科治疗经验.方法 对我院62例IE患者行全麻体外循环下心内直视手术,术中清除感染病灶,行心内畸形纠正和瓣膜置换.结果 本组术中植入生物瓣12例,机械瓣49例,另单独行动脉导管未闭缝合术1例.术后死亡1例,为人工瓣感染心内膜炎后再次换瓣,死于感染性休克和心功能不全.其余患者经过抗炎治疗4~6周后体温平稳出院.术后随访1年,未有复发病例.结论 早期给予足量、有效的抗生素治疗,感染无法控制时及时手术治疗,完善的手术纠治是治疗成功的关键.

  18. HACEK endocarditis: state-of-the-art.

    Revest, Matthieu; Egmann, Gérald; Cattoir, Vincent; Tattevin, Pierre

    2016-01-01

    The HACEK group of bacteria - Haemophilus parainfluenzae, Aggregatibacter spp. (A. actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, and A. segnis), Cardiobacterium spp. (C. hominis, C. valvarum), Eikenella corrodens, and Kingella spp. (K. kingae, K. denitrificans) - are fastidious gram-negative bacteria, part of the normal microbiota of oral and upper respiratory tract in humans. Although their pathogenicity is limited, they are responsible for 1-3% of all infective endocarditis. HACEK endocarditis mostly affect patients with underlying heart disease or prosthetic valves, and are characterized by an insidious course, with a mean diagnosis delay of 1 month (Haemophilus spp.) to 3 months (Aggregatibacter and Cardiobacterium spp.). The advent of continuously monitored blood culture systems with enriched media has erased the need for extended incubation for the diagnosis of HACEK endocarditis. Medical treatment relies on third-generation cephalosporin, with a favorable outcome in 80-90% of cases, with or without cardiac surgery. PMID:26953488

  19. Relationship between pathogenic, clinical, and virulence factors of Staphylococcus aureus in infective endocarditis versus uncomplicated bacteremia: a case-control study.

    Gallardo-García, M M; Sánchez-Espín, G; Ivanova-Georgieva, R; Ruíz-Morales, J; Rodríguez-Bailón, I; Viñuela González, V; García-López, M V

    2016-05-01

    Pathogenic factors of Staphylococcus aureus (SA) in the development of infective endocarditis (IE) have not been sufficiently investigated. The purpose of this study was to analyze the pathogenesis and virulence factors of SA in patients with IE as compared to patients with uncomplicated bacteremia (un-BAC). This is a retrospective case-control study (2002-2014) performed at a tertiary hospital in Spain. Clinical and epidemiological factors were analyzed. We assessed the presence of toxin genes [toxic shock syndrome toxin 1 (tst-1) and enterotoxins A (etA), B (etB), and D (etD)] and the potential relationship between accessory gene regulator (agr) groups and the development of IE confirmed by polymerase chain reaction (PCR). Twenty-nine patients with IE were compared with 58 patients with uncomplicated S. aureus bacteremia (SAB). As many as 75.9 % of patients had community-acquired IE (p infection and severe sepsis or septic shock and IE. Also, a minimum inhibitory concentration (MIC) of vancomycin ≥1.5 μg/ml was found to be associated with IE. The agr group I was prevalent (55.2 % vs. 31.0 %; p = 0.030). No association was observed between toxin genes (tst-1, etA, etB, and etD) and IE. The superantigen (SAg) most frequently found in SA isolates was tst-1 (12.6 %). We found no association between toxin genes and IE, probably due to the small sample size. However, a direct relationship was found between agr I and the development of IE, which suggests that agr I strains may have more potential to cause IE. PMID:26951263

  20. The first reported case of Bartonella endocarditis in Thailand

    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.

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

    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.

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

    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.

  3. Aspergillus Flavus Endocarditis of the Native Mitral Valve in a Bone Marrow Transplant Patient

    Demir, Tolga; Ergenoglu, Mehmet Umit; Ekinci, Abdurrahman; Tanrikulu, Nursen; Sahin, Mazlum; Demirsoy, Ergun

    2015-01-01

    Patient: Male, 36 Final Diagnosis: Aspergillus flavus endocarditis Symptoms: Malaise • fatigue and dyspnea Medication: — Clinical Procedure: Mitral vale replacemnet Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous dr...

  4. Native valve endocarditis due to Micrococcus luteus: a case report and review of the literature

    Elisaf Moses; Miltiadous George

    2011-01-01

    Abstract Introduction Micrococcus luteus endocarditis is a rare case of infective endocarditis. A total of 17 cases of infective endocarditis due to M luteus have been reported in the literature to date, all involving prosthetic valves. To the best of our knowledge, we describe the first case of native aortic valve M luteus endocarditis in an immunosuppressed patient in this report. Case report A 74-year-old Greek-Cypriot woman was admitted to our Internal Medicine Clinic due to fever and mal...

  5. 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

    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.

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

    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 18F-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

  7. Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia.

    Buitron de la Vega, P; Tandon, P; Qureshi, W; Nasr, Y; Jayaprakash, R; Arshad, S; Moreno, D; Jacobsen, G; Ananthasubramaniam, K; Ramesh, M; Zervos, M

    2016-02-01

    The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE. PMID:26676855

  8. Surgical management of congenital heart disease complicated by infective endocarditis%先天性心脏病并发感染性心内膜炎的外科治疗经验

    胡星明; 陈胜喜

    2002-01-01

    @@ 先天性心脏病患者易合并感染性心内膜炎(infective endocarditis, IE),单纯内科治疗往往效果欠佳,死亡率较高,而正确把握手术时机,及时手术能获较好的治疗效果.我院自1991年1月至2000年8月共收治先心病并IE患者25例,均采取手术治疗,疗效良好.

  9. 罹患缺血性卒中的感染性心内膜炎患者应予抗凝治疗吗?%Should the patients with ischemic stroke with infective endocarditis be treated with anticoagulants?

    苏克江

    2012-01-01

    在感染性心内膜炎基础上发生的缺血性卒中到底如何治疗才更为合理存在诸多争论,尤其是对是否应予抗凝治疗的意见并不一致.文章就此进行了讨论.%There are many controversies for how to treat the occurrence of ischemic stroke on the basis of infective endocarditis would be more reasonable,especially there is no consensus on whether to treat with anticoagulants.The article discusses about this.

  10. Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.

    Tsur, A; Slutzki, T; Flusser, D

    2015-09-01

    Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve. PMID:25295408

  11. 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.

    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 vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to a S. aureus infection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valve MSSA (methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications. PMID:26146571

  12. Cardiobacterium hominis endocarditis: two cases and a review of the literature

    Malani, A. N.; Aronoff, D. M.; Bradley, S. F.; Kauffman, C A

    2006-01-01

    Cardiobacterium hominis, a member of the HACEK group (Haemophilus parainfluenzae, Haemophilus aphrophilus, and Haemophilus paraphrophilus, Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella species), is a rare cause of endocarditis. There are 61 reported cases of C. hominis infective endocarditis in the English-language literature, 15 of which involved prosthetic valve endocarditis. There is one reported case of C. hominis after upper endoscopy and none report...

  13. Capnocytophaga canimorsus endocarditis with root abscess in a patient with a bicuspid aortic valve

    Guillaume Coutance; Olivier Lepage; Christophe Bachelet; Michèle Hamon; Damien Legallois; Arnaud Pellissier; Fabien Labombarda

    2009-01-01

    Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.

  14. Capnocytophaga canimorsus endocarditis with root abscess in a patient with a bicuspid aortic valve

    Michèle Hamon

    2009-04-01

    Full Text Available Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.

  15. Stenotrophomonas maltophilia prosthetic valve endocarditis: a case report

    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.

  16. 感染性心内膜炎合并脑栓塞患者的药学监护%Pharmaceutical care in a patient with infective endocarditis and cerebral embolism

    李丽萍; 方健; 罗崇彬; 曾智群

    2013-01-01

    Objective To clarify the roles of clinical pharmacist in rational drug use and probe into the approach of pharmaceutical care, by analyzing the drug application to a patient with infective endocarditis and cerebral embolism. Methods According to pathological state of the patient, rational pharmaceutical care and education were provided to a patient with infective endocarditis and cerebral embolism. Results The disease was controlled in time, and the patient recovered well. Conclusion The participation of clinical pharmacist can improve the level of rational drug use by providing professional knowledge of clinical pharmacy.%目的 通过1 例感染性心内膜炎合并脑栓塞患者的药学监护和用药分析,明确临床药师在合理用药中的作用,探讨药学监护的方法.方法 根据患者疾病特点,对患者进行药学监护和用药教育.结果 患者感染得到及时控制,病情恢复良好.结论 临床药师成为治疗团队中的一员,通过提供药学服务,可提高临床药物治疗的水平.

  17. Infective endocarditis caused by Gemella morbillorum,a case report and literature review%麻疹孪生球菌致感染性心内膜炎一例并国内外文献复习

    张闻多; 刘德平

    2011-01-01

    麻疹孪生球菌是人体口咽及肠道中共生菌丛中的条件致病菌,很少引起感染性心内膜炎.1例26岁女性无心脏基础疾病,患麻疹孪生球菌感染所致二尖瓣受累感染性心内膜炎,经抗生素和二尖瓣置换术后治愈.本例患者出现了颈内动脉栓塞,国内外报道较少见.%Gemella morbillorum ( G. morbillorum ) is an opportunistic pathogen colonizing the oropharynx and intestinal tract. On very rare occasions , it can cause infective endocarditis. A 26-year-old female patient with no history of heart disease was diagnosed as infective endocarditis caused by G, morbillorum and developed intemal carotid embolization. She was surcessfully treated with antibiotics and mitral valve replacement because of mitral valve vegetation and severe mitral regurgitation.

  18. 感染性心内膜炎患者瓣膜置换围术期护理配合分析%Perioperative Nursing Coordination for Patients With Infective Endocarditis Valve Replacement

    李丽

    2015-01-01

    目的:探讨感染性心内膜炎患者瓣膜置换围术期护理配合效果。方法对照组患者采用常规护理模式予以护理,观察组患者实施围术期护理。结果观察组患者的护理效果与总满意度均要优于对照组。结论对于感染性心内膜炎患者瓣膜置换的围术期配合有效的护理措施,是有效改善病情,降低并发症发生率,保证手术成功的重要手段。%Objective To investigate the effect of perioperative nursing in patients with infective endocarditis valve replacement.Methods The control group were treated with routine care model, the observation group were treated with perioperative care.Results The overall satisfaction with care results was better in observation group than the control group. Conclusion For patients with infective endocarditis valve replacement, effective perioperative care measures is effective in improving the condition and reduce the incidence of complications, it is an important means to ensure the success of surgery.

  19. Effect of immunization on susceptibility to experimental Streptococcus mutans and Streptococcus sanguis endocarditis.

    Durack, D T; Gilliland, B C; Petersdorf, R G

    1978-01-01

    It has been asserted that humoral immunity is an important potentiating factor in pathogenesis of infective endocarditis, in that prior immunization to certain bacteria may predispose the host to endocarditis caused by those organisms. If so, possible future vaccination of humans with streptococcal antigens for the prevention of dental caries might increase the susceptibility of the population to streptococcal endocarditis. To examine this hypothesis further, we immunized rabbits with killed Streptococcus sanguis or Streptococcus mutans. After complement-fixing antibody had developed, the rabbits were tested for susceptibility to experimental infective endocarditis. Rabbits with high titers of complement-fixing antibody to the infecting organism developed streptococcal endocarditis less often (13%) than animals with lower titers (69%; P less than 0.0002). These findings do not support the hypothesis that pre-immunization predisposes to infective endocarditis and lend no credence to the concept that vaccination of human subjects against dental caries might increase their susceptibility to streptococcal endocarditis. On the contrary, the results of these experiments indicate that specific antibody can confer relative immunity to infective endocarditis. PMID:730349

  20. Endocarditis associated with Erysipelothrix rhusiopathiae in a fat-tailed ram

    Aslani, M. R; Ebrahimi Kahrisangi, A; Baghban, F; Kazemi, A; Heidari, M; Salehi, N

    2015-01-01

    Endocarditis is rarely reported in sheep and information presented for ovine endocarditis is based mostly on comparative findings in the cattle. Infective vegetative endocarditis of the right heart was diagnosed in a 3-year-old fat-tailed ram. Clinical findings included tachycardia, marked brisket edema, jugular veins distention and pulsation and pale mucous membranes. Hematologic abnormality included neutrophilic leukocytosis. Necropsy confirmed severe right atrioventricular and pulmonary valves vegetative endocarditis with evidence of right heart failure. Erysipelothrix rhusiopathiae was isolated from those vegetative lisions.

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

    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

  2. Haemophilus segnis endocarditis

    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...

  3. Emphasize the diagnosis and treatment of infective endocarditis in patients with severe burn%重视严重烧伤患者感染性心内膜炎的诊断和治疗

    郇京宁

    2016-01-01

    The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high,which are attributed to invasive procedures,bacteremia,and wound infection after burns.Clinical clues for IE in burns are usually masked by burn-related manifestations,so the diagnosis of IE may be delayed or missed.For burned patients with persistent bacteremia of unknown source,especially Staphylococcus aureus -induced bacteremia,the diagnosis of IE should be considered according to the Duke criteria,and early echocardiography performance is particularly important.Antibiotic therapy is the mainstay initial management,and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns.In order to lower the incidence and mortality of IE in burns,it is very important to take prophylactic procedures along with the whole course of burn management.

  4. Infectious endocarditis caused by Escherichia coli

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas;

    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...

  5. Fungal endocarditis after homograft valve replacement: difficulties in diagnosis and treatment.

    Rudd, R. M.; Hill, P R; Kopelman, P; D. J. Parker

    1980-01-01

    Fungal endocarditis is an uncommon but important problem after cardiac surgery. Two cases of fungal endocarditis after homograft valve replacement are reported. In both patients prolonged periods of antifungal chemotherapy with apparently satisfactory clinical responses ultimately failed to eradicate the infection. Both patients remain free of infection two years after excision of the infected valves and further chemotherapy. The value of serial estimations of fungal antibody titres in diagno...

  6. Contemporary management of prosthetic valve endocarditis: principals and future outlook.

    O'Connor, Cormac T; Kiernan, Thomas J

    2015-05-01

    Infective endocarditis involving prosthetic valves accounts for 20% of all endocarditis cases. Rising in prevalence due to increasing placement of valvular prostheses, prosthetic valve endocarditis (PVE) is more difficult to diagnose by conventional methods, associated with more invasive infection and increased mortality. This report explores the existing literature in identifying a direct approach to the management of PVE; such as adjuncts to establishing a diagnosis (for instance positron emission tomography/computed tomography and radiolabeled leukocyte scintigraphy), the trends in specific pathogens associated with PVE and the recommended antimicrobials for each. The patterns of disease requiring surgical intervention are also highlighted and explored. In addition, a 5-year outlook offers consolidated knowledge on epidemiological trends of both culprit organisms and population subgroups suffering (and projected to suffer) from PVE. PMID:25865118

  7. Clinical effect of transthoracic ultrasonography on diagnosis of atypical infective endocarditis%不典型感染性心内膜炎超声诊断的临床研究

    胡喆; 朱文斌; 罗文华

    2014-01-01

    OBJECTIVE To explore the clinical effect of transthoracic ultrasonography on diagnosis of atypical infec-tive endocarditis .METHODS From Mar 2010 to Jul 2013 ,a total of 48 patients with confirmed atypical infective endocarditis were enrolled in the study ,all the patients received surgical procedures and underwent the transtho-racic ultrasonography before the surgery ,the results of ultrasonography were compared with the results of surgical procedures ,and the accuracy of echocardiography was observed .RESULTS The transthoracic ultrasonography found vegetations in 45 of 48 patients with atypical infective endocarditis ,and the echocardiography showed the vegetations in 42 patients with the detection rate of 93 .33% ;the accuracy of the ultrasonography was 87 .50% ,as compared with the accuracy of surgical procedures in detection of the valve damage and vegetation attachment sites ,the difference was not significant .CONCLUSION The transthoracic ultrasonography can detect the vegeta-tions rapidly and accurately in the patients with atypical infective endocarditis ,the rate of accordance with the sur-gical examination is high ,the effect ideal ,indicating that the transthoracic ultrasonography has strong clinical spe-cificity ,and it can be used as the major examination method for the clinical diagnosis .%目的:探讨经胸超声检查在不典型感染性心内膜炎患者诊断中的临床效果。方法选取2010年3月-2013年7月于医院诊断为不典型感染性心内膜炎的住院患者48例,均进行外科手术治疗,术前行经胸超声心动图检查,将超声检查结果与术后手术结果进行比较,观察超声心动图检查的准确性。结果48例经胸超声心动图检查的不典型感染性心内膜炎患者术中发现45例存在赘生物,超声心动图检出42例存在赘生物,检出率93.33%,超声诊断正确率为87.50%,与手术结果在瓣膜损害和赘生物附着部位检测正确率比较,差异

  8. 感染性心内膜炎赘生物超声心动图诊断的临床研究%Clinical study on infective endocarditis vegetations transthoracic echocardiography diagnosis

    黄楠; 徐永通; 李建华; 张红

    2014-01-01

    目的:探讨超声心动图诊断感染性心内膜炎赘生物的临床价值,以期提高临床诊治水平。方法选取2005年1月-2013年4月46例感染性心内膜炎赘生物患者为研究对象,均采用超声心动图检查,所有患者均行手术治疗,手术后对病理产物进行病理诊断,比较经胸超声心动图检查诊断结果和手术病理诊断结果的符合度情况,采用SPSS13.0软件进行分析。结果超声心动图与手术诊断进行比较,总符合率为95.65%,其中1例主动脉瓣+三尖瓣瓣根处有赘生物,超声心动图诊断为右心室结节,另外1例瓣膜脱垂,超声心动图诊断为右冠瓣穿孔。结论超声心动图对感染性心内膜炎赘生物诊断准确率高,作为一种无创的诊断方法,对临床感染性心内膜炎赘生物高危人群具有较高的筛选价值,早确诊、早治疗,提高该类患者的治疗预后具有较高的价值和临床意义。%OBJECTIVE To investigate the clinical value of infective endocarditis vegetation by transthoracic echo-cardiographic diagnosis in order to improve the clinical diagnosis and treatment .METHODS From Jan 2005 to Apr 2013 ,a total of 46 cases of patients with infective endocarditis vegetation were selected as the objects of study .All were examined by transthoracic echocardiography and underwent surgery .After surgery ,they had pathological product diagnosis , so as to compare the compliance of transthoracic echocardiography diagnosis and surgical pathology results by SPSS13 .0 software .RESULTS The diagnosis and surgery were compared ;the total coinci-dence rate was 95 .65% ,including one case with vegetations at aortic root and tricuspid valve root ;transthoracic echocardiography diagnosis found right ventricular nodules ,while another case had valvular prolapse ;the tran-sthoracic echocardiography showed the right coronary leaflet perforation .CONCLUSION The transthoracic echo-cardiography has

  9. Isolated pulmonic valve endocarditis presenting as neck pain

    Aditya Goud

    2015-12-01

    Full Text Available We discuss a unique case of a 52-year-old man with no history of intravenous drug use or dental procedures who presented with neck pain, 2 weeks of fevers, chills, night sweats, cough, and dyspnea found to have isolated pulmonic valve (PV endocarditis. The patient did not have an associated murmur, which is commonly seen in right-sided infectious endocarditis. A transthoracic echocardiogram showed a thickened PV leaflet, with subsequent transesophageal echocardiogram showing a PV mass. Speciation of blood cultures revealed Streptococcus oralis. In right-sided infective endocarditis, usually the tricuspid valve is involved; however, in our case the tricuspid valve was free of any mass or vegetation. The patient did meet Duke criteria and was thus started on long-term intravenous antibiotics for infectious endocarditis. The patient's symptoms quickly improved with antibiotics. A careful history and evaluating the patient's risk factors are key in earlier detection of infective endocarditis (IE. Because of early detection and a high index of suspicion, the patient had no further complications and did not require any surgery. In conclusion, clinical suspicion of right-sided IE should be high in patients who present with persistent fevers and pulmonary symptoms in order to reduce the risk of complications, and to improve outcomes.

  10. Factors Associated with Surgery of Active Infective Endocarditis in Patients with Congenital Heart Disease%手术治疗先天性心脏病患者活动期心内膜炎的相关因素

    周朝元; 付庆林; 段长恩; 苏国宝; 牛珊珊; 韩培立

    2016-01-01

    目的:确定先天性心脏病活动期感染性心内膜炎(active infective endocarditis,AIE)的手术指征.方法:于2003-2011年从71个机构数据库中调查并采集247例患有感染性心内膜炎的儿童及成人先天性心脏病(congenital heart disease,CHD)患者数据,其中74例(30%)进行了AIE手术治疗.回顾性分析患者的年龄、性别、感染心内膜炎前对CHD的诊断、致病微生物和感染部位等数据.结果:与AIE手术治疗必要性显著相关的指标是感染性心内膜炎(infective endocarditis,IE)病发前对心脏异常的诊断缺乏、主动脉辩IE、瓣周脓肿、心力衰竭以及抗生素发生变化.逐步逻辑回归方程分析结果表明瓣周脓肿、心力衰竭以及抗生素改变是先天性心脏病患者进行AIE手术治疗必要性的独立决定因素.结论:对IE合并CHD的患者而言,当心力衰竭、瓣周脓肿或抗生素变化发生时,手术可作为治疗AIE的一种手段.

  11. Contribution of lipoproteins and lipoprotein processing to endocarditis virulence in Streptococcus sanguinis.

    Das, Sankar; Kanamoto, Taisei; Ge, Xiuchun; Xu, Ping; Unoki, Takeshi; Munro, Cindy L; Kitten, Todd

    2009-07-01

    Streptococcus sanguinis is an important cause of infective endocarditis. Previous studies have identified lipoproteins as virulence determinants in other streptococcal species. Using a bioinformatic approach, we identified 52 putative lipoprotein genes in S. sanguinis strain SK36 as well as genes encoding the lipoprotein-processing enzymes prolipoprotein diacylglyceryl transferase (lgt) and signal peptidase II (lspA). We employed a directed signature-tagged mutagenesis approach to systematically disrupt these genes and screen each mutant for the loss of virulence in an animal model of endocarditis. All mutants were viable. In competitive index assays, mutation of a putative phosphate transporter reduced in vivo competitiveness by 14-fold but also reduced in vitro viability by more than 20-fold. Mutations in lgt, lspA, or an uncharacterized lipoprotein gene reduced competitiveness by two- to threefold in the animal model and in broth culture. Mutation of ssaB, encoding a putative metal transporter, produced a similar effect in culture but reduced in vivo competiveness by >1,000-fold. [(3)H]palmitate labeling and Western blot analysis confirmed that the lgt mutant failed to acylate lipoproteins, that the lspA mutant had a general defect in lipoprotein cleavage, and that SsaB was processed differently in both mutants. These results indicate that the loss of a single lipoprotein, SsaB, dramatically reduces endocarditis virulence, whereas the loss of most other lipoproteins or of normal lipoprotein processing has no more than a minor effect on virulence. PMID:19395487

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

    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.

  13. Bioprosthetic Aortic Valve Endocarditis in Association with Enterococcus durans

    Di Gioacchino, Lorena; Balestrini, Fabrizio

    2016-01-01

    Enterococci are common organisms associated with endocarditis, but infection by Enterococcus durans is very rare. To our knowledge, only 3 cases have been reported in the medical literature, and all 3 have involved native valves. Here we publish the first reported case (to our knowledge) of E. durans endocarditis in association with a bioprosthetic aortic valve. After the organism and its antibiotic susceptibility were identified, the 74-year-old male patient was treated successfully with teicoplanin and gentamicin, over a course of 6 weeks. PMID:27127436

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

    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.

  15. Endocarditis-associated Brain Lesions in Slaughter Pigs

    Karstrup, C.C.; Jensen, H.E.; Aalbæk, B.;

    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......-situ hybridization examinations. These examinations identified 11 cases of Streptococcus suis, six cases of Erysipelothrix rhusiopathiae, one Streptococcus spp. and two cases that remained aetiologically undetermined. One of the S. suis cases had a dual infection with S. suis in the aortic valve lesions and...

  16. Aorto-left ventricular tunnel complicated with infective endocarditis: diagnosed by transthoracic two-dimensional and three-dimensional echocardiography%经胸二维和三维超声心动图诊断主动脉-左心室通道合并感染性心内膜炎一例

    程蕾蕾; 赵维鹏; 潘翠珍; 丁文军; 王春生; 舒先红

    2011-01-01

    IntroductionAorto-left ventricular tunnel(ALVT)is an extrenle rare(0.001%)congenital para-valvular conmmnication between aorta and the left ventricle.It was first reported by Edwards and his colleagues in 1961[ 1].Only about 100 cases have been reported until now.We re port Out"first ease of ALVT with infective endocarditis demonstrated by two-dimensional and three-dimensional echocardiography and confirmed by surgery.%@@ IntroductionAorto-left ventricular tunnel ( ALVT) is an extreme rare (0.001% ) congenital para-valvular communication between aorta and the left ventricle.It was first reported by Edwards and his colleagues in 1961[1].Only about 100 cases have been reported until now.We report our first case of ALVT with infective endocarditis demonstrated by two-dimensional and three-dimensional echocardiography and confirmed by surgery.

  17. Brucella Endocarditis in Prosthetic Valves

    Mehanic, Snjezana; Mulabdic, Velida; Baljic, Rusmir; Hadzovic-Cengic, Meliha; Pinjo, Fikret; Hadziosmanovic, Vesna; Topalovic, Jasna

    2012-01-01

    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined...

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

    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.

  19. Staphylococcus lugdunensis Endocarditis in a 35-Year-Old Woman in Her 24th Week of Pregnancy

    Mounir Khafaga

    2016-01-01

    Full Text Available Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis by Staphylococcus lugdunensis in a pregnant woman. Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis. Blood culture detected Staphylococcus lugdunensis. A vegetation and severe mitral regurgitation due to complete destruction of the valve confirmed the diagnosis. An interdisciplinary panel of cardiologists, maternal-fetal medicine specialists, cardiac and plastic surgeons, infectiologists, anesthesiologists, and neonatologists was formed to determine the best therapeutic strategy. Conclusions. Timing and indications for surgical intervention to prevent embolic complications in infective endocarditis remain controversial. This original case report illustrates how managing infective endocarditis by Staphylococcus lugdunensis particularly in the 24th week of pregnancy can represent a therapeutic challenge to a broad section of specialties across medicine. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.

  20. 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.

    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. PMID:26881154

  1. Staphylococcus lugdunensis endocarditis--the hidden peril of coagulase-negative staphylococcus in blood cultures.

    Seenivasan, M H; Yu, V L

    2003-08-01

    Reported here is a successfully treated case of native mitral valve endocarditis caused by Staphylococcus lugdunensis and a review of 47 similar cases reported in the English literature. In the literature review, perineal skin flora appeared to be the source of the organism in patients with endocarditis. Staphylococcus lugdunensis is generally susceptible in vitro to beta-lactam agents. If speciation is not performed, these bacteria might be mistaken for Staphylococcus epidermidis, a relatively avirulent bacterium that is a common contaminant of cultures. Prompt speciation can lead to earlier recognition of endocarditis and possibly enable earlier surgical intervention with improved outcome for this high-mortality infection. Multiple positive blood cultures yielding coagulase-negative staphylococci should be identified to the species level; endocarditis or another intravascular source of infection should be sought. PMID:12845551

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

    Erica E. Palys

    2006-01-01

    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.

  3. Kingella kingae endocarditis: A rare case of mitral valve perforation

    Anthony A Holmes

    2011-01-01

    Full Text Available Kingella kingae , a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.

  4. Ventricular patch endocarditis caused by Propionibacterium acnes: advantages of gallium scanning.

    Vandenbos, F; Roger, P M; Mondain-Miton, V; Dunais, B; Fouché, R; Kreitmann, P; Carles, D; Migneco, O; Dellamonica, P

    2001-11-01

    Propionibacterium acnes is a weakly pathogenic commensal of the skin. When isolated from blood cultures it is often considered a contaminant. However, P. acnes may be responsible for severe infections and its role in certain cases of infectious endocarditis has now been definitely established.(1) We report a case of endocarditis due to P. acnes stemming from a ventricular patch and revealed by a gallium 67 scan. PMID:11869063

  5. [Destructive endocarditis caused by Streptococcus sanguis on normal valves after gastroduodenoscopy].

    Pentimone, F; Del Corso, L; Borelli, A; Riccioni, S; Salvatore, L

    1991-06-01

    In recent years, epidemiological and clinical patterns in infective endocarditis are changed: mean age of patients, sex, underlying cardiac diseases, source of bacteremia, availability of better diagnostic methods--specially two-dimensional and doppler echocardiography--and surgical options. The Authors report a paradigmatic case of a young man without cardiac disease, who developed a destructive endocarditis complicated by refractory congestive heart failure; the cause was an organism of low pathogenicity, Streptococcus sanguis, that entered the bloodstream after gastroduodenoscopy. PMID:1961444

  6. Endocarditis Prophylaxis in Cardiac Patients: Knowledge among General Dental Practitioners in Tabriz

    2008-01-01

    Background and aims Dental procedures injuring oral tissues may induce bacterial release to blood stream that can cause infective endocarditis in susceptible patients. The aim of this study was to determine the level of knowledge of general dental practitioners (GDPs) in Tabriz, Northwest of Iran, regarding endocarditis prophylaxis in cardiac pa-tients receiving dental treatments. Materials and methods This was a cross-sectional, descriptive, analytical study that included 150 GDPs. All pract...

  7. Right-Sided Endocarditis due to Staphylococcus lugdunensis: First Reported Case

    Cooper, CL; Choudhri, SH; Hoeschen, RJ

    1998-01-01

    Staphylococcus lugdunensis is a coagulase-negative organism first identified in 1988. It is often incorrectly identified as Staphylococcus aureus, and has been isolated as the etiological agent in over 20 cases of left-sided endocarditis. This report describes the first documented case of right-sided endocarditis caused by S lugdunensis. This experience suggests that S lugdunensis can infect native valves in the absence of any predisposing risk factors such as injection drug use.

  8. Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

    Jayashree Purkayastha; Leslie Edward Lewis; Morakhia Jwalit V; Ranjan Shetty K; Muhammad Najih L

    2015-01-01

    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 nutrit...

  9. Aorta-to-right atrium fistula, an unusual complication of endocarditis

    Chen, Miao-yan; Zhong, Dan-dan; Ying, Zhi-qiang

    2009-01-01

    Infective endocarditis (IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious complication of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis, vegetation, perforation of noncoronary sinus, and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardiography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis, aggres...

  10. Actinomyces naeslundii: An Uncommon Cause of Endocarditis

    Cortes, Christopher D.; Carl Urban; Glenn Turett

    2015-01-01

    Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces.

  11. Actinomyces naeslundii: An Uncommon Cause of Endocarditis

    Christopher D. Cortes

    2015-01-01

    Full Text Available Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces.

  12. Actinomyces naeslundii: An Uncommon Cause of Endocarditis.

    Cortes, Christopher D; Urban, Carl; Turett, Glenn

    2015-01-01

    Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces. PMID:26697243

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

    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

  14. Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis.

    Kauffman, Carol A

    2015-10-01

    Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents. PMID:26398531

  15. 一例感染性心内膜炎合并肾功能不全患者的药学监护%Pharmaceutical care for a patient with infective endocarditis and renal insuffi-ciency

    曹琴; 辛传伟

    2014-01-01

    The whole pharmaceutical care package was given by clinical pharmacist to a patient with infective endocarditis and renal insufficiency .The pharmacist performed pharmaceutical care by analyzing the condition of the patient ,evaluating and making treat-ment plan and adjusting the drug dosage .With the cooperation of clinical pharmacist ,the doctor optimized the treatment plan to individ-ualize treatment ,and ensured the effectiveness and safety of medications .%临床药师对一例感染性心内膜炎合并肾功能不全患者进行全程药学监护,从分析疾病用药特点、评估并提供可选治疗方案以及选择药物剂量等方面为临床提供药学服务。临床药师的建议优化了治疗方案,保证了患者用药的安全有效。

  16. 加强对小儿感染性心内膜炎诊治的研究%Values of the Duke criteria for the diagnosis of infective endocarditis

    陈树宝; 韩玲

    2001-01-01

    @@ 小儿感染性心内膜炎(infective endocarditis,IE)是一种严重的感染性疾病.在抗生素使用前的年代,IE患者很少存活.即使应用抗生素治疗,死亡率仍高达20%~25%.近50年来,IE的发病有增加趋势.国外报道,20世纪30年代,住院儿童中IE占1/4 500,而80年代占1/1 280[1].另有报道为1/500~1/1 000.IE患者中,无基础心脏病、新生儿及先天性心脏病手术后病例的比例增多.病原菌中条件致病菌的比例明显增加.上述变化与先天性心脏病,特别是复杂型先天性心脏病的手术增多,静脉内置管应用增多及风湿热病例减少等因素有关.

  17. 1例重症感染性心内膜炎病人多学科联合救治的体会%Experience of remedied by combination of multiple - subject medical staffs for a case with severe infective endocarditis

    丁璐; 孟蕾; 马香梅; 于海洋

    2007-01-01

    @@ 感染性心内膜炎(infective endocarditis)是发生于心内膜和(或)心瓣膜的炎症病变,主要侵犯有病变的心瓣膜、人造瓣膜以及先天性缺损,也可累及心内膜、大血管或植入人工材料[1].感染性心内膜炎是心血管疾病中的重症顽疾,临床救治难度很高,死亡风险大.2007年2月我院收治了1例先天性心脏病合并重症感染性心内膜炎的病人,并在多科室合作下组织实施救治并采取了及时有效的护理干预,取得了良好的疗效,现报道如下.

  18. The Value of Echocardiography in the Diagnosis of Infective Endocarditis%超声心动图诊断感染性心内膜炎的临床价值

    李春梅; 尹立雪; 邓燕; 程力剑

    2003-01-01

    目的评价超声心动图在感染性心内膜炎(infective endocarditis,IE)诊断中的价值.方法分析总结38例IE患者的临床和超声心动图资料.结果 IE多发生于原有器质性心脏病基础上,以风心病和先心病为主.赘生物有附着位置、大小、形态及随病程变化多种超声特点.超声心动图可检出瓣膜脱垂、腱索断裂和瓣周脓肿等心脏内并发症.结论超声能为临床提供IE患者的基础心脏病因、诊断、鉴别诊断、指导治疗和判断预后等具有重要价值的信息.

  19. 感染性心内膜炎患者体外循环手术中ACT的监测%Measurement of activated clotting time during cardiopulmonary bypass in patients with infective endocarditis patients

    蒋玲; 喻杰锋

    2007-01-01

    目的:探讨感染性心内膜炎(infective endocarditis,IE)患者外科治疗时肝素及鱼精蛋白的合理用量.方法:IE患者与风湿性心脏病(rheumatic heart disease,RHD)患者各30例,在体外循环(cardiopulmonary bypass,CPB)期间测定激活全血凝固时间(activated clotting time,ACT),CPB终止后,测ACT拮抗值.结果:转流前IE组肝素用量[(407.2±51.3)U/kg]明显高于RHD组[(350±25)U/kg(P<0.05)],鱼精蛋白用量IE组[(3.00±0.25)mg/kg]亦明显高于RHD组[(2.51±0.26)mg/kg(P<0.05)],鱼精蛋白与肝素之比IE组为0.76±0.23,RHD组为0.74±0.12,二组间无统计学差异(P>0.05).结论:IE病人转流前肝素用量大于400 U/kg,鱼精蛋白用量需增加至3 mg/kg,而鱼精蛋白与肝素之比无明显变化.

  20. Infectious endocarditis: rlieumatologic aspects

    G M Tarasova

    2008-01-01

    Full Text Available Objective. To assess rheumatologic aspects of modern infectious endocarditis (IE and to determine role of anti-inflammatory therapy in complex treatment of the disease. Material and methods. 50 pts with IE (24 female, 26 male aged 16 to 60 years were included. Primary IE was diagnosed in 15, secondary - in 35 cases. 7 pts had acute and 43 — subacute course. 40 pts had definite and 10 — probable IE. Results. Mean period till correct diagnosis establishment was 112± 116,5 days. Diagnostic difficulties were more frequent in subacute variant of IE (p=0,03. Heart diseases prevailed among cardiac risk factors (p=0,0l. Clinical picture of IE was very polymorphous. Glucocorticoids (GC were administered to 21 pts in addition to antibiotics due to signs of organ immunopatology and high laboratory measures of immune activity. Positive effect of glucocorticoids was achieved in 64% of pts. Conclusion. Development of immunological changes complicates timely diagnosis of IE and requires exclusion of different diseases including rheumatic pathology. IE treatment strategy does not exclude administration of GC low doses for prominent immunopathological signs in addition to massive antibacterial therapy.

  1. Gonococcal endocarditis: an ever-present threat

    Kawabata, Vitor Sérgio; Bittencourt, Márcio Sommer; Lovisolo, Silvana Maria; Felipe-Silva, Aloísio; de Lemos, Ana Paula Silva

    2016-01-01

    The incidence of severe complications of the Neisseria gonorrhoeae infection has presented variations over recent decades since the advent of penicillin. Gonococcal endocarditis (GE) still remains an ever-present threat afflicting the society’s poor and sexually active young population. This entity frequently requires surgical intervention and usually exhibits a poor outcome. The interval between the onset of symptoms and the diagnosis does not usually exceed 4 weeks. One of the characteristics of GE is a proclivity for aortic valve involvement with large vegetation and valve ring abscess formation. The authors report the case of a young man with a 2-week history of fever, malaise, weakness, and progressive heart failure symptoms, who had no previous history of genital complaints or cardiopathy. The physical examination was consistent with acute aortic insufficiency, which was most probably of an infectious origin. The echocardiogram showed thickened aortic cusps and valve insufficiency. After hospital admission, the patient’s clinical status worsened rapidly and he died on the second day. The autopsy findings disclosed aortic valve destruction with vegetation and a ring abscess besides signs of septic shock, such as diffuse alveolar damage, acute tubular necrosis, and zone 3 hepatocellular necrosis. The blood culture isolated N. gonorrhoeae resistant to penicillin and ciprofloxacin. The authors call attention to the pathogen of this particular infectious endocarditis, and the need for early diagnosis and evaluation by a cardiac surgery team. PMID:27547739

  2. Gonococcal endocarditis: an ever-present threat.

    de Campos, Fernando Peixoto Ferraz; Kawabata, Vitor Sérgio; Bittencourt, Márcio Sommer; Lovisolo, Silvana Maria; Felipe-Silva, Aloísio; de Lemos, Ana Paula Silva

    2016-01-01

    The incidence of severe complications of the Neisseria gonorrhoeae infection has presented variations over recent decades since the advent of penicillin. Gonococcal endocarditis (GE) still remains an ever-present threat afflicting the society's poor and sexually active young population. This entity frequently requires surgical intervention and usually exhibits a poor outcome. The interval between the onset of symptoms and the diagnosis does not usually exceed 4 weeks. One of the characteristics of GE is a proclivity for aortic valve involvement with large vegetation and valve ring abscess formation. The authors report the case of a young man with a 2-week history of fever, malaise, weakness, and progressive heart failure symptoms, who had no previous history of genital complaints or cardiopathy. The physical examination was consistent with acute aortic insufficiency, which was most probably of an infectious origin. The echocardiogram showed thickened aortic cusps and valve insufficiency. After hospital admission, the patient's clinical status worsened rapidly and he died on the second day. The autopsy findings disclosed aortic valve destruction with vegetation and a ring abscess besides signs of septic shock, such as diffuse alveolar damage, acute tubular necrosis, and zone 3 hepatocellular necrosis. The blood culture isolated N. gonorrhoeae resistant to penicillin and ciprofloxacin. The authors call attention to the pathogen of this particular infectious endocarditis, and the need for early diagnosis and evaluation by a cardiac surgery team. PMID:27547739

  3. Tratamento cirúrgico da endocardite infecciosa na fase aguda: experiência de três anos Surgical treatment of infective endocarditis in the acute phase: a three-year experience

    Iseu Affonso da Costa

    1987-08-01

    ápida resposta ao tratamento antibiótico.Surgical treatment is becoming accepted as the best means of dealing with acute bacterial endocarditis in many clinical settings. The continuing changes in diagnosis, bacteriology and clinical picture of this disease must be accounted for by the surgical teams. Definition of the rules for management of this severe condition has been a matter of concern for us in the last years. From November 1983 to November 1986, 6.7% of the valvar substitutions in our Service were due to active infection (32 of 477 patients. The site of infection was the mitral valve in six patients, aortic valve in 12 patients (one death mitral and aortic valves in six patients (two deaths, mitral prostheses in two patients (one death aortic prostheses (three deaths, mitral, aortic and tricuspid valves in one patient (one death and the wall of the left ventricle in one patient. Age varied from 10 to 56 years (m=29.2 years. Seven patients were females and 24 males. All patients were white. Analysis of the pathologic findings allowed us to define three subgroups: In subgroup A, 11 operations were done for simple valvar lesions. All patients left the hospital. Fifteen patients were in the subgroup of extensive valvar or perivalvar lesions, five of which died. Among the six prosthetic infections there were four deaths. The favorable outcome of the patients operated on for simple valvar lesions and the high risk of those who presented extensive tissue destruction or prosthetic infection makes us to prefer immediate surgical treatment if there is no clear response to antibiotics within 24 to 48 hours.

  4. Brucella Endocarditis in Prosthetic Valves

    Mehanic, Snjezana; Mulabdic, Velida; Baljic, Rusmir; Hadzovic-Cengic, Meliha; Pinjo, Fikret; Hadziosmanovic, Vesna; Topalovic, Jasna

    2012-01-01

    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed. PMID:24493988

  5. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis

    Makdisi, George; Casciani, Thomas; Wozniak, Thomas C.; Roe, David W.; Hashmi, Zubair A

    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 reg...

  6. Community acquired staphylococcal pulmonary valve endocarditis in non-drug users: case report and review of the literature

    Edmond, J; Eykyn, S; Smith, L.

    2001-01-01

    Right sided endocarditis usually involves the tricuspid valve, predominantly in intravenous drug users. It is also occasionally acquired in hospital as a result of contaminated intravascular devices. Isolated infection of the pulmonary valve is rarely seen. A case of community acquired Staphylococcus aureus pulmonary valve endocarditis that caused diagnostic confusion is reported. This infection occurred in a patient with no history of intravenous drug abuse and a previously structurally norm...

  7. Role of Monocytes and Bacteria in Staphylococcus epidermidis Endocarditis

    Bancsi, Maurice J. L. M. F.; Veltrop, Marcel H. A. M.; Bertina, Rogier M.; Thompson, Jan

    1998-01-01

    The endocardial vegetation which is formed in the course of bacterial endocarditis (BE) contains tissue factor (TF)-dependent procoagulant activity. Earlier studies showed that monocytes are the main source of TF in the vegetations. The TF activity (TFA) of vegetations isolated from Streptococcus sanguis-infected rabbits depended on the numbers of bacteria as well as monocytes in the vegetation. In this study, we investigated whether for Staphylococcus epidermidis, a frequent pathogen in BE, ...

  8. Role of granulocytes and monocytes in experimental Escherichia coli endocarditis.

    Meddens, M J; Thompson, J.; Bauer, W C; van Furth, R

    1984-01-01

    The role of granulocytes and monocytes during the induction and course of Escherichia coli endocarditis was investigated in rabbits by selectively depleting monocytes from the circulation with the drug VP16-213 and granulocytes and monocytes with nitrogen mustard. For induction, the number of E. coli needed to infect the vegetations in 50% of the rabbits was significantly lower in rabbits with combined granulocytopenia and monocytopenia than in those with selective monocytopenia or in control...

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

    Egido, S Hernández; Ruiz, M Siller; Inés Revuelta, S; García, I García; Bellido, J L Muñoz

    2016-01-01

    Small colony variants (SCV) are slow-growing subpopulations of bacteria usually associated with auxotrophism, causing persistent or recurrent infections. Enterococcus faecalis SCV have been seldom described, and only one case of Enterococcus faecium SCV has been reported, associated with sepsis in a leukaemia patient. Here we report the first case described of bacteraemia and endocarditis by SCV E. faecium in an immunocompetent patient. PMID:26862434

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

    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. Clinical Characteristics and Outcome of Cardiovascular Implantable Electronic Device Infections in Turkey.

    Aydin, Mesut; Yildiz, Abdulkadir; Kaya, Zeynettin; Kaya, Zekeriya; Basarir, Ahmet Ozgur; Cakmak, Nazmiye; Donmez, Ibrahim; Morrad, Baktash; Avci, Ahmet; Demir, Kenan; Cagliyan, Emre Caglar; Yuksel, Murat; Elbey, Mehmet Ali; Kayan, Fethullah; Ozaydogdu, Necdet; Islamoglu, Yahya; Cayli, Murat; Alan, Said; Ulgen, Mehmet Siddik; Ozhan, Hakan

    2016-07-01

    Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality. PMID:25589093

  12. Update on endocarditis-associated glomerulonephritis.

    Boils, Christie L; Nasr, Samih H; Walker, Patrick D; Couser, William G; Larsen, Christopher P

    2015-06-01

    Glomerulonephritis (GN) due to infective endocarditis (IE) is well documented, but most available data are based on old autopsy series. To update information, we now present the largest biopsy-based clinicopathologic series on IE-associated GN. The study group included 49 patients (male-to-female ratio of 3.5:1) with a mean age of 48 years. The most common presenting feature was acute kidney injury. Over half of the patients had no known prior cardiac abnormality. However, the most common comorbidities were cardiac valve disease (30%), intravenous drug use (29%), hepatitis C (20%), and diabetes (18%). The cardiac valve infected was tricuspid in 43%, mitral in 33%, and aortic in 29% of patients. The two most common infective bacteria were Staphylococcus (53%) and Streptococcus (23%). Hypocomplementemia was found in 56% of patients tested and ANCA antibody in 28%. The most common biopsy finding was necrotizing and crescentic GN (53%), followed by endocapillary proliferative GN (37%). C3 deposition was prominent in all cases, whereas IgG deposition was seen in <30% of cases. Most patients had immune deposits detectable by electron microscopy. Thus, IE-associated GN most commonly presents with AKI and complicates staphylococcal tricuspid valve infection. Contrary to infection-associated glomerulonephritis in general, the most common pattern of glomerular injury in IE-associated glomerulonephritis was necrotizing and crescentic glomerulonephritis. PMID:25607109

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

    Jensen, Henrik E.; Gyllensten, Johanna; Hofman, Carolina;

    2010-01-01

    . 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......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...

  14. Clinical study on blood culture positive patients with infective endocarditis%感染性心内膜炎血培养阳性患者的临床研究

    朱素玲; 杜平; 徐穆民; 李进启; 欧志宏

    2015-01-01

    目的:探讨感染性心内膜炎血培养阳性患者的临床诊治特点,以指导临床预防及控制疾病。方法将2004年12月-2014年12月的182例感染性心内膜炎患者按血培养结果分为阳性组80例、阴性组102例,分析阳性患者临床表现、病原菌分布及耐药性;统计患者预后。结果两组患者基础病因均以先天性心脏病为主,主要临床特征均为发热,组间比较差异无统计学意义,阳性组患者心脏杂音出现较少、贫血出现较多,组间比较差异有统计学意义(P<0.05);阳性组患者肾功能不全、脏器栓塞出现率较高,组间比较差异有统计学意义(P<0.05);两组患者白细胞总数、血沉、C‐反应蛋白比较,差异均有统计学意义(P<0.05);阳性组患者病原菌以酿脓链球菌、金黄色葡萄球菌、粪肠球菌为主,分别占50.0%、22.5%及11.3%,其对青霉素、红霉素、克林霉素均表现出较高的耐药性;阳性组患者死亡7例,病死率达8.8%;糖尿病史、致病菌类型、心脏感染部位为死亡独立危险因素(P<0.05)。结论感染性心内膜炎血培养阳性临床表现缺乏特异性,行实验室检查有助于明确病因。%OBJECTIVE To investigate the clinical diagnostic features of blood culture positive patients with infec‐tive endocarditis so as to guide clinical prevention and control of the disease .METHODS From Dec .2004 to Dec . 2014 ,totally 182 cases of infective endocarditis patients were divided into two groups according to the results of blood culture .The positive group had 80 cases and the negative group had 102 cases .The clinical manifestations , pathogenic distribution and drug resistance of the positive group were analyzed .RESULTS The basic disease of the two groups was mainly congenital heart disease ,manifested as fever clinically .The differences were not signifi‐cant .Patients in positive

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

    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. Gerbode Defect as a Result of Fungal Aortic Valve Endocarditis.

    Pasrija, Chetan; Mohammed, Isa; Shats, Inna; Hong-Zohlman, Susie; Reoma, Junewai; Mazzeffi, Michael A; Rajagopal, Keshava

    2015-05-01

    A 63-year-old male patient with HIV disease presented with dyspnea and complete heart block, and was found to have aortic valve (AV) endocarditis secondary to Candida parapsilosis infection. Echocardiography demonstrated AV endocarditis and possible aortic root versus subannular abscess with moderate AV regurgitation (AR), a ventricular septal defect (VSD) and possible left ventricular to right atrial shunt (Gerbode defect). Large AV vegetations, subannular abscess with an acquired membranous VSD, Gerbode defect, and tricuspid annular abscess at the insertion of septal leaflet were noted intraoperatively. The patient underwent AV replacement with a stented bioprosthesis, two-sided VSD patch closure, and tricuspid valve (TV) repair with an annuloplasty ring. The left-sided patch closed the VSD and facilitated AV replacement, while the right-sided patch facilitated the TV repair. PMID:26901898

  17. Q fever endocarditis with multi-organ complication: a case report

    ZHANG Li-juan; FU Xiu-ping; ZHANG Jing-shan

    2006-01-01

    @@ Qfever is a worldwide zoonosis and its agent is Coxiella burnetii (C. burnetii).1 There are two forms of Q fever: acute and chronic. Acute Q fever is caused by primary infection with C. burnetii and its main clinical features are high fever, granulomatous hepatitis and atypical pneumonia.2,3 Acute Q fever is extremely prone to develop chronic infection if it is improperly treated. Endocarditis is the main characteristic of chronic Q fever and it accounts for 3% to 5% of all cases of endocarditis.4,5

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

    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 imaging in infectious endocarditis

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

    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...... structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission...... the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested....

  20. Heart transplantation as salvage therapy for progressive prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE)

    Borde, J. P.; Sitaru, G.; Kopp, W. H.; Ruhparwar, A.; Ehlermann, P.; Lasitschka, F.; Dalpke, A.; Heininger, A

    2016-01-01

    Background Prosthetic valve endocarditis (PVE) has the highest in-hospital mortality among all cases of infective endocarditis (IE), it is estimated at about 40 %. Orthotopic heart transplantation (OHT) as a measure of last resort, may be considered in selected cases where repeated surgical procedures and conservative efforts have failed to eradicate persistent or recurrent IE. Only few clinical data are available regarding this rare indication for OHT, since active IE has traditionally been ...

  1. Serological diagnosis of experimental Enterococcus faecalis endocarditis

    Kjerulf, A; Espersen, F; Gutschik, E;

    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...... an increase in the CFU/g vegetation and the CFU/g spleen, the ID50 being about 10 CFU/ml and the ID90 about 1x10(2) CFU/ml. The lowest bacterial inoculum infecting 100% of the rats was 3x10(3) CFU/ml, and for further investigations we used this inoculum size. Rats were sacrificed on day 2, 5, 7, 9......, 11 and 28 after infection. The CFU/g vegetation and the CFU/g spleen increased until day 7 and then decreased. Serum samples were collected from 129 rats at different times after challenge. Three different ELISA systems were established to measure the IgG antibody responses: E. faecalis sonicate...

  2. Clinical features and treatment in children with infective endocarditis%儿童感染性心内膜炎临床特征与治疗对策

    李运泉; 陈国桢; 覃有振; 朱延力; 李格丽

    2006-01-01

    儿童感染性心内膜炎(infective endocarditis,IE)的发病率呈逐年上升趋势。但儿童IE不易早期诊断,病死率较高。如何进行早期诊断和有效的治疗是人们一直关注的问题。现对我院1991年6月~2005年6月收治的32例IE患儿的资料进行回顾性分析,对上述问题进行探讨。

  3. Brucella endocarditis on double valvular prosthesis.

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

  4. Antibiotic prophylaxis for bacterial endocarditis: A study of knowledge of guidelines among dentists participated in the 47th international congress of dentistry

    Hashemipour M.

    2008-12-01

    Full Text Available "nBackground and Aim: Infective endocarditis is a rare disease resulted in mortality and morbidity in 10-80% of patients. The purpose of present study was to investigate the knowledge of guidelines on antibiotic prophylaxis for bacterial endocarditis in a group of Iranian dentists. "nMaterials and Methods: This was a descriptive study in which the population under study was 205 who were participated in the 47th international congress of dentistry (Tehran-Spring 2007 and they were chosen by census sampling methods. Nameless questionnaires were designed and were given to the dentists to complete. The t-test, χ² and spearman with the SPSS 13.5 program were used in the data analysis. P<0.05 was considered as the level of significance. "nResults: Regarding to the prescribing of prophylactic antibiotic for patients with prosthetic cardiac valves, 94.6% of all answers were correct. Also, the most common procedures in which the prophylaxis antibiotic was distinguished to be necessary were periodontal surgery, scaling, dental extraction and using subgingival cord, respectively. More than half of the dentists (65.8% had chosen amoxicillin as a prophylactic antibiotic. Mean knowledge score was 38.77±12.4. "nConclusion: Results of the present study showed that the knowledge of dentists about prescribing antibiotics for prevention of bacterial endocarditis is relatively low. It was also found that the level of knowledge decreases by passing time from graduation.

  5. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. PMID:26403965

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

    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. PMID:25648998

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

    Joseph Orme; Tomas Rivera-Bonilla; Akil Loli; 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.

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

    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...

  9. Immunization with FimA protects against Streptococcus parasanguis endocarditis in rats.

    Viscount, H B; Munro, C L; Burnette-Curley, D; Peterson, D L; Macrina, F L

    1997-01-01

    FimA, a surface-associated protein of Streptococcus parasanguis, is associated with initial colonization of damaged heart tissue in an endocarditis model (D. Burnette-Curley, V. Wells, H. Viscount, C. Munro, J. Fenno, P. Fives-Taylor, and F. Macrina, Infect. Immun. 63:4669-4674, 1995). We have evaluated the efficacy of recombinant FimA as a vaccine in the rat model of endocarditis and investigated in vitro the mechanism for the protective role of immunization. FimA-immunized and nonimmunized ...

  10. Brucellosis with p-ANCA-associated renal failure, leukocytoclastic vasculitis and endocarditis: Case report

    Murat Turgay, Esin Ertuğrul, Orhan Küçükşahin, Ali Şahin

    2011-06-01

    Full Text Available The relationship between brucellosis and p-antinuclear cytoplasmic antibody (p-ANCA-associated vasculitis (pAAV is a rare condition. Herein, we report a 52-year-old man who was diagnosed as rapidly progressive glomerulonephritis (RPGN and endocarditis due to brucellosis. He was treated with antimicrobial agents, steroids, plasmapheresis, renal replacement therapy and aortic valve replacement. According to our best of knowledge, no similar case has been reportedpreviously in the literature in regard to p-ANCA anti-lactoferrin antibodies associated-glomerulonephritis with brucellosis and endocarditis. J Microbiol Infect Dis 2011;1(1:31-34.

  11. Aorta-to-right atrium fistula, an unusual complication of endocarditis

    Miao-yan CHEN; Dan-dan ZHONG; Zhi-qiang YING

    2009-01-01

    Infective endocarditis (IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious compli-cation of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis, vegetation, perforation of noncoronary sinus, and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardi-ography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis, aggressive antibacterial therapy, and surgical treatment may improve the prognosis.

  12. Successful surgical intervention in an unusual case of Aspergillus endocarditis with acute myeloid leukemia.

    Zahra Ansari Aval

    2013-07-01

    Full Text Available Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia (AML successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients.

  13. Improving Diagnosis and Treatment of Staphylococcus aureus Infections : Experimental Studies

    S. van den Berg (Sanne)

    2015-01-01

    markdownabstract__Abstract__ Staphylococcus aureus is an opportunistic pathogen that causes a variety of infections, ranging from mild skin infections like furuncles and impetigo, to severe, lifethreatening infections including endocarditis, osteomyelitis and pneumonia. Invasive infections are freq

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

    ... IV Cephalexin**† 2g 50 mg/kg Allergic to penicillins or ampicillin — Oral regimen OR Clindamycin OR Azithromycin ... 20 mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to take oral medication ...

  15. Recognizing Infective Endocarditis in the Emergency Department

    Tsagaratos, Costandinos; Taha, Farook W

    2012-01-01

    A 52-year-old Caucasian male presented to the emergency department complaining of nontraumatic painful swelling and redness of the distal left fourth finger for 2 days, associated with malaise and subjective fever. The patient denied medical history, drugs, tobacco, or alcohol use. [West J Emerg Med. 2012;13(1):92–93.

  16. Brucella Endocarditis Caused By Brucella Melitensis

    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.

  17. Scopulariopsis endocarditis associated with Duran ring valvuloplasty.

    Gentry, L O; Nasser, M M; Kielhofner, M

    1995-01-01

    Fungal endocarditis is rare and is usually caused by Aspergillus and Candida species. We present a patient with endocarditis caused by Scopulariopsis brevicaulis. The patient had a history of mitral valve disease and, 1 year earlier, had undergone valvuloplasty with the placement of a prosthetic Duran ring in the mitral valve position. S. brevicaulis was cultured from samples of a large vegetation on the mitral valve apparatus. The mitral valve was replaced with a St. Jude mechanical prosthes...

  18. Endocarditis infecciosa activa: 152 casos

    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.

  19. Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat

    Hady, Wessam Abdel; Bayer, Arnold S.; Xiong, Yan Q.

    2012-01-01

    Endovascular infections, including endocarditis, are life-threatening infectious syndromes1-3. Staphylococcus aureus is the most common world-wide cause of such syndromes with unacceptably high morbidity and mortality even with appropriate antimicrobial agent treatments4-6. The increase in infections due to methicillin-resistant S. aureus (MRSA), the high rates of vancomycin clinical treatment failures and growing problems of linezolid and daptomycin resistance have all further complicated th...

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

    Wolf, T. Y.; Moser, C.; Bundgaard, H.;

    2011-01-01

    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...... indicated that polymicrobial infections might be of importance in IE. However, the significance of the more unknown microorganisms needs to be investigated further....

  1. High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report

    Hsiao Chen-Yuan

    2011-05-01

    Full Text Available Abstract Background Emergence of daptomycin-nonsusceptible (DNS Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS S. aureus. Case presentation We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin. Conclusions Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.

  2. Indium-111 leukocyte localization in infected prosthetic graft

    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

  3. Calcific left atrium:A rare consequence of endocarditis

    Giuseppe; Dattilo; Carmelo; Anfuso; Matteo; Casale; Vincenza; Giugno; Lorenzo; Camarda; Natascia; Laganà; Gianluca; Di; Bella

    2014-01-01

    Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrioventricular plane and left atrium. Although we haven’t data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.

  4. External coronary artery compression due to prosthetic valve bacterial endocarditis.

    Harinstein, Matthew E; Marroquin, Oscar C

    2014-02-15

    Acute coronary syndromes in the setting of infective endocarditis may be the result of coronary compression secondary to periannular aortic valve complications, coronary embolism, obstruction of the coronary ostium due to a large vegetation, coronary atherosclerosis, and severe aortic insufficiency. External coronary artery compression as a result of infective endocarditis is a rare and lethal finding with few reported cases available in the medical literature. We present a rare occurrence of an acute coronary syndrome occurring in the setting of a bioprosthetic aortic valve abscess in which there was no complete coronary occlusion visualized and given the patient's recent unremarkable catheterization and findings of diffuse tapering of the proximal left coronary system, the most likely etiology was external compression secondary to the known aortic root abscess, which caused myocardial ischemia, and was confirmed during surgery. Although uncommon, external compression should be considered in the differential diagnosis of acute coronary syndrome in this setting and coronary angiography can be diagnostic of this entity. PMID:24660223

  5. Endocarditis

    ... IE mainly affects people who have: Damaged or artificial (man-made) heart valves Congenital heart defects (defects present at birth) Implanted medical devices in the heart or blood vessels People who have normal heart valves also can ...

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

    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.)

  7. Isolated Streptococcus agalactiae tricuspid endocarditis in elderly patient without known predisposing factors: Case report and review of the literature.

    Abid, Leila; Charfeddine, Salma; Kammoun, Samir

    2016-04-01

    Group B streptococcal (GBS) tricuspid infective endocarditis is a very rare clinical entity. It affects intravenous drug users, pregnant, postpartum women, and the elderly. We report the case of a 68-year-old patient without known predisposing factors who presented a GBS tricuspid endocarditis treated by penicillin and aminoglycosides with no response. The patient was operated with a good evolution. Our case is the 25th reported in the literature. GBS disease is increasing in the elderly and is mainly associated to comorbid conditions. Tricuspid infective endocarditis with Group B streptococcus predominantly presents as a persistent fever with respiratory symptoms due to pulmonary embolism. Therefore, it requires a medicosurgical treatment and close follow-up. PMID:27053903

  8. Risk Factors of Endocarditis in Patients with Enterococcus faecalis Bacteremia

    Dahl, Anders; Lauridsen, Trine K; Arpi, Magnus;

    2016-01-01

    BACKGROUND:  The NOVA score is a recently developed diagnostic tool to identify patients with increased risk of infective endocarditis (IE) among patients with Enterococcus faecalis (EF) bacteremia. We aim to validate an adapted version of the NOVA score and to identify risk factors for IE in......, unknown origin of infection 4 points, prior valve disease 2 points and heart murmur 1 point. RESULTS:  IE was diagnosed in 78 patients (12%). Monomicrobial EF bacteremia (HR 3.60; CI95% 1.6-8.0), prosthetic heart valve (HR 6.2; CI95% 3.8-10.1), male sex (HR 2.0; CI95% 1.1-3.8), and community acquisition...

  9. Bartonella, a common cause of endocarditis: a report on 106 cases and review.

    Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard; Raoult, Didier

    2015-03-01

    Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools. PMID:25540398

  10. Prevention of endocarditis in the Nordic countries.

    Gutschik, E

    1995-04-01

    Bacterial endocarditis as the consequence of an iatrogenic bacteraemia has been recognized for a long time in the Nordic countries, and national recommendations were issued by groups of experts. It is generally agreed that antibiotic prophylaxis is needed in patients with high-risk conditions and that the maintenance of healthy gums and teeth is of major importance. Investigations, however, reported poor level of compliance, and pointed out that the procedural/practical aspect of interactions between patients, dentists and physicians have largely been neglected. In order to improve the level of compliance an 'endocarditis risk' card has been produced, and there has been a remarkable degree of harmonization of chemotherapeutic regimens recommended by the national organizations. Generally, a single dose of prophylaxis is recommended, because there is little evidence that antibiotic levels in humans must be maintained more than 6-7 h for effective prevention of endocarditis, and because compliance with a multiple dose regimen is highly questionable. PMID:7671914

  11. Prolonged Use of Oritavancin for Vancomycin-Resistant Enterococcus faecium Prosthetic Valve Endocarditis.

    Johnson, Jennifer A; Feeney, Eoin R; Kubiak, David W; Corey, G Ralph

    2015-12-01

    Oritavancin is a novel lipoglycopeptide with activity against Gram-positive organisms including streptococci, methicillin-resistant Staphylococcus aureus, vancomycin-resistant S aureus (VRSA), and vancomycin-resistant enterococci (VRE) [1-3]. The US Food and Drug Administration approved oritavancin as a single intravenous dose of 1200 mg for the treatment of acute bacterial skin and skin structure infections on the basis of 2 clinical trials demonstrating noninferiority compared with vancomycin [4, 5]. There are limited options for treatment of serious VRE infections. Monotherapy with daptomycin or tigecycline or linezolid may be sufficient in some cases, but combination therapy is often indicated for severe or complicated infections such as endocarditis. Several antibiotic combinations have been used in isolated case reports with some efficacy, including the following: high-dose ampicillin with an aminoglycoside [6], ampicillin with ceftriaxone or imipenem [7, 8], high-dose daptomycin with ampicillin and gentamicin [9] or with gentamicin and rifampin [10], daptomycin with tigecycline [11, 12], quinupristin-dalfopristin with high-dose ampicillin [13] or doxycycline and rifampin [14], and linezolid with tigecycline [15]. The limited efficacy, limited susceptibility, and extensive toxicities with many of these agents and combinations present barriers to effective treatment. Additional treatment options for VRE endocarditis would be valuable. Although oritavancin has been shown to have in vitro activity against some isolates of VRE, clinical data are lacking. We describe the first use of a prolonged course of oritavancin in the treatment of a serious VRE infection, prosthetic valve endocarditis. PMID:26677455

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

    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.

  13. Hemorrhagic Transformation of Ischemic Stroke: Severe Complications of Prosthetic Valve Endocarditis

    Kim, Jin-Sun; Yang, Woo-In; Shim, Chi Young; Ha, Jong-Won; Chung, Namsik; Chang, Hyuk-Jae

    2011-01-01

    Ischemic stroke is a common complication of infective endocarditis (IE), occurring in 20-40% of left side IE cases. In these subsets, anticoagulation therapy may provoke hemorrhagic transformation (HT) of ischemic stroke, and complications of this magnitude deteriorate the clinical course for IE patients. However, in cases of IE complicated with a mechanical prosthetic valve, the physician can be concerned over the maintenance of anticoagulation due to the risk of thrombotic complication. Acc...

  14. A case of endocarditis with cerebral embolism successfully treated with daptomycin

    Roberta Doria; Enrico Tagliaferri; Giovanni Andreotti; Riccardo Taddei; Rubinia Nardini; Carlo Tascini; Francesco Menichetti

    2011-01-01

    A young girl was admitted for fever, headache, paresthesia of the hands, involuntary blinking of the left eye and aphasia. Imaging revealed mycotic cerebral aneurysms and finally infective endocarditis was diagnosed and successfully treated with daptomycin. She had a history of mitral prolapse and she had undergone dental procedures some months before without any antibiotic prophylaxis, according to the 2007 guidelines of the American Heart Association.

  15. A case of endocarditis with cerebral embolism successfully treated with daptomycin

    Roberta Doria

    2011-11-01

    Full Text Available A young girl was admitted for fever, headache, paresthesia of the hands, involuntary blinking of the left eye and aphasia. Imaging revealed mycotic cerebral aneurysms and finally infective endocarditis was diagnosed and successfully treated with daptomycin. She had a history of mitral prolapse and she had undergone dental procedures some months before without any antibiotic prophylaxis, according to the 2007 guidelines of the American Heart Association.

  16. Molecular characterization of a Streptococcus gallolyticus genomic island encoding a pilus involved in endocarditis.

    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

    International audience 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 refer...

  17. Modified Surgical Intervention for Extensive Mitral Valve Endocarditis and Posterior Mitral Annular Calcification

    Kim, Gwan Sic; Beom, Min Sun; Kim, Sung Ryong; Kim, Na Rae; Jang, Ji Wook; Jang, Mi Hee; Ryu, Sang Wan

    2016-01-01

    The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification. PMID:26889447

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

    Ryan Yu; Dale, Suzanne E; Deborah Yamamura; Vida Stankus; Christine Lee

    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...

  19. Infectious endocarditis caused by Escherichia coli

    Lauridsen, Trine Kiilerich; Arpi, Magnus; Fritz-Hansen, Thomas;

    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...

  20. Genome-wide Screening Identifies Phosphotransferase System Permease BepA to Be Involved in Enterococcus faecium Endocarditis and Biofilm Formation.

    Paganelli, Fernanda L; Huebner, Johannes; Singh, Kavindra V; Zhang, Xinglin; van Schaik, Willem; Wobser, Dominique; Braat, Johanna C; Murray, Barbara E; Bonten, Marc J M; Willems, Rob J L; Leavis, Helen L

    2016-07-15

    Enterococcus faecium is a common cause of nosocomial infections, of which infective endocarditis is associated with substantial mortality. In this study, we used a microarray-based transposon mapping (M-TraM) approach to evaluate a rat endocarditis model and identified a gene, originally annotated as "fruA" and renamed "bepA," putatively encoding a carbohydrate phosphotransferase system (PTS) permease (biofilm and endocarditis-associated permease A [BepA]), as important in infective endocarditis. This gene is highly enriched in E. faecium clinical isolates and absent in commensal isolates that are not associated with infection. Confirmation of the phenotype was established in a competition experiment of wild-type and a markerless bepA mutant in a rat endocarditis model. In addition, deletion of bepA impaired biofilm formation in vitro in the presence of 100% human serum and metabolism of β-methyl-D-glucoside. β-glucoside metabolism has been linked to the metabolism of glycosaminoglycans that are exposed on injured heart valves, where bacteria attach and form vegetations. Therefore, we propose that the PTS permease BepA is directly implicated in E. faecium pathogenesis. PMID:26984142

  1. Subacute bacterial endocarditis (SBE due to Streptococcus gordonii

    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.

  2. A Case of Scopulariopsis brevicaulis Endocarditis with Mycotic Aneurysm in an Immunocompetent Host

    Kelly Cawcutt

    2015-01-01

    Full Text Available Scopulariopsis is a genus of mold that is usually associated with onychomycosis and rarely causes complicated infection in immunocompetent persons. We describe a case of an immunocompetent 65-year-old male with a history of mitral valve repair with prosthetic ring placement who developed acute left posterior knee pain. Imaging showed a left popliteal artery aneurysm and thrombus, and further evaluation with transesophageal echocardiogram demonstrated two large, mobile mitral valve vegetations. He underwent debridement and replacement of the mitral valve, followed by debridement of the left popliteal artery with peroneal artery bypass. The intraoperative cultures grew Scopulariopsis brevicaulis. Due to the resistant nature of the organism, he was initially treated with combination antifungals including liposomal amphotericin B, caspofungin, and voriconazole and was continued on chronic suppression with posaconazole with no evidence of recurrence. Scopulariopsis is a rare cause of fungal endocarditis. Treatment of Scopulariopsis endocarditis is challenging and is not well understood due to its rarity.

  3. Septicemia, endocarditis, and cerebral infarction due to Staphylococcus aureus in a harp seal (Phoca groenlandica).

    Chinnadurai, Sathya K; Troan, Brigid V; Wolf, Karen N; DeVoe, Ryan S; Huijsmans, C J J; Hermans, Mirjam H A; Wever, Peter C

    2009-06-01

    An adult, wild-collected, male harp seal (Phoca groenlandica) was transferred from a rehabilitation center to a display facility because of unilateral phthisis bulbi and decreased use of the right forelimb, which precluded its release. In quarantine, the animal demonstrated limited use of the right forelimb, which acutely progressed to complete disuse of the limb accompanied by intermittent lethargy. One month after transfer, the animal was found dead on exhibit. Necropsy showed septic arthritis of the right scapulohumeral joint, valvular endocarditis with systemic bacterial thromboembolism, and infarction of the cerebrum and myocardium. Culture of the blood and affected joint space revealed Staphylococcus aureus. Bacterial polymerase chain reaction of formalin-fixed tissues from the heart and brain were also positive for S. aureus. Staphylococcus aureus infection should be considered as an additional cause of endocarditis and embolic encephalitis in seals. PMID:19569495

  4. Occult systemic lupus erythematosus with active lupus nephritis presenting as Libman-Sacks endocarditis

    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.

  5. Involvement of NADH Oxidase in Competition and Endocarditis Virulence in Streptococcus sanguinis.

    Ge, Xiuchun; Yu, Yang; Zhang, Min; Chen, Lei; Chen, Weihua; Elrami, Fadi; Kong, Fanxiang; Kitten, Todd; Xu, Ping

    2016-05-01

    Here, we report for the first time that the Streptococcus sanguinis nox gene encoding NADH oxidase is involved in both competition with Streptococcus mutans and virulence for infective endocarditis. An S. sanguinis nox mutant was found to fail to inhibit the growth of Streptococcus mutans under microaerobic conditions. In the presence of oxygen, the recombinant Nox protein of S. sanguinis could reduce oxygen to water and oxidize NADH to NAD(+) The oxidation of NADH to NAD(+) was diminished in the nox mutant. The nox mutant exhibited decreased levels of extracellular H2O2; however, the intracellular level of H2O2 in the mutant was increased. Furthermore, the virulence of the nox mutant was attenuated in a rabbit endocarditis model. The nox mutant also was shown to be more sensitive to blood killing, oxidative and acid stresses, and reduced growth in serum. Thus, NADH oxidase contributes to multiple phenotypes related to competitiveness in the oral cavity and systemic virulence. PMID:26930704

  6. Efficacy of oxacillin and ampicillin-sulbactam combination in experimental endocarditis caused by beta-lactamase-hyperproducing Staphylococcus aureus.

    Thauvin-Eliopoulos, C; Rice, L B; Eliopoulos, G M; Moellering, R C

    1990-01-01

    Optimal therapy of infections caused by borderline oxacillin-susceptible, beta-lactamase-hyperproducing Staphylococcus aureus has not been established. We used a rat model of aortic valve endocarditis to examine efficacies of antibiotic regimens against a borderline oxacillin-susceptible strain as compared with a fully susceptible S. aureus strain. Animals were treated with oxacillin alone or in combination with sulbactam or with ampicillin-sulbactam combinations at two dose levels. Infection...

  7. Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer.

    Corredoira, J; García-País, M J; Coira, A; Rabuñal, R; García-Garrote, F; Pita, J; Rodríguez-Macías, A; Blanco, M; Lopez-Roses, L; López-Álvarez, M J; Alonso-García, M P

    2015-08-01

    Streptococcus bovis group and Enterococcus spp. share phenotypic characteristics and intestinal habitat. Both have been associated with endocarditis and colorectal neoplasm (CRN). We studied all cases of endocarditis diagnosed between 1988 and 2014 in our centre and caused by S. bovis (109, 48.8 % of the bacteremia) and by Enterococcus spp. (36, 3.4 % of the bacteremia). Patients were seen until death or during a long-term follow-up, in order to rule out a concomitant CRN. The 109 cases of S. bovis endocarditis (SbIE) compared with the 36 caused by enterococci showed: a higher proportion of males (91 % vs. 72 %, p=0.005), more multivalvular involvement (28 % vs. 6 %, p=0.004), embolic complications (44 vs. 22 %, p=0.02) and colorectal neoplasm (64 % vs. 25 %, p=0.001). SbIE showed fewer co-morbidities (32 vs. 58 %, p=0.005), and less frequently urinary infection source (0 vs. 25 %, p=0.001) and healthcare-related infection (2 vs. 44 %, p=0.001). A total of 123 patients were followed up for an extended period (mean: 65.9 ± 57.5 months). During the follow-up, 6 of 28 (21 %) cases with enterococcal endocarditis and 43 of 95 (45.2 %, p=0.01) cases with SbIE developed a new CRN. These neoplasiae appeared a mean of 60.4 months later (range 12-181 months). Among the 43 cases with SbIE and CRN, 12 had had a previously normal colonoscopy and 31 had had a previous CRN and developed a second neoplasm. Cases of SbIE present important differences with those caused by Enterococcus spp. Colonoscopy must be mandatory both in the initial evaluation of SbIE, as during the follow-up period. PMID:26017665

  8. Bartonella endocarditis mimicking adult Still's disease.

    De Clerck, K F; Van Offel, J F; Vlieghe, E; Van Marck, E; Stevens, W J

    2008-01-01

    We describe the case of a 39-year-old Caucasian woman who was admitted to the University Hospital of Antwerp with a clinical picture suggestive of adult Still's disease. Even though a transoesophageal echocardiography showed endocarditis of the aortic valve, blood cultures remained negative. Additional serological testing revealed a positive result for Bartonella henselae. Histology of the supraclavicular lymph node showed a reactive lymph node with a positive polymerase chain reaction (PCR) for Bartonella henselae. Prednisolone treatment was started in a dosage of 10 mg per day and rifampicin 600 mg/d in combination with doxycyclin 200 mg/d was given for 6 months. During therapy the patient gradually improved and signs of endocarditis disappeared on echocardiography. PMID:18714850

  9. Commensal microbiota contributes to chronic endocarditis in TAX1BP1 deficient mice.

    Satoko Nakano

    Full Text Available Tax1-binding protein 1 (Tax1bp1 negatively regulates NF-κB by editing the ubiquitylation of target molecules by its catalytic partner A20. Genetically engineered TAX1BP1-deficient (KO mice develop age-dependent inflammatory constitutions in multiple organs manifested as valvulitis or dermatitis and succumb to premature death. Laser capture dissection and gene expression microarray analysis on the mitral valves of TAX1BP1-KO mice (8 and 16 week old revealed 588 gene transcription alterations from the wild type. SAA3 (serum amyloid A3, CHI3L1, HP, IL1B and SPP1/OPN were induced 1,180-, 361-, 187-, 122- and 101-fold respectively. WIF1 (Wnt inhibitory factor 1 exhibited 11-fold reduction. Intense Saa3 staining and significant I-κBα reduction were reconfirmed and massive infiltration of inflammatory lymphocytes and edema formation were seen in the area. Antibiotics-induced 'germ free' status or the additional MyD88 deficiency significantly ameliorated TAX1BP1-KO mice's inflammatory lesions. These pathological conditions, as we named 'pseudo-infective endocarditis' were boosted by the commensal microbiota who are usually harmless by their nature. This experimental outcome raises a novel mechanistic linkage between endothelial inflammation caused by the ubiquitin remodeling immune regulators and fatal cardiac dysfunction.

  10. Low efficacy of tobramycin in experimental Staphylococcus aureus endocarditis

    Lerche, C. J.; Christophersen, L. J.; Trøstrup, H.;

    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...... untreated (n = 22) or tobramycin-treated (n = 13) groups. The treatment group received tobramycin once-daily. Animals were evaluated at 1 day post infection (DPI), 2 DPI or 3 DPI. Quantitative bacteriology and cytokine expression were measured for valves, myocardium and serum. A decrease of bacterial load...

  11. Erysipelothrix rhusiopathiae bacteremia without endocarditis: rapid identification from positive blood culture by MALDI-TOF mass spectrometry. A case report and literature review

    Luigi Principe

    2016-03-01

    Full Text Available Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74- year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i no correlation with animal source; ii correlation between bacteremia and erysipeloid lesion; iii absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen.

  12. Erysipelothrix Rhusiopathiae Bacteremia without Endocarditis: Rapid Identification from Positive Blood Culture by MALDI-TOF Mass Spectrometry. A Case Report and Literature Review.

    Principe, Luigi; Bracco, Silvia; Mauri, Carola; Tonolo, Silvia; Pini, Beatrice; Luzzaro, Francesco

    2016-03-21

    Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74-year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i) no correlation with animal source; ii) correlation between bacteremia and erysipeloid lesion; iii) absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity) of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen. PMID:27103974

  13. Vegetative endocarditis in a scimitar-horned oryx (Oryx dammah).

    Chai, N

    1999-12-01

    Streptococcus uberis was cultured from vegetative endocarditis lesions in a scimitar-horned oryx (Oryx dammah) from the Parc de la Haute Touche, France. This is the first reported single isolation of S. uberis from an oryx with vegetative endocarditis leading to fatal congestive heart failure. PMID:10749451

  14. Bacterial endocarditis due to eikenella corrodens: A case report

    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.

  15. Phylodynamic analysis of a viral infection network

    TeiichiroShiino

    2012-07-01

    Full Text Available Viral infections by sexual and droplet transmission routes typically spread through a complex host-to-host contact network. Clarifying the transmission network and epidemiological parameters affecting the variations and dynamics of a specific pathogen is a major issue in the control of infectious diseases. However, conventional methods such as interview and/or classical phylogenetic analysis of viral gene sequences have inherent limitations and often fail to detect infectious clusters and transmission connections. Recent improvements in computational environments now permit the analysis of large datasets. In addition, novel analytical methods have been developed that serve to infer the evolutionary dynamics of virus genetic diversity using sample date information and sequence data. This type of framework, termed “phylodynamics”, helps connect some of the missing links on viral transmission networks, which are often hard to detect by conventional methods of epidemiology. With sufficient number of sequences available, one can use this new inference method to estimate theoretical epidemiological parameters such as temporal distributions of the primary infection, fluctuation of the pathogen population size, basic reproductive number, and the mean time span of disease infectiousness. Transmission networks estimated by this framework often have the properties of a scale-free network, which are characteristic of infectious and social communication processes. Network analysis based on phylodynamics has alluded to various suggestions concerning the infection dynamics associated with a given community and/or risk behavior. In this review, I will summarize the current methods available for identifying the transmission network using phylogeny, and present an argument on the possibilities of applying the scale-free properties to these existing frameworks.

  16. Novel imaging strategies for the detection of prosthetic heart valve obstruction and endocarditis.

    Tanis, W; Budde, R P J; van der Bilt, I A C; Delemarre, B; Hoohenkerk, G; van Rooden, J-K; Scholtens, A M; Habets, J; Chamuleau, S

    2016-02-01

    Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis.For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac infections. Evidence for the additional value of 3D-TEE is scarce.As clinical implications are major, clinicians should have a low threshold to perform additional MDCT in acquired mechanical PHV obstruction. For suspected PHV endocarditis, both FDG-PET and MDCT have complementary value. PMID:26744343

  17. Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism

    Ilaria Izzo

    2013-11-01

    Full Text Available A 63-year old diabetic male patient carrying an implantable cardioverter defibrillator (ICD was hospitalized with a 7- day history of fever, notwithstanding an antibiotic therapy. The white-blood cell count was 11,000/mm3, the platelet count was 135,000/mm3 and C-reactive protein (CRP 13 mg/dL. Chest X-rays showed right infiltrates. Ceftriaxone was started. Defervescence was rapid, but CRP was still 12 mg/dL after 6 days. A trans-thoracic ecochacardiogram (TTE incidentally showed a liver hypoechoic lesion. A computed tomography scan revealed bilateral cavitated lung nodules and a large liver abscess. Klebsiella pneumoniae was isolated in blood cultures and TTE showed ICD endocarditis and a patent foramen ovalis. Levofloxacin and imipenem/cilastatin were started. The liver abscess was drained. After 30 days, the ICD was removed and re-implanted. At discharge, blood tests were within the normal range and the patient was asymptomatic. Follow up showed improvement of lung and hepatic lesions. To our knowledge, this is the second reported case of K. pneumoniae infective endocarditis with multiple septic emboli. Endocarditis should be suspected in presence of fever after the device implantation, in particular if risk factors are present.

  18. Comparison of antimicrobial agents as therapy for experimental endocarditis: caused by methicillin-resistant Staphylococcus aureus.

    Sacar, Mustafa; Sacar, Suzan; Cevahir, Nural; Onem, Gokhan; Teke, Zafer; Asan, Ali; Turgut, Huseyin; Adali, Fahri; Kaleli, Ilknur; Susam, Ibrahim; Yaylali, Yalin Tolga; Baltalarli, Ahmet

    2010-01-01

    We used an experimental rat model to compare the therapeutic efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin with that of vancomycin as standard therapy for infective endocarditis.Aortic endocarditis was induced in rats by insertion of a polyethylene catheter into the left ventricle, followed by intravenous inoculation of 106 colony-forming units of methicillin-resistant Staphylococcus aureus 24 hours later. Forty-eight hours after bacterial challenge, intravenous antibiotic therapies were initiated. There were 6 groups of 8 rats each: uninfected control; infected, untreated control; vancomycin-treated (40 mg/kg twice daily); teicoplanin-treated (20 mg/kg twice daily after a loading dose of 40 mg/kg); linezolid-treated (75 mg/kg 3 times daily for 1 day, then 75 mg/kg twice daily); and quinupristin/dalfopristin-treated (30 mg/kg twice daily and an additional 10 mg/kg dalfopristin infusion over 6 to 12 hr daily). At the end of therapy, the aortic valve vegetations in the drug-treated rats were evaluated microbiologically.Compared with the infected, untreated group, all drug-treated groups had significantly reduced bacterial titers in the vegetations. Vancomycin, teicoplanin, and quinupristin/dalfopristin all effectively reduced the quantitative bacterial cultures of aortic valve vegetations. In addition, there was no significant difference in the comparative efficacy of teicoplanin, linezolid, and quinupristin/dalfopristin. Vancomycin significantly reduced bacterial counts in comparison with linezolid, which was nonetheless also effective.Our experimental model showed that each of the investigated antimicrobial agents was effective in the treatment of infective endocarditis. PMID:20844611

  19. Neonatal Staphylococcus lugdunensis urinary tract infection.

    Hayakawa, Itaru; Hataya, Hiroshi; Yamanouchi, Hanako; Sakakibara, Hiroshi; Terakawa, Toshiro

    2015-08-01

    Staphylococcus lugdunensis is a known pathogen of infective endocarditis, but not of urinary tract infection. We report a previously healthy neonate without congenital anomalies of the kidney and urinary tract who developed urinary tract infection due to Staphylococcus lugdunensis, illustrating that Staphylococcus lugdunensis can cause urinary tract infection even in those with no urinary tract complications. PMID:26177232

  20. Loeffler endocarditis: silent right ventricular myocardium!

    Çetin, Süha; Heper, Gülümser; Gökhan Vural, Mustafa; Hazirolan, Tuncay

    2016-07-01

    We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices. PMID:26980214

  1. Tricuspid valve endocarditis surgery: results of 67 patients

    Shahzadi M

    2009-08-01

    with preoperative values. The postoperative function class did not show any changes compared with peroperative values."n"nConclusion: Considering the specific epidemiology of patients with infective endocarditis, who are suffering from TV regurgitation, in some patients, it would be better to consider replacement instead of repair. This could be due to sever deformities and diffuse damage of TV leaflets from infection in our patients.

  2. Interleukin-10 Regulates the Tissue Factor Activity of Monocytes in an In Vitro Model of Bacterial Endocarditis

    Veltrop, Marcel H. A. M.; Langermans, Jan A. M.; Thompson, Jan; Bancsi, Maurice J. L. M. F.

    2001-01-01

    Monocytes are important effector cells in the pathogenesis of bacterial endocarditis since they provide the tissue factor that activates the coagulation system and maintains established vegetations. Monocytes secrete cytokines that can modulate monocyte tissue factor activity (TFA), thereby affecting the formation and maintenance of vegetations. In this study, we show that monocytes cultured for 4 h on a Streptococcus sanguis-infected fibrin matrix mimicking the in vivo vegetational surface e...

  3. Role of beta-lactamase in in vivo development of ceftazidime resistance in experimental Pseudomonas aeruginosa endocarditis.

    Bayer, A S; Peters, J.; Parr, T R; Chan, L; Hancock, R E

    1987-01-01

    Two ceftazidime-resistant variants of Pseudomonas aeruginosa (PA-48, PA-60), obtained from cardiac vegetations of rabbits with endocarditis receiving ceftazidime therapy, were studied for mechanisms of resistance. Both resistant variants were stably derepressed for the type Id beta-lactamase, which was ceftazidime inducible in the parental strain (PA-96) used to initially infect the rabbits. There was no evidence of ceftazidime bioinactivation by the resistant strains, and their outer membran...

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

    C. Magarinos Torres

    1928-01-01

    , 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

  5. Ciprofloxacin and rifampin, alone and in combination, for therapy of experimental Staphylococcus aureus endocarditis.

    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...

  6. Bilateral Macular Roth Spots as a Manifestation of Subacute Endocarditis

    Karolina Ceglowska

    2015-01-01

    Full Text Available A 42-year-old man presented with a 2-day history of impaired vision in the right eye (OD. The best corrected visual acuity (BCVA (LogMAR was 1.1 for the right eye and 0.0 for the left eye (OS. Fundus examination revealed white-centered hemorrhages resembling Roth spots in both macular regions. The spectral-domain optical coherence tomography (SD-OCT showed intraretinal pseudocysts and hyperreflective deposits in the areas corresponding to the Roth spots. Conducted blood tests revealed elevated D-dimer concentration, increased total number of neutrophils, high C-reactive protein concentration, and elevated erythrocyte sedimentation rate. Procalcitonin concentration, platelet count, and body temperature were within normal ranges. A blood culture was ordered and yielded Streptococcus mitis and intravenous antibiotics were started immediately. The patient started complaining of chest and left calf pain. The systemic examination revealed infective endocarditis accompanied by bicuspid aortic valve and paravalvular abscess formation. The patient underwent cardiac surgery with mechanical aortic valve implantation. After recovery, the patient’s visual acuities improved fully. Control ophthalmic examination, including SD-OCT, showed no abnormalities.

  7. Bilateral Macular Roth Spots as a Manifestation of Subacute Endocarditis.

    Ceglowska, Karolina; Nowomiejska, Katarzyna; Kiszka, Agnieszka; Koss, Michael J; Maciejewski, Ryszard; Rejdak, Robert

    2015-01-01

    A 42-year-old man presented with a 2-day history of impaired vision in the right eye (OD). The best corrected visual acuity (BCVA) (LogMAR) was 1.1 for the right eye and 0.0 for the left eye (OS). Fundus examination revealed white-centered hemorrhages resembling Roth spots in both macular regions. The spectral-domain optical coherence tomography (SD-OCT) showed intraretinal pseudocysts and hyperreflective deposits in the areas corresponding to the Roth spots. Conducted blood tests revealed elevated D-dimer concentration, increased total number of neutrophils, high C-reactive protein concentration, and elevated erythrocyte sedimentation rate. Procalcitonin concentration, platelet count, and body temperature were within normal ranges. A blood culture was ordered and yielded Streptococcus mitis and intravenous antibiotics were started immediately. The patient started complaining of chest and left calf pain. The systemic examination revealed infective endocarditis accompanied by bicuspid aortic valve and paravalvular abscess formation. The patient underwent cardiac surgery with mechanical aortic valve implantation. After recovery, the patient's visual acuities improved fully. Control ophthalmic examination, including SD-OCT, showed no abnormalities. PMID:26839725

  8. A rare cause of native tricuspid valve endocarditis: Abortus

    M.Sıddık Evsen

    2011-03-01

    Full Text Available A 28-year-old female patient, who at her 7 weeks ofpregnancy, admitted to hospital with abdominal painand vaginal bleeding. She had been hospitalized in anothercenter with the diagnosis of spontaneous completeabortion. After discharge, her clinical process, deteriorateddue to fever, chills and fatigue therefore she hadbeen admitted to emergency unit of that hospital onceagain, and received non-specific antibiotics. She was referredto our clinic because of persistant complaints.Transthoracic echocardiography showed vegetations onthe tricuspid valve leading to diagnosis of infective endocarditis,so treatment was started at our clinic. No microorganismisolated in blood cultures. Following 15-days antibiotic therapy no reduction was seen in the diameterof the vegetation, therefore surgical operationwas planned and a bioprosthetic tricuspid valve was putinto place. In this article we aimed to report the developmentof spontaneous abortus at 7 weeks of pregnancy,in order to emphasize that tricuspid valve endocarditiscan be developed secondary to very rare causes.J Clin Exp Invest 2011; 2(1: 102-105

  9. Infected total knee arthroplasty treatment outcome analysis

    Radoičić Dragan; Popović Zoran; Barjaktarović Radoslav; Marinković Jugoslav

    2012-01-01

    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. ...

  10. Continuous-infusion ampicillin therapy of enterococcal endocarditis in rats.

    Thauvin, C; Eliopoulos, G M; Willey, S; Wennersten, C; Moellering, R C

    1987-01-01

    Intermittent administration of ampicillin alone has resulted in high failure rates in previously described animal models of enterococcal endocarditis. We developed a rat model of enterococcal endocarditis which permits comparison of continuous intravenous infusion of ampicillin with intramuscular therapy. Continuous low-dose ampicillin infusion (450 mg/kg [body weight] per day) was compared with the same dose given intramuscularly in three divided doses and with high-dose infusion (4.5 g/kg p...

  11. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis

    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. PMID:26904243

  12. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis.

    Makdisi, George; Casciani, Thomas; Wozniak, Thomas C; Roe, David W; Hashmi, Zubair A

    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. PMID:26904243

  13. Infected total knee arthroplasty treatment outcome analysis

    Radoičić 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.

  14. Assessment of the incidence of infectious endocarditis in Limousin Poitou-Charentes and the buccodental follow-up of high-risk patients.

    Tabarly P

    2004-12-01

    Full Text Available Aims: To assess the incidence of infectious endocarditis in Limousin Poitou-Charentes in 2000 and to study the buccodental health of high-risk patients and improve their follow-up. Method: We performed a two-part, retrospective, cross-sectional study. In the first part, by using the computer program for hospitalization medical records (PMSI, we looked for all patients who were hospitalized for infectious endocarditis in 2000 in Limousin Poitou-Charentes and determined the incidence of the disease. In the second part, we performed a buccodental examination of all the volunteer patients who were waived from co-payments for a cardiac disease carrying a risk for infectious endocarditis and who had not filed a reimbursement request for any buccodental care between September 1, 2000 to August 31, 2001. Results: The regional incidence of infectious endocarditis was 57.4 cases/1,000,000 inhabitants/year. In 13% of the 135 patients who had been hospitalized for this disorder, the infection had a buccodental origin. The total regional cost for initial hospital care related to endocarditis was estimated to be 12,127 € per patient. Among the 4,460 high-risk patients, 2,379 (53.3 % had not filed a reimbursement request for dental care during the course of the preceding year. Only 544 patients accepted to be examined by the medical service; 74,8 % of them had poor bucodental health. Conclusion: This study confirms the relative increase in infectious endocarditis occurring in healthy hearts and the reduction in the role played by a buccodental origin and in overall mortality. The average cost for initial hospital care was lower than data seen in previously published literature. We undertook incentives to improve the buccodental follow-up of patients in the region

  15. Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

    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

  16. Identification of Clinically Relevant Nonhemolytic Streptococci on the Basis of Sequence Analysis of 16S-23S Intergenic Spacer Region and Partial gdh Gene▿

    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...

  17. [Infectious endocarditis in the University Hospital Center of Brazzaville. A study of 32 cases].

    Bouramoué, C; Azika-Mbiambina, M E

    1990-12-01

    Thirty-eight cases of infective endocarditis (IE) were observed between 1976 and 1989 (1.3% of all cardiac disease). Thirty two cases were retained for study based on Von Reyn's criteria: 28 native valve endocarditis (27 left and 1 right heart valves) of which 18 occurred on previously undiseased valves (56.3%); 4 cases of left heart prosthetic valve endocarditis. The average age of the patients was 27.5 +/- 14 years and the group comprised 24 women and 8 men (p less than 0.001). Blood cultures were negative in 13 cases, revealed a Gram negative pathogen in 8 cases, a streptoccocus in 3 cases. Blood cultures were not performed in 2 cases. The IE was acute in 18 cases (56.7%) and subacute in 14 cases (43.7%). The dominant clinical signs were of massive and sometimes acute valvular regurgitation (mitral: 21 cases; aortic: 10 cases; mitral and aortic: 3 cases; tricuspid: 1 case). Twenty-six patients had cardiac failure (81.2%): LVF: 15 cases, congestive cardiac failure: 10 cases, RVF: 1 case. The other complications were embolic: cerebral (3 cases), mesenteric (1 case), pulmonary (4 cases). Antibiotic therapy was prescribed in all patients; surgery was required in 9 cases. There were 12 fatalities (37.5%), 10 in the medically treated group and 2 in the surgical group (p less than 0.05). The results show that the prognosis of IE in underdeveloped regions remains poor. Effective strategies of early diagnosis and treatment are urgently required to reduce the high mortality. Prophylaxis of IE should commence with measures to counter the portals of entry of the pathogens and the valvular sequellae of acute rhumatic fever. PMID:2126713

  18. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose.

    Compain, F; Bruneval, P; Jarraud, S; Perrot, S; Aubert, S; Napoly, V; Ramahefasolo, A; Mainardi, J-L; Podglajen, I

    2015-11-01

    Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025

  19. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description.

    Collarino, R; Vergeylen, U; Emeraud, C; Latournèrie, G; Grall, N; Mammeri, H; Messika-Zeitoun, D; Vallois, D; Yazdanpanah, Y; Lescure, F-X; Bleibtreu, A

    2016-09-01

    Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis. PMID:27408740

  20. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

    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.

  1. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

    Compain, F.; Bruneval, P.; Jarraud, S.; Perrot, S.; Aubert, S.; Napoly, V.; Ramahefasolo, A.; Mainardi, J.-L.; Podglajen, I.

    2015-01-01

    Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025

  2. Bicarbonate enhances expression of the endocarditis and biofilm associated pilus locus, ebpR-ebpABC, in Enterococcus faecalis

    Thomson L Charlene

    2010-01-01

    Full Text Available Abstract Background We previously identified ebpR, encoding a potential member of the AtxA/Mga transcriptional regulator family, and showed that it is important for transcriptional activation of the Enterococcus faecalis endocarditis and biofilm associated pilus operon, ebpABC. Although ebpR is not absolutely essential for ebpABC expression (100-fold reduction, its deletion led to phenotypes similar to those of an ebpABC mutant such as absence of pili at the cell surface and, consequently, reduced biofilm formation. A non-piliated ebpABC mutant has been shown to be attenuated in a rat model of endocarditis and in a murine urinary tract infection model, indicating an important participation of the ebpR-ebpABC locus in virulence. However, there is no report relating to the environmental conditions that affect expression of the ebpR-ebpABC locus. Results In this study, we examined the effect of CO2/HCO3-, pH, and the Fsr system on the ebpR-ebpABC locus expression. The presence of 5% CO2/0.1 M HCO3- increased ebpR-ebpABC expression, while the Fsr system was confirmed to be a weak repressor of this locus. The mechanism by which the Fsr system repressed the ebpR-ebpABC locus expression appears independent of the effects of CO2- bicarbonate. Furthermore, by using an ebpA::lacZ fusion as a reporter, we showed that addition of 0.1 M sodium bicarbonate to TSBG (buffered at pH 7.5, but not the presence of 5% CO2, induced ebpA expression in TSBG broth. In addition, using microarray analysis, we found 73 genes affected by the presence of sodium bicarbonate (abs(fold > 2, P ebpA mRNA levels under the conditions tested. Conclusions This study reports that the ebp locus expression is enhanced by the presence of bicarbonate with a consequential increase in the number of cells producing pili. Although the molecular basis of the bicarbonate effect remains unclear, the pathway is independent of the Fsr system. In conclusion, E. faecalis joins the growing family of

  3. Infectious endocarditis caused by Nocardia sp.: histological morphology as a guide for the specific diagnosis

    Jussara Bianchi Castelli

    2011-08-01

    Full Text Available Nocardia is a rare opportunistic agent, which may affect immunocompromised individuals causing lung infections and exceptionally infective endocarditis (IE. There are few reports of IE caused by Nocardia sp., usually involving biological prostheses but rarely in natural valves. Its accurate microbiological identification may be hampered by the similarity with Rhodococcus equi and Corynebacterium spp. Here we report a case of native mitral valve IE caused by this agent in which the clinical absence of response to vancomycin and the suggestion of Nocardia sp. by histology pointed to the misdiagnosis of Corynebacterium spp. in blood cultures. The histological morphology can advise on the need for expansion of cultivation time and use of extra microbiological procedures that lead to the differential diagnosis with Corynebacterium spp. and other agents, which is essential to establish timely specific treatment, especially in immunocompromised patients.

  4. Enterococcus faecalis Endogenous Endophthalmitis from Valvular Endocarditis

    Sidnei Barge

    2013-01-01

    Full Text Available We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

  5. Native valve endocarditis due to Candida parapsilosis in an adult patient

    Krishnee Moodley

    2013-09-01

    Full Text Available Candida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans. The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition.

  6. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia.

    Emmanouil Nikolousis

    2011-06-01

    Full Text Available Fungal endocarditis (FE is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50% and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a current characterization of the syndrome. In this paper we have demonstrated the diversity of presentation of a critical fungal infection in immunocompromised but non neutropenic paediatric patients. The prompt diagnosis and initiation of treatment is crucial for a favourable outcome along with the use of double antifungal treatment with liposomal amphotericin and voriconazole initially which could be later switched to oral voriconazole with a good tissue penetration. Histological samples as well as radiological evidence and echocardiograms should be reviewed by experienced clinicians in order to aid diagnosis and promptly initiate treatment for these patients in order to achieve a favourable outcome

  7. Haemophilus parainfluenzae aortic prosthetic valve endocarditis (PVE) successfully treated with oral levofloxacin.

    Cunha, Burke A; Brahmbhatt, Kunal; Raza, Muhammad

    2015-01-01

    Antibiotic treatment of native valve infective endocarditis (IE) traditionally consists of 4-6 weeks of intravenous (IV) antibiotic therapy. Oral (PO) antibiotic therapy is being used more frequently, for part or all of treatment for IE but experience in treating IE with PO antibiotics is limited. Preferable agents for oral therapy of IE are antibiotics with a high degree of activity against the IE pathogen and that have high bioavailability (>90%) so that achievable serum and tissue levels are the same as with equivalent IV antibiotics. Oral antibiotic therapy of IE has several advantages over IV therapy given the long duration of treatment, i.e., 4-6 weeks for IE. Firstly, outpatient oral therapy for IE is easily administered over 4-6 weeks and decreases hospital length of stay (LOS). Secondly, oral antibiotics (administered at the same dose, frequency and duration) costs much less than their IV counterparts. Thirdly, with PO therapy for IE there are no central venous catheter (CVC) associated complications, e.g., phlebitis, bacteremia, fungemia. Compared to native valve IE, prosthetic valve endocarditis (PVE), depending on the IE pathogen, requires prolonged therapy and usually valve replacement. Haemophilus sp. IE is relatively virulent and often complicated by heart failure and/or embolic phenomena. We describe the first reported case of Haemophilus parainfluenzae aortic PVE successfully treated with oral levofloxacin without aortic valve replacement. PMID:25998992

  8. Comparison of heart valve culture between two Danish endocarditis centres

    Voldstedlund, Marianne; Fuursted, Kurt; Bruun, Niels Eske;

    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....

  9. Pyogenic infection and rheumatoid arthritis.

    Rowe, I F; Deans, A. C.; Keat, A C

    1987-01-01

    Ten episodes of severe pyogenic infection occurring in nine patients with rheumatoid arthritis are reported. There was a wide range of presenting features including pyoarthrosis in 7 episodes. Three cases presented with meningitis, bacterial endocarditis and probable multiple abscesses respectively. Infection was caused by Staphylococcus aureus in 7 episodes and by Staphylococcus epidermidis, Streptococcus pneumoniae and beta-haemolytic Streptococcus in each of one episode. Three infective ep...

  10. Pulmonary infections after kidney transplantation: analysis of CT findings

    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 χ2 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

  11. Meta-analysis of Chicken – Salmonella infection experiments

    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.

  12. Infective Endocarditis in a Patient with Williams’ Syndrome

    Koh, Kwang Kon; Lee, Jin Ho; Sohn, Dae Won; Oh, Byung Hee; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo; Park, Jae Hyeong

    1988-01-01

    An 18-year-old male was admitted to Seoul National University Hospital for the evaluation of fever and chill on February 3, 1988. On physical examination, his face showed a characteristic “elfin” facial appearance. His face was characterized by abnormalities of dental development, a broad overhanging upper lip, high arched palate and gum hypertrophy. He also showed mental retardation. Cardiac catheterization with selective cineangiocardiography demonstrated a supravalvular aortic narrowing, g...

  13. Salmonella typhi infection: a rare cause of endocarditis.

    Khan, Javaid Arif; Ali, Basharat; Masood, Tariq; Ahmed, Faisal; Sial, Jawaid A; Balooch, Zafer Haleem

    2011-09-01

    A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis. PMID:21914415

  14. Streptococcus agalactiae mural infective endocarditis in a structurally normal heart

    Ariyoshi, Nobuhiro; Miyamoto, Keisuke; Bolger, Jr., Dennis T.

    2016-01-01

    A 38-year-old Caucasian man with uncontrolled diabetes mellitus type 2 was admitted with a 1-week duration of fevers, chills, and a non-productive cough. He had a left ischiorectal abscess 1 month prior to admission. Physical examination revealed caries on a left upper molar and a well-healed scar on the left buttock, but no heart murmur or evidence of micro-emboli. Blood cultures grew Streptococcus agalactiae. A transesophageal echocardiogram revealed a mobile mass in the right ventricle tha...

  15. Prophylaxis for infective endocarditis: antibiotic sensitivity of dental plaque.

    MacFarlane, T W; McGowan, D. A.; Hunter, K; MacKenzie, D.

    1983-01-01

    The antibiotic sensitivity pattern of bacteria isolated from bacteraemia after dental extraction was compared with that of bacteria isolated from dental plaque samples from the same patient. The results supported the current practice of using penicillin and erythromycin empirically for prophylaxis. The prediction of the most appropriate antibiotic for prophylaxis using dental plaque samples was most accurate when the minimum inhibitory concentration (MIC) of plaque isolates were used. It appe...

  16. Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

    Doolub, Gemina

    2015-01-01

    A 37-year-old male with known intravenous drug use was admitted with an acute onset of worsening confusion and speech impairment. His vitals and biochemical profile demonstrated severe sepsis, with a brain CT showing several lesions suspicious for cerebral emboli. He then went on to have a bedside transthoracic echocardiogram that was positive for vegetation on the mitral valve, with associated severe mitral regurgitation. Unfortunately, before he was stable enough to be transferred for valve surgery, he suffered an episode of acute pulmonary oedema requiring intubation and ventilation on intensive care unit. PMID:26120312

  17. Complicated Whipple’s disease and endocarditis following tumor necrosis factor inhibitors

    Thomas; Marth

    2014-01-01

    AIM: To test whether treatment with tumor necrosis factor inhibitors(TNFI) is associated with complications of Tropheryma whipplei(T. whipplei) infection. METHODS: Because unexplained arthritis is often the first Whipple’s disease(WD) symptom, patients may undergo treatment with TNFI before diagnosis. This may influence the course of infection with T. whipplei, which causes WD, because host immune defects contribute to the pathogenesis of WD. A literature search and cross referencing identified 19 reports of TNFI treatment prior to WD diagnosis. This case-control study compared clinical data in patients receiving TNFI therapy(group Ⅰ, n = 41) with patients not receiving TNFI therapy(group Ⅱ, n = 61). Patients from large reviews served as controls(group Ⅲ, n = 1059).RESULTS: The rate of endocarditis in patient group Ⅰ was significantly higher than in patient group Ⅱ(12.2% in group Ⅰ vs 1.6% in group Ⅱ, P < 0.05), and group Ⅲ(12.2% in group Ⅰ vs 0.16% in group Ⅲ, P < 0.01). Other, severe systemic or local WD complications such as pericarditis, fever or specific organ manifestations were increased also in group Ⅰ as compared to the other patient groups. However, diarrhea and weight loss were somewhat less frequent in patient group Ⅰ. WD istypically diagnosed with duodenal biopsy and periodic acid Schiff(PAS) staining. PAS-stain as standard diagnostic test had a very high percentage of false negative results(diagnostic failure in 63.6% of cases) in group I. Polymerase chain reaction(PCR) for T. whipplei was more accurate than PAS-stainings(diagnostic accuracy, rate of true positive tests 90.9% for PCR vs 36.4% for PAS, P < 0.01).CONCLUSION: TNFI trigger severe WD complications, particularly endocarditis, and lead to false-negative PAS-tests. In case of TNFI treatment failure, infection with T. whipplei should be considered.

  18. Comparison of ampicillin-sulbactam with vancomycin for treatment of experimental endocarditis due to a beta-lactamase-producing, highly gentamicin-resistant isolate of Enterococcus faecalis.

    Lavoie, S R; Wong, E S; Coudron, P E; Williams, D S; Markowitz, S M

    1993-01-01

    Increasing antibiotic resistance in the enterococci, including the capacity for beta-lactamase production and the development of high-level aminoglycoside resistance, has complicated the treatment of serious enterococcal infections, which often require synergistic antibiotic combinations for cure. We utilized the rabbit model of aortic valve endocarditis to investigate the effects of various antibiotics, alone and in combination, against a multiply antibiotic-resistant isolate of Enterococcus...

  19. Erysipelothrix rhusiopathiae bacteremia without endocarditis: rapid identification from positive blood culture by MALDI-TOF mass spectrometry. A case report and literature review

    Luigi Principe; Silvia Bracco; Carola Mauri; Silvia Tonolo; Beatrice Pini; Francesco Luzzaro

    2016-01-01

    Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74- year-old man, probably started from an ery...

  20. 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.

    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...

  1. Nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage: case report

    Morinaga Yukiko

    2011-02-01

    Full Text Available Abstract A 63-year-old man was admitted to our hospital with a complaint of right lateroabdominal pain. He was diagnosed with metastatic colon cancer, and then developed multiple brain embolic infarctions 7 days after admission. Transesophageal echocardiography showed that mobile, echo-dense masses were attached to the anterior and posterior mitral valve leaflet. Furthermore, there was a thrombus in the left auricular appendage despite sinus rhythm. These findings led to a diagnosis of suspected infectious endocarditis with subsequent multiple brain infarctions. The patient's general condition worsened and he died 13 days after admission. An autopsy was performed, and, while poorly differentiated cancer was observed in multiple organs, no primary tumor could be identified. Histological analysis showed that the masses of the mitral valve consisted mainly of fibrin without bacteria or oncocytes. This patient was therefore diagnosed with nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage.

  2. Proteomic Analysis of Strawberry Leaves Infected with Colletotrichum fragariae

    Xianping Fang; Huasheng Ma; Songlin Raun

    2012-01-01

    Understanding the defense mechanisms used by anthracnose-resistant strawberries against Colletotrichum infection is important for breeding purposes.To characterize cell responses to Colletotrichum infection,proteomes from strawberry seedling leaves that had or had not been infected with Colletotrichum fragariae were characterized at different time points post infection by 2-DE and by MALDI-TOF/TOF MS/MS and database-searching protein identification.Mass spectrometry identified 49 differentially expressed proteins with significant intensity differences (> 1.5-fold,p <0.05) in mock-and C.fragariae-infected leaves at least at one time point.Notably,2-DE analysis revealed that C.fragariae infection increased the expression of well-known and novel pathogen-responsive proteins whose expression patterns tended to correlate with physiological changes in the leaves.Quantitative real-time PCR was used to examine the transcriptional profiles of infected and uninfected strawberry leaves,and western blotting confirmed the induction of β-1,3-glucanase and a lowmolecular-weight heat shock protein in response to C.fragariae infection.During the late phase of infection,proteins involved in the Calvin cycle and glycolysis pathway had suppressed expression.The abundance changes,putative functions,and participation in physiological reactions for the identified proteins produce a pathogenresponsive protein network in C.fragariae-infected strawberry leaves.Together,these findings increase our knowledge of pathogen resistance mechanisms,especially those found in non-model plant species.

  3. Endocarditis por Brucella abortus: Reporte del primer caso en C.R Brucella abortus Endocarditis

    Manuel Antonio Villalobos-Zúñiga; Edith Barrantes-Valverde; Patricia Monge-Ortega

    2011-01-01

    Paciente masculino de 36 años de edad, proveniente de la zona rural de Costa Rica, con un cuadro clínico de 8 meses de evolución de fiebre, mialgias, artralgias, pérdida de peso y lumbalgia; referido por la detección de un soplo de insuficiencia aórtica. El ecocardiograma reveló endocarditis de la válvula aórtica, y se obtuvieron 4 hemocultivos positivos por Brucella abortus biotipo 3, con serologías negativas por brucelosis. Se inició tratamiento con antibióticos y luego se le realizó un ree...

  4. Edwardsiella tarda Endocarditis Confirmed by Indium-111 White Blood Cell Scan: An Unusual Pathogen and Diagnostic Modality.

    Litton, Kayleigh M; Rogers, Bret A

    2016-01-01

    Edwardsiella tarda is a freshwater marine member of the family Enterobacteriaceae which often colonizes fish, lizards, snakes, and turtles but is an infrequent human pathogen. Indium-111- ((111)In-) labeled white blood cell (WBC) scintigraphy is an imaging modality which has a wide range of reported sensitivity and specificity (from 60 to 100% and from 68 to 92%, resp.) for diagnosing acute and chronic infection. We describe a case of suspected E. tarda prosthetic aortic valve and mitral valve endocarditis with probable vegetations and new mitral regurgitation on transthoracic and transesophageal echocardiograms which was supported with the use of (111)In-labeled WBC scintigraphy. PMID:26885418

  5. Endocarditis por Brucella abortus: Reporte del primer caso en C.R Brucella abortus Endocarditis

    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.

  6. Unusual extracardiac manifestations of isolated native tricuspid valve endocarditis

    Wilczynska, M; Khoo, JP; McCann, GP

    2010-01-01

    Isolated native tricuspid valve endocarditis (TVE) in non-intravenous drug users is a very rare condition. We describe an unusual presentation of Enterococcus faecalis TVE associated with spondylodiscitis, positive cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase-3 antibodies vasculitic rash in an otherwise healthy patient with no history of intravenous drug use or underlying cardiac abnormalities.

  7. Case report of Streptomyces endocarditis of a prosthetic aortic valve.

    Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G S

    1995-01-01

    We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem. PMID:8586732

  8. Case report of Streptomyces endocarditis of a prosthetic aortic valve.

    Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G. S.

    1995-01-01

    We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem.

  9. Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

    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...

  10. Infection

    ... Potential Hazards Exposure of employees to community and nosocomial infections, e.g., Methicillin-resistant Staphylococcus aureus (MRSA) . Nosocomial infections are infections that occur from exposure to infectious ...

  11. Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

    Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard; Raoult, Didier

    2014-01-01

    Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis c...

  12. Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

    Winkler, Jonathan; Chaudhry, Sunit-Preet; Stockwell, Philip H.

    2016-01-01

    Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myo...

  13. Oral antibiotic treatment of left-sided infectious endocarditis verified by 16S-PCR

    Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz;

    2011-01-01

    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....

  14. Infection Route Analysis of Ventilator Associated Pneumonia

    Wei; Guo; Jie; Zhang; Jing-yun; Li; Yue; Ma; Sheng-hui; Cui

    2012-01-01

    Objective A prospective study was conducted in a tertiary care center to identify the risk factors of ventilator associated pneumonia(VAP) through phenotypic and molecular biological methods. Methods The patients who were mechanically ventilated in the respiratory intensive care unit(RICU) and the neurological internal intensive care unit(NICU) were enrolled in our study, and samples were collected from the lower respiratory tract, oropharynx and stomach. Other samples, including the environmental air, swabs of nurses’ hands, subglottic secretion and ventilator circuit, were also collected. Microorganisms in the collected samples were recovered and identified at species level by biochemical detection. Genetic relationship of dominant species was further characterized by pulsed field gel electrophoresis(PFGE). Results Out of 48 enrolled patients, 22 cases developed VAP and bacterial cultures were recovered from the lower respiratory tract samples of 14 cases. The average hospitalization time with VAP was significantly longer than that of patients without VAP(P < 0.05). Among the recovered bacteria cultures, multidrug-resistant Pseudomonas aeruginosa and Stenotrophomonas maltophilia were dominant. It was more likely that subglottic secretion and gastric juice samples contained the same isolates as recovered in the lower respiratory tract by PFGE analysis. Conclusions Mechanical ventilation in RICU and NICU was a high risk factor for VAP development. Special emphasis of VAP prophylaxis should be paid on subglottic secretion and gastric juice reflux.

  15. Diagnosis of Helicobacter pylori infection: A meta-analysis

    2007-01-01

    Objective: To evaluate effects of diagnostic tests for Helicobacter pylori (H. pylori) infection. Methods: A meta-analysis was conducted in 22 identified studies through Chinese literature searching which were published after 1995 and evaluated diagnostic tests for Helicobacter pylori (H. pylori) infection. Results: Polymerase chain reaction (PCR) had the best performance with diagnostic odds ratio (DOR) of 6.7 (5.5-7.8), followed by 13C urea breath test and Enzyme-linked immunosorbent assay (ELISA) quantitative serological test, with DOR being 6.4 (5.4-7.4) and 4.5 (3.8-5.2), respectively. Conclusion: Non-invasive tests are the appropriate methods for screening H. pylori infection, whereas invasive tests are the best methods for ascertaining the suspected patients.

  16. Hypereosinophilic Syndrome: A Case of Fatal Löffler Endocarditis

    Mario Enrique Baltazares-Lipp

    2016-01-01

    Full Text Available Hypereosinophilic syndrome (HES is a rare disorder with unknown global prevalence, barely reported in Hispanic population, and characterized by persistent eosinophilia in association with organ dysfunctions directly attributable to eosinophilic infiltration. Cardiac involvement may be present in 50 to 60% of the patients. This is known as Löffler endocarditis. We present a case of a 36-year-old Hispanic man with signs of heart failure. Laboratory studies showed eosinophilia (23,100/μL. Thoracic computer tomography showed bilateral pleural effusion and a large left ventricular mass. Transthoracic echocardiography showed left ventricle apical obliteration and a restrictive pattern. Pulmonary angiography demonstrated a thrombus in the lingular and middle lobe. Despite treatment, the patient deceased seven days after admission. Autopsy confirmed the diagnosis of Löffler endocarditis.

  17. SURGICAL TREATMENT OF INFECTIOUS ENDOCARDITIS ASSOCIATED WITH INTRAVENOUS DRUG ABUSE

    T. F. Said

    2013-01-01

    Full Text Available Aim. The study was aimed to analyze the results of surgical treatment of infectious endocarditis associated with intravenous drug abuse. Methods and results. The study included 53 patients, 36 male and 17 female, 28,7 ± 7 years old. 60 operations were performed: 41 patients underwent tricuspid valve replacement, 7 pts – tricuspid valve repair, 7 pts – tricuspid valve rereplacement, 2 pts – mitral and tricuspidal valves replacement, 2 pts – aor- tic and tricuspid valves replacement, 1 patient – trivalve replacement. Hospital mortality was 1,7%. Conclusi- on. The used principles of surgical treatment of infectious endocarditis in drug abuse patients allow to rich a low mortality and complications rates in the postoperative period in this heavy group of patients. 

  18. Pyogenic infection and rheumatoid arthritis.

    Rowe, I. F.; Deans, A. C.; Keat, A. C.

    1987-01-01

    Ten episodes of severe pyogenic infection occurring in nine patients with rheumatoid arthritis are reported. There was a wide range of presenting features including pyoarthrosis in 7 episodes. Three cases presented with meningitis, bacterial endocarditis and probable multiple abscesses respectively. Infection was caused by Staphylococcus aureus in 7 episodes and by Staphylococcus epidermidis, Streptococcus pneumoniae and beta-haemolytic Streptococcus in each of one episode. Three infective episodes were fatal. Pyogenic, especially staphylococcal, infection should be considered in patients with rheumatoid arthritis with unexplained illness with or without sudden deterioration in joint symptoms. It is important to recognize and treat infection rapidly. Images Figure 1 Figure 2 PMID:3671222

  19. An investigation on the level of dental senior students knowledge about endocarditis prophylaxis incases with cardiac disease receiving dental treatment

    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

  20. Role of Monocytes in Experimental Staphylococcus aureus Endocarditis

    Veltrop, Marcel H. A. M.; Bancsi, Maurice J. L. M. F.; Bertina, Rogier M.; Thompson, Jan

    2000-01-01

    In the pathogenesis of bacterial endocarditis (BE), the clotting system plays a cardinal role in the formation and maintenance of the endocardial vegetations. The extrinsic pathway is involved in the activation of the coagulation pathway with tissue factor (TF) as the key protein. Staphylococcus aureus is a frequently isolated bacterium from patients with BE. We therefore investigated whether S. aureus can induce TF activity (TFA) on fibrin-adherent monocytes, used as an in vitro model of BE....

  1. Surgical treatment of aortic valve endocarditis: a 26-year experience

    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.

  2. A case of Aggregatibacter actinomycetemcomitans endocarditis presenting as quadriceps myositis

    Angeline Reid

    2012-03-01

    Full Text Available An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.

  3. Exopolysaccharide production by viridans streptococci in experimental endocarditis.

    Mills, J; Pulliam, L; Dall, L; Marzouk, J; Wilson, W; Costerton, J. W.

    1984-01-01

    Light and electron microscopy with histochemical staining were used to estimate exopolysaccharide production by strains of viridans streptococci recovered from patients with endocarditis. Six strains were selected for study because they represented a wide range of in vitro polysaccharide production. By light microscopy, there was good agreement between three polysaccharide stains (ruthenium red, periodic acid-Schiff and calcifluor white) in the amount of glycocalyx produced, which ranged from...

  4. Differential proteome analysis of chikungunya virus infection on host cells.

    Christina Li-Ping Thio

    Full Text Available BACKGROUND: Chikungunya virus (CHIKV is an emerging mosquito-borne alphavirus that has caused multiple unprecedented and re-emerging outbreaks in both tropical and temperate countries. Despite ongoing research efforts, the underlying factors involved in facilitating CHIKV replication during early infection remains ill-characterized. The present study serves to identify host proteins modulated in response to early CHIKV infection using a proteomics approach. METHODOLOGY AND PRINCIPAL FINDINGS: The whole cell proteome profiles of CHIKV-infected and mock control WRL-68 cells were compared and analyzed using two-dimensional gel electrophoresis (2-DGE. Fifty-three spots were found to be differentially modulated and 50 were successfully identified by MALDI-TOF/TOF. Eight were significantly up-regulated and 42 were down-regulated. The mRNA expressions of 15 genes were also found to correlate with the corresponding protein expression. STRING network analysis identified several biological processes to be affected, including mRNA processing, translation, energy production and cellular metabolism, ubiquitin-proteasome pathway (UPP and cell cycle regulation. CONCLUSION/SIGNIFICANCE: This study constitutes a first attempt to investigate alteration of the host cellular proteome during early CHIKV infection. Our proteomics data showed that during early infection, CHIKV affected the expression of proteins that are involved in mRNA processing, host metabolic machinery, UPP, and cyclin-dependent kinase 1 (CDK1 regulation (in favour of virus survival, replication and transmission. While results from this study complement the proteomics results obtained from previous late host response studies, functional characterization of these proteins is warranted to reinforce our understanding of their roles during early CHIKV infection in humans.

  5. Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report

    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.

  6. Unusual location of the Libman-Sacks endocarditis in a teenager: a case report.

    Wałdoch, Anna; Kwiatkowska, Joanna; Dorniak, Karolina

    2016-02-01

    Libman-Sacks endocarditis may be the first manifestation of systemic lupus erythematosus. The risk of its occurrence increases with the co-existence of the anti-phospholipid syndrome. Changes usually involve the mitral valve and the aortic valve. In this report, we present a case of Libman-Sacks endocarditis of the tricuspid valve in a teenage girl. PMID:25972079

  7. [Endocarditis, meningitis, pneumopathy and pneumococcal cerebral abscess in an alcoholic smoker].

    Vandenbos, F; Roth, S; Montagne, N

    2001-10-01

    We report a case of mitral endocarditis caused by Streptococcus pneumoniae in a 43 year old man with history of alcohol abuse and cigarette smoking. The pneumococcal endocarditis was associated with pneumonia, meningitis and brain abscess. Only transesophageal echocardiography could confirm the presence of vegetation. The patient was treated medically with good results. PMID:11887774

  8. Comparison of difloxacin, enoxacin, and cefazolin for the treatment of experimental Staphylococcus aureus endocarditis.

    Boscia, J A; Kobasa, W D; Kaye, D

    1988-01-01

    This study compared difloxacin administered orally, enoxacin administered orally, and cefazolin administered intramuscularly for the treatment of experimental Staphylococcus aureus endocarditis. Difloxacin significantly reduced bacterial counts of vegetations compared with enoxacin. This study demonstrated that difloxacin was significantly more effective than enoxacin and as effective as cefazolin for the treatment of S. aureus endocarditis in rabbits.

  9. Native Valve Bacillus cereus Endocarditis in a Non-Intravenous-Drug-Abusing Patient

    Thomas, Benjamin S.; Bankowski, Matthew J.; Lau, William K. K.

    2012-01-01

    Bacillus cereus is a rare cause of endocarditis, typically associated with intravenous drug abuse, rheumatic heart disease, prosthetic heart valves, pacemakers, or immunodeficiency. We present the first case of native valve Bacillus cereus endocarditis with no apparent risk factors. The patient had a fulminant course requiring emergent valve replacement.

  10. Global analysis of viral infection in an archaeal model system

    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

  11. Tratamiento con caspofungina de endocarditis por Candida tropicalis resistente a fluconazol Treatment with caspofungin of Candida tropicalis endocarditis resistant to fluconazol

    Marcelo del Castillo

    2004-04-01

    Full Text Available Las endocarditis causadas por hongos, (Candida en particular, requieren tratamiento médico-quirúrgico, siendo la anfotericina B la droga de elección. Caspofungina es una equinocandina con gran actividad sobre Candida y Aspergillus. Se presenta un paciente con una endocarditis por Candida tropicalis resistente a fluconazol tratado con caspofungina bajo un esquema de salvataje, luego de haber presentado efectos adversos por anfotericina B. El paciente tuvo respuesta microbiológica.Fungal endocarditis, in particular due to Candida species, requires medical and surgical treatment and amphotericin B is the drug of choice. Caspofungin is an echinocandin very effective against Candida and Aspergillus. We present a patient with Candida tropicalis endocarditis, fluconazol resistant, treated with caspofungin, on a compassional basis as a result of adverse effects with amphotericin B. The patient had a microbiological response.

  12. Tandem Repeat Analysis for Surveillance of Human Salmonella Typhimurium Infections

    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...... period beginning December 2003. The 1,019 typed isolates were separated into 148 PFGE types and 373 MLVA types. Several possible outbreaks were detected and confirmed. MLVA was particularly valuable for discriminating within the most common phage types. MLVA was superior to PFGE for both surveillance and...

  13. Hepatic safety of itraconazole intravenous solution in treatment of invasive fungal infection

    朱利平

    2006-01-01

    Objective To investigate the hepatic safety of itraconazole intravenous solution in the treatment of invasive fungal infection. Methods Forty-nine patients with invasive fungal infection, such as pneumonia, meningitis, endocarditis, and blood stream infection, caused by Aspergillus spp. Cryptococcus neoformans, Candida spp. Penicillium marneffei,and Prototheca wiekerhamii, 50 of which had underlying diseases, including hepatic disea-

  14. Congenital TORCH infections of the brain--CT manifestation (with analysis of 7 cases)

    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

  15. Diagnosing intramammary infections: evaluating expert opinions on the definition of intramammary infection using conjoint analysis.

    Andersen, S; Dohoo, I R; Olde Riekerink, R; Stryhn, H

    2010-07-01

    The primary purpose of this study was to develop a set of criteria to serve as a pseudo-gold standard for what constitutes an intramammary infection using data from 3 consecutive quarter milk samples taken 1 wk apart. Data from lactating cows in 90 dairy herds in 4 Canadian provinces were used to generate the data sets (profiles) used in the conjoint analysis to elicit expert opinions on the topic. The experts were selected from the participants (n=23) in the 2007 Mastitis Research Workers' Conference in Minneapolis and from a series of mastitis laboratory courses for bovine practitioners (n=25) in the Netherlands. Three-week udder quarter profiles with specific combinations of somatic cell count, bacterial species isolated, and plate colony count were selected and included in the conjoint analysis based on the desire to achieve even distributions in the categories of 6 constructed variables. The participants were presented with 3 sets of cards with 20 cards in each set. On each card, they were asked to assign a probability of infection on the middle day (test day) in the 3-wk profile. Depending on the set of cards, they were asked only to be concerned with the probability of infection with coagulase-negative staphylococci, Escherichia coli, or Staphylococcus aureus. These 3 organisms were chosen to represent a minor pathogen, a major environmental pathogen, and a major contagious pathogen, respectively. The assigned probabilities for each organism were cross-tabulated according to the number of times the organism of interest was isolated in the 3-wk period, how many colonies of the organism of interest were isolated on the test day, and the somatic cell count (200,000 cells/mL). There was considerable variation in the assigned probabilities within each of the combinations of factors. The median, minimum, and maximum values of the assigned probabilities for each combination were computed. The combinations with a median probability >50% were considered intramammary

  16. Analysis of the urinary peptidome associated with Helicobacter pylori infection

    Di Xiao; Fan-Liang Meng; Li-Hua He; Yi-Xin Gu; Jian-Zhong Zhang

    2011-01-01

    AIM: To investigate the relationship between urinary peptide changes and Helicobacter pylori (H. pylori ) infection using urinary peptidome profiling.METHODS: The study was performed in volunteers (n= 137) who gave informed consent. Urinary peptides were enriched by magnetic beads based weak cation exchange chromatography and spectrums acquired by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). ClinProTools bioinformatics software was used for statistical analysis and the recognition of peptide patterns. The marker peptides were identified by LTQ Obitrap XL tandem MS.RESULTS: Approximately 50 proteins or peptides which loaded onto the magnetic beads were detected by MALDI-TOF MS. By optimizing the parameters of the model,the Genetic Algorithm model had good recognition capability (97%) and positive predictive value (94%).Based on the model, 2 markers with molecular masses of 6788 and 1912 Da were found that differentiated between H. pylori positive and negative volunteers.The m/z 1912 sequence was parsed as SKQFTSSTSYNRGDSTF.The peptide was identified as isoform 1 of the fibrinogen α chain precursor, whose concentration in urine was markedly higher in H. pylori infected volunteers than in H. pylori non-infected ones.CONCLUSION: The appearance of urinary fibrinogen degradation products is caused by an active H. pylori -induced process.

  17. 感染性心内膜炎的临床治疗%Clinical Treatment of Infectious Endocarditis

    陈晓敏

    2014-01-01

    Objective:To study the clinical efficacy of infective endocarditis.Methods:84 patients with infective endocarditis were treated in our hospital from January 2012 to January 2013, all of the patients had positive blood culture examination and ultrasound heartbeat checking, if patients were diagnosed with revising duke standard, was only given antibiotic treatment.Results:The healing:32 cases (38.09%);effect:28 cases (33.33%);void:24 cases (28.57%), 5 cases of death (5.95%). The total effective rate was 71.43%. Conclusion:The choice of antibiotics for treating infective endocarditis, can effectively reduce the harm and death rate, improve the life quality of patients, is worthy to be popularized in clinical treatment process.%目的:研究感染性心内膜炎的临床疗效。方法:选择2012年1月~2013年1月在我院接受治疗的感染性心内膜炎患者84例,所有患者均行血培养检查阳性检查与超声心动检查,并按照修订后的Duke标准进行确诊,确诊后单纯给予抗生素治疗。结果:痊愈:32例(38.09%);显效:28例(33.33%);无效:24例(28.57%),死亡5例(5.95%)。治疗总有效率为71.43%。结论:选择应用抗生素治疗感染性心内膜炎,能够有效降低危害性与致死率,改善患者的生命质量,值得在临床治疗过程中推广应用。

  18. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis.

    Sandra A Asner

    Full Text Available Results from cohort studies evaluating the severity of respiratory viral co-infections are conflicting. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections.We searched electronic databases and other sources for studies published up to January 28, 2013. We included observational studies on inpatients with respiratory illnesses comparing the clinical severity of viral co-infections to single viral infections as detected by molecular assays. The primary outcome reflecting clinical disease severity was length of hospital stay (LOS. A random-effects model was used to conduct the meta-analyses.Twenty-one studies involving 4,280 patients were included. The overall quality of evidence applying the GRADE approach ranged from moderate for oxygen requirements to low for all other outcomes. No significant differences in length of hospital stay (LOS (mean difference (MD -0.20 days, 95% CI -0.94, 0.53, p = 0.59, or mortality (RR 2.44, 95% CI 0.86, 6.91, p = 0.09 were documented in subjects with viral co-infections compared to those with a single viral infection. There was no evidence for differences in effects across age subgroups in post hoc analyses with the exception of the higher mortality in preschool children (RR 9.82, 95% CI 3.09, 31.20, p<0.001 with viral co-infection as compared to other age groups (I2 for subgroup analysis 64%, p = 0.04.No differences in clinical disease severity between viral co-infections and single respiratory infections were documented. The suggested increased risk of mortality observed amongst children with viral co-infections requires further investigation.

  19. Native valve candida endocarditis complicating pregnancy after abdominal surgery

    P Saphina

    2015-01-01

    Full Text Available Candida endocarditis is an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial morbidity and mortality. A 28-year-old primigravida at 32 weeks of gestation was admitted with low-grade fever and lower abdominal pain for 2 weeks. She had undergone open appendicectomy 2 months before admission. Echocardiogram showed a pedunculated 24 mm × 21 mm mass attached to the undersurface of anterior mitral leaflet near the tip and moderate mitral regurgitation. Repeated blood cultures showed growth of nonalbicans candida. She was immediately started on liposomal amphotericin and was taken up for surgery, but despite all efforts she succumbed to her illness.

  20. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H;

    2015-01-01

    %) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...... or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]). CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves...

  1. Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

    Pedersen, Karl; Jørgensen, J.C.; Dietz, Hans-Henrik;

    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...... only a few isolates belonged to other Streptococcus species. Typing by pulsed-field gel electrophoresis of a selection of isolates revealed several patterns and several different clones. Attempts to reproduce disease by the injection of cultures of a field isolate into healthy mink failed....

  2. Characteristics and prognosis of pneumococcal endocarditis: a case-control study.

    Daudin, M; Tattevin, P; Lelong, B; Flecher, E; Lavoué, S; Piau, C; Ingels, A; Chapron, A; Daubert, J-C; Revest, M

    2016-06-01

    Case series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with co-morbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococcal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched for sex and age, during the years 1991-2013, in one referral centre. Alcoholism (39.3% versus 10.7%; p endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptom onset, 14.1 ± 18.2 versus 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% versus 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most cases. PMID:27021424

  3. Lactococcus garvieae endocarditis in a native valve identified by MALDI-TOF MS and PCR-based 16s rRNA in Spain: A case report

    V. Heras Cañas

    2015-05-01

    Full Text Available Lactococcus garvieae is a Gram-positive, catalase negative coccus arranged in pairs or short chains, well-known as a fish pathogen. We report a case of Infective Endocarditis (IE by L. garvieae in a native valve from a 68-year-old male with unknown history of contact with raw fish and an extensive history of heart disease. This case highlights the reliability of MALDI-TOF MS compared to conventional methods in the identification of rare microorganisms like this.

  4. Analysis of Wuchereria bancrofti infections in a village community in northern Nigeria: increased prevalence in individuals infected with Onchocerca volvulus.

    Engelbrecht, Fred; Oettl, Tobias; Herter, Ursula; Link, Claudia; Philipp, Diana; Edeghere, Henry; Kaliraj, P; Enwezor, Felicia

    2003-03-01

    Infections with Wuchereria bancrofti causing lymphatic filariasis still represent one of the major health problems in the tropics, with 120 million people infected and over 750 million exposed to this filarial parasite. We have studied lymphatic filariasis infections as part of a multi-parasite survey in a village community in the savannah of northern Nigeria. We analysed serum samples from 341 individuals aged 5-70 years, detecting a W. bancrofti circulating antigen using the commercially available ICT Filariasis card test. The prevalence of infections was 10% and clearly age-dependent, increasing from below 2% in children to over 20% in subjects older than 40 years. Measuring IgG4 antibodies against the recombinant W. bancrofti antigen SXP1 showed that 36% of all tested individuals had been at least exposed to the parasite. Antibody levels also increased very significantly with age. A further analysis measuring Onchocerca volvulus-specific IgG4 antibodies showed a very significant association between infections with O. volvulus and those with W. bancrofti. Our data show that infections with W. bancrofti in Nigeria are still a frequently occurring health problem, since they are more prevalent than previously reported, and that individuals with an O. volvulus infection are more often infected with W. bancrofti than expected statistically. PMID:12543143

  5. Diverse Virulent Pneumophages Infect Streptococcus mitis

    Siham Ouennane; Philippe Leprohon; Sylvain Moineau

    2015-01-01

    Streptococcus mitis has emerged as one of the leading causes of bacterial endocarditis and is related to Streptococcus pneumoniae. Antibiotic resistance has also increased among strains of S. mitis and S. pneumoniae. Phages are being reinvestigated as alternatives to antibiotics for managing infections. In this study, the two virulent phages Cp-1 (Podoviridae) and Dp-1 (Siphoviridae), previously isolated from S. pneumoniae, were found to also infect S. mitis. Microbiological assays showed tha...

  6. Endocardite por brucelose: relato de caso Brucella endocarditis: case report

    Desanka Dragosavac

    2007-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A endocardite é rara e grave complicação de brucelose humana. O diagnóstico é suspeito em casos de endocardite sem resposta ao tratamento comum e é confirmado com sorologia com teste de ELISA maior que 1:160. O tratamento na maioria dos casos é cirúrgico, associado a antibioticoterapia prolongada. Alguns casos são resolvidos com tratamento clínico, que inclui doxiciclina, rifampicina, ciproproxacina, gentamicina e tetraciclina. O objetivo deste estudo foi relatar um caso raro de endocardite por brucelose. RELATO DO CASO: Paciente do sexo masculino, 51 anos, trabalhador rural, admitido com quadro de febre e emagrecimento. O ecocardiograma mostrou espessamento e vegetação de válvula aórtica. Uma hemocultura foi positiva para Staphylococcus epidermidis. O tratamento foi iniciado no dia da internação com penicilina cristalina, associada com garamicina, sem melhora em três semanas. Foi suspeitada endocardite por brucelose, colhida sorologia e iniciado o tratamento. Os antibióticos usados foram rifampicina e ciprofloxacin associado à vancomicina, devido o resultado da primeira hemocultura. A sorologia de aglutinação para brucelose foi positiva com resultado de 1:360. O paciente melhorou e recebeu alta da UTI, hemodinamicamente estável e em uso de ciprofloxacin e gentamicina. CONCLUSÕES: A endocardite por brucelose não é comum, mas deve ser sempre lembrada quando o tratamento convencional de endocardite não tem boa resposta, principalmente nos pacientes com possível contato com animais e derivados de leite.BACKGROUND AND OBJECTIVES: Endocarditis is a rare and serious complication of human brucellosis. The diagnosis is suspected in cases of endocarditis without response to conservative antibiotic treatment and it is confirmed with enzyme-linked immunosorbent assay (ELISA test, titers being higher than 1:160. The treatment is usually a surgery, followed with antibiotics for long period of time. Some

  7. Digital Forensic Analysis Of Malware Infected Machine- Case Study

    Amulya Podile

    2015-08-01

    Full Text Available Abstract Internet banking has created a convenient way for us to handle our business without leaving our home. Man-in-the-Browser is a special case of Man-in-the-middle attack targeted against customers of Internet banking. One of the capabilities of Man-in-the-Browser Trojan is modification of html referred to as html injection that allows the attacker to alter the html of a page before it is sent to the browser for interpretation. In this paper the authors discussed about forensic analysis of RAM Volatile data system logs and registry collected from bank customer computer infected with Trojan and confirmed the source of attack time-stamps and the behavior of the malware by using open source and commercial tools.

  8. Ecto-5'-nucleotidase: a candidate virulence factor in Streptococcus sanguinis experimental endocarditis.

    Jingyuan Fan

    Full Text Available Streptococcus sanguinis is the most common cause of infective endocarditis (IE. Since the molecular basis of virulence of this oral commensal bacterium remains unclear, we searched the genome of S. sanguinis for previously unidentified virulence factors. We identified a cell surface ecto-5'-nucleotidase (Nt5e, as a candidate virulence factor. By colorimetric phosphate assay, we showed that S. sanguinis Nt5e can hydrolyze extracellular adenosine triphosphate to generate adenosine. Moreover, a nt5e deletion mutant showed significantly shorter lag time (P<0.05 to onset of platelet aggregation than the wild-type strain, without affecting platelet-bacterial adhesion in vitro (P=0.98. In the absence of nt5e, S. sanguinis caused IE (4 d in a rabbit model with significantly decreased mass of vegetations (P<0.01 and recovered bacterial loads (log(10CFU, P=0.01, suggesting that Nt5e contributes to the virulence of S. sanguinis in vivo. As a virulence factor, Nt5e may function by (i hydrolyzing ATP, a pro-inflammatory molecule, and generating adenosine, an immunosuppressive molecule to inhibit phagocytic monocytes/macrophages associated with valvular vegetations. (ii Nt5e-mediated inhibition of platelet aggregation could also delay presentation of platelet microbicidal proteins to infecting bacteria on heart valves. Both plausible Nt5e-dependent mechanisms would promote survival of infecting S. sanguinis. In conclusion, we now show for the first time that streptococcal Nt5e modulates S. sanguinis-induced platelet aggregation and may contribute to the virulence of streptococci in experimental IE.

  9. Post-stroke infection: A systematic review and meta-analysis

    Dijkgraaf Marcel G; Vermeij Jan-Dirk; Nederkoorn Paul J; Westendorp Willeke F; van de Beek Diederik

    2011-01-01

    Abstract Background stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. Methods MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical tri...

  10. Culture-Negative Neonatal Meningitis and Endocarditis Caused by Streptococcus agalactiae

    Nègre, Valérie Lefranc; Colin-Gorski, Anne-Marie; Magnier, Suzel; Maisonneuve, Lydia; Aujard, Yannick; Bingen, Edouard; Bonacorsi, Stéphane

    2004-01-01

    We describe a case of culture-negative meningitis and endocarditis caused by Streptococcus agalactiae in a 27-day-old boy. S. agalactiae was detected in cerebrospinal fluid and serum by broad-spectrum PCR amplification.

  11. Mitral Valve Perforation in Libman-Sacks Endocarditis: A Heart-Wrenching Case of Lupus.

    Aby, Elizabeth S; Rosol, Zachary; Simegn, Mengistu A

    2016-08-01

    Libman-Sacks (LS) endocarditis is one of the most common cardiac manifestations of systemic lupus erythematosus. Rarely, however, it can lead to serious complications, including severe valvular regurgitation or superimposed bacterial endocarditis. We describe the initial diagnostic challenges, clinical course, imaging studies and histopathological findings of a patient who presented with life-threatening lupus complicated by hemoptysis and respiratory failure secondary to a rare complication of LS endocarditis, acute mitral valve perforation. We review the current literature on valve perforation in the setting of LS endocarditis. In conclusion, although the disease is often asymptomatic and hemodynamically insignificant, it can result in serious and potentially fatal complications secondary to valve perforation, which may demand emergency surgical management. PMID:26976291

  12. Culture Positive Brucella Endocarditis in a Case of Baloon Mitral Valvotomy

    Satyajeet K. Pawar; MV Ghorpade; Swati Aundhkar

    2011-01-01

    Brucella endocarditis is a rare condition which occurs as a focal complication in chronic brucellosis cases. We report a rare brucella endocarditis case in a RVHD patient. A 26 years old male was admitted with fever on off for almost one year. The blood culture yielded growth of Brucella melitensis after ten days of incubation. Isolated colonies were reconfirmed as Brucella species by PCR study. Patient’s serum tested positive for brucella slide agglutination test and STAT titer was 640IU. Ec...

  13. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia

    Emmanouil Nikolousis; Mark Velangi

    2011-01-01

    Fungal endocarditis (FE) is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50%) and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a curr...

  14. Endocarditis Due to Kytococcus schroeteri: Case Report and Review of the Literature

    Mnif, Basma; Boujelbène, Inès; Mahjoubi, Fouzia; Gdoura, Radouane; Trabelsi, Imen; Moalla, Sana; Frikha, Imed; Kammoun, Samir; Hammami, Adnane

    2006-01-01

    We report the third case of endocarditis caused by the newly described micrococcal species Kytococcus schroeteri. A 49-year-old woman was admitted to the hospital with suspected prosthetic valve endocarditis. Five blood cultures and prosthetic valve cultures grew the same type of organism, initially identified as Micrococcus sp. Assignment to the genus Kytococcus was suggested by the arginine dihydrolase activity and resistance to oxacillin. After sequencing of the 16S rRNA genes, the isolate...

  15. Transaortic aortomitral junction reconstruction and mitral valve leaflet repair for recurrent endocarditis.

    Chiu, Peter; Allen, Jeremiah G; Woo, Y Joseph

    2015-03-01

    Transaortic interventions on the mitral valve are rarely performed, but offer advantages over traditional approaches in certain circumstances, including either extensive involvement of the aortomitral junction with endocarditis or the patient requiring reoperation for aortic and mitral disease. Herein is presented a case of recurrent endocarditis involving aortomitral continuity, reconstructed using a transaortic mitral valve repair and reconstruction of the aortic and mitral annuli with a pericardial patch, followed by aortic root replacement. PMID:26204680

  16. Influence of preformed antibody on the pathogenesis of experimental Candida albicans endocarditis.

    Scheld, W M; Calderone, R A; Brodeur, J P; Sande, M A

    1983-01-01

    The influence of preformed antibody on the induction of experimental Candida albicans endocarditis was investigated by both in vitro and in vivo techniques. Preincubation of C. albicans with immune serum (raised in rabbits by intravenous injection of Formalin-killed yeast cells) decreased adhesion to the constituents of nonbacterial thrombotic endocarditis, e.g., fibrin plus platelets, in vitro. Two different methods, with radiolabeled or viable yeast cells, were confirmatory and demonstrated...

  17. A Case of Escherichia coli Endocarditis After Hemorrhoidectomy Performed by a Herbalist

    Eryılmaz, Özlem Gün; Sarıkaya, Esma; Aksakal, Fatma Nur; Hamdemir, Sevtap; Muammer DOĞAN; MOLLAMAHMUTOĞLU, Leyla

    2012-01-01

    We describe the first reported case of Escherichia coli endocarditis following a hemorrhoidectomy that was performed by the patient's herbalist. With increasing frequency, patients are seeking care by those who practice alternative medicine. Physicians must become more aware of the impact and possible complications related to this practice. Prosthetic valve endocarditis ranges up to 1.5% per patient-year for mechanical mitral valves and up to 0.1% per patient-year for other valves...

  18. The value of {sup 18}F-FDG PET/CT in diagnosing infectious endocarditis

    Kouijzer, Ilse J.E. [Radboud University Nijmegen Medical Centre, Department of Internal Medicine, P.O. Box 9101, Nijmegen (Netherlands); Vos, Fidel J. [Radboud University Nijmegen Medical Centre, Department of Internal Medicine, P.O. Box 9101, Nijmegen (Netherlands); Sint Maartenskliniek, Nijmegen (Netherlands); Janssen, Marcel J.R. [Radboud University Nijmegen Medical Centre, Department of Nuclear Medicine, Nijmegen (Netherlands); Dijk, Arie P.J. van [Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen (Netherlands); Oyen, Wim J.G. [Radboud University Nijmegen Medical Centre, Department of Nuclear Medicine, Nijmegen (Netherlands); Radboud University Nijmegen Medical Centre, Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen (Netherlands); Bleeker-Rovers, Chantal P. [Radboud University Nijmegen Medical Centre, Department of Internal Medicine, P.O. Box 9101, Nijmegen (Netherlands); Radboud University Nijmegen Medical Centre, Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen (Netherlands)

    2013-07-15

    Early detection of infectious endocarditis is challenging. For diagnosing infectious endocarditis, the revised Duke criteria are the gold standard. Evidence of endocardial involvement on echocardiography is a major criterion, but sensitivity and specificity of echocardiography are not optimal. Here we investigated the utility of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to diagnose infectious endocarditis in patients with gram-positive bacteraemia. Seventy-two patients with gram-positive bacteraemia were prospectively included. Patients with a positive blood culture growing Staphylococcus aureus, Streptococcus species or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. Infectious endocarditis was defined according to the revised Duke criteria. All patients underwent {sup 18}F-FDG PET/CT and echocardiography. {sup 18}F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians. Sensitivity for diagnosing infectious endocarditis with {sup 18}F-FDG PET/CT was 39 % and specificity was 93 %. The positive predictive value was 64 % and negative predictive value was 82 %. The mortality rate in patients without infectious endocarditis and without increased {sup 18}F-FDG uptake in or around the heart valves was 18 %, and in patients without infectious endocarditis but with high {sup 18}F-FDG uptake in or around the heart valves the mortality rate was 50 % (p = 0.181). {sup 18}F-FDG PET/CT is currently not sufficiently adequate for the diagnosis of infectious endocarditis because of its low sensitivity. Improvements such as patient preparation with low carbohydrate-fat allowed diet and technical advances in the newest PET/CT scanners may increase sensitivity in future studies. (orig.)

  19. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse.

    Clemens, J D; Horwitz, R I; Jaffe, C C; Feinstein, A R; Stanton, B F

    1982-09-23

    The absence of controlled evidence and the high prevalence of mitral-valve prolapse have created substantial uncertainty about whether this condition is an important risk factor for bacterial endocarditis. We evaluated this risk in a case-control study of hospital inpatients who had undergone echocardiography and who lacked any known cardiovascular risk factors for endocarditis, apart from mitral-valve prolapse and isolated mitral-regurgitant murmurs. Thirteen (25 per cent) of 51 patients with endocarditis had mitral-valve prolapse, as compared with 10 (seven per cent) of the 153 matched controls without endocarditis. For the 51 matched case-control sets, the odds ratio (8.2; 95 per cent confidence interval, 2.4 to 28.4) indicated a substantially higher risk of endocarditis for people with mitral-valve prolapse than for those without it. This association remained statistically significant when parenteral drug abuse and routine antibiotic prophylaxis preceding dental work and other forms of instrumentation were taken into account. Furthermore, the risk may be higher than is indicated by this study, since 46 per cent of the controls underwent echocardiography for clinically suspected mitral-valve prolapse, suggesting an overrepresentation of mitral prolapse in the control group. The results support the contention that mitral-valve prolapse is a significant risk factor for bacterial endocarditis. PMID:7110242

  20. Tropheryma whipplei infection

    Hugh James Freeman

    2009-01-01

    Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.

  1. Dynamics Analysis of an HIV Infection Model including Infected Cells in an Eclipse Stage

    Shengyu Zhou

    2013-01-01

    Full Text Available In this paper, an HIV infection model including an eclipse stage of infected cells is considered. Some quicker cells in this stage become productively infected cells, a portion of these cells are reverted to the uninfected class, and others will be latent down in the body. We consider CTL-response delay in this model and analyze the effect of time delay on stability of equilibrium. It is shown that the uninfected equilibrium and CTL-absent infection equilibrium are globally asymptotically stable for both ODE and DDE model. And we get the global stability of the CTL-present equilibrium for ODE model. For DDE model, we have proved that the CTL-present equilibrium is locally asymptotically stable in a range of delays and also have studied the existence of Hopf bifurcations at the CTL-present equilibrium. Numerical simulations are carried out to support our main results.

  2. Bioimage analysis of Shigella infection reveals targeting of colonic crypts.

    Arena, Ellen T; Campbell-Valois, Francois-Xavier; Tinevez, Jean-Yves; Nigro, Giulia; Sachse, Martin; Moya-Nilges, Maryse; Nothelfer, Katharina; Marteyn, Benoit; Shorte, Spencer L; Sansonetti, Philippe J

    2015-06-23

    Few studies within the pathogenic field have used advanced imaging and analytical tools to quantitatively measure pathogenicity in vivo. In this work, we present a novel approach for the investigation of host-pathogen processes based on medium-throughput 3D fluorescence imaging. The guinea pig model for Shigella flexneri invasion of the colonic mucosa was used to monitor the infectious process over time with GFP-expressing S. flexneri. A precise quantitative imaging protocol was devised to follow individual S. flexneri in a large tissue volume. An extensive dataset of confocal images was obtained and processed to extract specific quantitative information regarding the progression of S. flexneri infection in an unbiased and exhaustive manner. Specific parameters included the analysis of S. flexneri positions relative to the epithelial surface, S. flexneri density within the tissue, and volume of tissue destruction. In particular, at early time points, there was a clear association of S. flexneri with crypts, key morphological features of the colonic mucosa. Numerical simulations based on random bacterial entry confirmed the bias of experimentally measured S. flexneri for early crypt targeting. The application of a correlative light and electron microscopy technique adapted for thick tissue samples further confirmed the location of S. flexneri within colonocytes at the mouth of crypts. This quantitative imaging approach is a novel means to examine host-pathogen systems in a tailored and robust manner, inclusive of the infectious agent. PMID:26056271

  3. Infection and T lymphocyte subpopulations: changes associated with bacteremia and the acquired immunodeficiency syndrome.

    Fishman, J A; Martell, K M; Rubin, R H

    1983-01-01

    Patients with bacteremia, bacterial endocarditis, or acquired immunodeficiency syndrome (AIDS) were prospectively studied using monoclonal antibody reagents to assess alterations in T-lymphocyte subpopulations. Patients with endocarditis had significantly higher ratios of T-helper (OKT4+) to T-suppressor-cytotoxic (OKT8+) cells than did patients with bacteremia alone. Staphylococcus aureus endocarditis patients had a mean ratio of 8.49 (range 4.73-22.36) while S aureus bacteremia had a mean ratio of 2.75 (range 2.15 to 3.21). Similar results were found with Staphylococcus epidermidis endocarditis (mean 1.62) and bacteremia (mean 1.23). Klebsiella pneumoniae endocarditis (5.10) and sepsis (4.32), and E coli bacteremia (2.15). Nine male patients with AIDS had markedly depressed ratios (mean 0.25, range 0.04 to 0.67) while eight male homosexuals with unexplained lymphadenopathy ("pre-AIDS") had normal or increased ratios. Bacteremic infections are associated with an increased OKT4+/OKT8+ ratio with the degree of increase dependent upon virulence, location, and duration of infection. The immunomodulating effects of infection are manifested in changes in T-cell subsets, and these measurements can be useful in clinical management. PMID:6094086

  4. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis

    Sabzi, Feridoun

    2015-11-01

    Full Text Available The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE. She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25 day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected.

  5. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis.

    Sabzi, Feridoun; Heidari, Aghighe; Faraji, Reza

    2015-01-01

    The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic Brucella endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve Brucella endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE). She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25(th) day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected. PMID:26605134

  6. Proteomic analysis of strawberry leaves infected with Colletotrichum fragariae.

    Fang, Xianping; Chen, Wenyue; Xin, Ya; Zhang, Hengmu; Yan, Chengqi; Yu, Hong; Liu, Hui; Xiao, Wenfei; Wang, Shuzhen; Zheng, Guizhen; Liu, Hongbo; Jin, Liang; Ma, Huasheng; Ruan, Songlin

    2012-07-16

    Understanding the defense mechanisms used by anthracnose-resistant strawberries against Colletotrichum infection is important for breeding purposes. To characterize cell responses to Colletotrichum infection, proteomes from strawberry seedling leaves that had or had not been infected with Colletotrichum fragariae were characterized at different time points post infection by 2-DE and by MALDI-TOF/TOF MS/MS and database-searching protein identification. Mass spectrometry identified 49 differentially expressed proteins with significant intensity differences (>1.5-fold, pstrawberry leaves, and western blotting confirmed the induction of β-1,3-glucanase and a low-molecular-weight heat shock protein in response to C. fragariae infection. During the late phase of infection, proteins involved in the Calvin cycle and glycolysis pathway had suppressed expression. The abundance changes, putative functions, and participation in physiological reactions for the identified proteins produce a pathogen-responsive protein network in C. fragariae-infected strawberry leaves. Together, these findings increase our knowledge of pathogen resistance mechanisms, especially those found in non-model plant species. PMID:22634039

  7. Flooding and Clostridium difficile Infection: A Case-Crossover Analysis

    Cynthia J. Lin

    2015-06-01

    Full Text Available Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospitalized and/or receiving antibiotics; however, community-associated infections affecting otherwise healthy individuals have become more commonly reported. A case-crossover study was used to assess emergency room (ER and outpatient visits for C. difficile infection following flood events in Massachusetts from 2003 through 2007. Exposure status was based on whether or not a flood occurred prior to the case/control date during the following risk periods: 0–6 days, 7–13 days, 14–20 days, and 21–27 days. Fixed-effects logistic regression was used to estimate the risk of diagnosis with C. difficile infection following a flood. There were 129 flood events and 1575 diagnoses of C. difficile infection. Among working age adults (19–64 years, ER and outpatient visits for C. difficile infection were elevated during the 7–13 days following a flood (Odds Ratio, OR = 1.69; 95% Confidence Interval, CI: 0.84, 3.37. This association was more substantial among males (OR = 3.21; 95% CI: 1.01–10.19. Associations during other risk periods were not observed (p < 0.05. Although we were unable to differentiate community-associated versus nosocomial infections, a potential increase in C. difficile infections should be considered as more flooding is projected due to climate change.

  8. Risk Factors and Impact of non-Aspergillus mold infections (NAMI) following Allogeneic HCT: A CIBMTR Infection & Immune Reconstitution analysis

    Riches, Marcie L.; Trifilio, Steven; Chen, Min; Ahn, Kwang Woo; Langston, Amelia; Lazarus, Hillard M.; Marks, David I.; Martino, Rodrigo; Maziarz, Richard T.; Papinicolou, Genofeva A.; Wingard, John R.; Young, Jo-Anne H.; Bennett, Charles L.

    2015-01-01

    Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic HCT diagnosed with either mucormycosis [n=72] or fusariosis [n=52] between days 0-365 after HCT are described and compared to a control cohort (n=11856). Patients with NAMI had more advanced disease [mucormycois 25%, fusariosis 23%, controls 18%; p = 0.004] and were more likely to have a KPS<90% at HCT [mucormycosis 42%, fusariosis 38%, controls 28%; p=0.048]. The 1-year survival after HCT was 22% (15–29%) for cases and was significantly inferior compared to controls [65%(64–65%); p < 0.001]. Survival from infection was similarly dismal regardless of mucormycosis [15% (8-25%)] and fusariosis [21% (11-33%)]. In multivariable analysis, NAMI was associated with a 6-fold higher risk of death (p<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GVHD, prior aspergillus infection, and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection, and transplant prior to May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality, and appears with similar frequency in the current antifungal era. PMID:26524262

  9. In Vitro Analysis of Metabolites Secreted during Infection of Lung Epithelial Cells by Cryptococcus neoformans.

    Liew, Kah Leong; Jee, Jap Meng; Yap, Ivan; Yong, Phelim Voon Chen

    2016-01-01

    Cryptococcus neoformans is an encapsulated basidiomycetous yeast commonly associated with pigeon droppings and soil. The opportunistic pathogen infects humans through the respiratory system and the metabolic implications of C. neoformans infection have yet to be explored. Studying the metabolic profile associated with the infection could lead to the identification of important metabolites associated with pulmonary infection. Therefore, the aim of the study was to simulate cryptococcal infection at the primary site of infection, the lungs, and to identify the metabolic profile and important metabolites associated with the infection at low and high multiplicity of infections (MOI). The culture supernatant of lung epithelial cells infected with C. neoformans at MOI of 10 and 100 over a period of 18 hours were analysed using gas chromatography mass spectrometry. The metabolic profiles obtained were further analysed using multivariate analysis and the pathway analysis tool, MetaboAnalyst 2.0. Based on the results from the multivariate analyses, ten metabolites were selected as the discriminatory metabolites that were important in both the infection conditions. The pathways affected during early C. neoformans infection of lung epithelial cells were mainly the central carbon metabolism and biosynthesis of amino acids. Infection at a higher MOI led to a perturbance in the β-alanine metabolism and an increase in the secretion of pantothenic acid into the growth media. Pantothenic acid production during yeast infection has not been documented and the β-alanine metabolism as well as the pantothenate and CoA biosynthesis pathways may represent underlying metabolic pathways associated with disease progression. Our study suggested that β-alanine metabolism and the pantothenate and CoA biosynthesis pathways might be the important pathways associated with cryptococcal infection. PMID:27054608

  10. In Vitro Analysis of Metabolites Secreted during Infection of Lung Epithelial Cells by Cryptococcus neoformans

    2016-01-01

    Cryptococcus neoformans is an encapsulated basidiomycetous yeast commonly associated with pigeon droppings and soil. The opportunistic pathogen infects humans through the respiratory system and the metabolic implications of C. neoformans infection have yet to be explored. Studying the metabolic profile associated with the infection could lead to the identification of important metabolites associated with pulmonary infection. Therefore, the aim of the study was to simulate cryptococcal infection at the primary site of infection, the lungs, and to identify the metabolic profile and important metabolites associated with the infection at low and high multiplicity of infections (MOI). The culture supernatant of lung epithelial cells infected with C. neoformans at MOI of 10 and 100 over a period of 18 hours were analysed using gas chromatography mass spectrometry. The metabolic profiles obtained were further analysed using multivariate analysis and the pathway analysis tool, MetaboAnalyst 2.0. Based on the results from the multivariate analyses, ten metabolites were selected as the discriminatory metabolites that were important in both the infection conditions. The pathways affected during early C. neoformans infection of lung epithelial cells were mainly the central carbon metabolism and biosynthesis of amino acids. Infection at a higher MOI led to a perturbance in the β-alanine metabolism and an increase in the secretion of pantothenic acid into the growth media. Pantothenic acid production during yeast infection has not been documented and the β-alanine metabolism as well as the pantothenate and CoA biosynthesis pathways may represent underlying metabolic pathways associated with disease progression. Our study suggested that β-alanine metabolism and the pantothenate and CoA biosynthesis pathways might be the important pathways associated with cryptococcal infection. PMID:27054608

  11. Proteomic analysis of primary duck hepatocytes infected with duck hepatitis B virus

    Zhou Tianlun

    2010-06-01

    Full Text Available Abstract Background Hepatitis B virus (HBV is a major cause of liver infection in human. Because of the lack of an appropriate cell culture system for supporting HBV infection efficiently, the cellular and molecular mechanisms of hepadnavirus infection remain incompletely understood. Duck heptatitis B virus (DHBV can naturally infect primary duck hepatocytes (PDHs that provide valuable model systems for studying hepadnavirus infection in vitro. In this report, we explored global changes in cellular protein expression in DHBV infected PDHs by two-dimension gel electrophoresis (2-DE combined with MALDI-TOF/TOF tandem mass spectrometry (MS/MS. Results The effects of hepadnavirus infection on hepatocytes were investigated in DHBV infected PDHs by the 2-DE analysis. Proteomic profile of PDHs infected with DHBV were analyzed at 24, 72 and 120 h post-infection by comparing with uninfected PDHs, and 75 differentially expressed protein spots were revealed by 2-DE analysis. Among the selected protein spots, 51 spots were identified corresponding to 42 proteins by MS/MS analysis; most of them were matched to orthologous proteins of Gallus gallus, Anas platyrhynchos or other avian species, including alpha-enolase, lamin A, aconitase 2, cofilin-2 and annexin A2, etc. The down-regulated expression of beta-actin and annexin A2 was confirmed by Western blot analysis, and potential roles of some differentially expressed proteins in the virus-infected cells have been discussed. Conclusions Differentially expressed proteins of DHBV infected PDHs revealed by 2-DE, are involved in carbohydrate metabolism, amino acid metabolism, stress responses and cytoskeleton processes etc, providing the insight to understanding of interactions between hepadnavirus and hepatocytes and molecular mechanisms of hepadnavirus pathogenesis.

  12. Respiratory infections and their influence on lung function in children: a multiple regression analysis.

    Yarnell, J W; St Leger, A S

    1981-01-01

    The relationship between a history of respiratory infections (and associated variables) in children and lung function in later life was examined in a study among 228 children aged 7 to 11 years. In a multiple regression analysis only a few variables showed marked and consistent effects on lung function. Respiratory tract infections showed increasing impairment of lung function with repeated infections, but the impairment was smaller than that caused by current asthma.

  13. Chronic plasma cell endometritis in hysterectomy specimens of HIV-infected women: a retrospective analysis.

    Kerr-Layton, J A; Stamm, C. A.; Peterson, L. S.; McGregor, J A

    1998-01-01

    OBJECTIVE: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients. METHODS: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surg...

  14. Post-stroke infection: A systematic review and meta-analysis

    Dijkgraaf Marcel G

    2011-09-01

    Full Text Available Abstract Background stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. Methods MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome. Results 87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU. There was significant heterogeneity between studies (P 2 = 97%. The overall pooled infection rate was 30% (24-36%; rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10% and 10% (95%CI 9-12%. For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%, 28% (95%CI 18-38% and 20% (95%CI 0-40%. Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68. Conclusions Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.

  15. Ultrastructural analysis of primary human urethral epithelial cell cultures infected with Neisseria gonorrhoeae.

    Harvey, H A; Ketterer, M R; Preston, A; Lubaroff, D; Williams, R; Apicella, M A

    1997-06-01

    In men with gonococcal urethritis, the urethral epithelial cell is a site of infection. To study the pathogenesis of gonorrhea in this cell type, we have developed a method to culture primary human urethral epithelial cells obtained at the time of urologic surgery. Fluorescent analysis demonstrated that 100% of the cells stained for keratin. Microscopic analyses indicated that these epithelial cells arrayed in a pattern similar to that seen in urethral epithelium. Using immunoelectron and confocal microscopy, we compared the infection process seen in primary cells with events occurring during natural infection of the same cell type in men with gonococcal urethritis. Immunoelectron microscopy studies of cells infected with Neisseria gonorrhoeae 1291 Opa+ P+ showed adherence of organisms to the epithelial cell membrane, pedestal formation with evidence of intimate association between the gonococcal and the epithelial cell membranes, and intracellular gonococci present in vacuoles. Confocal studies of primary urethral epithelial cells showed actin polymerization upon infection. Polyclonal antibodies to the asialoglycoprotein receptor (ASGP-R) demonstrated the presence of this receptor on infected cells in the primary urethral cell culture. In situ hybridization using a fluorescent-labeled probe specific to the ASGP-R mRNA demonstrated this message in uninfected and infected cells. These features were identical to those seen in urethral epithelial cells in exudates from males with gonorrhea. Infection of primary urethral cells in culture mimics events seen in natural infection and will allow detailed molecular analysis of gonococcal pathogenesis in a human epithelial cell which is commonly infected. PMID:9169783

  16. Flooding and Clostridium difficile infection: a case-crossover analysis

    Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospttalized and/or receiving antibiotics; however, community­ associated infections affecting otherwise healthy individuals have become more ...

  17. Clinical characteristics analysis of adult human adenovirus type 7 infection

    张乃春

    2014-01-01

    Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including

  18. Molecular analysis of early host cell infection by Trypanosoma cruzi

    Villalta, Fernando; Madison, M. Nia; Kleshchenko, Yuliya Y.; Nde, Pius N.; Lima, Maria F.

    2008-01-01

    Trypanosoma cruzi, the causative agent of Chagas heart disease, infects heart and other cells leading to cardiac arrest frequently followed by death (1). The disease affects millions of individuals in the Americas and is posing health problems because of blood transmission in the US due to large Latin American immigration (2–3). Since the current drugs present serious side effects and do not cure the chronic infection (4), it is critically important to understand the early process of cellular...

  19. Analysis of Michigan Medicaid costs to treat HIV infection.

    Solomon, D J; Hogan, A. J.; Bouknight, R R; Solomon, C T

    1989-01-01

    To obtain better understanding of the nature and cost of health care related to human immunodeficiency virus (HIV) infection, medical payment records were analyzed for 204 men, women, and children older than 60 months who had indications of HIV infection. The records were those of Michigan Medicaid, the General Assistance Medical Program, and the Resident County Hospitalization Program, with service dates on or after January 1, 1984, and which were processed by November 30, 1987. Patient paym...

  20. Flooding and Clostridium difficile Infection: A Case-Crossover Analysis

    Lin, Cynthia J.; Wade, Timothy J; Hilborn, Elizabeth D.

    2015-01-01

    Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospitalized and/or receiving antibiotics; however, community-associated infections affecting otherwise healthy individuals have become more commonly reported. A case-crossover study was used to assess emergency room (ER) and outpatient visits for C. difficile infection following flood events in Massachusetts from 2003 through 2007. Exposure status was based on...