WorldWideScience

Sample records for aorto pulmonar endocarditis

  1. Anestesia en la ventana aorto-pulmonar

    Directory of Open Access Journals (Sweden)

    Lincoln de la Parte Pérez

    2001-06-01

    Full Text Available Se realiza un estudio retrospectivo de 9 niños menores de 2 años operados de ventana aorto-pulmonar en el Cardiocentro del Hospital Pediátrico Docente "William Soler", durante el período de 1986 a 1994. El fentanyl fue el agente más utilizado en la inducción de la anestesia (8 pacientes, 89 % y se empleó en todos los pacientes durante el mantenimiento, lo que aportó gran estabilidad hemodinámica. Las complicaciones encontradas fueron el síndrome de bajo gasto cardíaco, broncoespasmo, hipertensión pulmonar y arritmias cardíacas. En todos los pacientes se utilizó el protocolo para el manejo de la hipertensión pulmonar. No hubo fallecidos durante el transoperatorio ni en el posoperatorio inmediato.A retrospective study of 9 children under 2 operated on of aorto-pulmonary window at the Heart Center of "William Soler" Pediatric Teaching Hospital from 1986 to 1994 was conducted. Fentanyl was the most used agent in the induction of anesthesia (8 patients, 89 % and it was administered to all patients during maintenance, which made possible a great hemodynamic stability. The complications found were the syndrome of low cardiac output, bronchospasm, pulmonary hypertension and cardiac arrhythmias. The protocol for the management of pulmonary hypertension was used with all patients. Deaths were not reported either during the transoperative or in the immediate postoperative.

  2. Endocarditis infecciosa de válvula pulmonar nativa

    Directory of Open Access Journals (Sweden)

    Franco Romaní R

    2007-04-01

    Full Text Available La endocarditis infecciosa en válvulas derechas es predominantemente en la válvula tricuspídea, mientras la válvula pulmonar es excepcionalmente afectada (menos de 1,5%, por lo que son pocos los casos reportados en la literatura mundial. Las manifestaciones clínicas de endocarditis en válvula pulmonar no son las clásicas de endocarditis infecciosa, como son los síntomas de embolismo séptico pulmonar. La endocarditis aislada de válvula pulmonar nativa es inusual en personas que no consumen drogas intravenosas. Se presenta el caso de un paciente varón con diabetes mellitus tipo 2 y sin otro factor predisponente.

  3. Endocarditis

    Science.gov (United States)

    ... lining of the heart. The most common type, bacterial endocarditis, occurs when germs enter your heart. These germs ... another part of your body, often your mouth. Bacterial endocarditis can damage your heart valves. If untreated, it ...

  4. Aorto-right atrial fistula after Bentall repair.

    Science.gov (United States)

    Howard, Charles E; Velasco, Carlos E; Roullard, Christina P; Rafael, Aldo

    2017-07-01

    We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can play in the detection of aorto-atrial fistula.

  5. Endocarditis - children

    Science.gov (United States)

    ... children; Streptococcus viridians - endocarditis - children; Candida - endocarditis - children; Bacterial endocarditis - children; Infective endocarditis - children; Congenital heart disease - endocarditis - ...

  6. Aorto-right atrial fistula after Bentall repair

    OpenAIRE

    Howard, Charles E.; Velasco, Carlos E.; Roullard, Christina P.; Rafael, Aldo

    2017-01-01

    We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can pla...

  7. Clinical and echocardiographic features of aorto-atrial fistulas

    Directory of Open Access Journals (Sweden)

    Ananthasubramaniam Karthik

    2005-01-01

    Full Text Available Abstract Aorto-atrial fistulas (AAF are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.

  8. Infective Endocarditis

    Science.gov (United States)

    ... your bloodstream. (You may have heard the term bacterial endocarditis , subacute bacterial endocarditis , or SBE. These terms are used for endocarditis ... to repair or replace the damaged valve. Tags: bacterial endocarditis , endocardium , infection of the heart , subacute bacterial endocarditis ( ...

  9. Endocarditis aórtica y pulmonar complicada con ictus hemorrágico: ¿cuál es el tiempo quirúrgico ideal?

    Directory of Open Access Journals (Sweden)

    Adrián Fernando Narvaez Muñoz

    2016-09-01

    Full Text Available Hombre de 77 años que presenta de forma súbita alteración del lenguaje y cambios de conducta; se realiza tomografía computarizada cerebral, en donde se observa hemorragia intraparenquimatosa frontal izquierda; su cuadro es acompañado de fiebre y hemocultivos positivos para Streptococcus bovis tipo i (gallolyticus. Se realiza un ecocardiograma transesofágico en donde se identifican vegetaciones a nivel de la válvula aortica y pulmonar; debido al contexto de su ictus hemorrágico, decidimos esperar al menos 4 semanas con tratamiento antibiótico antes de realizar cirugía. En la cirugía se resecó vegetación pulmonar y aórtica, realizándose recambio valvular aórtico metálico; la válvula pulmonar fue conservada. En el postoperatorio inmediato y mediato, el paciente presenta evolución favorable. El tratamiento antibiótico se continuó hasta la confirmación de los cultivos negativos de las válvulas extraídas. El ecocardiograma de control no mostró vegetaciones y el paciente fue dado de alta a su domicilio unos días después de su cirugía.

  10. Linfangioleiomiomatosis pulmonar

    OpenAIRE

    Carlos Salazar-Vargas; Victoria Monterroso-Azofeifa; Gloria Arauz-Pacheco; Bayardo Robelo-Pentzke

    2000-01-01

    La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de hace...

  11. Blastoma pulmonar

    Directory of Open Access Journals (Sweden)

    Mauro Zamboni

    2007-05-01

    Full Text Available Resumo: O blastoma pulmonar é um tumor primário do pulmão, raro, de mau prognóstico e que acomete doentes mais jovens do que os portadores do carcinoma de células não pequenas do pulmão. Geralmente, são vistos sob a forma de grandes massas pulmonares, sintomáticas e com metástases para linfonodos mediastinais. Do ponto de vista anátomo-patológico, estes tumores são bifásicos, englobando na sua estrutura componentes mesenquimal e epitelial. Embora infrequente, este tipo de tumor deve fazer parte do diagnóstico diferencial das neoplasias pulmonares. Os autores apresentam um caso de blastoma pulmonar e fazem revisão da literatura.Rev Port Pneumol 2007; XIII (3: 391-395 Abstract: Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.Rev Port Pneumol 2007; XIII (3: 391-395 Palavras-chave: Cancro do pulmão, blastoma, blas-toma pulmonar, tumor primário do pulmão, Keywords: Lung cancer, blastoma, pulmonary blastoma, primary tumors of lung

  12. [Aorto-intestinal fistulas. 4 case reports].

    Science.gov (United States)

    Bansky, G; Valli, C; Häcki, W H; Turina, M

    1984-09-15

    Four cases of aorto-enteric fistula are reported. The two primary types occurred after rupture of an aneurysm of the abdominal aorta into the duodenum and as a consequence of tumor infiltration of both the aorta and the intestinal wall in a woman with metastatic ovarian cancer. The two secondary types developed as a late complication of reconstructive surgery of the abdominal aorta. The condition was diagnosed or suspected on the basis of endoscopic findings in two cases. The pathogenetic role of graft infection in the development of secondary aorto-enteric fistula is emphasized. The generally poor prognosis can be considerably improved if prompt resection of the graft is combined with axillo-bifemoral anastomosis.

  13. Leptospirose pulmonar

    Directory of Open Access Journals (Sweden)

    João Cláudio Barroso Pereira

    2007-11-01

    Full Text Available Resumo: No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto. Abstract: In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome. Palavras-chave: Leptospirose, manifestações respiratórias, hemorragia alveolar difusa e síndroma da dificuldade respiratória do adulto, Key-words: Leptospirosis, respiratory manifestations, diffuse alveolar hemorrhage and adult respiratory distress syndrome

  14. Leptospirose pulmonar

    Directory of Open Access Journals (Sweden)

    João Cláudio Barroso Pereira

    2007-11-01

    Full Text Available Resumo: No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.Rev Port Pneumol 2007; XIII (6: 827-839 Abstracts: In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.Rev Port Pneumol 2007; XIII (6: 827-839 Palavras-chave: Leptospirose, manifestações respiratórias, hemorragia alveolar difusa e síndroma da dificuldade respiratória do adulto, Key-words: Leptospirosis, respiratory manifestations, diffuse alveolar hemorrhage and adult respiratory distress syndrome

  15. Aneurysmal aorto-right ventricular tunnel.

    Science.gov (United States)

    Singh, Sushil Kumar; Dwivedi, Sudhanshu Kumar; Kumar, Ambrish; Vijay, Sudarshan Kumar; Rajput, Nitin; Devenraj, Vijyant; Lal Sahni, Jeevan

    2012-02-01

    A successful closure of an aneurysmal aorto-right ventricular tunnel (ARVT) in a 16-year-old male patient is reported here. An attempt at device closure had failed in this patient. Diagnosis was confirmed by Doppler echocardiography, 3-dimensional computed tomography, and cardiac catheterization. Surgical closure with a Dacron patch (W.L. Gore & Associates, Flagstaff, AZ) at the aortic end and direct closure at the ventricular end was done successfully with the patient under mild hypothermia. The postoperative echocardiogram showed a competent aortic valve with a closed ARVT. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2017-06-01

    Full Text Available Resumo As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava.

  17. Histoplasmose pulmonar

    OpenAIRE

    Alexandre Campos Moraes Amato; Rodrigo Braga Dichtchekenian; Marcos Galan Morillo

    2007-01-01

    A histoplasmose é uma micose sistêmica associada a inúmeras síndromes clínicas, das quais, a mais freqüente é uma infecção respiratória semelhante à influenza, assintomática ou autolimitada; porém, pode se manifestar como doença pulmonar cavitária crônica, doença disseminada progressiva que afeta múltiplos órgãos, ou doença imunomediada do mediastino ou do olho. Apresenta como agente causador o Histoplasma capsulatum, um fungo dimórfico com duas variedades: H. capsulatum var. capsulatum (resp...

  18. Histoplasmose pulmonar

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2007-05-01

    Full Text Available A histoplasmose é uma micose sistêmica associada a inúmeras síndromes clínicas, das quais, a mais freqüente é uma infecção respiratória semelhante à influenza, assintomática ou autolimitada; porém, pode se manifestar como doença pulmonar cavitária crônica, doença disseminada progressiva que afeta múltiplos órgãos, ou doença imunomediada do mediastino ou do olho. Apresenta como agente causador o Histoplasma capsulatum, um fungo dimórfico com duas variedades: H. capsulatum var. capsulatum (responsável pela histoplasmose clássica e H. capsulatum var. duboisii (causador da histoplasmose africana.

  19. Infective endocarditis

    Directory of Open Access Journals (Sweden)

    Sénior, Juan Manuel

    2015-10-01

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

  20. INFECTIVE ENDOCARDITIS: MODERN COURSE

    Directory of Open Access Journals (Sweden)

    T. L. Vinogradova

    2014-07-01

    Full Text Available The paper presents the characteristic features of the modern course of infective endocarditis. Unresolved questions of classification of diseaseand drug therapy are discussed. Clearly defined indications for surgical treatment of endocarditis.

  1. Enterococcus faecalis infective endocarditis

    DEFF Research Database (Denmark)

    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....

  2. Embolia pulmonar por polimetilmetacrilato

    OpenAIRE

    Héctor Gómez Santa María; Mauro García Aurelio; Yanina Castillo Costa; Víctor Mauro; Carlos Barrero

    2009-01-01

    Los primeros registros de embolia pulmonar por polimetilmetacrilato se publicaron recientemente (2003) y desde entonces se describieron no más de 15 casos. Se presenta el caso de un paciente joven a quien dos meses antes de la consulta se le había efectuado una vertebroplastia percutánea con polimetilmetacrilato. Por síntomas pleuríticos se le realizó una radiografía de tórax, que evidenció múltiples imágenes radioopacas en ambos campos pulmonares. La embolia pulmonar por polimetilmetacrilato...

  3. Aorto-right ventricular fistula: a complication of aortic valve replacement.

    Science.gov (United States)

    Najib, Mohammad Q; Ng, Daniel; Vinales, Karyne L; Chaliki, Hari P

    2012-01-01

    The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.

  4. Embolia pulmonar por polimetilmetacrilato

    Directory of Open Access Journals (Sweden)

    Héctor Gómez Santa María

    2009-01-01

    Full Text Available Los primeros registros de embolia pulmonar por polimetilmetacrilato se publicaron recientemente (2003 y desde entonces se describieron no más de 15 casos. Se presenta el caso de un paciente joven a quien dos meses antes de la consulta se le había efectuado una vertebroplastia percutánea con polimetilmetacrilato. Por síntomas pleuríticos se le realizó una radiografía de tórax, que evidenció múltiples imágenes radioopacas en ambos campos pulmonares. La embolia pulmonar por polimetilmetacrilato es una complicación muy poco frecuente de ese procedimiento y un diagnóstico diferencial para tener en cuenta en pacientes con el antecedente y que consulten por dolor precordial o disnea.REV ARGENT CARDIOL 2009;77:129-130.

  5. Aorto-right atrial fistula after ascending aortic replacement or aortic value replacement

    International Nuclear Information System (INIS)

    Zhi Aihua; Dai Ruping; Jiang Shiliang; Lu Bin

    2012-01-01

    Objective: To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement (AVR) or ascending aortic replacement. Methods: Eighty-seven patients with aortic-right atrial fistula underwent CT after operation. The CT features were retrospectively analyzed. Fistula was measured according to maximum width of the shunt. Results: Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them, 25 patients were diagnosed as mild aorto-right atrial fistula, 47 patients as moderate, and 15 patients as severe. Thirty-seven patients underwent follow-up CT.Among them, 10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression, 8 patients with mild aorto-right atrial fistula considered to have incomplete regression, 14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition, and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up. Conclusion: CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up. (authors)

  6. Complicações pulmonares de endocardite tricúspide num doente toxicómano

    Directory of Open Access Journals (Sweden)

    Carlos Lousada

    1997-01-01

    Full Text Available RESUMO: Os autore apresentam o caso clínico de um doente toxicodependente com embolias pulmonares sépticas, pneumotórax e derrame pleural secundários a endocardite tricúspide e sindrome nefrótico.Discutese o diagnóstico, mecanismos etiopatogénicos, terapêutica médica, indicações cirúrgicas e prognóstico destas situações. SUMMARY: The authors present a case of an intravenous drug addict with septic pulmonary embolism, pneumothorax and pleural effusion secondary to tricuspid infectious endocarditis and nephrotic syndrome.The diagnosis, etiopathogenic mechanisms, treatment implications, the role of surgery and the prognosis are discussed. Palavras-chave: embolia pulmonar séptica, pneumotórax, endocardite tricúspide, Key-Word: septic pulmonary emboli, pneumothorax, tricuspid endocarditis

  7. La tuberculosis pulmonar

    OpenAIRE

    Suñé Ysamat, Bertila

    1982-01-01

    La tuberculosis pulmonar todavía no es una enfermedad erradicada, aunque su incidencia ha disminuido considerablemente. El tratamiento y el pronóstico de esta enfermedad han dado un cambio profundo durante estos últimos 30 años con el descubrimiento de nuevos medicamentos antituberculosos.

  8. Blastoma pulmonar Pulmonary blastoma

    Directory of Open Access Journals (Sweden)

    Mauro Zamboni

    2007-05-01

    Full Text Available O blastoma pulmonar é um tumor primário do pulmão, raro, de mau prognóstico e que acomete doentes mais jovens do que os portadores do carcinoma de células não pequenas do pulmão. Geralmente, são vistos sob a forma de grandes massas pulmonares, sintomáticas e com metástases para linfonodos mediastinais. Do ponto de vista anátomo-patológico, estes tumores são bifásicos, englobando na sua estrutura componentes mesenquimal e epitelial. Embora infrequente, este tipo de tumor deve fazer parte do diagnóstico diferencial das neoplasias pulmonares. Os autores apresentam um caso de blastoma pulmonar e fazem revisão da literatura.Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.

  9. Proteinosis alveolar pulmonar

    Directory of Open Access Journals (Sweden)

    Concepción Sánchez Infante

    2011-12-01

    Full Text Available La proteinosis alveolar pulmonar es una enfermedad respiratoria crónica, caracterizada por alteración en el metabolismo del surfactante, lo que determina su acumulación anormal en el espacio alveolar. Es una enfermedad extremadamente rara. Se han reportado solamente 500 casos en la literatura. Se describió por primera vez en 1958. Se presenta un caso de proteinosis alveolar pulmonar en un lactante de 2 meses, con desnutrición proteico energética, que ingresa por dificultad respiratoria e hipoxemia, y, con imágenes radiológicas de tipo retículo-nodulillar, en vidrio deslustrado, en el cual se plantea inicialmente el diagnóstico de bronconeumonía. Ante la evolución desfavorable y no respuesta al tratamiento, se realizó un estudio para descartar enfermedades pulmonares crónicas. El paciente fallece y se confirma el diagnóstico por anatomía patológica. Se realiza una revisión del tema.

  10. Leptospirose pulmonar Pulmonary leptospirosis

    Directory of Open Access Journals (Sweden)

    João Cláudio Barroso Pereira

    2007-12-01

    Full Text Available No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.

  11. Enterococcus faecalis infective endocarditis

    DEFF Research Database (Denmark)

    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...... or 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...

  12. Infective endocarditis, 1984 through 1993

    DEFF Research Database (Denmark)

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

    1997-01-01

    To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population.......To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population....

  13. Side-to-side aorto-Gore-Tex central shunt.

    Science.gov (United States)

    Gates, R N; Laks, H; Johnson, K

    1998-02-01

    This report details our experience in 13 patients with a technical modification of the standard central shunt. The study was performed using a retrospective chart review approach. In our operation, the aorto-Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) anastomosis is created in a side-to-side fashion with the free end of the Gore-Tex shunt being oversewn. All patients had echocardiographic evidence of shunt patency in the immediate postoperative period, and there have been no cases of late shunt occlusion at a mean follow-up period of 10 months. We believe this approach will yield patency rates equivalent to or better than those of the standard central shunt. The technique has the advantage of creating a short, straight-lying shunt that is less likely to kink or be injured on repeated sternotomy and in which flow may be more reliable.

  14. Linfangioleiomiomatosis y trasplante pulmonar

    OpenAIRE

    Ansótegui Barrera, Emilio

    2012-01-01

    La linfangioleiomiomatosis (LAM) es una enfermedad rara que afecta predominantemente a la mujer, sobre todo en edad fértil. Se caracteriza por una proliferación anormal de células musculares lisas inmaduras, células LAM, que crecen de una manera aberrante en la vía aérea, parénquima, linfáticos y vasos sanguíneos pulmonares, lo que determina una evolución progresiva hacia la insuficiencia respiratoria que condiciona el fallecimiento de las pacientes. Tiene carácter multisistémico afectando as...

  15. Haemophilus segnis endocarditis

    DEFF Research Database (Denmark)

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

    1988-01-01

    Haemophilus segnis is a rarely recognised commensal in the oropharynx. We wish to report the first published case of endocarditis caused by H. segnis. The patient, a 76-year-old female did not recover until after 2 courses of ampicillin given for a total of 57 days. In the second course of treatm......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...

  16. Endocarditis infecciosa canina

    OpenAIRE

    Santamarina, G.

    2011-01-01

    La endocarditis infecciosa es una enfermedad sistémica asociada a una alta morbilidad y mortalidad. Afecta fundamentalmente a perros de edad media y mayores, sobre todo de razas grandes. La endocarditis bacteriana presenta un gran desafío con respecto a su diagnóstico y tratamiento eficaz. La auscultación puede aportar indicios en relación a la implicación valvular, particularmente cuando está presente un soplo sistólico en la base izquierda que se corresponde con la regurgitación aórtica. La...

  17. Envolvimento pulmonar na polimiosite

    Directory of Open Access Journals (Sweden)

    Direndra Hasmucrai

    2010-07-01

    Full Text Available Resumo: Introdução: A polimiosite (PM e a dermatomiosite são classificadas como miopatias inflamatórias idiopáticas. O envolvimento pulmonar por PM é pouco frequente, estando descrito na literatura em cerca de 10% de casos.Os autores apresentam um caso de uma mulher de 75 anos, com queixas de febre, perda ponderal, artralgias, mialgias e diminuição simétrica e proximal da força muscular com impotência funcional dos membros superiores e inferiores, com início um mês antes do internamento. Apresentava infiltrados pulmonares na telerradiografia de tórax. Após estudo exaustivo estabeleceu-se o diagnóstico de envolvimento pulmonar na forma de pneumonia organizativa por PM. Efectuou-se corticoterapia e terapêutica com micofenolato com melhoria clínica, analítica e radiológica.Conclusão: Neste caso, foi a alteração na telerradiografia de tórax numa doente sem sintomatologia respiratória que levou ao estudo exaustivo até ao diagnóstico de PM, realçando mais uma vez a importância da telerradiografia no rastreio de patologias de outros foros.Rev Port Pneumol 2010; XVI (4: 671-677 Abstract: Introduction: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases.The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X-ray. After exhaustive study, the diagnosis of pulmonary envolvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome.Conclusion: In this case, it was the changes in the chest X-ray in a patient without respiratory sym ptomatology, that conducted to exhaustive study to polymyositis

  18. Envolvimento pulmonar na polimiosite

    Directory of Open Access Journals (Sweden)

    Direndra Hasmucrai

    2010-07-01

    Full Text Available Resumo: Introdução: A polimiosite (PM e a dermatomiosite são classificadas como miopatias inflamatórias idiopáticas. O envolvimento pulmonar por PM é pouco frequente, estando descrito na literatura em cerca de 10% de casos.Os autores apresentam um caso de uma mulher de 75 anos, com queixas de febre, perda ponderal, artralgias, mialgias e diminuição simétrica e proximal da força muscular com impotência funcional dos membros superiores e inferiores, com início um mês antes do internamento. Apresentava infiltrados pulmonares na telerradiografia de tórax. Após estudo exaustivo estabeleceu-se o diagnóstico de envolvimento pulmonar na forma de pneumonia organizativa por PM. Efectuou-se corticoterapia e terapêutica com micofenolato com melhoria clínica, analítica e radiológica. Conclusão: Neste caso, foi a alteração na telerradiografia de tórax numa doente sem sintomatologia respiratória que levou ao estudo exaustivo até ao diagnóstico de PM, realçando mais uma vez a importância da telerradiografia no rastreio de patologias de outros foros. Abstract: Introduction: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases.The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X-ray. After exhaustive study, the diagnosis of pulmonary envolvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome. Conclusion: In this case, it was the changes in the chest X-ray in a patient without respiratory symptomatology, that conducted to exhaustive study to polymyositis diagnosis, enhancing once again the

  19. Linfangioleiomiomatose pulmonar Pulmonary Lymphangioleiomyomatosis

    Directory of Open Access Journals (Sweden)

    Pedro Medeiros Junior

    2004-02-01

    Full Text Available Linfangioleiomiomatose pulmonar (LAM é uma doença rara, de etiologia desconhecida, que basicamente afeta mulheres jovens no período fértil de sua vida. Clinicamente, manifesta-se através de dispnéia progressiva, pneumotórax de repetição, tosse seca e, menos freqüentemente, por quilotórax e escarros hemoptóicos. Essas alterações surgem devido à proliferação anormal de células de músculo liso no parênquima pulmonar, linfonodos e em outros tecidos. Mais recentemente, estudos citogenéticos verificaram a presença de mutações do gene TSC-2 em células de angiomiolipoma renal e linfonodos abdominais de pacientes com LAM, indicando uma possível origem para as lesões hamartomatosas da doença. Radiologicamente, caracteriza-se pela presença de infiltrado intersticial reticulonodular e sinais de hiperinsuflação ao radiografia de tórax. Na tomografia computadorizada de alta resolução, cistos de paredes finas, localizados centralmente, são visibilizados por todo o parênquima do pulmão. O ultrassom e a tomografia de abdome podem revelar angiomiolipomas renais e linfonodomegalias retroperitoneais. Meningeomas também podem estar associados, porém a sua presença deve sempre levar à pesquisa de esclerose tuberosa. Funcionalmente, a doença caracteriza-se por um distúrbio ventilatório obstrutivo, de caráter progressivo, com hiperinsuflação pulmonar e diminuição da difusão de monóxido de carbono. Apesar da ausência de comprovação quanto à eficácia, o principal tratamento utilizado ainda é o anti-estrogênico e constitui-se de oofarectomia, progesterona contínua, tamoxifeno e análogos de GnRH. Além desse, a realização de transplantes pulmonares tem elevado para além de dez anos a sobrevida média das pacientes.Lymphangioleiomyomatosis (LAM is a rare lung disease of unkwnon etiology that frequently affects women in childbearing age. Clinically it manifests itself by and pneumothorax. Chylous pleural

  20. Endocarditis in adults with bacterial meningitis

    NARCIS (Netherlands)

    Lucas, Marjolein J.; Brouwer, Matthijs C.; van der Ende, Arie; van de Beek, Diederik

    2013-01-01

    Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown. We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with

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

    Directory of Open Access Journals (Sweden)

    Wada Yuko

    2011-10-01

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

  2. Dermatologic manifestations of infective endocarditis.

    Science.gov (United States)

    Gomes, Rafael Tomaz; Tiberto, Larissa Rezende; Bello, Viviane Nardin Monte; Lima, Margarete Aparecida Jacometo; Nai, Gisele Alborghetti; Abreu, Marilda Aparecida Milanez Morgado de

    2016-01-01

    Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler's nodes and Janeway lesions. Osler's nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes. Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. We report a case of infective endocarditis and highlight the importance of skin examination as a very important element in the presumptive diagnosis of infective endocarditis.

  3. Pneumococcal pulmonary valve endocarditis

    Directory of Open Access Journals (Sweden)

    Apostolos Vrettos

    2017-07-01

    Full Text Available Pulmonary valve endocarditis is a rare type of infective endocarditis (IE. Streptococcus pneumoniae is a pathogen that is uncommonly associated with IE. A 50 year-old male was referred to us after an incidental echocardiographic finding of a pulmonary valve vegetation. The patient had a recent admission for drainage of a scrotal abscess from which S. pneumoniae was isolated, complicated by hospital acquired pneumonia and pulmonary embolism. Analysis using polymerase chain reaction of the surgically resected mass revealed signs of 16S ribosomal DNA consistent with S. pneumoniae infection. This was an extremely rare case of pneumococcal pulmonary valve IE presenting entirely asymptomatically in the absence of any known risk factors.

  4. Comprometimento pulmonar na leptospirose

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Manhães de Carvalho

    1992-03-01

    Full Text Available Em 23 pacientes com leptospirose apresentando comprometimento pulmonar, internados no Hospital Universitário Antônio Pedro da XJFF, Niterói, hemoptise e hemoptóicos foram observados em 21,7% e 30,4%, respectivajnente. Gasometria arterial revelou hipoxemia e hipocapnia na maioria dos casos. Radiografia de tórax em 15 pacientes mostrou comprometimento alveolar em 60%, comprometimento intersticial-reticular em 6%, padrão misto (alveolar e intersticial em20%e ausência de alterações radiológicas em 14%. A necrópsiade 13 pacientes mostrou edema, congestão e hemorragia nos pulmões em 100% dos casos. A hemorragia foi focal em 46% e difusa em 54% dos casos. Houve formação de membrana hialina em 30% e trombos de fibrina em 46% dos pulmões estudados, o que estabelece o diagnóstico da coagulação intravascular disseminada e a ocorrência da síndrome de angústia respiratória na leptospirose.

  5. Absceso hepático asociado a absceso pulmonar y endoftalmitis

    OpenAIRE

    Jairo Cordero-Chen; Eduardo Catalán-Sánchez; Juan Ignacio Padilla-Cuadra; Jorge Ramírez-Arce

    2013-01-01

    El absceso hepático piógeno producido por Klebsiella pneumoniae es relativamente raro y puede complicarse con lesiones sépticas a distancia. Esto se relaciona con características propias del germen que incluyen el genotipo K1, resistencia a la fagocitosis y la presencia del gen mag-A. Tales metástasis sépticas contemplan absceso pulmonar, meningitis, endocarditis bacteriana y, muy especialmente, endoftalmitis. Esta última ocurre con mayor frecuencia en pacientes diabéticos, y puede causar ceg...

  6. CT finding of secondary aorto-enteric fistulae

    International Nuclear Information System (INIS)

    Tacchini, Simona; Nicoletti, Roberto; Ghio, Domenica; Martinenghi, Carlo Maria Andrea; Del Maschio, Alessandro; Chiesa, Roberto

    2005-01-01

    Purpose. The aim of our study was to review CT finding concerning secondary aorto-enteric fistulae (AEF). In particular, we aimed to evaluate signs of contrast medium extravasation from the aortic graft into the bowel (active bleeding), in correlation with clinical and surgical reports. Materials and methods. Clinical and CT findings were retrospectively evaluated in 13 surgically proven cases of AEF. All patients underwent spiral CT examination with biphasic contrast technique, before and 30 and 80 seconds after intravenous injection of 120-150 ml of contrast medium (Ultravist 370; flow rate 2.5-3 ml/sec). Late scans (240 seconds) were also acquired on surgical anastomoses. We used 3 mm (arterial phase) and 5 mm (venous phase slices. Results. At surgery, all patients presented a communication between the bowel and the aortic graft. At CT examination, all 13 patients presented one or more CT signs indicating AEF (perigraft soft tissue, perigraft fluid, ectopic air or bowel wall thickening). Moreover, in 6 out of 13 patients, contrast medium extravasation from the aortic graft into the small bowel (active bleeding) was detected with CT. Detection of active bleeding was possible because CT examinations were performed without oral administration of contrast medium. Conclusions. CT is easily and readily available and provides an accurate evaluation of the aorta and surrounding retroperitoneal tissues. In our study we were able to identify the CT sign of active bleeding in more than a half of the patients with acute gastrointestinal bleeding (66%). Hence, we suggest that patients undergo CT examination without oral contrast medium administration in order to better appreciate the presence of active bleeding [it

  7. Endocarditis de Libman-Sacks

    Directory of Open Access Journals (Sweden)

    Carolina Saldarriaga

    2015-05-01

    Se reporta el caso de un paciente de género masculino, de 63 años, quien manifestó signos y síntomas compatibles con endocarditis infecciosa, y cuyos diferentes estudios demostraron una endocarditis de Libman-Sacks que respondió de forma favorable al tratamiento inmunosupresor.

  8. ENDOCARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    AMEL Harzallah

    2017-04-01

    Full Text Available Endocarditis is one of the most prevalent forms of cardiac involvement in patients with lupus, as it is considered as one a life-threatening complication. Libman-Sacks endocarditis is common. Infective endocarditis can also cause complications within immunocompromised patients. The aim of this study is to determine particularities of endocarditis in patients with lupus and to look for distinguishing features between infectious or immunological origin. A retrospective study was conducted on patients with lupus presenting endocarditis. Lupus was diagnosed according to the American college of rheumatology criteria. The diagnosis of endocarditis was made based on the modified Duke criteria. The present case report studies seven cases of endocarditis. Six of these patients are women and the other one is a man. They are aged meanly of 29.4 years (extremes: 20-36. Fever was present in all the cases with a new cardiac murmur in six cases and a modification of its intensity in one case. Biologic inflammatory syndrome was present in six cases. Cardiac ultrasound performed in six cases made the diagnosis of endocarditis which involved the left heart valves in five cases and the right heart valves in one case. Valvular insufficiency was identified in six patients. The valve involvement was mitral in two cases, mitro-aortic in two others, aortic in the fifth one and tricuspid in the sixth one. Endocarditis was infectious in 4 cases, thanks to positive blood culture. The germs identified were gram negative bacilli in two cases, anaerobic organism in one case and gram positive cocci in one case. Candida albicans was isolated in one case. Libman-Sacks endocarditis was objectified in three cases. A combination of Libman-Sacks endocarditis with infectious endocarditis was diagnosed in one case. The treatment consisted of antibiotics in four cases with surgery in two cases. The outcome was favorable in five cases and fatal in the two others. Endocarditis in lupus

  9. Candida parapsilosis prosthetic valve endocarditis

    Directory of Open Access Journals (Sweden)

    André Silva-Pinto

    2015-09-01

    Full Text Available Candida endocarditis is a rare infection associated with high mortality and morbidity. There are still some controversies about Candida endocarditis treatment, especially about the treatment duration. We report a case of a Candida parapsilosis endocarditis that presented as a lower limb ischemia. The patient was surgically treated with a cryopreserved homograft aortic replacement. We used intravenous fluconazole 800 mg as initial treatment, followed with 12 months of 400 mg fluconazole per os. The patient outcome was good.

  10. Kytococcus schroeteri prosthetic valve endocarditis

    OpenAIRE

    Yousri, Taher; Hawari, Mohammad; Saad, Rasheed; Langley, Steve

    2010-01-01

    We report the case of a 64-year-old male patient with a prosthetic aortic valve who presented with clinical features of endocarditis confirmed by transoesophageal echocardiography. His blood cultures were positive for a very rare and newly described organism—Kytococcus schroeteri. The patient underwent aortic valve replacement and a 6-week course of intravenous antibiotics. This is the fifth reported case of endocarditis associated with this organism.

  11. Kytococcus schroeteri prosthetic valve endocarditis.

    Science.gov (United States)

    Yousri, Taher; Hawari, Mohammad; Saad, Rasheed; Langley, Steve

    2010-09-29

    We report the case of a 64-year-old male patient with a prosthetic aortic valve who presented with clinical features of endocarditis confirmed by transoesophageal echocardiography. His blood cultures were positive for a very rare and newly described organism-Kytococcus schroeteri. The patient underwent aortic valve replacement and a 6-week course of intravenous antibiotics. This is the fifth reported case of endocarditis associated with this organism.

  12. Cardiac imaging in infectious endocarditis

    DEFF Research Database (Denmark)

    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....... infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested....

  13. Tuberculosis pulmonar de campos inferiores

    Directory of Open Access Journals (Sweden)

    Alejandra González

    2010-10-01

    Full Text Available La tuberculosis (TB que compromete sólo los campos pulmonares inferiores (TBCI es poco frecuente en el adulto y en general está asociada a alguna causa de inmunodepresión. El objetivo de nuestro trabajo fue determinar la incidencia de TBCI en nuestra población y comparar sus características respecto de la TB pulmonar de localización habitual. Se estudiaron en forma retrospectiva en el período de 2004 a 2008, 42 pacientes con TBCI que fueron comparados con 84 pacientes con TB pulmonar de localización habitual (grupo control. Se excluyeron pacientes con HIV. La TBCI representó el 6% del total de TB pulmonar. No se encontraron diferencias significativas en cuanto a edad, sexo, presencia de cavidades en la radiografía, días de evolución y nivel de albúmina. La TBCI tuvo significativamente mayor proporción de comorbilidades (p < 0.001, presencia de condensación (p < 0.001 y compromiso unilateral (p < 0.001 en la radiografía de tórax, junto con mayor número de internaciones (p = 0.02. Cabe destacar que sólo16 de los 42 pacientes con TBCI (38% tenían alguna comorbilidad demostrada. La TBCI puede presentarse aun sin comorbilidades asociadas y debe sospecharse en neumonías de evolución tórpida independientemente de su localización.

  14. Embolia pulmonar séptica de origen cutáneo

    Directory of Open Access Journals (Sweden)

    Agustina Sosa Beláustegui

    2012-08-01

    Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.

  15. Tricuspid valve endocarditis.

    Science.gov (United States)

    Hussain, Syed T; Witten, James; Shrestha, Nabin K; Blackstone, Eugene H; Pettersson, Gösta B

    2017-05-01

    Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5-10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors. Staphylococcus aureus is the predominant causative organism in TVIE. Most patients with TVIE are successfully treated with antibiotics, however, 5-16% of RSIE cases eventually require surgical intervention. Indications and timing for surgery are less clear than for left-sided IE; surgery is primarily considered for failed medical therapy, large vegetations and septic pulmonary embolism, and less often for TV regurgitation and heart failure. Most patients with an infected prosthetic TV will require surgery. Concomitant left-sided IE has its own surgical indications. Earlier surgical intervention may potentially prevent further destruction of leaflet tissue and increase the likelihood of TV repair. Fortunately, TV debridement and repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques. Valve repair is advocated over replacement, particularly in IVDUs patients who are young, non-compliant and have a higher risk of recurrent infection and reoperation with valve replacement. Excising the valve without replacing, it is not advocated; it has been reported previously, but these patients are likely to be symptomatic, particularly in cases with septic pulmonary embolism and increased pulmonary vascular resistance. Patients with concomitant left-sided involvement have worse prognosis than those with RSIE alone, due predominantly to greater likelihood of

  16. Bacterial Clearance and Endocarditis in American Opossums

    Science.gov (United States)

    Musher, Daniel M.; Richie, Yvonne

    1974-01-01

    The American opossum is the only experimental animal that regularly develops bacterial endocarditis spontaneously. There was no relation between the ability of opossums to clear bacteria from the bloodstream and the subsequent development of endocarditis. PMID:4208530

  17. Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Tariq Shakoor

    2015-01-01

    Full Text Available Transcatheter aortic valve replacement (TAVR techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.

  18. Aorto-Right Ventricular Tunnel in Transposition of the Great Arteries

    Directory of Open Access Journals (Sweden)

    Antonio F. Corno

    2018-02-01

    Full Text Available Aorto-ventricular tunnel is an extremely rare congenital heart defect, consisting of failure of attachment of an aortic leaflet along the semilunar hinge. In all published reports the leaflet involved was either the right coronary leaflet, most frequently, or the left coronary leaflet, in most of the cases opening toward the left ventricle, with only one-eighth of the reported cases communicating with the right ventricle. Treatment of the aorto-ventricular tunnel has been anecdotally reported by interventional closure with a device and more frequently with surgical approach, either as an isolated malformation or as associated lesions. To the best of our knowledge, the presence of an aorto-ventricular tunnel of the non-adjacent aortic leaflet in transposition of the great arteries has never been reported. We have observed an aorto-ventricular tunnel involving the non-adjacent leaflet of the aortic root, which after arterial switch became the pulmonary root. The patient presented 18 years after the arterial switch with progressive dilatation of the right ventricle due to severe degree of pulmonary valve regurgitation, confirmed by echocardiography and cardiac MRI. Indication for surgery was given with the plan for a pulmonary valve implantation. Because of the intra-operative finding of disconnection of the anterior leaflet of the pulmonary valve (former aortic valve along the semilunar hinge, the surgical plan was modified and the anterior leaflet was attached to the valve annulus, with subsequent plasty in correspondence with the right and left commissurae to reduce the size of the dilated annulus to normal diameter. The post-operative course was uneventful, with extubation after few hours and discharge 4 days after surgery, with echocardiography showing trivial degree of pulmonary valve regurgitation. The patient remains in good conditions 6 months after surgery.

  19. Molecular imaging in Libman-Sacks endocarditis

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  20. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis

    Directory of Open Access Journals (Sweden)

    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.

  1. [Infective endocarditis: a changing disease].

    Science.gov (United States)

    Venditti, M; Martino, P

    1990-01-01

    Infective endocarditis is best characterized as a disease in evolution. The list of patients at risk, which formerly included almost exclusively patients with rheumatic heart disease, is being continuously modified and expanded. Nowadays, patients with prosthetic heart valves, users of illicit intravenous drugs, and patients with mitral valve prolapse rather than patients with rheumatic heart disease account for the majority of cases of infective endocarditis. Moreover, due to the widespread use of indwelling atrial catheters for parenteral nutrition as well as for intensive cytotoxic therapy, catheter-related right-sided endocarditis is emerging among nosocomial infections. With the advent of successful antimicrobial therapy, complications rather than endocardial infection pose the major therapeutic problems. In addition to progressive heart failure, myocardial abscesses, fungal endocarditis, relapsing infection, and major systemic emboli in the presence of large protuberant vegetations constitute indications for replacement of the valve. Despite progresses in diagnosis and therapy, infective endocarditis will most likely continue to challenge physicians even in the next future.

  2. Nuclear medicine imaging in endocarditis

    International Nuclear Information System (INIS)

    Ivancevic, V.; Munz, D.L.

    1999-01-01

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

  3. Fungal Endocarditis: Update on Diagnosis and Management.

    Science.gov (United States)

    Pasha, Ahmed Khurshid; Lee, Justin Z; Low, See-Wei; Desai, Hem; Lee, Kwan S; Al Mohajer, Mayar

    2016-10-01

    Fungal endocarditis is an extremely debilitating disease associated with high morbidity and mortality. Candida spp. are the most common isolated organisms in fungal endocarditis. It is most prevalent in patients who are immunosuppressed and intravenous drug users. Most patients present with constitutional symptoms, which are indistinguishable from bacterial endocarditis, hence a high index of suspicion is required for pursuing diagnosis. Diagnosis of fungal endocarditis can be very challenging: most of the time, blood cultures are negative or take a long time to yield growth. Fungal endocarditis mandates an aggressive treatment strategy. A medical and surgical combined approach is the cornerstone of therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Musculoskeletal manifestations of bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Érika Bevilaqua Rangel

    2000-09-01

    Full Text Available CONTEXT: The incidence of staphylococcal infection has been increasing during the last 20 years. OBJECTIVE: Report a case of staphylococcal endocarditis preceded by musculoskeletal manifestations, which is a rare form of clinical presentation. DESIGN: Case report. CASE REPORT: A 45-year-old-man, without addictions and without known previous cardiopathy, was diagnosed as having definitive acute bacterial endocarditis due to Staphylococcus aureus. Its etiology was community-acquired, arising from a non-apparent primary focus. In addition, the musculoskeletal symptoms preceded the infective endocarditis (IE by about 1 month, which occurred together with other symptoms, e.g. mycotic aneurysms and petechiae. Later, the patient showed perforation of the mitral valve and moderate mitral insufficiency with clinical control.

  5. Bacterial Endocarditis and Cerebrovascular Disease.

    Science.gov (United States)

    Silver, Brian; Behrouz, Réza; Silliman, Scott

    2016-12-01

    Cerebrovascular complications of endocarditis occur in 25-70% of patients with infective endocarditis. The cornerstone of treatment is early initiation of antibiotic treatment, which significantly reduces the risk of embolization after 1 week of treatment. In general, thrombolysis and anticoagulation of these patients should be avoided, while antiplatelet therapy may be considered in those with other indications. Endovascular treatment of acute septic emboli is uncertain, but a few case reports have demonstrated benefit. Other complications of infective endocarditis include intracerebral hemorrhage, which may be predicted by the presence of two or more cerebral microbleeds on gradient echo sequences. Intracranial mycotic aneurysms can often be managed with serial imaging and coiled if there is evidence of failure to reduce in size, or enlargement.

  6. Listeria Endocarditis: A Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Wilhelmina J. A. R. M. Valckx MD

    2017-04-01

    Full Text Available A 74-year-old hemodialysis patient with a history of an atrial septum defect closure, coronary bypass surgery, and a St. Jude aortic prosthetic valve was diagnosed with pneumonia and volume overload. Blood cultures were positive for Listeria monocytogenes, and amoxicillin was given for 2 weeks. Immediately after discontinuation of amoxicillin, fever relapsed. Transthoracic and transesophageal echocardiography showed no sign of endocarditis. Given the fever relapse and 3 positive minor Duke criteria, an 18F-FDG PET-CT scan (18F-fluorodeoxyglucose-positron emission tomography-computed tomography scan was performed. This scan showed activity at the aortic root, proximal ascending aorta, and inferior wall of the heart, making Listeria monocytogenes endocarditis a likely explanation. Amoxicillin was given for 6 weeks with good clinical result. Diagnosing a life-threatening Listeria monocytogenes endocarditis can be challenging and an 18F-FDG PET-CT scan can be helpful.

  7. Endocarditis infecciosa por Paecilomyces variotii

    Directory of Open Access Journals (Sweden)

    Juan Manuel Senior

    2009-06-01

    Full Text Available La endocarditis infecciosa por hongos es una complicación cada vez más frecuente en el mundo. Presentamos un caso de endocarditis infecciosa por Paecilomyces variotii en un paciente de sexo masculino con bioprótesis mitral, que respondió satisfactoriamente al tratamiento con cirugía de reemplazo valvular mitral y anfotericina B (dosis total de 3.670 mg. Hasta la fecha, sólo se han reportado seis casos similares en el mundo, con una mortalidad del 100%.

  8. Enfermedad pulmonar intersticial asociada a rituximab

    Directory of Open Access Journals (Sweden)

    Marcelo Fernández Casares

    2013-08-01

    Full Text Available La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

  9. Partial oral treatment of endocarditis

    DEFF Research Database (Denmark)

    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...

  10. Isolated tricuspid valve infective endocarditis

    African Journals Online (AJOL)

    1990-07-07

    Jul 7, 1990 ... A report of 6 cases. D. P. NAIDOO,. I. P. NAICKER,. S. NAICKER, S. VYTHYLlNGUM,. M. A. K. OMAR, A. S. MITHA. F. HASSEN,. Summary. Six cases of isolated tricuspid valve endocarditis in young women are described. Preceding ... friction rub, became hypotensive and died. At autopsy vegetations were ...

  11. Nosocomial infective endocarditis in Hemodialysis

    International Nuclear Information System (INIS)

    Bhat, A.W.; Solangi, S.; Murtada, O.

    2002-01-01

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

  12. [Streptococcus equi subsp. Zooepidemicus endocarditis].

    Science.gov (United States)

    Villamil, Iago; Serrano, Marta; Prieto, Elisabeth

    2015-04-01

    Zoonotic infections with S. equi subsp. zooepidemicus have been reported occasionally in individuáis with exposure to farm animals, especially horses. They exceptionally present as a human pathogen. We present a S. equi subsp. zooepidemicus well documented endocarditis after a horse's female genital tract contact, and excellent surveillance with exclusive antibiotic management.

  13. Esclerose tuberosa com envolvimento pulmonar

    Directory of Open Access Journals (Sweden)

    Susana Ferreira

    2010-03-01

    Full Text Available Resumo: A esclerose tuberosa (ET é uma doença rara, esporádica ou transmitida de forma autossómica dominante. Caracteriza-se pela tríade convulsões, atraso mental e angiofibromas faciais. O envolvimento pulmonar é raro e, quando ocorre, é mais frequente no sexo feminino. Os autores apresentam o caso de uma doente de 52 anos, não fumadora, com antecedentes conhecidos de epilepsia na infância e angiomiolipomas renais. Assintomática e sem alterações ao exame objectivo. Em tomografia do tórax realizada para avaliação da doença, foram detectadas formações microquísticas dispersas em ambos os campos pulmonares. Exame funcional respiratório normal. A ressonância magnética cerebral evidenciou tuberosidades corticais e nódulos subependimários calcificados. Concluiu-sepelo diagnóstico de ET (linfangioleiomiomatose, tuberosidades corticais, nódulos subependimários e angiomiolipomas renais. Os autores apresentam o caso pela raridade da doença e do envolvimento pulmonar, ainda que em fase assintomática.Rev Port Pneumol 2010; XVI (2: 339-344 Abstract: Tuberous sclerosis (TS is a rare, sporadic or autosomal dominant disease characterized by the triad of seizures, mental retardation and angiofibromas. Lungs are rarely involved in TS, and pulmonary involvement is almost always found in females. We report the case of a 52 year-old female, nonsmoker, with a history of seizures in childhood and renal angiomyolipomas. She presented no complaints and her physical exam was normal. Chest CT performed for the evaluation of the disease detected thin-walled pulmonary cysts in both lungs. Lung function tests were normal. Cortical tubers and calcified subependymal nodules were seen in cerebral magnetic resonance. Tuberous sclerosis was diagnosed (lymphangioleiomyomatosis, cortical tubers, calcified subependymal nodules and angiomyiolipomas. The authors present this case because of its rarity and the existence of pulmonary involvement, while

  14. Esclerose tuberosa com envolvimento pulmonar

    Directory of Open Access Journals (Sweden)

    Susana Ferreira

    2010-03-01

    Full Text Available Resumo: A esclerose tuberosa (ET é uma doença rara, esporádica ou transmitida de forma autossómica dominante. Caracteriza-se pela tríade convulsões, atraso mental e angiofibromas faciais. O envolvimento pulmonar é raro e, quando ocorre, é mais frequente no sexo feminino. Os autores apresentam o caso de uma doente de 52 anos, não fumadora, com antecedentes conhecidos de epilepsia na infância e angiomiolipomas renais. Assintomática e sem alterações ao exame objectivo. Em tomografia do tórax realizada para avaliação da doença, foram detectadas formações microquísticas dispersas em ambos os campos pulmonares. Exame funcional respiratório normal. A ressonância magnética cerebral evidenciou tuberosidades corticais e nódulos subependimários calcificados. Concluiu-se pelo diagnóstico de ET (linfangioleiomiomatose, tuberosidades corticais, nódulos subependimários e angiomiolipomas renais. Os autores apresentam o caso pela raridade da doença e do envolvimento pulmonar, ainda que em fase assintomática. Abstract: Tuberous sclerosis (TS is a rare, sporadic or autosomal dominant disease characterized by the triad of seizures, mental retardation and angiofibromas. Lungs are rarely involved in TS, and pulmonary involvement is almost always found in females. We report the case of a 52 year-old female, nonsmoker, with a history of seizures in childhood and renal angiomyolipomas. She presented no complaints and her physical exam was normal. Chest CT performed for the evaluation of the disease detected thin-walled pulmonary cysts in both lungs. Lung function tests were normal. Cortical tubers and calcified subependymal nodules were seen in cerebral magnetic resonance. Tuberous sclerosis was diagnosed (lymphangioleiomyomatosis, cortical tubers, calcified subependymal nodules and angiomyio-lipomas. The authors present this case because of its rarity and the existence of

  15. Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

    International Nuclear Information System (INIS)

    Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Recaldini, Chiara; Lumia, Domenico; Cuffari, Salvatore; Caronno, Roberto; Castelli, Patrizio; Fugazzola, Carlo

    2007-01-01

    Purpose. To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. Materials. We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. Results. Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. Conclusion. Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach

  16. Adenocarcinoma pulmonar em um bovino

    OpenAIRE

    Viott,Aline de Marco; Langohr,Ingeborg Maria; Vannucci,Fábio Augusto; Almeida,Aliny Pontes; Leite,Rômulo Cerqueira; Ecco,Roselene

    2010-01-01

    Um bovino Guzerá, fêmea, adulto, com histórico de insuficiência cardíaca congestiva direita de duração de duas semanas, morreu durante o transporte ao hospital veterinário. À necropsia, o lobo pulmonar cranial esquerdo estava moderadamente aumentado de tamanho e firme. O parênquima do lobo afetado era branco e continha múltiplas áreas de 0,3 a 1,5cm de diâmetro, amareladas e caseosas. Alterações semelhantes foram observadas nos linfonodos mediastínicos e brônquicos, no pericárdio parietal, no...

  17. Dirofilariose pulmonar humana: relato de sete casos

    Directory of Open Access Journals (Sweden)

    CAVALLAZZI RODRIGO SILVA

    2002-01-01

    Full Text Available Dirofilariose pulmonar humana é uma doença rara causada pelo parasita Dirofilaria immitis. Apresenta-se usualmente como um nódulo pulmonar solitário que mimetiza câncer de pulmão. Embora considerada uma doença clinicamente benigna, uma biópsia pulmonar excisional é quase sempre necessária para o diagnóstico. Relatam-se as características epidemiológicas, clínicas e radiológicas de sete casos de dirofilariose pulmonar humana em Florianópolis. De sete pacientes relatados, seis tiveram como achado radiológico um nódulo pulmonar e foram submetidos à biópsia pulmonar excisional para o diagnóstico. Em um paciente, a imagem radiológica não estava disponível para revisão e, portanto, não foi descrita no trabalho; o diagnóstico foi estabelecido pela biópsia transbrônquica.

  18. Criptococose pulmonar: aspectos na tomografia computadorizada

    Directory of Open Access Journals (Sweden)

    Silva Ana Carina Gamboa da

    2003-01-01

    Full Text Available A criptococose pulmonar é uma doença causada pelo Criptococcus neoformans, um fungo unimórfico que possui distribuição mundial, existindo na mesma forma tanto no seu habitat natural quanto em animais e humanos. A doença possui apresentações clínica e patológica variáveis e pode manifestar-se tanto em pacientes com a imunidade normal como em imunocomprometidos, que representam a maioria dos casos. Neste trabalho são analisados os aspectos encontrados nas tomografias computadorizadas do tórax de 14 pacientes com criptococose pulmonar confirmada. Os achados mais freqüentes na tomografia do tórax foram as massas e os nódulos pulmonares. Outros aspectos observados foram as áreas de escavação, as consolidações, o espessamento do interstício peribroncovascular e o reticulado difuso. Massa pulmonar foi o achado isolado mais comum (64,2%, seguido dos nódulos isolados ou múltiplos (35,7%. Doença pulmonar difusa foi vista em apenas 14,2% dos casos. Os lobos superiores foram os mais comprometidos, sendo a doença mais comum nas regiões anteriores. A tomografia do tórax permitiu avaliar com precisão o grau de comprometimento do parênquima pulmonar.

  19. Uso de neumocitos de tipo II en el tratamiento de enfermedades pulmonares asociadas con fibrosis pulmonar

    OpenAIRE

    Serrano-Mollar, Anna; Closa, Daniel; Bulbena, Oriol

    2005-01-01

    Se describe el empleo de neumocitos tipo II como agentes inhibidores de la proliferación de fibroblastos, por lo que pueden ser utilizados en la elaboración de un medicamento para el tratamientode enfermedades pulmonares que cursan con fibrosis pulmonar.

  20. Efficacy of cardiac surgery in endocarditis

    Directory of Open Access Journals (Sweden)

    Moradmand S

    2000-06-01

    Full Text Available 2 factors changed the clinical course of infective endocarditis dramatically: 1 The discovery and evolution of techniques for identifying and treating its microbiologic causes and 2 Valvular surgery. We retrospectively evaluated 43 (33.5% patients (8 female, 35 male from 4 to 65 years old of 128 patients with infective endocarditis who underwent surgical intervention. Indication for surgery were: Refractory congestive heart failure 14 (32.5%, prosthetic valves 10 (23.2%, large vegetation 6 (13.9%, recurrent endocarditis 4 (9.3%, ring abscess 4 (9.3%, brucella endocarditis 2 (4.6%, staph aureus endocarditis 3 (6.9% and recurrent emboli 2 (4.6%. 30 to 50% of patients with infective endocarditis are operated during the active phase of the disease, this percentage is higher in case of aortic valve endocarditis, prosthetic valve endocarditis, some microorganisms such as staph aureus, gram negative bacilli, fungus and brucella. We suggest that internists refer patients for surgical intervention with infective endocarditis as early as possible in the active stage of infection.

  1. Intracardiac lead endocarditis due to Staphylococcus lugdunensis.

    Science.gov (United States)

    Chopra, Anish; Gulati, Dhiraj; Woldenberg, Nina; Singh, Mamta

    2010-09-01

    Staphylococcus Lugdunensis is a rare but potentially aggressive pathogen in the family of coagulase negative staphylococcus (CoNS). It can cause a wide variety of infections ranging from superficial skin to fulminant infections like endocarditis. Both native and prosthetic valve endocarditis due to S. lugdunensis have been documented in the English literature. Eight cases of pacemaker lead endocarditis due to S. lugdunensis have been described so far. We present the ninth case of pacemaker lead and first case of automatic implantable cardioverter defibrillator (AICD) lead endocarditis due to S. lugdunensis. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  2. Embolia pulmonar séptica de origen cutáneo Septic pulmonary embolism of cutaneous origin

    Directory of Open Access Journals (Sweden)

    Agustina Sosa Beláustegui

    2012-08-01

    Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic

  3. Teste de vasorreatividade pulmonar Testing pulmonary vasoreactivity

    Directory of Open Access Journals (Sweden)

    Edmundo Clarindo Oliveira

    2008-10-01

    Full Text Available A hipertensão arterial pulmonar é classificada como idiopática ou secundária (associada a colagenoses, cardiopatias, hipertensão portal, tromboembolismo pulmonar e doenças da vasculatura pulmonar. O teste de vasorreatividade pulmonar é indicado para definir a melhor opção terapêutica. Muitas drogas têm sido utilizadas para a realização desse teste, sendo o óxido nítrico inalado a melhor opção, por apresentar ação específica pulmonar e meia vida muita curta (5-10 s. O resultado desse teste identifica candidatos à cirurgia cardíaca nas cardiopatias congênitas e candidatos ao uso de antagonista de cálcio nas outras formas de hipertensão pulmonar. A realização e interpretação do teste de vasorreatividade pulmonar exigem grande responsabilidade, e erros podem levar a decisões erradas e à ocorrência de óbitos.Pulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases. Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due its specific pulmonary effect and very short half-life (5-10 s. The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.

  4. Endovascular treatment of a bleeding secondary aorto-enteric fistula. A case report with 1-year follow-up.

    Science.gov (United States)

    Brountzos, Elias N; Vasdekis, Spyros; Kostopanagiotou, Georgia; Danias, Nikolaos; Alexopoulou, Efthymia; Petropoulou, Konstantina; Gouliamos, Athanasios; Perros, Georgios

    2007-01-01

    We report a patient with life-threatening gastrointestinal bleeding caused by a secondary aorto-enteric fistula. Because the patient had several comorbid conditions, we succesfully stopped the bleeding by endovascular placement of a bifurcated aortic stent-graft. The patient developed periaortic infection 4 months later, but he was managed with antibiotics. The patient is well 1 year after the procedure.

  5. Schwannoma intercostal simulando neoplasia pulmonar

    Directory of Open Access Journals (Sweden)

    Henn L.A.

    1998-01-01

    Full Text Available Schwannoma é uma neoplasia mesenquimal, usualmente solitária, encontrada no mediastino, retroperitônio ou pelve, sendo rara sua apresentação na parede torácica. OBJETIVO: Relatar o caso de um paciente masculino, tabagista, com um nódulo pulmonar direito com características de malignidade, detectado em radiografia de tórax de rotina, cujo diagnóstico anatomopatológico foi de schwannoma benigno de nervo intercostal. MÉTODOS: Revisaram-se os dados referentes ao quadro clínico, exames laboratoriais e de imagem (radiografia e tomografia computadorizada de tórax do caso em estudo, assim como os exames anatomopatológico e imuno-histoquímico do espécime cirúrgico. RESULTADOS: O paciente foi submetido à toracotomia direita diagnóstica com ressecção da tumoração. O exame anatomopatológico convencional mostrou células tumorais de aspecto fusiforme, dispostas em paliçada, formando os corpos de Verocay, compatível com schwannoma intercostal. A imuno-histoquímica foi positiva para proteína S-100, vimentina e enolase, e negativa para neurofilamentos. CONCLUSÃO: O diagnóstico definitivo de schwannoma só é possível por meio da análise histopatológica e imuno-histoquímica da lesão. Seu aspecto celular, associado à atividade mitótica e a áreas de pleomorfismo, pode levar ao diagnóstico incorreto de malignidade. A imuno-histoquímica, por meio da proteína S-100, é útil na caracterização da benignidade da lesão, já que não é detectada nas lesões malignas. Os schwannomas de parede torácica podem simular neoplasias pulmonares na radiografia e tomografia computadorizada de tórax.

  6. Resecciones pulmonares: Morbilidad y mortalidad

    Directory of Open Access Journals (Sweden)

    Carlos Romero Díaz

    2001-12-01

    Full Text Available Se reportan las complicaciones de 72 enfermos con resecciones pulmonares, durante el período de 1995 a 1999 en el Hospital Clinicoquirúrgico "Comandante Manuel Fajardo". El 61,1 % fue por resecciones regladas (lobectomías y neumonectomías y el resto atípicas. La mortalidad quirúrgica fue de 4,1 % y la morbilidad del 11,1 %. Las complicaciones más frecuentes fueron la neumonía y la sepsis de la herida, observada en el 2,7 %. La fístula bronquial se presentó en un enfermo (1,3 %.The complications of 72 patients with pulmonary resections performed at "Comandante Manuel Fajardo" Clinical and Surgical Hospital from 1995 to 1999 are reported. 61.1 % of the complications were due to segmental resections (lobectomies and neuronectomies and the rest were atypical. Surgical mortality was 4.1 % and morbidity 11.1 %. The most frequent complications were pneumonia and wound sepsis, which were observed in 2.7 %. A patient had bronchial fistula (1.3 %.

  7. Tromboendarterectomía pulmonar en el tratamiento de la hipertensión pulmonar tromboembólica crónica

    Directory of Open Access Journals (Sweden)

    José Antonio Blázquez

    2007-01-01

    Conclusiones: La tromboendarterectomía pulmonar mejora la hemodinámica pulmonar, prolonga la supervivencia, y optimiza la calidad de vida de pacientes con hipertensión pulmonar tromboembólica crónica.

  8. Hipertensión pulmonar asociada a enfermedad cardiaca izquierda

    OpenAIRE

    Efraín A. Gómez-López

    2017-01-01

    La falla cardiaca izquierda es una las causas más frecuentes de hipertensión pulmonar. Se define como la presión arterial pulmonar media mayor o igual a 25 mm Hg, sumada a una presión capilar pulmonar o presión de oclusión de la arteria pulmonar mayor a 15 mm Hg. Su aparición en el contexto de falla cardiaca izquierda tiene implicaciones de orden pronóstico, en el sentido en que es vital definir el grado de compromiso del componente arterial pulmonar que inicialmente es consecuencia de flujo ...

  9. Aerococcus christensenii native aortic valve subacute bacterial endocarditis (SBE) presenting as culture negative endocarditis (CNE) mimicking marantic endocarditis.

    Science.gov (United States)

    Jose, Anita; Cunha, Burke A; Klein, Natalie C; Schoch, Paul E

    2014-01-01

    This is a case report of an adult who presented with apparent culture negative endocarditis (CNE) thought to be marantic endocarditis due to a B-cell lymphoproliferative disorder. This was a most perplexing case and was eventually diagnosed as subacute bacterial endocarditis (SBE) due to a rare slow growing organism. Against the diagnosis of SBE was the lack of fever, hepatomegaly, peripheral manifestations and microscopic hematuria. Also, against a diagnosis of SBE was another explanation for the patient's abnormal findings, e.g., elevated ferritin levels, elevated α1/α2 globulins on SPEP, an elevated alkaline phosphatase, flow cytometry showing B-lymphocytes expressing CD5, and a bone lesion in the right iliac. Findings compatible with both SBE and marantic endocarditis due to a B-cell lymphoproliferative disorder included an elevated ESR, and splenomegaly. Blood cultures eventually became positive during hospitalization. We report a case of native aortic valve (AV) subacute bacterial endocarditis (SBE) due to Aerococcus christensenii mimicking marantic endocarditis due to a B-cell lymphoproliferative disorder. To the best of our knowledge, this is the first reported case of native AV SBE due to A. christensenii presenting as marantic endocarditis. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. ENDOCARDITIS BACTERIANA: REPORTE DE CASO

    OpenAIRE

    Dávila F., Roberto; Marroquín A., Miguel

    2014-01-01

    La endocarditis bacteriana es una inflamación del endocardio donde hay colonización bacteriana que genera vegetaciones en alguna válvula del corazón, las cuales alteran la función cardiaca generando regurgitaciones y alteraciones hemodinámicas. Además, puede producir cuadros propios de la infección como trombo embolismo séptico y alteraciones inflamatorias como complejos inmunes. En el presente estudio se describe el caso de un canino hembra de 2.5 años, que presentó fiebre, decaimiento, anor...

  11. Endocarditis in adults with bacterial meningitis.

    Science.gov (United States)

    Lucas, Marjolein J; Brouwer, Matthijs C; van der Ende, Arie; van de Beek, Diederik

    2013-05-21

    Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown. We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of bacterial meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants, and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurological (54%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died. Endocarditis is an uncommon coexisting condition in bacterial meningitis but is associated with a high rate of unfavorable outcome.

  12. Tratamiento quirúrgico de la endocarditis infecciosa Surgical treatment of infective endocarditis

    Directory of Open Access Journals (Sweden)

    Milvio Ramírez López

    2010-09-01

    Full Text Available La cirugía constituye un ataque vigoroso a la incompetencia valvular que ocasiona las graves complicaciones hemodinámicas que se observan en la endocarditis infecciosa. Se presenta una breve revisión de las diferentes técnicas quirúrgicas que se emplean para el tratamiento de la endocarditis infecciosa de la válvula mitral nativa, utilización de homoinjertos mitrales, tratamiento quirúrgico de la endocarditis infecciosa de la válvula aórtica y de la endocarditis infecciosa de prótesis valvular aórtica, homoinjertos criopreservados, prótesis sin soporte valvular y otros tipos de prótesis, así como de otras técnicas que se pueden emplear en caso de no contar con homoinjertos. Se revisan las técnicas que se utilizan en la endocarditis infecciosa de la válvula tricúspide y la conducta quirúrgica en la endocarditis por cables de marcapasos o desfibriladores automáticos implantables.Surgery is a strong attack to valvular incompetence causing the severe hemodynamic complications seen in infective endocarditis. This is a brief review of the different surgical techniques used in the treatment of infective endocarditis of native mitral valve, utilization of mitral homografts, surgical treatment of the infective endocarditis of the aortic valve and the infective endocarditis of the aortic valvular prosthesis, cryopreservation of the homografts, prosthesis without valvular support and other types of prostheses, as well as of other techniques that could be used if the homografts are not available. Techniques used in the infective endocarditis of tricuspid valve are reviewed and the surgical behavior in the endocarditis provoked by the pacemakers cables or implanted automated defibrillators.

  13. Classic Peripheral Signs of Subacute Bacterial Endocarditis

    Directory of Open Access Journals (Sweden)

    Yooyoung Chong

    2016-10-01

    Full Text Available A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.

  14. Medical dental prophylaxis of endocarditis

    Directory of Open Access Journals (Sweden)

    Regina C. Basilio

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

  15. Direct measured systolic pressure gradients across the aorto-iliac segment in multiple-level-obstruction arteriosclerosis

    DEFF Research Database (Denmark)

    Noer, Ivan; Praestholm, J; Tønnesen, K H

    1981-01-01

    Patients with severe ischemia due to multi-level obstructions in the leg arteries both above and below the region were assessed preoperatively by intraarterial brachial and femoral artery pressure measurements. The systolic pressure drop along aorto-iliac obstructions was compared to the angiogra....... Due to large variations, however, the angiographic information was found to be useless in the individual patient. No difference in the pressure drop was found between cases in which rich and poor collateral networks were visualized....

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

    Directory of Open Access Journals (Sweden)

    Lucía R. Kazelian

    2012-04-01

    Full Text Available La endocarditis infecciosa es una enfermedad de baja incidencia que en las últimas décadas mostró modificaciones respecto de su presentación, posibilidad diagnóstica y tratamiento. A pesar de estos avances, la mortalidad hospitalaria sigue siendo muy elevada. Nuestro objetivo fue analizar las características de los pacientes con endocarditis infecciosa activa y su relación con la mortalidad hospitalaria a lo largo de 16 años. Se realizó un registro prospectivo entre 1994 y 2010 de pacientes ingresados con endocarditis. Se analizaron características clínicas, evolución y tratamiento y se registraron los eventos intrahospitalarios. Ingresaron 152 pacientes, 64.5% varones, edad 45 ± 16 años, las causas más frecuentes de cardiopatía de base fueron: congénita 32 (21% y reumática 20 (13.2%. Los motivos de internación fueron síndrome febril 116 (76.3% e insuficiencia cardíaca 61 (40.1%. Se identificó el agente infeccioso en 106 (69.7% de los casos, el más frecuente fue Streptococcus viridans. El ecocardiograma mostró vegetaciones en 123 (80.9% de los pacientes y 88 (57.8% presentaron complicaciones durante su internación, siendo la más frecuente la insuficiencia cardíaca. Se indicó tratamiento quirúrgico en 96 (63.1% de los casos, fundamentalmente por insuficiencia cardíaca en 66. La mortalidad hospitalaria global fue 46 (30.2%. El desarrollo de complicaciones en la internación, la indicación de cirugía y la presencia de insuficiencia cardíaca refractaria al tratamiento fueron predictores independientes de mortalidad hospitalaria, mientras que la presencia de vegetaciones resultó un predictor independiente de mejor supervivencia. La identificación temprana de estos predictores descriptos podría ayudar a mejorar los resultados.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

  17. INFECTIVE ENDOCARDITIS IN INTRAVENOUS DRUGS ABUSED PATIENT

    Directory of Open Access Journals (Sweden)

    E. Y. Ponomareva

    2011-01-01

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

  18. Erysipelothrix Rhusiopathiae Endocarditis and Presumed Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Marc Romney

    2001-01-01

    Full Text Available 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.

  19. Subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans.

    Science.gov (United States)

    Peters, J; Robinson, F; Dasco, C; Gentry, L O

    1983-01-01

    Sixteen documented cases of Actinobacillus actinomycetemcomitans endocarditis have been reported in the past 15 years. The characteristic granular growth and the fastidious nature and slow-growing character of this organism decrease the yield of positive blood cultures. Two recently observed cases of subacute endocarditis due to Actinobacillus are reported, one in a patient who required surgical intervention for complications of his disease and the other case associated with an aortic prosthetic valve. The first patient had late embolic complications which are commonly seen with Actinobacillus endocarditis. A review of the literature; including a synoptic table with clinical failures, treatment, and outcome is presented. Unless special care is taken to isolate these slow growing organisms, these cases will be misclassified as culture negative endocarditis.

  20. Diagnostic value of echocardiography in infective endocarditis

    International Nuclear Information System (INIS)

    Luo Yinli; Ni Xianda; Hu Yuanping; Liu Jingyun; Yang Weiyu

    2010-01-01

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

  1. RVOT mural and mitral valve endocarditis: A case report

    Directory of Open Access Journals (Sweden)

    Maadh Jawad

    2015-11-01

    Full Text Available Mural endocarditis is a very rare condition. This entity involves bacterial growth on cardiac walls. In addition, concomitant valvular endocarditis, along with mural endocarditis, is an extremely rare combination. The diagnosis of mural endocarditis is difficult and requires more advanced cardiac imaging, such as a transesophageal echocardiogram. The differential diagnoses of mural masses include vegetations, thrombi, metastasis, and benign and malignant tumors. We present a rare and unusual case of Methicillin-Resistant Staphylococcus aureus bacteremia with findings of both right ventricular outflow tract mural endocarditis and valvular endocarditis involving the mitral valve.

  2. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    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....

  3. Brucella Endocarditis Caused By Brucella Melitensis

    Directory of Open Access Journals (Sweden)

    Suzan Saçar

    2008-01-01

    Full Text Available Brucellosis is a zoonotic disease endemically seen in Turkey, which occurs with various clinical findings. It can lead to complications affecting many systems. Endocarditis is an infrequent, but serious complication of brucellosis.The aim of this case presentation is to remind that endocarditis can be a complication of brucellosis and if is undiagnosed or misdiagnosed, progresses fatal in a high rate.

  4. Endocarditis infecciosa activa: 152 casos

    Directory of Open Access Journals (Sweden)

    Lucía R. Kazelian

    2012-04-01

    Full Text Available La endocarditis infecciosa es una enfermedad de baja incidencia que en las últimas décadas mostró modificaciones respecto de su presentación, posibilidad diagnóstica y tratamiento. A pesar de estos avances, la mortalidad hospitalaria sigue siendo muy elevada. Nuestro objetivo fue analizar las características de los pacientes con endocarditis infecciosa activa y su relación con la mortalidad hospitalaria a lo largo de 16 años. Se realizó un registro prospectivo entre 1994 y 2010 de pacientes ingresados con endocarditis. Se analizaron características clínicas, evolución y tratamiento y se registraron los eventos intrahospitalarios. Ingresaron 152 pacientes, 64.5% varones, edad 45 ± 16 años, las causas más frecuentes de cardiopatía de base fueron: congénita 32 (21% y reumática 20 (13.2%. Los motivos de internación fueron síndrome febril 116 (76.3% e insuficiencia cardíaca 61 (40.1%. Se identificó el agente infeccioso en 106 (69.7% de los casos, el más frecuente fue Streptococcus viridans. El ecocardiograma mostró vegetaciones en 123 (80.9% de los pacientes y 88 (57.8% presentaron complicaciones durante su internación, siendo la más frecuente la insuficiencia cardíaca. Se indicó tratamiento quirúrgico en 96 (63.1% de los casos, fundamentalmente por insuficiencia cardíaca en 66. La mortalidad hospitalaria global fue 46 (30.2%. El desarrollo de complicaciones en la internación, la indicación de cirugía y la presencia de insuficiencia cardíaca refractaria al tratamiento fueron predictores independientes de mortalidad hospitalaria, mientras que la presencia de vegetaciones resultó un predictor independiente de mejor supervivencia. La identificación temprana de estos predictores descriptos podría ayudar a mejorar los resultados.

  5. Aneurismas de la arteria pulmonar. Reporte de un caso y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Rosalba Vivas, MD

    2011-07-01

    Se presenta el caso de una paciente de siete años, quien fue referida para evaluación por endocarditis infecciosa de la válvula tricúspide debida a Staphylococcus aureus. Desarrolló aneurismas bilaterales en ramas lobulares de la arteria pulmonar secundarios a la infección valvular. El aneurisma del lado derecho era de gran tamaño y con alto riesgo de ruptura, razón de peso para que se le efectuara embolización con coils. El procedimiento fue exitoso y no se documentaron complicaciones. La lesión del lado izquierdo se trató de forma expectante teniendo en cuenta que era de menor tamaño. En la actualidad la paciente está en seguimiento ambulatorio con el fin de vigilar la evolución del aneurisma del lado izquierdo.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    OBJECTIVES: The aim of this retrospective study was to determine the incidence and outcome of infectious endocarditis in Greenland with an emphasis on pneumococcal endocarditis. STUDY DESIGN: Retrospective, non-interventional study. METHODS: Review of files and medical history of all patients wit...

  7. Outcome and quality of life after aorto-bifemoral bypass surgery.

    Science.gov (United States)

    Abelha, Fernando J; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

    2010-03-18

    Aorto-bifemoral bypass (AFB) is commonly performed to treat aorto-iliac disease and a durable long-term outcome is achieved. Most studies documenting beneficial outcomes after AFB have been limited to mortality and morbidity rates, costs and length of hospital stay (LOS). Few studies have examined the dependency of patients and how their perception of their own health changes after surgery. The aim of the present study was to evaluate outcome after AFB and to study its determinants. This retrospective study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. Out of 1597 intensive care patients admitted to the PACU, 75 were submitted to infrarenal AFB and admitted to these intensive care unit (ICU) beds over 2 years. Preoperative characteristics and outcome were evaluated by comparing occlusive disease with aneurysmatic disease patients. Six months after discharge, the patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in Activities of Daily Living (ADL) evaluated. Patient's characteristics and postoperative follow-up data were compared using Mann-Whitney U test, t test for independent groups, chi-square or Fisher's exact test. Patient preoperative characteristics were evaluated for associations with mortality using a multiple logistic regression analysis. The mortality rate was 12% at six months. Multivariate analysis identified congestive heart disease and APACHE II as independent determinants for mortality. Patients submitted to AFB for occlusive disease had worse SF-36 scores in role physical and general health perception. Patients submitted to AFB had worse SF-36 scores for all domains than a comparable urban population and had similar scores to other PACU patients. Sixty-six percent and 23% of patients were dependent in at least one activity in instrumental and personal ADL, respectively, but 64% reported having better general health. This study shows that

  8. O pneumologista face ao transplante pulmonar

    Directory of Open Access Journals (Sweden)

    Carlos José Cordeiro Lopes

    2005-03-01

    Full Text Available Resumo: Nas duas últimas décadas ocorreram grandes avanços no transplante pulmonar que levaram à sua aceitação como terapêutica válida para o estádio terminal de múltiplas doenças pulmonares. Os principais obstáculos à sua generalização são a escassez de órgãos e a elevada incidência de rejeição crónica.Neste trabalho descrevem-se as várias fases do processo de transplantação, evidenciandose o importante papel do pneumologista.Actualmente, os resultados do transplante pulmonar dependem muito mais dos cuidados médicos peri-operatórios, detecção precoce e tratamento das complicações, do que da técnica cirúrgica, já completamente consolidada.Rev Port Pneumol 2005; XI, 2 (Supl 1: S9-S32 Abstract: In the last two decades, huge developments in lung transplant led to its acceptance as a valid therapy for a diverse array of end-stage pulmonary lung diseases. The primary obstacles to its generalized use are organ shortage and high incidence of chronic rejection.We review the different phases of the transplant process and highlight the important role of the Pulmonologist.Nowadays, lung transplant outcomes are much more dependent on perioperative medical management, early detection and treatment of complications, than on the operative techniques that are already consolidated.Rev Port Pneumol 2005; XI, 2 (Supl 1: S9-S32 Palavras-chave: Transplante pulmonar, imunossu-pressão, rejeição crónica, pneumologista, Key-words: Lung transplant, imunossupression, chronic rejection, pulmonologist

  9. Endocarditis

    Science.gov (United States)

    ... bloodstream through: Everyday oral activities. Activities such as brushing your teeth, or other activities that could cause your gums ... of germs entering your bloodstream. In addition to brushing and flossing, regular dental exams are an important part of maintaining good ...

  10. Endocarditis

    Science.gov (United States)

    ... best antibiotic. You will then need long-term antibiotic therapy. People most often need therapy for 4 to 6 weeks to fully kill all the bacteria from the heart chambers and valves. Antibiotic treatments that are started in the hospital will ...

  11. Endocarditis

    Science.gov (United States)

    ... need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment. You also will need close medical followup, usually ...

  12. Hemosiderosis pulmonar idiopática con osificación pulmonar. A propósito de un caso

    Directory of Open Access Journals (Sweden)

    Ana Madeleine Barrera

    2016-12-01

    Full Text Available La osificación pulmonar es un hallazgo poco usual, generalmente asintomático y reportado como hallazgo incidental en biopsias de pulmón. Igualmente la hemosiderosis pulmonar idiopática es una causa poco frecuente de infiltrados pulmonares. Se presenta el caso de un hombre de 64 años con síntomas respiratorios crónicos en quien confluyen estos dos hallazgos histopatológicos.

  13. Diagnóstico do embolismo pulmonar

    Directory of Open Access Journals (Sweden)

    João Castaño

    2003-03-01

    Full Text Available RESUMO: O diagnóstico do Embolismo Pulmonar é considerado por vezes difícil. É importante reconhecer as situações clínicas que podem ser potencialmente desencadeantes. Existe uma série de meios auxiliares de diagnóstico, quer laboratoriais quer imagiológicos, que devem ser adaptados aos meios disponíveis em cada instituição.REV PORT PNEUMOL 2003; IX (2: 129-137 ABSTRACT: Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution.REV PORT PNEUMOL 2003; IX (2: 129-137 Palavaras-chave: Tromboembolismo Pulmonar, Pulmão, Perfusão Pulmonar, Tomografia Computorizada (TC, Angiografia, Helicoidal, Key-words: Pulmonary Embolism, Lung, Lung Perfusion, Computed Tomography (CT, Angiography, Helical

  14. ENFOQUE ACTUAL DE LAS MALFORMACIONES PULMONARES

    Directory of Open Access Journals (Sweden)

    Dra. Mónica Saavedra

    2017-01-01

    Full Text Available Las malformaciones pulmonares corresponden a distintas anomalías del sistema respiratorio que se presentan con baja incidencia (1 en cada 10.000 a 35.000 embarazos, dentro de las que se incluye a las Malformaciones Pulmonares Congénitas y de la vía aérea (MCPA, antes conocida malformación adenomatosa quística, secuestros pulmonares, lesiones híbridas y enfisema lobar congénito. Durante los últimos años se ha visto un aumento en el diagnóstico antenatal y avances en el conocimiento de la patogénesis e historia natural de esta enfermedad, pero aún existe controversia en cuanto a la clasificación a utilizar y a su tratamiento. La mayoría de los recién nacidos (90% son asintomáticos al nacer, pero hay malformaciones que generan serias complicaciones para el feto o recién nacido. El propósito de esta publicación es hacer un resumen actualizado de la historia natural, diagnóstico y tratamiento de las MCPA.

  15. Massas pulmonares bilaterais. Mesma etiologia?

    Directory of Open Access Journals (Sweden)

    C. Damas

    2007-03-01

    Full Text Available Resumo: Os autores descrevem o caso de uma mulher de 50 anos, fumadora. Assintomática até Setembro de 2003, altura em que refere o aparecimento de tosse seca, cansaço e perda de peso. Na radiografia do tórax eram evidentes duas massas, uma no lobo superior direito e outra no lobo lingular. A doente foi submetida a biópsia aspirativa transtorácica e a citologia obtida foi compatível com carcinoma de pulmão do tipo pequenas células. No estadiamento da doença foram identificadas lesões hepáticas secundárias, motivo porque a doença foi considerada como disseminada, dada a existência de lesões hepáticas e pulmonares contra-laterais. Foi, nesta fase, iniciada quimioterapia com carboplatinum e etoposídeo. Seis meses mais tarde, a lesão direita inha diminuído, mas a lesão esquerda apresentava aumento das suas dimensões. A biópsia desta lesão mos-trou uma citologia compatível com adenocarcinoma do pulmão, motivo porque inicia novo ciclo de quimioterapia com vinorelbina e gencitabina. Aos quatro ciclos e por não se evidenciar nenhuma resposta ao tratamento, foi realizada radioterapia da lesão esquerda. Durante este período (28 meses mantém-se assintomática, mantendo a sua actividade diária habitual.De acordo com o momento do diagnóstico as neo-plasias do pulmão podem ser consideradas síncronas ou metácronas. Estas últimas são mais frequentes, re-presentando cerca de 50-70% dos casos, sendo o pa-drão histológico mais frequente o adenocarcinoma.No caso apresentado, a situação parecia ser uma doença disseminada, o que afastou a hipótese de tumores síncronos. Apesar de a doença se apresentar num estádio avançado aquando do diagnóstico e do mau prognósti-co associado, a evolução dos dois tipos de tumor não pareceu comprometer a actividade diária da doente.Rev Port Pneumol 2007; XIII (2: 287

  16. Aggregatibacter aphrophilus pacemaker endocarditis: a case report.

    Science.gov (United States)

    Patel, Sahil R; Patel, Nishi H; Borah, Amit; Saltzman, Heath

    2014-12-08

    Aggregatibacter bacteria are a rare cause of endocarditis in adults. They are part of a group of organisms known as HACEK--Haemophilus, Aggregatibacter, Cardiobacter, Eikenella, and Kingella. Among these organisms, several Haemophilus species have been reclassified under the genus Aggregatibacter. Very few cases of Aggregatibacter endocarditis in patients with pacemaker devices have been reported. We present here what we believe to be the first case of Aggregatibacter aphrophilus pacemaker endocarditis. A 62-year-old African American male with a medical history significant for dual-chamber pacemaker placement in 1996 for complete heart block with subsequent lead manipulation in 2007, presented to his primary care doctor with fever, chills, night sweats, fatigue, and ten-pound weight loss over a four-month period. Physical examination revealed a new murmur and jugular venous distension which prompted initiation of antibiotics for suspicion of endocarditis. Both sets of initial blood cultures were positive for A. aphrophilus. Transesophageal echocardiogram revealed vegetations on the tricuspid valve and the right ventricular pacemaker lead (Figure 1). This case highlights the importance of identifying rare causes of endocarditis and recognizing that treatment may not differ from the standard treatment for typical presentations. The patient received intravenous ceftriaxone for his endocarditis for a total of six weeks. Upon device removal, temporary jugular venous pacing wires were placed. After two weeks of antibiotic treatment and no clinical deterioration, a new permanent pacemaker was placed and the patient was discharged home. This is the first case of A. aphrophilus endocarditis in a patient with a permanent pacemaker. Our patient had no obvious risk factors other than poor dentition and a history of repeated pacemaker lead manipulation. This suggests that valvulopathies secondary to repeated lead manipulation can be clinically significant factors in morbidity

  17. Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Thomson V

    2009-01-01

    Full Text Available A 70-year-old lady presented with recurrent gastrointestinal bleeding and septicemia caused by multiple enteric pathogens. She was diagnosed to have primary aorto-enteric fistula (PAEF complicating abdominal aortic aneurysm. Endovascular aneurysm repair was carried out that arrested gastrointestinal bleeding, but despite prolonged antibiotic therapy the patient died a month later of probable sepsis. PAEF refers to abnormal communication between the aorta and the intestine resulting from disease at either site; this rare condition should be suspected in patients with abdominal aortic aneurysm who present with unexplained life-threatening gastrointestinal bleeding. Computerized tomography is the most sensitive investigation. Presence of ectopic gas adjacent to or within the aorta and of contrast within the gastrointestinal tract is the pathognomonic finding. Definitive treatment consists of surgical intervention, but it is associated with high risk in the acute setting. Endovascular therapy using stent-grafts is safe and effective in arresting gastrointestinal bleeding. However, it is frequently associated with recurrent sepsis even with continued antibiotic therapy, and should be considered as a bridge to more definitive surgical repair at a later time, after optimization of the patient′s condition.

  18. Infective endocarditis - the effect of liposomes as carrier substance ...

    African Journals Online (AJOL)

    1991-05-18

    May 18, 1991 ... Infective endocarditis has a high mortality and morbidity rate despite all available treatment. Little attention has ... Infective endocarditis (lE) is an uncommon but important disease with a rising incidence in .... bacterial endocarditis in infancy, childhood and adolescence. Eur] Pediatr. 1983; 140: 253-259. 6.

  19. Atresia pulmonar con comunicación interventricular

    Directory of Open Access Journals (Sweden)

    Tomasa Centella Hernández

    2014-04-01

    Full Text Available La atresia pulmonar con comunicación interventricular es una cardiopatía congénita cianótica, severa y rara, de alta complejidad, que se caracteriza por la ausencia de conexión entre el ventrículo derecho y las arterias pulmonares. Coexiste con una comunicación interventricular. El flujo hacia el territorio pulmonar puede realizarse a través del ductus arterioso o de colaterales sistémico-pulmonares. La dificultad de esta cardiopatía viene determinada por los diferentes niveles de interrupción desde el ventrículo derecho hasta el territorio pulmonar, y por la diferencia anatómica de las fuentes del flujo hacia dicho territorio, lo que determina diferentes tipos de abordaje quirúrgico.

  20. Streptococcus dysgalactiae endocarditis presenting as acute endophthalmitis

    Directory of Open Access Journals (Sweden)

    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.

  1. Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

    Science.gov (United States)

    Patel, Shivam; Usmani, Abdullah Y.; Muralidhar, K.

    2017-06-01

    Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q-function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m-2 and is lowered to the range ±0.2 N m-2 in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed.

  2. High prevalence of Bartonella quintana endocarditis in Sfax, Tunisia.

    Science.gov (United States)

    Znazen, Abir; Rolain, Jean-Marc; Hammami, Nader; Kammoun, Samir; Hammami, Adnane; Raoult, Didier

    2005-05-01

    Bartonella quintana is a fastidious microorganism associated with blood culture negative endocarditis. In this study, 40 sera with cross-reactivity between Chlamydia species from patients from Sfax, Tunisia, were serologically tested for Bartonella. Thirteen sera were positive for Bartonella with IgG titers >/=1:800. Western blot and cross-absorption confirmed the diagnosis of Bartonella quintana endocarditis in 12 cases and Bartonella henselae endocarditis in 1 case. These sera were also positive by LightCycler nested PCR amplification for the rnpb (7 of 13) and fur (11 of 13) genes. Eleven patients had a definite diagnosis of endocarditis, which represents 9.8% of all endocarditis. Because Bartonella endocarditis seems to be very common in Tunisia, we suggest that its serology be performed systematically whenever endocarditis is suspected.

  3. Le syndrome de la pince aorto-mésentérique: rare, mais pensez-y ...

    African Journals Online (AJOL)

    Le syndrome de la pince aorto-mésentérique «SPAM » ou syndrome de Wilkie, est une obstruction duodénale secondaire à une pince anatomiquement acquise qui résulte de la compression du troisième duodénum par l'artère mésentérique supérieure « AMS » en avant, et l'aorte en arrière suite à la disparition du tissu ...

  4. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    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...

  5. Successful surgical repair of tricuspid valve endocarditis.

    Science.gov (United States)

    Salhiyyah, Kareem; Senanayake, Eshan; Cooper, Graham J

    2010-03-01

    Surgical treatment of tricuspid valve endocarditis is challenging especially in intravenous drug users. We present a case of a 30-year-old male active drug user with anterior leaflet endocarditis treated successfully with valve repair. This was achieved through excision of the vegetation with part of the leaflet. Bovine pericardium was used to close the defect. The edges were reinforced with Teflon pledgeted polytetrafluoroethylene Gore-Tex neochordae (W.L. Gore & Associates, Flagstaff, AZ, USA). An annuloplasty ring was used to reinforce the whole annulus. Repair was competent and the patient recovered well. This technique is simple and effective and should be considered for similar cases.

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

    DEFF Research Database (Denmark)

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

    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...... streptococcal isolates from the oral cavities of periodontal patients without endocarditis. Subsequently, surface hydrophobicity was assessed by hydrophobic interaction chromatography, production of extracellular dextran was determined by precipitation, and non-specific proteolytic activity was evaluated...... and non-endocarditis isolates. CONCLUSIONS: The present study showed that infective endocarditis may be caused by a variety of oral streptococcal species. The possible virulence factors investigated were found in the same proportions in endocarditis and non-endocarditis isolates, and thus did not seem...

  7. Proteinosis alveolar pulmonar Pulmonary alveolar proteinosis

    Directory of Open Access Journals (Sweden)

    Concepción Sánchez Infante

    2011-12-01

    Full Text Available La proteinosis alveolar pulmonar es una enfermedad respiratoria crónica, caracterizada por alteración en el metabolismo del surfactante, lo que determina su acumulación anormal en el espacio alveolar. Es una enfermedad extremadamente rara. Se han reportado solamente 500 casos en la literatura. Se describió por primera vez en 1958. Se presenta un caso de proteinosis alveolar pulmonar en un lactante de 2 meses, con desnutrición proteico energética, que ingresa por dificultad respiratoria e hipoxemia, y, con imágenes radiológicas de tipo retículo-nodulillar, en vidrio deslustrado, en el cual se plantea inicialmente el diagnóstico de bronconeumonía. Ante la evolución desfavorable y no respuesta al tratamiento, se realizó un estudio para descartar enfermedades pulmonares crónicas. El paciente fallece y se confirma el diagnóstico por anatomía patológica. Se realiza una revisión del tema.The pulmonary alveolar proteinosis is a chronic respiratory disease characterized by surfactant metabolism alteration determining its abnormal accumulation in the alveolar space. It is a disease very rare and in literature only 500 cases have been reported; it was described for the first time in 1958. This is a case presentation of pulmonary alveolar proteinosis in an infant aged 2 months with energetic protein malnutrition admitted due to respiratory difficulty and hypoxemia and with radiologic images of the reticulonodulillary, in frosting glass, where initially is made the diagnosis of bronchopneumonia. In the face of unfavorable evolution and no response to treatment, a study was conducted to rule out chronic pulmonary diseases. Patient died confirming the diagnosis according to the pathologic anatomy. A review on subject is carried out.

  8. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature.

    Science.gov (United States)

    Uno, Kaname; Koike, Tomoyuki; Takahashi, Seiichi; Komazawa, Daisuke; Shimosegawa, Tooru

    2017-10-01

    Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.

  9. Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Terranova Antonio

    2005-09-01

    Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, in patients with pacemaker or central venous lines and in patients with congenital heart disease. The vast majority of cases involve the tricuspid valve. Eustachian valve endocarditis is an uncommon disease with similar signs and symptoms of the tricuspid valve endocarditis. A series of only 16 cases of eustachian valve endocarditis are reported in the literature. Case Presentation We present a case of a 25-year old woman with intravenous drug abuse who had a staphylococcus aureus tricuspid valve endocarditis associated to eustachian valve endocarditis. Transthoracic echocardiography, as first line examination, showed the vegetations on tricuspid and eustachian valve. Conclusion Our case describe an unusual location of right side endocarditis in a intravenous drug abuser. In our case, in accord with other cases described in the literature, transthoracic echocardiography disclosed eustachian valve endocarditis. Antimicrobial management is not altered by the recognition of eustachian valve endocarditis. Antibiotic treatment and duration of eustachian endocarditis depends on the isolated organism and is similar to antibiotic therapy used in native valve endocarditis.

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

    DEFF Research Database (Denmark)

    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 cases...... with PE, 67% needed acute valve replacement and the mortality rate was 33%. CONCLUSIONS: The high incidence rate, clinical characteristics and grave prognosis of PE are consistent with another study of an Inuit population in Alaska....

  11. Hemosiderosis pulmonar idiopática

    Directory of Open Access Journals (Sweden)

    Marlen Rivero González

    2012-09-01

    Full Text Available Se denomina hemosiderosis pulmonar a los procesos caracterizados por depósitos anormales de hemosiderina en el parénquima pulmonar, secundarios a sangrados alveolares difusos y repetidos. Es una enfermedad de causa desconocida, poco frecuente, y en muchas ocasiones grave. En la mayoría de los pacientes se presenta en la primera década de la vida, sin predilección en cuanto a sexo. Se presenta una paciente de 7 años de edad, femenina, de piel blanca, con antecedentes de 22 ingresos desde la etapa de lactante por episodios recurrentes de dificultad respiratoria, interpretados como bronconeumonías, asociados a anemia aguda. Para el diagnóstico se realizó lavado broncoalveolar, y se observaron los macrófagos cargados de hemosiderina. La evaluación clínica y de laboratorio permitió excluir causas secundarias. Se instauró tratamiento con prednisona, con lo cual se logró una mejoría de la enfermedad. Se discuten los elementos clínicos, diagnósticos y terapéuticos de esta entidad.

  12. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  13. Return to the workforce following infective endocarditis

    DEFF Research Database (Denmark)

    Butt, Jawad H.; Kragholm, Kristian; Dalager-Pedersen, Michael

    2018-01-01

    Background The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age. Methods Using Danish...

  14. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

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

    2011-01-01

    -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...

  15. A misinterpreted case of aorta prosthesis endocarditis

    DEFF Research Database (Denmark)

    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 structur...

  16. Infective endocarditis following transcatheter aortic valve replacement-

    DEFF Research Database (Denmark)

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

    2013-01-01

    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 successfully...

  17. Spondylodiscitis and endocarditis caused by S. vestibularis

    Directory of Open Access Journals (Sweden)

    Muge Aydin Tufan

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

  18. Serological diagnosis of experimental Enterococcus faecalis endocarditis

    DEFF Research Database (Denmark)

    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...

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

    Science.gov (United States)

    Rattanavong, Sayaphet; Fournier, Pierre-Edouard; Chu, Vang; Frichitthavong, Khamthavy; Kesone, Pany; Mayxay, Mayfong; Mirabel, Mariana; Newton, Paul N

    2014-12-01

    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 Bartonella

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

    Directory of Open Access Journals (Sweden)

    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

  1. Aneurismas de la arteria pulmonar. Reporte de un caso y revisión de la literatura Aneurysm of the pulmonary artery. A case report and literature review

    Directory of Open Access Journals (Sweden)

    Rosalba Vivas

    2011-07-01

    Full Text Available Los aneurismas de la arteria pulmonar son poco frecuentes en niños. Entre sus principales causas se encuentran procesos infecciosos como la endocarditis, que favorece el desarrollo de aneurismas micóticos, en especial en pacientes con defectos cardíacos congénitos y en aquellos con adicción a drogas de uso endovenoso (sobre todo en adultos, y lleva al desarrollo de aneurismas micóticos. Las opciones de tratamiento dependen de las características de la lesión y de la condición clínica del paciente. Se presenta el caso de una paciente de siete años, quien fue referida para evaluación por endocarditis infecciosa de la válvula tricúspide debida a Staphylococcus aureus. Desarrolló aneurismas bilaterales en ramas lobulares de la arteria pulmonar secundarios a la infección valvular. El aneurisma del lado derecho era de gran tamaño y con alto riesgo de ruptura, razón de peso para que se le efectuara embolización con coils. El procedimiento fue exitoso y no se documentaron complicaciones. La lesión del lado izquierdo se trató de forma expectante teniendo en cuenta que era de menor tamaño. En la actualidad la paciente está en seguimiento ambulatorio con el fin de vigilar la evolución del aneurisma del lado izquierdo.Pulmonary artery aneurysms are infrequent in children. Among its main causes are infectious processes such as endocarditis which favors the development of mycotic aneurysms especially in patients with congenital heart defects and in those with endovenous drug addiction (mainly in adults that develop mycotic aneurysms. Treatment options depend on the characteristics of the lesion and the clinical condition of the patient. We present the case of a seven year old female patient who was referred for evaluation of infectious endocarditis of the tricuspid valve due to Staphylococcus aureus. She developed bilateral aneurysms in lobular branches of the pulmonary artery secondary to the valve infection. The right aneurysm was

  2. Measurement of free radicals using electron paramagnetic resonance spectroscopy during open aorto-iliac arterial reconstruction.

    Science.gov (United States)

    Majewski, Wacław; Krzyminiewski, Ryszard; Stanisić, Michał; Iskra, Maria; Krasiński, Zbigniew; Nowak, Marek; Dobosz, Bernadeta

    2014-11-27

    Aortic cross-clamping during abdominal aortic aneurysm (AAA) open repair leads to development of ischemia-reperfusion injury. Electron paramagnetic resonance spectroscopy (EPR) spin-trapping is a valuable method of direct measurement of free radicals. The objective of the study was to evaluate the results of EPR as a direct method of free radical measurement and degree of inflammatory response in open operative treatment of patients with AAA and aorto-iliac occlusive disease (AIOD). The study was performed on a group of 32 patients with AAA and 25 patients with AIOD scheduled for open repair. Peripheral venous blood for EPR spectroscopy and for SOD, GPx, ox-LDL, Il-6, TNF-alfa, CRP, and HO-1 were harvested. Selected parameters were established accordingly to specified EPR and immunohistochemical methods and analyzed between groups by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test with Bonferroni correction. Free radicals level was correlated with the time of the aortic cross-clamping after the reperfusion of he first and second leg in AAA (r=0.7; r=0.47). ox-LDL in AAA decreased 5 min after reperfusion of the first leg (32.99 U/L, range: 14.09-77.12) and 5 min after reperfusion of the second leg (26.75 U/L, range: 11.56-82.12) and 24 h after the operation (25.85 U/L, range: 14.29-49.70). HO-1 concentration increased to above the level before intervention 24 h after surgery. The activities of GPx and SOD decreased 5 min after the first-leg reperfusion in AAA. Twenty-four hours after surgery, inflammatory markers increased in AAA to CRP was 14.76 ml/l (0.23-38.55), IL-6 was 141.22 pg/ml (84.3-591.03), TNF-alfa was 6.82 pg/ml (1.76-80.01) and AIOD: CRP was 18.44 mg/l (2.56-33.14), IL-6: 184.1 pg/ml (128.46-448.03), TNF-alfa was 7.74 pg/ml (1.74-74.74). EPR spin-trapping demonstrates temporarily elevated level of free radicals in early phase of reperfusion, leading to decrease antioxidants in AAA. Elevated free radical levels decreased 24 h after

  3. Complicación pulmonar de las infestaciones parasitarias

    Directory of Open Access Journals (Sweden)

    Aquiles Penuela Rozo

    1949-07-01

    Full Text Available La literatura de los cinco últimos años presenta numerosos informes de complicación pulmonar por parásitos animales. Estos parásitos causan complicación pulmonar por tres vías diferentes: l.-Por medio de la larva migratoria mientras pasa al través de los pulmones. 2.-Por una acción directa del parásito adulto sus larvas migratorias o sus huevos. 3.-Por una acción indirecta (Toxina o acción anafiláctica. Como el espacio no permite el estudio de tántos parásitos, tengo que limitarme a un solo parásito, el Strongyloides, estudiarlo en detalle con referencia especial al ataque pulmonar producido por él comparándolo con el ataque pulmonar producido por el Ascaris.

  4. Embolectomía en una embolia pulmonar aguda masiva

    Directory of Open Access Journals (Sweden)

    Manuel Carnero Alcázar

    2007-07-01

    Full Text Available Presentamos el caso de un varón de 57 años que, en el seno de un meningioma microcítico, padece una tromboembolia pulmonar masiva aguda con inestabilidad hemodinámica. Dado el riesgo de hemorragia por el tumor craneal, se contraindica la terapia fibrinolítica y se procede a practicar embolectomía pulmonar. Ésta se realiza bajo anestesia general, con canulación convencional y bajo hipotermia moderada. Se extrae émbolo en el tronco de la arteria pulmonar y con catéter de Fogarty se extraen émbolos en ramas lobares y segmentarias. Discutimos la asociación de enfermedad tromboembólica con determinadas neoplasias y el tratamiento de la tromboembolia pulmonar

  5. Subacute bacterial endocarditis (SBE due to Streptococcus gordonii

    Directory of Open Access Journals (Sweden)

    Raffaella Battista

    2009-12-01

    Full Text Available Endocarditis is an inflammatory state of the endothelium that promotes thrombus formation and tissue damage on the surface of heart valves. Recent studies have reported endocarditis mortality rates ranging from 12% to 46% (2008. The Streptococcus gordonii is a normal inhabitant of the human oral cavity. It is a component of the microbial communities responsible of plaque formation, associated with dental caries and also regarded as the main causative agent in the development of subacute bacterial endocarditis (SBE.

  6. Dentigenous infectious foci ? a risk factor of infective endocarditis

    OpenAIRE

    Wisniewska-Spychala, Beata; Sokalski, Jerzy; Grajek, Stefan; Jemielity, Marek; Trojnarska, Olga; Choroszy-Kr?l, Irena; S?jka, Anna; Maksymiuk, Tomasz

    2012-01-01

    Summary Background Dentigenous, infectious foci are frequently associated with the development of various diseases. The role of such foci in the evolution of endocarditis still remains unclear. This article presents the concluding results of an interdisciplinary study verifying the influence of dentigenous, infectious foci on the development of infective endocarditis. Material/Methods The study subjects were 60 adult patients with history of infective endocarditis and coexistent acquired hear...

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

    International Nuclear Information System (INIS)

    Parietti, G; Artucio, C.; Fernandez, A; Areco, D.; Mallo, D; Lluberas, R.

    2012-01-01

    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

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

    Science.gov (United States)

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

    2000-01-01

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


Keywords: endocarditis; Aspergillus niger; transoesophageal echocardiography PMID:10644391

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

    Science.gov (United States)

    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".

  10. Factores de riesgo de mortalidad precoz del Trasplante Pulmonar

    OpenAIRE

    Kreis Esmendi, Germán

    2006-01-01

    Consultable des del TDX Títol obtingut de la portada digitalitzada A pesar de la experiencia acumulada, la mortalidad postoperatoria temprana del trasplante pulmonar continua siendo elevada. Los factores asociados a este evento permanecen siendo controvertidos. Objetivo: Revisar la serie de trasplantes pulmonares realizados en el Hospital Vall d' Hebron para establecer la supervivencia acumulada e identificar los factores asociados con riesgo de mortalidad postoperatoria precoz. Pacient...

  11. Idade pulmonar em mulheres com obesidade mórbida

    Directory of Open Access Journals (Sweden)

    Fabiana Sobral Peixoto-Souza

    2013-06-01

    Full Text Available OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos às eutróficas (38,8 ± 11,4 anos. Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente. Houve uma correlação negativa entre a capacidade vital forçada (CVF, volume expiratório forçado no primeiro segundo (VEF1, razão (VEF1/CVF e volume de reserva expiratório (VRE com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente. CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.

  12. Edema pulmonar agudo neurogênico: relato de caso

    OpenAIRE

    Brito,José Correia De Farias; Diniz,Maria Cerly Almeida; Rosas,Roberto Ramalho; Silva,José Alberto Gonçalves Da

    1995-01-01

    Os autores apresentam um caso de edema pulmonar agudo numa paciente de 28 anos de idade acometida de hemorragia subaracnóidea secundária à rotura de aneurisma intracraniano. A sintomatologia respiratória ocorreu durante o agravamento do quadro neurológico. Alguns aspectos etiológicos e fisiopatogênicos do edema pulmonar agudo neurogênico são analisados.

  13. Left atrial endocarditis as a rare complication of mitral valve endocarditis: a clinical case

    Directory of Open Access Journals (Sweden)

    Hamadanchi Ali

    2012-11-01

    Full Text Available Abstract Background Infective Endocarditis (IE is considered as a multifaceted problem in every aspect from etiology and presentation to diagnosis and management. Early recognition of this disease and especially its complications, remain a critical task for the cardiologist. Atrial endocarditis is a rare and sometimes unrecognized complication of mitral valve endocarditis. Case presentation We present a 48 year-old male patient who was admitted to our clinic because of recent onset of malaise, fever, jaundice and peripheral edema. Important physical findings were peripheral stigmata of IE in addition to holosystolic murmur over the left sternal border. Transthoracic and transesophageal echocardiophy revealed a severe eccentric MR due to a flailed posterior mitral valve caused by IE. The presence of atrial septal endocarditis caused by jet streaming was also observed. Blood culture was positive for streptococcus oralis and antibiotic therapy was immediately initiated. Considering the large burden of infective tissue, the patient was planned for an early surgical intervention. A minimally invasive resection of the atrial mass, direct closure of the defect, resection of the diseased portions of mitral leaflets and implantation of a biological mitral valve prosthesis was performed. Intra-operative and histological findings confirmed provisional diagnosis by echocardiography. Conclusions Together with comprehensive echocardiographic evaluation, attention should be placed on mural vegetations and excluded among all cases of mitral valve endocarditis, particularly those with severe eccentric regurgitant jets.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone

    Directory of Open Access Journals (Sweden)

    José Pedro Fonseca

    2018-01-01

    Full Text Available Objectives: To report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone. Materials and methods: We describe a clinical case and present a review of the literature. Results: A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported. Conclusion: Prosthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone.

  16. Clinical outcome and echocardiographic findings of native and prosthetic valve endocarditis in the 1990's.

    Science.gov (United States)

    Schulz, R; Werner, G S; Fuchs, J B; Andreas, S; Prange, H; Ruschewski, W; Kreuzer, H

    1996-02-01

    Prosthetic valve endocarditis is considered to be associated with a more severe prognosis than native valve endocarditis. Among other factors, inappropriate visualization of vegetations in prosthetic valve endocarditis by transthoracic echocardiography is responsible for this observation. Since the introduction of transoesophageal echocardiography into clinical practice the diagnostic sensitivity and specificity of the detection of vegetations located on prosthetic valves have been enhanced. Therefore we aimed to determine and compare the prognosis of prosthetic valve endocarditis and native valve endocarditis in the era of this improved diagnostic approach. One hundred and six episodes of infective endocarditis in 104 patients were seen at our institution between 1989 and 1993. Eighty patients (77%) had native valve endocarditis and 24 (23%) had late prosthetic valve endocarditis. In the latter group two patients had recurrent infective endocarditis. Patients with prosthetic valve endocarditis were older (mean age 64 vs 54 years in native valve endocarditis; P < 0.001) and the majority was female (62% vs 38% in native valve endocarditis; P < 0.05). In prosthetic valve endocarditis, infection of a valve in the mitral position predominated (65% vs 30% in native valve endocarditis; P < 0.01), whereas in native valve endocarditis more than half the cases had isolated aortic valve endocarditis (51% vs 27% in prosthetic valve endocarditis; P < 0.01). In prosthetic valve endocarditis more cases were caused by Staphylococcus aureus (31% vs 14% in native valve endocarditis; P = 0.08), whereas in native valve endocarditis the most frequent organisms were streptococci (29% vs 19% in prosthetic valve endocarditis; P = 0.12). Differences in the clinical features of native valve endocarditis and prosthetic valve endocarditis could not be found except for a higher rate of embolism in native valve endocarditis (40% vs 19% in prosthetic valve endocarditis; P < 0.05). Vegetations

  17. Triple valve infective endocarditis - a late diagnosis

    Directory of Open Access Journals (Sweden)

    Edme R. Mustafa

    2018-04-01

    Full Text Available Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation. The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and evaluation of rheumatic diseases and permits optimal management in daily practice.

  18. Infectious endocarditis caused by Escherichia coli

    DEFF Research Database (Denmark)

    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...

  19. Infective endocarditis with spondylodiscitis after prostate biopsy

    Directory of Open Access Journals (Sweden)

    Fernando Pivatto Júnior

    2014-04-01

    Full Text Available Transrectal ultrasonography-guided prostate needle biopsy is the ideal method to obtain prostate specimens for histological analysis and is therefore frequently used in clinical practice. In the majority of the studies, prostate biopsy is considered a safe procedure with few major complications. In the present report, we describe a case of endocarditis with spondylodiscitis, two very rare complications of prostate biopsy.

  20. Mitral valve endocarditis during brucellosis relapse

    Directory of Open Access Journals (Sweden)

    Obrenović-Kirćanski Biljana

    2012-01-01

    Full Text Available Introduction. Endocarditis is the most common cardiovascular manifestation of brucellosis with high mortality rate. Brucella is less accesable to antibiotic (but not for all and relapse can occur after a various period of clinical latency. Case report. A 55-year-old farmer was diagnozed with acute systemic Brucella infection in May 2008 and treated with antibiotic therapy in regional hospital for two months and for three months after discharge. He began to feel myalgia, arthralgia, malaise, shortness of breath, abdominal pain, vomiting, diarrhoea and lost weight eight months after initial symptoms occured. Because symptoms progressed he was admitted to our hospital in February 2009. Based on a combination of epidemiological, clinical data (on admission he was catchetic, adynamic, dyspneic, hypotensive 80/50 mmHg, fever up to 39.50C, positive serological Wright test for brucellosis (1 : 5,120, and echocardiographic examination findings, the diagnosis of very severe relapse of brucellosis with mitral valve endocarditis, complicated with perforation of anterior mitral leaflet, severe mitral regurgitation and pulmonary hypertension was established. He was treated with a combined triple antibiotic therapy (vancomycin, ciprofloxacin and gentamicin, and swiched to regimen with doxycycline, gentamicin and imipenem, replacing gentamicin by rifampicin for 4 weeks and for the next 2 weeks was receiving trimetoprime/sulfamethoxazole and rifampicin. The patients' condition was improved and he was operated. The diagnosis of infective endocarditis was confirmed intraoperatively. Mitral valve replacement was performed, and combined triple antibiotic treatment (amikacin + ciprofloxacin + cefazolin, for 2 weeks and cephazolin + doxycycline + rifampicin, for 2 weeks was continued, following with two antibiotics (doxycycline + rifampicin for 5 months. The patient completely recovered without any signs of infection 30 months postoperatively. Conclusion. A combined

  1. Tricuspid valve endocarditis caused by Eikenella corrodens

    Directory of Open Access Journals (Sweden)

    Martin Tretjak

    2015-06-01

    Full Text Available AbstractBackground. Infectious endocarditis of the tricuspid valve is rare in non-intravenous drug users and patients without central venous devices. The most frequent causative agents are staphylococci, rarely other bacteria.Methods. We describe a case of a 57-year-old patient without history of drug abuse that was admitted to our hospital because of fever with chills, dry cough, loss of appetite and wasting lasting for a few months. He had a venous ulcer on the right foot and interdigital inflammation on both feet. Eikenella corrodens was isolated from blood cultures. Transthoracic echocardiography showed a large vegetation on the anterior leaflet of tricuspid valve. CT scan oh the thorax showed probable septic emboli. The patient was treated conservatively with prolonged double antibiotic regimen. During the treatment there were no further complications.Conclusions. In our patients a rare form of tricuspid valve endocarditis was confirmed, caused by Eikenella corrodens. The possibility of infectious endocarditis should always be considered in patients with prolonged fever, especially when a possible causative agent is isolated from blood cultures.

  2. Rehabilitación pulmonar en hipertensión pulmonar

    OpenAIRE

    Vilma Gómez; Alejandro Casas

    2017-01-01

    El manejo del paciente con hipertensión pulmonar es complejo y requiere de un equipo interdisciplinario. Es trascendental que los programas de rehabilitación cuenten con neumólogo, fisioterapeutas entrenados, psicólogos, profesionales en trabajo social, nutrición y enfermería. Para el ingreso al programa los pacientes deben contar con manejo farmacológico óptimo y prueba de ejercicio cardiopulmonar integrada o prueba de caminata de seis minutos para determinar la condición basal, las causas d...

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

    Directory of Open Access Journals (Sweden)

    Mahapatra A

    2003-01-01

    Full Text Available Of all the causes of bacterial endocarditis, HACEK group consisting of Haemophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella Kingae are rare causative agents. We report a case of bacterial endocarditis by E. corrodens, which is one of the members of the HACEK group.

  4. Very late-onset lead-associated endocarditis

    Directory of Open Access Journals (Sweden)

    Min-Soo Cho

    2011-01-01

    Full Text Available Lead-associated endocarditis is a serious complication due to device implantation. The present article reports on a case involving a 57-year-old man with microbiologically and pathologically confirmed lead-associated endocarditis caused by Staphylococcus capitis. Transesophageal echocardiography is essential for diagnosis, and treatment usually requires appropriate antibiotics and removal of the lead.

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

    Directory of Open Access Journals (Sweden)

    Pablo M. A Pomerantzeff

    1993-12-01

    Full Text Available O comprometimento valvar direto do coração pela endocardite infecciosa, com indicação cirúrgica, tem sido classicamente tratada por excisão da valva e tecidos adjacentes comprometidos, associada ou não a implante de prótese. Dois casos de operação conservadora em endocardite infecciosa da valva tricúspide com 42 e 3 meses de evolução são descritos. Os autores discutem as vantagens de, quando possível, não retirar toda a valva tricúspide na endocardite bacteriana.Valve replacement and excision without using a prosthesis are the two mostfrequently used surgical techniques for the treatment of infective endocarditis of the tricuspid valve. Conservative operation with preservation of the native valve and resection of the infected tissue is a more recent approach, which is becoming the procedure of choice whenever feasible, specialy in intravenous drug abusers. Two cases of tricuspid valve reconstruction with good results are reported. One of the patients has also been aorto coronary bypassed at the same operation time.

  6. Mycobacterium abscessus Endocarditis: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Wei-Chung Tsai

    2008-09-01

    Full Text Available Infective endocarditis owing to Mycobacterium abscessus infection is rarely reported. Most cases of infective endocarditis caused by Mycobacterium abscessus are seen in patients after valve replacement. Although early surgical intervention is recommended and medical treatment with antibiotics according to the susceptibility to the pathogen, such as amikacin, imipenem, cefoxitin, quinolones and macrolides, are applied, the course of such endocarditis is usually subacute and often has fatal outcomes. The present case was a 29-year-old male patient who was an intravenous drug user who had recurrent endocarditis caused by Mycobacterium abscessus. Unusually, our reported case was infected on his native valve. However, we experienced recurrence despite antimicrobial therapy. For culture-negative endocarditis, physicians should consider the possibility of Mycobacterium abscessus infection and related treatment difficulties.

  7. Virulence Factors Associated with Enterococcus Faecalis Infective Endocarditis

    DEFF Research Database (Denmark)

    Madsen, Kristian T; Skov, Marianne N; Gill, Sabine

    2017-01-01

    been associated with E. faecalis infective endocarditis. Absence of these factors entailed attenuation of strains in both mixed- and mono-bacterial infection endocarditis models as well as in in vitro and ex vivo assays when compared to their virulence factor expressing parental strains. PATHOGENESIS......INTRODUCTION: The enterococci are accountable for up to 20% of all cases of infective endocarditis, with Enterococcus faecalis being the primary causative isolate. Infective endocarditis is a life-threatening infection of the endocardium that results in the formation of vegetations. Based...... on a literature review, this paper provides an overview of the virulence factors associated with E. faecalis infective endocarditis. Furthermore, it reports the effects of active or passive immunization against some of these involved factors. INDIVIDUAL VIRULENCE FACTORS: Nine virulence factors have in particular...

  8. Clinical Risk Factors for Infective Endocarditis in Staphylococcus aureus Bacteremia.

    Science.gov (United States)

    Salvador, Vincent Bryan D; Chapagain, Bikash; Joshi, Astha; Brennessel, Debra J

    2017-02-01

    Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis. In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography. The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis. There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus ( P =0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker ( P =0.006) or a prosthetic heart valve ( P =0.003), and recent hospitalization ( P =0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia. The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups ( P =0.437). In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis. Early evaluation with transesophageal echocardiography might well be warranted.

  9. Diagnóstico precoz de enfermedades pulmonares por tabaquismo

    Directory of Open Access Journals (Sweden)

    Dr. D. Rodrigo Gil

    2010-09-01

    Full Text Available El tabaquismo es una epidemia y en Chile la prevalencia no ha disminuido. Entre las causas más importantes de muerte por tabaquismo están el cáncer pulmonar y la enfermedad pulmonar obstructiva crónica (EPOC. La erradicación del tabaquismo es la mejor estrategia de prevención de estas enfermedades. La segunda estrategia es la detección precoz de ellas. Sin embargo la EPOC está sub diagnosticada en todo el mundo. No está claro si la solución es hacer más espirometrías en población de riesgo. Es posible que otros métodos diagnósticos como la tomografía axial computada de tórax (TAC y la difusión pulmonar, puedan mejorar la capacidad de diagnóstico precoz de esta enfermedad. El cáncer pulmonar es el más mortal de los cánceres. El diagnóstico en etapas tempranas mejora significativamente su pronóstico. Hay varios estudios en curso que evalúan el beneficio de hacer pesquisa de cáncer pulmonar con TAC.

  10. Actualizacin en el diagnstico y tratamiento de la hipertensin pulmonar

    Directory of Open Access Journals (Sweden)

    Juan A. Mazzei

    2011-05-01

    Full Text Available El trmino hipertensin pulmonar agrupa a un conjunto heterogneo de enfermedades que tienen en comn una remodelacin obstructiva del lecho vascular pulmonar. Esta alteracin provoca un estado hemodinmico caracterizado por una elevacin sostenida de la presin del circuito arterial pulmonar. La morbilidad y mortalidad de esta enfermedad son la consecuencia del fracaso de la compensacin del ventrculo derecho a este aumento de la poscarga. La presuncin clnica y el diagnstico precoz, una estratificacin adecuada basada en las causas subyacentes y los diferentes territorios vasculares comprometidos, la respuesta a los frmacos y el grado de gravedad, la seleccin de las diferentes alternativas teraputicas y su indicacin oportuna son los objetivos para el tratamiento contemporneo ptimo de los enfermos con hipertensin pulmonar y ser una importante tarea en el futuro. Estas recomendaciones estn destinadas al mdico general y tienen por objeto facilitar la deteccin precoz, el diagnstico y el tratamiento de los pacientes con hipertensin pulmonar, y pueden representar una diferencia significativa en el pronstico. Adems, como la evaluacin diagnstica requiere exmenes complementarios que habitualmente no estn disponibles en todas las instituciones asistenciales, tambin pueden ser utilizadas como fundamento para solicitar la derivacin oportuna a centros asistenciales de referencia.

  11. Hipertensión pulmonar postparto

    Directory of Open Access Journals (Sweden)

    Juan Pablo Escalante

    2015-02-01

    Full Text Available La presencia de hipertensión pulmonar (HP en el embarazo es poco frecuente y conlleva un alto riesgo para madres e hijos. Existe escasa bibliografía relacionada al diagnóstico de la misma luego del parto. Se describen tres pacientes a quienes se diagnostica HP luego de cursar sus embarazos y partos libres de eventos. A pesar de desconocerse las causas, son varios los mecanismos propuestos, como la hipercoagulabilidad, la hipoxia placentaria o la embolia de líquido amniótico. Resulta difícil definir si la HP diagnosticada en el puerperio, corresponde a una HP en período asintomático que fue desenmascarada por el estrés fisiológico del parto o es una condición de reciente comienzo. A pesar de la falta de datos que avalen la ausencia de HP previa al embarazo en nuestras tres casos, el curso libre de eventos en sus embarazos, sin síntomas y con partos normales, indican que no padecían esta enfermedad hasta el momento del parto, y que la desarrollaron posteriormente. De haberla padecido antes se hubieran presentado síntomas previos al parto o en el puerperio inmediato, ya que las demandas hemodinámicas deterioran gravemente a un ventrículo con poca reserva.

  12. Tratamiento acortado estrictamente supervisado para tuberculosis pulmonar

    Directory of Open Access Journals (Sweden)

    Alvarez-Gordillo Guadalupe del Carmen

    1998-01-01

    Full Text Available Objetivo. Evaluar la posibilidad de aplicar el tratamiento acortado estrictamente supervisado (TAES en el Programa de Control de la Tuberculosis en Chiapas, México. Material y métodos. Se evaluó la eficacia y la eficiencia del tratamiento en una cohorte de pacientes con tuberculosis pulmonar confirmada por baciloscopía, que ingresaron a tratamiento con esquemas de autoadministración semisupervisión y estricta supervisión, de enero a junio de 1996. Resultados. La eficacia fue de 90.9. 97.7 y 100% para los esquemas de tratamiento autoadministrado, semisupervisado y TAES, respectivamente, mientras que la eficiencia fue de 68.1. 77.6 y 88.5% en el mismo orden. Conclusiones. Para la salud pública el TAES demostró ser la actividad más importante en el control de la tuberculosis, al elevar las tasas de curación y disminuir, por lo tanto, las fuentes de transmisión de la enfermedad.

  13. Enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Reinaldo Pino Blanco

    2011-01-01

    Full Text Available La enfermedad pulmonar obstructiva crónica se ha convertido en una de las enfermedades crónicas atendidas con mayor frecuencia en la atención primaria de salud. Produce altas tasas de morbilidad y mortalidad en todo el mundo, con una evolución lenta aunque progresivamente mortal, a pesar de tratarse de una enfermedad prevenible, que depende en gran medida, del hábito de fumar. La prevalencia variará según el consumo de tabaco, y se espera que siga aumentando en los próximos 25 años. La mortalidad y morbilidad son cada vez mayores, lo que supone un enorme gasto sanitario, social y personal, pero es una enfermedad potencialmente modificable, motivo por el que requiere de un abordaje multifactorial.Chronic Obstructive Pulmonary Disease has become one of the most frequently treated chronic diseases in primary health care. High rates of morbidity and mortality are worldwide related to this disease. Although it is a preventable disease closely related to smoking, its evolution is slow but progressively fatal. Prevalence varies according to tobacco consumption and is expected to increase in the next 25 years. Even when it is a potentially modifiable disease, mortality and morbidity are also increasing, causing a major health, social and personal spending. For all these reasons, a multifactorial approach is needed both, for health and social issues.

  14. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Christopher C .C. Hudson

    2014-01-01

    Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

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

    Directory of Open Access Journals (Sweden)

    Ebru Kursun

    2015-03-01

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

  16. Micetoma pulmonar por Scedosporium sp, reporte de dos casos

    Directory of Open Access Journals (Sweden)

    José G. Somocurcio

    2009-07-01

    Full Text Available Se reporta los dos primeros casos de micetoma pulmonar por Scedosporium sp, en el Perú, tratados quirúrgicamente en el Hospital Nacional Hipólito Unanue. Se practicó resección pulmonar debido a micetoma pulmonar de donde se tomó muestras que fueron enviadas a microbiología y anatomía patológica para cultivo y estudio histopatológico. Se identificó el moho Scedosporium sp en dos pacientes con secuelas cavitarias por tuberculosis, quienes presentaron tos y hemoptisis de dos meses y tres años de evolución, respectivamente. Radiológicamente las cavidades estaban ocupadas por una "bola fúngica". La histopatología indicó presencia de abundantes hifas, indistinguibles de las de Aspergillus sp, mientras que la inmunodifusión para Aspergillus fue negativa.

  17. The Changing Epidemiology of Pediatric Endocarditis.

    Science.gov (United States)

    Elder, Robert W; Baltimore, Robert S

    2015-09-01

    The epidemiology of infective endocarditis (IE) appears to be related to changes in the management of children with congenital heart disease (CHD) and the virtual disappearance of rheumatic heart disease. To better understand these changes, we divide the history into: I. The pre-surgical era, II. The early years of CHD surgical intervention, correlated with introduction of antibiotics, III. The modern era of cardiac interventions. Microbiologic changes include an early predominance of viridans streptococci and an overtaking by staphylococci. Additionally, there have been advances in imaging that allow earlier detection of IE and a reduction in IE-related mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Tromboendarterectomía pulmonar en el tratamiento de la hipertensión pulmonar tromboembólica crónica

    OpenAIRE

    José Antonio Blázquez; José María Cortina; Enrique Pérez; Alberto Forteza; María Jesús López; Jorge Centeno; Enrique Ruiz; Carlos Esteban Martín; Javier de Diego; Juan José Rufilanchas

    2007-01-01

    La tromboendarterectomía pulmonar representa el tratamiento potencialmente curativo de la hipertensión pulmonar tromboembólica crónica. Material y método: Entre febrero de 1996 y mayo de 2006, 20 pacientes con hipertensión pulmonar tromboembólica crónica fueron sometidos a tromboendarterectomía pulmonar. El 90% (18/20) presentaba clase funcional III-IV. Los datos hemodinámicos preoperatorios son: presión sistólica pulmonar 86 ± 17 mmHg, presión arterial pulmonar media 49 ± 9 mmHg, resisten...

  19. [Simultaneous pulmonar, laryngeal and lingual affectation by Mycobacterium tuberculosis].

    Science.gov (United States)

    Díaz Manzano, J A; Castillo Romero, J L; Padilla Romero, M J; Sánchez Laínez, J J; Castillo Aguilar, C; Cegarra Navarro, M F

    2007-01-01

    The incidence of tuberculosis has lately increased in developed countries. The most frequent affectation is the pulmonar one and in the ORL area the laryngeal. The lingual affectation is exceptional. We present a case of a man 39 years old, with bilateral pulmonar, left vocal cord and mobile tongue affectation, negative Mantoux, positive spit culture and presence of acido-alcohol resistent bacillus in lingual and laryngeal biopsies. After antituberculosis treatment during 6 months the laryngeal and lingual lesions disappeared. We have only found two cases published of simultaneous tuberculosis in these three localisations in the last 30 years.

  20. Tuberculosis Amigdalina con foco pulmonar primario: Reporte de un caso

    OpenAIRE

    Lugo Machado, Juan Antonio; Canche Martin, Edwin

    2015-01-01

    La tuberculosis en una enfermedad infecciosa que afecta a varios órganos y tejidos del cuerpo, teniendo mayor tropismo por afección pulmonar, gastrointestinal y sistema nervioso central, e incluso tejido óseo, sin embargo se han reportado casos aislados de afección a otras estructuras en diferentes reportes de casos,  de la misma forma  en el que se presenta  un paciente que acudió con síntomas a nivel deltejido amigdalino y posteriormente se evidenció involucramiento pulmona,r considerándose...

  1. Nuevas intervenciones en hipertensión arterial pulmonar

    OpenAIRE

    Juan Esteban Gómez Mesa

    2017-01-01

    El manejo farmacológico de la hipertensión arterial pulmonar se basa en agentes que actúan en tres vías principales: endotelina 1, prostaglandina I2 y óxido nítrico. La mayoría de estudios clínicos para aprobación de medicamentos desarrollados para tratar esta condición, han sido cortos y enfocados en el cambio en la caminata de 6 minutos. Al tener en cuenta que las diferentes formas de hipertensión arterial pulmonar tienen como denominador común para las alteraciones moleculares y celulares ...

  2. La tuberculosis pulmonar, enfermedad reemergente en Cuba

    Directory of Open Access Journals (Sweden)

    Margarita González Tapia

    2014-08-01

    Full Text Available Sr. Editor: La tuberculosis es una de las enfermedades remergentes en Cuba; por ello en todas las provincias cubanas se trabaja con mucha fuerza, dedicación y profesionalidad con respecto a esta problemática. En este contexto, resulta muy acertada la publicación del artículo “Algunas variables clínico-epidemiológicas de la tuberculosis pulmonar. Puerto Padre, 2008-2012”, que salió en el Vol.38 No.6.01 del mes de junio de 2013 de la Revista Electrónica Dr. Zoilo E. Marinello Vidaurreta; tanto por el significado social que reviste la divulgación de este tema, como por el propio resultado de la investigación realizada. La historia de la tuberculosis es un tema apasionante. En pocas enfermedades es posible documentar su estrecha relación con la historia de la propia humanidad como en la que nos ocupa. Existen evidencias paleológicas de tuberculosis vertebral en momias egipcias que datan aproximadamente del año 2400 a.C. La tuberculosis se ha conocido a través de la historia, con los nombres de: tisis, consunción, escrófula, mal de Pott, plaga blanca y mal del rey.1 En el artículo se plantea como conclusión que la tendencia de la tuberculosis en el quinquenio de estudio es estacionaria, pero en los últimos cuatro años tiende al ascenso. En los casos diagnosticados de tuberculosis en este quinquenio más de dos tercios correspondieron al sexo masculino y mayores de 45 años, las ocupaciones que más prevalecieron fueron recluso, desocupado, ama de casa y jubilado. Los factores de riesgo que más se relacionaron fueron el albergamiento prolongado en instituciones cerradas, el alcoholismo, y la edad mayor de 65 años; la forma clínica de mayor incidencia en casi la totalidad de los pacientes fue la pulmonar y, dentro de ella, los casos con baciloscopia positiva. Hubo fallas en el diagnóstico, ya que alrededor de la mitad de los casos se diagnosticaron en la atención secundaria y con un tiempo de demora de más de dos meses de

  3. The first reported case of Bartonella endocarditis in Thailand

    Directory of Open Access Journals (Sweden)

    Orathai Pachirat

    2011-06-01

    Full Text Available Bartonella species have been shown to cause acute, undifferentiated fever in Thailand. A study to identify causes of endocarditis that were blood culture-negative using routine methods led to the first reported case in Thailand of Bartonella endocarditis A 57 year-old male with underlying rheumatic heart disease presented with severe congestive heart failure and suspected infective endocarditis. The patient underwent aortic and mitral valve replacement. Routine hospital blood cultures were negative but B. henselae was identified by serology, PCR, immunohistochemistry and specific culture techniques.

  4. A severe infective endocarditis successfully treated with linezolid

    Directory of Open Access Journals (Sweden)

    Graziano Antonio Minafra

    2010-03-01

    Full Text Available Despite significant improvements in surgical and medical therapy, prosthetic valve endocarditis (PVE is a diagnostic and therapeutic challenge and is often associated with a severe prognosis. We report a case of a 59-year-old woman, with  PVE and bacterial endocarditis (Streptococcus bovis successfully treated with linezolid. Linezolid is a bacteriostatic oxazolidinone antibiotic that has been proven to be effective for the treatment of patients with pneumonia, skin and soft tissue infections, and infections due to Gram-positive cocci. Linezolid is not yet recognised as a standard therapy for infective endocarditis, but its use becomes a necessity when infection is due to multidrug-resistant microorganisms.

  5. Brucella Endocarditis as a Late Onset Complication of Brucellosis

    Directory of Open Access Journals (Sweden)

    Panagiotis Andriopoulos

    2015-01-01

    Full Text Available Brucella endocarditis (BE is a rare but life threatening complication of brucellosis. We present a case report of a patient with relapsing brucellosis complicated with aortic valve endocarditis. The patient underwent valve replacement and required prolonged antibiotic treatment because of rupture of the noncoronary leaflet and development of congestive heart failure. Since the onset of endocarditis in patients with brucellosis is not known, proper follow-up is required in order to identify any late onset complications, especially in endemic areas.

  6. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry.

    Science.gov (United States)

    Glenny, Anne-Marie; Oliver, Richard; Roberts, Graham J; Hooper, Lee; Worthington, Helen V

    2013-10-09

    Infective endocarditis is a severe infection arising in the lining of the chambers of the heart with a high mortality rate.Many dental procedures cause bacteraemia and it was believed that this may lead to bacterial endocarditis (BE) in a few people. Guidelines in many countries have recommended that prior to invasive dental procedures antibiotics are administered to people at high risk of endocarditis. However, recent guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales has recommended that antibiotics are not required. To determine whether prophylactic antibiotic administration, compared to no such administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis influences mortality, serious illness or the incidence of endocarditis. The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 21 January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE via OVID (1946 to 21 January 2013) and EMBASE via OVID (1980 to 21 January 2013). We searched for ongoing trials in the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/). No restrictions were placed on the language or date of publication when searching the electronic databases. Due to the low incidence of BE it was anticipated that few if any trials would be located. For this reason, cohort and case-control studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of antibiotic, compared to no such administration, before a dental procedure in people with an increased risk of BE. Cohort studies would need to follow those individuals at increased risk and assess outcomes following any invasive dental procedures, grouping by whether

  7. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

    DEFF Research Database (Denmark)

    Regueiro, Ander; Linke, Axel; Latib, Azeem

    2016-01-01

    IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective...... endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter...... aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20...

  8. Rehabilitación pulmonar en hipertensión pulmonar

    Directory of Open Access Journals (Sweden)

    Vilma Gómez

    2017-09-01

    Full Text Available El manejo del paciente con hipertensión pulmonar es complejo y requiere de un equipo interdisciplinario. Es trascendental que los programas de rehabilitación cuenten con neumólogo, fisioterapeutas entrenados, psicólogos, profesionales en trabajo social, nutrición y enfermería. Para el ingreso al programa los pacientes deben contar con manejo farmacológico óptimo y prueba de ejercicio cardiopulmonar integrada o prueba de caminata de seis minutos para determinar la condición basal, las causas de limitación al ejercicio y la intensidad del ejercicio, y prever riesgos. Se indican al menos dos a tres sesiones a la semana supervisadas durante 10 a 12 semanas para lograr mejoría en cuanto a capacidad de ejercicio, calidad de vida y niveles de actividad física. Se puede hacer entrenamiento en ambiente hospitalario, ambulatorio o mixto aunque siempre con comienzo en un ámbito supervisado y con el equipo de monitorización necesario. En cuanto al riesgo, en pacientes con hipertensión pulmonar clase funcional IV, la frecuencia de eventos adversos no fue mayor al compararse con pacientes en clase funcional II y III; los efectos del entrenamiento en estos pacientes son similares a los obtenidos en aquellos con mejor clase funcional con necesidad de reducir la intensidad del ejercicio para que sea tolerado y seguro. Es vital educar tanto al paciente como a su cuidador en cuanto a la enfermedad, y adicionalmente brindar soporte psicosocial y nutricional.

  9. Tromboembolismo pulmonar crônico: papel da angiotomografia

    Directory of Open Access Journals (Sweden)

    Rogério Ferrari Peron

    2007-10-01

    Full Text Available Hipertensão pulmonar por tromboembolismo pulmonar (TEP crônico é freqüentemente subdiagnosticada e tem prognóstico sombrio se não tratada adequadamente. Quando a presença de trombo arterial é confirmada, tromboendarterectomia é o tratamento de escolha, com resultados favoráveis. Relatamos caso de paciente masculino, 52 anos, com dispnéia aos esforços havia quatro meses, sem quadro clínico agudo de TEP ou de TVP. O ecocardiograma mostrava hipertensão pulmonar moderada e angiotomografia de tórax revelou êmbolos em artérias pulmonares direita e esquerda, artérias lobares e segmentares, bilateralmente. Cortes tomográficos em membros inferiores revelaram trombo em veia poplítea direita. Outros casos de trombose de membros inferiores na família sugerem a possibilidade de trombofilia. Paciente foi tratado com warfarina com sucesso e dois meses após, o ecocardiograma e a angiotomografia estavam normais e não foi necessário indicar tromboendarterectomia.

  10. Estado actual del tratamiento del cáncer pulmonar

    Directory of Open Access Journals (Sweden)

    Dr. Clavero R. José Miguel

    2013-07-01

    Pese a la letalidad de esta neoplasia y el aumento de su incidencia a nivel mundial, los avances que se describen en el presente artículo permiten vislumbrar un mejor futuro para los pacientes con cáncer pulmonar.

  11. Characteristics of Streptococcus bovis endocarditis and its differences with Streptococcus viridans endocarditis.

    Science.gov (United States)

    Corredoira, J; Alonso, M P; Coira, A; Casariego, E; Arias, C; Alonso, D; Pita, J; Rodriguez, A; López, M J; Varela, J

    2008-04-01

    The purpose of this study was to evaluate the characteristics of infective endocarditis (IE) caused by S. bovis and compare them to those caused by streptococci of the viridans group (SVG). A prospective study was undertaken considering 55 consecutive cases of IE due to S. bovis and 41 to SVG over 18 years. The study was divided into two periods (1988-1996 and 1997-2005). S. bovis caused 24% of the IE in our centre and constituted the main aetiology for this disease, showing an increase of 358% during the second period studied. Biotype I was responsible for 94.5% of cases and there was a high degree of association with colon tumours (53%). Over the period of the study, 107 patients admitted to our hospital had bacteraemia caused by S. bovis and 310 patients had bacteraemia caused by SVG. In the first group, 55 (51%) were endocarditis cases, but only 41 (13%) of the patients with SVG bacteraemia had endocarditis (p < 0.0001). The distinguishing features of endocarditis caused by S. bovis in comparison with those caused by SGV were: a greater increase in cases during the 2nd period studied (from 12 to 43 vs. from 19 to 22, p < 0.01), a higher percentage of males (93% vs. 71%, p < 0.004), patients significantly older (median age 66 vs. 58.5, p < 0.004), less predisposing cardiopathy (42% vs. 76%, p < 0.0009), more bivalvular involvement (42% vs. 22%, p < 0.04), more spondylitis (9% vs. 0%, p < 0.04), a higher association with colonic tumours (53% vs. 5%, p < 0.0001), and a higher percentage of antibiotic resistance: erythromycin 66% vs. 19%, p < 0.0001; clindamycin 67% vs. 11%, p < 0.0001; cotrimoxazole 77% vs. 30.5%, p < 0.0001, respectively. IE due to S. bovis is an emergent disease in our environment, presenting different characteristics to those produced by SVG.

  12. Early results for active infective endocarditis | Aithoussa | Pan ...

    African Journals Online (AJOL)

    Early results for active infective endocarditis. Mahdi Aithoussa, Noureddine Atmani, Reda Mounir, Younes Moutakiallah, Mehdi Bamous, Abdessamad Abdou, Fouad Nya, Anis Seghrouchni, Siham Bellouize, Mohamed Drissi, Mostafa Elouennass, Youssef Elbekkali, Abdelatif Boulahya ...

  13. [Infective endocarditis : Update on prophylaxis, diagnosis, and treatment].

    Science.gov (United States)

    Dietz, S; Lemm, H; Janusch, M; Buerke, M

    2016-05-01

    The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

  14. Infective Endocarditis in Children — New Approach in Antimicrobial Prophylaxis

    Directory of Open Access Journals (Sweden)

    Togănel Rodica

    2016-06-01

    Full Text Available Infective endocarditis (IE is an infection of the endocardium and/or heart valves with the formation of a thrombus and secondary damage of the involved tissue, with significant mortality and severe complications. The prevention of bacterial endocarditis is of great controversy. Antimicrobial prophylaxis is usable in the prevention of endocarditis by killing bacteria before or after their extension to the damaged endocardium. No human studies offer strong evidence to support the efficacy of antibiotic prophylaxis so far, thus it could be potentially dangerous. Therefore, the European Society of Cardiology (ESC may need to reconsider and update the previous guidelines with the proposal of reducing the prophylactic approach of IE. The 2015 Task Force recommends prophylaxis for highest risk patients undergoing highest risk procedures, focused on prevention rather than prophylaxis of IE, especially in nosocomial endocarditis.

  15. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics

    NARCIS (Netherlands)

    van der Meer, J. T.; Thompson, J.; Valkenburg, H. A.; Michel, M. F.

    1992-01-01

    BACKGROUND: Studies of the epidemiology of bacterial endocarditis are usually based on a retrospective review of medical records from referral centers serving diverse patient populations. These studies are therefore likely to suffer from selection bias. We conducted a nationwide prospective

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

    DEFF Research Database (Denmark)

    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...

  17. Sinus of Valsalva Pseudoaneurysm as a Sequela to Infective Endocarditis.

    Science.gov (United States)

    Lee, Chin C; Siegel, Robert J

    2016-02-01

    Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity.

  18. Experimental Bacterial Endocarditis in the Opossum (Didelphis virginiana)

    Science.gov (United States)

    Sherwood, B. F.; Rowlands, D. T.; Vakilzadeh, J.; LeMay, J. C.

    1971-01-01

    It was possible to induce bacterial endocarditis in opossums with single intravenous injections of Streptococcus viridans or Staphylococcus aureus. Fiftyeight percent of those animals given Streptococcus viridans developed bacterial endocarditis in which most of the lesions were on the left side of the heart. The experimentally induced streptococcal disease was similar to that which may occur spontaneously in opossums, both with respect to the distribution and structure of the vegetations. Single injections of Staphylococcus aureus resulted in endocarditis in 100% of the test animals. These lesions differed from those due to streptococci by having a relatively high frequency of right- as well as left-sided valvular disease and by being somewhat smaller than those due to streptococci.Endocarditis could not be successfully induced with injection of three different fungi. PMID:5133514

  19. Infective endocarditis: diagnostic and therapeutic approach in emergency medicine

    Directory of Open Access Journals (Sweden)

    Rita Previati

    2007-02-01

    Full Text Available The infective endocarditis is an uncommon disease in the Emergency Department. Anyway, the emergency physician may be in front of the complications of this disease. A case of a patient with fever, laboratory signs of infection and an acute heart failure is described in this article. The final diagnosis was infective endocarditis with vegetations on the aortic valve and severe valvular regurgitation. The definition of infective endocarditis according to the major and minor criteria for the diagnosis is discussed. The echocardiography is central in the diagnosis and management of patients with infective endocarditis in the emergency setting, even if the clinical suspicion is very important. The main available therapeutic options in according to the Internation Guidelines are evaluated. The possible complications are also discussed. Several clinical and echocardiographic features identify patients at high risk for a complicated course or with a need for surgery.

  20. [Case of infective endocarditis diagnosed with renal infarction].

    Science.gov (United States)

    Nakayama, Takayuki; Yokoyama, Minato; Saito, Kazutaka; Takenaka, Shunsuke; Kubo, Yuichi; Iimura, Yasumasa; Numao, Noboru; Sakai, Yasuyuki; Koga, Fumitaka; Fujii, Yasuhisa; Kobayashi, Tsuyoshi; Kawakami, Satoru; Kihara, Kazunori

    2009-03-01

    A 46-year-old woman with sudden on set strong right flank pain was transferred to our hospital with the diagnosis of right renal infarction. Cardiac ultrasonography revealed a vegetation on the posterior cusp of the mitral valve, and the renal infarction was thought to be caused by renal artery embolism from infective endocarditis. Since the vegetation remained after antimicrobial therapy as conservative management, the patient was surgically treated by mitral annuloplasty. It has been known that infective endocarditis can cause renal infarction. Infective endocarditis requires immediate and adequate treatment because of high mortality. Therefore, the appropriate diagnosis of infective endocarditis is needed for patients with renal infarction without any other disorder causing renal infarction.

  1. Echocardiographic agreement in the diagnostic evaluation for infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Selton-Suty, Christine; Tong, Steven Y C

    2016-01-01

    Echocardiography is essential for the diagnosis and management of infective endocarditis (IE). However, the reproducibility for the echocardiographic assessment of variables relevant to IE is unknown. Objectives of this study were: (1) To define the reproducibility for IE echocardiographic variab...

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

    Science.gov (United States)

    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. © 2014 Blackwell Verlag GmbH.

  3. [Role of procalcitonin in the diagnosis of uncomplicated infective endocarditis].

    Science.gov (United States)

    Hryniewiecki, Tomasz; Sitkiewicz, Dariusz; Rawczyńska-Englert, Irena

    2002-01-01

    Infective endocarditis especially where blood culture is negative frequently causes problems in diagnosis despite of many nonspecific inflammation parameters. Procalcitonin (PCT) concentration is a new marker of severe bacterial and fungal infection. The aim of this study was to evaluate the usefulness of PCT concentration assessment in the diagnosis of uncomplicated infective endocarditis of bacterial etiology. The study group consisted of 30 patients with ongoing infective endocarditis in the course of acquired valvular heart disease. The diagnosis of bacterial endocarditis was established according to the Duke criteria on the basis of: clinical examination, laboratory investigations (inflammatory parameters, transthoracic and transesophageal echocardiography) and positive blood cultures. Patients with sepsis, concomitant infections and in an early postoperative period were excluded. Two control groups consisted of: 10 patients without endocarditis and other infections and another 10 patients without endocarditis and with an urinary tract infection. Serum procalcitonin concentrations were measured by an immunoluminometric assay (LUMItest PCT set). Mean serum PCT concentrations in patients with endocarditis (0.12 +/- 0.13, range 0-0.4 ng/ml) were significantly higher than in control group without infection (0.03 +/- 0.05, range 0-0.1 ng/ml) and higher than in control group with an urinary tract infection (0.02 +/- 0.04, range 0-0.1 ng/ml). However in 12 patients (of 30) were below sensitivity of the method and in the rest were within normal range (< 0.5 ng/ml). Serum PCT concentration assessment seems to have no value in the diagnosis of uncomplicated infective endocarditis.

  4. Aspergillus endocarditis in a native valve after amphotericin B treatment.

    Science.gov (United States)

    Kotanidou, Anastasia N; Zakynthinos, Epaminonthas; Andrianakis, Ilias; Zervakis, Dimitrios; Kokotsakis, Ioannis; Argyrakos, Theodoros; Argiropoulou, Athina; Margariti, Georgia; Douzinas, Emmanuel

    2004-10-01

    Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation.

  5. Isolated Native Tricuspid Valve Endocarditis Caused by Viridans Streptococcus

    Directory of Open Access Journals (Sweden)

    John Swiston

    2001-01-01

    Full Text Available The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.

  6. Isolated native tricuspid valve endocarditis caused by viridans streptococcus

    OpenAIRE

    Swiston, John; Shafran, Stephen D; Kassam, Narmin

    2001-01-01

    The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.

  7. Actinobacillus equuli subsp. equuli associated with equine valvular endocarditis

    DEFF Research Database (Denmark)

    Aalbæk, Bent; Østergaard, Stine; Buhl, Rikke

    2007-01-01

    Microbiological and pathological data from a case of equine valvular endocarditis are reported. Limited information is available on the pathogenic potential of equine Actinobacillus species as several strains originate from apparently healthy horses. After the establishment of two subspecies within...... this species, this seems to be the first report of an etiological association between A. equuli subsp. equuli and equine endocarditis. Furthermore, new information on some phenotypical characteristics of this subspecies are reported, compared to previous findings...

  8. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    Directory of Open Access Journals (Sweden)

    R. Zea-Vera

    2016-01-01

    Full Text Available Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.

  9. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study

    NARCIS (Netherlands)

    Durante-Mangoni, Emanuele; Bradley, Suzanne; Selton-Suty, Christine; Tripodi, Marie-Françoise; Barsic, Bruno; Bouza, Emilio; Cabell, Christopher H.; Ramos, Auristela Isabel de Oliveira; Fowler, Vance; Hoen, Bruno; Koneçny, Pam; Moreno, Asuncion; Murdoch, David; Pappas, Paul; Sexton, Daniel J.; Spelman, Denis; Tattevin, Pierre; Miró, José M.; van der Meer, Jan T. M.; Utili, Riccardo; Gordon, David; Devi, Uma; Kauffman, Carol; Armstrong, William; Giannitsioti, Efthymia; Giamarellou, Helen; Lerakis, Stamatios; del Rio, Ana; Mestres, Carlos A.; Paré, Carlos; Garcia de la Maria, Cristina; de Lazzario, Elisa; Marco, Francesc; Gatell, Jose M.; Miró, José M.; Almela, Manel; Azqueta, Manuel; Jiménez-Expósito, Maria Jesús; de Benito, Natividad; Perez, Noel; Almirante, Benito; Fernandez-Hidalgo, Nuria; Rodriguez de Vera, Pablo; Tornos, Pilar; Falcó, Vicente; Claramonte, Xavier; Armero, Yolanda; Sidani, Nisreen; Kanj-Sharara, Souha; Kanafani, Zeina; Raglio, Annibale; Goglio, Antonio; Gnecchi, Fabrizio; Suter, Fredy; Valsecchi, Grazia; Rizzi, Marco; Ravasio, Veronica; Chirouze, Catherine; Leroy, Joel; Plesiat, Patrick; Bernard, Yvette; Casey, Anna; Lambert, Peter; Watkin, Richard; Elliott, Tom; Patel, Mukesh; Dismukes, William; Pan, Angelo; Caros, Giampiero; Tribouilloy, Amel Brahim Mathiron Christophe; Goissen, Thomas; Delahaye, Armelle; Delahaye, Francois; Vandenesch, Francois; Vizzotti, Carla; Nacinovich, Francisco M.; Marin, Marcelo; Trivi, Marcelo; Lombardero, Martin; Cortes, Claudia; Horacio Casabe, José; Altclas, Javier; Kogan, Silvia; Clara, Liliana; Sanchez, Marisa; Commerford, Anita; Hansa, Cass; Deetlefs, Eduan; Ntsekhe, Mpiko; Commerford, Patrick; Wray, Dannah; Steed, Lisa L.; Church, Preston; Cantey, Robert; Morris, Arthur; Read, Kerry; Raymond, Nigel; Lang, Selwyn; Chambers, Stephen; Kotsanas, Despina; Korman, Tony M.; Peterson, Gail; Purcell, Jon; Southern, Paul M.; Shah, Manisha; Bedimo, Roger; Reddy, Arjun; Levine, Donald; Dhar, Gaurav; Hanlon-Feeney, Alanna; Hannan, Margaret; Kelly, Sinead; Wang, Andrew; Cabell, Christopher H.; Woods, Christopher W.; Benjamin, Danny; Corey, G. Ralph; McDonald, Jay R.; Federspiel, Jeff; Engemann, John J.; Reller, L. Barth; Drew, Laura; Caram, Lauren B.; Stryjewski, Martin; Morpeth, Susan; Lalani, Tahaniyat; Chu, Vivian; Mazaheri, Bahram; Neuerburg, Carl; Naber, Christoph; Athan, Eugene; Henry, Margaret; Harris, Owen; Alestig, Eric; Olaison, Lars; Wikstrom, Lotta; Snygg-Martin, Ulrika; Francis, Johnson; Venugopal, K.; Nair, Lathi; Thomas, Vinod; Chaiworramukkun, Jaruwan; Pachirat, Orathai; Chetchotisakd, Ploenchan; Suwanich, Tewan; Kamarulzaman, Adeeba; Tamin, Syahidah Syed; Premru, Manica Mueller; Logar, Mateja; Lejko-Zupanc, Tatjana; Orezzi, Christina; Klein, John; Moreno, Mar; Rodríguez-Créixems, Marta; Fernández, Miguel; Muñoz, Patricia; Fernández, Rocío; Ramallo, Victor; Raoult, Didier; Thuny, Franck; Habib, Gilbert; Casalta, Jean-Paul; Fournier, Pierre-Edouard; Chipigina, Natalia; Kirill, Ozerecky; Vinogradova, Tatiana; Kulichenko, Vadim P.; Butkevich, O. M.; Lion, Christine; Alla, Francois; Coyard, Hélène; Doco-Lecompte, Thanh; Iarussi, Diana; Ragone, Enrico; Dialetto, Giovanni; Tripodi, Marie Françoise; Casillo, Roberta; Kumar, A. Sampath; Sharma, Gautam; Dickerman, Stuart A.; Street, Alan; Eisen, Damon Peter; McBryde, Emma Sue; Grigg, Leeanne; Abrutyn, Elias; Michelet, Christian; Donnio, Pierre Yves; Fortes, Claudio Querido; Edathodu, Jameela; Al-Hegelan, Mashael; Font, Bernat; Anguera, Ignasi; Raimon Guma, Joan; Cereceda, M.; Oyonarte, Miguel J.; Montagna Mella, Rodrigo; Garcia, Patricia; Braun Jones, Sandra; de Oliveira Ramos, Auristela Isabel; Paiva, Marcelo Goulart; de Medeiros, Regina Aparecida; Woon, Lok Ley; Lum, Luh-Nah; Tan, Ru-San; Rees, David; Lawrence, Richard; Dever, Robyn; Post, Jeffrey; Jones, Phillip; Ryan, Suzanne; Harkness, John; Feneley, Michael; Rubinstein, Ethan; Strahilewitz, Jacob; Ionac, Adina; Mornos, Cristian; Dragulescu, Stefan; Forno, Davide; Cecchi, Enrico; de Rosa, Francesco; Imazio, Massimo; Trinchero, Rita; Wiesbauer, Franz; Gattringer, Rainer; Deans, Greg; Andrasevic, Arjana Tambic; Klinar, Igor; Vincelj, Josip; Bukovski, Suzana; Krajinovic, Vladimir; Cabell, Christopher; Stafford, Judy; Baloch, Khaula; Redick, Thomas; Harding, Tina; Karchmer, Adolf W.; Bayer, Arnie; Durack, David T.; Corey, Ralph; Moreillon, Phillipe; Eykynm, Susannah

    2008-01-01

    BACKGROUND: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. METHODS: In this multinational, prospective, observational cohort study within the

  10. [Clinical, echocardiographic and prognostic profile of Streptococcus viridans left-sided endocarditis].

    Science.gov (United States)

    López, Javier; San Román, José A; Revilla, Ana; Vilacosta, Isidre; Luaces, María; Sarriá, Cristina; Gómez, Itziar; Fernández-Avilés, Francisco

    2005-02-01

    Published case series on Streptococcus viridans endocarditis are scarce and outdated. The aims of our study were multiple: to analyze the profile of the Streptococcus viridans endocarditis, to compare it with other types of left-sided endocarditis and with cases caused by Staphylococcus aureus, and to determine predictors of poor outcome in Streptococcus viridans endocarditis. We analyzed 441 episodes of endocarditis: 330 left-sided and 54 caused by Streptococcus viridans (16%). We compared the 54 cases due to Streptococcus viridans with the remaining cases of left-sided endocarditis in our series, and also with cases caused by Staphylococcus aureus. We also analyzed the predictors of death and urgent surgery in Streptococcus viridans endocarditis. Left-sided endocarditis due to Streptococcus viridans led to a similar degree of valvular destruction, showed acute onset less frequently, and led to less renal failure, septic shock and mortality than the remaining cases of left-sided endocarditis in our series. The same differences were found in comparison to Streptococcus viridans endocarditis. Prognostic factors for Streptococcus viridans left-sided endocarditis were heart failure and periannular complications. Although Streptococcus viridans is a nonaggressive microorganism, valvular destruction is similar to that caused by other pathogens when it causes left-sided endocarditis. Nonetheless its prognosis is better, a feature which may be related to the fact that the systemic infectious syndrome can be treated more effectively. Prognostic factors in left-sided endocarditis due to Streptococcus viridans are heart failure and periannular complications.

  11. Serological diagnosis of experimental Enterococcus faecalis endocarditis

    DEFF Research Database (Denmark)

    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...

  12. Microbiology of Odontogenic Bacteremia: beyond Endocarditis

    Science.gov (United States)

    Parahitiyawa, N. B.; Jin, L. J.; Leung, W. K.; Yam, W. C.; Samaranayake, L. P.

    2009-01-01

    Summary: The human gingival niche is a unique microbial habitat. In this habitat, biofilm organisms exist in harmony, attached to either enamel or cemental surfaces of the tooth as well as to the crevicular epithelium, subjacent to a rich vascular plexus underneath. Due to this extraordinary anatomical juxtaposition, plaque biofilm bacteria have a ready portal of ingress into the systemic circulation in both health and disease. Yet the frequency, magnitude, and etiology of bacteremias due to oral origin and the consequent end organ infections are not clear and have not recently been evaluated. In this comprehensive review, we address the available literature on triggering events, incidence, and diversity of odontogenic bacteremias. The nature of the infective agents and end organ infections (other than endocarditis) is also described, with an emphasis on the challenge of establishing the link between odontogenic infections and related systemic, focal infections. PMID:19136433

  13. Risco de Hemorragia Secundária a Biópsia Pulmonar por Broncoscopia Rígida, em doentes com doença do Interstício Pulmonar com Hipertensão Pulmonar

    Directory of Open Access Journals (Sweden)

    Michael J. Morris, M.D. MAJ, MC

    1998-07-01

    Full Text Available RESUMO: A Hipertensão Pulmonar (HP é considerada geralmente uma contra-indicação para Biópsia Pulmonar por Broncoscopia (BPB porque existe um grande risco de hemorragia.Para analisar o risco da biópsia pulmonar nestes doentes foi efectuado urn estudo prospectivo, duplamente cego, em cinquenta doentes com Doença do Interstício Pulmonar (DIP mas sem manifestações clínicas e radiológicas de Hipertensão Pulmonar (HP.Antes de efectuar a Biópsia Pulmonar por Broncosco pia (BPB os doentes foram submetidos a urn Eco Dopller Cardíaco para determinar as pressões da artéria pulmonar e o grau de dilatação da aurícula direita e ventrículo direito.A Hipertensão Pulmonar (HP foi definida como pressão da artéria pulmonar superior a 30 mm Hg ou a evidência de aumento de volume do coração direito caso a pressão da artéria pulmonar não tenha sido medida.A hemorragia durante a broncoscopia foi quantificada. As perdas sanguíneas foram consideradas: mínimas, inferiores a 10 ml; médias, entre 11 ml e 25 ml; moderadas, entre 25 ml a 50 ml e graves superiores a 50ml.Em vinte e oito doentes não havia evidência de Hipertensão Pulmonar (HP por Eco Dopller Cardíaco e neste grupo só um doente teve uma hemorragia média.Em vinte e dois doentes evidenciase a existência de hipertensão pulmonar. Contudo só um doente teve uma hemorragia moderada.Não houve diferenças significativas nas hemorragias existentes nos dois grupos. Os doentes com hipertensão pulmonar tiveram perdas sanguíneas no valor de 2 ml, mais ou menos 6,2 ml; e os doentes sem Hipertensão Pulmonar (HP tiveram perdas sanguíneas de 1,8 ml, mais ou menos 3,8 ml.Da análise destes resultados concluise que 44% dos doentes com doença intersticial difusa submetidos a Biópsia Pulmonar por Broncoscopia (BPB tem Hipertensão Pulmonar (HP, mas que não há aumento significativo de complicações neste grupo. Palavras-chave: HP Hipertensão Pulmonar, BPB Bi

  14. Aggregatibacter aphrophilus infective endocarditis confirmed by broad-range PCR diagnosis: A case report

    Directory of Open Access Journals (Sweden)

    Koji Hirano

    2017-01-01

    Conclusion: A rare disease, Aggregatibacter aphrophilus infective endocarditis was successfully treated with surgical repair and appropriate antibiotic therapy. To avoid misdiagnosis, br-PCR testing should be performed in patients with blood culture-negative endocarditis.

  15. Estado del arte en hipertensión pulmonar y cateterismo cardiaco derecho

    Directory of Open Access Journals (Sweden)

    Rubén Dueñas V.

    2017-09-01

    Full Text Available La definición universalmente aceptada de hipertensión pulmonar corresponde a todos los pacientes con presión arterial pulmonar media igual o mayor a 25 mm Hg en reposo, medida por cateterismo cardíaco derecho, sin olvidar que la presión promedio normal de la arteria pulmonar es de máximo 20 mm Hg, lo cual obliga a seguir a los pacientes con presión arterial pulmonar media entre 20 y 24 mm Hg. También cabe recordar ser claros al diferenciar entre hipertensión pulmonar e hipertensión arterial pulmonar. La hipertensión pulmonar incluye cinco grupos, entre los cuales la hipertensión arterial pulmonar constituye el grupo 1. El concepto de hipertensión arterial pulmonar inducida por el ejercicio puede definirse como todos los pacientes con presión arterial pulmonar por encima de los 30 mm Hg a un gasto cardíaco menor de 10 l, o una resistencia pulmonar total de más de 3 unidades Wood. La hipertensión pulmonar inducida por el ejercicio es un campo de investigación hasta ahora poco explorado. La clasificación continúa con los cinco grupos, y es dinámica de acuerdo con el progreso en entender la fisiopatología de cada enfermedad.

  16. Side-to-side aorto-GoreTex central shunt warrants central shunt patency and pulmonary arteries growth.

    Science.gov (United States)

    Barozzi, Luca; Brizard, Christian P; Galati, John C; Konstantinov, Igor E; Bohuta, Lyubomyr; d'Udekem, Yves

    2011-10-01

    Central shunts may be associated with a high rate of thrombosis and pulmonary artery distortion. Between January 2000 and April 2010, 68 consecutive patients underwent side-to-side aorto-Gore-Tex central shunts (W.L. Gore & Associates, Flagstaff, AZ). Median age at surgery was 31 days (8 to 122). Cardiac morphologies were tetralogy of Fallot (33), pulmonary atresia with collateral dependent lung circulation (20), and other (15). Shunt sizes ranged from 3 to 6 mm. The procedure was performed on cardiopulmonary bypass in 43 patients (63%). Six patients died during hospital stay (9%) of low output syndrome (3), sepsis (2), and stroke (1). Only one shunt needed early redo. Follow-up was 100% complete. After a median follow-up of 236 days (116 to 340), there were 7 late deaths related to sudden death (3), sepsis (2), reoperation (1), and lack of growth of pulmonary arteries with a patent shunt (1). Repair was completed in 42 patients and still pending in 12. Only one patient needed a late redo shunt (221 days). A larger shunt was performed in 5 patients after a median of 139 days (130 to 258). In the 45 patients who had serial assessment of pulmonary arteries sizes, Nakata index increased from 83 ± 62 mm(2)/m(2) to 153 ± 83 mm(2)/m(2) over a median period of 227 days (146 to 330), with equal growth observed in both pulmonary arteries (p Gore-Tex anastomosis seems to reliably warrant shunt patency and harmonious growth of pulmonary arteries. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Avaliação do gradiente pressórico aorto-radial em pacientes submetidos à intervenção cirúrgica com circulação extracorpórea Evaluación del gradiente presórico aorto-radial en pacientes sometidos a la intervención quirúrgica con circulación extracorpórea Evaluation of the aorta-to-radial artery pressure gradient in patients undergoing surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Maria José Carvalho Carmona

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversos estudos têm demonstrado diferença significativa entre a pressão aórtica e a pressão radial em pacientes submetidos à circulação extracorpórea (CEC. Os objetivos deste estudo foram avaliar o comportamento da diferença entre pressão arterial radial e a pressão aórtica durante revascularização do miocárdio (RM com CEC e sua correlação com resistência vascular sistêmica. MÉTODO: Após aprovação pelo Comitê de Ética Hospitalar, 16 pacientes submetidos à RM com CEC hipotérmica foram estudados. Pressões sistólica, diastólica e média foram obtidas na raiz da aorta e na artéria radial, através de cateteres específicos. Débito cardíaco foi obtido com o uso de cateter de artéria pulmonar ou diretamente da máquina de CEC e resistência vascular sistêmica indexada (RVSi foi calculada nos momentos pré-CEC, início da CEC, após a última RM, no fim da CEC e pós-CEC. A análise estatística foi realizada por meio de Análise de Variância para medidas repetidas e correlação de ordem de Spearman e o nível de significância foi fixado em 0,05. RESULTADOS: Após o início da CEC, a pressão arterial radial foi sistematicamente menor que a pressão aórtica em 3 a 5 mmHg. Foi observada correlação significativa entre o gradiente médio de pressão aorto-radial e a RVSi somente após a última RM, correspondendo ao aquecimento do paciente (Rho = 0,67, p = 0,009. CONCLUSÕES: A medida de pressão na arterial radial subestimou sistematicamente a pressão arterial na raiz da aorta após a CEC e a RVSi não forneceu estimativa acurada da magnitude do gradiente de pressão aorto-radial.JUSTIFICATIVA Y OBJETIVOS: Diversos estudios han demostrado diferencia significativa entre la presión aórtica y la presión radial en pacientes sometidos a la circulación extracorpórea (CEC. Los objetivos de este estudio fueron evaluar el comportamiento de la diferencia entre presión arterial radial y la

  18. In vitro Assays of Staphylococcus epidermidis Characteristics and Outcome in an Endocarditis Model

    Directory of Open Access Journals (Sweden)

    Betty Herndon

    1993-01-01

    Full Text Available Objective: Staphylococcus epidermidis adherence to indwelling polymers is important in prosthetic valve endocarditis. Earlier studies have related streptococcal endocarditis to isolates with high levels of cell-associated hexoses. The objective of the present study was to determine if a relationship exists between an S epidermidis isolate assay score and production/severity of experimental endocarditis.

  19. Metastização pulmonar de neoplasia da mama

    Directory of Open Access Journals (Sweden)

    Jorge Dionísio

    2002-03-01

    Full Text Available RESUMO: Para caracterizar os doentes com metastização pulmonar de neoplasia da mama, procedemos a um estudo retrospectivo dos processos de 129 doentes referenciados à Unidade de Pneumologia entre Julho de 1990 e Janeiro de 2000.Foi considerada a existência de metastização pulmonar em 89 casos.Avaliámos as manifestações clínicas apresentadas, o intervalo de tempo até ao diagnóstico de metastização pulmonar, os aspectos radiológicos, endoscópicos, as terapêuticas efectuadas e a sobrevida.O intervalo médio entre o diagnóstico da neoplasia da mama e o diagnóstico de metastização pulmonar foi de 81,9±5,7 meses. Os sintomas respiratórios foram referidos em 83,1% dos doentes. O padrão radiológico mais comum foi a presença de massas ou nódulos pulmonares (66,3%. Foram observadas 49 com sinais directos de neoplasia na broncofibroscopia. Em 47 os aspectos anatomopatológicos encontrados foram compatíveis com metastização endobrônquica de tumor da mamaO tratamento mais frequentemente utilizado após o diagnóstico de metástase pulmonar foi a quimioterapia, em 60,2% dos casos.Após o diagnóstico de metastização, a sobrevida mediana foi de 20,1 meses, com 63,4% dos doentes vivos ao fim de 1 ano.Nos doentes com carcinoma da mama e suspeita de metastização verificámos um grande intervalo livre entre o diagnóstico do tumor da mama e o aparecimento de metastização. Os sintomas respiratórios tra-duziram a grande frequência de envolvimento endobrônquico. O diagnóstico anatomopatológico de metastização pulmonar foi obtido em 52,8% dos doentes. A terapêutica mais utilizada após diagnóstico de metastização foi a quimioterapia e a sobrevida ao ano foi de 63,4%.REV PORT PNEUMOL 2002; VIII (2: ABSTRACT: We performed a retrospective study of 129 patients observed in Pneumology unit between July 1990 and January 2000 to evaluate the clinical, radiological and endoscopic patterns as well as the clinical evolution of

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

    DEFF Research Database (Denmark)

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

    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....

  1. Embolia séptica pulmonar – A propósito de um caso clínico

    Directory of Open Access Journals (Sweden)

    Luís Coentrão

    2008-11-01

    Full Text Available Resumo: A embolia séptica pulmonar (ESP é frequentemente a apresentação clínica de variadas doenças de etiologia infecciosa, por vezes subdiagnosticadas na prática clínica. Esta entidade foi descrita há cerca de 30 anos, quase sempre associada a toxicodependentes com endocardite infecciosa da válvula tricúspide. Ao longo das últimas três décadas, a epidemiologia desta síndroma sofreu alterações relevantes. No entanto, carece a existência na literatura de critérios de diagnóstico de ESP validados. Os autores apresentam um caso clínico de endocardite infecciosa da válvula tricúspide em toxicodependente, cuja forma de apresentação foi a ESP. O doente apresentava sintomas constitucionaise febre com um mês de evolução. A radiografia de tórax (RXT apresentava múltiplos infiltrados alveolares no terço inferior do campo pulmonar direito. O diagnóstico inicial foi pneumonia da comunidade, persistente. O ecocardiograma transtorácico revelou a presença de uma vegetação na válvula tricúspide. Foi isolada em hemoculturas espécie de Staphylococcus aureus meticilino-sensível. O doente realizou antibioterapia dirigida com sucesso terapêutico.Perante estes achados clínicos e após revisão da literatura, os autores propõem critérios de diagnóstico de ESP.Rev Port Pneumol 2008; XIV (6: 881-885 Abstract: SPE is a rare syndrome, although a frequent clinical presentation of several disorders, many times misdiagnosed in medical practice. It was described 30 years ago, almost always associated with intravenous drug abuse. Recent reports indicate that the epidemiology of patients with septic pulmonary embolism has changed over the past 30 years. We report a case of septic pulmonary embolism associated with tricuspid valve endocarditis. The patient had a personal history of intravenous drug abuse. The chief complaints were fever

  2. Embolia séptica pulmonar – A propósito de um caso clínico

    Directory of Open Access Journals (Sweden)

    Luís Coentrão

    2008-11-01

    Full Text Available Resumo: A embolia séptica pulmonar (ESP é frequentemente a apresentação clínica de variadas doenças de etiologia infecciosa, por vezes subdiagnosticadas na prática clínica. Esta entidade foi descrita há cerca de 30 anos, quase sempre associada a toxicodependentes com endocardite infecciosa da válvula tricúspide. Ao longo das últimas três décadas, a epidemiologia desta síndroma sofreu alterações relevantes. No entanto, carece a existência na literatura de critérios de diagnóstico de ESP validados. Os autores apresentam um caso clínico de endocardite infecciosa da válvula tricúspide em toxicodependente, cuja forma de apresentação foi a ESP. O doente apresentava sintomas constitucionais e febre com um mês de evolução. A radiografia de tórax (RXT apresentava múltiplos infiltrados alveolares no terço inferior do campo pulmonar direito. O diagnóstico inicial foi pneumonia da comunidade, persistente. O ecocardiograma transtorácico revelou a presença de uma vegetação na válvula tricúspide. Foi isolada em hemoculturas espécie de Staphylococcus aureus meticilino-sensível. O doente realizou antibioterapia dirigida com sucesso terapêutico.Perante estes achados clínicos e após revisão da literatura, os autores propõem critérios de diagnóstico de ESP. Abstract: SPE is a rare syndrome, although a frequent clinical presentation of several disorders, many times misdiagnosed in medical practice. It was described 30 years ago, almost always associated with intravenous drug abuse. Recent reports indicate that the epidemiology of patients with septic pulmonary embolism has changed over the past 30 years. We report a case of septic pulmonary embolism associated with tricuspid valve endocarditis. The patient had a personal history of intravenous drug abuse. The chief complaints were fever, anorexia and weight loss for 30 days. A

  3. Trasplante pulmonar: experiencia en clínica las condes

    Directory of Open Access Journals (Sweden)

    C. María Teresa Parada, Dra

    2010-03-01

    Hace 10 años Clínica Las Condes inicia su programa de trasplante pulmonar el que ha sido pionero nacional en número de injertos realizados y resultados obtenidos a largo plazo. Se realiza una revisión de las indicaciones, complicaciones precoces y tardías, capacidad física posterior al trasplante y sobrevida alejada de los pacientes trasplantados de pulmón en nuestro programa.

  4. Patología de la tuberculosis pulmonar.

    OpenAIRE

    FERRUFINO, JC

    2013-01-01

    Este artículo trata sobre la patología de la tuberculosis pulmonar desde el momento del ingreso del bacilo de Koch a los pulmones del paciente. Para ello se ha dividido en dos partes. La primera se ocupa de algunos aspectos de la inmunopatología de esta enfermedad y en la segunda se desarrolla los diferentes periodos en la evolución natural de este mal.

  5. Porcine models of non-bacterial thrombotic endocarditis (NBTE) and infective endocarditis (IE) caused by Staphylococcus aureus: a preliminary study.

    Science.gov (United States)

    Christiansen, Johanna G; Jensen, Henrik E; Johansen, Louise K; Kochl, Janne; Koch, Jørgen; Aalbaek, Bent; Nielsen, Ole L; Leifsson, Páll S

    2013-05-01

    Non-bacterial thrombotic endocarditis (NBTE) and, in particular, infective endocarditis (IE), are serious and potentially life-threatening diseases. An increasingly important agent of human IE is Staphylococcus aureus, which typically causes an acute endocarditis with high mortality. The study aim was to evaluate the pig as a model for non-bacterial as well as S. aureus-associated endocarditis, as these models would have several advantages compared to other laboratory animal models. Fourteen animals underwent surgery with placement of a plastic catheter in the left side of the heart. Six of the pigs did not receive a bacterial inoculation and were used to study the development of NBTE. The remaining eight pigs were inoculated intravenously once or twice with S. aureus, 10(5)-10(7) cfu/kg body weight. Two bacterial strains were used: S54F9 (porcine) and NCTC8325-4 (human). Clinical examination, echocardiography and bacterial blood cultures were used to diagnose and monitor the development of endocarditis. Animals were euthanized at between two and 15 days after catheter placement, and tissue samples were collected for bacteriology and histopathology. Pigs inoculated with 10(7) cfu/kg of S. aureus strain S54F9 developed clinical, echocardiographic and pathologic signs of IE. All other pigs, except one, developed NBTE. Serial blood cultures withdrawn after inoculation were positive in animals with IE, and negative in all other animals. S. aureus endocarditis was successfully induced in pigs with an indwelling cardiac catheter after intravenous inoculation of 10(7) cfu/kg of S. aureus strain S54F9. The model simulates typical pathological, clinical and diagnostic features seen in the human disease. Furthermore, NBTE was induced in all but one of the pigs without IE. Thus, the pig model can be used in future studies of the pathogenesis, diagnosis and therapy of NBTE and S. aureus endocarditis.

  6. Nuevas intervenciones en hipertensión arterial pulmonar

    Directory of Open Access Journals (Sweden)

    Juan Esteban Gómez Mesa

    2017-09-01

    Full Text Available El manejo farmacológico de la hipertensión arterial pulmonar se basa en agentes que actúan en tres vías principales: endotelina 1, prostaglandina I2 y óxido nítrico. La mayoría de estudios clínicos para aprobación de medicamentos desarrollados para tratar esta condición, han sido cortos y enfocados en el cambio en la caminata de 6 minutos. Al tener en cuenta que las diferentes formas de hipertensión arterial pulmonar tienen como denominador común para las alteraciones moleculares y celulares el entrecruzamiento celular con la pared vascular asociado a procesos inflamatorios e inmunes inapropiados, disbalance entre la síntesis y degradación de matriz extracelular, alteraciones genéticas (gen BMPR2 en hipertensión arterial pulmonar hereditaria y epigenéticas, se requiere un mejor entendimiento de la fisiopatología de la enfermedad, lo cual permitirá desarrollar nuevos tratamientos o intervenciones en estos pacientes en cada uno de estos niveles.

  7. Isolated pulmonic valve endocarditis presenting as neck pain

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    Azuma, Asako; O'uchi, Toshihiro; Toyoda, Keiko

    2009-01-01

    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)

  9. Secuestro pulmonar una infrecuente causa de hipertension pulmonar persistente en el recién nacido reporte de un caso

    Directory of Open Access Journals (Sweden)

    Lupo Méndez

    2017-01-01

    Full Text Available La hipertensión pulmonar persistente del recién nacido ( HPPRN es una entidad frecuente en las unidades de cuidados intensivos neonatales ( UCIN , sin embargo, algunas de sus causas pasan desapercibidas, debido a su baja frecuencia y poca asociación con esta patología. A propósito de un caso en nuestra UCIN , en un neonato a término que presentó HPPRN secundario a una malformación pulmonar, raramente asociada con esta patología en este grupo etareo, ya que se encontró mayor disposición a factores propios del nacimiento, y noxas maternas. El paciente presentó dificultad respiratoria horas después de su nacimiento, con evolución y persistencia de su sintomatología, por lo que se necesitó de diversos medios diagnósticos para establecer su etiología. Es importante destacar que el primer ecocardiograma doppler no mostró ninguna alteración anatómica o funcional, reportado normal; con posterior empeoramiento clínico del neonato, por lo que se ordenó un control ecocardiografico, y se evidenció una presión pulmonar estimada de 71 mmHg; se continuó el estudio etiológico con imágenes complemen - tarias, en esta caso una tomografía de tórax contrastada, y finalmente fue corroborado con un cateterismo cardiaco, lo cual permitió a su vez, manejo terapéutico y corrección de anomalía estructural de vasos pulmonares.

  10. Manifestações pulmonares de patologias auto-imunes

    Directory of Open Access Journals (Sweden)

    Diva Ferreira

    2007-01-01

    Full Text Available Resumo: O pulmão é uma interface particular entre o antigénio e o sangue circulante. É alvo de acções extrínsecas/intrínsecas e é particularmente vulnerável à agressão por agentes em circulação. Tal como a superfície mucosa, é um local de intensa acção imune, permitindo a expressão antigénica através da recirculação linfocitária. Assim, geram-se reacções locais, inflamatórias, ao antigénio. A imagiologia tem um papel importante no diagnóstico de doenças pulmonares imunológicas. Este grupo inclui as doenças pulmonares auto-imunes. A telerradiografia torácica tem muitas vantagens, mas também algumas limitações. A tomografia computorizada (TC constituiu uma revolução na imagiologia de doenças pulmonares, sendo a técnica de alta resolução uma mais-valia no estudo do interstício. Esta técnica permite uma maior exactidão do que a radiografia convencional no diagnóstico de patologias pulmonares, como as patologias auto-imunes. Abstract: The lung is a unique interface between the antigen and the circulating blood volume. It is submited to extrinsic/intrinsic challenges and is particularly vulnerable to circulating insulting agents. It is a site of intense immune surveillance, allowing antigen sampling to expand the immunologic repertoire through lymphocyte recirculation. In addition, local inflammatory reactions to antigens are generated.Imaging has an important role in diagnosis of patients with immunologic lung diseases. This group includes autoimmune lung diseases. There are many advantages of plain chest radiography but also significant limitations. It was a revolution in imaging of lung diseases with Computed Tomography (CT, being high resolution an important help in pulmonary interstitium study. This technique has a higher diagnostic accuracy than the conventional chest X-ray both in the detection and the diagnosis of lung diseases, such as autoimmune lung diseases. Palavras-chave: Doença pulmonar

  11. Manifestações pulmonares de patologias auto-imunes

    Directory of Open Access Journals (Sweden)

    Diva Ferreira

    2007-01-01

    Full Text Available Resumo: O pulmão é uma interface particular entre o antigénio e o sangue circulante. É alvo de acções extrín-secas/intrínsecas e é particularmente vulnerável à agressão por agentes em circulação. Tal como a superfície mucosa, é um local de intensa acção imune, permitindo a expressão antigénica através da recirculação linfocitária. Assim, geram-se reacções locais, inflamatórias, ao antigénio. A imagiologia tem um papel importante no diagnóstico de doenças pulmonares imunológicas. Este grupo inclui as doenças pulmonares auto-imunes. A telerradiografia torácica tem muitas vantagens, mas também algumas limitações. A tomografia computorizada (TC constituiu uma revolução na imagiologia de doenças pulmonares, sendo a técnica de alta resolução uma mais-valia no estudo do interstício. Esta técnica permite uma maior exactidão do que a radiografia convencional no diagnóstico de patologias pulmonares, como as patologias auto-imunes.Rev Port Pneumol 2007; XIII (1: 83-100 Abstract: The lung is a unique interface between the antigen and the circulating blood volume. It is submited to extrinsic/intrinsic challenges and is particularly vulnerable to circulating insulting agents. It is a site of intense immune surveillance, allowing antigen sampling to expand the immunologic repertoire through lymphocyte recirculation. In addition, local inflammatory reactions to antigens are generated.Imaging has an important role in diagnosis of patients with immunologic lung diseases. This group includes autoimmune lung diseases. There are many advantages of plain chest radiography but also significant limitations. It was a revolution in imaging of lung diseases with Computed Tomography (CT, being high resolution an important help in pulmonary interstitium study. This technique has a higher diagnostic accuracy than the conventional chest X-ray both in the detection and the diagnosis of lung diseases, such as autoimmune lung

  12. Os abcessos pulmonares em revisão

    Directory of Open Access Journals (Sweden)

    Ana Moura Gonçalves

    2008-01-01

    Full Text Available Resumo: Os abcessos pulmonares são cavidades que surgem no parênquima pulmonar, apresentando maior ou menor quantidade de tecido necrosado no seu interior. Surgem em indivíduos predispostos, como sejam os doentes com doença pulmonar crónica ou obstrução secundária a neoplasia e os doentes com maior risco de aspiração, estando incluidos os doentes com alteração do estado neurológico, os utilizadores de drogas endovenosas, os doentes com alcoolismo, patologia da faringe e esofágica, doença neuromuscular, entre outras. É feita a revisão dos principais agentes causais, da metodologia diagnóstica, da abordagem terapêutica na actualidade e do prognóstico destas situações.Os abcessos pulmonares, para além de relativamente pouco frequentes, são difíceis de caracterizar, sendo a resistência aos antibióticos um problema a ter presente, na sua abordagem terapêutica. Abstract: Lung abscesses are cavitating lesions containing necrotic debris caused by microbial infection. Patients with chronic lung disease, bronchial obstruction secondary to cancer, a history of aspiration or risk of aspiration caused by alcoholism, altered mental status, structural or physiologic alterations of the pharynx and esophagus, neuromuscular disorders, anesthesia, are among others at higher risk of developing lung abcess.The main bacteriological characteristics, the diagnosis, therapy and prognosis are considered. The problem of antimicrobial resistance is also referred. Palavras-chave: Abcesso pulmonar, pneumonia de aspiração, resistência antimicrobiana, anaeróbios, Key-words: Lung abscesses, aspiration pneumonia, antimicrobial resistance, anaerobes

  13. Risk of infective endocarditis in patients with end stage renal disease

    DEFF Research Database (Denmark)

    Chaudry, Mavish S.; Carlson, Nicholas; Gislason, Gunnar H.

    2017-01-01

    in hemodialysis recipients with central venous catheters was more than two-fold higher as compared with those with arteriovenous fistulas. Overall mortality, subsequent to endocarditis, was 22% inhospital and 51% at 1 year. The first 6 months in RRT, aortic valve disease, and previous endocarditis were identified...... as significant risk factors of endocarditis. Conclusions Patients receiving RRT have a high incidence of endocarditis, in particular during hemodialysis treatment usingcentral venous catheters. The first 6 months in RRT, aortic valve disease, and previous endocarditis are significant risk factors for developing...

  14. Enterococcus faecalis Endogenous Endophthalmitis from Valvular Endocarditis

    Directory of Open Access Journals (Sweden)

    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.

  15. Actualización en endocarditis protésica

    Directory of Open Access Journals (Sweden)

    Carmen Olmos

    2017-01-01

    Full Text Available La endocarditis infecciosa (EI sobre prótesis valvulares (EIPV es una de las formas más graves de esta enfermedad y se asocia con elevada mortalidad intrahospitalaria y necesidad de cirugía. Todo paciente con EIPV debe ser atendido en centros hospitalarios de referencia en endocarditis, en los que exista un equipo de endocarditis muldisciplinar que incluya a cardiólogos clínicos y expertos en imagen cardiaca, cirujanos cardiacos, microbiólogos y especialistas en enfermedades infecciosas con experiencia en EI. En este trabajo se revisan los aspectos diagnósticos, terapéuticos y pronósticos de esta entidad.

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

    Directory of Open Access Journals (Sweden)

    Ebrahim Nematipour

    1995-06-01

    Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.

  17. Endocarditis-associated Brain Lesions in Slaughter Pigs

    DEFF Research Database (Denmark)

    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...

  18. Rarity of invasiveness in right-sided infective endocarditis

    DEFF Research Database (Denmark)

    Hussain, Syed T; Shrestha, Nabin K; Witten, James

    2018-01-01

    OBJECTIVE: The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients. PATIENTS AND METHODS: From January 2002 to January 2015......, 1292 patients underwent surgery for active IE, 138 right-sided and 1224 left-sided. Among patients with right-sided IE, 131 had tricuspid and 7 pulmonary valve IE; 12% had prosthetic valve endocarditis. Endocarditis-related invasiveness was based on echocardiographic and operative findings. RESULTS......-microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium....

  19. Axillary artery thrombus and infective endocarditis in lupus

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2011-01-01

    Full Text Available Systemic lupus erythematosus is a chronic systemic autoimmune disease, often associated with severe infection. A female patient was referred for surgical treatment of infective endocarditis after being treated for systemic lupus erythematosus and lupus nephritis. She developed symptoms of left axillary artery occlusion before heart operation. Bulky fungal hyphae were noted on pathological examination of the surgically removed thrombi. The patient had an uncomplicated recovery after receiving high doses of antibiotics and subsequent mitral valve replacement. Either infective endocarditis or fungal thrombi may be secondary to systemic lupus erythematosus and impaired renal function.

  20. Current controversies in infective endocarditis [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Thomas J. Cahill

    2015-11-01

    Full Text Available Infective endocarditis is a life-threatening disease caused by a focus of infection within the heart. For clinicians and scientists, it has been a moving target that has an evolving microbiology and a changing patient demographic. In the absence of an extensive evidence base to guide clinical practice, controversies abound. Here, we review three main areas of uncertainty: first, in prevention of infective endocarditis, including the role of antibiotic prophylaxis and strategies to reduce health care-associated bacteraemia; second, in diagnosis, specifically the use of multimodality imaging; third, we discuss the optimal timing of surgical intervention and the challenges posed by increasing rates of cardiac device infection.

  1. Aortic valve endocarditis complicated by ST-elevation myocardial infarction.

    Science.gov (United States)

    Jenny, Benjamin E; Almanaseer, Yassar

    2014-12-01

    Infective endocarditis complicated by abscess formation and coronary artery compression is a rare clinical event with a high mortality rate, and diagnosis requires a heightened degree of suspicion. We present the clinical, angiographic, and echocardiographic features of a 73-year-old woman who presented with dyspnea and was found to have right coronary artery compression that was secondary to abscess formation resulting from diffuse infectious endocarditis. We discuss the patient's case and briefly review the relevant medical literature. To our knowledge, this is the first reported case of abscess formation involving a native aortic valve and the right coronary artery.

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

    DEFF Research Database (Denmark)

    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....

  3. Gallium-67 myocardial imaging for the detection of bacterial endocarditis

    International Nuclear Information System (INIS)

    Wiseman, J.; Rouleau, J.; Rigo, P.; Strauss, H.W.; Pitt, B.

    1976-01-01

    Eleven patients with a clinical diagnosis of bacterial endocarditis underwent scintillation scanning of the precordial region 2--7 days after the intravenous administration of 3 mCi of gallium-67 citrate. Seven had positive scans, 3 of which were confirmed by postmortem imaging at autopsy. Serial images revealed the scans to be frequently negative at 48 hours and positive from 3 to 8 days following injection. Uptake was not seen in the region of the myocardium 48 hours or longer after the injection of 15 patients without endocarditis used as controls

  4. Gallium-67 myocardial imaging for the detection of bacterial endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Wiseman, J.; Rouleau, J.; Rigo, P.; Strauss, H.W.; Pitt, B.

    1976-07-01

    Eleven patients with a clinical diagnosis of bacterial endocarditis underwent scintillation scanning of the precordial region 2--7 days after the intravenous administration of 3 mCi of gallium-67 citrate. Seven had positive scans, 3 of which were confirmed by postmortem imaging at autopsy. Serial images revealed the scans to be frequently negative at 48 hours and positive from 3 to 8 days following injection. Uptake was not seen in the region of the myocardium 48 hours or longer after the injection of 15 patients without endocarditis used as controls.

  5. First Reported Case of Bacterial Endocarditis Attributable to Actinomyces meyeri

    Directory of Open Access Journals (Sweden)

    Susan Moffatt

    1996-01-01

    Full Text Available A 48-year-old man presented to the Victoria General Hospital, Halifax, Nova Scotia in severe congestive heart failure. Echocardiographic studies revealed significant aortic valve insufficiency. Two anaerobic blood cultures performed two weeks apart were both positive for Actinomyces meyeri. The patient was treated with high dose intravenous penicillin. Three weeks after antibiotics were begun, he underwent aortic valve replacement. Intraoperative cultures were negative. Histopathological examination revealed findings in keeping with subacute bacterial endocarditis. The patient completed a six-week course of penicillin and was doing well three months after surgery. This is the first case of endocarditis attributable to A meyeri reported in the literature.

  6. Bioprosthetic Aortic Valve Endocarditis in Association with Enterococcus durans.

    Science.gov (United States)

    Fallavollita, Luca; Di Gioacchino, Lorena; Balestrini, Fabrizio

    2016-04-01

    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.

  7. The heterogeneity of Streptococcus viridans: therapeutic considerations in infective endocarditis

    Science.gov (United States)

    Fisher, J.; Levene, D.L.

    1975-01-01

    A 24-year-old woman with Marfan's syndrome and mitral regurgitation had clinical features suggestive of infective endocarditis. The causative organism was Streptococcus viridans. Initial therapy with penicillin G, in a dose that should have been bactericidal and hence curative according to the results of the initial quantitative antimicrobial studies, became inadequate. The strain of S. viridans displayed considerable variation in both growth properties and antimicrobial sensitivity during the course of therapy. In addition, a different strain of S. viridans was cultured 1 month after treatment had begun. It is therefore important to repeat cultures and antimicrobial sensitivity testing during treatment of infective endocarditis. PMID:1125890

  8. Estado del arte en hipertensión pulmonar y cateterismo cardiaco derecho

    OpenAIRE

    Rubén Dueñas V.

    2017-01-01

    La definición universalmente aceptada de hipertensión pulmonar corresponde a todos los pacientes con presión arterial pulmonar media igual o mayor a 25 mm Hg en reposo, medida por cateterismo cardíaco derecho, sin olvidar que la presión promedio normal de la arteria pulmonar es de máximo 20 mm Hg, lo cual obliga a seguir a los pacientes con presión arterial pulmonar media entre 20 y 24 mm Hg. También cabe recordar ser claros al diferenciar entre hipertensión pulmonar e hipertensión arterial p...

  9. Ruptura da artéria pulmonar pelo cateter de Swan-Ganz: relato de caso

    OpenAIRE

    Schechter,Marcos Coutinho; Prezzi,Eduardo Della Valle; Cabral,Gustavo; Fernandes,Eduardo Souza Martins; Vianna,Arthur Oswaldo de Abreu

    2009-01-01

    O cateter de artéria pulmonar é frequentemente usado na monitorização de pacientes durante o transplante hepático. O advento de métodos menos invasivos para estimar o débito cardíaco e a pressão de oclusão da artéria pulmonar, aliado ao fracasso de estudos randomizados em demonstrar redução da mortalidade com o uso do cateter de artéria pulmonar, reduziu sua aplicabilidade. A ruptura de artéria pulmonar pelo uso do cateter de artéria pulmonar é complicação rara, porém grave. Objetivamos relat...

  10. Acute aortic regurgitation due to infective endocarditis

    Directory of Open Access Journals (Sweden)

    Claudia M Cortés

    2017-10-01

    Full Text Available Acute aortic regurgitation (AAR due to infective endocarditis (IE is a serious disease and usually requires surgical treatment. Our study aims to compare the clinical, echocardiographic, and microbiological characteristics as well as in-hospital outcome of patients with AAR according to the severity of heart failure (HF and to evaluate predictors of in-hospital mortality in a tertiary centre. In a prospective analysis, we compared patients with NYHA functional class I-II HF (G1 vs. functional class III-IV HF (G2. From 06/92 to 07/16, 439 patients with IE were hospitalized; 86 presented AAR: (G1, 39: 45.4% y G2, 47: 54.7%. The G1 had higher prosthetic IE (43.6% vs. 17%, p 0.01. All G2 patients had dyspnoea vs. 30.8% of the G1 (p < 0.0001. There were no differences in clinical, echocardiographic and microbiological characteristics. Surgical treatment was indicated mainly due to infection extension or valvular dysfunction in G1 and HF in G2. In-hospital mortality was 15.4% vs. 27.7% (G1 and G2 respectively p NS. In multivariate analysis, health care-associated acquisition (p 0.001, negative blood cultures (p 0.004, and functional class III-IV HF (p 0.039 were in-hospital mortality predictors. One-fifth of the patients with EI had AAR. Half of them had severe HF which needed emergency surgery and the remaining needed surgery for extension of the infection and / or valvular dysfunction. Both groups remain to have high surgical and in-hospital mortality. Health care-associated acquisition, negative blood cultures and advanced HF were predictors of in-hospital mortality

  11. Tabaco e morfologia: Doenças pulmonares

    Directory of Open Access Journals (Sweden)

    Lina Carvalho

    2007-05-01

    Full Text Available Resumo: O tabaco está implicado na carcinogénese multiorgânica, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e poluição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica, RB-ILD (bronquiolite respiratória e doença pulmonar intersticial, DIP (pneumonia intersticial descamativa, bronquiolite e fibrose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco. Abstract: Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease, RB-ILD (respiratory bronchiolitis and interstitial lung disease, DIP (desquamative interstitial pneumonia

  12. Tabaco e morfologia: Doenças pulmonares

    Directory of Open Access Journals (Sweden)

    Lina Carvalho

    2007-05-01

    Full Text Available Resumo: O tabaco está implicado na carcinogénese multiorgâni-ca, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e po-luição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica, RB-ILD (bron-quiolite respiratória e doença pulmonar intersticial, DIP (pneumonia intersticial descamativa, bronquiolite e fi-brose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco.Rev Port Pneumol 2007; XIII (3: 383-389 Abstract: Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease, RB-ILD (respira-tory bronchiolitis and interstitial lung disease

  13. Aplasia pulmonar: a propósito de dos casos

    Directory of Open Access Journals (Sweden)

    Augusto Ignacio Siegert-Olivares

    2015-01-01

    Conclusiones: La aplasia pulmonar es una entidad infrecuente. Debido a la variabilidad en la presentación clínica debe tenerse un alto índice de sospecha ante el hallazgo de la radiopacidad total del hemitórax. Los métodos diagnósticos que se utilizan son radiografía, tomografía y gammagrafía. Para confirmar el diagnóstico se requiere realizar broncoscopia. La escisión del muñón y la traslocación diafragmática se han descrito como opciones quirúrgicas de tratamiento.

  14. Hidrocefalia y Carcinomatosis Leptomeningea secundaria a Adenocarcinoma pulmonar

    OpenAIRE

    Jose Alexis Quesada; Maikel Vargas; Fernando Gonzalez; Eva Moreno

    2015-01-01

    La carcinomatosis leptomeningea se diagnostica en aproximadamente un 5% al 7% de los tumores malignos, dentro de los cuales, el mas frecuente es el Carcinoma pulmonar en todos sus subtipos histológicos. Presentamos un caso clínico en el cual el paciente se presenta con un cuadro cefelea, visión borrosa e hidrocefalia de origen idiopático como síntoma inicial. Meses después de la colocación de una derivación Ventriculo-peritoneal, reingresa con un síndrome de desgaste, pérdida de peso, hiporex...

  15. KINESIOLOGÍA Y ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA

    OpenAIRE

    Kine Lorena Ross V.; Kine Jorge Zlatar E.; Kine Romina Nervi D.

    2015-01-01

    Los pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) junto con desarrollar las alteraciones respiratorias propias de la patología desarrollan también alteraciones multisistémicas que repercuten principalmente en la musculatura respiratoria y periférica, reduciendo la capacidad de tolerancia física del paciente a las actividades diarias. Junto al tratamiento médico, la kinesiología representa una importante herramienta terapéutica, ya que se orienta a mantener las capacidades fí...

  16. Enfermedades con alteraciones de la circulación pulmonar

    OpenAIRE

    Suñé Ysamat, Bertila

    1982-01-01

    El edema pulmonar es el acúmulo de líquido seroso o serohemático en el exterior de los vasos. Cualquiera que sea su etiología, el mecanismo de producción es siempre el mismo: en primer lugar es intersticial; es decir, alrededor de los alveolos. Se traduce clínicamente por una aceleración de la frecuencia respiratoria. A medida que la extravasación de líquido aumenta, los alveolos se ven afectados por el edema. Al edema intersticial se le ha añadido el edema alveolar...

  17. Hemangioendotelioma epitelioide pulmonar, um caso clínico

    OpenAIRE

    Teresa Alfaiate; Fernando Barata; Manuela Meruje; Ana Figueiredo; Fernando Matos; Correia De Matos

    2000-01-01

    RESUMO: Os autores apresentam o caso clínico de uma doente do sexo feminino, de 48 anos, com história de diabetes mellitus tipo 2, que desenvolveu um quadro de hemoptises associado a manifestações radiológicas difusas.Foi-lhe diagnosticado um hemangioendotelioma epitelioide pulmonar, tumor de natureza vascular, com comportamento intermédio entre os hemangiomas benignos e os angiossarcomas.Não há descrição na literatura quanto ao beneficio da utilização de radioterapia ou quimioterapia, pelo q...

  18. Early prosthetic valve endocarditis caused by Corynebacterium kroppenstedtii.

    Science.gov (United States)

    Hagemann, Jürgen Benjamin; Essig, Andreas; Herrmann, Manuel; Liebold, Andreas; Quader, Mohamed Abo

    2015-12-01

    Corynebacterium (C.) kroppenstedtii is a rarely detected agent of bacterial infections in humans. Here, we describe the first case of prosthetic valve endocarditis caused by C. kroppenstedtii. Application of molecular methods using surgically excised valve tissue was a cornerstone for the establishment of the microbiological diagnosis, which is crucial for targeted antimicrobial treatment. Copyright © 2015 Elsevier GmbH. All rights reserved.

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

    DEFF Research Database (Denmark)

    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. Dentigenous infectious foci – a risk factor of infective endocarditis

    Science.gov (United States)

    Wisniewska-Spychala, Beata; Sokalski, Jerzy; Grajek, Stefan; Jemielity, Marek; Trojnarska, Olga; Choroszy-Król, Irena; Sójka, Anna; Maksymiuk, Tomasz

    2012-01-01

    Summary Background Dentigenous, infectious foci are frequently associated with the development of various diseases. The role of such foci in the evolution of endocarditis still remains unclear. This article presents the concluding results of an interdisciplinary study verifying the influence of dentigenous, infectious foci on the development of infective endocarditis. Material/Methods The study subjects were 60 adult patients with history of infective endocarditis and coexistent acquired heart disease, along with the presence at least 2 odontogenic infectious foci (ie, 2 or more teeth with gangrenous pulp and periodontitis). The group had earlier been qualified for the procedure of heart valve replacement. Swabs of removed heart valve tissue with inflammatory lesions and blood were then examined microbiologically. Swabs of root canals and their periapical areas, of periodontal pockets, and of heart valves were also collected. Results Microbial flora, cultured from intradental foci, blood and heart valves, fully corresponded in 14 patients. This was accompanied in almost all cases by more advanced periodontitis (2nd degree, Scandinavian classification), irrespective of the bacterial co-occurrence mentioned. In the remaining patients, such consistency was not found. Conclusions Among various dentigenous, infectious foci, the intradental foci appear to constitute a risk factor for infective endocarditis. PMID:22293883

  1. ANTIMICROBIAL TREATMENT BEFORE DENTAL PROCEDURES IN PATIENTS WITH BACTERIAL ENDOCARDITIS

    Directory of Open Access Journals (Sweden)

    Adriana Krasteva

    2010-12-01

    Full Text Available Infective endocarditis is a rare condition with significant morbidity and mortality. It may arise following bacteraemia in a patient with a predisposing cardiac lesion. In an attempt to prevent this disease, over the past 50 years, at-risk patients have been given antibiotic prophylaxis before dental procedures.

  2. Gallium67 scintigraphy in fibrinous pericarditis associated with bacterial endocarditis

    International Nuclear Information System (INIS)

    Martin, P.; Verhas, M.; Devriendt, J.; Goffin, Y.

    1982-01-01

    An 80-year-old man presented with pyrexia, progressive cardiac failure and inflammation. A diagnosis of pericarditisd associated with bacterial endocarditis was suggested from Gallium 67 scintigraphy and confirmed at autpsy. This case of fibrinous pericarditis without effusion could not be diagnosed by echography or routine cardiopulmonary scintigraphy. (orig.)

  3. Infective endocarditis: a consumptive disease among the elderly

    Directory of Open Access Journals (Sweden)

    Vilma Takayasu

    2011-12-01

    Full Text Available The clinical presentation of infective endocarditis varies according to theetiologic agent and the host. In elderly individuals, infective endocarditis canbe difficult to diagnose and poses a challenge for the physician. The course ofsubacute infective endocarditis is indolent, and the onset of cardiac structurallesion is slow and gradual. In elderly patients, anemia and weight loss areoccasionally the only or the most striking symptoms. In such cases, the clinicalreasoning process leads to a hypothesis of wasting syndrome or neoplasticdisease, especially when there is no fever. We report the case of an elderlypatient who had mitral insufficiency due to degenerative valve disease andpresented with bacterial endocarditis due to Streptococcus mitis. The patientwas not treated, because the diagnosis was not established in a timely manner.It is of note that the patient presented with marked weight loss and no fever.The autopsy revealed impairment of the mitral valve and left atrium due toendocarditis, as well as lung involvement due to chronic inhalation of smokefrom biomass burning, such as that produced by wood-burning stoves.

  4. Infective endocarditis presenting as acute coronary syndrome | El ...

    African Journals Online (AJOL)

    We report tow cases of infective endocarditis (IE) presenting as acute coronary syndrome (ACS). Case 1: A 60-year-old man with the diagnosis of mitral IE complicated by an ST segment elevation myocardial infarction. Primary percutaneous coronary intervention with aspiration of the thrombus at the distal leftanterior ...

  5. Dentigenous infectious foci - a risk factor of infective endocarditis.

    Science.gov (United States)

    Wisniewska-Spychala, Beata; Sokalski, Jerzy; Grajek, Stefan; Jemielity, Marek; Trojnarska, Olga; Choroszy-Krol, Irena; Sójka, Anna; Maksymiuk, Tomasz

    2012-02-01

    Dentigenous, infectious foci are frequently associated with the development of various diseases. The role of such foci in the evolution of endocarditis still remains unclear. This article presents the concluding results of an interdisciplinary study verifying the influence of dentigenous, infectious foci on the development of infective endocarditis. The study subjects were 60 adult patients with history of infective endocarditis and coexistent acquired heart disease, along with the presence at least 2 odontogenic infectious foci (ie, 2 or more teeth with gangrenous pulp and periodontitis). The group had earlier been qualified for the procedure of heart valve replacement. Swabs of removed heart valve tissue with inflammatory lesions and blood were then examined microbiologically. Swabs of root canals and their periapical areas, of periodontal pockets, and of heart valves were also collected. Microbial flora, cultured from intradental foci, blood and heart valves, fully corresponded in 14 patients. This was accompanied in almost all cases by more advanced periodontitis (2nd degree, Scandinavian classification), irrespective of the bacterial co-occurrence mentioned. In the remaining patients, such consistency was not found. Among various dentigenous, infectious foci, the intradental foci appear to constitute a risk factor for infective endocarditis.

  6. [Actinobacillus actinomycetemcomitans endocarditis. A case report and literature review].

    Science.gov (United States)

    Bansky, G; Russi, E

    1981-07-25

    A case of subacute endocarditis caused by Actinobacillus actinomycetemcomitans is reported. After successful treatment with ampicillin and tobramycin, the destroyed aortic valve was replaced and a communication between an aneurysm of sinus of Valsalva and the right atrium was closed. A further 23 well documented cases from the literature are reviewed.

  7. A case of infectious endocarditis due to BCG

    Directory of Open Access Journals (Sweden)

    Alice Fournier

    2015-06-01

    Full Text Available The occurrence of bacillus Calmette–Guérin (BCG disease following instillation for bladder cancer is commonly documented. The intravesical administration of BCG is generally safe, but may present severe complications. A fatal case of native aortic valve infectious endocarditis with septicemia due to BCG in a patient treated with intravesical instillation is reported herein.

  8. Native valve endocarditis due to Candida parapsilosis in an adult ...

    African Journals Online (AJOL)

    endocarditis cases.[5] Other described risk factors include abdominal surgery, IV drug use and prosthetic heart valves. Candidiasis is the most common opportunistic infection in HIV- positive patients with CD4+ counts <200 cells/µl. The most prevalent presentation is mucocutaneous candidiasis, although invasive.

  9. Second Fatal Case of Infective Endocarditis caused by Gemella bergeriae

    Directory of Open Access Journals (Sweden)

    Aijan Ukudeeva

    2017-03-01

    Full Text Available Our case illustrates a fatal course of infection with Gemella bergeriae endocarditis that was complicated by cardiogenic shock due to perforation of the mitral valve with severe mitral regurgitation, extension of infection into the myocardium adjacent to the mitral valve, and coronary sinus thrombosis.

  10. Enterococcal Infective Endocarditis following Periodontal Disease in Dogs.

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Acute Q fever and the risk of developing endocarditis.

    Science.gov (United States)

    Martín-Aspas, A; Collado-Pérez, C; Vela-Manzano, L; Fernández-Gutiérrez Del Álamo, C; Tinoco-Racero, I; Girón-González, J A

    2015-01-01

    Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. Eighty patients were recruited, 20% of whom had phase i IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase i IgG antibodies. The early increase in phase i IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Pulmonary Valve Bacterial Endocarditis in Tetralogy of Fallot

    Directory of Open Access Journals (Sweden)

    Kyomars Abbasi

    2007-03-01

    Full Text Available We report two cases of Tetralogy of Fallot with pulmonary valve bacterial endocarditis where one extended to the branch of pulmonary artery (PA. This is a rare occurrence. Aggressive supportive care plus early and radical surgery can be life saving.

  14. Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

    DEFF Research Database (Denmark)

    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...

  15. Garenoxacin Treatment of Experimental Endocarditis Caused by Viridans Group Streptococci

    Science.gov (United States)

    Anguita-Alonso, Paloma; Rouse, Mark S.; Piper, Kerryl E.; Steckelberg, James M.; Patel, Robin

    2006-01-01

    The activity of garenoxacin was compared to that of levofloxacin or penicillin in a rabbit model of Streptococcus mitis group (penicillin MIC, 0.125 μg/ml) and Streptococcus sanguinis group (penicillin MIC, 0.25 μg/ml) endocarditis. Garenoxacin and levofloxacin had MICs of 0.125 and 0.5 μg/ml, respectively, for both study isolates. Rabbits with catheter-induced aortic valve endocarditis were given no treatment, penicillin at 1.2 × 106 IU/8 h intramuscularly, garenoxacin at 20 mg/kg of body weight/12 h intravenously, or levofloxacin at 40 mg/kg/12 h intravenously. For both isolates tested, garenoxacin area under the curve (AUC)/MIC and maximum concentration of drug in serum (Cmax)/MIC ratios were 368 and 91, respectively. Rabbits were sacrificed after 3 days of treatment; cardiac valve vegetations were aseptically removed and quantitatively cultured. For S. mitis group experimental endocarditis, all studied antimicrobial agents were more active than no treatment (P viridans group endocarditis and that garenoxacin and levofloxacin may not be ideal choices for serious infections caused by some quinolone-susceptible viridans group streptococci. PMID:16569838

  16. Isolated tricuspid valve infective endocarditis - A report of 6 cases ...

    African Journals Online (AJOL)

    Six cases of isolated tricuspid valve endocarditis in young women are described. Preceding genital sepsis was a predisposing factor in 4 patients. Cardiac signs are unusual at presentation, rendering the diagnosis difficult. Pleuropulmonary manifestations are the predominant findings, while overt signs of tricuspid ...

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

    DEFF Research Database (Denmark)

    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...

  18. Endocarditis caused by Streptococcus canis: an emerging zoonosis?

    Science.gov (United States)

    Lacave, Guillaume; Coutard, Aymeric; Troché, Gilles; Augusto, Sandrine; Pons, Stéphanie; Zuber, Benjamin; Laurent, Virginie; Amara, Marlène; Couzon, Brigitte; Bédos, Jean-Pierre; Pangon, Béatrice; Grimaldi, David

    2016-02-01

    We report a human case of infective endocarditis caused by Streptococcus canis. Identification was carried out from positive blood culture using mass spectrometry and SodA gene sequencing. S. canis related zoonotic invasive infections may have been previously underdiagnosed due to inadequate identification of group G Streptococcus species.

  19. Triple valve endocarditis by mycobacterium tuberculosis. A case report

    Directory of Open Access Journals (Sweden)

    Shaikh Quratulain

    2012-09-01

    Full Text Available Abstract Background Granulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series. Case presentation We report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement and tricuspid repair. The vegetations showed granulomatous inflammation but blood cultures and other biological specimen cultures were negative for any organisms. She was started on antituberculous treatment and anticoagulation. Conclusion This is the first reported case of triple valve endocarditis by Mycobacterium Tuberculosis in an immunocompetent host. Especially important is the fact that the right heart is involved which has been historically described in the setting of intravenous drug abuse. This implies that Tuberculosis should be considered in cases of culture negative endocarditis in endemic areas like Pakistan even in immunocompetent hosts.

  20. Risks and Challenges of Surgery for Aortic Prosthetic Valve Endocarditis.

    Science.gov (United States)

    Grubitzsch, Herko; Tarar, Waharat; Claus, Benjamin; Gabbieri, Davide; Falk, Volkmar; Christ, Torsten

    2018-03-01

    Prosthetic valve endocarditis is the most severe form of infective endocarditis. This study assessed the risks and challenges of surgery for aortic prosthetic valve endocarditis. In total, 116 consecutive patients (98 males, age 65.2±12.7years), who underwent redo-surgery for active aortic prosthetic valve endocarditis between 2000 and 2014, were reviewed. Cox regression analysis was used to identify factors for aortic root destructions as well as for morbidity and mortality. Median follow-up was 3.8 years (0-13.9 years). Aortic root destructions (42 limited and 29 multiple lesions) were associated with early prosthetic valve endocarditis and delayed diagnosis (≥14 d), but not with mortality. There were 16 (13.8%) early (≤30 d) and 32 (27.6%) late (>30 days) deaths. Survival at 1, 5, and 10 years was 72±4.3%, 56±5.4%, and 46±6.4%, respectively. The cumulative incidence of death, reinfection, and reoperation was 19.0% at 30days and 36.2% at 1year. Delayed diagnosis, concomitant procedures, and EuroSCORE II >20% were predictors for early mortality and need for mechanical circulatory support, age >70years, and critical preoperative state were predictors for late mortality. In their absence, survival at 10 years was 70±8.4%. Reinfections and reoperations occurred more frequently if ≥1 risk factor for endocarditis and aortic root destructions were present. At 10 years, freedom from reinfection and reoperation was 89±4.2% and 91±4.0%. The risks of death, reinfection, and reoperation are significant within the first year after surgery for aortic prosthetic valve endocarditis. Early diagnosis and aortic root destructions are the most important challenges, but advanced age, critical preoperative state, and the need for mechanical circulatory support determine long-term survival. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B

  1. Adenocarcinoma pulmonar em um bovino Pulmonary adenocarcinoma in a bovine

    Directory of Open Access Journals (Sweden)

    Aline de Marco Viott

    2010-02-01

    Full Text Available Um bovino Guzerá, fêmea, adulto, com histórico de insuficiência cardíaca congestiva direita de duração de duas semanas, morreu durante o transporte ao hospital veterinário. À necropsia, o lobo pulmonar cranial esquerdo estava moderadamente aumentado de tamanho e firme. O parênquima do lobo afetado era branco e continha múltiplas áreas de 0,3 a 1,5cm de diâmetro, amareladas e caseosas. Alterações semelhantes foram observadas nos linfonodos mediastínicos e brônquicos, no pericárdio parietal, no epicárdio e na adventícia da artéria pulmonar. Histologicamente, a massa tecidual do lobo pulmonar era constituída por células epiteliais neoplásicas de padrão acinar, com duas ou mais camadas celulares, algumas com projeções papilares intraluminais. A anisocariose era acentuada, e o índice mitótico, moderado (dois a três por campo de maior aumento. Envolvendo as neoformações, observava-se abundante tecido conjuntivo fibroso. Focos de necrose e mineralização eram multifocais moderados. Alterações histológicas semelhantes foram observadas nos linfonodos brônquicos, nos mediastínicos, nos pericárdios visceral e parietal e na adventícia da artéria pulmonar. Com exceção do fígado com congestão generalizada crônica, não foram observadas alterações macro e microscópicas em outros órgãos. Os achados histológicos foram compatíveis com adenocarcinoma pulmonar, com metástases regionais. O quadro de insuficiência cardíaca congestiva direita provavelmente foi decorrente do impedimento da drenagem linfática pelas metástases.An adult Guzera cow, dysplaying for two weeks signs of right-sided congestive heart failure died during the transport to the veterinary hospital. At necropsy, the left cranial lung lobe was moderately increased in volume and firm. The parenchyma of the affected lung lobe was white and contained multiple 0.3 to 1.5cm in diameter, yellow, dry, friable nodules. Similar changes were observed in

  2. Superantigens Are Critical for Staphylococcus aureus Infective Endocarditis, Sepsis, and Acute Kidney Injury

    Science.gov (United States)

    Salgado-Pabón, Wilmara; Breshears, Laura; Spaulding, Adam R.; Merriman, Joseph A.; Stach, Christopher S.; Horswill, Alexander R.; Peterson, Marnie L.; Schlievert, Patrick M.

    2013-01-01

    ABSTRACT Infective endocarditis and kidney infections are serious complications of Staphylococcus aureus sepsis. We investigated the role of superantigens (SAgs) in the development of lethal sepsis, infective endocarditis, and kidney infections. SAgs cause toxic shock syndrome, but it is unclear if SAgs contribute to infective endocarditis and kidney infections secondary to sepsis. We show in the methicillin-resistant S. aureus strain MW2 that lethal sepsis, infective endocarditis, and kidney infections in rabbits are critically dependent on high-level SAgs. In contrast, the isogenic strain lacking staphylococcal enterotoxin C (SEC), the major SAg in this strain, is attenuated in virulence, while complementation restores disease production. SAgs’ role in infective endocarditis appears to be both superantigenicity and direct endothelial cell stimulation. Maintenance of elevated blood pressure by fluid therapy significantly protects from infective endocarditis, possibly through preventing bacterial accumulation on valves and increased SAg elimination. These data should facilitate better methods to manage these serious illnesses. PMID:23963178

  3. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

    Directory of Open Access Journals (Sweden)

    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante. Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent

  4. Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable

    OpenAIRE

    Antonio Miranda; Sergio Franco; William Uribe; Mauricio Duque; Francisco Femenía; Adrián Baranchuk

    2012-01-01

    La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permea...

  5. Pseudocisto pulmonar pós-traumático em jogador de futebol: relato de caso

    Directory of Open Access Journals (Sweden)

    Andre Nathan Costa

    2013-04-01

    Full Text Available Pseudocistos pulmonares são lesões raras que se desenvolvem no parênquima pulmonar após traumas fechados e de grande energia, cujo diagnóstico se baseia na associação da história clínica com exames de imagem. Relata-se a seguir um pseudocisto pulmonar ocorrido no parênquima contralateral ao trauma em um homem de 31 anos que apresentou episódio de hemoptise após queda durante partida de futebol.

  6. Biomarcadores de lesión miocárdica y edema pulmonar de las alturas

    OpenAIRE

    Uribe, Hellen C.; Linares, Gerardo; Cortés, Luis A.

    2014-01-01

    El edema pulmonar de las alturas es una entidad potencialmente fatal que se presenta en individuos que ascienden rápidamente por encima de 2.500 msnm. La hipoxia, el deterioro de la clase funcional y la dificultad respiratoria son el resultado de un edema pulmonar no cardiogénico. En este caso clínico de edema pulmonar de las alturas se encontró elevación de biomarcadores de lesión miocárdica y de sobrecarga de presión, sin compromiso estructural cardiaco o coronario, hallazgo que no ha sido ...

  7. Oral antibiotic treatment of left-sided infectious endocarditis verified by 16S-PCR

    DEFF Research Database (Denmark)

    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....

  8. Purulent Meningitis as an Unusual Presentation of Staphylococcus aureus Endocarditis: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Giancarlo Ceccarelli

    2011-01-01

    Full Text Available On presentation of Staphylococcus aureus endocarditis, unusual manifestations may represent the main clinical features of the disease. Isolated bacterial meningitis as the first manifestation of endocarditis is considered to be an unusual neurological complication. Here, we describe a case S. aureus endocarditis presenting as isolated meningitis and mimicking meningococcal septicaemia. Because of the high mortality rate of the disease, the prompt recognition of this infectious syndrome is of crucial importance for the correct management of patients.

  9. Kytococcus schroeteri endocarditis successfully managed with daptomycin: a case report and review of the literature.

    Science.gov (United States)

    Liu, J C; Jenkins, D R; Malnick, H; Kovac, J; Szostek, J

    2012-05-01

    Kytococcus shroeteri is a rare cause of prosthetic valve endocarditis. Here, we report what is believed to be the first case of K. schroeteri endocarditis to be treated successfully by daptomycin and review the published literature of K. schroeteri endocarditis. There are no published daptomycin susceptibility data for Kytococcus and additional work was carried out on six other isolates stored at the Laboratory of HealthCare Associated Infections (LHCAI), Health Protection Agency (HPA) Centre for Infections, Colindale, London. © 2012 SGM

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

    DEFF Research Database (Denmark)

    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...

  11. Pulmonary valve endocarditis associated to a septal interventricular defect and infundibular and pulmonary valve Stenosis

    International Nuclear Information System (INIS)

    Echeverri, Juan G; Diaz, Alejandro; Jaramillo, Nicolas; Gonzalez, Sergio

    2004-01-01

    Ventricular septal defects generate 10% of all adult congenital cardiopathies. 4% to 8% of patients to whom the defect has not been corrected are in risk of developing endocarditis. Pulmonary valve endocarditis is a rare event (1.5% to 2% of all endocarditis cases) and its mean etiology is intravenous drug abuse. The most frequently isolated microorganism in these cases is staphylococcus aurous. We report a case of pulmonary valve endocarditis associated with ventricular septal defect and valvular and infundibular pulmonary stenosis caused by streptococcus sp. in a patient without past medical history of drug abuse, alcoholism or previous invasive procedures

  12. Infective Endocarditis: A Review of the Past and Present, and a Look into the Future

    Directory of Open Access Journals (Sweden)

    Eric I-Hun Jeng, MD, MBA

    2017-05-01

    Full Text Available Infective endocarditis is a lethal and challenging multifaceted disease that can involve any vascularized system. We believe that multimodality imaging is invaluable to provide a comprehensive diagnosis. Our management approach to infective endocarditis adheres to a combination of the AHA, ACC, STS, and ESC guidelines. With the rapidly increasing transcatheter valve population, we expect an increased caseload of infective endocarditis. Beyond patients with hemorrhagic strokes, we advocate for early surgery if medical management has failed. Furthermore, a multidisciplinary team approach is imperative in infective endocarditis, and clear communication reduces the time to diagnosis and definitive treatment for this patient population.

  13. Cervical epidural abscess: rare complication of bacterial endocarditis with streptococcus viridans: a case report.

    Science.gov (United States)

    Oh, Jae-Sang; Shim, Jai-Joon; Lee, Kyeong-Seok; Doh, Jae-Won

    2015-03-01

    Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis.

  14. Volúmenes pulmonares normales en pacientes con fibrosis pulmonar idiopática y enfisema Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema

    Directory of Open Access Journals (Sweden)

    Juan Pablo Casas

    2008-08-01

    Full Text Available La fibrosis pulmonar idiopática (FPI es una enfermedad que se caracteriza por presentar un compromiso pulmonar de tipo restrictivo, resultante de una reducción en la complacencia pulmonar secundaria a fibrosis difusa. En el enfisema, la pérdida de elasticidad pulmonar y el colapso de las vías aéreas periféricas generan obstrucción e hiperinflación. El efecto simultáneo que ambas enfermedades producen sobre la fisiología pulmonar no es del todo claro y se han descripto volúmenes pulmonares normales o casi normales. Presentamos 4 pacientes de sexo masculino de 64, 60, 73 y 70 años, con antecedentes de tabaquismo e historia de disnea progresiva, tres de ellos con grave limitación en su calidad de vida al momento de la consulta. En la tomografía de tórax de alta resolución todos los pacientes presentaban signos de enfermedad intersticial pulmonar avanzada, con cambios de tipo fibrótico con predominio basal y subpleural, que coexistían con enfisema centroacinar con predominio en lóbulos superiores. Uno de ellos tuvo confirmación diagnóstica de ambas condicioes por biopsia pulmonar a cielo abierto. En los cuatro pacientes la espirometría y volúmenes pulmonares fueron normales, pero tenían importante compromiso del intercambio gaseoso evaluado mediante el test de caminata de 6 minutos. Tres de los pacientes tenían hipertensión pulmonar grave diagnosticado por ecocardiograma. La presencia de volúmenes pulmonares normales no excluye un diagnóstico de fibrosis pulmonar idiopática en pacientes fumadores si coexisten evidencias tomográficas de enfisema. En estos pacientes el grado de compromiso funcional, determinado por la reducción de los volúmenes pulmonares, no debería ser considerado en la evaluación de la gravedad.Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive

  15. Esclerose tuberosa com envolvimento pulmonar Tuberous sclerosis with pulmonary involvment

    Directory of Open Access Journals (Sweden)

    Susana Ferreira

    2010-04-01

    Full Text Available A esclerose tuberosa (ET é uma doença rara, esporádica ou transmitida de forma autossómica dominante. Caracteriza-se pela tríade convulsões, atraso mental e angiofibromas faciais. O envolvimento pulmonar é raro e, quando ocorre, é mais frequente no sexo feminino. Os autores apresentam o caso de uma doente de 52 anos, não fumadora, com antecedentes conhecidos de epilepsia na infância e angiomiolipomas renais. Assintomática e sem alterações ao exame objectivo. Em tomografia do tórax realizada para avaliação da doença, foram detectadas formações microquísticas dispersas em ambos os campos pulmonares. Exame funcional respiratório normal. A ressonância magnética cerebral evidenciou tuberosidades corticais e nódulos subependimários calcificados. Concluiu-se pelo diagnóstico de ET (linfangioleiomiomatose, tuberosidades corticais, nódulos subependimários e angiomiolipomas renais. Os autores apresentam o caso pela raridade da doença e do envolvimento pulmonar, ainda que em fase assintomática.Tuberous sclerosis (TS is a rare, sporadic or autosomal dominant disease characterized by the triad of seizures, mental retardation and angiofibromas. Lungs are rarely involved in TS, and pulmonary involvement is almost always found in females. We report the case of a 52 year-old female, nonsmoker, with a history of seizures in childhood and renal angiomyolipomas. She presented no complaints and her physical exam was normal. Chest CT performed for the evaluation of the disease detected thin-walled pulmonary cysts in both lungs. Lung function tests were normal. Cortical tubers and calcified subependymal nodules were seen in cerebral magnetic resonance. Tuberous sclerosis was diagnosed (lymphangioleiomyomatosis, cortical tubers, calcified subependymal nodules and angiomyiolipomas. The authors present this case because of its rarity and the existence of pulmonary involvement, while still asymptomatic.

  16. Envolvimento pulmonar na polimiosite Pulmonary disease in polymyositis

    Directory of Open Access Journals (Sweden)

    Direndra Hasmucrai

    2010-08-01

    Full Text Available Introdução: A polimiosite (PM e a dermatomiosite são classificadas como miopatias inflamatórias idiopáticas. O envolvimento pulmonar por PM é pouco frequente, estando descrito na literatura em cerca de 10% de casos. Os autores apresentam um caso de uma mulher de 75 anos, com queixas de febre, perda ponderal, artralgias, mialgias e diminuição simétrica e proximal da força muscular com impotência funcional dos membros superiores e inferiores, com início um mês antes do internamento. Apresentava infiltrados pulmonares na telerradiografia de tórax. Após estudo exaustivo estabeleceu -se o diagnóstico de envolvimento pulmonar na forma de pneumonia organizativa por PM. Efectuou-se corticoterapia e terapêutica com micofenolato com melhoria clínica, analítica e radiológica. Conclusão: Neste caso, foi a alteração na telerradiografia de tórax numa doente sem sintomatologia respiratória que levou ao estudo exaustivo até ao diagnóstico de PM, realçando mais uma vez a importância da telerradiografia no rastreio de patologias de outros foros.Introduction: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases. The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X -ray. After exhaustive study, the diagnosis of pulmonary envolvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome. Conclusion: In this case, it was the changes in the chest X -ray in a patient without respiratory symptomatology, that conducted to exhaustive study to polymyositis diagnosis, enhancing once again the importance of X

  17. INVOLVEMENT OF BACTERICIDAL FACTORS FROM THROMBIN-STIMULATED PLATELETS IN CLEARANCE OF ADHERENT VIRIDANS STREPTOCOCCI IN EXPERIMENTAL INFECTIVE ENDOCARDITIS

    NARCIS (Netherlands)

    VANDERWERFF, J; ZAAT, SAJ; JOLDERSMA, W; HESS, J

    Platelets activated with thrombin release bactericidal factors. We studied the role of the susceptibility of viridans streptococci to these bactericidal factors in the development of infective endocarditis (IE). By using the experimental endocarditis rabbit model, the initial adherence and the

  18. Severe Staphylococcus aureus Endocarditis Presenting as Peripartum Thrombotic Thrombocytopenic Purpura.

    Science.gov (United States)

    Quinn, Kieran L; Osmond, Mark; Badiwala, Mitesh; Sermer, Mathew; Lapinsky, Stephen E

    2016-11-01

    Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness that occurs in both pregnant and non-pregnant women. Several other conditions can mimic the disease, which makes the diagnosis challenging. We describe a case of severe Staphylococcus aureus endocarditis that initially presented as peripartum TTP in a 39-year-old woman at 29+6 weeks' gestation. We give an overview of the diagnostic considerations and management of thrombocytopenia in pregnancy and review the literature related to TTP and peripartum infective endocarditis. Given the significant differences in definitive therapies for the spectrum of thrombocytopenic conditions that occur in pregnancy, timely and accurate diagnosis of TTP is critical for optimal management. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  19. Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis

    Directory of Open Access Journals (Sweden)

    Dores Hélder

    2012-02-01

    Full Text Available Abstract Gerbode defect is a rare type of left ventricle to right atrium shunt. It is usually congenital in origin, but acquired cases are also described, mainly following infective endocarditis, valve replacement, trauma or acute myocardial infarction. We report a case of a 50-year-old man who suffered an extensive and complex infective endocarditis involving a bicuspid aortic valve, the mitral-aortic intervalvular fibrosa and the anterior leaflet of the mitral valve. After dual valve replacement and annular reconstruction, a shunt between the left ventricle and the right atrium - Gerbode defect, and a severe leak of the mitral prosthesis were detected. Reintervention was performed with successful shunt closure with an autologous pericardial patch and paravalvular leak correction. No major complications occurred denying the immediate post-surgery period and the follow-up at the first year was uneventful.

  20. [Brucella abortus endocarditis: survival of a 74 year old patient].

    Science.gov (United States)

    Olea M, Pilar

    2010-02-01

    Brucellosis is not frequent in Chile but it may present with life threatening complications like endocarditis. The case reported refers to a 74 year old man admitted to the Infectious Diseases Hospital Dr. Lucio Córdova in Santiago. He had been febrile for 3 months with no specific symptoms. The trans-esophageal echocardiography confirmed multiple large vegetations and important involvement of the aortic valve. Blood cultures yielded Brucella abortus. The patient required cardiac surgery, along with antibiotics, and he had a satisfactory outcome, being alive at the moment of this report???. Brucellosis can be the responsible for prolonged fever of unknown origin. It is necessary to take in mind brucellosis to obtain the specific laboratory tests. For a best prognosis an early treatment with associated antibiotics for at least 4 a 6 weeks is important. If endocarditis is present valve replacement is often necessary.

  1. Infective endocarditis case due to streptococcus parasanguinis presented with spondylodiscitis

    Directory of Open Access Journals (Sweden)

    ismail Necati Hakyemez

    2016-09-01

    Full Text Available Streptococcus parasanguinis is a natural member of oral flora. It is an opportunistic pathogen, and rarely cause systemic infections due to it's low virulence. Subacute infective endocarditis may present with various clinical manifestations (eg., spondylodiscitis. A sixty-five years old male patient from Northern Iraq has referred to our emergency service with high fever, weight loss, back pain and inability to walk. The patient was a veterinarian. He was operated three years ago for colonic carcinoma and irradiated. In magnetic resonance imaging, spondylodiscitis was detected localized in lumbar 1-2 region. Transthorasic echocardiography demonstrated aortic valve vegetation. S. parasanguinis was identified in the blood cultures. In conclusion; all in all, it's remarkable to isolate S. parasanguinis as a causal agent of infective endocarditis in a patient who is a veterinarian with history of colonic carcinoma presented with clinical manifestation of spondylodiscitis. [Cukurova Med J 2016; 41(3.000: 591-594

  2. Streptobacillus moniliformis endocarditis: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    M. Madhubashini

    2013-07-01

    Full Text Available Rat bite fever is a rare infection and sometimes results in complications. This case report describes native mitral valve endocarditis in a 44-year-old male patient caused by Streptobacillus moniliformis. The diagnosis was confirmed by transesophageal echocardiography and blood cultures (BACTEC. The patient was treated with IV crystalline penicillin (6 weeks and gentamicin (2 weeks. The fundamental importance of a high index of suspicion, interpreting investigations and appropriateness of therapy are highlighted.

  3. Late bacterial endocarditis of an Amplatzer atrial septal device

    Directory of Open Access Journals (Sweden)

    Bhavith Aruni

    2013-07-01

    Full Text Available A 59-year-old male with an secundum atrial septal defect status post repair with an Amplatzer occluder in 2001 was admitted with sepsis and MRSA bacteremia. Transesophageal Echocardiography (TEE showed presence of an overlying mobile echogenic structure on the left atrial surface of the device suggestive of a vegetation/infected thrombus. This is only the 3rd case description of late endocarditis involving the Amplatzer ASD closure device in an adult.

  4. Rarity of invasiveness in right-sided infective endocarditis.

    Science.gov (United States)

    Hussain, Syed T; Shrestha, Nabin K; Witten, James; Gordon, Steven M; Houghtaling, Penny L; Tingleff, Jens; Navia, José L; Blackstone, Eugene H; Pettersson, Gösta B

    2018-01-01

    The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients. From January 2002 to January 2015, 1292 patients underwent surgery for active IE, 138 right-sided and 1224 left-sided. Among patients with right-sided IE, 131 had tricuspid and 7 pulmonary valve IE; 12% had prosthetic valve endocarditis. Endocarditis-related invasiveness was based on echocardiographic and operative findings. Invasive disease was rare on the right side, occurring in 1 patient (0.72%; 95% confidence interval 0.02%-4.0%); rather, it was limited to valve cusps/leaflets or was superficial. In contrast, IE was invasive in 408 of 633 patients with aortic valve (AV) IE (65%), 113 of 369 with mitral valve (MV) IE (31%), and 148 of 222 with AV and MV IE (67%). Staphylococcus aureus was a more predominant organism in right-sided than left-sided IE (right 40%, AV 19%, MV 29%), yet invasion was observed almost exclusively on the left side of the heart, which was more common and more severe with AV than MV IE and more common with prosthetic valve endocarditis than native valve IE. Rarity of right-sided invasion even when caused by S aureus suggests that invasion and development of cavities/"abscesses" in patients with IE may be driven more by chamber pressure than organism, along with other reported host-microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis.

    OpenAIRE

    Daly, J S; Worthington, M G; Brenner, D J; Moss, C W; Hollis, D G; Weyant, R S; Steigerwalt, A G; Weaver, R E; Daneshvar, M I; O'Connor, S P

    1993-01-01

    A Rochalimaea-like organism (strain F9251) was isolated from a patient with endocarditis after blood drawn for culture before antimicrobial therapy was subcultured onto blood and chocolate agars and incubated for 2 weeks in 5% CO2. The strain was phenotypically similar to known Rochalimaea species. The cellular fatty acid composition of strain F9251 was close to but distinct from those of the three known Rochalimaea species and was most similar to that of R. vinsonii. Labeled DNA from strain ...

  6. Surgical treatment of aortic valve endocarditis: a 26-year experience

    Directory of Open Access Journals (Sweden)

    Taylan Adademir

    2014-03-01

    Full Text Available Objective: We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years. Methods: From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3% patients were male and the mean age was 39.3±14.4 (9-77 years. Twenty-seven (15.5% patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2 adding up to a total of 1030.8 patient/years. Results: Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%. In-hospital mortality occurred in 27 (15.5% cases. Postoperatively, 25 (14.4% patients had low cardiac output and 17 (9.8% heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up. Conclusion: Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    S. Hernández Egido

    2016-01-01

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

  9. Daptomycin-Vancomycin–Resistant Enterococcus faecium Native Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    Khandakar Hussain MD

    2016-09-01

    Full Text Available Multidrug-resistant enterococcal nosocomial invasive infections are a rising concern faced by the medical community. Not many options are available to treat these highly virulent organisms. Risk factors for developing these highly resistant organisms include prolonged hospital stay, previous antibiotic use, and immunosuppression. In this article, we report a case of daptomycin-resistant enterococcal native infective endocarditis treated with off-label use of quinupristin-dalfopristin.

  10. Achados Radiológicos Pulmonares da Fibrose Cística

    Directory of Open Access Journals (Sweden)

    Kelly Ribeiro Neves

    2011-07-01

    Full Text Available As radiografias de tórax são essenciais na avaliação pulmonar em pacientes com fibrose cística e a despeito da superioridade técnica da tomografia computadorizada, elas ainda permanecem como a ferramenta diagnóstica primária no seguimento destes pacientes. Demonstramos algumas manifestações radiológicas pulmonares desta entidade diagnóstica e destacamos alguns aspectos da literatura.

  11. Hemosiderosis pulmonar idiopática Idiopathic pulmonary hemosiderosis

    Directory of Open Access Journals (Sweden)

    Marlen Rivero González

    2012-09-01

    Full Text Available Se denomina hemosiderosis pulmonar a los procesos caracterizados por depósitos anormales de hemosiderina en el parénquima pulmonar, secundarios a sangrados alveolares difusos y repetidos. Es una enfermedad de causa desconocida, poco frecuente, y en muchas ocasiones grave. En la mayoría de los pacientes se presenta en la primera década de la vida, sin predilección en cuanto a sexo. Se presenta una paciente de 7 años de edad, femenina, de piel blanca, con antecedentes de 22 ingresos desde la etapa de lactante por episodios recurrentes de dificultad respiratoria, interpretados como bronconeumonías, asociados a anemia aguda. Para el diagnóstico se realizó lavado broncoalveolar, y se observaron los macrófagos cargados de hemosiderina. La evaluación clínica y de laboratorio permitió excluir causas secundarias. Se instauró tratamiento con prednisona, con lo cual se logró una mejoría de la enfermedad. Se discuten los elementos clínicos, diagnósticos y terapéuticos de esta entidad.Idiopathic pulmonary hemosiderosis is those processes characterized by anomalous depots of hemosiderin in the pulmonary parenchyma, secondary to diffuse and repeated alveolar bleedings. It is an unknown disease, uncommon and mostly severe. It occurs in the first decade of life of most of the patients, regardless of sex. Here is a 7 years-old patient, female, Caucasian, with a history of 22 hospitalizations since she was a baby, due to recurrent episodes of respiratory distress diagnosed as bronchial pneumonias associated to acute anemia. For the diagnosis of this disease, bronchoalveolar lavage was performed and hemosiderin-loaded macrophages were observed. The clinical and lab evaluation excluded secondary causes. She was treated with prednisone and she improved her condition. The clinical, diagnosing and therapeutic elements of this disease were discussed.

  12. Una mirada general a las enfermedades pulmonares intersticiales y una específica a la fibrosis pulmonar idiopática

    Directory of Open Access Journals (Sweden)

    Pedro J. Marcos

    2013-03-01

    Full Text Available Las enfermedades pulmonares intersticiales difusas (EPID engloban un conjunto heterogéneo de patologías caracterizadas por afectar predominantemente al intersticio pulmonar, que es el espacio anatómico comprendido entre lasmembranas basales del epitelio alveolar y el endotelio capilar. Con frecuencia se observa un retraso en el diagnósticode las EPID. La falta de especificidad de los síntomas y el escaso uso de técnicas diagnósticas como es la espirometría en los primeros niveles asistenciales, hacen que sea bastante frecuente que los clínicos achaquen los síntomasrespiratorios del paciente a entidades más prevalentes comoes la enfermedad pulmonar obstructiva crónica (EPOC

  13. Reconstructive valve surgery within 10 days of stroke in endocarditis.

    Science.gov (United States)

    Raman, Jai; Ballal, Apoorva; Hota, Bala; Mirza, Sara; Lai, David; Bleck, Thomas; Lateef, Omar

    2016-07-01

    The optimal timing of surgical treatment for infective endocarditis complicated by cerebrovascular events is controversial, largely due to the perceived risk of perioperative intracranial bleeding. Current guidelines suggest waiting 2 weeks between the diagnosis of stroke and surgery. The aim of this study was to investigate the clinical and neurological outcomes of early surgery following a stroke. This was a single-center retrospective analysis of 12 consecutive patients requiring surgery for infective endocarditis between 2011 and 2014 at Rush University Medical Center, with either ischemic (n = 6) and/or hemorrhagic (n = 6) cerebrovascular complications. All underwent computed tomographic angiography prior to early valve reconstructive surgery to identify potentially actionable neurological findings. Early valve surgery was performed for ongoing sepsis or persistent emboli. Neurologic risk and outcome were assessed pre- and postoperatively using the National Institutes of Health Stroke Scale and the Glasgow Outcome Scale, respectively. All 12 patients underwent surgical treatment within 10 days of the diagnosis of stroke. Mortality in the immediate postoperative period was 8%. Eleven of the 12 patients exhibited good neurological recovery in the immediate postoperative period, with a Glasgow Outcome Scale score ≥ 3. There was no correlation between duration of cardiopulmonary bypass and neurological outcomes. Early cardiac surgery in patients with infective endocarditis and stroke maybe lifesaving with a low neurological risk. Comprehensive neurovascular imaging may help in identifying patient-related risk factors. © The Author(s) 2016.

  14. Severe Rhabdomyolysis Associated with Staphylococcus aureus Acute Endocarditis Requiring Surgery.

    Science.gov (United States)

    Ravry, Céline; Fedou, Anne-Laure; Dubos, Maria; Denes, Éric; Etchecopar, Caroline; Barraud, Olivier; Vignon, Philippe; François, Bruno

    2015-12-01

    Rhabdomyolysis has multiple etiologies with unclear mechanisms; however, rhabdomyolysis caused by Staphylococcus aureus infection is rare. A case report of severe rhabdomyolysis in a patient who presented with endocarditis caused by methicillin-susceptible S. aureus and review of relevant literature. The patient had a history of cardiac surgery for tetralogy of Fallot. He was admitted to the hospital because of fever and digestive symptoms. Respiratory and hemodynamic status deteriorated rapidly, leading to admission to the intensive care unit (ICU) for mechanical ventilation and vasopressor support. Laboratory tests disclosed severe rhabdomyolysis with a serum concentration of creatine kinase that peaked at 49,068 IU/L; all blood cultures grew methicillin-susceptible S. aureus. Antibiotic therapy was amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin initially and was changed subsequently to oxacillin, clindamycin, and gentamicin. Transesophageal echocardiography showed vegetation on the pulmonary valve, thus confirming the diagnosis of acute endocarditis. Viral testing and computed tomography (CT) scan ruled out any obvious alternative etiology for rhabdomyolysis. Bacterial analysis did not reveal any specificity of the staphylococcal strain. The patient improved with antibiotics and was discharged from the ICU on day 26. He underwent redux surgery for valve replacement on day 53. Staphylococcal endocarditis should be suspected in cases of severe unexplained rhabdomyolysis with acute infectious symptoms.

  15. Hemangiomatose capilar pulmonar, uma rara causa de hipertensão pulmonar: primeiro caso brasileiro Pulmonary capillary hemangiomatosis. A rare cause of pulmonary hypertension: the first Brazilian case

    Directory of Open Access Journals (Sweden)

    Helano Neiva de Castro

    2005-08-01

    Full Text Available A hemangiomatose capilar pulmonar é uma doença rara, caracterizada por proliferação de capilares que invadem o interstício pulmonar e o septo alveolar. Documentamos o primeiro caso brasileiro: um paciente do sexo masculino, de 21 anos, com hipertensão pulmonar grave, que evoluiu para óbito. Na tomografia computadorizada de alta resolução apresentava pequenas opacidades intersticiais nodulares maldefinidas, bilateralmente. Foi realizada biópsia pulmonar post-mortem e encontrada intensa proliferação multifocal de capilares nas paredes alveolares, septos interlobulares e tecido conjuntivo peribrônquico. O diagnóstico de hemangiomatose capilar pulmonar deve ser considerado nos pacientes com hipertensão pulmonar e alterações sugestivas na tomografia computadorizada de alta resolução.Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.

  16. Candida endocarditis: systematic literature review from 1997 to 2014 and analysis of 29 cases from the Italian Study of Endocarditis.

    Science.gov (United States)

    Giuliano, Simone; Guastalegname, Maurizio; Russo, Alessandro; Falcone, Marco; Ravasio, Veronica; Rizzi, Marco; Bassetti, Matteo; Viale, Pierluigi; Pasticci, Maria Bruna; Durante-Mangoni, Emanuele; Venditti, Mario

    2017-09-01

    Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.

  17. Unusual location of the Libman-Sacks endocarditis in a teenager: a case report.

    Science.gov (United States)

    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.

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

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-04-08

    Abstract Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults, with an overall mortality rate of up to 25%, but it is a rare cause of infective endocarditis. We present herein a case of N. meningitidis meningitis complicated with infective endocarditis.

  19. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    International Nuclear Information System (INIS)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-01-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using 111 In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities

  20. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis

    NARCIS (Netherlands)

    van der Meer, J. T.; Thompson, J.; Valkenburg, H. A.; Michel, M. F.

    1992-01-01

    BACKGROUND: The reported frequency with which endocarditis is ascribed to an antecedent dental or medical procedure varies from 3% to 62%. METHODS: We performed a nationwide prospective study of the epidemiology of bacterial endocarditis in the Netherlands. During a 2-year period, all consecutively

  1. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis

    NARCIS (Netherlands)

    van der Meer, J. T.; van Wijk, W.; Thompson, J.; Vandenbroucke, J. P.; Valkenburg, H. A.; Michel, M. F.

    1992-01-01

    Whether antibiotic prophylaxis can prevent bacterial endocarditis is hotly debated. In an attempt to settle this issue, we have assessed the efficacy of prophylaxis for bacterial endocarditis on native valves in a nationwide, case-control study in the Netherlands. Cases were patients with known

  2. Exophiala (Wangiella dermatitidis Prosthetic Aortic Valve Endocarditis and Prosthetic Graft Infection in an Immune Competent Patient

    Directory of Open Access Journals (Sweden)

    Jay S. Berger

    2017-01-01

    Full Text Available Exophiala (Wangiella dermatitidis is an emerging dematiaceous fungus associated with high mortality rates and is a rare cause of endocarditis. We describe the first case of E. dermatitidis endocarditis of a prosthetic aortic valve and aortic graft in an immune competent patient with no clear risk factors of hematological acquisition.

  3. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

    NARCIS (Netherlands)

    Tomsic, Anton; Li, Wilson W. L.; van Paridon, Marieke; Bindraban, Navin R.; de Mol, Bas A. J. M.

    2016-01-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred

  4. Three-dimensional transesophageal echocardiography in the evaluation of aortic valve destruction by endocarditis

    NARCIS (Netherlands)

    Nemes, Attila; Lagrand, Wim K.; McGhie, Jackie S.; ten Cate, Folkert J.

    2006-01-01

    Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. The aim of this study was to demonstrate the clinical usefulness of 3-dimensional transesophageal echocardiography for the spatial assessment of aortic valve endocarditis. This case showed severe

  5. Mitral valve repair for disruptive acute endocarditis: extensive replacement of posterior leaflet with bovine pericardium.

    Science.gov (United States)

    Nwaejike, Nnamdi; Ascione, Raimondo

    2011-01-01

    Surgery for infective mitral valve endocarditis should include resection/debridement of all infected tissue, but this may leave behind insufficient-autologous mitral valve tissue for an adequate repair. Effective mitral valve repair using only bovine pericardium is feasible even in the presence of extensive endocarditis involving a large part of the free margin of the affected leaflet. © 2010 Wiley Periodicals, Inc.

  6. Streptococcus viridans osteomyelitis and endocarditis following dental treatment: a case report.

    Science.gov (United States)

    Choudhury, Maitrayee; Patel, Brijesh R; Patel, Minal; Bashir, Tariq

    2009-09-14

    Vertebral osteomyelitis is an uncommon complication of infective endocarditis with the organism Streptococcus viridans being a rare cause of the condition. This case highlights an unusual presentation of Streptococcus viridans associated with infective endocarditis and pyogenic osteomyelitis in a patient following a dental procedure.

  7. Streptococcus viridans osteomyelitis and endocarditis following dental treatment: a case report

    OpenAIRE

    Choudhury, Maitrayee; Patel, Brijesh R; Patel, Minal; Bashir, Tariq

    2009-01-01

    Vertebral osteomyelitis is an uncommon complication of infective endocarditis with the organism Streptococcus viridans being a rare cause of the condition. This case highlights an unusual presentation of Streptococcus viridans associated with infective endocarditis and pyogenic osteomyelitis in a patient following a dental procedure.

  8. Rothia dentocariosa Septicemia without Endocarditis in a Neonatal Infant with Meconium Aspiration Syndrome

    Science.gov (United States)

    Shin, Jeong Hwan; Shim, Jae Dong; Kim, Hye Ran; Sinn, Jong Beom; Kook, Joong-Ki; Lee, Jeong Nyeo

    2004-01-01

    Rothia dentocariosa, a gram-positive coccoid- to rod-shaped bacterium with irregular morphology, is a rare cause of bacteremia in patients without endocarditis. We report the first case of R. dentocariosa septicemia without endocarditis, which occurred in a neonatal infant with meconium aspiration syndrome. PMID:15472374

  9. Right-heart infective endocarditis: apropos of 10 cases | Sarr | Pan ...

    African Journals Online (AJOL)

    We studied the epidemiological, clinical as well as their laboratory profiles. There were 10 cases of right-heart infective endocarditis representing 3.04% of cases of infective endocarditis. There was a valvulopathy in 3 patients, an atrial septal defect in 1 patient, parturiency in 2 patients and the presence of a pacemaker in ...

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

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2012-02-01

    Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults, with an overall mortality rate of up to 25%, but it is a rare cause of infective endocarditis. We present herein a case of N. meningitidis meningitis complicated with infective endocarditis.

  11. NEUMOTÓRAX ESPONTÁNEO ASOCIADO A FIBROSIS PULMONAR EN UN PACIENTE CON NEUROFIBROMATOSIS TIPO 2

    Directory of Open Access Journals (Sweden)

    Gabriel Alcalá Cerra

    2010-04-01

    Full Text Available El compromiso pulmonar en pacientes con neurofibromatosis ha sido reiteradamente descrito como una complicación muy rara en la variedad tipo 1. Se caracteriza por enfermedad pulmonar intersticial difusa, fibrosis pulmonar, neoplasias torácicas y formación de bulas, estas últimas, con alto riesgo de ruptura. Describimos un caso de neumotórax espontáneo en una paciente con neurofibromatosis tipo 2, como consecuencia de cambios fibróticos pulmonares. A nuestro conocimiento, esta asociación no había sido reportada.

  12. Sensitivity, specificity and predictive value of blood cultures from cattle clinically suspected of bacterial endocarditis

    DEFF Research Database (Denmark)

    Houe, Hans; Eriksen, L.; Jungersen, Gregers

    1993-01-01

    This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis...... of the isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied...... the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases....

  13. Infectious Endocarditis from Enterococcus faecalis Associated with Tubular Adenoma of the Sigmoid Colon

    Directory of Open Access Journals (Sweden)

    Emilly Caroline de Freitas Silva

    2017-01-01

    Full Text Available Introduction. Enterococcus faecalis (E. faecalis, a constituent of the gut microbiota, can be associated with both colonic lesions and endocarditis. Since this microorganism is one of the endocarditis etiological agents, there is a need for greater study in regard to the association with endocarditis and colonic lesions. Case Presentation. This is the case description of a 53-year-old man with history of prolapse of the anterior mitral valve leaflet who was diagnosed with endocarditis by E. faecalis and treated with ampicillin and gentamicin. Upon investigation by colonoscopy, he was found to have a tubular adenoma with low grade dysplasia. Conclusion. There are a few descriptions in scientific literature of an association between endocarditis by E. faecalis and colonic lesions. However, further studies with significant correlation between the two pathologies are required, so that proper measures can be implemented in clinical practice.

  14. Tratamiento con caspofungina de endocarditis por Candida tropicalis resistente a fluconazol Treatment with caspofungin of Candida tropicalis endocarditis resistant to fluconazol

    Directory of Open Access Journals (Sweden)

    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.

  15. Construcción de un modelo animal de fibrosis pulmonar inducido por Bleomicina

    Directory of Open Access Journals (Sweden)

    Dacia Malambo García

    2016-01-01

    Full Text Available La fibrosis pulmonar es una enfermedad crónica, progresiva y letal, cuya etiología se desconoce. El modelo de fibrosis pulmonar inducida por Bleomicina en ratas es útil para ilustrar la patobiología in vivo de la enfermedad, así como para identificar nuevos blancos farmacológicos y estimar la eficiencia de nuevas moléculas o procedimientos Objetivo: El objetivo de este trabajo fue construir un modelo animal de fibrosis pulmonar secundaria a Bleomicina, en ratas Wistar, como herramienta que pueda servir de base para futuros diseños experimentales. Materiales y métodos: Se trabajó con dos grupos de ratas Wistar para la administración del medicamento por vía intratraqueal. El grupo experimental recibió una dosis única (2.0 U/Kg de Bleomicina, mientras que el grupo control recibió un volumen equivalente de solución salina. A los 14 o 28 días se realizó un lavado broncoalveolar con recuento total y diferencial celular y análisis histopatológico pulmonar. Resultados: La histología de una parte del grupo experimental tratado con Bleomicina y sacrificado a los 14 días reveló daño pulmonar caracterizado por inflamación aguda, hemorragia intraalveolar y proliferación fibroblástica intersticial incipiente; en el resto del grupo experimental la histología a 28 días reveló además alteración de la arquitectura pulmonar debida a fibrosis y aumento en el número de macrófagos intraalveolares e inflamación linfocitaria. Conclusiones: Se implementó satisfactoriamente un modelo de fibrosis pulmonar inducido farmacológicamente por Bleomicina en ratas Wistar.

  16. Toxicidade pulmonar induzida pela rapamicina Lung toxicity induced by rapamycin

    Directory of Open Access Journals (Sweden)

    C Damas

    2006-11-01

    Full Text Available As doenças pulmonares induzidas por fármacos constituem uma causa crescente de morbilidade, tendo sido descritas diferentes formas de toxicidade associadas a inúmeras substâncias. O sirolimus (rapamicina é um fármaco imunossupressor usado de forma crescente no contexto do transplante de órgãos sólidos, nomeadamente no transplante renal. A toxicidade pulmonar tem sido descrita como um dos potenciais efeitos laterais, nomeadamente causando formas de pneumonite intersticial ou, mais raramente, hemorragia alveolar. Os autores descrevem os casos de quatro doentes (3 do sexo masculino, 1 do sexo feminino com idades compreendidas entre os 46-71 anos, recipientes de transplante renal (rim cadáver há 3 anos (1 doente e 7 anos (3 doentes. A imunosupressão consistia em micofenolato mofetil, prednisolona e rapamicina. Os quatro doentes foram admitidos por febre, tosse produtiva (2 e dispneia (3. Apresentavam imagem radiológica de infiltrados pulmonares bilaterais de predomínio basal. O LBA mostrou alveolite linfocítica em 3 doentes, tendo-se observado no entanto diferentes relações CD4/CD8., para além de neutrofilia em 2 deles. No restante doente, observou-se hemorragia alveolar grave. Não houve em nenhum dos casos qualquer isolamento de micro organismos patogénicos no LBA. As queixas apresentadas, bem como as alterações radiológicas regrediram com a suspensão do fármaco. Estes quatro casos revelaram alguma variedade, quer na apresentação clínica, quer nos achados dos exames subsidiários efectuados, nomeadamente no LBA. Este facto pode ter como causa diferentes mecanismos fisiopatológicos a nível do pulmão induzidos pelo sirolimus.Drug induced lung diseases (DILD are an increasingly cause of morbidity. Many drugs have been described, causing several patterns of injury. Sirolimus is an immunosuppressive agent increasingly used in renal and other solid organ transplantation. Pulmonary toxicity has been recognised as a potential

  17. Comportamiento del Programa Nacional de Tuberculosis pulmonar, en un municipio

    Directory of Open Access Journals (Sweden)

    René F. Espinosa Alvarez

    1998-10-01

    Full Text Available Se conoce que la tuberculosis pulmonar constituye un serio problema de salud en la mayor parte de los países del mundo. En el nuestro existe un programa de control de dicha entidad y su conocimiento y objetivos son de vital importancia para el médico de la familia. Se analizó el comportamiento del programa nacional de tuberculosis pulmonar en el policlínico docente Lawton en el trienio 1995-1997, a cuyo efecto se revisaron desde el 1-1-95 al 31-12-97 los esputos indicados por los médicos de la familia de los 49 consultorios que existen en dicha unidad y se extrajeron los datos de las hojas de cargo de los médicos del departamento de estadísticas y del laboratorio clínico que controla esta actividad. Los resultados demuestran algunas dificultades que subsisten en el control de la enfermedad que pudieran solucionarse con una mayor dedicación a esta actividad por parte de los médicos de la familia como responsables directos de sus diferentes áreas de salud, así como de las autoridades sanitarias que tienen que ver con el problemaIt is known that pulmonary tuberculosis is a serious health problem in most of the countries. In our country, there is a tuberculosis control program whose knowledge and objectives are of vital importance for the family physician. The behavior of the national program to control pulmonary tuberculosis was analyzed at "Lawton" Teaching Polyclinic from 1995 to 1997. To this end the sputa ordered from 1-1-95 to 31-12-97 by the family physicians from the 49 physicians’ offices existing in this unit were reviewed. Data were given by the Statistics Department and by the Clinical Laboratory controlling this activity. The results show that there are still some difficulties to control this disease that may be solved through a greater dedication to this activity on the part of the family physicians as direct responsible of their different health areas, and of the health authorities having to do with this problem

  18. Abcesso Pulmonar – Estudo Retrospectivo

    Directory of Open Access Journals (Sweden)

    M. José Augusto

    1995-11-01

    Full Text Available RESUMO: O abcesso pulmonar é definido como uma supuração colectada numa cavidade neoformada no pulmão, por uma inflamação aguda não tuberculosa. Por esta definição, estão excluídas as supuraçãoes desenvolvidas em cavidades pré existentes (quistos aereos, carcinoma escavado, bronquiectasias e as resultantes de processos bacilares (1,2,4.Os autores apresentam os resultados de uma revisão clínica de 24 casos correspondentes aos doentes internados com aquele diagnóstico desde 1 de Janeiro de 1990 a 31 de Dezembro de 1994 no Serviço de Medicina Interna do Hospital Distrital de Aveiro.O estudo incidiu na análise dos processos clínicos e radiológicos avaliando a distribuição por sexo, faixa etária, factores predisponentes, tempo de internamento, expressão clínica, radiológica, bacteriológica e finalizando com a terapêutica e evolução. SUMMARY: Lung abcess is defined as a collected suppuration in a neoformed cavity in the lung, caused by a non tuberculous inflammation. From this definition, supurations developed in pre-existant cavities (aerial cysts, escavated carcinoma, bronchiectasis and those resulting from bacillary process, are excluded.The authors submit the results of a clinical revision of 24 cases corresponding to resident patients with that diagnosis from 1st. January 1990 to 31st December 1994 in the Internal Medicine at R.D. Aveiro.The study rests on the analysis of the radiologic and clinical processes taking into account distribution by age and sex, predisposing factors, lenght of internment, radiological and clinical expression, bacteriological profile, therapy and evolution. Palavras-chave: Abcesso Pulmonar, terapêutica, radiologia, Key-Words: Lung abcess, therapy, radiology

  19. Lesao pulmonar induzida pela ventilacao em recem-nascidos prematuros

    Directory of Open Access Journals (Sweden)

    Clarissa Gutierrez Carvalho

    2013-12-01

    Full Text Available A necessidade de intubação e do uso de ventilação mecânica na prematuridade está relacionada à chamada lesão pulmonar induzida pela ventilação e à consequente displasia broncopulmonar. Busca-se a melhor compreensão dos mecanismos de lesão envolvendo resposta inflamatória mediada pelas citocinas para o desenvolvimento de novas estratégias protetoras. Pesquisou-se na base de dados PubMed, incluindo artigos relevantes, os unitermos "ventilator induced lung injury preterm", "continuous positive airway pressure", "preterm" e "bronchopulmonary dysplasia". Dados e informações significativas foram compilados em tópicos, com o objetivo de formar uma visão crítica e plena acerca da lesão induzida pela ventilação e de suas consequências ao prematuro. Foi revisado o papel das citocinas pró-inflamatórias como mediadores da lesão, especialmente interleucinas 6 e 8, e fator de necrose tumoral alfa. Foram apresentadas evidências em estudos com animais e também em humanos, mostrando que breves períodos de ventilação mecânica são suficientes para a liberação dessas interleucinas inflamatórias. Também foram revisadas outras formas de ventilação mecânica e de ventilação não invasiva, como alternativas protetoras aos modos convencionais. Concluiu-se que o uso de ventilação não invasiva, a intubação com administração precoce de surfactante e a extubação rápida para CPAP nasal, além de estratégias que regulam o volume corrente evitando o volutrauma (como a ventilação com volume garantido, são medidas protetoras da lesão pulmonar induzida pela ventilação mecânica no prematuro.

  20. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres

    Directory of Open Access Journals (Sweden)

    María Soledad Rodríguez-Pecci

    2012-06-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV en una población de pacientes con EPOC. En este estudio prospectivo observacional de corte transversal, se incluyeron pacientes con EPOC ingresados consecutivamente entre el 1 de septiembre de 2008 al 1 de marzo de 2010. Se registraron edad, sexo, habito tabáquico, factores de riesgo y enfermedad cardiovascular, tratamiento y gravedad de la EPOC. Se midió índice tobillo-brazo (ITB y se realizó Euroqol-5D. Se incluyeron 246 pacientes (195 hombres. Los hombres fueron más ex fumadores (68.7% vs. 15.7%, p < 0.001, tuvieron un VEF1 menor (48.7% ± 15.7 vs. 58.2% ± 10.9 de teórico, p < 0.001 y mayor frecuencia de cardiopatía isquémica (16.4% vs. 5.9%, p = 0.04. Las mujeres presentaron más prevalencia de EPOC sin exposición al tabaco (64.7% vs. 7.2%, p < 0.001, más síntomas de ansiedad y depresión (p = 0.004 e ITB alterado en menor frecuencia (20% vs. 41.6%, p = 0.01. Concluimos que hubo diferencias en la EPOC en relación al sexo, con compromiso pulmonar y cardiovascular más grave en hombres y más síntomas de ansiedad y depresión en mujeres.

  1. Aorto-hepatic bypass graft for repair of an inferior pancreatico-duodenal artery aneurysm associated with coeliac axis occlusion: A case report.

    Science.gov (United States)

    Hughes, Tom; Chatzizacharias, Nikolaos A; Richards, James; Harper, Simon

    2016-01-01

    Inferior pancreatico-duodenal artery (IPDA) aneurysms are very rare and commonly associated with coeliac axis stenosis or occlusion due to atherosclerosis, thrombosis or median arcuate ligament syndrome. We present a case of a surgical repair of an IPDA aneurysm with the use of a supra-coeliac aorto-hepatic bypass with a polytetrafluoroethylene (PTFE) graft, following a failed initial attempt at an endovascular repair. A 75 year old female, who was under investigation for night sweats, was referred to our team with an incidental finding of a 19mm fusiform IPDA aneurysm. Initial attempt at endovascular coiling of the aneurysm was unsuccessful. Elective surgical repair involved excision of the aneurysm and to restore arterial inflow to the hepatic artery, a PTFE bypass graft was used from the supra-coeliac aorta to the hepatic artery. The patient was well 2 months following the procedure with a patent graft shown on contrast enhanced computer tomography (ceCT). Management options for IPDA aneurysms include radiologically guided endovascular approach or surgical repair. Given the high mortality of greater than 50% with ruptured aneurysms intervention is indicated in all detected cases. Surgical excision with bypass grafting from the supra-coeliac aorta, as reported by our team, represents a satisfactory management option in patients where interventional approaches have failed or are not appropriate. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  2. Aneurismas múltiplos de pontes aorto-coronárias de veia safena com ruptura fatal Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture

    Directory of Open Access Journals (Sweden)

    Fábio R. Távora

    2007-05-01

    Full Text Available Aneurismas de pontes aorto-coronárias de veia safena são eventos raros, usualmente assintomáticos e detectados de forma incidental. Rupturas espontâneas de pontes de safena são raras, havendo poucos dados radiológicos disponíveis na literatura. Relatamos o caso de um senhor de 39 anos internado com hematêmese dez anos depois de ter sido submetido a cirurgia de revascularização miocárdica. Imagens tomográficas mostraram três aneurismas nas pontes de safena, mas o exame não detectou ruptura. O paciente veio a falecer e a necropsia revelou que a causa do óbito havia sido ruptura de aneurisma de pontes de safena. Esse caso ilustra a necessidade de tratamento agressivo de aneurismas sintomáticos de pontes coronarianas.Aortocoronary saphenous vein graft (SVG aneurysms are rare, and are usually asymptomatic and detected incidentally. Spontaneous rupture of SVG is rare and imaging data are few. We report on a 39-year old man who was admitted to the hospital with hematemesis 10 years after aortocoronary bypass surgery. CT images revealed 3 aortocoronary SVG aneurysms, but failed to detect any rupture. His subsequent death due to rupture of SVG aneurysm was documented at autopsy, illustrating the need for aggressive treatment of symptomatic coronary graft aneurysms.

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

    Directory of Open Access Journals (Sweden)

    Dina Montasser

    2011-01-01

    Full Text Available Since the 1960s, regular hemodialysis (HD was recognized as a risk factor for the development of infective endocarditis (IE, particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving re-gular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Sta-phylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphlococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.

  4. Early or late surgery for endocarditis with neurological complications.

    Science.gov (United States)

    Oh, Timothy Hou Teng; Wang, Tom Kai Ming; Pemberton, James A; Raudkivi, Peter J

    2016-06-01

    The European Society of Cardiology 2015 guidelines advise urgent surgery for endocarditis complicated by cerebral embolism or transient ischemic events (1B evidence). Nevertheless, the timing of surgery remains contentious. This study aimed to review our experience of early versus delayed surgery in a selected cohort. Our surgical database was examined for patients with a discharge diagnosis of endocarditis from 2005 to 2011. Selection was limited to patients who fulfilled the Duke criteria and underwent brain imaging for a clinically diagnosed preoperative neurological event. Patients were categorized as early surgery (≤7 days of clinical or cerebral imaging diagnosis of stroke) or delayed surgery (>7 days after diagnosis). Thirty-nine patients were identified: 20 in the early group (mean age 52 ± 15 years, diagnosis-to-surgery time 4 ± 2 days) and 19 in the delayed group (mean age 45 ± 15 years, diagnosis-to-surgery time 17 ± 11 days). There were no statistical differences in preoperative risks, operative data (cardiopulmonary bypass and crossclamp times) or postoperative neurological and mortality outcomes between the 2 groups. The size of the cerebral lesion was not a significant predictor of postoperative hemorrhagic or neurological outcome. Multivariate analysis did not show any independent predictor of mortality during follow-up (mean 51 ± 27 months). There was no difference in long-term survival, freedom from reoperation, or recurrent endocarditis between the 2 groups. This study showed no statistical excess of mortality or neurological outcomes after early surgical intervention, regardless of the preoperative cerebral lesion size. © The Author(s) 2016.

  5. Tricuspid endocarditis in hyper-IgE syndrome

    Directory of Open Access Journals (Sweden)

    Gupta S

    2010-01-01

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

  6. Mycobacterium goodii endocarditis following mitral valve ring annuloplasty.

    Science.gov (United States)

    Parikh, Rohan B; Grant, Matthew

    2017-03-21

    Mycobacterium goodii is an infrequent human pathogen which has been implicated in prosthesis related infections and penetrating injuries. It is often initially misidentified as a gram-positive rod by clinical microbiologic laboratories and should be considered in the differential diagnosis. We describe here the second reported case of M. goodii endocarditis. Species level identification was performed by 16S rDNA (ribosomal deoxyribonucleic acid) gene sequencing. The patient was successfully treated with mitral valve replacement and a prolonged combination of ciprofloxacin and trimethoprim/sulfamethoxazole. Confirmation of the diagnosis utilizing molecular techniques and drug susceptibility testing allowed for successful treatment of this prosthetic infection.

  7. Endocarditis infecciosa : significado de la disfunción renal

    OpenAIRE

    Salomón, Susana Elsa; Dromi, Carolina; Santolín, María; Attorri, Silvia; Cassata, Andrea; Miatello, Roberto; Carena, José Alberto

    2010-01-01

    Objetivo: Determinar la significación clínica y pronóstica de la disfunción renal en pacientes con Endocarditis Infecciosa (EI) Material y método: Estudio protocolizado, descriptivo, observacional y transversal de pacientes con EI diagnosticados según criterios de Duke. Se realizó un análisis comparativo entre los pacientes con EI sin (Grupo Sin) y con Disfunción Renal (Grupo DR), que se definió en base a uremia > 0.60 g/l y/o creatininemia...

  8. Acquired ventricular septal defect due to infective endocarditis

    Directory of Open Access Journals (Sweden)

    Randi E Durden

    2018-01-01

    Full Text Available Acquired intracardiac left-to-right shunts are rare occurrences. Chest trauma and myocardial infection are well-known causes of acquired ventricular septal defect (VSD. There have been several case reports describing left ventricle to right atrium shunt after infective endocarditis (IE. We present here a patient found to have an acquired VSD secondary to IE of the aortic and tricuspid valves in the setting of a known bicuspid aortic valve. This is the first case reported of acquired VSD in a pediatric patient in the setting of IE along with literature review of acquired left-to-right shunts.

  9. Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

    DEFF Research Database (Denmark)

    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....

  10. Selección de donantes y receptores en trasplante pulmonar: procedimientos generales

    Directory of Open Access Journals (Sweden)

    C. María Teresa Parada, Dra.

    2010-03-01

    Full Text Available El trasplante pulmonar es una alternativa terapéutica que se ha validado en lo últimos 30 años para aquellos pacientes portadores de una enfermedad pulmonar terminal. Las características propias del trasplante pulmonar dadas por su conexión al ambiente a través de la vía aérea y la isquemia presente en las suturas durante el primer mes han constituído por mucho tiempo la principal causa de morbilidad y mortalidad de los pacientes trasplantados pulmonares. Los nuevos medicamentos inmunosupresores, la mejoría de las soluciones de preservación y de las técnicas quirúrgicas han disminuido las complicaciones y mortalidad precoz, siendo el gran desafío aún, el rechazo crónico conocido como el Sindrome de Bronquiolitis Obliterante (SBO. La selección del receptor de acuerdo a la patología de base se ha modificado, promoviendo la derivación precoz en patologías como la fibrosis pulmonar y la fibrosis quística disminuyendo así la mortalidad en la lista de espera.

  11. Hipertensión pulmonar a moderada altura en niños

    Directory of Open Access Journals (Sweden)

    Gabriel F. Díaz, MD

    2012-07-01

    Full Text Available Se reporta la carencia de estudios sobre la relación entre hipertensión pulmonar y altura en niños y, con base en la fisiología de esta última, se hace énfasis en la importancia de la hipoxia hipobárica, que desempeña un papel determinante en la etio y biopatogénesis de la hipertensión pulmonar del habitante de la altura. En cuanto a la biopatogénesis, se señala la importancia de la hiperreactividad del lecho vascular pulmonar y su correcta evaluación. De igual forma, se resumen las patologías relacionadas con hipertensión pulmonar en el niño habitante de la altura y, finalmente, en lo que respecta al tratamiento de la hipertensión pulmonar del habitante de la altura, se resalta, a través de la evolución de casos clínicos, la importancia de vivir a baja altura sobre el nivel del mar.

  12. Hemangioendotelioma epitelioide pulmonar, um caso clínico

    Directory of Open Access Journals (Sweden)

    Teresa Alfaiate

    2000-03-01

    Full Text Available RESUMO: Os autores apresentam o caso clínico de uma doente do sexo feminino, de 48 anos, com história de diabetes mellitus tipo 2, que desenvolveu um quadro de hemoptises associado a manifestações radiológicas difusas.Foi-lhe diagnosticado um hemangioendotelioma epitelioide pulmonar, tumor de natureza vascular, com comportamento intermédio entre os hemangiomas benignos e os angiossarcomas.Não há descrição na literatura quanto ao beneficio da utilização de radioterapia ou quimioterapia, pelo que, o tratamento preconizado nesta situação foi apenas sintomático.REV PORT PNEUMOL 2000; VI (2: 155-162 ABSTRACT: The authors report the clinical case of a 48-year­old female patient, with a history of diabetes mellitus type 2. She developed hemoptysis associated with widespread radiological manifestations. An epithelioid hemangioendothelioma of the lung was diagnosed. This is a tumor of a vascular nature with an intermediate behaviour between a benign hemangioma and a angiosarcoma.As there is no description of the benefits of radiotherapy or chemiotberapy in the literature, the treatment recommended in this case for this condition was simply symptomatic.REV PORT PNEUMOL 2000; VI (2: 155-162 Palavras-chave: Hemangioendotelioma, Tumor, Diagnóstico, Key-words: Hemangioendothelioma, Tumor, Diagnosis

  13. Abcessos pulmonares: Revisão de 60 casos

    Directory of Open Access Journals (Sweden)

    Luísa Magalhães

    2009-03-01

    Full Text Available Resumo: Abcessos pulmonares (AP acarretam graves implicações clínicas e sociais. Os autores analisam retrospectivamente a casuística dum hospital terciário.Identificaram-se 60 internamentos por AP ocorridos entre 2000 e 2005. Quarenta e cinco doentes eram homens; a idade média foi 56,2 (±15,1 anos. A duração média dos sintomas de pré-hospitalização foi de 23,0 (±50,2 dias, mas a infecção respiratória aguda foi o modo de apresentação em 36 doentes. Em 40 casos, com base em dados clínicos, a suspeita de AP seria elevada. O diagnóstico estabeleceu-se em 8,7 (±11,4 dias após a admissão. Identificouse agente microbiano em 26 casos. Em 27 doentes classificou-se o AP como primário. Mau estado dentário e imunodeficiência foram os principais factores de risco. Exis tiam comorbilidades em 34 casos. Após o diagnóstico, todos receberam antibioterapia (AB intravenosa (IV em média durante 16,5 (±10,9 dias. A média do tempo global de AB foi de 39,2 (±15,7 dias. Dez opções de AB foram usadas e a AB IV inicial alterada em 23 casos. Foi necessária cirurgia em 6 doentes. Conseguiu-se apirexia em média após 6,4 (±6,4 dias. Ocorreram complicações em 21 doentes; 7 faleceram. A duração média do internamento foi de 27,5 (±16,3 dias e 38 doentes foram convocados para consulta pós-alta.Estes dados são, em geral, concordantes com a literatura. A elevada percentagem de doentes do sexo masculino coincide com maior prevalência do alcoolismo e do carcinoma pulmonar nos homens. Aspectos pertinentes no sentido de melhorar o prognóstico e tempo de internamento poderão ser a brevidade no diagnóstico e o consenso no tratamento antibiótico.Rev Port Pneumol 2009; XV (2: 165-178 Abstract: Lung abscesses (LA carry with them severe clinical and social implications. The authors retrospectively analyse case files from a tertiary

  14. Pulmonar collision tumor: Metastatic adenoid cystic carcinoma and lung adenocarcinoma

    Directory of Open Access Journals (Sweden)

    M. Blanco

    2012-01-01

    Full Text Available Summary: We report an extraordinary case of collision tumor consisting of a lung adenocarcinoma and a metastatic adenoid cystic carcinoma in a 56 year-old man. He was diagnosed with a pulmonary nodule 11 years after treatment of an adenoid cystic carcinoma of the right maxillary sinus. A non-small cell carcinoma was observed when a transbronchial biopsy was performed. The other component of the nodule was only diagnosed with pathological examination of the resection specimen. Resumo: Descrevemos um caso único de tumor de colisão constituído por um adenocarcinoma de pulmão e uma metástase dum carcinoma adenóide cístico em um homem de 56 anos de idade. Ao doente foi diagnosticado um nódulo pulmonar 11 anos após o tratamento de um carcinoma adenóide cístico do seio maxilar direito. O carcinoma de pulmão de não pequenas células foi observado no momento da realização de uma biópsia transbrônquica. O outro componente do nódulo foi diagnosticado depois do exame histológico do material ressecado. Keywords: Bronchogenic carcinoma, Collision tumor, Adenoid cystic carcinoma, Palavras-chave: Carcinoma broncogénico, Tumor de colisão, Carcinoma adenóide cístico

  15. LA TUBERCULOSIS PULMONAR EN BARRANQUILLA, 1930-1960

    Directory of Open Access Journals (Sweden)

    William Alfredo Chapman Quevedo

    2015-01-01

    Full Text Available En el presente artículo analizamos el papel de la tuberculosis en la ciudad de Barranquilla entre 1930 y 1960. En este sentido mostramos como esta enfermedad se convirtió en endémica debido a los altos índices de morbilidad y mortalidad, llamando la atención de los médicos y autoridades locales, quienes utilizaron los medios de comunicación para prevenir y difundir las formas de contagio. Para dicho análisis, entrelazamos las fuentes primarias (las actas de defunción, informes de los secretarios departamentales de higiene del departamento del Atlántico, la revista departamental de higiene y la prensa que reposan en el Archivo Histórico del Atlántico y la Biblioteca Nacional de Colombia con las fuentes secundarias (bibliografía escrita sobre la temática de la tuberculosis, higiene y salubridad a nivel global y en Colombia. Llegamos a la conclusión que, la tuberculosis pulmonar fue una enfermedad de suma importancia con la capacidad de alterar la vida cotidiana de los barranquilleros. Las autoridades locales lograron establecer espacios propicios para su tratamiento, como el dispensario, el hospital sanatorio infantil y la búsqueda del hospital de adultos, medidas que fueron insuficientes para combatir la enfermedad.

  16. Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

    Directory of Open Access Journals (Sweden)

    Evanil Pires de Campos

    1992-09-01

    Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.

  17. Embolia séptica pulmonar - A propósito de um caso Clínico Septic pulmonary embolism - Case report

    Directory of Open Access Journals (Sweden)

    Luís Coentrão

    2008-12-01

    Full Text Available A embolia séptica pulmonar (ESP é frequentemente a apresentação clínica de variadas doenças de etiologia infecciosa, por vezes subdiagnosticadas na prática clínica. Esta entidade foi descrita há cerca de 30 anos, quase sempre associada a toxicodependentes com endocardite infecciosa da válvula tricúspide. Ao longo das últimas três décadas, a epidemiologia desta síndroma sofreu alterações relevantes. No entanto, carece a existência na literatura de critérios de diagnóstico de ESP validados. Os autores apresentam um caso clínico de endocardite infecciosa da válvula tricúspide em toxicodependente, cuja forma de apresentação foi a ESP. O doente apresentava sintomas constitucionais.SPE is a rare syndrome, although a frequent clinical presentation of several disorders, many times misdiagnosed in medical practice. It was described 30 years ago, almost always associated with intravenous drug abuse. Recent reports indicate that the epidemiology of patients with septic pulmonary embolism has changed over the past 30 years. We report a case of septic pulmonary embolism associated with tricuspid valve endocarditis. The patient had a personal history of intravenous drug abuse. The chief complaints were fever, anorexia and weight loss for 30 days. A chest radiograph revealed multiple pulmonary infiltrates in the lower third of the right lung.

  18. Hipertensão pulmonar em lactente associada a pulmão em ferradura: relato de caso

    Directory of Open Access Journals (Sweden)

    Juliana Rodrigues Neves

    2011-06-01

    Full Text Available Relatamos caso de lactente jovem com desconforto respiratório precoce e hipertensão pulmonar, diagnosticado como variante de pulmão em ferradura, e revisamos literatura a cerca desta rara malformação pulmonar e suas repercussões cardíacas e hemodinâmicas.

  19. Metastização pulmonar na apresentação de angiossarcoma cardíaco: Caso clínico e discussão Pulmonary metastasis in a cardiac angiosarcoma: Case report and discussion

    Directory of Open Access Journals (Sweden)

    Vítor Fonseca

    2009-11-01

    Full Text Available Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiograficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico apos terapêutica anti-inflamatória; contudo, no internamento houve como intercorrencia pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado a consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardíacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante.We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti- inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent videothoracsopy which diagnosed cardiac angiosarcoma with pulmonary metastisation. Within a few

  20. Transthoracic echocardiography (TTE): sufficiently sensitive screening test for native valve infective endocarditis (IE).

    Science.gov (United States)

    McDermott, Brian P; Cunha, Burke A; Choi, David; Cohen, Jerald; Hage, Jean

    2011-01-01

    We recently reviewed our experience with paired transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) studies for the diagnosis of native valve infective endocarditis. In patients with normal heart valves, we demonstrated that a normal TTE effectively rules out infective endocarditis and a TTE is unnecessary. In patients with abnormal heart valves, a TEE did not enhance the diagnostic yield in most patients (12/15). We reviewed 87 paired TTEs and TEEs, that is, TEE with a preceding TTE performed for the evaluation of native valve IE. Of 87 paired echocardiograms, 72 of 87 had normal TTEs and TEEs, with no evidence of a vegetation indicative of infective endocarditis. A total of 15 of 87 TTEs had thickened/calcified valves without a definite vegetation. Of these, only 3 of 15 were subsequently shown to have a vegetation indicative of endocarditis by TEE. In patients with possible native valve infective endocarditis, before blood culture results are known, a negative TTE was sufficiently specific to rule out native valve infective endocarditis. Our data showed that the negative predictive value of a normal TTE in the evaluation of possible native valve endocarditis is 90% or greater. In those with some valve abnormality (ie, thickened/calcified heart valves), subsequent TTE did not materially increase vegetation detection. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. [Infective endocarditis in intensive cardiac care unit - clinical and biochemical differences of blood-culture negative infective endocarditis].

    Science.gov (United States)

    Kaziród-Wolski, Karol; Sielski, Janusz; Ciuraszkiewicz, Katarzyna

    2017-01-23

    Diagnosis and treatment of infective endocarditis (IE) is still a challenge for physicians. Group of patients with the worst prognosis is treated in Intensive Cardiac Care Unit (ICCU). Etiologic agent can not be identified in a substantial number of patients. The aim of study is to find differences between patients with blood culture negative infective endocarditis (BCNIE) and blood culture positive infective endocarditis (BCPIE) treated in ICCU by comparing their clinical course and laboratory parameters. Retrospective analysis of 30 patients with IE hospitalized in ICCU Swietokrzyskie Cardiac Centre between 2010 and 2016. This group consist of 26 men (86,67%) and 4 women (13,3%). Mean age was 58 years ±13. Most of the cases were new disease, recurrence of the disease was observed in 2 cases (6,7%). 8 patients (26,7%) required artificial ventilation, 11 (36,7%) received inotropes and 6 (20%) vasopresors. In 14 (46,7%) cases blood cultures was negative (BCNIE), the rest of patients (16, 53,3%) was blood cultures - positive infective endocarditis (BCIE). Both of the groups were clinically similar. There were no statistically significant differences in incidence of cardiac implants, localization of bacterial vegetations, administered catecholamines, antibiotic therapy, artificial ventilation, surgical treatment, complication and in-hospital mortality. Incidence of cardiac complications in all of BCNIE cases and in 81,3% cases of BCPIE draws attention, but it is not statistically significant difference (p=0,08). There was statistically significant difference in mean BNP blood concentration (3005,17 ng/ml ±2045,2 vs 1013,42 ng/ml ±1087,6; p=0,01), but there were no statistically significant differences in rest of laboratory parameters. BCNIE group has got higher mean BNP blood concentration than BCPIE group. There were no statistically significant differences between these groups in others laboratory parameters, clinical course and administered antibiotic therapy

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

    Directory of Open Access Journals (Sweden)

    Demóstenes G. Lima Ribeiro

    2005-03-01

    Full Text Available OBJETIVO: Identificar aspectos clínico-laboratoriais da endocardite infecciosa valvar, tratada com cirurgia, no Hospital de Messejana, Fortaleza, CE, no período de 1988 a 2003. MÉTODO: Estudo observacional, retrospectivo, da fase hospitalar, de 64 pacientes portadores de endocardite infecciosa, submetidos à substituição valvar aórtica e/ou mitral, vegectomia e plastia da tricúspide e excisão da valva pulmonar, como parte do tratamento. Analisados o sexo, a idade, o tempo decorrido entre a internação e a cirurgia e entre a internação e a alta hospitalar, a valva acometida, o resultado da hemocultura, o procedimento cirúrgico efetuado e a mortalidade. RESULTADOS: A endocardite infecciosa valvar, tratada com cirurgia, preponderou na terceira década, 81,2% dos pacientes eram masculinos. O tempo decorrido entre a internamento e a cirurgia foi menor nos pacientes que faleceram. A valva aórtica, de modo isolado ou associado, foi acometida em 65% dos casos. Hemoculturas foram positivas em 42%; em 52,4% delas, isolou-se Estafilolococo aureus. Necessitaram de substituição valvar 93,7% dos pacientes. Houve mortalidade de 14,1%, não influenciada pela idade nem pelo resultado da hemocultura. CONCLUSÃO: Endocardite infecciosa valvar, submetida ao tratamento cirúrgico, foi mais freqüente em homens e na terceira década. Acometeu preferencialmente a valva aórtica. Estafilolococo aureus foi o patógeno mais comum. Na quase totalidade dos casos, procedeu-se substituição valvar e a mortalidade hospitalar foi de 14,1%.OBJECTIVE: To identify some aspects of the infective valve endocarditis treated by heart surgery, as well as antibiotic therapy, in a public hospital, in the city of Fortaleza, Ceará state, Brazil, from1988 to 2003. METHOD: A retrospective and observational study of 64 patients with Infective Valve Endocarditis who required aortic and/or mitral valve replacement, tricuspid vegectomy and repair or pulmonary valve valvulectomy

  3. Tratamento da hipertensão pulmonar persistente do recém-nascido

    OpenAIRE

    Rodrigues, Marisa Isabel Garcia

    2008-01-01

    A hipertensão pulmonar persistente do recém-nascido (HPPRN) é um síndrome clínico complexo com múltiplas causas que resulta da incapacidade da circulação pulmonar fetal fazer a transição para a vida extra-uterina. Define-se como uma resistência vascular pulmonar aumentada e shunt direito-esquerdo através do foramen ovale e/ou do ductus arteriosus, causando hipoxémia arterial refractária à suplementação de oxigénio. Com o aparecimento de novas modalidades terapêuticas, fruto ...

  4. RESSECÇÃO PULMONAR EM CÃES: ESTUDO EXPERIMENTAL

    Directory of Open Access Journals (Sweden)

    Marcelo Alves Pinto

    1993-12-01

    Full Text Available A proposta deste trabalho foi investigar as alterações fisiológicas, pós-ressecções pulmonares, medidas através do volume corrente, pressão arterial média, pressão venosa central, radiologia e gasometria sanguínea. Oito cães sem raça definida, clinicamente sadios (três machos e cinco fêmeas foram divididos em três séries: lobectomisados, bilobectomisados e pneumectomisados, cada animal servindo como próprio controle (pré e pós-operatório. Foi diagnosticado aumento do volume corrente em todos os cães operados. Nos animais bilobectomisados e pneumectomisados detectou-se edema pulmonar, acidose respiratória com hipoxemia resultante das ressecções pulmonares e das mudanças perfusionais.

  5. Trombolisis farmacológica y mecánica en tromboembolismo pulmonar submasivo

    Directory of Open Access Journals (Sweden)

    Jorge O. Cáneva

    2014-04-01

    Full Text Available La enfermedad tromboembólica pulmonar, en sus formas aguda, subaguda o crónica, presenta dificultades para su tratamiento y tiene elevada morbimortalidad. La gravedad del evento agudo y su potencial compromiso sobre la función del ventrículo derecho necesitan estrategias terapéuticas, a veces combinadas, para cambiar el curso de la enfermedad a favor de la supervivencia del paciente. Las trombolisis farmacológica y mecánica son instrumentos útiles para tratar un evento embólico pulmonar agudo grave. Se presenta el caso de una joven que desarrolló una embolia pulmonar submasiva de instalación subaguda en quien la terapia combinada y secuencial trombolítica, farmacológica y mecánica, fue exitosa.

  6. Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable

    Directory of Open Access Journals (Sweden)

    Antonio Miranda

    2012-04-01

    Full Text Available La alta mortalidad de los pacientes con tromboembolismo pulmonar masivo de alto riesgo amerita un enfoque terapéutico enérgico e invasivo que incluya la embolectomía pulmonar quirúrgica en aquellos pacientes con contraindicación para trombolisis o trombolisis fallida. Describimos un caso de tromboembolismo pulmonar masivo de alto riesgo que recibió tratamiento quirúrgico en vez de trombolisis debido a que al momento del diagnóstico presentaba un trombo móvil a través de un foramen oval permeable con altísima posibilidad de embolismo paradójico arterial.

  7. Nuevos agentes para el tratamiento de la hipertensión pulmonar

    Directory of Open Access Journals (Sweden)

    Beatriz Wills

    2014-11-01

    Así mismo, el macitentán, un antagonista dual del receptor de endotelina redujo la morbimortalidad en forma dosis-dependiente en pacientes con hipertensión arterial pulmonar en un periodo de 3,5 años. Los resultados de estas investigaciones adicionan alternativas a la aproximación terapéutica de la hipertensión arterial pulmonar como se observa en las nuevas guías de hipertensión pulmonar realizadas en Niza, Francia, publicadas en 2013. Aún es indispensable conducir nuevos ensayos clínicos que comparen estas moléculas con el tratamiento recomendado hoy en día.

  8. Origen pulmonar anómalo de la arteria circunfleja en un paciente adulto

    Directory of Open Access Journals (Sweden)

    Ricardo L. Levin

    2009-01-01

    Full Text Available RESUMENEl origen anómalo de las arterias coronarias constituye una entidad poco frecuente y enpacientes adultos resulta excepcional el hallazgo de una arteria circunfleja naciendo desdela arteria pulmonar. Se presenta un caso de origen aberrante de la arteria circunfleja desdela rama derecha de la arteria pulmonar, detectado por métodos semiinvasivos (ecocardiogramatransesofágico y angiotomografía coronaria multicorte. Debido a las características clínicas del paciente, joven deportista, sintomático por angor, con prueba funcionalpositiva para isquemia y el origen pulmonar de la arteria circunfleja, se decidió efectuartratamiento quirúrgico con reimplante del ostium coronario en la aorta. La evoluciónposoperatoria resultó favorable.REV ARGENT CARDIOL 2009;77:524-526.

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

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nicodemo

    2014-09-01

    Full Text Available Rothia aeria is an uncommon pathogen mainly associated with endocarditis in case reports. In previous reports, endocarditis by R. aeria was complicated by central nervous system embolization. In the case we report herein, endocarditis by R. aeria was diagnosed after acute self-limited diarrhea. In 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.

  10. Haemophilus parainfluenzae Endocarditis Associated With Maxillary Sinusitis and Complicated by Cerebral Emboli in a Young Man

    Directory of Open Access Journals (Sweden)

    Anthony E. Duzenli MD

    2017-04-01

    Full Text Available HACEK endocarditis is often difficult to diagnose given the slow-growing characteristics of the organisms involved. Haemophilus parainfluenzae, one of the HACEK organisms, is an uncommon cause of endocarditis. We describe a case of a previously healthy young man with H parainfluenzae endocarditis that was associated with maxillary sinusitis and severe systemic complications, including septic cerebral emboli and mitral valve perforation. Previously reported cases have also described a predilection for younger people, cardiac valve pathology, and a high prevalence of stroke.

  11. Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Danielle Savitsky Strauss

    2011-03-01

    Full Text Available Danielle Savitsky Strauss, Samuel Baharestani, Julia Nemiroff, Kiran Amesur, David HowardNew York University Langone Medical Center, New York, NY, USAIntroduction: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE.Methods: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT, and blood cultures were all performed.Results: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103.9°F and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections.Conclusion: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE. Keywords: endocarditis, scotoma, streptococcal infections, visual fields

  12. [Bacillus cereus endocarditis and a probable cutaneous gateway].

    Science.gov (United States)

    Soudet, S; Becquart, C; Dezoteux, F; Faure, K; Staumont-Salle, D; Delaporte, E

    2017-01-01

    Bacillus cereus is a ubiquitous telluric organism. B. cereus endocarditis is a rare condition seen mostly in prosthetic heart valves and among intravenous drug users. We report a new case of a patient without risk factors and with a good clinical outcome not requiring valve replacement. In October 2014, a 50-year-old woman was referred to the dermatology department of Lille University Hospital for lower-limb wounds developing 6 months earlier. She presented fever without clinical signs of infection, except for the lower-limbs wounds. Blood cultures revealed the presence of B. cereus. Transesophageal echocardiography was performed and revealed two foci of aortic valve vegetation with a diameter of 5mm. After bacterial sensitivity testing, rifampicin and levofloxacin treatment was given for six weeks, with complete remission. A skin graft was performed and good improvement was seen. Nineteen cases of B. cereus endocarditis have been described previously, only one of which was without risk factors. We described a case of complete remission after a 6-week course of antibiotics. Our case demonstrates that BC should not be considered as a blood culture contamination, and that treatment may be complex due to antibiotic resistance. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Case report: Infective endocarditis caused by Brevundimonas vesicularis

    Directory of Open Access Journals (Sweden)

    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.

  14. Endocarditis lenta-patient survived septic shock: a case report

    Directory of Open Access Journals (Sweden)

    Amra Macić Džanković

    2012-09-01

    Full Text Available Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its intracardiac effects include severe valvular insuffi ciency, which may lead to intractable congestive heart failure and myocardialabscesses. This disease still carries a poor prognosis and a high mortality.A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presentedwith prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months and lumbar pain. He was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showedaortic vegetations and possible periaortal abscess formation. Nonspecifi c infl ammation parameters were high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presentedwith worsening of cutaneous vasculitis, subacute glomerulonephritis and subsequent acute respiratory distress syndrome and septic shock. This patient survived with residual bilateral necrosis of the feet andtoxic peroneal paresis. At the end transthoracic echocardiogram showed enlarged heart chambers, LV mild dilated and concentric hypertrophy with ejection fraction about 40%, degenerative postinfl ammatory mitralvalve changes, mild mitral regurgitation and tricuspid regurgitation, postinfl ammatory aortic root fi brosis and moderate aortic valve stenosis (AVPG max 50,9 mmHg, AVPG mean 24 mmHg with no pericardial effusion. Initial suspicion of Q fever was defi nitely excluded by serological testing showing nonspecifi c IgM positivity,probably rheumatoid factor related.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Infective endocarditis and phlebotomies may have killed mozart.

    Science.gov (United States)

    Lee, Simon Jong-Koo

    2010-12-01

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

  17. Lesões pulmonares em caninos (achados de necrópsias)

    OpenAIRE

    Souza, V. T. F. de; Paraguassu, A. A.; Moreira, E. L. T.

    2001-01-01

    p. 43-47 O estudo macroscópico dos pulmões de 381 caninos necropsiados no Setor de Anatomia Patológica do HOSPMEV/UFBA, revelou alta incidência de lesões pulmonares ( 499 ). Das alterações diagnosticadas, os distúrbios circulatórios compareceram com maior frequência (284) casos, seguidos das alterações da expansão pulmonar (121 ), das inflamatórias ( 69 ), das pigmentares (16 ), das neoplásicas ( metástases) (08) e das parasitárias ( 01 caso ).

  18. Luis Mercado (1532-1611) y el paso pulmonar de la sangre. Nuevas perspectivas

    OpenAIRE

    Hernández, Justo

    2017-01-01

    El médico Luis Mercado (1532-1611) escribió algunos textos sobre el tránsito pulmonar de la sangre que han pasado inadvertidos hasta ahora. En este artículo se estudian dichas referencias y se concluye que realmente no hay una relevancia epistémica de este paso en relación con el galenismo y que la historiografía de Mercado sobre este tránsito pulmonar de la sangre debe ser revisado con detenimiento, pues nunca rechazó categóricamente este paso de la sangre.

  19. Nuevos agentes para el tratamiento de la hipertensión pulmonar

    OpenAIRE

    Wills, Beatriz; Buitrago, Andres F.

    2014-01-01

    La hipertensión pulmonar es un desorden complejo que requiere manejo multidisciplinario. Recientes avances médicos han llevado al reconocimiento de nuevas terapias que ofrecen alternativas de tratamiento, como se concluye a partir de estudios clínicos publicados en el último año. Esta revisión del tema discute los ensayos clínicos que han dado lugar a la aprobación de nuevos fármacos para el tratamiento de la hipertensión pulmonar. Dos estudios clínicos fase tres, controlados, aleatorizado...

  20. Edema pulmonar neurogênico: uma revisão atualizada da literatura

    OpenAIRE

    Flávio Antônio Siqueira Ridenti

    2012-01-01

    O edema pulmonar neurogênico ainda é um fenômeno pouco compreendido no contexto da assistência ao paciente neurológico grave. Trata-se de uma situação clínica relativamente rara. Situações de importante dano cerebral como hemorragia subaracnóidea, traumatismos encefálicos severos, hemorragias cerebrais intra-parenquimatosas, crises convulsivas ou outras condições específicas fazem o perfil do paciente com risco de desenvolver edema pulmonar neurogênico. A falta de reconhecimento desta condiçã...

  1. Edema pulmonar pós-pneumonectomia Postpneumonectomy pulmonary edema

    Directory of Open Access Journals (Sweden)

    Marcos Naoyuki Samano

    2005-02-01

    Full Text Available A pneumonectomia, embora seja tecnicamente simples, está associada a alta incidência de complicações (cerca de 60%. As complicações respiratórias correspondem a aproximadamente 15% deste total. A mortalidade global dessa cirurgia é de 8,6%, mas em presença de complicações respiratórias, a taxa de mortalidade chega a 30%. O edema pulmonar pós-pneumonectomia é uma complicação rara (3% a 5%, mas muito grave, sendo fatal na maioria dos casos. Foi descrito pela primeira vez há pouco mais de vinte anos mas, apesar da gravidade alarmante, pouco sabemos acerca de sua fisiopatologia, embora muitas hipóteses tenham sido levantadas. Uma vez instalado, nenhuma medida é comprovadamente eficaz no seu tratamento. Vários fatores de risco estão associados ao aparecimento do edema pulmonar pós-pneumonectomia, dentre os quais a sobrecarga hídrica, que foi o primeiro fator evitado. Entretanto, muitos trabalhos mostram não haver relação direta entre o volume recebido e o desenvolvimento do edema. A prevenção é a melhor forma de evitá-lo e deve ser realizada de maneira multifatorial, envolvendo toda a equipe médica, desde o momento da anestesia até os cuidados cirúrgicos e na terapia intensiva. No entanto, tão importante quanto a prevenção, é a suspeita clínica precoce, identificando os pacientes em risco para essa grave complicação.Although pneumonectomy is a technically simple procedure, it has been associated with a high (60% incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases, it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known

  2. An angry cat causing Pasteurella multocida endocarditis and aortic valve replacement—A case report

    Directory of Open Access Journals (Sweden)

    Anders Ahlsson

    2016-01-01

    Conclusion: Cat bites are often deep, and in rare circumstances can lead to life-threatening endocarditis. Proper surgical revision, antibiotic treatment, and patient compliance are necessary components in patient care to avoid this complication.

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

    Directory of Open Access Journals (Sweden)

    Porokhnya N.G.

    2014-09-01

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

  4. Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Ali Asghar Moeinipour

    2015-01-01

    Full Text Available Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD. We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup.

  5. Spondylodiscitis and infectious endocarditis: a round-trip to be considered

    Directory of Open Access Journals (Sweden)

    Daniela Calderaro

    Full Text Available The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course. A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflamatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the need of a longer antibiotic therapy course, which can range from 6 weeks to 3 months.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Endocarditis of the tricuspid valve associated with congenital coronary arteriovenous fistula

    OpenAIRE

    Ong, Mei Lin

    1993-01-01

    A 17 year old girl with a congenital right coronary artery to coronary sinus fistula presented with recurrent septic pulmonary embolism secondary to tricuspid valve endocarditis. The diagnosis was made on the basis of echocardiography and cardiac angiography.

  8. Streptococcal endocarditis in a captive southern white rhinoceros (Ceratotherium simum simum).

    Science.gov (United States)

    Houszka, Marek; Dzimira, Stanislaw; Krol, Jaroslaw; Kandefer-Gola, Malgorzata; Ciaputa, Rafal; Sobieraj, Leslaw; Podkowik, Magdalena

    2014-09-01

    Postmortem examination of a 43-yr-old male southern white rhinoceros (Ceratotherium simum simum) revealed gross lesions and histopathologic findings consistent with endocarditis. The animal was born in Umfolozi National Park, South Africa, and then it was moved at 2 yr of age to two successive European zoologic collections. For several weeks prior to death, the animal was increasingly recumbent or assuming a dog-sitting position. Postmortem examination revealed cutaneous pressure sores and multiple rough nodular structures on the mitral valve and left ventricular endocardium. Histopathologic examination revealed vegetative endocarditis, myocardial and hepatocellular degeneration, hepatic fibrosis, and chronic nephritis. Bacterial culture from the oral cavity, trachea, lung, skin, and heart isolated beta hemolytic Streptococcus dysgalactiae subsp. equisimilis and Streptococcus ovis. The cause of death was acute cardiopulmonary failure due mainly to endocarditis and moderate myocardial degeneration. Streptococcal infections are not uncommon causes of morbidity and mortality in rhinoceros. This is the first detailed report of streptococcal endocarditis in a rhinoceros.

  9. Rare presentation of Candida albicans: infective endocarditis and a pulmonary coin lesion.

    Science.gov (United States)

    Öner, Taliha; Korun, Oktay; Çelebi, Ahmet

    2018-04-01

    We present a case of a rare association of infective endocarditis and a coin lesion in the lung caused by Candida albicans. The lesion disappeared after 6 weeks of treatment with 5 mg/kg/day amphotericin B.

  10. Embolia pulmonar na sala de cirurgia: relato de caso Embolia pulmonar en sala operatoria: relato de caso Pulmonary embolism in the operating room: case report

    Directory of Open Access Journals (Sweden)

    Karina Bernardi Pimenta

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embolia pulmonar é uma complicação freqüente no período pós-operatório. O objetivo deste relato é apresentar um caso de embolia pulmonar ocorrida na sala de operação e chamar a atenção para a importância da profilaxia de trombose venosa em pacientes cirúrgicos. RELATO DO CASO: Trata-se de um paciente do sexo masculino, 55 anos e 83 kg com diagnóstico de câncer de próstata, submetido a prostatectomia supra-púbica sob anestesia geral. Ao final da cirurgia, o paciente já extubado e logo após sua passagem para a maca de transporte apresentou instabilidade hemodinâmica e diminuição da SpO2 para 80%. Foi reintubado e encaminhado para a UTI. A tomografia computadorizada mostrou imagens com aspecto de embolia pulmonar. O paciente evoluiu para óbito no 5º dia de pós-operatório. CONCLUSÕES: O elevado índice de suspeita não é suficiente para firmar o diagnóstico pois a embolia pulmonar é uma doença silenciosa e a rotina de investigação não possui elevada sensibilidade. A profilaxia precoce e adequada é a melhor estratégia.JUSTIFICATIVA Y OBJETIVOS: Embolia pulmonar es una complicación frecuente en el período pós-operatorio. El objetivo de este relato es presentar un caso de embolia pulmonar ocurrida en la sala de operación y llamar la atención para la importancia de la profilaxis de trombosis venosa en pacientes cirúrgicos. RELATO DE CASO: Se trata de un paciente del sexo masculino, 55 años y 83 kg con diagnóstico de cáncer de próstata, sometido a prostatectomia supra-púbica bajo anestesia general. Al final de la cirugía, el paciente ya entubado y luego después de pasar para la camilla de transporte presentó inestabilidad hemodinámica y diminución de la SpO2 para 80%. Fue reintubado y encaminado para la UTI. La tomografía computadorizada mostró imágenes con aspecto de embolia pulmonar. El paciente evolucionó para óbito en el 5º día de pós-operatorio. CONCLUSIONES: El

  11. Esquistossomose pulmonar. I. Forma crônica extensa sem hipertensão pulmonar e na ausência de hipertensão portal

    Directory of Open Access Journals (Sweden)

    Jayme Neves

    1980-12-01

    Full Text Available Com o objetivo de demonstrar algumas modalidades distintas do comprometimento pulmonar na esquistossomose mansoni, ressaltando sempre a diversidade dé interação dos múltiplos fatores envolvidos, os Autores iniciam a publicação de uma seqüência de casos ilustrativos, embora considerados pouco comuns na clínica diária. No caso ora descrito, ao lado de sintomatologia definida dominantemente por surtos paroxísticos de asma, o estudo radiológico seriado, durante sete anos, revelou imagem pieuro-parenquimatosa caracterizada por irregularidades de radiopacidade com traves fibróticas extensas, notadamente à direita e desvio acentuado do mediastino para este lado; a área cardíaca encontrava-se aparentemente normal. À microtoracotomia, observou-se lesão pleural dominante com enclausuramento do LSD e condensação extensa subpleural do LSD, afetando amplamente o parênquima. Procedeu-se àdetorticação do LM e LID e reexpansão parcial de seus parénquimas, bem como à biopsia pulmonar. Apesar de o estudo histopatológico haver revelado uma arterite pulmonar grave, não foram registrados sinais e sintomas de cor pulmonale. Este comprometimento pulmonar verificou-se, entretanto, isoladamente de uma forma hepato-esplênica e, conseqüentemente, na ausência de síndrome de hipertensão portai a determinar a rota oreferencial de migração de ovos e, eventualmente, de vermes aos pulmões.

  12. Aderência dos portadores de doença pulmonar obstrutiva crônica a um programa de reabilitação pulmonar

    Directory of Open Access Journals (Sweden)

    Janaina Schafer

    2012-01-01

    Full Text Available A falta de adesão e a não obediência aos tratamentos recomendados é um problema muito comum que preocupa e interfere no sucesso da assistência aos portadores de Doença Pulmonar Obstrutiva Crônica-DPOC. Este estudo comparou o perfil dos portadores de DPOC aderentes e não aderentes a um programa de reabilitação pulmonar. Métodos: Estudo observacional exploratório prospectivo, envolvendo24 portadores de DPOC do programa de Reabilitação Pulmonar, alocados em dois grupos conforme participação integral do tratamento proposto: Grupo Aderente (GA=18 sujeitos e Não-aderente (GN=06sujeitos. O tratamento ocorreu em 08 semanas, 3x/semana, com duração de 1 hora e 30 minutos, composto por equipe multiprofissional (fisioterapeuta, profissional de educação física, nutricionista, farmacêutica, psicólogo e médico pneumologista. Resultados: O GA não diferiu do GN quanto à situação sociodemográfica, antropométrica, capacidade cardiorrespiratória de exercício e função respiratória. GN apresentou mais comorbidades quando comparadas ao GA e em média maior quantidade de medicamentos utilizados. Todos os pacientes caracterizaram-se com redução da qualidade de vida e correlações entre a função cardiorrespiratória e qualidade de vida foi observada para ambos os grupos. Conclusão: Nossos resultados revelam queo estadiamento avançado da doença e o agravamento da sintomatologia foram fatores determinantes para a adesão dos portadores de DPOC ao programa de reabilitação pulmonar.

  13. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-05-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using /sup 111/In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities.

  14. Bacterial Endocarditis Caused by Lactobacillus acidophilus Leading to Rupture of Sinus of Valsalva Aneurysm.

    Science.gov (United States)

    Encarnacion, Carlos Omar; Loranger, Austin Mitchell; Bharatkumar, A G; Almassi, G Hossein

    2016-04-01

    Lactobacillus acidophilus rarely causes bacterial endocarditis, because it usually resides in the mucosa of the vagina, gastrointestinal tract, and oropharynx. Moreover, sinus of Valsalva aneurysms are rare cardiac anomalies, either acquired or congenital. We present the case of a middle-aged man whose bacterial endocarditis, caused by Lactobacillus acidophilus, led to an aneurysmal rupture of the sinus of Valsalva into the right ventricular outflow tract. The patient underwent successful surgical repair, despite numerous complications and sequelae.

  15. The value of {sup 18}F-FDG PET/CT in diagnosing infectious endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  16. The value of 18F-FDG PET/CT in diagnosing infectious endocarditis

    International Nuclear Information System (INIS)

    Kouijzer, Ilse J.E.; Vos, Fidel J.; Janssen, Marcel J.R.; Dijk, Arie P.J. van; Oyen, Wim J.G.; Bleeker-Rovers, Chantal P.

    2013-01-01

    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 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 18 F-FDG PET/CT and echocardiography. 18 F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians. Sensitivity for diagnosing infectious endocarditis with 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 18 F-FDG uptake in or around the heart valves was 18 %, and in patients without infectious endocarditis but with high 18 F-FDG uptake in or around the heart valves the mortality rate was 50 % (p = 0.181). 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.)

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

    Directory of Open Access Journals (Sweden)

    Olcay Murat Disli

    2013-06-01

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

  18. Genomic analysis of a Streptococcus pyogenes strain causing endocarditis in a child

    Directory of Open Access Journals (Sweden)

    M. Beye

    2017-05-01

    Full Text Available We sequenced the genome of Streptococcus pyogenes strain G773 that caused an infective endocarditis in a 4-year-old boy suffering from acute endocarditis. The 1.9-Mb genome exhibited a specific combination of virulence factors including a complete integrative and conjugative element, sp2905, previously described as incomplete in S. pyogenes, and five bacteriocin-coding genes. However, strain G773 lacked a CRISPR-Cas system.

  19. Large aortic root pseudoaneurysm occurring late after aortic root repair and valve replacement for endocarditis

    Directory of Open Access Journals (Sweden)

    Prashanth Panduranga

    2013-01-01

    Full Text Available A 68-year-old male presented with Group B Streptococcus aortic valve (AV endocarditis with aortic root abscess and refractory sepsis. An emergency cardiac surgery was performed with root abscess drainage, excision and debridement of necrotic tissue, reconstruction of annulus, and AV replacement. Fifteen months later he presented with a huge aortic root pseudoaneurysm (PA. This case illustrates late occurrence of aortic root PA following AV surgery for endocarditis.

  20. Isolated Tricuspid Valve Libman-Sacks Endocarditis in Systemic Lupus Erythematosus with Secondary Antiphospholipid Syndrome

    OpenAIRE

    Unic, Daniel; Planinc, Mislav; Baric, Davor; Rudez, Igor; Blazekovic, Robert; Senjug, Petar; Sutlic, Zeljko

    2017-01-01

    Libman-Sacks endocarditis, one of the most prevalent cardiac presentations of systemic lupus erythematosus, typically affects the aortic or mitral valve; tricuspid valve involvement is highly unusual. Secondary antiphospholipid syndrome increases the frequency and severity of cardiac valvular disease in systemic lupus erythematosus. We present the case of a 47-year-old woman with lupus and antiphospholipid syndrome whose massive tricuspid regurgitation was caused by Libman-Sacks endocarditis ...

  1. Procedimento e complicações anestésicas no manejo de lavagem pulmonar total em paciente obeso com proteinose alveolar pulmonar: relato de caso

    Directory of Open Access Journals (Sweden)

    Helena Marta Rebelo

    2012-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O primeiro caso de proteinose alveolar pulmonar (PAP foi descrito por Rose em 1958, mas ainda é um distúrbio raro. PAP é caracterizada pela deposição de material lipoproteico secundário ao processamento anormal de surfactantes pelos macrófagos. Os pacientes podem ter dispneia progressiva e tosse, às vezes acompanhadas pelo agravamento da hipóxia, e seu curso pode variar de deterioração progressiva a melhora espontânea. Muitas terapias foram usadas, incluindo antibióticos, drenagem postural e ventilação com pressão positiva intermitente com acetilcisteína, heparina e soro fisiológico em aerossol. Atualmente, a base do tratamento é a lavagem pulmonar total (LPT. A LPT, embora seja geralmente bem-tolerada, pode estar associada a algumas complicações. RELATO DE CASO: Relatamos um caso de PAP grave durante o procedimento anestésico e as complicações no manejo da proteinose alveolar pulmonar em um paciente que havia sido submetido a múltiplas e alternadas lavagens de um dos pulmões ao longo de sete anos (os últimos três em nosso hospital, com melhora dos sintomas depois de cada tratamento.

  2. Estudo angiográfico da circulação pulmonar na tetralogia de Fallot com atresia pulmonar Angiographic study of pulmonary circulation in tetralogy of Fallot with pulmonary atresia

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Santos

    2005-02-01

    Full Text Available OBJETIVO: Identificar os tipos de suprimento sangüíneo vascular pulmonar na tetralogia de Fallot com atresia pulmonar por meio de estudo hemodinâmico. MÉTODOS: Foram submetidos a estudo cineangiocardiográfico 56 pacientes portadores de tetralogia de Fallot com atresia pulmonar com idade de 20 dias a 4 anos e efetuadas injeções de contraste nas seguintes estruturas vasculares: 1 veia pulmonar encunhada, 2 colaterais aortopulmonares, 3 aorta torácica e 4 ductus arteriosus e/ou shunt sistêmico pulmonar. RESULTADOS: Dos 56 pacientes, 15 tinham o suprimento sangüíneo pulmonar através de colaterais aortopulmonares, em 36 o suprimento sangüíneo pulmonar era feito isoladamente pelo ductus arteriosus e em 5 pelo ductus arteriosus e colaterais aortopulmonares. Conforme a presença ou ausência de estruturas vasculares que compõem a circulação pulmonar na tetralogia de Fallot com atresia pulmonar e do tipo de perfusão vascular pulmonar, os doentes foram classificados em 6 tipos. CONCLUSÃO: Em função da grande complexidade e extrema variabilidade do suprimento sangüíneo pulmonar na tetralogia de Fallot com atresia pulmonar torna-se possível, com este tipo de abordagem, a obtenção de informações, suficientemente necessárias, para o correto manuseio clínico-cirúrgico.OBJECTIVE: To identify the types of pulmonary vascular blood supply in tetralogy of Fallot with pulmonary atresia by use of hemodynamic study. METHODS: Fifty-six patients with tetralogy of Fallot and pulmonary atresia, and ages ranging from 20 days to 4 years, underwent cineangiocardiographic study with contrast medium injections in the following vascular structures: 1 wedged pulmonary vein; 2 aortopulmonary collaterals; 3 thoracic aorta; and 4 ductus arteriosus or systemic-pulmonary shunt. RESULTS: In the 56 patients studied, pulmonary blood was supplied as follows: in 15, by aortopulmonary collaterals; in 36, only by the ductus arteriosus; and in 5, by the ductus

  3. Infective endocarditis causing mitral valve stenosis - a rare but deadly complication: a case report.

    Science.gov (United States)

    Hart, Michael A; Shroff, Gautam R

    2017-02-17

    Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred. We report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness. The discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.

  4. Linezolid in prophylaxis against experimental aortic valve endocarditis due to Streptococcus oralis or Enterococcus faecalis.

    Science.gov (United States)

    Athanassopoulos, George; Pefanis, Angelos; Sakka, Vissaria; Iliopoulos, Dimitrios; Perrea, Despina; Giamarellou, Helen

    2006-02-01

    There are no experimental studies regarding the prophylactic efficacy of linezolid against infective endocarditis. Nonbacterial thrombotic endocarditis of the aortic valve was induced in rabbits by the insertion of a polyethylene catheter. Twenty-four hours later, animals were randomly assigned to a control group, and groups receiving either ampicillin (two doses of 40 mg/kg of body weight each, given intravenously, 2 h apart) or linezolid (a single per os dose of 75 mg/kg). The first dose of ampicillin and the single dose of linezolid were administered 0.5 and 1 h, respectively, prior to the intravenous inoculation of approximately 10(7) CFU of Streptococcus oralis or Enterococcus faecalis. Linezolid peak levels in rabbit serum were similar to the peak serum levels in humans following a 600-mg oral dose of linezolid. Linezolid prevented endocarditis in 87% of S. oralis-challenged rabbits (P faecalis, linezolid prevented endocarditis in 73% (P = 0.003 versus controls; P = 0.049 versus ampicillin). Ampicillin prevented endocarditis due to S. oralis or due to E. faecalis in 47% (P = 0.005 versus controls) and in 30% (P = not significant versus controls) of the challenged animals, respectively. In conclusion, linezolid was effective as prophylaxis against endocarditis caused by a strain of S. oralis and to a lesser degree against that caused by a strain of E. faecalis. Its prophylactic efficacy was superior to that of ampicillin.

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

    Directory of Open Access Journals (Sweden)

    Greub Gilbert

    2010-08-01

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

  6. Echocardiographic findings predict in-hospital and 1-year mortality in left-sided native valve Staphylococcus aureus endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine K.; Park, Lawrence; Tong, Steven Y C

    2015-01-01

    BACKGROUND: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS......: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log...

  7. Linfangioleiomiomatose pulmonar inicial provável e linfangioleiomioma mediastínico

    Directory of Open Access Journals (Sweden)

    M. Pontes

    2014-03-01

    Full Text Available Resumo: Uma mulher de 68 anos foi submetida a uma ressecção de um linfoangioendotelioma mediastinal observado na monitorização de uma lobectomia inferior esquerda devido a bronquiectasia, complicada por quilotórax. Isto levou a uma reavaliação do espécime pulmonar que revelou, além da bronquiectasia inflamatória, nódulos de pequenas células fusiformes no parênquima pulmonar, semelhantes a nódulos pulmonares de tipo meningotelial, mas com positividade imunohistoquímica para actina do músculo liso. A hipótese de desenvolvimento inicial de linfangioleiomiomatose pulmonar é discutida. Abstract: A 68 year old woman was submitted to a mediastinal lymphangioleiomyoma resection found in a follow-up study of lower left lung resection due to bronchiectasis complicated by chylothorax. This led to a revaluation of the pulmonary specimen that revealed, in addition to inflammatory bronchiectasis, small spindle cell nodules in the lung parenchyma, similar to minute pulmonary meningothelial-like nodules, but with smooth muscle actin immunohistochemical positivity. The possibility of initial pulmonary development of lymphangioleiomyomatosis is discussed. Palavras-chave: Mediastinal, Linfangioleiomioma, Linfangioleiomiomatose, Keywords: Mediastinal, Lymphangioleiomyoma, Lymphangioleiomyomatosis

  8. O problema da hemossiderose pulmonar na doença de Chagas

    Directory of Open Access Journals (Sweden)

    Leila Andrade Siqueira

    1972-10-01

    Full Text Available Os autores estudaram a existência de hemosiderose pulmonar em 60 casou de autopsia, 20 dos quais chagásicos crônicos com cardiopatia, 20 pacientes com cardiopatia não chagásica e 20 casos sem nenhuma manifestação de doença cardíaca. A incidência de hemossiderose pulmonar foi de 75% entre os chagásicos e de 80% entre os pacientes de cardiopatia não chagásica. Nos casos controle sem cardiopatia a incidência foi relativamente baixa (45% e, guando presente, o grau de intensidade era mínimo. Com esses achados, conclui-se que a hemossiderose pulmonar na Doença de Chagas é uma conseqüência da congestão crônica passiva, resultante da insuficiência cardíaca congestiva, do mesmo modo que ocorre em outras condições mórbidas tais como Estenose mitral e Cor-pulmonar crônico, não havendo evidências de uma pneumopatia peculiar em chagásicos.

  9. Drenaje venosa pulmonar anómalo total. Técnicas y resultados

    Directory of Open Access Journals (Sweden)

    Ángel Aroca

    2014-04-01

    Se citan recomendaciones para el a veces complejo manejo postoperatorio y se revisa la literatura más reciente que aporta datos sobre el tratamiento y resultados de la complicación tardía más letal: la obstrucción anastomótica y/o de venas pulmonares.

  10. Infective Endocarditis Prophylaxis in Patients Undergoing Oral Surgery

    Directory of Open Access Journals (Sweden)

    Zoumpoulakis M.

    2016-03-01

    Full Text Available Infective endocarditis (IE, an infection of the endocardium that usually involves the valves and adjacent structures, may be caused by a wide variety of bacteria and fungi that entered the bloodstream and settled in the heart lining, a heart valve or a blood vessel. The IE is uncommon, but people with some heart conditions have a greater risk of developing it. Despite advances in medical, surgical, and critical care interventions, the IE remains a disease that is associated with considerable morbidity and mortality. Hence, in order to minimize the risk of adverse outcome and achieve a yet better management of complications, it is crucial to increase the awareness of all the prophylactic measures of the IE.

  11. Staphylococcus simulans associated with endocarditis in broiler chickens.

    Science.gov (United States)

    Stępień-Pyśniak, D; Wilczyński, J; Marek, A; Śmiech, A; Kosikowska, U; Hauschild, T

    2017-02-01

    This report suggests a strong association between coagulase-negative Staphylococcus simulans and endocarditis in broiler chickens of a single flock. Clinical signs included increased mortality and lameness, and some dead chickens were found on their backs. Lesions included cauliflower-like, fibrinous vegetative lesions on the left atrioventricular valve; cream-coloured, necrotic foci of varying size in the liver; and necrosis of the femoral head. Histopathological examination of the heart revealed multifocal conglomerates of bacterial colonies attached to the valvular endocardium, threads of fibrin, and inflammatory cells with the presence of heterophils. S. simulans strains were first identified by API ID32, and then confirmed with Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry and by partial sequencing of the rpoB and dnaJ genes. These bacteria were resistant to methicillin but sensitive to vancomycin and characterized by slime production and protease activity.

  12. Subacute Bacterial Endocarditis Caused by Cardiobacterium hominis: A Case Report

    Directory of Open Access Journals (Sweden)

    Davie Wong

    2015-01-01

    Full Text Available Cardiobacterium hominis, a member of the HACEK group of organisms, is an uncommon but important cause of subacute bacterial endocarditis. First-line therapy is a third-generation cephalosporin due to rare beta-lactamase production. The authors report a case involving endovascular infection due to C hominis that initially tested resistant to third-generation cephalosporins using an antibiotic gradient strip susceptibility method (nitrocephin negative, but later proved to be susceptible using broth microdilution reference methods (a ‘major’ error. There are limited studies to guide susceptibility testing and interpretive breakpoints for C hominis in the medical literature, and the present case illustrates some of the issues that may arise when performing susceptibility testing for fastidious organisms in the clinical microbiology laboratory.

  13. Low efficacy of tobramycin in experimental Staphylococcus aureus endocarditis

    DEFF Research Database (Denmark)

    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...... into 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...... was observed at 2 DPI (p ≤ 0.001) but not at 3 DPI. Tobramycin as functional monotherapy only reduced bacterial load and inflammation transiently, and was insufficient in most cases of S. aureus IE....

  14. An Uncommon Cause of Stroke: Non-bacterial Thrombotic Endocarditis.

    Science.gov (United States)

    Gundersen, Hilde; Moynihan, Barry

    2016-10-01

    Our objective is to present the case of an uncommon but probably under-recognized cause of stroke: Non-bacterial thrombotic endocarditis (NBTE). A 59-year-old man presented to our hospital with multiple bihemispheric infarcts despite taking rivaroxaban for pulmonary emboli diagnosed 2 weeks earlier. The patient's symptoms progressed quickly and he died within a week of his initial presentation despite attempts at neuroradiologically guided clot retrieval and early recognition and treatment of disseminated intravascular coagulation. On postmortem examination it was discovered that he had an undiagnosed squamous cell adenocarcinoma of the lung and NBTE. NBTE is difficult to diagnose and difficult to treat. It is associated with a mortality rate and is often not diagnosed until autopsy. However there are case reports in the literature where NBTE has been successfully treated. Early recognition and prompt treatment of the underlying disease process is the essential first step. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Right-sided infective endocarditis: recent epidemiologic changes

    Science.gov (United States)

    Yuan, Shi-Min

    2014-01-01

    Background: Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE. Methods: Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature. Results: Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients’ survival. Conclusions: Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before. PMID:24482708

  16. Infective Endocarditis Presenting as Bilateral Orbital Cellulitis: An Unusual Case.

    Science.gov (United States)

    Asif, Talal; Hasan, Badar; Ukani, Rehman; Pauly, Rebecca R

    2017-06-14

    Orbital cellulitis is a severe and sight-threatening infection of orbital tissues posterior to the orbital septum. The most common causes of orbital cellulitis are rhinosinusitis, orbital trauma, and surgery. Infective endocarditis (IE) is a systemic infection that begins on cardiac valves and spreads by means of the bloodstream to peripheral organs. Septic emboli can spread to any organ including the eyes and can cause focal or diffuse ophthalmic infection. Ocular complications of IE classically include Roth's spots, subconjunctival hemorrhages, chorioretinitis, and endophthalmitis. IE as a cause of orbital cellulitis has been described by only one author in the literature. Here, we present a very rare case of bilateral orbital cellulitis caused by IE. Through this case, we aim to create awareness of the potential for serious ocular complications in IE and provide an overview of the management.

  17. Distribution of streptococcal groups causing infective endocarditis: a descriptive study.

    Science.gov (United States)

    Kim, So Lim; Gordon, Steven M; Shrestha, Nabin K

    2018-02-24

    The purpose of this study was to describe the distribution of streptococci causing infective endocarditis (IE). A total of 296 patients with definite IE admitted from July 2007 to December 2014 were identified, with microbial identification done by a combination of blood culture, valve culture, and valve polymerase chain reaction (PCR). The overall distribution of streptococci was 76% viridans (n = 224), 17% pyogenic (50), 6% nutritionally variant (17), and 2% anaerobic (5). Sixty-three (21%) viridans group streptococci were not identified further. The distribution of the remaining 161 viridans group streptococci was Streptococcus mitis group 61%, S. bovis group 15%, S. mutans group 13%, S. anginosus group 9%, and S. salivarius group 1%. Of the 50 pyogenic streptococci, 78% were S. agalactiae and 16% were S. dysgalactiae. PCR was significantly more sensitive than culture in identifying streptococci in excised heart valves. Copyright © 2018. Published by Elsevier Inc.

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

    Science.gov (United States)

    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. © The Author(s) 2016.

  19. Trovafloxacin Treatment of Viridans Group Streptococcus Experimental Endocarditis

    Science.gov (United States)

    Piper, Kerryl E.; Rouse, Mark S.; Ronningen, Karen L.; Steckelberg, James M.; Wilson, Walter R.; Patel, Robin

    2000-01-01

    The activity of trovafloxacin was compared with those of vancomycin and penicillin in a model of Streptococcus sanguis species group (trovafloxacin MIC, 0.125 μg/ml) and Streptococcus mitis species group (trovafloxacin MIC, 0.125 μg/ml) experimental endocarditis. Rabbits with catheter-induced aortic valve vegetations were given no treatment, trovafloxacin at 15 mg/kg of body weight three times a day (t.i.d.), vancomycin at 15 mg/kg twice a day, or penicillin at 1.2 × 106 IU t.i.d. After 3 days of treatment, the animals were sacrificed; cardiac valve vegetations were aseptically removed and cultured quantitatively. Penicillin was as active as vancomycin as measured by in vivo clearance of bacteria. Trovafloxacin was less active (P viridans group streptococci. PMID:10952616

  20. Infective endocarditis in neutropenic patients with viridans streptococci bacteraemia.

    Science.gov (United States)

    Beteille, Elisa; Guarana, Mariana; Nucci, Marcio

    2018-03-17

    Viridans streptococci (VS) are important agents of bacteraemia in neutropenic patients and important agents of community-acquired infective endocarditis (IE) in non-neutropenic patients. However, the incidence of IE in neutropenic patients seems to be rare. In this systematic review of the literature we sought to answer the following questions: (1) What is the frequency of IE in neutropenic patients with VS bacteraemia? (2) What is the most frequent clinical presentation of IE? (3) Is routine investigation for IE indicated in neutropenic patients with VS bacteraemia? The incidence of IE in patients with VS bacteraemia was 0.74% and a new cardiac murmur was the most frequent clinical presentation. Given the rarity of IE in neutropenic patients, routine investigation with echocardiography is not indicated. However, the presence of a new significant murmur should prompt appropriate investigation to rule out IE. Copyright © 2018. Published by Elsevier Ltd.

  1. Candida tropicalis endocarditis: Treatment in a resource-poor setting

    Directory of Open Access Journals (Sweden)

    Kumar Prashant

    2010-01-01

    Full Text Available Fungal endocarditis (FE is rare in children and does not usually occur in structurally normal hearts. The commonest causative agent is Candida albicans. We report a 5-year-old female child presenting with high-grade fever and cardiac failure. Anemia, leukocytosis and high CRP were found, but bacterial blood culture was sterile. There was no response to antimicrobial agents. Two-dimensional echocardiography revealed a large heterogeneous mass attached to the right ventricle and tricuspid valve. Provisional diagnosis of FE was made, which was confirmed by growth of Candida tropicalis in blood culture. Liposomal amphotericin B was started, followed by radical curative surgery including excision of the entire vegetation with total tricuspid valve excision. Histopathology and culture of the resected vegetation confirmed the diagnosis. The patient was given antifungal therapy for a total of 7 weeks, including 2 weeks of post-operative treatment, following which she was afebrile.

  2. Bilateral sudden sensorineural hearing loss in Staphylococcus aureus endocarditis.

    Science.gov (United States)

    Lau, Joanne Wai Ling; Ceranic, Borka; Harris, Robert; Timehin, Elwina

    2015-09-14

    This case highlights the diagnostic challenges in patients presenting with bilateral sudden sensorinueral hearing loss (SNHL). The aetiology of bilateral sudden SNHL may span several medical disciplines. Therefore, clinicians should be mindful of such presentations, and consider aetiologies beyond otological and neurological causes. We present a case of a previously healthy 51-year-old woman who presented with coryzal symptoms and sudden audiovestibular failure. Examination revealed fever, tachycardia, bilateral profound hearing loss and nystagmus. Following investigations, an initial working diagnosis of vasculitis was made. Later, blood cultures revealed methicillin-sensitive Staphylococcus aureus (MSSA) and a transoesophageal echocardiogram confirmed endocarditis. The patient made a good recovery, but the hearing loss was permanent and managed with a cochlear implant. 2015 BMJ Publishing Group Ltd.

  3. Infective Endocarditis with Uveitis: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Hsiang-Chun Lee

    2007-01-01

    Full Text Available We report a case of a 51-year-old diabetic male who presented with a complaint of intermittent chills and fever that he had experienced for 10 days. No obvious respiratory tract, genitourinary tract, gastrointestinal tract, or skin lesions were observed. Blood culture data were positive for group B β-streptococcus. Transthoracic and transesophageal echocardiography revealed vegetation in the anterior leaflet of the mitral valve. The patient was diagnosed with infective endocarditis (IE and prescribed a parenteral antibiotic. Three days after admission, the patient complained of progressively blurred vision. Slit lamp examination found fine keratic precipitates and aqueous cells in the anterior chambers in both eyes, implying that the patient had uveitis. He was then prescribed a topical steroid for 4 months, and his vision improved gradually. This case is an important reminder that uveitis, not only endophthalmitis, can occur with IE. Treatment for one condition, if misapplied, may worsen the other.

  4. Diagnóstico por imagem do tromboembolismo pulmonar agudo Imaging of acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    C. Isabela S. Silva

    2004-10-01

    Full Text Available O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC. Na última década vários estudos têm demonstrado que a TC espiral apresenta elevada sensibilidade e especificidade no diagnóstico de tromboembolismo pulmonar agudo. Uma melhor avaliação das artérias pulmonares tornou-se possível com a recente introdução dos equipamentos de TC espirais com multidetectores. Vários pesquisadores têm sugerido que a angiografia pulmonar por TC espiral deve substituir a cintilografia na avaliação de pacientes com suspeita clinica de tromboembolismo pulmonar agudo. Os autores discutem os principais métodos de imagem utilizados no diagnóstico de tromboembolismo pulmonar agudo enfatizando o papel da TC espiral.The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q, scintigraphy, angiography, and computed tomography (CT. In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.

  5. Despistaje de patología pulmonar obstructiva en padres de niños con problemas respiratorios

    OpenAIRE

    Rey Pardo, Carmen

    2009-01-01

    Falta por incorporar las palabras clave Hemos realizado un trabajo de investigación clínica en el que se han planteado como principales objetivos conocer la función pulmonar de los progenitores de niños con asma actual o antecedentes de asma en la infancia, conocer si existe relación entre la función pulmonar de esos niños con asma y la función pulmonar de sus progenitores y saber si estudiar a sus progenitores puede facilitar el reconocimiento de patología respiratoria no detectada previa...

  6. 58. Actitud frente al flujo sanguíneo pulmonar adicional en la operación de glenn

    Directory of Open Access Journals (Sweden)

    F. Serrano Martínez

    2010-01-01

    Conclusiones: El mantenimiento de FPAC no incrementa la morbimortalidad post-Glenn ni altera la conservación funcional del ventrículo único, permitiendo llegar a la fase pre-Fontan con mayor SaO2 y mejor tamaño de ramas pulmonares. La existencia o ausencia de FPAC no influyó en los resultados del Fontan posterior, aunque consideramos interesante mantenerlo, especialmente en casos con ramas pulmonares pequeñas. La paliación pre-Glenn tipo banding pulmonar se asoció a mayor imposibilidad de conservar un FPAC.

  7. Multiple systemic embolism in infective endocarditis underlying in Barlow's disease.

    Science.gov (United States)

    Yu, Ziqing; Fan, Bing; Wu, Hongyi; Wang, Xiangfei; Li, Chenguang; Xu, Rende; Su, Yangang; Ge, Junbo

    2016-08-11

    Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive. We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow's disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up. Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully.

  8. Combined computed tomography and fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic valve endocarditis: a case series.

    Science.gov (United States)

    Bartoletti, Michele; Tumietto, Fabio; Fasulo, Giovanni; Giannella, Maddalena; Cristini, Francesco; Bonfiglioli, Rachele; Raumer, Luigi; Nanni, Cristina; Sanfilippo, Silvia; Di Eusanio, Marco; Scotton, Pier Giorgio; Graziosi, Maddalena; Rapezzi, Claudio; Fanti, Stefano; Viale, Pierluigi

    2014-01-13

    The diagnosis of prosthetic valve endocarditis is challenging. The gold standard for prosthetic valve endocarditis diagnosis is trans-esophageal echocardiography. However, trans-esophageal echocardiography may result in negative findings or yield images difficult to differentiate from thrombus in patients with prosthetic valve endocarditis. Combined computed tomography and fluorodeoxyglucose positron emission tomography is a potentially promising diagnostic tool for several infectious conditions and it has also been employed in patients with prosthetic valve endocarditis but data are still scant. We reviewed the charts of 6 patients with prosthetic aortic valves evaluated for suspicion of prosthetic valve endocarditis, at two different hospital, over a 3-year period. We found 3 patients with early-onset PVE cases and blood cultures yielding Pseudomonas aeruginosa, Staphylococcus epidermidis and Staphylococcus lugdunensis, respectively; and 3 late-onset cases in the remaining 3 patients with isolation in the blood of Streptococcus bovis, Candida albicans and P. aeruginosa, respectively. Initial trans-esophageal echocardiography was negative in all the patients, while fluorodeoxyglucose positron emission tomography showed images suspicious for prosthetic valve endocarditis. In 4 out of 6 patients valve replacement was done with histology confirming the prosthetic valve endocarditis diagnosis. After an adequate course of antibiotic therapy fluorodeoxyglucose positron emission tomography showed resolution of prosthetic valve endocarditis in all the patients. Our experience confirms the potential role of fluoroseoxyglucose positron emission tomography in the diagnosis and follow-up of prosthetic valve endocarditis.

  9. ¿(Anti-TNF-¿ y tuberculosis pulmonar

    Directory of Open Access Journals (Sweden)

    Carlo Vinicio Caballero Uribe

    2006-01-01

    Full Text Available Presentación de una paciente con artritis reumatoide severa en tratamiento con inhibidores del Factor de Necrosis Tumoral (Anti-TNF, quien presenta además un cuadro de tuberculosis pulmonar. La artritis reumatoide es una enfermedad inflamatoria crónica de las articulaciones, que afecta en un inicio la membrana sinovial, pero que si no es tratada oportunamente lleva a daño estructural irreversible del sistema músculo-esquelético y eventualmente de otros sistemas orgánicos. Dentro de los criterios de la American College of Rheumatology se incluyen la Rigidez Matutina, Artritis de 3 o más articulaciones, Artritis simétrica, Nódulos reumáticos, Factor Reumatoideo y hallazgos radiográficos. Dentro de la patogenia de esta enfermedad, el Factor de Necrosis Tumoral es una citocina que juega un papel importante, una producción elevada de TNF-α se ha encontrado en la sinovial de estos pacientes, y por su capacidad de inducir la producción de otras citocinas, como IL-6, IL-17, GM-CSF, M-CSF, e incluso IL-1 y TNF-α (función autócrina, parecería que el TNF-α ejerce una acción “jerárquica” dentro de la llamada red de citocinas y una inhibición de su acción da como resultado un beneficio terapéutico en los pacientes con AR. Sin embargo, es conocido que la infección concurrente más frecuentemente informada con el uso de agentes biológicos (Anti-TNF es la TB, y la incidencia de ésta se ha incrementado desde el advenimiento de la terapia biológica. Por tanto, la descripción de este caso no corresponde a un hecho médico aislado, sino a una problemática actual y real. Este es el primer caso que se reporta en la Costa Caribe.

  10. Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience

    International Nuclear Information System (INIS)

    Ierardi, Anna Maria; Duka, Ejona; Radaelli, Alessandro; Rivolta, Nicola; Piffaretti, Gabriele; Carrafiello, Gianpaolo

    2016-01-01

    AimTo evaluate the feasibility of image fusion (IF) of pre-procedural arterial-phase CT angiography or MR angiography with intra-procedural fluoroscopy for road-mapping in endovascular treatment of aorto-iliac steno-occlusive disease.Materials and MethodsBetween September and November, 2014, we prospectively evaluated 5 patients with chronic aorto-iliac steno-occlusive disease, who underwent endovascular treatment in the angiography suite. Fusion image road-mapping was performed using angiographic phase CT images or MR images acquired before and intra-procedural unenhanced cone-beam CT. Radiation dose of the procedure, volume of intra-procedural iodinated contrast medium, fluoroscopy time, and overall procedural time were recorded. Reasons for potential fusion imaging inaccuracies were also evaluated.ResultsImage co-registration and fusion guidance were feasible in all procedures. Mean radiation dose of the procedure was 60.21 Gycm2 (range 55.02–63.75 Gycm2). The mean total procedure time was 32.2 min (range 27–38 min). The mean fluoroscopy time was 12 min and 3 s. The mean procedural iodinated contrast material dose was 24 mL (range 20–40 mL).ConclusionsIF gives Interventional Radiologists the opportunity to use new technologies in order to improve outcomes with a significant reduction of contrast media administration

  11. Endocarditis fatal con localización mitral producida por Erysipelothrix rhusiopathiae Fatal mitral valve endocarditis by Erysipelothrix rhusiopathiae

    Directory of Open Access Journals (Sweden)

    G.V. Vallespi

    2005-06-01

    Full Text Available Se describe un caso fatal de endocarditis en válvula mitral por Erysipelothrix rhusiopathiae, en un paciente varón de 45 años con antecedentes de etilismo crónico y sin contacto previo con animales. Presentaba un síndrome febril prolongado con poliartralgias, pérdida de peso y dolor en región lumbar y miembros inferiores. Los hemocultivos (2/2 fueron positivos a las 48 hs. de incubación y en el examen directo se observaron bacilos gram-positivos pleomórficos. En el subcultivo en agar sangre ovina al 5% desarrollaron colonias puntiformes con alfa hemólisis, catalasa y oxidasa negativas, PYR y LAP positivas y con producción de H2S en medio TSI. La cepa aislada fue identificada como E. rhusiopathiae de acuerdo a la metodología convencional y confirmada con API Coryne. El cuadro se asumió como una probable endocarditis demostrada mediante un ecocardiograma transtorácico. Se comenzó el tratamiento endovenoso con ampicilina y gentamicina. El paciente evolucionó favorablemente y se tornó afebril, sin embargo falleció a los 19 días de internación por edema agudo de pulmón. La prueba de sensibilidad por E-test demostró resistencia a vancomicina y gentamicina y sensibilidad a penicilina y cefotaxima. Es importante valorar los aislamientos de bacilos gram-positivos pleomórficos, catalasa y oxidasa negativos y realizar la prueba de producción de SH2 en el medio TSI. La resistencia a vancomicina ayuda a la identificación y permite establecer una correcta terapia antimicrobiana. Si bien se considera que las infecciones por E. rhusiopathiae son de carácter ocupacional, el contacto con cerdos u otros animales puede no ser evidente.A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis is described in a 45 years old male, with a history of chronic alcohol abuse and without animals contact. He presented intermittent fever, polyarthralgia, weight loss, and low back pain. In blood cultures (2 bottles, gram

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

    Directory of Open Access Journals (Sweden)

    Ardeshir Lafzi

    2008-04-01

    Full Text Available

    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 patients receiving dental treatments.

    Materials and methods. This was a cross-sectional, descriptive, analytical study that included 150 GDPs. All practitioners were given a self-administered questionnaire which consisted of three parts assessing their knowledge of cardiac diseases requiring prophylaxis, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis. Statistical analysis of data was carried out using independent t-test, one-way ANOVA and chi-square test.

    Results. The level of knowledge among GDPs in three areas of cardiac diseases requiring prophylaxis, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis were 63.7%, 66.8% and 47.7%, respectively. Their overall level of knowledge regarding endocarditis prophylaxis was 59%. Association of the level of knowledge with age and practice period was statistically significant (P < 0.05. However, the level of knowledge was not significantly associated with gender or university of graduation in either of three areas evaluated (P > 0.05.

    Conclusion. According to our results, the knowledge of endocarditis prophylaxis among GDPs in Tabriz was in a moderate level. Regarding the importance of endocarditis prophylaxis in susceptible patients, it should be more emphasized in the curriculum of dental schools and continuing dental education programs.

  13. Impact of serology and molecular methods on improving the microbiologic diagnosis of infective endocarditis in Egypt.

    Science.gov (United States)

    El-Kholy, Amany Aly; El-Rachidi, Nevine Gamal El-din; El-Enany, Mervat Gaber; AbdulRahman, Eiman Mohammed; Mohamed, Reem Mostafa; Rizk, Hussien Hasan

    2015-10-01

    Conventional diagnosis of infective endocarditis (IE) is based mainly on culture-dependent methods that may fail because of antibiotic therapy or fastidious microorganisms. We aimed to evaluate the added values of serological and molecular methods for diagnosis of infective endocarditis. One hundred and fifty-six cases of suspected endocarditis were enrolled in the study. For each patient, three sets of blood culture were withdrawn and serum sample was collected for Brucella, Bartonella and Coxiella burnetii antibody testing. Galactomannan antigen was added if fungal endocarditis was suspected. Broad range PCR targeting bacterial and fungal pathogens were done on blood culture bottles followed by sequencing. Culture and molecular studies were done on excised valve tissue when available. One hundred and thirty-two cases were diagnosed as definite IE. Causative organisms were detected by blood cultures in 40 (30.3 %) of cases. Blood culture-negative endocarditis (BCNE) represented 69.7 %. Of these cases, PCR followed by sequencing on blood and valvular tissue could diagnose five cases of Aspergillus flavus. Eleven patients with BCNE (8.3 %) were diagnosed as zoonotic endocarditis by serology and PCR including five cases of Brucella spp, four cases of Bartonella spp and two cases of Coxiella burnetii. PCR detected three cases of Brucella spp and two cases of Bartonella spp, while cases of Coxiella burnetii were PCR negative. The results of all diagnostic tools decreased the percentage of non-identified cases of BCNE from 69.7 to 49.2 %. Our data underline the role of serologic and molecular tools for the diagnosis of blood culture-negative endocarditis.

  14. 220. Asistencia univentricular izquierda Berlin heart como puente al trasplante en pacientes con hipertensión pulmonar grave

    Directory of Open Access Journals (Sweden)

    P. Martínez Cabeza

    2010-01-01

    Conclusiones: En nuestra limitada experiencia, este tipo de estrategia permite: a reducir significativamente la presión pulmonar; b realizar el trasplante cardíaco, y c hacerlo con garantías de éxito.

  15. Codificação da sepse pulmonar e o perfil de mortalidade no Rio de Janeiro, RJ

    Directory of Open Access Journals (Sweden)

    Bruno Baptista Cardoso

    Full Text Available RESUMO: Objetivo: Descrever os óbitos com menção de sepse pulmonar, medir a associação entre sepse pulmonar e pneumonia, assim como avaliar o impacto da regra de codificação no perfil de mortalidade, com a inclusão simulada do diagnóstico de pneumonia, nas declarações de óbito (DO com menção de sepse pulmonar, no Rio de Janeiro, em 2011. Métodos: Foram identificados os óbitos com menção de sepse pulmonar independentemente da causa básica. Aos médicos atestantes, aplicou-se questionário medindo a associação entre sepse pulmonar e pneumonia. O registro de pneumonia nos prontuários dos óbitos com menção de sepse pulmonar e sem menção de pneumonia na DO foi investigado. Foi descrito o perfil de mortalidade após a inclusão simulada do código de pneumonia nas declarações com sepse pulmonar. Resultados: Sepse pulmonar correspondeu a 30,9% das menções de sepse e a menção de pneumonia estava ausente em 51,3% dessas declarações. Pneumonia constava em 82,8% da amostra de prontuários investigados. Dos médicos entrevistados, 93,3% relataram pneumonia como a mais frequente causa de sepse pulmonar. A simulação revelou que a inclusão da pneumonia alterou a causa básica de 7,8% dos óbitos com menção de sepse e 2,4% de todos os óbitos, independentemente da causa original. Conclusão: Sepse pulmonar está associada à pneumonia e a simples inclusão do código de pneumonia nas declarações de óbito com menção de sepse pulmonar impactaria o perfil de mortalidade, apontando necessidade de aprimoramento das regras de codificação na Classificação Internacional de Doenças (CID-10.

  16. Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

    Directory of Open Access Journals (Sweden)

    Vítor Fonseca

    2009-11-01

    Full Text Available Resumo: Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante.Rev Port Pneumol 2009; XV (6: 1175-1184 Abstract: We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE. After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the

  17. 115. Cirugía urgente en un caso de tromboembolia pulmonar con trombo acabalgado en foramen oval permeable

    Directory of Open Access Journals (Sweden)

    Y. Castillo

    2012-04-01

    Conclusiones: La embolectomía pulmonar bajo circulación extracorpórea es una alternativa terapéutica reservada a los casos de tromboembolia pulmonar con fallo ventricular derecho e inestabilidad hemodinámica, y puede ser utilizada de forma segura y eficaz en aquellos casos en que la fibrinólisis esté contraindicada y la localización del trombo permita su extracción quirúrgica.

  18. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study

    NARCIS (Netherlands)

    Murdoch, David R.; Corey, G. Ralph; Hoen, Bruno; Miró, José M.; Fowler, Vance G.; Bayer, Arnold S.; Karchmer, Adolf W.; Olaison, Lars; Pappas, Paul A.; Moreillon, Philippe; Chambers, Stephen T.; Chu, Vivian H.; Falcó, Vicenç; Holland, David J.; Jones, Philip; Klein, John L.; Raymond, Nigel J.; Read, Kerry M.; Tripodi, Marie Francoise; Utili, Riccardo; Wang, Andrew; Woods, Christopher W.; Cabell, Christopher H.; Gordon, David; Devi, Uma; Spelman, Denis; van der Meer, Jan T. M.; Kauffman, Carol; Bradley, Suzanne; Armstrong, William; Giannitsioti, Efthymia; Giamarellou, Helen; Lerakis, Stamatios; del Rio, Ana; Moreno, Asuncion; Mestres, Carlos A.; Ninot, Carlos A.; Pare, Carlos; de la Maria, Cristina Garcia; Armero, Yolanda; de Lazzari, Elisa; Marco, Francesc; Gatell, Jose M.; Almela, Manel; Azqueta, Manuel; Sitges, Marta; Claramonte, Xavier; Jiménez-Expósito, Maria Jesús; de Benito, Natividad; Ramirez, Jose; Perez, Noel; Miro, José M.; Almirante, Benito; Fernandez-Hidalgo, Nuria; de Vera, Pablo Rodriguez; Tornos, Pilar; Falco, Vicenç; Sidani, Nisreen; Kanj-Sharara, Souha; Kanafani, Zeina; Raglio, Annibale; Goglio, Antonio; Gnecchi, Fabrizio; Suter, Fredy; Valsecchi, Grazia; Rizzi, Marco; Ravasio, Veronica; Chirouze, Catherine; Leroy, Joel; Plesiat, Patrick; Bernard, Yvette; Casey, Anna; Lambert, Peter; Watkin, Richard; Elliott, Tom; Patel, Mukesh; Dismukes, William; Pan, Angelo; Caros, Giampiero; Mathiron, Amel Brahim; Tribouilloy, Christophe; Goissen, Thomas; Delahaye, Armelle; Delahaye, Francois; Vandenesch, Francois; Vizzotti, Carla; Nacinovich, Francisco M.; Marin, Marcelo; Trivi, Marcelo; Lombardero, Martin; Cortes, Claudia; Casabé, José Horacio; Altclas, Javier; Kogan, Silvia; Clara, Liliana; Sanchez, Marisa; Commerford, Anita; Hansa, Cass; Deetlefs, Eduan; Ntsekhe, Mpiko; Commerford, Patrick; Wray, Dannah; Steed, Lisa L.; Church, Preston; Cantey, Robert; Morris, Arthur; Lang, Selwyn; Kotsanas, Despina; Korman, Tony M.; Peterson, Gail; Purcell, Jon; Southern, Paul M.; Shah, Manisha; Bedimo, Roger; Reddy, Arjun; Levine, Donald; Dhar, Gaurav; Hanlon-Feeney, Alanna; Hannan, Margaret; Kelly, Sinead; Sexton, Daniel J.; Benjamin, Daniel J.; McDonald, Jay R.; Federspiel, Jeff; Engemann, John J.; Reller, Barth; Drew, Laura; Caram, L. B.; Stryjewski, Martin; Morpeth, Susan; Lalani, Tahaniyat; Mazaheri, Bahram; Neuerburg, Carl; Naber, Christoph; Athan, Eugene; Henry, Margaret; Harris, Owen; Alestig, Eric; Wikstrom, Lotta; Snygg-Martin, Ulrika; Francis, Johnson; Venugopal, K.; Nair, Lathi; Thomas, Vinod; Chaiworramukkun, Jaruwan; Pachirat, Orathai; Chetchotisakd, Ploenchan; Suwanich, Tewan; Kamarulzaman, Adeeba; Tamin, Syahidah Syed; Premru, Manica Mueller; Logar, Mateja; Lejko-Zupanc, Tatjana; Orezzi, Christina; Bouz, Emilio; Rodríguez-Créixems, Marta; Marín, Mercedes; Fernández, Miguel; Muñoz, Patricia; Fernández, Rocío; Ramallo, Victor; Raoult, Didier; Thuny, Franck; Habib, Gilbert; Casalta, Jean-Paul; Fournier, Pierre-Edouard; Chipigina, Natalia; Kirill, Ozerecky; Vinogradova, Tatiana; Kulichenko, Vadim P.; Butkevich, O. M.; Lion, Christine; Selton-Suty, Christine; Coyard, Hélène; Doco-Lecompte, Thanh; Iarussi, Diana; Durante-Mangoni, Emanuele; Ragone, Enrico; Dialetto, Giovanni; Casillo, Roberta; Kumar, A. Sampath; Sharma, Gautam; Dickerman, Stuart A.; Street, Alan; Eisen, Damon Peter; McBryde, Emma Sue; Grigg, Leeanne; Abrutyn, Elias; Michelet, Christian; Tattevin, Pierre; Donnio, Pierre Yves; Fortes, Claudio Querido; Edathodu, Jameela; Al-Hegelan, Mashael; Font, Bernat; Anguera, Ignasi; Guma, Joan Raimon; Cereceda, M.; Oyonarte, Miguel J.; Mella, Rodrigo Montagna; Garcia, Patricia; Jones, Sandra Braun; Ramos, Auristela Isabel de Oliveira; Paiva, Marcelo Goulart; Tranchesi, Regina Aparecida de Medeiros; Woon, Lok Ley; Lum, Luh-Nah; Tan, Ru-San; Rees, David; Kornecny, Pam; Lawrence, Richard; Dever, Robyn; Post, Jeffrey; Ryan, Suzanne; Harkness, John; Feneley, Michael; Rubinstein, Ethan; Strahilewitz, Jacob; Ionac, Adina; Mornos, Cristian; Dragulescu, Stefan; Forno, Davide; Cecchi, Enrico; de Rosa, Francesco; Imazio, Massimo; Trinchero, Rita; Wiesbauer, Franz; Gattringer, Rainer; Deans, Greg; Andrasevic, Arjana Tambic; Barsic, Bruno; Klinar, Igor; Vincelj, Josip; Bukovski, Suzana; Krajinovic, Vladimir; Stafford, Judy; Baloch, Khaula; Redick, Thomas; Harding, Tina; Corey, Ralph; Durack, David T.; Eykyn, Susannah

    2009-01-01

    BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25

  19. Impacto da reabilitaÃÃo pulmonar nos marcadores inflamatÃrios prÃ-operatÃrios e nas complicaÃÃes pulmonares pÃs-operatÃrias de pacientes com cÃncer de pulmÃo candidatos a ressecÃÃo pulmonar

    OpenAIRE

    Maria Tereza Aguiar Pessoa Morano

    2011-01-01

    O cÃncer de pulmÃo (CP) à uma agressÃo maligna com caracterÃsticas inflamatÃrias e muitas vezes ressecÃveis. A escolha do fibrinogÃnio e albumina deve ao fato de serem marcadores inflamatÃrios e se manifestarem em CP, muitas vezes associado à doenÃa obstrutiva crÃnica. As complicaÃÃes pulmonares ainda sÃo preocupaÃÃes nas ressecÃÃes pulmonares. O estudo avaliou o impacto da reabilitaÃÃo pulmonar nos marcadores inflamatÃrios prÃ-operatÃrios e nas complicaÃÃes pulmonares pÃs-operatÃrias de pac...

  20. Epithelioid hemangioendothelioma - A rare pulmonary tumor Hemangioendotelioma epitelióide - Um tumor pulmonar raro

    Directory of Open Access Journals (Sweden)

    Sandra Saleiro

    2008-06-01

    Full Text Available The authors report a case of a rare pulmonary neoplasm - epithelioid hemangio-endothelioma, in a 39 year-old woman, asymptomatic until December 2003, when she developed pleuritic and right-sided chest pain. The patient presented a previous chest radiograph, performed 13 years before, which showed multiple small bilateral pulmonary nodules attributed to tuberculous sequelae. The definitive histological diagnosis was made by lung biopsy through thoracotomy. The patient developed a clinical and imagiological worsening and then therapy with interferon α-2a was started. Even with imagiological stability of pulmonary lesions the patient remained symptomatic and died nine months after the diagnosis had been established. The authors emphasise the rarity of this type of pulmonary neoplasm and discuss its clinical presentation, histological features, treatment and prognosis.Os autores descrevem um caso de uma neoplasia pulmonar rara - hemangio-endotelioma epitelióide - numa doente do sexo feminino, de 39 anos, assintomática até Dezembro de 2003, altura em que apresentou toracalgia direita de características pleuríticas. A doente era portadora de uma radiografia torácica antiga, efectuada há 13 anos, que revelava múltiplos pequenos nódulos pulmonares bilaterais, atribuídos a sequelas de tuberculose pulmonar. O diagnóstico histológico definitivo foi efectuado através de biópsia pulmonar por toracotomia. Dado a doente ter apresentado agravamento clínico e imagiológico foi iniciada terapêutica com interferão α-2a. Apesar da estabilidade imagiológica das lesões pulmonares, a doente manteve-se sintomática e faleceu nove meses depois do diagnóstico ter sido estabelecido. Os autores realçam a raridade deste tipo de neoplasia pulmonar e discutem a sua apresentação clínica, características histológicas, tratamento e prognóstico.

  1. Surgical Management of Active Infective Endocarditis During 1996-06 in Tabriz, Northwestern Iran

    Directory of Open Access Journals (Sweden)

    Azin Alizadehasl1,

    2008-03-01

    Full Text Available Objective: Surgical treatment of active infective endocarditis (IE requires not only homodynamic repair, but also, special emphasis on the eradiation of the infection to prevent recurrence. This study was undertaken to examine the outcome of surgery for active infective endocarditis in a cohort of patients.Patients and Methods: One hundred and sixty-four consecutive patients underwent valve surgery for active IE in Madani heart centre (Tabriz, Iran from 1996 to 2006. The patients with diagnosis of IE (according to Duke Criteria were eligible for the study.Results: The mean age of patients was 36.3 ± 16 years, with 34.6±17.5 yrs for native valve endocarditis and 38.6±15.2 yrs for prosthetic valve endocarditis (p= 0.169. Ninety-one (55.5% of patients were males. The infected valve was native in 112 (68.3% of patients and prosthetic in 52 (31.7%. There was no predisposing heart disease in 61 (37% of patients. The aortic valve was infected in 78(47.6%, the 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 implantedin 69 patients (42.1% and bioprostheses in 95 (57.9%, including homograft in 19 (11.5% cases. There were 16 (9% operation-related deaths, but only 1 death in patients undergoing aortic homograft replacement. Reoperation was required in 18 (10.9% cases.Based 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 hospital mortality.Conclusions: Surgery for infective endocarditis continues to be challenging and associated with high operation-related mortality and

  2. Pharmacokinetic modeling of gentamicin in treatment of infective endocarditis: Model development and validation of existing models.

    Directory of Open Access Journals (Sweden)

    Anna Gomes

    Full Text Available Gentamicin shows large variations in half-life and volume of distribution (Vd within and between individuals. Thus, monitoring and accurately predicting serum levels are required to optimize effectiveness and minimize toxicity. Currently, two population pharmacokinetic models are applied for predicting gentamicin doses in adults. For endocarditis patients the optimal model is unknown. We aimed at: 1 creating an optimal model for endocarditis patients; and 2 assessing whether the endocarditis and existing models can accurately predict serum levels. We performed a retrospective observational two-cohort study: one cohort to parameterize the endocarditis model by iterative two-stage Bayesian analysis, and a second cohort to validate and compare all three models. The Akaike Information Criterion and the weighted sum of squares of the residuals divided by the degrees of freedom were used to select the endocarditis model. Median Prediction Error (MDPE and Median Absolute Prediction Error (MDAPE were used to test all models with the validation dataset. We built the endocarditis model based on data from the modeling cohort (65 patients with a fixed 0.277 L/h/70kg metabolic clearance, 0.698 (±0.358 renal clearance as fraction of creatinine clearance, and Vd 0.312 (±0.076 L/kg corrected lean body mass. External validation with data from 14 validation cohort patients showed a similar predictive power of the endocarditis model (MDPE -1.77%, MDAPE 4.68% as compared to the intensive-care (MDPE -1.33%, MDAPE 4.37% and standard (MDPE -0.90%, MDAPE 4.82% models. All models acceptably predicted pharmacokinetic parameters for gentamicin in endocarditis patients. However, these patients appear to have an increased Vd, similar to intensive care patients. Vd mainly determines the height of peak serum levels, which in turn correlate with bactericidal activity. In order to maintain simplicity, we advise to use the existing intensive-care model in clinical practice to

  3. 18F-fluoro-2-deoxyglucose positron emission tomography-negative endocarditis lenta caused by Bartonella henselae

    NARCIS (Netherlands)

    Sankatsing, Sanjay U. C.; Kolader, Marion-Eliëtte; Bouma, Berto J.; Bennink, Roel J.; Verberne, Hein J.; Ansink, Tieneke M.; Visser, Caroline E.; van der Meer, Jan T. M.

    2011-01-01

    It has been suggested that 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) might serve as a tool for the often difficult diagnosis of infective endocarditis. The case is described of a patient with a Bartonella henselae endocarditis with a negative FDG-PET. This case report

  4. Distribution, antibiotic susceptibility and tolerance of bacterial isolates in culture-positive cases of endocarditis in The Netherlands

    NARCIS (Netherlands)

    van der Meer, J. T.; van Vianen, W.; Hu, E.; van Leeuwen, W. B.; Valkenburg, H. A.; Thompson, J.; Michel, M. F.

    1991-01-01

    During a two-year period data were collected nationwide in The Netherlands on 438 episodes of bacterial endocarditis (BE) in 432 patients. Of the strains isolated in these patients 419 were available for analysis. Of these, 326 were isolated in native valve endocarditis (NVE) and 93 in prosthetic

  5. Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations

    NARCIS (Netherlands)

    Verhagen, D. W. M.; Vedder, A. C.; Speelman, P.; van der Meer, J. T. M.

    2006-01-01

    In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jose N. Galeas

    2015-12-01

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

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

    International Nuclear Information System (INIS)

    Ellmann, A.; Rubow, S.M.; Erlank, P.; Reuter, H.

    2002-01-01

    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

  9. Imaging endocarditis with Tc-99m-labeled antibody--an experimental study: concise communication

    Energy Technology Data Exchange (ETDEWEB)

    Wong, D.W.; Dhawan, V.K.; Tanaka, T.; Mishkin, F.S.; Reese, I.C.; Thadepalli, H.

    1982-03-01

    The sensitivity and specificity of Tc-99m-labeled antibacterial antibody (Tc-99m Ab) for detecting bacterial endocarditis were evaluated in an experimental model. Rabbit-produced antistaphylococcal antibody was extracted using Rivanol and chemically labeled with Tc-99m. This Tc-99m Ab was injected intravenously in New Zealand rabbits 24 hr after producing Staphylococcus aureus endocarditis of the aortic valve. Imaging and tissue analyses were performed on the following day. All 11 animals developed S. aureus aortic-valve vegetations and showed increased uptake of Tc-99m Ab at the aortic valve, 118 times higher than at the uninfected tricuspid valve. Although high hepatic radioactivity and anatomic uncertainties interfered with in vivo delineation of these lesions, images of the excised hearts showed all affected valves. Two rabbits inoculated with Escherichia coli did not develop endocarditis and had little uptake of Tc-99m Ab, while six rabbits with enterococcal endocarditis had no uptake of the Tc-99m Ab in their vegetations. The findings suggest potential value of Tc-99m Ab on the rapid diagnosis of endocarditis.

  10. Imaging endocarditis with Tc-99m-labeled antibody--an experimental study: concise communication

    International Nuclear Information System (INIS)

    Wong, D.W.; Dhawan, V.K.; Tanaka, T.; Mishkin, F.S.; Reese, I.C.; Thadepalli, H.

    1982-01-01

    The sensitivity and specificity of Tc-99m-labeled antibacterial antibody (Tc-99m Ab) for detecting bacterial endocarditis were evaluated in an experimental model. Rabbit-produced antistaphylococcal antibody was extracted using Rivanol and chemically labeled with Tc-99m. This Tc-99m Ab was injected intravenously in New Zealand rabbits 24 hr after producing Staphylococcus aureus endocarditis of the aortic valve. Imaging and tissue analyses were performed on the following day. All 11 animals developed S. aureus aortic-valve vegetations and showed increased uptake of Tc-99m Ab at the aortic valve, 118 times higher than at the uninfected tricuspid valve. Although high hepatic radioactivity and anatomic uncertainties interfered with in vivo delineation of these lesions, images of the excised hearts showed all affected valves. Two rabbits inoculated with Escherichia coli did not develop endocarditis and had little uptake of Tc-99m Ab, while six rabbits with enterococcal endocarditis had no uptake of the Tc-99m Ab in their vegetations. The findings suggest potential value of Tc-99m Ab on the rapid diagnosis of endocarditis

  11. Ulcerative dermatitis and valvular endocarditis associated with Staphylococcus aureus in a hyacinth macaw (Anadorhynchus hyacinthinus).

    Science.gov (United States)

    Huynh, Minh; Carnaccini, Silvia; Driggers, Todd; Shivaprasad, H L

    2014-06-01

    An 18-yr-old male hyacinth macaw (Anadorhynchus hyacinthinus) was found dead in his aviary with no preexisting signs. The bird had a chronic history of feather damaging behavior, with severe ulcerative dermatitis. Pathologic findings revealed a vegetative valvular endocarditis, myocarditis, septicemia, chronic severe glomerulonephritis, and thyroid dysplasia. Staphylococcus aureus was isolated from the valve, the liver, and the skin. Repeated trauma and low-rate bacteriemia may have contributed to the development of endocarditis. Translocation of S. aureus skin infection in the bloodstream may lead to subacute endocarditis in humans and such mechanism is suspected in this case. This case suggests that endocarditis associated with S. aureus septicemia is a potential complication of feather damaging behavior. This case also reports a systemic complication of ulcerative dermatitis secondary to feather damaging behavior. Endocarditis has been poorly reported in psittacine species, and such medical complication of feather damaging behavior has never been reported to our knowledge. Furthermore, S. aureus is a bacteria of public health concern and should be integrated into the differential when pet parrots with dermatitis are in proximity to owners.

  12. Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination.

    Science.gov (United States)

    Sijpkens, Y W; Buurke, E J; Ulrich, C; van Asselt, G J

    1995-03-01

    To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). Intensive care unit (ICU) in a general hospital. The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aortic surgery and gastrointestinal surgery. Because these patients needed mechanical ventilation they received systemic cefotaxime and SDD (polymyxin E, amphotericin B and norfloxacin). Colonisation with E. faecalis was documented in all patients. Intravascular catheter-related infection with E. faecalis occurred in 4 patients. None of the patients received antibiotics active against, E. faecalis, because body temperature normalised after catheter removal. In the course of his ICU stay one patient died. Autopsy showed E. faecalis endocarditis. The other 4 patients recovered from their primary illness, but had to be readmitted after several months because of E. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients needed acute valve replacement. The latter 3 patients survived. We observed 5 patients with E. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.

  13. Bartonella Species, an Emerging Cause of Blood-Culture-Negative Endocarditis.

    Science.gov (United States)

    Okaro, Udoka; Addisu, Anteneh; Casanas, Beata; Anderson, Burt

    2017-07-01

    Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana . We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella -mediated endocarditis and represents a potential reservoir for persistence by these bacteria. Copyright © 2017 American Society for Microbiology.

  14. Diffusion of ofloxacin in the endocarditis vegetation assessed with synchrotron radiation UV fluorescence microspectroscopy.

    Directory of Open Access Journals (Sweden)

    Eric Batard

    Full Text Available The diffusion of antibiotics in endocarditis vegetation bacterial masses has not been described, although it may influence the efficacy of antibiotic therapy in endocarditis. The objective of this work was to assess the diffusion of ofloxacin in experimental endocarditis vegetation bacterial masses using synchrotron-radiation UV fluorescence microspectroscopy. Streptococcal endocarditis was induced in 5 rabbits. Three animals received an unique i.v. injection of 150 mg/kg ofloxacin, and 2 control rabbits were left untreated. Two fluorescence microscopes were coupled to a synchrotron beam for excitation at 275 nm. A spectral microscope collected fluorescence spectra between 285 and 550 nm. A second, full field microscope was used with bandpass filters at 510-560 nm. Spectra of ofloxacin-treated vegetations presented higher fluorescence between 390 and 540 nm than control. Full field imaging showed that ofloxacin increased fluorescence between 510 and 560 nm. Ofloxacin diffused into vegetation bacterial masses, although it accumulated in their immediate neighborhood. Fluorescence images additionally suggested an ofloxacin concentration gradient between the vegetation peripheral and central areas. In conclusion, ofloxacin diffuses into vegetation bacterial masses, but it accumulates in their immediate neighborhood. Synchrotron radiation UV fluorescence microscopy is a new tool for assessment of antibiotic diffusion in the endocarditis vegetation bacterial masses.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial.

    Science.gov (United States)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U; Hasbak, Philip; Kjær, Andreas; Kofoed, Klaus F; Lindschou, Jane; Jakobsen, Janus Christian; Gluud, Christian; Olsen, Peter Skov; Steinbrüchel, Daniel A

    2014-04-23

    Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. The NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the

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

    Directory of Open Access Journals (Sweden)

    M.E. Corti

    2004-06-01

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

  18. Diagnóstico y tratamiento de la hipertensión pulmonar tromboembólica crónica

    OpenAIRE

    Carlos Payares-Jardim

    2017-01-01

    La hipertensión pulmonar tromboembólica crónica, es una forma de hipertensión pulmonar que se clasifica dentro del grupo 4. Se caracteriza por la aparición de trombos fibróticos organizados que ocluyen las arterias pulmonares y arteriopatía en pequeños vasos, que conlleva aumento de la resistencia vascular pulmonar. El diagnóstico se basa en valores hemodinámicos, obtenidos después de transcurridos tres meses de anticoagulación eficaz con el fin de discriminar esta condición de la embolia ...

  19. Hipertensão arterial pulmonar hereditária apresentando-se como venopatia oclusiva

    Directory of Open Access Journals (Sweden)

    Sonia Meiken Franchi

    2011-07-01

    Full Text Available Um homem de 33 anos com hipertensão arterial pulmonar hereditária teve um diagnóstico confirmado de venopatia oclusiva e microvasculopatia. O paciente permaneceu estável por 3 anos e meio recebendo sildenafila via oral, 75 mg 3x/dia (teste de caminhada de seis minutos de 375 m vs 105 m basal, mas necessitou da adição de bosentana (125 mg 2x/dia posteriormente. A despeito do desfecho fatal após 5 anos, as observações sugerem um utilidade potencial dos vasodilatadores como uma ponte para o transplante de pulmão em casos selecionados com envolvimento venocapilar significante. A ocorrência de lesões veno-oclusivas e capilares na forma familiar da hipertensão arterial pulmonar enfatiza as dificuldades com a atual classificação da doença.

  20. Síndromes hemorrágicas pulmonares Pulmonary hemorrhage syndromes

    Directory of Open Access Journals (Sweden)

    Eduardo da Rosa Borges

    2005-07-01

    Full Text Available As síndromes hemorrágicas pulmonares caracterizam-se por infiltrado pulmonar bilateral, queda dos níveis de hemoglobina e hipoxemia. Dentre as causas de sangramento estão as infecções, vasculites, coagulopatias e doenças do colágeno. A terapêutica consiste do tratamento da doença causal e suporte ventilatório, podendo ser associada a plasmaferese.Pulmonary hemorrhage syndromes are characterized by bilateral pulmonary infiltrates, decreased serum levels of hemoglobin, and hypoxemia. The causes of pulmonary hemorrhage include: infections, vasculitis, coagulopathies and collagen diseases. The therapy consists of treating the underlying disease and providing ventilatory support. In some cases, performing plasmapheresis can be beneficial.

  1. Imaginología actual del cáncer pulmonar

    Directory of Open Access Journals (Sweden)

    Dr. D. Raúl Pefaur

    2013-01-01

    Los exámenes imaginológicos que en la actualidad se utilizan en el diagnóstico del cáncer pulmonar son la radiografía simple de tórax, la tomografía computada, la resonancia magnética y el PET-CT. En este artículo se analizará el rendimiento de estos exámenes en el diagnóstico y etapificación del cáncer pulmonar, así como la influencia de éstos en el tratamiento, pronóstico y evolución de esta enfermedad.

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

    International Nuclear Information System (INIS)

    Wang Li; Zhao Liangping; Xu Weiting; Chen Jianchang; Tong Guangming; Hong Xiaosu

    2012-01-01

    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)

  3. Dental Procedures and the Risk of Infective Endocarditis

    Science.gov (United States)

    Chen, Pei-Chun; Tung, Ying-Chang; Wu, Patricia W.; Wu, Lung-Sheng; Lin, Yu-Sheng; Chang, Chee-Jen; Kung, Suefang; Chu, Pao-Hsien

    2015-01-01

    Abstract Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE. Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed. In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54–1.59), 1.64 for surgery (95% CI 0.61–4.42), 0.92 for dental scaling (95% CI 0.59–1.42), 1.69 for periodontal treatment (95% CI 0.88–3.21), and 1.29 for endodontic treatment (95% CI 0.72–2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE. Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based. PMID:26512586

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Infective endocarditis - maybe yes, maybe no: Case report

    Directory of Open Access Journals (Sweden)

    Ivanović Branislava

    2013-01-01

    Full Text Available Introduction. Infective endocarditis (IE is a rare disease which manifests in different ways. Case Outline. We are presenting a female patient who was suspected of IE based on the presence of fever, accelerated erythrocyte sedimentation rate, increased levels of C-reactive protein and echocardiographic findings of filamentous structures on the aortic valve which were assumed to be vegetation. Because of the well-known fact that in the pre-antibiotic era IE was almost always a fatal disease, empirical antibiotic therapy was conducted despite the absence of clear criteria for IE and it resulted in a satisfactory outcome. The course of the disease and the persistence of echocardiographic findings with a completely competent aortic valve, suggested us to consider the diagnosis of Lambl’s excrescences. There was no indication for surgical treatment in our patient; so that in the absence of pathological confirmation our diagnostic dilemma was left unresolved. Conclusion. In patients with typical clinical features of IE and filamentous structures on the cardiac valves that are completely competent, Lambl’s excrescences should be kept in mind as a possible differential diagnosis.

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

    Directory of Open Access Journals (Sweden)

    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

  7. Streptococcus bovis endocarditis: Update from a multicenter registry.

    Science.gov (United States)

    Olmos, Carmen; Vilacosta, Isidre; Sarriá, Cristina; López, Javier; Ferrera, Carlos; Sáez, Carmen; Vivas, David; Hernández, Miguel; Sánchez-Enrique, Cristina; García-Granja, Pablo Elpidio; Pérez-Cecilia, Elisa; Maroto, Luis; San Román, José Alberto

    2016-01-01

    Infective endocarditis (IE) due to Streptococcus bovis has been classically associated with elderly patients, frequently involving >1 valve, with large vegetations and high embolic risk, which make it a high-risk group. Our aim is to analyze the current clinical profile and prognosis of S bovis IE episodes, in comparison to those episodes caused by viridans group streptococci and enterococci. We analyzed 1242 consecutive episodes of IE prospectively recruited on an ongoing multipurpose database, of which 294 were streptococcal left-sided IE and comprised our study group. They were classified into 3 groups: group I (n = 47), episodes of IE due to S bovis; group II (n = 134), episodes due to viridans group streptococci; and group III (n = 113), those episodes due to enterococci. The incidence of enterococci IE has significantly increased in the last 2 decades (6.4% [1996-2004] vs 11.1% [2005-2013]; P = .005), whereas the incidence of IE due to S bovis and viridans streptococci have remained stable (4% and 10%, respectively). Gender distribution was similar in the 3 groups. Patients with S bovis and enterococci IE were older than those from group II. Nosocomial acquisition was more frequent in group III. Concerning comorbidity, diabetes mellitus (36.7% vs 9.2% vs 26.8%; P viridans group streptococci. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Infective endocarditis of a rare etiology: Serratia marcescens

    Directory of Open Access Journals (Sweden)

    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.

  9. Seqüestro pulmonar: uma série de nove casos operados

    Directory of Open Access Journals (Sweden)

    PÊGO-FERNANDES PAULO M.

    2002-01-01

    Full Text Available Seqüestro pulmonar é uma anomalia congênita que envolve parênquima e vascularização pulmonar e apresenta-se como extralobar ou intralobar. Objetivo: Descrever os casos de seqüestro pulmonar tratados no InCor e Hospital das Clínicas da FMUSP no período de 1987 a 1996. Método: Análise retrospectiva dos prontuários. Resultados: Foram tratados nove pacientes, sendo quatro mulheres e cinco homens; duas crianças e sete adultos. Infecção respiratória de repetição e hemoptise foram achados clínicos freqüentes nesses pacientes. Todos os casos eram intralobares. A principal localização foi no lobo inferior esquerdo (66%. Apenas um diagnóstico foi intra-operatório. Nos outros oito casos, o diagnóstico foi suspeitado pela radiografia de tórax (100% e confirmado pela arteriografia (77% e/ou tomografia computadorizada (66%. Lobectomia (77% foi o principal tratamento cirúrgico, com baixa morbidade pós-operatória e sem mortalidade. Exame anatomopatológico foi realizado em sete casos e confirmou a doença. Conclusões: O seqüestro pulmonar é uma entidade incomum, em que a tomografia computadorizada e a arteriografia são os exames que mais informações oferecem para um diagnóstico definitivo e seguro. A ressecção do tecido envolvido leva a excelentes resultados.

  10. Alteraciones espirométricas en pacientes con secuela de tuberculosis pulmonar

    Directory of Open Access Journals (Sweden)

    Félix Llanos-Tejada

    2010-04-01

    Full Text Available El pulmón con secuela de tuberculosis es un diagnóstico frecuente de limitación en la función pulmonar que requiere estudio. Objetivo: Determinar las alteraciones espirométricas más frecuentes en pacientes con secuela de tuberculosis pulmonar que requirieron hospitalización, grado de severidad y la respuesta a broncodilatadores. Material y Métodos: Se realizó un estudio descriptivo transversal retrospectivo con revisión de los informes de espirometría realizadas durante el año 2007 en la Unidad de Función Pulmonar del Servicio de Neumología del Hospital Nacional Dos de Mayo. Resultados: Se revisaron 104 espirometrías. El promedio de edad fue 51,2 años. El motivo de hospitalización fue broncorrea infectada en 75%, disnea en 74,04% y hemoptisis en 30,77%. La CVF, VEF1, VEF1%CVF, CVIF% y FEF25-27%, en promedio fue 109%; 72,9%, 57%, 59,7% y 31,4%, respectivamente. Se obtuvo patrón de normalidad ventilatoria en 16,35%; obstructivo en 79,81% y no-obstructivo (restrictivo en 13,46%. En los pacientes con patrón obstructivo, la presencia de reversibilidad total a los broncodilatadores se obtuvo en 28,92%. Se encontró una correlación negativa (p<0,05 entre disnea y CIVF. Conclusiones: El patrón obstructivo sin reversibilidad a broncodilatadores fue la alteración espirométrica más frecuente encontrada en pacientes con secuela de tuberculosis pulmonar. Existe una relación inversa la disnea y la CI.(Rev Med Hered 2010;21:77-83.

  11. Prolonged fever and involuntary weight loss as manifestations of bacterial endocarditis: A case report

    Science.gov (United States)

    Sukmawati, N. M. D. D.; Merati, T. P.; Somia, A.; Utama, S.; Gayatri, Y.

    2018-03-01

    We reported an unusual presentation of prolonged fever and involuntary weight loss in older adult as a manifestation of infective bacterial endocarditis. The patient had pre-existing compensated asymptomatic valvular heart disease without treatment. A positive fecal occult blood test is prompting an investigation of malignancy of gastrointestinal as one of other possible cause of prolonged fever with wasting, evaluation of HIV serostatus shows seronegative. The case fulfilled criteria for definitive infective endocarditis: one major criterion of positive blood culture for Streptococcus mitis, which was one of viridans group streptococci and three minor criteria of fever at least 38°Celsius, immunologic phenomena in the form of glomerulonephritis, and a predisposing heart condition. One course of third-generation cephalosporin successfully cleared the Streptococcus mitis infection proven by culture. Infective endocarditis should be considered as one of the causes of prolonged fever with wasting, especially in cases with the previous history of heart disease.

  12. Infective endocarditis and osteomyelitis caused by Cellulomonas: a case report and review of the literature.

    Science.gov (United States)

    Lai, Ping-Chang; Chen, Yao-Shen; Lee, Susan Shin-Jung

    2009-10-01

    Cellulomonas spp. are often believed to be of low virulence and have never been reported as a pathogen causing human disease before. We report the first case of endocarditis caused by Cellulomonas and complicated with osteomyelitis of the lumbar spine in a 78-year-old woman. General weakness and aggravated lower back pain followed by sudden-onset of fever and chills were the major presentation. The diagnosis of infective endocarditis in this case was definitely using the Duke criteria. The magnetic resonance imaging of the lumbar spine revealed infective spondylodisciitis at an early stage. After a full course of antibiotics treatment, the patient's fever subsided but her lower back pain persisted. A slow clinical response to appropriate antimicrobial agents was characteristic of Gram-positive bacillary endocarditis.

  13. Lupus-Negative Libman-Sacks Endocarditis Complicated by Catastrophic Antiphospholipid Syndrome.

    Science.gov (United States)

    Murtaza, Ghulam; Iskandar, Joy; Humphrey, Tara; Adhikari, Sujeen; Kuruvilla, Aneesh

    2017-04-01

    Libman-Sacks endocarditis is characterized by sterile and verrucous lesions that predominantly affect the aortic and mitral valves. In most cases, patients do not have significant valvular dysfunction. However, patients with significant valvular dysfunction may present with serious complications such as cardiac failure, arrhythmias, and thromboembolic events. Recently, association of Libman-Sacks endocarditis with antiphospholipid antibody syndrome (APS) has been made. APS is most commonly defined by venous and arterial thrombosis, recurrent pregnancy loss, and thrombocytopenia. While the syndrome can be a primary syndrome, it is usually secondary to systemic lupus erythematosus. Catastrophic antiphospholipid syndrome (CAPS) can be a life-threatening presentation of APS and can occur in 1% of patients with antiphospholipid syndrome. We present a very rare case of a young female patient with lupus-negative Libman-Sacks endocarditis complicated by CAPS.

  14. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

    Directory of Open Access Journals (Sweden)

    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  15. [Iris abscess after bacterial endocarditis in a patient with leukaemia. Differential diagnosis].

    Science.gov (United States)

    Manrique Lipa, R; González Sánchez, E; Asencio Duran, M; Gonzalez-Peramato, P; Fonseca Santodomingo, A

    2014-04-01

    To report a case of iris abscess due to bacterial endocarditis. A 46-year-old male under diagnosis of promielocitic leukemia and endocarditis presented with decreased vision in left eye (OS). Ophthalmic exploration revealed iris abscess and hypopyon with fibrinous exudate in iris of the left eye and tyndall +1 in right eye (OD). Blood culture and anterior chamber paracentesis was positive for methicillin-sensitive Staphylococcus aureus and negative for blastic cells in citology. Treatment with systemic antibiotic was initiated with total resolution of inflammation. Iris abscess is an unusual septic focus in bacterial endocarditis. It is crucial to rule out an extramedullary metastasis in a patient with leukemia due to the general prognosis. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  16. Endocarditis due to Kytococcus schroeteri: case report and review of the literature.

    Science.gov (United States)

    Mnif, Basma; Boujelbène, Inès; Mahjoubi, Fouzia; Gdoura, Radouane; Trabelsi, Imen; Moalla, Sana; Frikha, Imed; Kammoun, Samir; Hammami, Adnane

    2006-03-01

    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 was recognized as K. schroeteri. The patient was treated first with vancomycin combined with gentamicin and later with pristinamycin and rifampin. Three cases of K. schroeteri endocarditis described within a short period of time might indicate a specific pathogenicity of this new species. The isolation of kytococci from normally sterile sites should not be overlooked.

  17. Infective endocarditis caused by Neisseria elongata on a native tricuspid valve and confirmed by DNA sequencing.

    Science.gov (United States)

    Yoo, Yeon Pyo; Kang, Ki-Woon; Yoon, Hyeon Soo; Yoo, Seungmin; Lee, Myung-Shin

    2014-04-01

    Neisseria elongata, a common oral bacterium, has been recognized as a cause of infections such as infective endocarditis, septicemia, and osteomyelitis. Neisseria-induced infective endocarditis, although infrequently reported, typically arises after dental procedures. Without antibiotic therapy, its complications can be severe. We report the case of a 27-year-old man who presented with fever, severe dyspnea, and a leg abscess from cellulitis. An echocardiogram showed a vegetation-like echogenic structure on the septal leaflet of the patient's native tricuspid valve, and an insignificant Gerbode defect. Three blood cultures grew gram-negative, antibiotic-susceptible coccobacilli that were confirmed to be N. elongata. Subsequent DNA sequencing conclusively isolated N. elongata subsp nitroreducens as the organism responsible for the infective endocarditis. The patient recovered after 21 days of antibiotic therapy. In addition to the patient's unusual case, we discuss the nature and isolation of N. elongata and its subspecies.

  18. [Role of ceftaroline fosamil in the treatment of bacteremia and infectious endocarditis].

    Science.gov (United States)

    Almirante, Benito; Pericás, Juan M; Miró, José M

    2014-03-01

    Ceftaroline fosamil is a new subclass of cephalosporins with high intrinsic activity against various multi-resistant Gram-positive organisms, including Staphylococcus aureus and Streptococcus pneumoniae, as well as against Enterobacteriaceae causing bacteremia and infective endocarditis. Because of its pharmacokinetic profile and pharmacodynamic characteristics, this drug is a good therapeutic option for these infections. Experimental studies have shown good clinical efficacy for the treatment of endocarditis caused by S. aureus, regardless of their sensitivity to methicillin or vancomycin. Clinical experience is limited, although clinical trials and case series have reported a favorable clinical response in patients with bacteremia associated with skin and soft tissue infections, pneumonia, or infective endocarditis. Future studies should define more precisely the role of this new antibiotic in the treatment of these infections. Copyright © 2014 Elsevier España, S.L. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Siva P. Sontineni

    2010-01-01

    Full Text Available 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 Measures. Physical examination, National Institute of Health Stroke Scale, radiologic examination results. Conclusions. Thrombolytic therapy in selected cases of stroke due to infective endocarditis manifesting as major neurologic deficits can be considered as an option after careful consideration of risks and benefits. The basis for such favorable response rests in the presence of fibrin as a major constituent of the vegetation. The risk of precipitating hemorrhage with thrombolytic therapy especially with large infarcts and mycotic aneurysms should be weighed against the benefits of averting a major neurologic deficit.

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

    Directory of Open Access Journals (Sweden)

    Manuel Wilbring

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

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

    Science.gov (United States)

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

    2015-02-01

    Culture-negative endocarditis remains a diagnostic and therapeutic challenge despite recent medical advances. Streptococcus tigurinus, a novel member of the Streptococcus mitis group, was first identified in Zurich. S. tigurinus possesses virulence determinants and causes invasive infections. We report a case of culture-negative endocarditis with serious complications due to S. tigurinus, which was identified by 16S ribosomal RNA gene sequence analysis of excised valve tissue specimens. This technique is useful for identification of the causative microorganism in patients with culture-negative endocarditis and may facilitate early diagnosis and appropriate antimicrobial treatment. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  2. A rare localization in right-sided endocarditis diagnosed by echocardiography: A case report

    Directory of Open Access Journals (Sweden)

    Beaufils Philippe

    2003-08-01

    Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. Case presentation A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. Conclusions Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.

  3. Estenosis de venas pulmonares post ablación por radiofrecuencia

    Directory of Open Access Journals (Sweden)

    Marcelo Guzzi

    2011-06-01

    Full Text Available Es importante estar atento ante la aparición de síntomas respiratorios luego de la realización de un procedimiento de ablación por radiofrecuencia en el tratamiento de la fibrilación auricular, pues la estenosis de venas pulmonares (EVP tiene una incidencia de entre 1 y 3% y puede aparecer hasta en los dos años posteriores al procedimiento1. Presentamos el caso de un paciente de 41 años de sexo masculino, que ingresó por un cuadro de hemoptisis y toracodinia de tres semanas de evolución, con antecedente de ablación por radiofrecuencia 6 meses antes de la admisión. La angiotomografía no evidenció tromboembolismo pulmonar (TEP y la angiorresonancia detectó hipoperfusión deI lóbulo superior del pulmón izquierdo (LSI. Debido a los antecedentes de ablación se solicitó angiotomografía de venas pulmonares, que evidenció estenosis de la vena del LSI. Se realizó estudio hemodinámico con dilatación y colocación de stent.

  4. Secuestro pulmonar intralobar: Reporte de un caso y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Armando Leal Mursulí

    2002-12-01

    Full Text Available Las malformaciones quísticas pulmonares constituyen un espectro de lesiones dentro de las cuales se incluye el secuestro pulmonar intralobar, del cual existe un caso por cada 1 000 nacimientos. Se presenta una paciente de 15 años de edad, la cual desde los 10 meses se le diagnosticó lesión quística pulmonar. Un mes previo al ingreso comenzó con síntomas respiratorios de tipo infeccioso, y se comprueba en las radiografías de tórax, niveles hidroaéreos en el lóbulo inferior izquierdo. La paciente se interviene quirúrgicamente y se demuestra la existencia de vasos anómalos que emergen de debajo del diafragma por lo que queda así comprobada la presencia de un secuestro intralobar. La evolución posoperatoria fue satisfactoria. Por lo infrecuente de esta entidad, se hace un análisis crítico de ella con el propósito de engrosar el conocimiento científico que sobre esta se tiene

  5. Descripción de lesiones pulmonares por Pseudalius inflexus en la marsopa Phocaena spinipinnis

    Directory of Open Access Journals (Sweden)

    Alfonso Chavera

    2011-05-01

    Full Text Available Se describen las lesiones pulmonares ocasionadas por el nematodo, Pseudalius inflexus (Rudolphi, 1808 Schneider, 1866 en dos especímenes, macho y hembra, de Phocoena spinipinnis Burmeisteir, 1865 "marsopa espinosa", capturados en aguas de la Reserva Nacional de Paracas, Perú. Macroscópicamente, los pulmones mostraron nódulos indurados superficiales de 0,5 - 2 cm de diámetro, donde al corte se encontraron nematodos rodeados por una severa reacción inflamatoria crónica y en los bronquios se observa que el extremo anterior de los parásitos obstruye la luz mientras que el extremo posterior se encuentra libre. Microscópicamente, los parásitos están en diferentes grados de degeneración, rodeados de un extenso exudado inflamatorio compuesto por eosinófilos, macrófagos, mononucleares, células gigantes multinucleadas con extenso tejido de granulación que infiltra el parénquima pulmonar, alvéolos distendidos y en algunos sectores destruidos. Además, se observa hiperplasia de mucosa bronquial, pared arterial con hiperplasia de capa muscular lisa, disminución del lumen. P. inflexus ocasiona una bronconeumonía crónica severa. Esta es la primera descripción de las lesiones pulmonares que produce P. inflexus en P. spinipinnis.

  6. Fisiopatología de la hipertensión arterial pulmonar

    Directory of Open Access Journals (Sweden)

    Herney Manuel Benavides-Luna

    2017-09-01

    Full Text Available El balance entre agentes vasoconstrictores y vasodilatadores, así como factores mitogénicos y antimitogénicos derivados del endotelio, está alterado en algunas situaciones y trae como resultado final un aumento en la presión arterial pulmonar. La disfunción endotelial es promovida por estímulos como hipoxia, acidosis, radicales libres, mediadores inflamatorios, tensión tangencial causada por aumento del flujo sanguíneo pulmonar de izquierda a derecha por cortocircuito intracardiaco y fibrina derivada de tromboembolia. La disfunción endotelial y el remodelado vascular son dos procesos importantes que explican el desarrollo de hipertensión pulmonar. El enfoque terapéutico de esta entidad ha progresado rápidamente en los últimos años, pero aún no existe un tratamiento ideal. Estrategias para el futuro pueden incluir mejoría en los métodos para administrar los medicamentos disponibles, combinaciones de los mismos, nuevos grupos terapéuticos y la posibilidad de terapia genética.

  7. Reabilitação pulmonar em longo prazo na doença pulmonar obstrutiva crônica (DPOC

    Directory of Open Access Journals (Sweden)

    Cintia Laura Pereira de Araújo

    2014-04-01

    Full Text Available Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC prejudica o estado funcional, com consequente limitação das Atividades de Vida Diária (AVD. Este estudo teve como objetivo investigar o efeito de um programa de Reabilitação Pulmonar (RP, em longo prazo, no estado funcional, na dispneia e no índice BODE em pacientes com DPOC. Relato de caso: Trata-se de um estudo retrospectivo e documental, com análise dos prontuários de cinco pacientes participantes de um programa de RP por um ano. Destes prontuários foram coletados dados referentes às avaliações: espirometria, Índice de Massa Corporal (IMC, escalas London Chest Activity of Daily Living (LCADL e Medical Research Council e (MRC teste de caminhada de seis minutos. Após um ano participando do programa de exercício físico, a maioria dos pacientes apresentou maior capacidade funcional, menor dispneia e redução no risco de mortalidade. Conclusão: Um ano de RP parece ter função de manutenção da melhora da capacidade funcional de pacientes com DPOC, após 24 sessões de treinamento.

  8. Infective endocarditis caused by Cellulomonas spp. in an intravenous drug user: case report.

    Science.gov (United States)

    Logar, Mateja; Lejko-Zupanc, Tatjana

    2013-06-01

    Cellulomonas spp. are often believed to be of low virulence. There are only a few reports of human infections. We report the first case of endocarditis caused by Cellulomonas in an intravenous drug abuser. The diagnosis of infective endocarditis (IE) in this case was definite using the Duke criteria. The course of the disease was complicated with a heart failure and possible mycotic aneurysm in the left leg. After the end of antimicrobial therapy aortic valve replacement was done because of severe heart failure.

  9. Beta-hemolytic streptococcus group a endocarditis: a rare clinical presentation

    International Nuclear Information System (INIS)

    Alam, A.; Tariq, M.

    2008-01-01

    A case report of an elderly gentleman is reported herein, who presented with one week history of fever, drowsiness and left lower limb weakness. Examination revealed left lower limb weakness with power of grade 3/5. His workup showed evidence of infection and multiple cerebral infarcts on the right side. Blood culture grew Streptococcus pyogens. Echocardiogram showed two vegetations on the aortic valve. Fever was the main presenting feature in this case but it was the presentation of patient with multiple cerebral infarcts that lead to the diagnosis of infective endocarditis. The organism causing Infective Endocarditis (IE) in this patient was a rare one. (author)

  10. A Case of Brucella Endocarditis in Association with Subclavian Artery Thrombosis

    Directory of Open Access Journals (Sweden)

    Claudia Colomba

    2012-01-01

    Full Text Available Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors.

  11. Endocarditis caused by Staphylococcus warneri on a normal aortic valve following vasectomy.

    Science.gov (United States)

    Dan, M; Marien, G J; Goldsand, G

    1984-08-01

    Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans.

  12. Absceso paravalvular en la endocarditis bacteriana: influencia en el pronóstico postoperatorio

    OpenAIRE

    Varela Barca, Laura; López Menéndez, Jose; Martín García, Miren; Redondo Palacios, Ana; Centella Hernández, Tomasa; Miguelena Hycka, Javier; Muñoz Pérez, Rafael; Rodríguez-Roda Stuart, Jorge

    2017-01-01

    Objetivo: El absceso paravalvular (AbP) aumenta la mortalidad, la complejidad y las complicaciones asociadas a la cirugía de endocarditis infecciosa (EI). Analizamos la influencia del AbP en las distintas formas de presentación de endocarditis bacteriana. Métodos: Estudio retrospectivo, observacional, incluyendo a todos los pacientes intervenidos de EI entre 2002 y 2015, y realizando seguimiento clínico tras el alta. Resultados: Se intervino a 169 pacientes, presentando AbP el 33% de lo...

  13. Reparación valvular mitral en un caso de endocarditis de Libman-Sacks

    OpenAIRE

    Bernabeu, Eduardo; Manrique, Rebeca; García-Valentín, Antonio; Vela, Paloma; Jovani, Vega; Aranda, Ignacio; Llamas, Patricio

    2012-01-01

    La endocarditis de Libman-Sacks es una forma de endocarditis no bacteriana asociada a los pacientes con lupus eritematoso sistémico (LES). Aunque con frecuencia cursa de forma asintomática, en ocasiones es causa de insuficiencia cardíaca grave. Presentamos un caso de reparación valvular mitral en una paciente aquejada de esta infrecuente entidad, que debutó clínicamente con un edema agudo de pulmón secundario a insuficiencia mitral masiva. La reparación valvular mitral puede ser un procedimie...

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

    Directory of Open Access Journals (Sweden)

    Shailee Y. Shah

    2015-01-01

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

  15. Rapidly Progrediating Aortic Valve Infective Endocarditis in an Intravenous Drug User Treated by Antibiotics and Surgery

    Directory of Open Access Journals (Sweden)

    Malkia S. Swedi

    2012-01-01

    Full Text Available We report the case of a 22-year old male, a self-confessed recreational drug user who developed cardiogenic shock because of severe destruction of the aortic valve by rapidly progressive aortic valve endocarditis. The disease progression was acute; in a matter of days, the clinical manifestations were life-threatening necessitating urgent aortic valve replacement surgery. Cultivation revealed Streptococcus viridans as the microbial agent. Subsequent recovery with antibiotic treatment was without complication. This case report shows that immediately performed transoesophageal echocardiography and early consultation with a cardiac surgeon has fundamental importance in diagnosis and management of acute infective endocarditis in haemodynamically instable patients.

  16. Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis.

    Science.gov (United States)

    Hoda, Mehar; Verma, Arushi; Alapati, Sridevi; Alapati, Srilatha; Yarrabolu, Tharakanatha R

    2017-03-01

    Rupture of aneurysm of sinus of Valsalva into the right atrium mimicking tricuspid valve endocarditis is a rare presentation. We review a case of spontaneous rupture of aneurysm of sinus of Valsalva into the right atrium presenting as a murmur. Transthoracic echocardiogram showed a mobile mass that appeared to be attached to the tricuspid valve leaflet with moderate tricuspid regurgitation suggestive of tricuspid valve endocarditis. The diagnosis was confirmed as spontaneous rupture of noncoronary sinus in to the right atrium by transesophageal echocardiogram. Patient recovered completely after surgical repair. © 2017, Wiley Periodicals, Inc.

  17. Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente

    Directory of Open Access Journals (Sweden)

    Karen Melissa Ordóñez

    2010-08-01

    La presentación clínica de la endocarditis infecciosa es inespecífica, lo cual genera diagnósticos tardíos que impiden la instauración de un tratamiento precoz y eficaz, como el reemplazo valvular, indicado en endocarditis por hongos o por gérmenes como P. aeruginosa. Este caso es fortuito por su resolución solamente con tratamiento médico combinado, con amikacina y meropenem, ya que tuvo varias complicaciones que contraindicaron el manejo quirúrgico.

  18. Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

    Directory of Open Access Journals (Sweden)

    Joshua Peñafiel-Sam

    Full Text Available Abstract Infective endocarditis due to Bartonella bacilliformis is rare. A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias. A systolic murmur was heard on the tricuspid area upon examination, and an echocardiogram showed endocardial lesions in the right atrium. Bartonella bacilliformis was isolated in blood cultures, defining the diagnosis of infective endocarditis using Duke’s criteria. Subsequently, the patient developed clinical and laboratory features compatible with antineutrophil cytoplasmic antibody-associated vasculitis. This case presents an uncommon complication of B. bacilliformis infection associated with the development of systemic vasculitis.

  19. Isolated Tricuspid Valve Libman-Sacks Endocarditis in Systemic Lupus Erythematosus with Secondary Antiphospholipid Syndrome.

    Science.gov (United States)

    Unic, Daniel; Planinc, Mislav; Baric, Davor; Rudez, Igor; Blazekovic, Robert; Senjug, Petar; Sutlic, Zeljko

    2017-04-01

    Libman-Sacks endocarditis, one of the most prevalent cardiac presentations of systemic lupus erythematosus, typically affects the aortic or mitral valve; tricuspid valve involvement is highly unusual. Secondary antiphospholipid syndrome increases the frequency and severity of cardiac valvular disease in systemic lupus erythematosus. We present the case of a 47-year-old woman with lupus and antiphospholipid syndrome whose massive tricuspid regurgitation was caused by Libman-Sacks endocarditis isolated to the tricuspid valve. In addition, we discuss this rare case in the context of the relevant medical literature.

  20. Diagnóstico diferencial de trombose aortoilíaca e mieloencefalite protozoária equina: relato de caso Differential diagnosis between aorto-iliac thrombosis and equine protozoal myeloencephalitis: case report

    Directory of Open Access Journals (Sweden)

    P.B. Escodro

    2010-10-01

    Full Text Available Relata-se o caso de uma égua de atividade de polo, que apresentou inicialmente claudicação leve no membro posterior esquerdo, a qual evoluiu para ataxia e atrofia da musculatura glútea do lado esquerdo, com diagnóstico de trombose aortoilíaca (TAI. A paciente foi tratada com suspeita de mieloencefalite protozoária equina, devido à semelhança dos sinais clínicos com essa doença, porém o líquido cefalorraquidiano apresentou-se negativo para anticorpos anti-Sarcocystis neurona. A palpação transretal indicou uma massa na bifurcação aortoilíaca esquerda. Na avaliação ultrassonográfica, visualizou-se imagem hiperecoica aderida ao endotélio vascular, sugerindo TAI atingindo a estenose de 70% da luz arterial.The case of a mare used for polo is reported. The animal showed clinical signs of soft lameness of the hindlimb, evolving to ataxia and gluteal muscle atrophy, with aorto-iliac thrombosis (AIT. The patient was treated with the suspect of equine protozoal myeloencephalitis (EPM, due to the resemblance of clinical signs. Cerebrospinal fluid analysis was negative for antibodies against Sarcocystis neurona. The transrectal examination indicated a mass in the left aorto-iliac bifurcation. In the ultrasonographic evaluation, a hyperechoic image adhered to the vascular endothelium was observed, suggesting (AIT, occupying 70% of arterial lumen. The present article has the objective of pointing out the importance of the differential diagnosis between AIT and EPM in horses with ataxia in hindlimbs and muscular atrophy.