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PubMed1994

[Infectious endocarditis].

The diagnosis of infective endocarditis remains a challenge to physicians providing primary care. On one hand this type of infection will be rarely encountered in primary care, but on the other hand this disease carries an enormous detrimental potential. Furthermore infective endocarditis, particularly in its initial phase, often has an uncharacteristic presentation with findings and symptoms shared with many much more frequent and often harmless diseases. To confront these difficulties, which are responsible for the often delayed diagnosis of infective endocarditis, strict rules must be applied. In patients at risk for infectious endocarditis no antibiotic therapy should be instituted without prior cultures. Also, in all other patients aimless, "blind" antibiotic therapy without diagnosis of a bacterial infection should be avoided. In patients with uncharacteristic symptoms and findings compatible with the diagnosis of infective endocarditis that persist for more than 5 days, blood cultures prior to any antibiotic therapy are warranted in addition to other clinical exams and tests. The sensitivity of echocardiography in detecting infective endocarditis is frequently overestimated. Furthermore, transesophageal echocardiography in endocarditis high-risk patients requires antibiotic prophylaxis which would obscure bacteriological diagnosis. For these reasons echocardiography should not be used as first test method when considering the diagnosis of infective endocarditis.

Abscess↗

PubMed1992

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

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 cardiac disease in whom endocarditis developed within 180 days of a medical or dental procedure for which prophylaxis was indicated. Of a total of 438 patients with endocarditis diagnosed during 2 years, 48 were eligible for the study. Controls were patients with the same cardiac status in whom endocarditis did not develop within 180 days of a similar procedure; of a total of 889 controls from five hospitals, 200 were eligible. Overall, about 1 in 6 patients in both groups had received prophylaxis. The best estimate of protective efficacy was 49% for first-ever endocarditis occurring within 30 days of a procedure. Endocarditis developed within 30 days of a procedure in only 13% of patients with a previously diagnosed heart lesion which predisposed to the disease. The findings suggest that strict adherence to generally accepted recommendations for prophylaxis might do little to decrease the total number of patients with endocarditis in the community.

Adolescent↗

PubMed1996

Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users.

OBJECTIVE: To study incidence rates of and risk factors for skin abscesses at the site of injection and episodes of endocarditis among injection drug users (IDU). DESIGN: A comprehensive, open cohort study of drug users on the natural history of human immunodeficiency virus (HIV) infection. METHODS: From 1986 to 1994, injection drug users in Amsterdam were included in the study. Incidence rates of self-reported skin abscesses and verified episodes of endocarditis were calculated. In uni- and multivariate Poisson regression analysis, risk factors for skin abscesses and endocarditis were determined. RESULTS: 521 HIV-seronegative and 237 HIV-seropositive IDU were followed for 1640 person-years. A total of 545 skin abscesses were reported by 269 IDU (incidence 33/100 person-years). HIV infection, female gender, prostitution among females, foreign nationality, injection of heroin and cocaine, a high frequency of injecting, and obtaining syringes through the needle exchange program were independently and positively associated with skin abscesses. During follow-up, 17 verified episodes of endocarditis were observed (incidence 1.3/100 person-years). Endocarditis was independently associated with HIV infection and a previous history of endocarditis. Furthermore, women and IDU with a skin abscess appeared to be at an increased risk for endocarditis. CONCLUSIONS: HIV infection is an independent risk factor for skin abscesses and endocarditis. Also, women are at an increased risk for these injection-related infections. Prevention activities, like promotion of skin cleaning, should be directed at those IDU in whom one or more risk factors have been identified.

Abscess↗

PubMed2004

Are all echocardiographic findings equally predictive for diagnosis in prosthetic endocarditis?

OBJECTIVE: The purpose of this study was to analyze the predictive value of different anatomic echocardiographic findings for diagnosis of prosthetic endocarditis. BACKGROUND: Prognosis in endocarditis has improved in recent years after the wide acceptance of new clinical diagnostic criteria. One of the most important issues in clinical diagnosis is to use echocardiography for identification of endocardial involvement, but prosthetic material impairs echo quality. METHODS: In all, 49 patients with 58 episodes of suggested prosthetic endocarditis were prospectively studied using transthoracic and transesophageal echocardiography. The patients were divided into two groups: group A, patients with 34 episodes of definite endocarditis according to Durack's criteria; and group B, patients with 24 episodes who were eventually classified as not having endocarditis, either by surgical exploration or by a mean of 32.6 months (range: 8-38 months) of follow-up. RESULTS: In group A, valve dehiscence was observed in 4 episodes of suggested endocarditis, pseudoaneurysms in 3, fistulae in 2, and moderate to severe perivalvular regurgitation in 15. No patient in group B had these abnormalities (P <.001). Vegetations were present in 17 episodes in group A (50%) versus 1 in group B (9%; P <.001); perivalvular abscesses were seen in 19 episodes in group A (56%) versus 1 in group B (P <.001). Mild perivalvular regurgitation was observed in only 1 episode for group A (3%) and in 14 episodes for group B (58%; P <.01). The presence of any of the above echocardiographic finding, when used in combination with the exclusion of mild perivalvular regurgitation, had a positive and negative predictive value for diagnosing endocarditis of 94% and 96%, respectively. Isolated mild perivalvular regurgitation had a poor positive predictive value (6%). CONCLUSION: Isolated mild perivalvular regurgitation should not be used as diagnostic criteria in patients with suggested prosthetic valve endocarditis.

Adult↗

PubMed2005

[Non infectious endocarditis: retrospective study (6 cases)].

PURPOSE: If there is cardiac valve vegetation and the blood cultures are negatives we need to look for slow growing bacteria, fungi, Legionella pneumophilia, Bartonella henselae and quintana, Brucella melitensis and abortus, Coxiella burneti, Chlamydiae pneumoniae by serologic tests. The diagnosis of non- infectious endocarditis could be considered only if these results were negative. The main purpose of this study was to describe the clinical and echocardiographic signs of non-infectious endocarditis cases observed in two different wards. METHODS: This study was done retrospectively during a five-year period in a cardiology and an internal medicine wards. The selection criteria are: the proof of at least one cardiac valve vegetation, observed on echocardiography, negative blood cultures and negative serologic tests as described above. RESULTS: Six non-bacterial endocarditis were described. Four Libman-Sacks endocarditis, two associated with a primary antiphospholipid syndrome revealed by an acute ischemia of leg for one patient and by an eclampsia for another and the other two associated with a systemic lupus erythematous revealed by fever for one patient and by neurologic symptoms for the other. One fibroblastic endocarditis associated to an essential hypereosinophilia and one marastic endocarditis associated to a metastatic mucin-producing cancer. CONCLUSIONS: For these six cases, a complete physical examination, a CBC for hypereosinophylia, a dosage of antiphospholipid antibodies and a thoraco-abdominal CT-scan allowed the etiologic diagnosis of non infectious endocarditis. Libman Sacks endocarditis associated with an antiphospholipid syndrome is the main etiology for which a long-term anticoagulation treatment was not followed.

Adolescent↗

PubMed1977

A clinicopathologic study of prosthetic valve endocarditis in 22 patients: morphologic basis for diagnosis and therapy.

Although endocarditis is a frequently lethal complication of prosthetic valve replacement, there is little pathological information on which to base diagnosis and treatment. We have studied the clinical and pathological features of 22 patients with prosthetic valve endocarditis seen at The Johns Hopkins Hospital over the past 17 years. Five patients developed endocarditis within two months of operation and 17 between two and 48 months (average 12) after operation. Patients dying early had a more fulminant course and their endocarditis was less often recognized during life. Late deaths, tending to present with fever and bacteremia unmasked by postoperative problems, were more readily recognized. Mitral and aortic prosthetic endocarditis generally led to a different type of prosthetic valve dysfunction: nine of 14 aortic valve prostheses with endocarditis developed incompetence and one other stenosis; five of seven patients with mitral valve prostheses developed stenosis and one, a homograft, developed incompetence. Prosthetic valve dysfunction led to death in 10 patients (45 per cent) and embolic events in five (23 per cent), including four cerebrovascular accidents. Ring infection, often believed to be universally present, and a contraindication to surgery, was found only in 50 per cent of these patients. In four patients (18 per cent) the endocarditis was sterilized by antibiotics but death occurred from valve dysfunction or emboli. These findings suggest that early surgical intervention combined with antibiotics has a chance of providing effective therapy for prosthetic valve endocarditis.

Adolescent↗

PubMed2001

Comparison of clinical and echocardiographic characteristics of Streptococcus bovis endocarditis with that caused by other pathogens.

The aim of our study was to compare the clinical, echographic, and prognostic features of Streptococcus bovis (S. bovis) endocarditis with those caused by other streptococci and pathogens in a large sample of patients with definite endocarditis by Duke criteria, using transesophageal echocardiography. Two hundred six patients (149 men, mean age 57 +/- 15 years) with a diagnosis of infective endocarditis formed the study population. All patients underwent multiplane transesophageal echocardiography and blood cultures. Cerebral, thoracoabdominal computed tomographic scan was performed in almost all patients (95%). All patients with S. bovis endocarditis underwent colonoscopy. Incidence of S. bovis endocarditis in our sample was 19%. Patients with S. bovis endocarditis were older than other groups. Multiple valve involvement, native valves, and large vegetations (>10 mm) were more frequent in patients with S. bovis. There was a significantly higher occurrence of embolism in the S. bovis group. Splenic embolism and multiple embolisms were significantly more frequent in patients with S. bovis. Gastrointestinal lesions, anemia, and spondylitis were observed more frequently with S. bovis endocarditis. In addition to the requirement for gastrointestinal examination for S. bovis endocarditis, our study underlines the need for systematic screening for vertebral and splenic localizations, and suggests the use of early surgery to prevent the high risk of embolism in these patients.

Aged↗

PubMed1998

Pacemaker infective endocarditis.

We identified 33 patients with definite pacemaker endocarditis--that is, with direct evidence of infective endocarditis, based on surgery or autopsy histologic findings of or bacteriologic findings (Gram stain or culture) of valvular vegetation or electrode-tip wire vegetation. Most of the patients (75%) were > or = 60 years of age (mean 66 +/- 3; range 21 to 86). Pouch hematoma or inflammation was common (58%), but other predisposing factors for endocarditis were rare. At the time that pacemaker endocarditis was found, the mean number of leads was 2.4 +/- 1.1 (range 1 to 7). The interval from the last procedure to diagnosis of endocarditis was 20 +/- 4 months (range 1 to 72). Endocarditis appeared after pacemaker implantation, early (< 3 months) in 10 patients and late (> or = 3 months) in 23 patients. Fever was the most common symptom, being isolated in 36%, associated with a poor general condition in 24%, and associated with septic shock in 9%. Transthoracic echocardiography showed vegetations in only 2 of 9 patients. Transesophageal echocardiography demonstrated the presence of lead vegetations (n = 20) or tricuspid vegetations (n = 3) in 23 of 24 patients (96%; p <0.0001 compared with transthoracic echocardiography). Pulmonary scintigraphy showed a typical pulmonary embolization in 7 of 17 patients (41%). Pathogens were mainly isolated from blood (82%) and lead (91%) cultures. The major pathogens causing pacemaker endocarditis were Staphylococcus epidermidis (n = 17) and S. aureus (n = 7). S. epidermidis was found more often in early than in late endocarditis (90% vs 50%; p = 0.05). All patients were treated with prolonged antibiotic regimens before and after electrode removal. Electrode removal was achieved by surgery (n = 29) or traction (n = 4). Associated procedures were performed in 9 patients. After the intensive care period, only 17 patients needed a new permanent pacemaker. Overall mortality was 24% after a mean follow-up period of 22 +/- 4 months (range 1 to 88). Eight patients who were significantly older (74 +/- 3 vs 63 +/- 3 years; p = 0.05) died < or = 2 months after electrode removal, whereas 25 were alive and asymptomatic.

Adult↗

PubMed1999

Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis.

BACKGROUND: There are advantages to using homografts and autografts as aortic valve replacements, particularly in patients with infective endocarditis. To better define these advantages, we reviewed our 13-year experience with the surgical management of infective endocarditis involving the aortic valve and root. METHODS: From 1986 through 1998, 81 adults with aortic valve endocarditis underwent valve replacement (AVR). The mean age of the 65 men and 16 women was 44 +/- 14 years. Sixty-three (78%) patients had active endocarditis at the time of operation. Non-native valve endocarditis was present in 29 (36%) patients, in 9 of whom the infection was a recurrence. Aortic valve replacements were performed with 46 homografts (homo-AVR), 25 autografts (Ross-AVR), and 10 prosthetic valves (prosth-AVR). Among Ross-AVR and homo-AVR patients, 11 required mitral valve replacement or repair (homo-Ross DVR). Follow-up was 90% complete within 2 years of the end of the study with a mean of 3.7 +/- 3.4 years. RESULTS: Early mortality was 16% (13 of 81 patients). This was 12% (3 of 25 patients) for Ross-AVR, 17% (8 of 46 patients) for homo-AVR, and 20% (2 of 10 patients) for prosth-AVR. Overall late mortality was 10% (7 of 68 patients) with a valve-related late mortality of 7% (5 of 68 patients). Actuarial survival at 5 years was 88% +/- 9% in Ross-AVR, 69% +/- 11% in homo-AVR, and 29% +/- 22% in prosth-AVR (p = 0.03). Endocarditis recurred in 12.5% (1 of 8 patients) with prosth-AVR and 3% (2 of 60 patients) in homo-Ross AVR. CONCLUSIONS: Valve replacement in the presence of native and prosthetic endocarditis remains a formidable challenge. Autografts and homografts are the preferred replacement aortic valves for these patients even if concomitant mitral valve replacement is required, and risk of valve-related death or recurrent endocarditis is low at medium-term follow-up.

Adult↗

PubMed1999

Infective endocarditis: an epidemiological review of 128 episodes.

OBJECTIVES: The objective was to determine the current epidemiology of infective endocarditis. PATIENTS AND METHODS: All microbiologically positive episodes of infective endocarditis treated at The University Hospital of Wales over a 9-year period from March 1987 to March 1996 was reviewed. Patients originated from the catchment area of The University Hospital of Wales or were referred from other hospitals in Wales. Data extraction was from records held in the Microbiology Department and, whenever possible, from patients' casenotes. The epidemiological parameters were: (1) age and sex of patients; (2) distribution of affected sites; (3) frequency of predisposing risk factors (cardiac and extracardiac); (4) incidence of early prosthetic valve endocarditis; and (5) mortality rates. RESULTS: There were 128 microbiologically positive episodes of endocarditis in 125 patients. The mean age of the population was 53.1 years and the aortic valve was the most frequently involved site of infection (51.6%). A presumed source of infection was identified in 20% if episodes. The commonest predisposing cardiac risk factor in native valve episodes was bicuspid aortic valve (16.7%) but there was no identifiable cardiac risk factor in a much larger proportion (37.7%) of native valve episodes. There was a low incidence (0.6%) of culture positive early prosthetic valve episodes and low mortality rates for both native and prosthetic valve endocarditis (12.3% and 24.5%) in this study. Viridans streptococci were the predominant organisms. In prosthetic valve episodes with onset after the 60th postoperative day but within one postoperative year the identity of the isolate suggested, in most cases, perioperative valve contamination. CONCLUSIONS: The epidemiology of infective endocarditis has undergone significant change. Inability to detect clinically common predisposing lesions, and the frequent absence of any identifiable predisposing cardiac risk factor mean that initial diagnosis is often difficult and demands a high index of suspicion. There was a low incidence of culture positive early prosthetic valve episodes and there were low mortality rates for both native and prosthetic valve endocarditis; these figures suggest improvements in cardiac care. The microbiological evidence indicates that the duration of the postoperative time period used for classifying prosthetic valve endocarditis into 'early' and 'late' episodes should be extended from 60 days to 1 year.

Adolescent↗

PubMed2002

Risk of embolization after institution of antibiotic therapy for infective endocarditis.

OBJECTIVES: This study was designed to assess the risk of systemic embolization in patients with left-sided infective endocarditis, once adequate antibiotic treatment had been initiated, on the basis of prospective clinical follow-up. BACKGROUND: As one of the complications of infective endocarditis, embolization has a great impact on prognosis. Prediction of an individual patient's risk of embolization is very difficult. METHODS: We studied 217 episodes of left-sided endocarditis that were experienced among a cohort of 211 prospectively recruited patients. According to the Duke criteria, 91% of the episodes were definite infective endocarditis. Seventy-two episodes involved infections located on prosthetic valves. All patients were studied by transthoracic and transesophageal echocardiography. Clinical, echocardiographic and microbiologic data were entered in a data base. The mean follow-up interval was 151 days. RESULTS: Twenty-eight episodes (12.9%; group I) of endocarditis had embolic events after the initiation of antibiotic therapy. The remaining 189 episodes did not embolize (group II). Most emboli (52%) affected the central nervous system, and 65% of the embolic events occurred during the first two weeks after initiation of antibiotic therapy. Previous embolism was associated with new embolism (relative risk [RR] 1.73, 95% confidence interval [CI] 1.02 to 2.93; p = 0.05). There was an increase in the risk of embolization with increasing vegetation size (RR 3.77, 95% CI 0.97 to 12.57; p = 0.07). Vegetation size had no impact on the risk of embolization in streptococcal endocarditis or aortic infection. By contrast, large (> or = 10 mm) vegetations had a higher incidence of embolism when the microorganism was staphylococcus (p = 0.04) and the mitral valve was infected (p = 0.03). The increase in vegetation size at follow-up showed a higher risk for embolization (RR 2.64, 95% CI 0.98 to 7.16; p = 0.02). CONCLUSIONS: Embolism before antimicrobial therapy is a risk factor for new emboli. The risk of embolization seems to increase with increasing vegetation size, and this is particularly significant in mitral endocarditis and staphylococcal endocarditis. An increase in vegetation size, despite antimicrobial treatment, may predict later embolism.

Adult↗

PubMedDate not supplied

Pulmonic valve endocarditis as an underdiagnosed disease: role of transesophageal echocardiography.

Pulmonic valve endocarditis is a rare clinical entity. In spite of an increase in the frequency of right-sided endocarditis, primarily it is the tricuspid valve that is involved. Two-dimensional transthoracic echocardiography has improved our ability to diagnose infective endocarditis but has not identified many cases of pulmonic valve endocarditis. With the use of transesophageal echocardiography, three recent cases of pulmonic valve endocarditis were diagnosed by our laboratory. Each of these patients had clinical evidence of right-sided endocarditis, yet routine transthoracic echocardiograms failed to identify any pulmonic valve abnormalities. The true incidence of pulmonic valve endocarditis may be higher than previously reported, and the transesophageal echocardiogram is the preferred method for identifying and evaluating pulmonic valve endocarditis in adults.

Adult↗

PubMed1999

Bacterial endocarditis in neonatal intensive care.

OBJECTIVES: To ascertain the incidence of bacterial endocarditis in a level III neonatal nursery. To document the clinical features, assess survival, and evaluate the role of central venous catheters in neonates with bacterial endocarditis. METHODOLOGY: Index cases were identified by retrospective review of the echocardiographic records of infants admitted to the neonatal nursery from 1983 to 1995. Data obtained by review of the clinical records of these infants, and case-matched controls. RESULTS: From January 1983 to December 1995, 12,249 infants were admitted to the Special Care Nursery. Eight infants with endocarditis were identified, an incidence of 0.07%. Presenting symptoms and signs were often vague and nonspecific. Gestation less than 32 weeks, birthweight less than 1500 g, thrombocytopenia and neutropenia or neutrophilia were common features. Infants with endocarditis had a significantly higher Clinical Risk Index for Babies score than those without endocarditis. The tricuspid valve was involved in seven infants, six of whom had a percutaneous central venous catheter in situ before diagnosis. Mitral valve involvement occurred in two infants, neither of whom had central lines inserted. However, compared to infants without endocarditis, the placement of a central venous line was not of statistical significance. Seven of the eight infants survived following prolonged antibiotic therapy. CONCLUSIONS: Bacterial endocarditis is a rare but serious condition which is usually not fatal. In the premature newborn infant, presenting signs and symptoms are often nonspecific. Endocarditis should therefore be considered in the unwell very low birthweight infant.

Catheterization, Central Venous↗

PubMed2000

Multi-valvular endocarditis.

OBJECTIVE: Seventy-seven cases of native valve infective endocarditis as determined by the Duke criteria, were reviewed to determine the incidence and clinical features of multi-valvular endocarditis. METHODS: Fourteen of 77 patients (18%) had multi-valvular endocarditis most commonly involving the mitral and aortic valves. Staphylococcus aureus (43%) and viridans streptococci (36%) were the most common organisms causing multi-valvular endocarditis. RESULTS: Definite or probable vegetations were found in 50% of the patients by two-dimensional transthoracic echocardiograph and/or transesophageal echocardiograph, and possible vegetations were detected in 21%. The overall mortality in our series was 21%; 29% underwent valve replacement and 50% were treated medically. The major complications of multi-valvular endocarditis were congestive heart failure (64%), acute renal failure (50%), embolic events (21%), and splenic abscess/infarcts (21%). CONCLUSIONS: Our data suggests complications of multi-valvular endocarditis, compared with uni-valvular endocarditis are similar except for heart failure. Heart failure is statistically more common in multi-valvular endocarditis (P < or = 0.002).

Acute Kidney Injury↗

PubMed2005

Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia.

BACKGROUND AND OBJECTIVE: Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. Only a few studies of MRSA infective endocarditis have been conducted, and none have reported its risk factors. We sought to determine the host-related risk factors for infective endocarditis in patients with nosocomial MRSA bacteremia. SETTING: A 2,000-bed, university-affiliated, tertiary-care hospital. PATIENTS: Thirty-one patients with nosocomial MRSA infective endocarditis between October 1996 and May 2003. DESIGN: A retrospective chart review was conducted. Data were compared with those from a control group of patients with nosocomial MRSA bacteremia. Logistic regression was used to identify independent risk factors for nosocomial infective endocarditis. RESULTS: Compared with patients who had nosocomial MRSA bacteremia and no infective endocarditis, patients who had infective endocarditis had a higher incidence of chronic liver disease and a lower incidence of immunodeficiency. The risk of developing infective endocarditis was approximately 10% for patients with nosocomial MRSA bacteremia. CONCLUSION: Patients with MRSA bacteremia and underlying chronic liver disease were prone to infective endocarditis.

Adolescent↗

PubMed2006

Autoimmunohistochemistry: a new method for the histologic diagnosis of infective endocarditis.

BACKGROUND: Although the pathologic examination of cardiac valves remains the reference standard for the diagnosis of infective endocarditis, the detection of microorganisms often poses a challenge for pathologists. This can be done by use of nonspecific histochemical stains or by immunohistochemical analysis, but specific antibodies are often not available. We describe a novel method for the detection of microorganisms in valve specimens from patients with infective endocarditis. METHODS: Detection of microorganisms was performed in valve specimens from patients with endocarditis caused by gram-positive cocci (25 specimens), blood culture-negative endocarditis (15 specimens: 6 cases caused by Coxiella burnetii, 5 caused by Tropheryma whipplei, and 4 caused by Bartonella species), or noninfective degenerative damage (30 specimens, used as negative controls), using the patients' own serum. This technique, called "autoimmunohistochemistry," is an immunohistochemical peroxidase-based method that we compared with results of culture and polymerase chain reaction (PCR) assay. RESULTS: Bacteria were detected by autoimmunohistochemistry in 20 (80%) specimens from patients with endocarditis caused by gram-positive cocci and in 15 (100%) specimens from patients with blood culture-negative endocarditis but in no control specimens. The rate of detection of bacteria by autoimmunohistochemistry was significantly higher than that by culture but was similar to that by PCR. CONCLUSIONS: Autoimmunohistochemistry may be useful for the detection of microorganisms in samples of valves from patients with infective endocarditis. This new diagnostic tool may be particularly useful in cases of blood culture-negative endocarditis.

Actinomycetales↗

PubMed1986

Enzyme-linked immunosorbent assay for the detection of antibodies to nutritionally variant streptococci in patients with endocarditis.

The viridans streptococci are responsible for 50%-55% of microbial endocarditis. Among these varied species, the nutritionally variant streptococci (NVS) have recently been associated with culture-negative endocarditis and are responsible for 5%-10% of all streptococcal endocarditis. The isolation and identification of these bacteria has been hampered by the extremely fastidious nature of their growth requirements as well as by their slow growth rate. In addition, their antibiotic sensitivity varies greatly, a characteristic leading to a higher rate of morbidity and mortality than is found in patients with non-NVS endocarditis. For these reasons sera from patients with NVS endocarditis were examined for antibodies to the NVS serotype I antigen by using an enzyme-linked immunosorbent assay. Seventy-four percent of patients with NVS endocarditis had elevated titers to this antigen. None of the sera from controls and only 6.7% of the sera from patients with non-NVS streptococcal endocarditis showed increased titers. These results indicate that antibody to the NVS serotype I antigen can serve as a marker for NVS endocarditis.

Antibodies, Bacterial↗

PubMed1986

Serological diagnosis of Q fever endocarditis.

The diagnosis of Q fever endocarditis cannot be made by bacterial cultures and necessitates serological identification of specific antibodies to Coxiella burnetii which stimulates mainly the production of anti-phase II antibodies during the acute disease, but primarily anti-phase I antibodies in endocarditis. Indirect microimmunofluorescence allows rapid detection of specific IgA, IgG and IgM. The results of serological analyses of 191 acute cases of Q fever were compared with those of 8 cases of Coxiella burnetii endocarditis. All sera were evaluated by complement fixation and microimmunofluorescence tests. The highest titre differences between primary Q fever and Q fever endocarditis were observed with anti-phase I IgA and IgG antibodies measured by microimmunofluorescence followed by anti-phase I antibodies measured by complement fixation tests. Antiphase I IgG and IgM titres were consistently higher than anti-phase II titres in endocarditis. The reverse is true in acute Q fever. In addition, anti-phase I IgA appeared to be diagnostic for Coxiella burnetii endocarditis. Accordingly we recommend the testing of these specific IgA, IgG, and IgM by microimmunofluorescence in cases of culture-negative endocarditis. These tests could also prove useful for following the development of Coxiella burnetii endocarditis in patients under treatment.

Antibodies, Bacterial↗