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PubMed1999

[Splenic involvement in infectious endocarditis. Association for the Study and Prevention of Infectious Endocarditis].

INTRODUCTION: Splenic involvement in the course of endocarditis consists in either splenic infarct or abscess. Pathophysiological examinations suggest the existence of a continuum between the two types of lesion. Signs and symptoms are usually poor or aspecific. Current incidence and diagnostic methods are rarely reported in recent medical literature. EXEGESIS: We report a retrospective study conducted from a questionnaire that was circulated to nine French medical units. Two hundred and twenty five patients with infectious endocarditis according to Duke university criteria were included in the study. The existence of splenic lesions was investigated in 153 patients (68%). Splenic involvement was documented in 35 patients. Diagnostic methods were: abdominal echography (n = 77), abdominal CT scan (n = 40), and both techniques (n = 36). The incidence of splenic lesions was 9%, 35% and 36%, respectively. Among patients investigated using both diagnostic techniques, splenic abnormalities were detected by CT scan in 13 cases and by echography in six cases. Splenic abscess was suspected in nine patients by combining suggestive clinical course and radiological abnormalities, but was definitively evidenced in only four patients (surgery, n = 2, post-mortem examination, n = 2) presenting with large lesions (> or = 8 cm) associated with aortic endocarditis. All other 26 cases were categorized as splenic infarcts; however, diagnosis was confirmed in only two cases (surgery n = 1, autopsy n = 1). CONCLUSION: These data suggest that: 1) the incidence of splenic involvement during endocarditis is approximately 35%, 2) CT scan is probably superior to echography for spleen screening, and 3) incidence of abscess requiring specific surgery is very low, inferior to 2%.

Abscess↗
PubMed2002

Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation.

In the century and a quarter since William Osler delivered his framed lectures on endocarditis substantial advancements have occurred in the understanding and treatment of this disease. This article summarizes current understanding of endocarditis in the areas of population epidemiology, host factors, microorganisms, diagnosis, and therapy. In addition, the authors discuss possible directions for investigation in the future, including a new multinational consortium, the International Collaboration on Endocarditis (ICE). This collaboration aims to provide a mechanism to advance the understanding of endocarditis in areas difficult to study without an established network. The multinational nature of the collaboration may also permit a more global view of IE and provide opportunities for studies such as randomized trials of therapeutic treatment strategies.

Bacteria↗
PubMedDate not supplied

The challenge of staphylococcal pacemaker endocarditis in a patient with transposition of the great arteries endocarditis in congenital heart disease.

Staphylococcus aureus is a leading cause of septicaemia and infective endocarditis. The overall incidence of staphylococcal bacteraemia is increasing, contributing to 16% of all hospital-acquired bacteraemias. The use of cardiac pacemakers has revolutionized the management of rhythm disturbances, yet this has also resulted in a group of patients at risk of pacemaker lead endocarditis and seeding in the range of 1% to 7%. We describe a 26-year-old man with transposition of the great arteries who had a pacemaker implanted and presented with S. aureus septicaemia 2 years postpacemaker implantation and went on to develop pacemaker lead endocarditis. This report illustrates the risk of endocarditis in the population with congenital heart disease and an intracardiac device.

Adult↗
PubMed2003

Vancomycin treatment failure associated with heterogeneous vancomycin-intermediate Staphylococcus aureus in a patient with endocarditis and in the rabbit model of endocarditis.

Heterogeneous resistance to vancomycin is thought to precede emergence of intermediate susceptibility to vancomycin in Staphylococcus aureus, but the clinical significance of heterogeneous resistance is unknown. Paired S. aureus isolates from a patient with endocarditis who relapsed after vancomycin treatment were tested for heterogeneous resistance to vancomycin. The pretreatment and the relapse clinical isolates (strains SF1 and SF2, respectively) were genotyped by pulsed-field gel electrophoresis. Susceptibility to vancomycin was assessed by the broth dilution method, population analysis, and time-kill studies and in the rabbit model of endocarditis. Strains SF1 and SF2 had similar genotypes, and the vancomycin MICs for the strains were </=2 micro g/ml. SF2 exhibited heterogeneous resistance to vancomycin. Vancomycin eradicated SF1 in the rabbit model of endocarditis, while SF2 persisted at pretreatment levels. Vancomycin treatment failure in this patient with endocarditis was attributable to heterogeneous resistance to vancomycin.

Animals↗
PubMed2004

Nonbacterial thrombotic endocarditis presenting as aortic stenosis with suspected infective endocarditis: clinicopathological correlation.

Endocarditis has been traditionally classified as infective and non-bacterial thrombotic endocarditis (NBTE). NBTE has been associated with connective tissue diseases, chronic inflammatory processes and malignancy. During the pre-echocardiography era, the diagnosis of NBTE was most commonly determined at postmortem examination. A 63-year-old female patient with transient cerebral ischemic attacks and weight loss, who subsequently presented with aortic stenosis, is reported. She was treated for infective endocarditis, but developed a clinical picture of sepsis with disseminated intravascular coagulation. Despite aortic valve replacement, she died early postoperatively. Autopsy found valvular NBTE, multiple vascular thromboses and associated metastatic adenocarcinoma of unknown primary site. NBTE associated with malignancy April clinically mimic sepsis and infective endocarditis.

Aortic Valve Stenosis↗
PubMed1983

Infective endocarditis in Jerusalem. A comparative analysis of native and prosthetic valve endocarditis.

Thirty patients with prosthetic valve endocarditis (PVE) and 62 patients with native valve endocarditis (NVE) observed during a concurrent period of time (1970-80) were analyzed. Patients with PVE were also compared with 697 patients who underwent cardiac valve replacement in the same period, in an attempt to uncover risk factors for PVE. In the operated patients the overall incidence of endocarditis was 4.3%. There were several significant differences between the NVE and PVE groups. Atrial fibrillation was more prevalent in the PVE group (33.4 vs. 11.5%, P less than 0.05), while infection with gram-positive organisms was more prevalent in the NVE patients (79 vs. 47%, P less than 0.01). The outcome of combined medical and surgical treatment showed a much higher mortality rate (50 vs. 6.4%, P less than 0.01) in the PVE group. Staphylococcal endocarditis resulted in 16% mortality in NVE vs. 100% in the PVE group (P less than 0.01). Careful surveillance may hopefully lead to early detection, treatment and better outcome of PVE.

Adolescent↗
PubMed1996

[Nonbacterial thrombotic endocarditis: a contribution to the clinical differential diagnosis in culture-negative endocarditis].

Nonbacterial thrombotic endocarditis is rarely diagnosed before death. We report on 3 patients with nonbacterial thrombotic endocarditis to illustrate the clinical course of this disease that can cause severe systemic thromboembolism and may be the first manifestation of malignant disease. Nonbacterial thrombotic endocarditis must be considered in the differential diagnosis of culture-negative endocarditis.

Adenocarcinoma↗
PubMed1998

[Experimental endocarditis. Pathological anatomy of human endocarditis].

Experimental reproduction of human endocarditis in animal models has been based on the induction of structural lesions in valve endocardium using different methods. The primary lesion caused in this way is the so called non-bacterial thrombotic endocarditis. Its colonization is then induced by inoculation of microorganisms in the bloodstream. Freedman's modified method has been the most widespread model of this type. It has mainly been performed in rabbits with inoculation of Staphylococcus aureus or alpha-hemolitic Streptococcus. Experimental models of endocarditis have contributed to our knowledge of the pathogenic mechanisms, causative agents and predisposing factors of endocarditis. They have also allowed us to develop appropriate diagnostic, therapeutic and prophylactic measures for its management.

Animals↗
PubMed2004

Prognostic factors in 61 cases of Staphylococcus aureus prosthetic valve infective endocarditis from the International Collaboration on Endocarditis merged database.

Staphylococcus aureus prosthetic valve infective endocarditis (SA-PVIE) is associated with a high mortality rate, but prognostic factors have not been clearly elucidated. The International Collaboration on Endocarditis merged database (ICE-MD) contained 2212 cases of definite infective endocarditis (as defined using the Duke criteria), 61 of which were SA-PVIE. Overall mortality rate was 47.5%, stroke was associated with an increased risk of death, and early valve replacement was not associated with a significant survival benefit in the whole population; however, patients who developed cardiac complications and underwent early valve replacement had the lowest mortality rate (28.6%).

Adult↗
PubMed2005

Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database.

BACKGROUND: Staphylococcus aureus native valve infective endocarditis (SA-NVIE) is not completely understood. The objective of this investigation was to describe the characteristics of a large, international cohort of patients with SA-NVIE. METHODS: The International Collaboration on Endocarditis Merged Database (ICE-MD) is a combination of 7 existing electronic databases from 5 countries that contains data on 2212 cases of definite infective endocarditis (IE). RESULTS: Of patients with native valve IE, 566 patients [corrected] had IE due to S. aureus, and 1074 patients had IE due to pathogens other than S. aureus (non-SA-NVIE). Patients with S. aureus IE were more likely to die (20% vs. 12%; P < .001), to experience an embolic event (61% [corrected] vs. 31%; P < .001), or to have a central nervous system event (21% [corrected] vs. 13%; P < .001) and were less likely to undergo surgery (26% vs. 39%; P < .001) than were patients with non-SA-NVIE. Multivariate analysis of prognostic factors of mortality identified age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), periannular abscess (OR, 2.4; 95% CI, 1.0 [corrected] -5.6), heart failure (OR, 3.9; 95% CI, 2.3-6.7), and absence of surgical therapy (OR, 2.3; 95% CI, 1.3-4.2) as variables that were independently associated with mortality in patients with SA-NVIE. After adjusting for patient-, pathogen-, and treatment-specific characteristics by multivariate analysis, geographical region was also found to be associated with mortality in patients with SA-NVIE (P < .001). CONCLUSIONS: S. aureus is an important and common cause of IE. The outcome of SA-NVIE is worse than that of non-SA-NVIE. Several clinical parameters are independently associated with mortality for patients with SA-NVIE. The clinical characteristics and outcome of SA-NVIE vary significantly by geographic region, although the reasons for such regional variations in outcomes of SA-NVIE are unknown and are probably multifactorial. A large, prospective, multinational cohort study of patients with IE is now under way to further investigate these observations.

Databases as Topic↗
PubMed1977

Echocardiographic observations in opiate addicts with active infective endocarditis. Frequency of involvement of the various values and comparison of echocardiographic features of right- and left-sided cardiac valve endocarditis.

Echocardiographic observations are described in 25 opiate addicts with active infective endocarditis involving apparently previously normal valves. Infective endocarditis was isolated to the tricuspid valve in 11 patients, involved both right- (tricuspid valve) and left-sided valves in 7 and was isolated to the left-sided valves in 7 (mitral valve in 6). Twenty patients (80%) had tricuspid valve regurgitation, 12 had mitral regurgitation, 3 had aortic regurgitation and none had pulmonary valve regurgitation. Considering the 75 cardiac valves (excluding the pulmonary) in the 25 patients, echocardiographic abnormalities consistent with active infective endocarditis were detected in 26 (74%) of the 35 clinically incompetent valves but in none of the 40 competent valves. Comparison of the 20 incompetent tricuspid valves with the 12 incompetent mitral valves indicated that (1) the echocardiogram was less sensitive in detecting tricuspid valve lesions, (2) rupture of tricuspid valve chordae tendineae was absent or not detectable, and (3) tricuspid valve vegetations tended to be larger.

Adult↗
PubMed2004

Infective endocarditis due to Moraxella lacunata: report of 4 patients and review of published cases of Moraxella endocarditis.

Moraxella is an aerobic, oxidase-positive, Gram-negative coccobacillus, which is rarely associated with serious and invasive infections. We describe 4 cases of Moraxella lacunata endocarditis and review 12 previously published cases of Moraxella endocarditis, including 1 further case with M. lacunata, 5 with M. catarrhalis, 2 with M. phenylperuvica and the remainder consisting of 1 case each of M. liquefaciens, M. osloensis, M. nonliquefaciens and 1 non-specified. Of these 16 patients, 5 had prosthetic valves, 5 suffered from an underlying heart abnormality, and the other 6 had normal hearts. Therapy consisted of a beta-lactam antimicrobial and, in several instances, an aminoglycoside as well. The mean duration of antibiotic treatment was 35+/-13 d. Four patients (25%) underwent surgery and 4 out of 16 (25%) died. Moraxella should be added to the growing list of organisms which may occasionally cause infective endocarditis, even in patients without preexisting valvular abnormality.

Adult↗
PubMed1999

A 10-year retrospective study of infective endocarditis at a university hospital with special regard to the timing of surgical evaluation in S. viridans endocarditis.

A total of 154 episodes of infective endocarditis (IE) in 149 patients were studied retrospectively with special regard to the major aetiological groups and the surgical evaluation. There were 136 episodes of native valve endocarditis (NVE) (88%) and 18 episodes of prosthetic valve endocarditis (PVE) (12%). Three major groups of NVE crystallized: Streptococcus viridans in 37 (27%), Staphylococcus aureus in 39 (29%) and culture negative IE in 28 (21%) episodes. In these groups surgery during the active phase was required in 41, 28 and 18%, respectively. At the operation myocardial abscess was found in as many as 7/15 cases with S. viridans, but in only in 3/11 cases with S. aureus and 1/5 cases with culture negative IE. The mean duration of preoperative antibiotic treatment was 34 d. This long period of unsuccessful pharmacotherapy, preceded by a mean of 47 d from start of symptoms to admission to hospital, has probably resulted in the high frequency of myocardial abscess in S. viridans NVE. Surgical evaluation should be considered when fever persists beyond 10 d of adequate treatment, even in the absence of clinically apparent complications. Among the PVE episodes, 11/18 were managed with pharmacological treatment alone. Uncomplicated PVE may thus often be successfully treated with antibiotics alone.

Abscess↗
PubMed1993

Experimental endocarditis: a review of its relevance to human endocarditis.

Bacterial endocarditis is a difficult-to-cure infection, owing to (i) poor penetration of antibiotics into infected vegetations; (ii) altered metabolic state of bacteria within the lesion; (iii) absence of adequate host-defence cellular response which could cooperate with antibiotic action. The contribution of infection models to definition and improvement of therapeutic regimens of endocarditis in man remains of great importance because of the difficulties encountered in clinical trials. The advantage of the experimental model is that besides the fact that it closely simulates the characteristics of the infection in humans, it provides clear endpoints which allow statistical comparisons among different therapeutic regimens: number of bacteria/g of tissue, frequency of emergence of resistance, positivity of blood cultures, death vs survival rates, and percentage of relapses after treatment has been stopped. All these parameters are more sensitive and more easy to use than in man. The infection model has definitively established that bactericidal therapy is warranted and that in-vitro susceptibility tests, especially those evaluating the killing rate, have a good predictive value for the therapeutic outcome. Three main aspects are discussed for their influence on human therapy (i) the kinetics of antibiotic diffusion into vegetations, with a special reference to the data obtained by autoradiography, (ii) the specificity of some pharmacodynamic aspects of antibiotics in endocarditis, including the clinical consequences of these two parameters on antibiotic dosing regimens and length of therapy, and (iii) in-vivo synergy. This phenomenon involves a variety of mechanisms which are difficult or even impossible to analyse on the sole basis of in-vitro data: enhanced bactericidal activity (beta-lactam-aminoglycoside), prevention of emergence of resistance (as demonstrated for rifampin, quinolones or fosfomycin) and, as shown with rifampin or quinolones, 'pharmacokinetic synergy'. Animal models have helped to define the importance of antibiotic dosing strategies to achieve in-vivo synergy which appears as essential to increase the rate of both bacteriological and clinical cure rate.

Animals↗
PubMed1993

Surgical treatment of active infective endocarditis--early and late results of active native and prosthetic valve endocarditis.

The purpose of this study was to determine the clinical predictors of active infective endocarditis in 45 cases we treated between January 1971 and August 1991 (30 native valve endocarditis (NVE) and 15 prosthetic valve endocarditis (PVE). The indication of surgery in 45 patients was progressive congestive heart failure (CHF), septicemia and systemic embolization. The aortic valve was involved in 24 (53%) of 45 patients (13 of 30 NVE and 11 of 15 PVE) and there was significantly higher early mortality in aortic PVE (36%) than in aortic NVE (8%). The 9 patients with severe cardiac failure (NYHA Class V) before surgery were associated with a significantly higher incidence of early mortality (5/9 = 56%) than those in Class III (2/14 = 14%) and Class IV (3/18 = 17%). We concluded that aortic valve infection is more prevalent than mitral valve infection and is more often associated with staphylococcus infection, including abscess formation. Early surgical intervention should be performed despite the risk of cardiac failure and extensive infection.

Abscess↗
PubMed2002

[Combination of Libman-Sacks endocarditis with infectious endocarditis].

Out of 242 patients treated for systemic lupus erythematosus (SLE) in Novosibirsk for 15 years, valvular lesions and endocarditis were diagnosed in 41(16.9%) patients. Combination of Libman-Sax endocarditis (LSE) with infectious endocarditis (IE) was observed in three patients (two women, one man, age 18-40 year). SLE ran a subacute course in one woman, an acute one--in the other. LSE emerged early in SLE in two patients. All the patients had polyorganic lupus pathology, lupus nephritis with nephrotic syndrome (morphological class IV). Two patients had mitral valve disease, one patient--mitral-aortic disease. The rise of secondary IE was seen after massive immunosuppressive therapy. The diagnosis of secondary IE was made after SLE duration for 10-36 months. At IE diagnosis, all the patients had high titers of blood antiphospholipid antibodies. IE was of staphylococcal origin in two patients and candidosis-induced in one patient. In SLE with IE there was thromboembolic syndrome. LSE and IE have related aspects which should be regarded in clinical practice: possible "IE mask" in LSE, risk of secondary IE in about 10% of LSE patients, prophylactic measures necessary to prevent IE in hemodynamically prominent forms of LSE.

Adolescent↗
PubMed1971

Experimental bacterial endocarditis in the opossum (Didelphis virginiana). 3. Comparison of spontaneously occurring endocarditis with that induced experimentally by pyogenic bacteria and fungi.

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.

Animals↗
PubMed1982

Experimental endocarditis in rabbits. 7. Results of long-term combined therapy of Streptococcus faecalis endocarditis with penicillin and gentamicin.

The purpose of this study was to investigate the efficacy of long-term penicillin-gentamicin treatment on experimental S. faecalis endocarditis due to selected strains; one strain was homogeneously resistant to 8000 micrograms/ml streptomycin (IC50 and MIC greater than 8000 micrograms ml), the other strain heterogeneously resistant to 8000 micrograms/ml streptomycin (IC50: 3300 micrograms/ml, MIC: greater than 8000 micrograms/ml. Both strains showed low-grade resistance to gentamicin (MIC 10.5 and 25 micrograms/ml, respectively). The results showed that there was significant effect of the treatment in rabbits with endocarditis due to both strains, as measured by lowered mortality and by high bacteriologic cure rate. Despite effective antibiotic treatment, a high incidence (57%) of congestive heart failure was noted in rabbits late in the treatment period or after termination of antibiotic treatment, probably due to healing processes on the aortic valves. In human cases of S. faecalis endocarditis the antibiotic treatment should be either penicillin plus streptomycin or penicillin plus gentamicin. However, in cases where the infecting strain is homogeneously resistant to 8000 micrograms/ml streptomycin, the treatment with penicillin plus gentamicin is clearly the drug combination of choice.

Animals↗