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PubMed1983

[Detection and evaluation of infectious endocarditis].

Based on the findings of 50 patients with infective endocarditis, 37 affecting the aortic, six the mitral and seven both the aortic and mitral valves, in addition to analysis of predisposing factors, prominent signs and symptoms distinctive for the clinical entity were assessed (Tables 1 to 3). Preexistent conditions such as aortic valve lesions including bicuspid aortic valve as well as mitral valve lesions including mitral valve prolapse were proven in 66%. Factors which may have compromised host defense mechanisms such as cachexia and chronic alcohol or intravenous drug abuse were present in isolated cases. In 38% of the patients, a diagnostic or therapeutic manipulation, suspected to have given rise to the bacteremia, antedated the onset of endocarditis. Malaise, fatigue and chills were the most frequent symptoms (Table 4). Fever and cardiac murmurs were observed in all patients, anemia and bacteremia in 74% of the patients, respectively (Tables 4 to 6). In blood cultures, the most common microorganisms were found to be hemolytic and nonhemolytic streptococci accounting for 65% of positive findings, followed by enterococci and gram-negative bacteria each with 14% respectively (Table 6). Congestive heart failure predominated among cardiac complications with its occurrence in 84% of the patients. Valvular ring or myocardial abscess, aortic or sinus of Valsalva aneurysm, occasionally with perforation, were found in 24% of our patients. Coronary embolism was documented in 6%; infection-associated pericarditis was observed only rarely (Table 7). Extracardiac complications involved the skin, central nervous system, spleen and kidneys, respectively, in 20 to 30% of the patients. Complications afflicting the eyes, lungs, gastrointestinal tract and the musculo-skeletal system were seen with a lesser frequency of 0 to 12% (Table 8). The diagnosis of infective endocarditis, rendered highly-probable by the constellation of fever, cardiac murmur, bacteremia and anemia, necessitates, however, confirmation through cardiac examinations. In this respect, electrocardiographic and radiologic findings are of limited value, although they may be useful in the detection of cardiac complications. In 6% of the patients, positive criteria for myocardial infarction were indicative of coronary embolism and, i 30%, atrioventricular or fascicular block suggested the presence of abscess formation (Table 9). As radiologic evidence of heart failure, 74% of the patients were found to have pulmonary vascular congestion (Table 10).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

[Surgical treatment of infectious endocarditis].

Fifteen patients with diagnosis of infective endocarditis underwent surgical treatment. They were divided in two groups, the first one in which the infection rested in the patient's own valve, and the second in which the patients already had had valve replacement. Forty percent had a previous history of invasive procedure. Fifty-three percent had been treated with antibiotics prior to admission. Blood cultures were positive in 60%, gram positive germ such as streptococcus and staphylococcus predominated. Echocardiogram showed vegetation in 73% of our patients. The indications for surgery was: lack of response to medical treatment (34%), septic emboli (27%), heart failure (27%), severe renal damage (13%). The mortality rate was 20%. In none of the cases a relapse of the infection was observed.

Adolescent↗
PubMed1983

[Antibiotic therapy in infectious endocarditis].

The most common causes of infective endocarditis, accounting for 65 to 85% of all cases, are viridans streptococci and other nonhemolytic streptococci. Enterococci are the offending microorganisms in 5 to 15%, staphylococci in 5 to 15% and gram-negative bacteria from the intestinal tract in 2 to 6%. In rare cases, infective endocarditis may be caused by any of a number of other pathogenic and nonpathogenic bacteria. Men over 60 years of age and women under 40 have a higher likelihood of contracting enterococcal endocarditis subsequent to febrile infections of the urogenital tract or after abortion; intravenous drug users tend to infections with gram-negative bacteria; patients with intravascular catheters who are administered cortisone, broad-spectrum antibiotics or cytostatic drugs are at risk of endocarditis from Candida or Aspergillus. At least two, but in general, five blood cultures should be drawn in short intervals. With the use of proper techniques for detection of aerobic and anaerobic microorganisms as well as fungi, positive blood cultures can be obtained in 95% of the patients. Antibiotics may be discontinued temporarily in pretreated patients. Bactericidal antibiotics are indicated. The following rule is valid as a guideline for adequate antibacterial chemotherapy: at maximal concentration after antibiotic administration, a bactericidal effect should still be demonstrated after 1:8 dilution of the patient's serum. Prior to receipt of blood culture findings, in forms tending to be subacute, treatment should be directed at streptococci and enterococci. If the course is more acute, in the presence of an intracardiac foreign body or in intravenous drug users, the antibiotic employed should also be effective against staphylococci.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Acute mitral obstruction during infectious endocarditis].

We describe a patient with mitral valve endocarditis and valve obstruction due to a large vegetation on a previously normal mitral orifice. The diagnosis was suggested before surgery by two-dimensional echocardiography. We review the clinical features of 13 previously reported patients. In view of its ominous prognosis, accurate diagnosis of acute mitral obstruction is vital. This condition requires emergency surgery.

Adolescent↗
PubMed1983

[Emergency surgical treatment of infectious endocarditis. Experience developed on 19 consecutive cases].

Our experience with the emergency surgical treatment of 19 consecutive cases of infective endocarditis (IE) is reported. The aortic valve was always affected, either alone (n = 16) or together with the mitral valve (n = 3). All patients were male. In 10 cases it was possible to identify the infecting agent (a staphylococcus was found in 6). Congestive heart failure (CHF) was the principal indication for surgery in 14 cases (in 6 active IE was associated). Five patients (1 with CHF) underwent operative treatment because of systemic emboli. Fifteen patients were in New York Heart Association (NYHA) functional class IV, 3 in class III and 1 was in class II. Two patients (10.5%), both operated on for CHF, died in the early postoperative period. Early prosthetic valve dehiscence occurred in 2 cases, reoperation was successful in both. Follow-up of operative survivors ranges between 7 and 108 months (mean = 53.24 +/- 41.89). One patients died 10 months after operation with CHF following late prosthetic dehiscence. Out of 16 currently surviving patients 14 are in NHYA functional class I, 1 is in class II and 1 in class III. No one of them has had relapse of IE.

Adolescent↗
PubMed1983

[Infectious endocarditis in the neonatal period].

A case of bacterial endocarditis in a newborn without any congenital heart disease is reported. The clinical diagnosis was suspected on evolutive heart failure by mitral dysfunction with sepsis. T.M. mode echocardiography could detect only the valvular defects. Correlations between anatomic and echocardiographic findings allowed to discuss the limits of the method. Neonatal bacterial endocarditis is a rare event. Its diagnosis is difficult and its prognosis very poor. This affection must be prevented.

Endocarditis, Bacterial↗
PubMed1983

Splenic abscess complicating infectious endocarditis.

Infective endocarditis is the most common condition predisposing a patient to splenic abscess, and the conditions of 37 such patients are reviewed herein. Streptococci accounted for 18 abscesses, with six containing enterococci; 12 other contained staphylococci. Symptoms suggesting splenic abscess include abdominal distention, hiccups, and pain in the left flank, abdomen, and shoulder. Physical signs include recurrent or persistent fever and abdominal tenderness, with splenomegaly often inapparent. The most frequent finding on x-ray film is pleural effusion on the left side. Seventeen patients not undergoing splenectomy died; in these, the diagnosis of splenic abscess was established postmortem. Twenty patients underwent splenectomy, 19 of whom received antibiotics and survived; one patient who was not treated with antibiotics died. Physicians should suspect splenic abscess in patients with endocarditis, particularly those with staphylococcal or enterococcal endocarditis. Those patients with clinical evidence suggestive of splenic abscess should undergo specific diagnostic studies, and exploratory laparotomy may be necessary.

Abscess↗