Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOCARDITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources
PubMed1999

Endocarditis caused by group A beta-hemolytic Streptococcus in an infant: case report and review.

Acute bacterial endocarditis in the absence of underlying heart disease is rare. We report the occurrence of endocarditis caused by group A beta-hemolytic Streptococcus (GABHS), following varicella, in a 5-month-old child without heart disease. In addition to this child, seven other children with endocarditis caused by GABHS have been reported since 1966, six of whom did not have preexisting heart disease. In one of these children, GABHS endocarditis was preceded by varicella. These cases indicate that GABHS is capable of causing endocarditis in the absence of heart disease, and they provide further evidence that varicella is an important risk factor for invasive GABHS infections.

Endocarditis, Bacterial↗
PubMed1992

Persistent fever in association with infective endocarditis.

Fever persisting despite adequate antimicrobial therapy for endocarditis can be an ominous sign. To evaluate the significance of persistent fever in this situation, we reviewed the records of patients at three hospital affiliates of Albert Einstein College of Medicine. Twenty-six patients with 27 episodes of endocarditis and fever lasting for > or = 2 weeks despite appropriate antimicrobial therapy were identified and compared with a matched cohort of 26 patients with endocarditis but without prolonged fever. The median duration of fever in the former group was 35 days. Cardiac infection caused fever in 13 of these patients, seven of whom had myocardial abscesses. Additional causes of infection included drug treatment, nosocomial transmission of pathogens, and pulmonary emboli. Sixteen patients required cardiac surgery (seven on an emergent basis), whereas only two controls underwent such a procedure (P < .001). Twenty-two patients with persistent fever and five controls developed nosocomial complications (P < .001). Six patients with fever died, five from endocarditis-related complications. Thus persistent fever often indicates complicated endocarditis. We present an approach for the evaluation of the patients affected by this condition.

Adolescent↗
PubMedDate not supplied

Pathogenesis of experimental endocarditis.

Numerous important observations concerning the pathogenesis of infective endocarditis have been made over the past 18 years. Many of these observations have been obtained with animal models of endocarditis in which an indwelling catheter has been used to produce predisposing endocardial lesions for subsequent infection. Unlike several previously used animal models, the catheter-induced endocarditis models have many characteristics similar to infective endocarditis in humans. Key findings regarding microbial adherence and persistence and the host response to endocardial infection have led to a better appreciation of the complex issues operative in the pathogenesis of endocarditis.

Animals↗
PubMedDate not supplied

Enterococcal endocarditis: a comparison of prosthetic and native valve disease.

Between 1973 and 1987, 36 patients with 41 episodes of enterococcal endocarditis were seen at our institution. There were 22 episodes of native valve endocarditis (NVE) and 19 episodes of prosthetic valve endocarditis (PVE). The overall mortality before completion of therapy was 15% (18% due to NVE and 11% due to PVE). Among patients with NVE, involvement of the aortic valve was significantly associated with death or complicated illness (defined as the need for valve replacement before completion of antibiotic therapy or relapse of endocarditis after completion of therapy). Among patients who survived episodes of PVE, 69% were cured without surgical intervention. Gentamicin was administered in combination with a penicillin or vancomycin in the majority of episodes (mean duration of therapy with aminoglycosides: 5 weeks). Renal dysfunction occurred in 44% of patients who received gentamicin and occurred more frequently in patients with elevated serum creatinine levels before treatment. Our results suggest that enterococcal PVE can often be successfully treated with antibiotics alone, and they confirm the efficacy of gentamicin when it is administered in combination with cell wall-active agents for the treatment of endocarditis due to enterococci that lack high-level resistance to this agent.

Adult↗
PubMedDate not supplied

Endocarditis due to Trichosporon beigelii: in vitro susceptibility of isolates and review.

Infection with Trichosporon beigelii is an uncommon cause of endocarditis. Of the eight cases of T. beigelii endocarditis that have been reported (one herein and seven previously), six involved prosthetic heart valves and two involved native heart valves. The clinical manifestations of this infection included embolization of the superficial femoral artery or of the bifurcation of the posterior tibial and peroneal arteries in three of these patients (two with prosthetic valve and one with native valve endocarditis). In seven of the eight reported cases, blood cultures were positive for the organism. Although clinical isolates of the organism are generally reported to be susceptible to amphotericin B, isolates can vary in their sensitivities to antifungal agents in vitro depending on the methodology used, and clinical response to therapy with antifungal agents in a regimen that includes amphotericin B is generally poor. Only two of six patients who were treated with antifungal agents survived endocarditis caused by T. beigelii and were apparently cured; one of these patients was also managed surgically with valve replacement. Infection with T. beigelii should be considered in the differential diagnosis of endocarditis in immunocompetent patients, particularly those who have a prosthetic heart valve. Rapid, aggressive therapy may be necessary to eradicate this organism.

Adult↗
PubMed1996

Infective endocarditis: review of 135 cases over 9 years.

One hundred thirty-five cases of infective endocarditis in adults at the University of Alberta Hospital from 1985 to 1993 were reviewed and the von Reyn and Duke criteria were compared. There were 80 cases of native valve endocarditis, 15 cases of endocarditis in intravenous drug users, 7 cases of early prosthetic valve endocarditis, and 33 cases of late prosthetic valve endocarditis. Valve replacement or repair was performed in 33% of all cases. The overall mortality was 19%. The mortality among patients treated surgically was significantly lower than that among those treated medically (9% vs. 24%, respectively; P = .037). However, when patients who were too medically unstable for surgery or who refused surgery were excluded, the mortality among the medically treated group decreased to 15%, which was not significantly different from that among the surgically treated group. The 33 patients transferred from other hospitals were infected with similar pathogens; however, the rate of surgical intervention among these patients was much higher than that among other patients (64% vs. 24%, respectively; P < .0001), and the mortality was slightly lower (12.1% vs. 21.6%, respectively; P = .31). The 54 surgical and autopsy-proven cases were classified by the von Reyn and the Duke criteria without knowledge of the operative and autopsy results: 15% of these cases were rejected by the von Reyn criteria, and none were rejected by the Duke criteria.

Adolescent↗
PubMed1997

Microbiological cultures of heart valves and valve tags are not valuable for patients without infective endocarditis who are undergoing valve replacement.

We evaluated the significance of the results of microbiological cultures of heart valves and identification tags from newly inserted prosthetic valves that were removed from patients with valvular heart disease; none of these patients had a preoperative diagnosis of endocarditis. We reviewed the charts of patients with positive cultures for evidence of infections before or after surgery. Cultures were positive for 11.9% of 219 valves (206 native valves and 13 prosthetic or bioprosthetic valves) and 11.6% of 224 tags. The most common isolates were coagulase-negative staphylococci. Typical agents of endocarditis--viridans streptococcus, Enterococcus faecalis, and Staphylococcus aureus--were cultured from five specimens, and Mycobacterium avium complex was identified in six valves. None of the patients with positive valve or tag cultures developed postsurgical endocarditis or wound infection. Findings on histopathologic examination of the valves were not consistent with endocarditis. We conclude that the results of cultures of valves from patients without preoperative diagnoses of endocarditis lack clinical significance, and positive tag cultures are not predictive of postsurgical infection. Positive cultures are most likely a result of contamination during surgery or thereafter.

Adolescent↗
PubMedDate not supplied

Infective endocarditis complicating mitral valve prolapse: epidemiologic, clinical, and microbiologic aspects.

Cases of infective endocarditis superimposed upon prolapsing mitral valves were first described two decades ago. In the intervening years 72 reports in the English-language literature have described 267 such cases. Men predominated numerically in cases occurring after the age of 40 years and in surgical and autopsy series. In cases with auscultatory abnormalities documented before the onset of infective endocarditis, murmurs-and not merely isolated systolic clicks--were usually present. Complications of infective endocarditis were relatively common, and at least 42 patients required valve replacement in the acute phase of illness or during convalescence. Although viridans streptococci were the most frequent etiologic agents (46% of cases), deaths occurred primarily among patients infected with other organisms and among those over 40 years of age. Mitral valve prolapse is increasingly being recognized as a precursor of infective endocarditis because of its high prevalence in the general population and the wider availability of echocardiographic diagnostic techniques. The risk/benefit and cost/benefit ratios for endocarditis prophylaxis in patients with prolapsing mitral valves remain controversial.

Adolescent↗
PubMedDate not supplied

Prosthetic valve endocarditis due to small-colony staphylococcal variants.

Although Staphylococcus epidermidis is a major cause of prosthetic valve endocarditis, little is known about the pathogenesis of this disease. In one case described herein, small-colony variant forms of S. epidermidis were isolated from clinical specimens obtained from a patient with prosthetic valve endocarditis. Data from the rat model of experimental endocarditis provide further evidence that small-colony variants may be operative in the production of prosthetic valve infection. Moreover, a review of the literature indicates that small-colony variants could account for the subtle clinical course after prolonged dormant infection that characterizes S. epidermidis prosthetic valve endocarditis. It is therefore hypothesized that small-colony variants of S. epidermidis may play a role in the pathogenesis of prosthetic valve endocarditis.

Animals↗
PubMed1995

Prevention of bacterial endocarditis in Germany.

The goal of this study was to assess the current practice of endocarditis prophylaxis in Germany. We conducted a survey using a standardized questionnaire, which was sent to 100 hospital cardiologists, to 430 cardiologists in office practice and to 389 dentists and oral surgeons. In addition, 364 patients with valvular or congenital heart disease were interviewed in our outpatient clinic. Seventy five percent of cardiologists informed their patients by both written and oral instructions. Half recommended the use of penicillin, according to the German Society of Cardiology, while the rest followed recommendations of other societies. Sixty-three percent of patients who had undergone a procedure requiring prophylaxis against bacterial endocarditis within the year prior to the questionnaire, had actually received it. This is higher than previously reported, but is far from acceptable. The indications for prevention of endocarditis, as seen by the dentists, deviated markedly from official recommendations. Although 77% administered antibiotics themselves, in only 57% did the type of prophylaxis applied correspond to one of the available recommendations. Recommendations on the prevention of bacterial endocarditis are not well known dentists and oral surgeons who perform procedures for which it is indicated. Further patient- and physician-oriented strategies are urgently needed to improve compliance with prevention of endocarditis in Germany.

Anti-Bacterial Agents↗
PubMed1995

Fungal endocarditis.

Fungal endocarditis has become an important infection associated with medical progress and a modern lifestyle. The most common organisms isolated from patients with fungal endocarditis are: Aspergillus spp.; Candida spp. and Torulopsis glabrata. Men are more frequently affected than women and predisposing factors include: previous cardiac surgery, antibiotic use and hyperalimentation, long-term i.v. catheters. Common clinical findings in patients with endocarditis include: fever, changing murmurs, peripheral emboli which are characteristically large and chorioretinitis. Characteristic laboratory findings are absent and positive blood cultures are obtained only in a relatively small number of patients. Characteristically, Aspergillus spp. almost never grow in blood cultures and must be isolated from removed emboli, from the diseased valve or from infected foreign bodies. Overall survival in patients with fungal endocarditis is rather poor, and hardly exceeds 50%. In general, a combined surgical-medical approach would yield the best results. New therapeutic modalities are needed in order to improve the prognosis of fungal endocarditis.

Endocarditis↗
PubMed1985

Successful prophylaxis of experimental streptococcal endocarditis with single doses of sublethal concentrations of penicillin.

Penicillin prophylaxis against experimental endocarditis due to a strain of Streptococcus intermedius isolated from a patient with endocarditis was studied in rats. The minimum bactericidal concentration of penicillin for this strain was more than 64 mg/l and was higher than the peak penicillin serum level obtained in rats 30 min after the iv injection of 60 mg/kg, and in man after an oral dose of 2 g of phenoxymethyl penicillin. Moreover timed kill curves performed in the presence of 64 mg/l of penicillin showed no decrease in the number of colony-forming units during the first 6 h of incubation and only a 95% decrease after 24 h. In addition, no bactericidal activity could be detected in the serum 30 min after penicillin injection, that is at the time of bacterial challenge. Using the minimum bacterial inoculum needed to produce endocarditis in 90% of control animals (ID90), penicillin successfully prevented endocarditis due to this strain. We conclude that penicillin may prevent streptococcal endocarditis by other mechanisms than bacterial killing.

Animals↗
PubMed2003

Efficacy of ampicillin combined with ceftriaxone and gentamicin in the treatment of experimental endocarditis due to Enterococcus faecalis with no high-level resistance to aminoglycosides.

OBJECTIVE: This study tests the usefulness of ceftriaxone combined with ampicillin as an alternative to ampicillin plus gentamicin for the treatment of experimental endocarditis due to Enterococcus faecalis without high-level resistance to aminoglycosides. It also determines whether adding ceftriaxone to ampicillin and gentamicin increases the effectiveness against experimental enterococcal endocarditis resulting from E. faecalis. METHODS: Animals with catheter-induced endocarditis were infected intravenously with 108 cfu of the EF91 strain of E. faecalis and were treated for 3 days with ampicillin 2 g every 4 h administered as 'human-like' (H-L) pharmacokinetics, plus gentamicin 1 mg/kg every 8 h H-L, or ceftriaxone 2 g every 12 h H-L alone or combined with gentamicin 6 mg/kg every 24 h administered subcutaneously. RESULTS: The results of therapy for experimental endocarditis resulting from EF91 showed that the combination of ampicillin plus ceftriaxone was as effective as ampicillin plus gentamicin. The triple combination did not improve on the overall efficacies of the two-drug combinations. CONCLUSIONS: Because of its lower nephrotoxicity, ampicillin plus ceftriaxone may be a useful alternative therapy for E. faecalis endocarditis in selected patients.

Aminoglycosides↗
PubMed2004

Viridans streptococci in endocarditis and neutropenic sepsis: biofilm formation and effects of antibiotics.

OBJECTIVES: Viridans group streptococci (VGS) are a frequent cause of bacterial endocarditis or sepsis in patients with neutropenia. Endocarditis in particular, is associated with plaque formation on the endocardium and valve leaflets whereas VGS septicaemia in neutropenic patients is caused by the influx of oral flora bacteria through mucositic lesions. This study examined the in vitro potency for biofilm formation of clinical VGS bloodstream isolates, and the effects of antibiotics on these biofilms. METHODS: During the years 1998-2000, 40 VGS bloodstream isolates from 18 patients with endocarditis and 22 patients with severe sepsis and neutropenia were collected. The MICs of penicillin, teicoplanin and moxifloxacin were determined using the microdilution broth method according to NCCLS criteria. Biofilms were grown in microtitre plates, dyed with Crystal Violet, and the mean optical density (OD) was used for quantification. Biofilms were incubated with penicillin, teicoplanin and moxifloxacin at various concentrations starting with the MICs for the respective isolates tested. RESULTS: Isolates from eight out of 18 patients with endocarditis and six out of 22 patients with neutropenia formed biofilms (not significant). For the 14 isolates, the MIC(90)s (range) of penicillin, teicoplanin and moxifloxacin were 0.5 mg/L (0.001-0.5), 0.125 mg/L (0.025-0.125) and 0.5 mg/L (0.05-0.5), respectively. Generally, biofilms persisted although incubated with the antibiotics up to concentrations of 128 x MIC. However, the ODs of biofilms after incubation with an antibiotic were significantly lower than the ODs of biofilms without antibiotic (P<0.05). A significant decrease in the biofilms with increasing antibiotic concentrations was observed for teicoplanin and moxifloxacin, but not for penicillin G. CONCLUSIONS: VGS isolated from patients with endocarditis and patients with sepsis and neutropenia form biofilms. Biofilms persist even when exposed to antibiotics at concentrations up to 128 x MIC. Nevertheless, teicoplanin and moxifloxacin reduced the density of the biofilms at concentrations >/=16 x MIC. Thus, testing the effects of antibiotics on biofilms may supply useful information in addition to standard in vitro testing, particularly in diseases where biofilm formation is involved in the pathogenesis.

Adolescent↗
PubMed2005

Successful moxifloxacin prophylaxis against experimental streptococcal aortic valve endocarditis.

OBJECTIVES: Studies related to the prophylactic efficacy of fluoroquinolones against infective endocarditis are scarce. The aim of this study was to evaluate the efficacy of moxifloxacin, a quinolone active in vitro against Gram-positive cocci, in preventing streptococcal aortic valve endocarditis. METHODS: Non-bacterial thrombotic endocarditis of the aortic valve was induced by the insertion of a polyethylene catheter. Twenty-four hours later, rabbits were randomly assigned to a control group, and groups receiving either two doses of ampicillin (40 mg/kg, intravenously), 2 h apart, or a single dose of moxifloxacin (15 mg/kg, intravenously). Ampicillin and moxifloxacin were administered 0.5 and 1 h, respectively, prior to the intravenous inoculation of 10(7) cfu of Streptococcus oralis. RESULTS: Eighty-nine percent of the control animals developed infected vegetations. In rabbits challenged with this very high inoculum, moxifloxacin and ampicillin prevented endocarditis in 80% (P < 0.001 versus controls) and in 50% (P = 0.022 versus controls) of animals, respectively. The difference between ampicillin and moxifloxacin was not statistically significant (P = 0.128). CONCLUSIONS: Moxifloxacin was at least as effective as ampicillin in preventing streptococcal endocarditis.

Ampicillin↗
PubMed2000

Renal pathological findings in infective endocarditis.

BACKGROUND: Accounts of renal pathological findings in infective endocarditis are mostly based on studies from many years ago. We reviewed a group of patients with infective endocarditis in the light of modern concepts of renal pathology, including the largest reported series of renal biopsies in this condition. METHODS: Renal tissue was available for retrospective study from 62 patients with confirmed infective endocarditis out of 354 diagnosed with the disease between 1981 and 1998 inclusive. Twenty patients had a renal biopsy and 42 a necropsy. RESULTS: Common renal lesions noted were localized infarcts in 31%, noted only in necropsy material, and acute glomerulonephritis in 26%, noted in biopsy and necropsy material. The commonest type of glomerulonephritis was vasculitic, without deposition of immunoproteins in glomeruli. Of the renal infarcts over half were due to septic emboli, mostly in patients infected with Staphylococcus aureus. Acute interstitial nephritis was found in 10% but was more common in biopsy material and seemed attributable to antibiotics. Renal cortical necrosis found in 10% was apparent only at necropsy. There were various other findings in the kidney. CONCLUSIONS: The kidneys are commonly affected in infective endocarditis by a variety of complications of clinical significance. The commonest type of glomerulonephritis does not appear to be attributable to deposition of immune complexes. A renal biopsy may be helpful in the investigation of renal impairment in a patient with infective endocarditis.

Adult↗
PubMed1997

Incidence and prognosis of embolic events and metastatic infections in infective endocarditis.

AIMS: In infective endocarditis, the true incidence of embolic events and metastatic infections remains unknown probably because a large number of events are asymptomatic. The consequences of the prognosis of such events have never been evaluated by a prospective follow-up. This study aimed to assess the incidence of symptomatic or asymptomatic embolic events and metastatic infections in definite infective endocarditis and to determine whether these events carry a risk of mortality. METHODS AND RESULTS: From January 1991 to December 1993, 102 patients with suspected or known infective endocarditis were referred to our institution. Among them, we selected 68 patients (50 males, 18 females, mean age = 52.7 years) exhibiting definite infective endocarditis according to the Duke University criteria. Blood cultures were positive in 49 cases (72%). Echocardiography revealed valvular vegetations in 55 cases (81%). Irrespective of the clinical presentation, patients were examined radiologically by cerebral computed tomography scanning (n = 60), magnetic resonance imaging (n = 3), abdominal computed tomography scanning (n = 32) or abdominal echocardiography (n = 20). Depending on the symptoms, thoracic computed tomography scanning (n = 22), pulmonary angiography (n = 2), ventilation-perfusion scintigraphy (n = 4), or gallium citrate radionuclide scanning (n = 7) were also performed. All patients were prospectively followed-up for a mean period of 21.4 +/- 17.5 months. In 35 patients (51%), 51 embolic or metastatic events were revealed, involving the central nervous system (n = 23), spleen (n = 7), kidney (n = 5), lung (n = 5), liver (n = 4), bone and joint (n = 4), iliac (n = 2) or mesenteric (n = 1) arteries. During the hospital stay, the mortality rate was higher in patients exhibiting embolic or metastatic events (20 vs 12%), but the difference did not reach statistical significance. Kaplan-Meier analysis demonstrated no difference in long-term follow-up. CONCLUSION: Our data suggest that embolic or metastatic events had a high incidence (51%) during infective endocarditis, but were not associated with significant attributable mortality.

Adult↗
PubMed1995

Identification of high-risk subgroups in infective endocarditis and the role of echocardiography.

The outcome of infective endocarditis remains poor. It has an overall mortality of around 30%, rising in high-risk subgroups to 50% and 100%. The prognosis can be improved by identification of high-risk patients and special management. Patients with infective endocarditis are found to be at high risk for death or serious complications when one or more of the following factors exist: old age (especially > 60 years old), delayed diagnosis, staphylococcal infection, aortic valve endocarditis, large valvular vegetation, congestive heart failure, embolization in the central nervous system or coronary artery, prosthetic valve infection, recurrent events, and failed antibiotic therapy. These factors often coexist and interrelate with one another. Early diagnosis and active treatment are critical for a better clinical outcome. However, infective endocarditis is difficult to diagnose because of the atypical clinical manifestations and frequent negative results from blood culture. Echocardiography plays an indispensable role in the diagnosis and management of suspected or known infective endocarditis. By detecting and monitoring certain pathological changes associated with the disease, e.g. vegetation, abscess formation, or valvular destruction, echocardiography helps to diagnose the disease early, to identify patients at high risk, to monitor the patients, and to optimize the timing and mode of surgical intervention. Serious complications can thus be avoided or cured at an early stage and the prognosis significantly improved.

Age Factors↗