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PubMed1997

Tricuspid valve infectious endocarditis associated with dental treatment.

A 52-year-old man with neither congenital heart disease nor history of drug abuse had a spiking fever after dental treatment and was diagnosed with pneumonia at a local clinic. He was treated with antibiotics and his fever went down. Ten months later, he had again pyrexia and suffered from congestive heart failure. He admitted to our hospital and tricuspid valve endocarditis was proved by echocardiography. He was treated with penicillin. However, during the treatment, he developed a pulmonary embolism. So he underwent surgical treatment. We should take dental treatment into account one of predisposing causes of tricuspid endocarditis.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Infectious endocarditis at the National Institute of Cardiology "Ignacio Chavez". Five year's experience (1990-1994)].

BACKGROUND: Infective endocarditis (IE) is one of the most life threatening infections in both medical and surgical practices. In the last few years, changes in its epidemiology, diagnostic methods and therapeutical trends have appeared. We analysed our experience in the diagnosis and treatment of IE. METHODS: The clinical records of patients admitted to our hospital with definitive (Group I) and highly probable (Group II) diagnosis of IE, during a period of five years (1990-1994), were retrospectively reviewed. Age, sex, clinical features, risk, factors, echocardiographic abnormalities, microbiologic and surgical findings, as well as mortality were recorded. In addition, an evaluation was made of the accuracy of the diagnostic criteria proposed by Von Reyn versus those brought forward by Duke University. RESULTS: One hundred thirty one patients were included, 99 in Group I and 32 in Group II. The mean age was 35 years. Native valve endocarditis was present in 88 patients and prosthetic valve endocarditis in 43 patients. Streptococcus sp. (48%) was the most frequently causative german and 16.7% of cases were culture negative. The sensitivity of transesophageal echocardiography was higher than transthoracic echocardiography in the diagnosis of both vegetations (76% vs 55%) and abscesses (30% vs 16.5%), (p < 0.05). Vegetations (95%) were the most frequent surgical finding followed by abscesses (23%). Inpatient mortality was 22% in Group I and 45% in Group II (p < 0.05). The sensitivity of Von Reyn's diagnostic criteria and that of Duke's University group was 49% and 85.8% (p < 0.05). Mean follow up was 531 days. Two patients had a new event of IE and no outpatient deaths were recorded. CONCLUSION: IE is a medical and surgical emergency. Because of the high mortality rate, in the medically treated group, surgery should be considered in all cases as early as possible in the course of the disease.

Adult↗
PubMed1997

[Coronary embolism and myocardial infarction with heat rupture during infectious endocarditis].

We report a case of transmural myocardial infarction due to coronary embolism complicating infective endocarditis in a 41 year old woman. The infarction, clinically silent, was followed by rupture of left ventricular free wall, leading to hemopericardium and cardiac tamponade. The case is an uncommon complication of infective endocarditis, at the same time an uncommon cause of myocardial infarction.

Adult↗
PubMed1997

[Infectious endocarditis: prognostic factors of mortality in 131 cases].

BACKGROUND: Global hospital mortality for infective endocarditis ranges from 13 to 40%. AIM: To compare clinical, microbiological, echocardiographic factors and complications between patients that died during an episode of infective endocarditis and those who survived. PATIENTS AND METHODS: We followed during their hospital stay, 129 patients, aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. RESULTS: Thirty three patients died during hospital stay (25.2%). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occurred with higher frequency in deceased patients (57.1 and 24.3% respectively). Blood cultures were positive in 55% in survivors and 48% in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65% respectively) and embolic episodes (77 and 46% respectively) than survivors. Antimicrobial treatment was successful in 94% of survivors and 15% of those who died. Forty percent of survivors and 54% of deceased patients were subjected to surgical procedures. CONCLUSIONS: The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure.

Adolescent↗
PubMed1997

[A review of infectious endocarditis due to Candida].

OBJECTIVE: As fungal endocarditis is a serious disease, frequently requiring cardiac surgery, a review was made of the experience of our Departments in this pathology. DESIGN: A retrospective analysis of clinical, echocardiographic and surgical data. SETTING: Patients studied in a tertiary care Hospital with cardiac surgery available. PATIENTS: Between 1984 and 1994 there were ten cases of candida endocarditis in nine patients, four male and five female, mean age--45 +/- 12 years (31-65). INTERVENTIONS: The following parameters were analysed: clinical (predisposing factors, clinical evolution, complications, therapy and mortality), echocardiographic (presence of vegetations, abscesses, valvular regurgitations). Patients studied in other Centres and referred to our Department only for examination (echocardiograms) were excluded from this analysis. RESULTS: Eight cases in seven patients were prosthetic valve endocarditis and two native valve endocarditis. No patient was drug addicted. Seven cases of prosthetic valve endocarditis developed less than one year after surgery and another had a gynecological fungal infection as the cause of the endocarditis. Four patients had had previous endocarditis. There were four embolic events and three developed heart failure. There were three perivalvular infections, six valvular regurgitations and only one case with huge vegetations on echocardiography. Nine patients were treated with amphotericin B, in five fluocytosin was added and in four ketoconazol, which was replaced by flukonazol in one patient. Therapy was continued for at least eight weeks. Six patients were operated during the acute stage and one died. One patient was operated on late after the infection. Three patients died during the active stage. In a follow up of 5.2 +/- 4.8 years (8 months to 8 years) there was one fatal candida endocarditis relapse, one fatal candida sepsis, one non cardiac death, one patient developed a periprosthetic leak and one had recurrent systemic embolization. Abscesses/pseudoaneurysms were found in five out of seven patients submitted to surgery. CONCLUSION: Candida infective endocarditis has a bad prognosis, specially in those patients not operated early; it develops in patients with predisposing factors, which in our series were a previous infective endocarditis (four patients) and/or a prosthetic valve implantation less than one year before; it has important morbidity with multiple embolic events, perivalvular involvement, valvular regurgitation and heart failure.

Adult↗
PubMed1998

[A classic example of infectious endocarditis?].

A 15-year-old girl in whom the diagnosis of infective endocarditis was established was sent to our cardiothoracic centre for mitral valve replacement because of a streptococcal endocarditis resistant to adequate antibiotic therapy. Despite the combination of fever, a 'new' heart murmur, 'positive blood cultures' and 'vegetations' on the mitral valve, the clinical picture gave rise to some doubt about the diagnosis. Finally the diagnosis of systemic lupus erythematosus was made and after treatment with corticosteroids all symptoms disappeared. In our modern era 'simple symptoms' still play a very important part in clinical decision making.

Adolescent↗