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 883 records · Page 49Linked to original sources
PubMed2000

Unusual association: Streptococcus bovis tricuspid endocarditis with atrial-septal aneurysm and patent foramen ovale.

Streptococcus bovis endocarditis is a frequent cause of streptococcal endocarditis and is associated with colonic tumours. The tricuspid valve is very rarely affected and its involvement is a complication which can lead to a less favourable outcome. We report the seventh case of tricuspid valve endocarditis due to S. bovis, and the first, to our knowledge, to be associated with an atrial-septal aneurysm and a patent foramen ovale. The underlying medical conditions and predisposing factors for development of tricuspid valve endocarditis are described and interesting new echocardiographic data are presented. The current guidelines on antibiotic therapy for S. bovis tricuspid valve endocarditis are reviewed.

Drug Therapy, Combination↗
PubMedDate not supplied

[Pacemaker lead endocarditis: analysis of 11 cases].

BACKGROUND: The prevalence of infection of permanent pacemaker ranges from 0.13 to 19.9%. Our objective is to review our experience and to analyze the epidemiology and treatment of those diagnosed as having pacemaker lead endocarditis. METHODS: A retrospective study include all cases diagnosis of pacemaker endocarditis in our hospital, since 1991 to 1998. Eleven patients with pacemaker endocarditis were included. RESULTS: Eleven patients were admitted for endocarditis related to pacemaker-lead infection. Fever occurred in nine patients (81.8%). A germ was isolated in nine patients (81.8%) and was a Staphylococcus in eight (88.9%). Transthoracic echocardiography demonstrated vegetations in only two patients (18.2%), whereas transesophageal echocardiography disclosed abnormal appearances on the pacemaker lead in eleven patients (100%). Six patients were treated with antibiotics initially and four patients required the removal of the whole infected material after finishing treatment with antibiotic. Five patients were treated since the beginning with a electrode removal who responded favorably. CONCLUSIONS: The diagnosis of endocarditis related to pacemaker infection should be suspected in the presence of fever and patient with pacemaker. Transesophageal echocardiography should be performed to look for vegetations. S. aureus and S. epidermidis are involved in the majority of these infections. The best treatment is an immediate removal of the entire pacing system and antimicrobial therapy.

Aged↗
PubMed2001

Prosthetic valve fungal endocarditis due to histoplasmosis.

Fungal endocarditis is associated with severe patient morbidity and mortality. Unfortunately, fungal endocarditis is difficult to diagnose because fungal pathogens are uncommonly isolated from routine blood cultures. Histopathological examination of surgically excised cardiac valves, peripheral emboli and systemic ulcers may be useful in identifying pathogens as etiological agents of culture-negative endocarditis. The authors describe a 63-year-old man who had culture-negative endocarditis. Multiple echocardiograms showed progression of the vegetations with valve stenosis despite treatment with multiple antimicrobials. He had multiple peripheral emboli before surgery. Disseminated histoplasmosis was diagnosed by bone marrow culture. Yeast organisms consistent with histoplasma were shown in the vegetations of his excised mitral valve prosthesis. The patient was treated with amphotericin and has been doing well in the two years since his surgery. The diagnosis and management of fungal endocarditis are emphasized.

Anti-Bacterial Agents↗
PubMed2001

Infective endocarditis with neurologic complications: 10-year experience.

The impact of neurologic complications on clinical outcomes in infective endocarditis was assessed. Medical records of patients with infective endocarditis from January 1, 1987 through September 30,1998 were analyzed. Patients were divided into two groups: one with neurological complications and the other without. The outcomes of the two groups were compared using Fisher's exact test. Fifty-eight patients fulfilled the definite Duke criteria. There were 46 men and 12 women, ranging from 3 to 71 years of age with a mean of 40.6 years. Pathogens of infective endocarditis were documented by blood culture in 55 (94.8%) of 58 patients as follows: 52 with gram-positive cocci, two with gram-negative bacilli, and one with fungus. All 58 patients had initially received antimicrobial agents. Eight (13.8%) of the 58 patients had received surgical valvular replacement because of medical treatment failure. Overall, 16 (27.6%) of 58 patients died. Neurologic complications were either the chief complaint or one of the major presenting symptoms in 16 (27.6%) of the 58 patients. Patients with neurologic complications had a higher mortality rate (50% vs 20.9%, p = 0.025) than those without neurologic complications. The adjusted risk ratio for neurologic complications for a fatal event was 3.51 (95% CI = 1.1-11.18, p = 0.03). Neurologic complications pose a significant problem in infective endocarditis. To reduce mortality, we recommend that more attention be paid to the treatment and prevention of the neurologic complications of infective endocarditis.

Adolescent↗
PubMed2001

Infective endocarditis of native cardiac valves: 22 years' surgical experience.

BACKGROUND AND AIM OF THE STUDY: Most previous studies on surgery for endocarditis included cases of both prosthetic and native valve endocarditis (NVE), which clearly differ in their course and prognosis. METHODS: Between February 1979 and July 2000, 199 patients underwent surgical treatment for NVE. The native valve was replaced in 185 patients, and repaired in 14. Correlations between previous heart disease and site of NVE, site and etiology, site and embolism, and etiology and extracardiac infection were analyzed. Viability of echocardiography to identify NVE features was compared with surgical inspection. Risk factors for hospital, late mortality and recurrence were assessed by multivariate analysis, including preoperative, operative and postoperative variables. RESULTS: Streptococci were found in 52 cases (26.1%), mostly spreading from splanchnic (n = 10) and cutaneous (n = 9) infections; Staphylococci were found in 43 cases (21.6%), mostly from cutaneous foci (n = 20). Tricuspid valve endocarditis was due to Staphylococcus sp. in all documented cases (11/15; p <0.001), while Streptococcus sp. predominated in the mitral (p = 0.026) position. Echocardiography was reliable in identifying anatomic features of NVE, except for periannular abscess (13 versus 31 found at surgery; p <0.001). Hospital mortality was 6% (n = 12): preoperative NYHA class IV (p = 0.034) and emergency surgery (p = 0.001) were significant predictors of mortality. Average follow up was 57.2+/-4.4 months and was 96.3% complete. There were 27 late deaths (15%). Actuarial survival was 75.7% at 10 years and 60.3% at 20 years. Low social status (p = 0.022), diabetes mellitus (p = 0.003), fever at time of surgery (p = 0.041) and persistent postoperative fever (p = 0.0002) were predictors for late mortality. Endocarditis recurred in 28 patients (15.5%), with 74.1% freedom at 10 years and 68.7% at 20 years. Drug abuse (p = 0.001), mitral endocarditis (p = 0.002), positive blood cultures (p = 0.0003), homograft implantation (p = 0.0012) and persistent postoperative fever (p <0.0001) were significant predictors for recurrence. CONCLUSION: Preoperative conditions of patients with NVE significantly affect early and long-term outcomes. Prognosis is worsened by delayed diagnosis and operation during the active septic process.

Adolescent↗
PubMed2001

Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.

BACKGROUND AND AIM OF THE STUDY: The study aim was to describe the long-term results and determinants of mortality after operative treatment of native and prosthetic valve endocarditis at a single institution. METHODS: Between March 1985 and October 1999, 171 patients underwent surgery for native (NVE) or prosthetic valve endocarditis (PVE). NVE was present in 98 patients (57%), and PVE in 73 patients (43%). Mean follow up was 5.6+/-3.9 years (range: 0 to 15 years). RESULTS: Overall hospital mortality was 9.9% (n = 17). Hospital mortality was higher among patients with PVE (15.1%) than those with NVE (6.1%; p = 0.05). Overall survival at 10 years was 46+/-5%. Patients with NVE had a higher 10-year survival rate (53+/-7%) than those with PVE (37+/-7%; p = 0.02). At 10 years, overall freedom from any late complication was 47+/-6% and from residual or recurrent endocarditis was 78+/-5%. Predictors of hospital death were emergency surgery (p <0.003) and preoperative renal insufficiency (p <0.008). Predictors of late death were age >70 years (p <0.002), renal failure (p <0.03) and fungal endocarditis (p <0.04). CONCLUSION: These findings demonstrate the increased perioperative, as well as postoperative, risks associated with PVE versus NVE. Cardiac and extracardiac manifestations of the disease, as well as fungal organisms, but not the activity of the endocarditis, were significant adverse determinants of late outcome.

Endocarditis↗
PubMed2001

[Antibiotic treatment of infectious endocarditis].

BACKGROUND: Infective endocarditis is a septic condition in which the heart valves and the endocardial surfaces are infected, causing bacteraemia. In Norway, infective endocarditis is the most common infectious disease of the heart and accounts for approximately one case per 1,000 hospital admissions. The mortality rate is 15-40%. MATERIAL AND METHODS: This article presents a review of antimicrobial treatment of infective endocarditis, based on relevant literature and the author's clinical experience. Prophylactic treatment is not described. RESULTS AND INTERPRETATION: Early start of antimicrobial treatment is extremely important in order to avoid destruction of the heart valves and should always be started as soon as endocarditis is suspected and blood cultures have been drawn. The patient must be treated with bactericidal antibiotics in high doses given intravenously for four to eight weeks, depending on the aetiologic agents and the response. Only antibiotics that have been proven effective against endocarditis should be used. The minimal inhibitory concentration (MIC) should be determined for all antibiotics used.

Anti-Bacterial Agents↗
PubMed2002

Q fever endocarditis: over 14 years of surgical experience in a referral center for rickettsioses.

BACKGROUND AND AIM OF THE STUDY: Q fever endocarditis caused by Coxiella burnetii is the most important etiology of negative blood culture endocarditis. Without specific clinical findings, diagnosis is difficult and prevalence of this life-threatening disease is underestimated. METHODS: Q fever endocarditis was assessed in 19 patients (15 men, four women; age range: 36-79 years) by evaluating clinical and echocardiographic criteria and specific serology. All patients had evidence of pre-existing valvular disease, and 10 had a valvular prosthesis. Diagnosis was assessed in: the presence of unexplained fever (n = 5), heart failure with valvular dysfunction (n = 10), hemolysis (n = 1), glomerulonephritis (n = 1) and stroke (n = 2). A late diagnosis was made in eight patients, either during or after surgery. RESULTS: In all cases, usual blood cultures remained negative, despite specific serology being positive. Transthoracic and transesophageal echocardiography were conclusive in only six cases (four vegetations, two periannular abscesses). Surgery was indicated in 15 patients for heart failure or valvular dysfunction (n = 12), hemolysis (n = 1) and periannular abscess (n = 2). Intraoperative findings were suggestive of endocarditis in seven cases; valvular cultures were positive in 92% of cases. All patients were treated with combined doxycycline/ hydrochloroquine or quinolone, for a mean of 24 months (range: 6-60 months). Mean follow up was 40 months (range: 6-144 months). Two patients died from heart failure, one patient was lost to follow up, and 16 patients had no late relapses. CONCLUSION: Q fever is an underestimated cause of endocardititis, and early diagnosis is the key to good prognosis. The need for systematic serologic examination in case of valvular dysfunction, with or without endocarditis symptoms, is emphasized.

Adult↗
PubMedDate not supplied

Complications and outcome in left-sided endocarditis in children.

We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatric patients to find out the prognostic significance of the presence and size of echocardiographically detected vegetations. Among the children admitted to our institution with endocarditis between January 1987 and October 1999, 16 patients (mean age 9.03 +/- 4.95 years) who met the Duke criteria for the diagnosis of infective endocarditis (IE) were included in this study. Rheumatic valvular disease was the most frequent underlying heart disease (10 patients: 62.5%). Five patients were operated at a mean of 13.9 months before endocarditis, and all had residual defects. Vegetation was detected in 11 cases (69%). Ten patients had major complications (within 2 weeks in 6 patients). Three patients developed congestive heart failure (CHF), six had intracranial and one had lower extremity emboli. Among them four were operated because of complications (CHF: 3 cases, intracranial emboli: 1 case). All the operated cases are doing well. The association between intracranial embolic events and echocardiographically detected vegetations was determined by calculating specificity (40%), sensitivity (100%), positive predictive value (50%), and negative predictive value (100%). No intracranial embolism occurred in patients without vegetations. All vegetations were < or = 6 mm in patients with systemic embolism. There were four deaths, three of which were because of intracranial embolism. This study suggests that intracranial emboli have a major risk of mortality in left-sided endocarditis. The larger size of the vegetation is not a predictor of complications; furthermore, the absence of vegetations predicts that the patient is safe from embolic events. Therefore all patients with left-sided IE should be considered for earlier surgical intervention.

Adolescent↗
PubMed2002

Aortic root pseudoaneurysm following surgery for aortic valve endocarditis.

Prosthetic aortic valve replacement for aortic valve endocarditis remains a primary practice of most cardiac surgeons. Usually it cures endocarditis and restores cardiac function. However, in advanced aortic valve endocarditis with complex annular destruction, complications following prosthetic aortic valve replacement do occur and present a formidable challenge for reoperation. Herein, we describe a case of an adult man who was operated on initially for advanced aortic valve endocarditis with a large periannular abscess cavity and who developed congestive heart failure 3 months later. Furthermore, he was diagnosed with a giant pseudoaneurysm around the aortic root without evidence of recurrent infection or aortic prosthetic incompetence. During his reoperation, a cryopreserved aortic homograft as a root replacement that included reimplantation of bilateral coronary artery buttons was used to exteriorize this pseudoaneurysm and reconstruct a left ventricular outflow tract. The postoperative course was unremarkable, and the patient, during a follow-up of 2 years, remained in New York Heart Association functional class I. Aortic root pseudoaneurysm following prosthetic aortic valve replacement for infective endocarditis is rare in clinical practice and can cause rapid hemodynamic deterioration which requires imminent reoperation. Homograft aortic root replacement has proven to be a versatile treatment option of this complex disease.

Aneurysm, False↗
PubMed2001

[Infective endocarditis in adults].

OBJECTIVE: The aim of the research was to demonstrate that the early diagnosis of infective endocarditis influences significantly the results of treatment. METHODS: The following clinical analysis covered 56 patients, aged 18 to 81 (the average age--50 years) with infective endocarditis treated in the years 1998-2000. Data from patient history, physical examination, laboratory investigations and treatment were analysed. Apart from clinical symptoms for infective endocarditis diagnosis, also blood cultures and echocardiography were important. MAIN OBSERVATIONS: Infective endocarditis was present in 24 patients (42.8%) with heart defects, 7 (12.5%) with prosthetic heart valves, and 4 (7.1%) treated with haemodialysis. RESULTS: In 38 (67.8%) individuals, the echocardiography showed vegetations, and in 14 (25.0%) other abnormalities. Blood cultures were positive in 33 (58.9%) patients. Fever was present in 47 (83.9%) patients. The progression of heart failure appeared in 26 (46.4%) individuals. The average time of antibiotic therapy was 34 days. 11 (19.6%) patients died. 9 (16.1%) individuals had cardiosurgery operations. CONCLUSIONS: Early diagnosis of infective endocarditis is substantial as it improves patients' prognosis as to health and life.

Adult↗
PubMed2002

Infective endocarditis--a twelve year surgical outcome series.

AIM: To review the clinical course and outcome of patients with infective endocarditis proceeding to surgical treatment in the South Island of New Zealand. METHODS: A retrospective review of all cases of infective endocarditis requiring cardiac surgery, excepting homograft replacement between 1989 and June 2001 was performed. All patients treated at both cardiothoracic units over this time frame in the South Island of New Zealand were included. RESULTS: A total of 29 patients, ten females and nineteen males, age range 31-79 years (mean 55) underwent surgery. 27 patients had native valve endocarditis, two infection of prosthetic valves. A variety of causative micro-organisms were isolated, and all patients received aggressive intravenous antibiotic therapy. Heart failure was the predominant indication for surgical intervention. Fifteen patients underwent aortic, nine mitral, three combined and two replacement of infected prosthetic valves. There were five peri-operative deaths (17% mortality) and significant morbidity in a further eleven patients (38%). Of the 23 survivors available to follow-up none have recurrent endocarditis, with an average disease free survival of 35 months. CONCLUSIONS: Patients who require valve surgery for endocarditis have significant peri-operative morbidity and mortality. Long-term outcome in survivors, however, is extremely good with a prognosis similar to those undergoing elective valve replacement surgery. Mycotic cerebral aneurysms are an emerging important cause of early deaths.

Adult↗
PubMed2002

[Vascular complications of infective endocarditis: a retrospective analysis of 18 cases].

OBJECTIVES: Among 82 patients hospitalized for infective endocarditis between June 1995 and June 2001 at the cardiology B unit of the Rabat University Hospital Morocco, 18 (22%) had one or more vascular complications. We present here a retrospective analysis. PATIENTS AND METHODS: The cohort included 12 men and 6 women, mean age 22 years. Infective endocarditis had grafted on a pre-existing cardiopathy among 17 patients: rheumatic heart disease (n=14), mechanical prosthetic valve (n=2), congenital heart disease (n=1). RESULTS: For 12 patients, vascular disease was the only complication, 1 had two complications and 4 three complications. This gave 26 lesions: 11 neurological complications, 10 arterial diseases involving the limbs including 5 mycotic aneurysms, 2 acute myocardial infarcts, 2 splenic infarcts, and 1 recurrent septic pulmonary embolism. Vascular disease was the inaugural manifestation in 9 patients and 54% of the complications occurred before the end of the second week of antibiotic treatment. Blood cultures were positive in 7 patients (40%). Oral streptococcus was isolated in 5 cases, Gram-negative bacillus in 1 case and Staphylococcus aureus in 1. Echography revealed valvular vegetations in the 16 cases of infective endocarditis on native valves: mitral (n=9), aortic (n=5), mitroaortic (n=1), tricuspid (n=1). Short term outcome was marked by 4 deaths including 3 directly related to the vascular complication. DISCUSSION: We emphasize the variable and diverse features of vascular complications of infective endocarditis. Prevention and early diagnosis are essential to institute optimal management of infective endocarditis.

Adolescent↗
PubMedDate not supplied

[Course and outcomes of infectious endocarditis in HIV-infected patients].

39 patients with acute infectious endocarditis were observed; of these, 28 patients had HIV infection at different stages of the disease. The specific features of the course of acute infectious endocarditis in HIV-infected patients were established. The severe course of acute septic endocarditis was observed in those patients whose parameters of the cell-mediated immune system (cells CD4+) were in the state of compensation or subcompensation. At different stages of HIV infection different clinical syndromes of infectious endocarditis prevailed. In patients with HIV infection the combined lesions of the heart valve apparatus were observed and mixed microflora was isolated from the blood more frequently. The development of acute septic endocarditis negatively affected the course of HIV infection and was manifested by a rapid decrease in the amount of CD4 lymphocytes.

Acute Disease↗
PubMed2003

[Prevention of bacterial endocarditis].

Because of its severity, it is agreed that infectious endocarditis should be prevented whenever possible. Certain patient populations at risk for endocarditis have been identified. Antibiotic prophylaxis is therefore recommended when these individuals undergo procedures likely to cause bacteremia with organisms that cause endocarditis. In this article we attempt to provide a comprehensive approach to infectious endocarditis prophylaxis based both on the pathophysiology of the disease and on the mechanisms of action of prophylactic drugs. Approaches to the prevention of endocarditis have been recently modified and are reviewed in this paper, especially important issues for the primary care physician.

Antibiotic Prophylaxis↗
PubMed1992

[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Amphotericin B↗
PubMed1992

[Meningitis and other neurological complications in infectious endocarditis].

PURPOSE: To study the localization, etiological agents and the respective prognosis in patients with infective endocarditis with or without neurological complications, with emphasis on the association of endocarditis and meningitis. METHODS: 222 patients with clinical, echocardiographic and laboratory diagnosis of infective endocarditis were treated at Instituto Dante Pazzanese de Cardiologia from 1985 to 1990. They were classified in two groups: group A-116 patients without neurological complications, ages 4 months-76 (mean 30) years old and 66.3% males. group B-56 patients with neurological complication, ages 1-71 (mean 31) years old and 46.4% males. A third group, group C, comprised 17 patients, ages 8-51 (mean 23.7) years old and 9 patients (52.9%) male, assisted at Hospital Emilio Ribas, which is specialized at infectious diseases, which presented meningitis as the unique manifestation of neurological complication associated to the diagnosis of infective endocarditis (IE). In all patients the diagnosis of IE was based on the presence of at least two of three essential findings: echocardiogram with vegetations or valvar dysfunctions, positive hemocultures and the compatible clinical picture. For the comparative analysis among the groups was employed through the chi-square test corrected according to Yates. RESULTS: No differences of sex and age of the patients were found among the three groups. Predominated the Staphylococcus aureus as etiological agent. The localization of cardiac lesions was similar in the three groups, except for the tricuspid valve affected in 16.3% of patients of group A and 2.3% of group B. There was a greater association of the structures on the left side of the heart with IE of group B (p < 0.05). Group B and C showed a general mortality rate greater than group A (p < 0.001). CONCLUSION: Meningitis and other neurological complications showed interrelationship between the presence of "Staphylococcus aureus" as etiological agent of endocarditis and the association with infection of the left heart side.

Adolescent↗
PubMed2003

Infective endocarditis caused by group G streptococcus with multiple cerebral emboli.

The group G streptococcal endocarditis is a rare form of infective endocarditis. In this form of infective endocarditis, serious neurological complications most commonly develop. We reported this case because of its being an unusual form of infective endocarditis that was caused by Group G Streptococcus. We also reviewed the literature. The patient was admitted to infectious disease service with a presumptive diagnosis of central nervous system infection. Blood cultures were positive for group G streptococcus. There was a mass on the posterior surface of the mitral valve which was 2 x 2.5 cm in length on the echocardiography. In the cranial computerized tomography of our patient, slightly increased contrast media uptake was observed in the both parietal lobes, in the both frontal lobes, and in the anterior areas of right occipital lobe. Therefore, this case was assumed as infective endocarditis caused by group G streptococcus with multiple cerebral emboli. Ceftriaxone was given for 4 weeks and gentamicin was given for 2 weeks, and progressive improvement of the patient's condition was seen.

Adult↗