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PubMed1998

[Laboratory control in diagnosis and treatment of infective endocarditis].

Infectious endocarditis is caused by a wide variety of microorganisms. Etiological diagnosis depends either on direct methods, directed to the detection and isolation of the causative organisms, or serological methods. Blood cultures remain as the best method for the diagnosis of bacterial endocarditis. Blood culture technology has changed due to the appearance of new automatic continuous monitoring systems which shorten the detection time. Endocarditis with a negative blood culture has decreased below 5% because of new blood culture systems, new serological methods and molecular technology. The control of antimicrobial therapy in endocarditis must be performed by expert laboratories. A minimal bactericidal concentration, serum levels of antimicrobials and the serum bactericidal test are the most useful parameters. Their execution requires the use of strict protocols and interpretation must be carried out with an expert in clinical microbiology and infectious diseases.

Anti-Bacterial Agents↗

PubMed2000

[Practice guidelines of the Spanish Society of Cardiology on endocarditis].

Infectious endocarditis is a disease which mainly involves the cardiac valves. It has a bad prognosis and is caused by a great variety of microorganisms. Prophylaxis is important although the effectiveness and the best way to achieve it remain unclear. Recommendations are herein presented. The diagnosis is based on clinical, bacteriological, and echocardiographic findings mainly based on Duke's criteria. Transthoracic and transesophageal echography are not only of diagnostic value but are also a tool to determine the therapy to follow. Antibiotic therapy should be selected according to the organisms isolated and their in vitro susceptibility. Guidelines for empirical antibiotic therapy in cases of negative cultures are also included. Lastly, indications and time for surgery are discussed.

Anti-Bacterial Agents↗

PubMed2002

Combined brucella melitensis and streptococcal viridans endocarditis.

Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis.

Anti-Bacterial Agents↗

PubMed2004

Update on infective endocarditis.

Infectious Endocarditis is a disease almost invariably fatal if it is not treated in the proper manner. A review is presented of the cardiac abnormalities and procedures associated with its development as well as the most recent classification of the different modalities of endocarditis. The clinical manifestation, the causative organisms and diagnostic procedures are summarized. The American Heart Assciation and the American College of Cardiology (AHA/ACC) recommendations for management of native valve endocarditis, infective endocarditis in drug users, prosthetic valve endocarditis and culture negative endocarditis are summarized. The conditions that justify surgical interventions are also presented.

Clinical Trials as Topic↗

PubMed1988

[Cardiac echo-Doppler in the diagnosis and surveillance of the course of acute endocarditis].

Infectious endocarditis is still currently a problem. Its frequency is not decreasing and new etiologies have developed, which are often responsible for acute endocarditis, resistant to hospital bacteria. The cardiac Doppler has a role in the positive diagnosis of endocarditis, especially on native valves. This examination permits an accurate evaluation of valvular and perivalvular lesions (abscess, mycotic aneurysms) and their repercussions on the ventricle. Studies in this last decade, have emphasized that the presence of vegetations is a factor of gravity. The Doppler permits an "active" monitoring in high risk forms: endocarditis of the aortic orifice, endocarditis with perivalvular abscess, endocarditis occurring on a prosthetic valve.

Acute Disease↗

PubMed1985

Surgery for prosthetic valve endocarditis.

Infectious endocarditis is the main complication after prosthetic valvular replacement. 2 problems remain unsolved: 1. Diagnostic: Fever, heart failure and paravalvular leaks should be indications for re-operations. 2. Technical: perfect fixation of the prosthetic valve is a surgical challenge. The difficulties as shown here are the cause for so many operative techniques. Early surgical intervention is the best method to prevent myocardial failure.

Abscess↗

PubMed1998

[Clinical case of the month. Metastatic endocarditis: clinical observation and review of the literature].

The authors describe a case of metastatic endocarditis associated with a gastric carcinoma. The diagnosis was made early and the treatment by surgery and chemotherapy allowed a survival of 18 months, which is unusually long. The differential diagnosis is discussed and includes nonbacterial thrombotic endocarditis, infectious endocarditis and primary tumors of the heart.

Adenocarcinoma↗

PubMed1979

Aspergillus mural endocarditis.

Infectious mural endocarditis is uncommon and not well documented. The clinical setting and pathologic features of five patients with Aspergillus mural endocarditis are described. Leukemia, carcinoma, renal transplantation, and hepatic failure were the primary diseases. Associated conditions include high-dose corticosteroids, cytotoxic therapy, renal failure, gram-negative sepsis, and endotracheal intubation. All patients received prolonged antibiotic therapy or treatment with three or more antibiotics. All had clinically undetected aspergillosis and severe fungal pneumonia. Fungal myocardial abscesses were present in each patient. Aspergillus mural endocarditis developed in more than 40% of patients with cardiac aspergillosis. Endocardial vegetations were contiguous with underlying myocardial infection; yet they may develop initially as a subendocardial focus rather than from a myocardial abscess. Aspergillus mural endocarditis progressed to destroy the mitral valve ring and served as a source of mycotic embolization to vital organs.

Adolescent↗

PubMed2005

Performance of the Fontan procedure using extra-cardiac direct anastomosis on patients treated for penicillin-resistant Streptococcus pneumoniae endocarditis.

Streptococcus pneumoniae is now a rare cause of endocarditis in humans. We report a patient with a double outlet right ventricle and mitral atresia, who underwent the Fontan procedure without prosthetic materials after treatment for penicillin-resistant Streptococcus pneumoniae endocarditis. Postoperative infectious endocarditis was not found. In patients with a history of infectious endocarditis, direct anastomosis of the main pulmonary artery and inferior vena cava would reduce the risk of recurrent infectious endocarditis.

Abnormalities, Multiple↗

PubMedDate not supplied

The diagnostic challenge of infective endocarditis: cutaneous vasculitis leading to the diagnosis of infective endocarditis.

BACKGROUND: Signs and symptoms of infectious endocarditis are protean. They result from destruction of cardiac endothelium, metastatic embolization, hematogenous seeding, and immune complex deposition. Embolic manifestations of infectious endocarditis can mimic several other pathologic conditions and make the diagnosis of infectious endocarditis difficult. METHODS: We describe a case of cutaneous vasculitis leading to the diagnosis of infectious endocarditis. A review of the literature highlights the variable clinical presentations and key diagnostic strategies in the evaluation of infectious endocarditis. RESULTS AND CONCLUSION: Infective endocarditis has protean clinical symptoms and signs and can be a challenging diagnosis. Being alert to the condition is crucial, and where a high clinical probability exists despite a negative transthoracic echocardiogram, diagnostic evaluation with transesophageal echocardiograph is required.

Anti-Bacterial Agents↗

PubMed2005

Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome.

PURPOSE: The relationship between pyogenic vertebral osteomyelitis and infectious endocarditis is uncertain. This study investigates the incidence and risk factors of infectious endocarditis in patients with pyogenic vertebral osteomyelitis, and the outcome of pyogenic vertebral osteomyelitis with and without associated infectious endocarditis. METHODS: A retrospective record review was conducted of all cases of vertebral osteomyelitis from January 1986 to June 2002, occurring in a tertiary referral hospital. Patients were followed for at least 6 months with careful attention to detection of infectious endocarditis and relapses. RESULTS: Among 606 patients with infectious endocarditis, 28 (4.6%) had pyogenic vertebral osteomyelitis. Among 91 cases of pyogenic vertebral osteomyelitis, 28 (30.8%) had infectious endocarditis. In 6 patients with no clinical signs of infectious endocarditis, the disease was established by routine echocardiography. Infectious endocarditis was more common in patients with predisposing heart conditions and streptococcal pyogenic vertebral osteomyelitis infection. Overall, pyogenic vertebral osteomyelitis in-hospital mortality was 11% (7.1% with infectious endocarditis). Twelve of 25 patients with infectious endocarditis with uncomplicated pyogenic vertebral osteomyelitis were treated for 4 to 6 weeks (endocarditis protocol), with no pyogenic vertebral osteomyelitis relapses. CONCLUSIONS: When specifically sought, the incidence of infectious endocarditis is high in patients with pyogenic vertebral osteomyelitis. Oral therapy may be an option for uncomplicated pyogenic vertebral osteomyelitis; nevertheless, in gram-positive infections, this approach should only be considered after excluding infectious endocarditis. Favorable outcome with shorter treatment in uncomplicated pyogenic vertebral osteomyelitis associated with infectious endocarditis suggests that prolonged therapy may not be needed in this subgroup except for those infected by difficult to treat microorganisms, such as methicillin-resistant Staphylococcus aureus or Candida spp.

Abscess↗

PubMed1999

[A right aorto-atrial fistula as a complication of early prosthetic endocarditis].

Early infectious endocarditis occurs in 3% of prostheses in the first 12 months after valvular surgery and is more aggressive than late prosthetic endocarditis. Mortality remains high, especially in early cases, despite combined medical and surgical treatment. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction, and is mainly caused by staphylococci. We present a case report of early prosthetic endocarditis in aortic prostheses complicated with severe aortic regurgitation and right atria-aortic root fistula with auriculoventricular and intraventricular disturbance in electrocardiogram.

Aged↗

PubMed2000

[Infectious enterococcal endocarditis associated with Laubry and Pezzi syndrome].

Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocarditis risk. Authors report a case of an 18 years old young girl presenting an enterococcus infectious endocarditis associated to Laubry and Pezzi syndrome. Initial course is not favourable requiring a surgical treatment in the acute stage. Bacterial endocarditis combined with Laubry and Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoring factor is present.

Adolescent↗

PubMed2000

Endocarditis prophylaxis revisited: experimental evidence of efficacy and new Swiss recommendations. Swiss Working Group for Endocarditis Prophylaxis.

Because of its severity, it is agreed that infectious endocarditis should be prevented whenever possible. Determining adequate prophylactic measures involves establishing (a) the patients at risk, (b) the procedures that might provoke bacteraemia, (c) the most effective prophylactic regimen, and (d) a balance between the risks of side effects from prophylaxis and of developing infectious endocarditis. Patients at risk and procedures inducing bacteraemia have been identified by clinical studies. On the other hand, the efficacy of prophylactic antibiotics has been based on animal studies. Randomised, placebo-controlled studies do not exist in humans because they would require large patient numbers and would raise ethical issues due to the severity of the disease. Case-control studies have indicated that infectious endocarditis prophylaxis is effective, but prevents only a limited number of cases. Animal experiments have revealed several key issues for human application. First, antibiotics do not prevent the early stages of valve colonisation, but rather kill the microorganisms after their attachment to the cardiac lesions. Second, the duration of antibiotic presence in the serum is critical. Under experimental conditions, the drugs must remain above their minimal inhibitory concentration for the organisms for > or = 10 h, to allow time for bacterial clearance from the valves. Third, antibiotic-induced killing is not the only mechanism allowing bacterial clearance. Other factors, such as platelet microbicidal proteins, may act in concert with the drugs to sterilise the lesions. Recommendations for prophylaxis have recently been revised in Europe and the USA. New information has improved the definition of groups at risk. Since most cases of infectious endocarditis are not preceded by medical procedures, primary prevention of infectious endocarditis should target infected foci responsible for spontaneous bacteraemia (e.g. poor dental hygiene). The purpose of this article is to update the existing recommendations in Switzerland, under the perspective of changing epidemiology, the availability of new drugs, and harmonisation with recommendations in other countries.

Antibiotic Prophylaxis↗

PubMed2001

[Differential diagnosis of infectious and non-infectious thrombotic endocarditis].

The aim of the study was analysis of clinical and laboratory markers of non-infectious thrombotic endocarditis (NITE) to facilitate differential diagnosis with infectious endocarditis (IE). 20 NITE patients (8 males and 12 females, mean age 32.3 years) were included in the trial. They had primary antiphospholipid syndrome, secondary antiphospholipid syndrome in systemic lupus erythematosus, nodular polyarteritis, nonspecific aortic arteritis, paraneoplastic NITE in lung and stomach cancer. NITE was also diagnosed in patients with gout and ankylosing spondylarthritis. Clinical and laboratory findings allow to differentiate IE with NITE. The former is characterized by destructive valvular lesions registered at echo-CG, positive hemoculture and arterial embolism. As a rule, NITE is associated with antiphospholipid syndrome and manifests with arterial and venous thrombosis, thrombocytopenia, livedo and presence of antibodies to cardiolipins.

Adult↗

PubMed1991

Value of transesophageal echocardiography as an adjunct to transthoracic echocardiography in evaluation of native and prosthetic valve endocarditis.

To determine if transesophageal echocardiography provides better visualization of valvular vegetations than transthoracic echocardiography, we used both methods to evaluate 24 consecutive patients (mean age, 54 years; 15 female patients and nine male patients) referred for symptoms suggestive of infectious endocarditis. Ten of the 24 patients had one or more valvular prostheses. Echocardiograms were classified as positive or negative based on visualization of valvular vegetations or abscesses. Of ten patients with a final diagnosis of infectious endocarditis on extended follow-up, transthoracic echocardiography was positive in five patients. Transesophageal echocardiography not only yielded abnormal findings in all ten of these patients, but also revealed additional information in four of the five patients with abnormal transthoracic echocardiographic examinations. Among the 14 patients who, on subsequent follow-up, were found not to have infectious endocarditis, transthoracic echocardiography was normal in 13 and falsely abnormal in one. Transesophageal echocardiography revealed no evidence of infectious endocarditis in any of these patients. The ten patients who were determined to have infectious endocarditis all had positive blood cultures and no alternative cause for their clinical presentation; in seven patients in this group who underwent operative or postmortem evaluation, infectious endocarditis was confirmed. All patients without infectious endocarditis were demonstrated to have other causes for their clinical presentation. We conclude that transesophageal echocardiography is a highly valuable test in the work-up of patients with suspected infectious endocarditis, especially those patients with inconclusive or normal transthoracic echocardiograms. In addition, transesophageal echocardiography may be of benefit to patients with previously documented infectious endocarditis and a complicated clinical course in whom additional cardiac lesions are suspected but not demonstrated by transthoracic echocardiography.

Abscess↗

PubMed1991

[Embolic retinitis in Haemophilus parainfluenzae endocarditis].

Infectious embolic retinopathy occurring secondary to a bacterial endocarditis is described in a 38-year-old woman with known aortic disease. The infectious organism was a haemophilus parainfluenzae confirmed by serial blood cultures and characterized by an embolic power equal to fungal infection. After four-weeks period of appropriate and intensive antibiotic therapy, blood cultures became negative but new emboli were observed in the fundus. This report describes ocular lesions rarely observed in endogenous bacterial retinitis. The delay between the bacterial endocarditis and the occurrence of the retinitis emphasizes the need for a long-term follow-up. Ophthalmologic examination can be acline for changing the heart valve.

Adult↗

PubMed1990

Pathogenesis, management, and prevention of infective endocarditis in the elderly dental patient.

Aortic stenosis and mitral valve insufficiency are common precipitating causes of infectious endocarditis in older persons. These degenerative cardiac valvular lesions may result from an exaggerated calcification process seen in association with aging. Mitral valve prolapse, especially when noted in an older man, may predispose the person to infectious endocarditis. Infectious endocarditis is harder to diagnosis and treat in older persons, and about half of patients die of the disease or its complications. Prophylactic antibiotics must be prescribed for patients with degenerative cardiac or atherosclerotic valvular defects having dental procedures likely to produce a bacteremia.

Aged↗