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PubMed1998

[Drug treatment of native valve infective endocarditis in patients not addicted to parenteral drugs].

Infectious endocarditis is an infection that is characterized by the presence of microorganisms in dense populations in vegetating lesions in the endocardium. Because phagocyte penetration to the interior of the vegetation is practically impossible, to cure infectious endocarditis, high doses of bactericidal antibiotics are administered, usually intravenously and for a long duration. In this article, antibiotic treatment is reviewed, depending on the isolated microorganism and in cases where necessary, treatment is initiated in an empirical manner. Once the microorganism was isolated, the recommended guidelines for antibiotic treatment have gone through some variations in recent years, due to the changing pattern of antibiotic sensitivity of some microorganisms, to the point of finding ourselves on occasion without an effective treatment (e.g. multiresistant enterococci). In addition, these variations are due to the introduction of new antibiotics that allow, in special cases, for the treatment to be administered on an outpatient basis. Using anticoagulation in infectious endocarditis is still considered controversial. In general, only patients having cardiac valvular prostheses seem to benefit from its use.

Algorithms↗
PubMed1998

Granulocyte colony stimulating factor in neutropenic patients with infective endocarditis.

A well known complication in the treatment of infectious endocarditis is development of neutropenia caused by treatment with antibiotics in high concentrations over long periods. Neutropenia often necessitates discontinuation of antibiotic treatment. Three patients with infectious endocarditis who developed neutropenia are reported. The patients were treated with granulocyte colony stimulating factor (G-CSF), a haematopoietic growth factor that stimulates neutrophils. G-CSF induced an immediate increase in white blood cell count, primarily neutrophils. G-CSF may be effective in ameliorating neutropenia in patients who receive antibiotics for treatment of infectious endocarditis.

Adult↗
PubMed1998

[Left atrial dissection and infective endocarditis].

A rare case of left atrial dissection as a consequence of infectious endocarditis is reported. We present a patient with infectious endocarditis with involvement of mitral and aortic valves; in whom the trans-esophageal echocardiography was able to visualise the left atrial dissection. This complication has been reported after surgical repair of the mitral valve, but never in infectious endocarditis.

Aged↗
PubMed1994

[A case of aortic and mitral regurgitation with two aneurysms in the mitral valve].

A 59-year-old male was found to have two aneurysms in the mitral valve, mitral regurgitation, and aortic regurgitation by the echocardiographic examination. The patient had a previous history of infectious endocarditis by streptococcus at the age of 24. Under the diagnosis of mitral aneurysms developed after infectious endocarditis, surgery was undertaken. A 5 x 8 mm sized perforation in the right coronary cusp and two aneurysms in the anterior mitral leaflet, 22 mm and 17 mm in size, were found intraoperatively. Both the mitral and aortic valves were replaced. Patients with a history of infectious endocarditis have to be followed up for a long period of time. Transesophageal echocardiogram is useful in those patients. Considering high prevalence of aortic valvular diseases in those with a mitral aneurysm after infectious endocarditis, aortic valves should be carefully evaluated.

Aneurysm, Infected↗
PubMed1995

[Bacterial endocarditis in Morocco].

This retrospective study was based on 157 cases of infectious endocarditis observed in the Cardiology department of Ibn Rochd Hospital in Casablanca between January 1983 and December 1994. The mean age of the patients was 27.5 years (11 to 65 years) with a male predominance (62.8%). Infectious endocarditis was secondary to rheumatic valvular heart disease in 63.% of patients and was primary in 29.9% of cases. Mitral or mitro-aortic valve involvement was clearly predominant. A portal of entry of the infection was identified in 63% of patients. It was dental in 64% of cases. Blood cultures were positive in 42% of cases with a predominance of unclassifiable Streptococci (37.8%) and coagulase-negative Staphylococci (25.7% of cases). Echocardiography was very useful, particularly in the presence of negative blood cultures. It demonstrated specific lesions of infectious endocarditis in 73.2% of cases and revealed very large, mobile vegetations in every case complicated by systemic embolism. The clinical course was complicated by heart failure (47.8%), renal failure (14.6%) or neurological lesions (11.5%). The global mortality was 28.7%, related to refractory heart failure in most cases.

Adolescent↗
PubMed2002

Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia.

OBJECTIVES: Enterococci are a major leading cause of infectious endocarditis and also a common cause of hospital-acquired bacteraemia, which is not believed to represent a serious hazard for the endocarditis. The incidence and risk factors for infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is determined. METHODS: Prospective analysis of 116 patients with enterococcal bacteraemia admitted to medical or surgical wards of a tertiary-care, university affiliated hospital during a period of 5 years. Echocardiography was performed when indicated by clinical criteria. RESULTS: Seventy-five (61.4%) episodes were hospital-acquired and 47 (38.5%) were community-acquired. Most patients had one or more underlying chronic diseases and major abdominal (58.6%) or genitourinary (38.6%) surgery. Seventeen patients (14.6%) developed enterococcal endocarditis. By univariate analysis the risk factors associated with endocarditis were community-acquired infection (P 0.012); monomicrobial bacteraemia (P 0.006); three or more positive blood cultures (P < 0.001); underlying valvulopathy (P < 0.001); presence of a prosthetic valve (P < 0.001) and age (P 0.012). Six patients (8%) developed nosocomial endocarditis. In this group of patients, three or more positive blood cultures (P < 0.01), bacteraemia as a result of Enterococcus faecalis (P 0.007); underlying valvulopathy (P < 0.001) and presence of a prosthetic valve (P < 0.001) were associated with endocarditis. By logistic regression, the presence of underlying valvulopathy and three or more positive blood cultures were associated with endocarditis (OR 21.0; CI 95% 1.65-26.9; P 0.019). CONCLUSIONS: The risk of developing infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is significant. Patients with underlying valvulopathy and three or more positive blood cultures with E. faecalis are prone to nosocomial enterococcal endocarditis.

Adult↗
PubMed2003

Western immunoblotting for Bartonella endocarditis.

To differentiate infectious endocarditis (IE) from other Bartonella infections and to identify infecting Bartonella bacteria at the species level on a serological basis, we used Western immunoblotting to test sera from 51 patients with Bartonella IE (of which 27 had previously benefited from species identification by molecular techniques), 11 patients with chronic Bartonella quintana bacteremia, and 10 patients with cat scratch disease. Patients with IE were Western blot positive in 49 of 51 cases, and significant cross-reactivity with three heterologous Bartonella antigens was found in 45 of 49 cases. Sera from bacteremic patients did not react with more than one heterologous antigen, and sera from patients with cat scratch disease gave negative results. Sera reacted only with B. henselae in four cases of IE, including one with a positive PCR result for valve tissue. Western blot and cross-adsorption performed on serum samples from patients with IE (the identity of the causative species having been determined by PCR) were demonstrated to identify efficiently the causative species in all cases. When applied to patients diagnosed on the basis of serological tests only, this technique allowed identification of the causative species in 20 of 22 cases. The results were in accordance with epidemiological features. Six reactive bands of B. quintana (of molecular sizes from 10 to 83 kDa) demonstrated significant association with sera from patients with B. quintana endocarditis. Overall, Western blotting and cross-adsorption made it possible to identify the causative species in 49 of 51 (96%) IE cases.

Antibodies, Bacterial↗
PubMed1993

[Surgery for bacterial endocarditis. When?].

In 1993, infectious endocarditis (IE) remains a common and serious condition. Surgery has become an essential feature of treatment in many cases. The choice and optimal timing depend on many factors: the tolerance of the underlying cardiac disease is an important feature, surgery being indicated not only in cases of necessity (refractory cardiac failure) but also as treatment of choice in cases of episodic decompensation even if temporary when related to valvular dysfunction. In these conditions, if the lesion is severe aortic incompetence, surgery can be programmed in two or three weeks after initiating antibiotic therapy; the bacteriological indications are less common: fungal endocarditis, prosthetic valve endocarditis due to gram-negative bacilli or staphylococcus aureus endocarditis, or IE on native valves with persistent signs of sepsis after one week of antibiotic therapy; the occurrence of some complications may require urgent surgery: high degree atrioventricular block, septal perforation, ring or perivalvular abscess detected at echocardiography, single or multiple systemic embolism with persistence of large, mobile vegetations at echocardiography. Conversely, tricuspid valve endocarditis usually respond well to medical treatment alone: surgery (valvuloplasty with excision of vegetations, valvulectomy or, preferably, bioprosthetic valve replacement) is sometimes indicated in septic states related to certain pathogenic organisms. The operative indications in 1993 have become more extensive and earlier: analysis of surgical results shows that operative mortality depends mainly on the haemodynamic status at the time of operation, but also on the severity of the anatomical lesions, the nature of surgery, the type of endocarditis, native or prosthetic valve, and the causal organism.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed2001

Vasculitis associated with septicemia: case report and review of the literature.

We report an unusual case in which infectious endocarditis presented systemic vasculitis and glomerulonephritis as the initial manifestation of the disease. The patient was a 16-year-old girl with congenital cyanotic heart disease who presented with skin purpura, proteinuria, and hematuria. She had hypergammaglobulinemia, cryoglobulinemia, and positive circulating immune complexes. Renal biopsy revealed crescentic glomerulonephritis. Her serum C3 level, which was initially normal, became decreased, and prednisolone and azathioprine were administered with a tentative diagnosis of systemic lupus erythematosus (SLE). Soon after, she developed fever and renal failure. Blood culture grew Streptococcus pyogenes, and the diagnosis of infectious endocarditis was made. Eight cases of systemic vasculitis and glomerulonephritis associated with infectious endocarditis have been described in the literature. Infectious endocarditis should be included in the differential diagnosis of systemic vasculitis and glomerulonephritis.

Adolescent↗
PubMed1996

[Survey on the practice of antibiotic prophylaxis of infective endocarditis by dentists].

The authors undertook an enquiry among 287 dentists to assess their practice of prophylactic antibiotic therapy against infectious endocarditis. Of the 227 dentists who replied, most (90%) knew that a dental extraction required prophylactic antibiotic therapy. They correctly prescribed antibiotics to prosthetic valve patients (84%) and to those with post-rheumatic cardiac disease (87%). Many dentists considered that coronary bypass (66%), mitral valve prolapse without mitral regurgitation (65%) or chronic myocardial infarction (68%) also required antibiotic prophylaxis, contrary to published recommendations. Only 21% of dentists used the recommended 3 gram dose of amoxicillin; the others prescribed a lower dose or another antibiotic. Approximately half the dentists started treatment 1 to 3 days too soon and less than 5% used the recommended single dose of antibiotic. These results show that dentists do not adhere strictly to the rules of prophylaxis on infectious endocarditis defined by different working groups. The authors make several suggestions to improve the prevention of infectious endocarditis and to remedy the problems shown up by this study.

Anti-Bacterial Agents↗
PubMed2001

[Perioperative monitoring using transesophageal echocardiography in a case of endocarditis-related tricuspid valve disease].

The risk of infectious endocarditis is higher for intravenous drug users than for patients with either rheumatic disease or valve prostheses. We report the case of a 33-year-old woman who self-administered opioid drugs parenterally and who developed a clinical picture of infectious endocarditis. Serious involvement of the tricuspid valve developed in the form of vegetation requiring surgical repair, during which transesophageal echocardiography was used for perioperative monitoring.

Adult↗
PubMedDate not supplied

[Reintervention on valve prosthesis. 13 years' experience].

1584 valve prosthesis implants [1231 mechanical (MP) and 353 biological (BP)] were carried out personally between March 1974 and December 1986. Over the same period, 72 patients, 36 m and 26 f, average age 48, underwent 75 reintervention (RI) on 80 malfunctioning prostheses 41 MP, 39 BP, 41 in mitral position, 28 aortic, 1 tricuspid). The reasons for RI in the MP were: partial detachment (61%), infectious endocarditis (19.5%), mechanical dysfunction (14.7%), thrombosis (2.4%), wear (2.4%) and in the BP: wear (84.6%), infectious endocarditis (12.8%), partial detachment (2.6%). The malfunction was diagnosed before the onset of subjective symptomatology in 30.7% of patients. Operative mortality (OM) was 17.3% related to the functional class (II = 0%; III = 2.7%; IV = 38.7%) and to whether or not the intervention was an emergency or of choice (90.9% and 4.7% respectively). Mortality was higher in patients operated on for infectious endocarditis (38.4%) and in wearers of MP (28.2% vs. 5.7% BP); however this difference is largely attributable to a difference in NYHA class. It is concluded that reintervention on valvular prosthesis may have a very prognosis provided diagnosis of malfunction is quick enough to avoid excessive functional deterioration.

Adolescent↗
PubMed1998

[Diagnostic criteria of infective endocarditis: from Von Reyn to Duke. Transthoracic and transesophageal echocardiography].

The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.

Echocardiography↗
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↗
PubMed2006

[Bacterial endopathalmitis caused by B streptococcus endocarditis].

BACKGROUND: Bacterial endophthalmitis is often caused by a shift in the primary focus of infection in the patient's body. It is a high risk disease that can cause the loss of sight. Bacterial endophthalmitis with infectious endocarditis is very rare in Japan. CASE: A fifty-three-year-old woman visited our clinic complaining of pain, fever, and visual impairment in her left eye. OBSERVATIONS: The patient's left eye was blind, and showed hapopyon in the anterior chamber. She was admitted to our hospital with a diagnosis of endophthalmitis. Medical treatment with antibiotics was carried out, but the inflammation in her left eye increased. Her left eye was enucleated, and group B Streptococcus was found in the vitreous specimen. Echocardiography demonstrated vegetation of the posterior mitral valve. The diagnosis was made of endophthalmitis due to infectious endocarditis. CONCLUSION: We report an endophthalmitis patient with infectious endocarditis caused by group B streptococcus, based on histopathological findings. This is the first such case reported in Japan.

Endocarditis, Bacterial↗
PubMed1996

Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis.

BACKGROUND: Q fever endocarditis is a life-threatening disease for which the diagnosis is usually based on serology. The major microbiologic criterion for the diagnosis of infectious endocarditis (two separate positive blood cultures) cannot be achieved in most routine laboratories because of the biohazard associated with the culture of Coxiella burnetii, the etiological agent of Q fever. PURPOSE: Recently, new criteria for the diagnosis of infectious endocarditis have been proposed, and in this study we attempted to assess the suitability of these criteria specifically for the diagnosis of Q fever endocarditis. PATIENTS AND METHODS: To achieve this aim, we first selected from our series 20 recent cases in whom endocarditis had been confirmed following valvular pathological examination, and for whom microbiological evidence for the involvement of C burnetii was available. Then, we applied the criteria proposed by the Duke Endocarditis Service (ie, C burnetii positive serology being considered a minor criterion) to this cohort of patients but excluding pathological findings. Although the Duke Endocarditis Service criteria confirmed diagnosis in 16 of the patients, 4 were misclassified as "possible" cases (20%). However, when the Q fever serological results (using an 1/800 antiphase I immunoglobulin G cut off) and single blood culture results were changed from minor to major diagnostic criteria, endocarditis was confirmed in them all. A second time, prospectively, we applied the Duke Endocarditis Service criteria to a further 5 patients affected with Q fever endocarditis. Strict application of these criteria resulted in 1 of the 5 being misdiagnosed. Applying the suggested modification for C burnetii results, all 5 were confirmed as having infectious endocarditis. CONCLUSION: We propose that the modifications discussed in this study be applied to the Duke Endocarditis Service criteria in order that the diagnosis of C burnetii induced endocarditis is improved.

Coxiella burnetii↗
PubMed2000

[Non-infectious thrombotic endocarditis: a case report].

A 48 year-old female patient, admitted with an ischemic stroke, had a transesophageal echocardiogram (TEE) that revealed a dense vegetation in the noncoronary aortic cusp, which was considered the probable source of embolism. The clinical investigation did not identify any other disease or infectious process. However the lack of histologic proof, the absence of fever, the fact that the blood cultures were persistently negative, the patient recovery with no need of antibiotics, and the results of the TEE, are highly suggestive of the presence of a non infectious thrombotic endocarditis. After 18 months of anti-platelet treatment, the patient showed no new embolic episodes and TEE demonstrated the resolution of the vegetation.

Echocardiography, Transesophageal↗
PubMedDate not supplied

[Prosthesis of the aortic valve by a loose allograft].

A procedure has been developed to prepare live aortic allografts, which consists in taking a valve early after a donor's death, sterilizing it in antibiotics and freezing it to -190 degrees C in the presence of the cryoprotective agent dimethylsulfoxide. The preservation of valve tissue is evidenced by morphological studies. The first 3 operations for aortic valvular diseases were performed. In two cases, the indication for surgery was infectious endocarditis refractory to antibiotic therapy. Postimplantation complications were not seen. The competence of the allograft was confirmed by intraoperative transesophageal echocardiographical study. The patients examined 4 months postoperation developed no signs of aortic incompetence and infectious endocarditis. Thus, the creation of a bank of live valves allows this prosthesis to be implanted with appropriate indications, one of which is active infectious endocarditis of the aortic valve.

Adult↗