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PubMed1982

[Clinico-morphologic analysis of septic (infectious) endocarditis].

Pathomorphosis of the disease has been studied on the basis of clinical and autopsy observations in the last three decades. The importance of staphylococcus, enterococcus, and gram-negative bacteria has been shown to increase among the causative agents of septic endocarditis; frequently the infectious agents have been observed to alternate in the course of the disease. Many manifestations of endocarditis were established to be associated with the circulating immune complexes containing bacterial antigens. In the last decade, primary septic endocarditis comprised about half of the observations. The proportion of isolated endocarditis and destructive changes of aortal valves increased. Myocarditis has become more frequent and in more than half of the cases it is associated with glomerulonephritis. In contrast, peripheral manifestations of endocarditis have considerably lost their diagnostic value. Among thromboembolic complications, venous thromboembolus of the pulmonary artery, and pulmonary infarction became more prevalent.

Adolescent↗
PubMed1981

[Bacterial endocarditis and its relationships with obstructive hypertrophic cardiomyopathy and hepatic cirrhosis (author's transl)].

Although in the last few years several cases of bacterial endocarditis have been reported in patients with obstructive hypertrophic cardiomyopathy, such as association is still infrequent and only in rare instances has pathologic examination of the cardiac lesions been possible. In this work a brief comment is made on the different forms of clinical presentation of the disease. The type of endocarditis, the relative incidence of responsible germs, and the prognosis are similar to those of other endocarditis. The clinical and autopsy findings of a female patient with alcoholic liver cirrhosis and symptomatic obstructive hypertrophic cardiomyopathy who developed a bacterial endocarditis of the mitral valve due to Staphylococcus aureus are reported. The patient died of an infected ascites. Some recent reports point to a higher incidence of bacterial endocarditis in cirrhotic patients, and this fact is felt to be an argument in favour of the hematogenous origin of spontaneous bacterial peritonitis.

Cardiomyopathy, Hypertrophic↗
PubMedDate not supplied

Vancomycin therapy for infective endocarditis.

The use of vancomycin is increasing for the treatment of serious life-threatening staphylococcal and other bacterial infections, including infective endocarditis, in patients who are allergic to the penicillins. The literature through 1978 reveals approximately 55 cases of infective endocarditis treated with vancomycin alone or with combined antibiotic therapy. Many of these 55 patients were treated by different clinicians, were given variable regimens of therapy, received other therapy before vancomycin, had associated valve replacement; various amounts of data were provided for the reported cases. A summary of these reports indicates a cure in 48 (87%) of the 55 patients. Recent in vitro and in vivo animal and patient data indicate that vancomycin alone or as part of combined therapy is bactericidal and curative in patients allergic to penicillin for infective endocarditis caused by staphylococci and streptococci-both enterococcal and nonenterococcal (Streptococcus bovis and viridans group streptococci) infections. In this study, 10 patients with infective endocarditis were treated with vancomycin or combined therapy; seven were cured. Five of the 10 patients with infective endocarditis caused by viridans streptococci were cured with combined vancomycin-streptomycin given in short-term therapy for two weeks.

Adolescent↗
PubMed1980

Experimental Streptococcus sanguis endocarditis: immune complexes and renal involvement.

An increase of agglutinins and circulating immune complexes (CIC) was observed in the sera of rabbits after the induction of bacterial endocarditis (BE) by intravenous injection of live streptococci into animals with a non-bacterial thrombotic endocarditis. Rabbits immunized for 12 days with heat-killed streptococci developed higher levels of agglutinins and CIC than did those unimmunized during BE. The levels remained elevated in the immunized rabbits after the induction of streptococcal endocarditis. In rabbits with very high levels of CIC complement activation occurred in vivo, possibly via the classical pathway. Kidneys from both unimmunized and immunized rabbits with streptococcal endocarditis contained bacteria and also showed inflammatory reactions but only the renal tissue of immunized rabbits with endocarditis showed a little mesangial deposition of immunoglobulin. The findings in this study indicate that in rabbits, renal inflammation due to BE is initiated more often by septic emboli than by immune complex deposition, at least during the first 12 days after infection.

Agglutinins↗
PubMed1995

Therapeutic advantage of recombinant human plasminogen activator in endocarditis: evidence from experiments in rabbits.

In infective endocarditis vegetations are stabilized by fibrin. To learn if fibrin digestion would be therapeutic, experimental endocarditis was induced in rabbits by inoculation with a platelet-aggregating strain (Agg+) of Streptococcus sanguis and treated with recombinant tissue plasminogen activator (rt-PA), rt-PA with penicillin, or penicillin alone. Control rabbits were inoculated with saline. All treatments of Agg+ endocarditis reduced the mass of valvular vegetations and clinical signs of endocarditis, including the frequency of left axis deviation and heart ischemia. rt-PA with penicillin was more effective than penicillin or rt-PA alone, reducing the mass of vegetations and clinical signs to that of saline controls. Within 50 min, rt-PA cleared 5-fold more 111Indium-labelled platelets from the heart than untreated rabbits and 1.4-fold more after 3 days. Combined with penicillin, thrombolytic therapy for human endocarditis should be reconsidered.

Animals↗
PubMed1995

Mitral valve aneurysm and infective endocarditis: report of four cases.

From March 1992 to March 1994, four cases of mitral valve aneurysm were diagnosed at National Taiwan University Hospital. Mitral valve infective endocarditis was documented in three patients, while aortic valve infective endocarditis was found in the other. The diagnosis of mitral valve aneurysm was based on characteristic echocardiographic findings. The mitral valve aneurysms in these four cases were all visualized by transesophageal but not transthoracic echocardiography. At the time of diagnosis, three patients with a history of mitral valve endocarditis had perforated mitral valve aneurysms and severe mitral regurgitation. Although not found before surgery, the remaining patient with a history of aortic valve endocarditis was noted to have an unperforated mitral valve aneurysm one month after aortic valve replacement. All three patients with severe mitral regurgitation underwent mitral valve replacement and the patient with an unperforated mitral valve aneurysm was managed conservatively and obtained a stable clinical condition. In conclusion, mitral valve aneurysm usually appears to be associated with infective endocarditis and transesophageal echocardiography is more helpful in the diagnosis of mitral valve aneurysm than transthoracic echocardiography. Furthermore, unperforated mitral valve aneurysms may be managed conservatively with careful follow-up.

Adult↗
PubMed1994

Surgical treatment of infective endocarditis.

From February, 1975 through October, 1990, 26 patients underwent surgical treatment for infective endocarditis at Tokai University Hospital. The overall operative mortality rate was 11.5% (3/26). The three patients who died were suffering from aortic prosthetic valve endocarditis (PVE) in the active stage. Among 16 patients in the active stage, the mortality rate was 18.7% (3/16) Among 10 patients with native valve endocarditis (NVE) in the healed stage, all survived. Among the total of 21 patients with NVE, the mortality rate was zero and among those with PVE, the rate was 60% (3/5). Various species of streptococci were the most common organisms encountered, followed by Staphylococcus epidermides. The two PVE patients with S. epidermides died. Nine of the 11 NVE cases in the active stage were of the localized type. Only one case of the localized type of PVE suffered from an infected mitral bioprosthetic valve. The 6 extensive-type cases had aortic valve endocarditis (2NVE, 4PVE). Three patients with the extensive type of PVE died. We conclude that patients with infective endocarditis who develop progressive congestive heart failure, recurrent embolization, or progressive sepsis despite antimicrobial treatments, should undergo prompt valve replacement within 7 days after institution of therapy.

Adolescent↗
PubMed1975

[Proceedings: Experimental endocarditis. Experimental basis and prophylaxis].

A simple model has been developed for the production of bacterial endocarditis in rabbits. The principle depends on the insertion of a polyethylene catheter into the venous or arterial system so that the tip rests in the heart cavity in which endocarditis is to be established. After catheter placement, intravenous injection of any one of a variety of microorganisms regularly produces infective endocarditis. The characteristics of the infection in rabbits are similar to those observed in infective endocarditis in man. The production of streptococcus viridans infections in previously immunized animals leads to the development of diffuse glomerulonephritis. Translating antibiotic doses on a weight basis, prophylactic antibiotic treatment programs recommended in man have been shown to be ineffective in rabbits. If the activity of antibiotics in this model infection in rabbits can be assumed to be comparable to that in man, it is necessary that we reconsider the currently accepted recommendation for prophylaxis and treatment of infective endocarditis in man.

Animals↗
PubMed1975

[Proceedings: Microbiology of endocarditis].

The classical paper published by Schottmüller in 1903 has shown beyond doubt that blood cultures are a crucial diagnostic procedure for the diagnosis of endocarditis. Positive blood cultures also make it possible to distinguish between bacteremia and endocarditis: in the latter condition the number of organisms per ml of blood is relatively constant and all blood cultures are usually positive. Gram positive cocci are still the commonest organisms found in classical endocarditis. Gram negative organisms, yeasts and fungi are cultured with increasing frequency in cases of endocarditis secondary to valve replacement. Sensitivity testing by the disc diffusion method determines the minimal inhibitory concentration of the antibiotic towards the isolated organism. However, minimal bactericidal concentrations are of much greater prognostic value in endocarditis and should be performed routinely on the isolated organism.

Anti-Bacterial Agents↗
PubMed1995

[Dental care and prevention of infectious endocarditis].

Infective endocarditis causes substantial morbidity and mortality despite adequate antimicrobial, medical and surgical treatment. The rationale for antibiotic prophylaxis against endocarditis is derived from the etiology and pathogenesis of the disease. Endocarditis usually follows bacteremia with certain endocarditis-prone bacteria in a patient with a predisposing heart condition. Protection by antibiotic prophylaxis is estimated to reach only 50% for a lot of reasons (transient bacteremia without dental or surgical intervention, predisposing heart disease not diagnosed previously, etc). Most authorities in the field of infective endocarditis strongly advocate the use of antibiotic prophylaxis for patients at risk. Clear guidelines are published by various highly qualified scientific committees. Recent schemes allow orally administered antibiotic prophylaxis because of a better doctor and patient compliance.

Administration, Oral↗
PubMed1995

[Left ventricular function in post-endocarditis aortic insufficiency and aortic-annular ectasia].

BACKGROUND: The duration of valvular regurgitation is an important determinant of left ventricular function in the presence of severe volume overload. PURPOSE: To evaluate the effect of aortic regurgitation (aortoannullar dilatation vs. history of bacterial endocarditis) on left ventricular (LV) function. PATIENTS: Between February 1976 and January 1993 45 patients (mean; age 45 +/- 12 years) underwent diagnostic evaluation for clinical purposes. Patients were divided into three groups: group 1 consisted of 17 patients with normal LV function (controls), group 2 of 11 patients with severe aortic regurgitation due to aortoannullar dilatation (AAD) and group 3 of patients with severe aortic regurgitation and a history of bacterial endocarditis (BE). METHODS: LV function was assessed by biplane LV-angiography and simultaneous pressure recordings. The ejection fraction and peak systolic wall stress were calculated in all patients. Systolic and diastolic LV function was determined and compared within the three groups. RESULTS: Heart rate, mean aortic pressure and cardiac index were similar in the three groups. The mean aortic diameter was significantly increased in group 2 when compared to the other two groups (p < 0,001). Systolic function was significantly reduced in both groups with aortic regurgitation when compared to the control patients. The end diastolic pressure-volume relationship was shifted to the right in patients with aortic regurgitation, but only 3 patients with a history of bacterial endocarditis showed severe diastolic dysfunction. CONCLUSIONS: No hemodynamic differences were observed in patients with severe aortic regurgitation with regard to the etiology or time course of LV volume overload. However, 17% of the patients with a history of bacterial endocarditis had severe diastolic dysfunction, which is probably due to the faster development of volume overload after bacterial endocarditis.

Adult↗
PubMed1994

[Infectious endocarditis following artificial insemination. A clinical case report and review of the literature].

We describe a case of infective endocarditis in a 33 year old patient, with mitral valve prolapse (MVP), who underwent nine attempts of artificial insemination with semen by donor. Several blood cultures demonstrated the presence of Enterococcus faecalis; the same agent was identified in some vaginal cultures. Despite antibiotic therapy, infective endocarditis was complicated by severe mitral regurgitation, followed by the rupture of a chorda tendinea. The patient underwent cardiac surgery: valvuloplasty of posterior mitral cusp, chordae tendineae in Goretex and anulus reinforcement with autologous pericardium. MVP is the most common heart disease associated with infective endocarditis in non-drug addict patients (32-54%). The review of the literature did not show any other case of infective endocarditis after artificial insemination procedures. Because of the large spread of these procedures, we think antibiotic prophylaxis of infective endocarditis should be considered in patients with MVP.

Adult↗
PubMed1994

Staphylococcus aureus endocarditis at a community teaching hospital, 1980 to 1991. An analysis of 106 cases.

BACKGROUND: The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital. METHODS: I reviewed medical records identified through consultation records, International Classification of Diseases, Ninth Edition codes, and autopsy records of patients who fulfilled the criteria for the diagnosis of S aureus endocarditis during 1980 to 1991. RESULTS: During the 12-year period, there were 106 cases, for a prevalence of 0.34 per 1000 admissions. Ninety-three (87.7%) of these patients were seen by me. The patients' ages ranged from 12 to 83 years (median, 61 years). Eighteen cases were nosocomial (15 were associated with intravascular catheters). Twenty-one patients were injecting drug users. Severe back pain was the chief complaint in nine patients. Twenty-seven patients had no heart murmur at the time of diagnosis. The overall mortality was 25.5%. CONCLUSIONS: Age 60 years or older, female gender, community-acquired infection, absence of heart murmur, presence of congestive heart failure, or central nervous system involvement was associated with higher mortality. Tricuspid valve endocarditis alone was associated with lower mortality.

Adolescent↗
PubMed1994

[Transesophageal echocardiography in the diagnosis of endocarditis].

Transesophageal echocardiography is a new diagnostic method for visualization of retrocardial structures and heart valves with high resolution. This retrospective analysis describes the use of and the findings by transesophageal echocardiography in patients suspected to suffer from endocarditis studied in three hospitals. 50 patients were studied; the diagnosis was confirmed in 64%, whereas 36% (controls) had other findings. The leading initial symptoms were fever and valvular incompetence. Laboratory parameters were altered in both groups with equal frequency. One or more diagnostic features were detected by transesophageal echocardiography in 88% of patients with endocarditis: vegetations (approximately with equal frequency on the mitral and the aortic, rarely on the tricuspid valve) were detected in 75% and/or abscesses in 22% of them. Only one patient in the control group with a history of endocarditis had vegetation-like structures on the aortic valve. Transesophageal echocardiography was on the average performed on the seventh day of hospitalization. With the exception of one female patient, all had been treated with antibiotics. Valve replacement was recommended in 65% of the patients with endocarditis and was in 59% also performed (single or double valve replacement), most frequently because of aortic or mitral regurgitation. The other patients were treated with antibiotics. Transesophageal echocardiography thus detects vegetations and abscesses in endocarditis frequently, findings that influence treatment in a significant manner.

Adult↗
PubMed1994

[Endocarditis due to Corynebacterium diphtheriae cause by contact with intravenous drugs: report of 5 cases].

The clinical features of 5 patients with invasive disease due to nontoxigenic Corynebacterium diphtheriae are presented. 4 patients had proven left sided endocarditis, and one had probable endocarditis of the mitral valve. 4 patients were intravenous drug abusers, and one had a girl friend who was also an iv-drug abuser. Only one patient had antibodies against human immunodeficiency virus. 2 patients with endocarditis of the mitral or the aortic valve, and one patient with endocarditis of a prosthetic aortic valve, died of septic complications. All patients or their partners frequented the same community of drug abusers. Since the blood culture isolates shared common features for biotyping, resistance patterns and also for ribotyping in three tested patients, we assume that all patients were infected by the same clone of C. diphtheriae. Drug abusers may become a new reservoir for C. diphtheriae infection. Along with our patients, we present an overview of the 49 published cases of C. diphtheriae endocarditis.

Adult↗
PubMed1994

[Surgical treatment of infective endocarditis].

Since 1976, 37 patients have undergone valve replacement for infective endocarditis at our institute. Twenty patients required surgery during the active stage and 17 in the inactive stage. The former group consisted of 17 native and three prosthetic valve endocarditis, and all patients in the latter group had native valve endocarditis. Eighteen patients had AVRs, 15 had MVRs and four had DVRs. Congestive heart failure was the indication for surgery in 80% of the active and 100% of the inactive group. There were nine early deaths (45%) and one late death in the active group, and one early (6%) and one late death in the inactive group. Operative mortality in the active group, however, has recently been reduced to 30% for the 10 patients operated upon in the past two years. Two patients with active endocarditis were complicated by rupture of cerebral mycotic aneurysms postoperatively and resulted in one early and one late death, respectively. It is suggested that timely surgical intervention according to the hemodynamic state of the patients is essential in reducing early mortality in infective endocarditis. Attention should be paid to cerebral mycotic aneurysm as one of the problems affecting on postoperative mortality and morbidity.

Adult↗
PubMed1994

Hospital practices influence the pattern of infective endocarditis.

OBJECTIVE: To identify factors contributing to infective endocarditis at a major teaching hospital. METHODS: Retrospective review of clinical records of patients diagnosed with endocarditis by standard case definitions with respect to causative organisms, clinical features and outcome. RESULTS: One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed. In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci. Nosocomial acquisition and/or inter-hospital transfer accounted for 83 episodes; 48 (58%) S. aureus (P < 0.001) and nine (11%) viridans streptococci (P < 0.001). In cases from the local community, viridans streptococci were more common than S. aureus (37% versus 25%); these included 18 episodes (14 S. aureus) in intravenous drug users. CONCLUSION: We conclude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly by the prevalence of nosocomial endocarditis and the need for interhospital transfer of complicated cases.

Community-Acquired Infections↗
PubMed1994

[Endocarditis caused by Cardiobacterium hominis].

The incidence of endocarditis due to Cardiobacterium hominis is probably underestimated because clinical presentations vary greatly and culture of this Gram negative germ is difficult. A 48-year-old man with a past history of post-streptococcic aortic regurgitation was hospitalized twice within 1 week for fever (38 degrees C) and junctional tachycardia which responded to amiodarone. Subsequently, infero-apical necrosis was documented. Based on the result of the laboratory tests, coronary embolism was suspected although 12 blood cultures were negative. The patient recovered well with a standard antibiotic treatment. Fifteen days later, the blood cultures revealed Cardiobacterium hominis. Antibiotic therapy was adapted and aortic valve replacement was programmed. Two months later the patient died from uncontrollable left heart failure. A 63-year-old man who had had mitral valve replacement 10 years earlier for Streptococcus mitis endocarditis was hospitalized for fever (38 degrees C) and a painful left calf. Phlebocavography eliminated deep vein thrombosis and a complete cardiac work-up was inconclusive. Endocarditis was suspected although blood cultures were negative. The patient was given oral penicillin and discharged after one week. Three months later, the patient was again febrile (38 degrees C) and suffered a cerebral vascular event. Fourteen days after blood sampling, cultures revealed Cardiobacterium hominis. The patient's haemodynamic status worsened and valve replacement with atrioplasty was performed. Outcome after 4 years follow-up has been favourable. Endocarditis due to Cardiobacterium hominis, a saprophitic germ of the upper airway and the female genital tract, has been reported in 64 cases in the literature. The clinical picture is often limited to fever and a heart murmur and laboratory tests show an accelerated erythrocyte sedimentation rate and hyperleukocytosis. Inflammatory type anaemia is often found due to the latency of the endocarditis. Complications are frequent and can be fatal due to massive pulmonary emboli, cerebral vascular events or irreversible heart failure. C. hominis is sensitive to amoxycillin and netilmicin. Surgical treatment of the valvulopathy is indicated.

Anti-Bacterial Agents↗