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At least 973 records · Page 54Linked to original sources
PubMed1998

Mitral valve aneurysm as a sequela of infective endocarditis: review of pathologic findings in Japanese cases.

Mitral valve aneurysm is defined as a localized protrusion of the valve with a different radius from that of the remaining portion of the valve. The medical records and pathological findings of seven patients with mitral valve aneurysm [aged 48-69 years (mean 64), 4 males] and the pathological findings of other 29 Japanese cases were reviewed. All seven patients were diagnosed pathologically as infective endocarditis, but two patients had no documentation of clinical symptoms suggestive of infective endocarditis (latent infective endocarditis). The underlying lesion of the heart was aortic valve disease and/or fibrosal degeneration of the mitral valve. Only 29 of 36 Japanese case reports stated a precise description of the valve pathology. Of these 29 cases, 23 were associated with infective endocarditis, two with rheumatic valvular disease with fusion and/or shrinkage of the chordae tendineae, three with mitral valve prolapse or myxomatous degeneration of the mitral valve, and one with aortitis syndrome. Neovascularization was described in eight cases. Neovascularization with thick wall should be considered as post-inflammatory vascularization. This review indicates that patients with latent infective endocarditis and mitral valve aneurysm should be considered as potential candidates for valve surgery.

Aged↗
PubMed1998

[The microbiology of infectious endocarditis].

If streptococci and staphylococci remain the main bacteria responsible for infective endocarditis (80%), the emergence of Streptococcus bovis associated with intestinal lesions, the confirmation of the role of Coxiella burnetii, and the discovery of the responsibility of Bartonella sp in case of negative blood culture endocarditis have been the principal microbiological modifications during the last few years. Blood cultures performed under the best technical conditions and the examination and culture of the valve after surgery remain the better means for diagnosing infective endocarditis. In case of negative blood culture (11% of the infective endocarditis), the serologic tests against C. burnetii and Bartonella should decrease the rate of diagnostic uncertainty. The development of bacteriological techniques, particularly molecular methods, should improve the microbiology of infective endocarditis lead to the discovery new aetiological agents.

Bacteremia↗
PubMed1998

[Surgery of infectious endocarditis].

Thirty to fifty percent of patients with infective endocarditis are operated on during the active phase of the disease; this percentage is higher in case of some valvular localizations (aortic), in case of early prosthetic valve endocarditis, in case of some microorganisms (Staphylococcus aureus, gram-negative, fungus, intracellular microorganism). Operative death (at 30 days) is below 10% in native valve endocarditis, close to 50% in early prosthetic valve endocarditis, and below 20% in late prosthetic valve endocarditis. When active infective disease has been healed by medical treatment alone, half the patients need surgery in the first 2 years of follow-up; the indications for surgery are the functional status, the degree of valvular leaks and other lesions, the degree of ventricular dilatation.

Aortic Valve↗
PubMed1977

Staphylococcal endocarditis: clinical observations on 113 patients.

A 10-year analysis of 113 cases of staphylococcal endocarditis seen in two Washington, D.C., hospitals is presented. 96% of the cases occurred in parenteral drug addicts, but 4% complicated septicemia from known foci of infection. Coagulase positive staphylococcus was responsible for 97% of the infection, and the rest were caused by coagulase negative staphyloccus. Except in four patients with previously known cardiac murmurs, infection occurred on normal valves in these patients. Infection was isolated to the tricuspid valve in 71%, to the mitral valve in 6% and to the aortic valve in 3.5% of our cases; and more than one cardiac valve was affected in the remaining patients. All patients were treated with antibiotics based on bacterial sensitivity testing. The mortality from isolated tricuspid endocarditis was 5%, from isolated mitral endocarditis 33%, and from isolated aortic valve endocarditis 100%. The overall mortality was 18%. The better prognosis documented for acute tricuspid endocarditis is related to the much less severe haemodynamic consequences of acute tricuspid regurgitation, and the probably milder consequences of septic pulmonary embolism compared with coronary or cerebral embolism.

Adolescent↗
PubMed1982

The clinical manifestations of infective endocarditis.

Frequently, the presence of endocarditis is disguised. The emphasis of this description of the clinical manifestations of endocarditis is on the various modes of presentation, rather than on individual symptoms and signs. Endocarditis can manifest with cardiac, pulmonary, ophthalmic, central nervous system, renal, orthopedic, phthisic, and peripheral vascular disorders. The following clinical data are most useful in helping to establish a diagnosis of endocarditis: a history of fever, anorexia, weight loss, and back pain; a search for petechiae; splenomegaly; and daily examination, especially cardiac auscultation and funduscopic examination, of those patients in whom incomplete evidence exists at admission. The most helpful laboratory tests include those revealing anemia, increased erythrocyte sedimentation rate, abnormalities in the urine compatible with nephritis, or embolization. In patients who have not received antimicrobial therapy just before the diagnostic workup, one set of three blood cultures is sufficient to isolate the offending microorganism in about 95% of cases.

Anti-Bacterial Agents↗
PubMed2000

Surgical aspects of endocarditis.

Endocarditis represents a difficult medical problem that must occasionally be treated surgically. Constitutional symptoms of infection are important and are usually the reason that the patient seeks medical attention. Fever is the most common sign of infective endocarditis and a heart murmur, which changes in character or is new, is a significant hallmark. The diagnosis for infective endocarditis is made by high index of suspicion in a patient with valvular heart disease or a prosthetic heart valve and in the presence of fever and a cardiac murmur. A positive blood culture is the hallmark of the diagnosis. The absolute indications for operative intervention are congestive heart failure, unstable prosthetic valve, uncontrolled infection, and relapse after optimal therapy (prosthetic valve). Relative indications for operative intervention are perivalvular extension of the infection, staphylococcal infection of a prosthesis, persistent fever (culture negative), large vegetation, or relapse after optimal therapy (native valve). The principles of surgical management are to remove all infected tissue by thorough debridement back to normal tissue. This is combined with replacement of damaged valves and repair of associated defects. The mortality after operation for infective endocarditis is 15-20%. Late survival after operation for infective endocarditis on a native heart valve is 70-80% at 5 years. Survival falls to 50-80% at 5 years for surgery on an infected prosthetic heart valve.

Journal Article↗
PubMed2002

The changing profile of bacterial endocarditis as seen at an australian provincial centre.

BACKGROUND: The clinical profile of endocarditis has changed over the past four decades with studies showing trends towards increasing age, more nosocomial and prosthetic valve infection and increasing rates of Staphylococcus aureus infection. However, these studies have been biased by referral patterns. METHODS: We reviewed data collected at three hospitals in the Barwon-South-West region in Victoria, Australia. All cases identified between 1994 and 1999 were reviewed according to the Duke criteria. RESULTS: During this period, 58 patients were diagnosed as having endocarditis. The incidence rate during this time was 3.0 per 100 000 with a rise in the rate of admissions from 0.15 to 0.26 per 1000 from 1995 to 1999. Sixteen (28%) were nosocomial with the majority from line-related sepsis. No intravenous drug users were identified. Eighteen (31%) involved endovascular prosthetic material. S. aureus was the causative pathogen in 23 (40%), with 'viridans' streptococci contributing 12 (21%) and other organisms accounting for 12 (21%). Attributable mortality in this series was 17%. CONCLUSIONS: We have seen a rise in the rate of endocarditis during this time. The proportions of endocarditis due to S. aureus and 'viridans' streptococci, as well as rates of nosocomial and prosthetic valve infection, are consistent with more recent series at referral hospitals and district hospitals, representing a change since studies performed in the 1960s and 1970s. Our findings confirm a trend towards a clinical profile seen at referral centres and reinforce the emerging importance of S. aureus, nosocomial bacteraemia and prosthetic valve endocarditis.

Journal Article↗
PubMed1999

Infective endocarditis: new concepts in pathogenesis.

Gram-positive cocci account for the large majority of cases of infective endocarditis. Pathogenesis investigations of endocarditis have therefore focused on purported virulence factors in staphylococci, viridans group streptococci and enterococci. In addition to novel molecular techniques that have been adapted for use in the examination of gram-positive cocci, animal models of experimental endocarditis have been employed to support or discount the role of specific bacterial components in production of infective endocarditis. This review details recent work that addresses endocarditis pathogenesis and highlights pertinent findings from these investigations.

Journal Article↗
PubMed1987

Infective endocarditis: diagnosis, treatment, and mortality, as related to surgical timing and infectious organism.

To evaluate the timing of surgical treatment in infective endocarditis and to determine the relationship between the risk of mortality and the species of infectious organism, we reviewed a consecutive series of 65 cases involving patients with infective endocarditis who had been treated over a 17-year period. The patients included 41 males and 24 females, who ranged in age from 6 to 85 years (mean, 39.3 years). Forty-five had native valve endocarditis, 14 had prosthetic valve endocarditis, and six had endocarditis associated with congenital heart defects. Fifty-two patients underwent valve replacement, which was associated with an overall operative mortality of 19%. Those who underwent valve replacement during the early active stage (first 3 weeks) of infection had a higher mortality rate than those who had surgery either during the late active stage (second 3 weeks) of infection or after 6 weeks of antibiotic therapy. S. aureus and Pseudomonas organisms were responsible for the most deaths. On the basis of this study, we recommend that, when cardiovascular function permits, patients who are hemodynamically stable and free of emboli should receive 4 to 6 weeks of antibiotic therapy before undergoing surgical treatment. In contrast, patients with high-risk organisms are more likely to survive if subjected to early surgical intervention.

Journal Article↗
PubMed1983

Immune reactions in infective endocarditis. II. Relevance of circulating immune complexes, serum inhibition factors, lymphocytotoxic reactions, and antibody-dependent cellular cytotoxicity against cardiac target cells.

Circulating immune complexes (IC) were detected in 35 out of 41 patients (85%) with infective endocarditis of known bacterial origin in contrast to only 9 out of 20 patients (45%) with endocarditis but negative blood cultures (p less than 0.05). Peak IC levels of 33.25 +/- 24.33 micrograms/ml in the early period fell significantly to 8.38 +/- 13.37 micrograms/ml after antibiotic treatment (p less than 0.001). High levels of IC coincided with relative hypocomplementemia. Erythrocyturia was observed in 51 of 58 IC-positive patients demonstrating peripheral sequelae of circulating IC. Incidence and concentrations of IC correlated neither with the mere presence of the rheumatoid factor nor with the titers of antimyolemmal antibodies, nor with antibody mediated cytolysis in the presence of complement. Serum inhibition factors (SIF) and E-rosette inhibitory factors (RIF) were not demonstrated, indicating that IC in endocarditis do not suppress phytohemagglutinin-induced lymphocyte proliferation or the E-rosetting of T cells. Significant lymphocytotoxicity against heterologous cardiac target cells without serum (LC) could be demonstrated in 11 out of 23 patients (48%) with endocarditis as compared to its absence in controls (n = 33, p less than 0.01). In assays of antibody-dependent cellular cytotoxicity (ADCC), either enhancement or blocking of lymphocytotoxicity by autologous serum or both was observed. The modulation of lymphocytotoxicity was most likely due to antimyolemmal antibodies, to IC, or to both, although effects of other serum factors cannot be ruled out completely.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1992

Surgical management of infective endocarditis in children.

Infective endocarditis occurs infrequently in the general pediatric population, occurring mostly in patients with congenital heart disease. This study reviews our surgical experience with infective endocarditis based on a policy of aggressive intervention, conservative operative debridement, and creative reconstruction options using pericardium and prosthetic heart valves. From 1982 to 1989, 16 patients, 3 weeks to 16 years of age, underwent 19 intracardiac operations for infective endocarditis therapy at Kosair Children's Hospital. Eight (42%) were for resection of vegetations alone; an additional 11 operations (58%) involved more extensive debridements requiring either valve replacement or valvuloplasty using pericardium for exclusion of an abscess cavity, closure of a fistula, or for valve repair. Operative mortality was 25% (4 patients) and related to preoperative disease severity. There was one late death. Offending organisms included Staphylococcus species (31%), Haemophilus influenzae (13%), pneumococcus (5%), gram-negative organisms (13%), and Candida (13%); no organism grew on culture in 25%. We conclude that aggressive surgical exploration in patients with infective endocarditis is indicated and often requires resection of vegetations alone. More extensive procedures should preserve as much valvular tissue as possible. Pericardium is useful for reconstruction after debridement.

Adolescent↗
PubMed2002

Current best practices and guidelines. Assessment and management of complications in infective endocarditis.

The most important complications of endocarditis are congestive heart failure, paravalvular abscess formation, and embolism, especially stroke. In addition, endocarditis may be complicated by septic arthritis, vertebral osteomyelitis, pericarditis, metastatic abscesses and an array of renal problems ranging from immune-complex glomerulonephritis to renal abscesses. Adverse reactions associated with medical treatment of endocarditis can also result in significant complications such as ototoxicity and nephrotoxicity, skin rashes, and serum sickness. This review focuses on the cardiac, embolic, neurologic and renal complications of endocarditis and discusses how these complications influence the clinical management of individual cases in daily practice.

Abscess↗
PubMed1975

[Valvular replacement in florid endocarditis. Report on 5 cases].

This is an account of experience with valve replacement in patients with active endocarditis. In four patients the aortic valve was replaced, and in one, the mitral valve. Indication for surgery in all five cases was heart insufficiency. Two patients died, one of acute left heart failure five weeks postoperatively, and one of brain embolus in the presence of persisting acute endocarditis, four months postoperatively. Covered in the discussion are other indications for valve replacement in the presence of acute endocarditis, namely, serial emboli, fungus endocarditis, resistance to and toxic reactions of antibiotics, and mycotic sinus of valsava aneurysm. In conclusion, results obtained by other authors are reported.

Acute Disease↗
PubMed2006

Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.

BACKGROUND: Alternative therapies for Staphylococcus aureus bacteremia and endocarditis are needed. METHODS: We randomly assigned 124 patients with S. aureus bacteremia with or without endocarditis to receive 6 mg of daptomycin intravenously per kilogram of body weight daily and 122 to receive initial low-dose gentamicin plus either an antistaphylococcal penicillin or vancomycin. The primary efficacy end point was treatment success 42 days after the end of therapy. RESULTS: Forty-two days after the end of therapy in the modified intention-to-treat analysis, a successful outcome was documented for 53 of 120 patients who received daptomycin as compared with 48 of 115 patients who received standard therapy (44.2 percent vs. 41.7 percent; absolute difference, 2.4 percent; 95 percent confidence interval, -10.2 to 15.1 percent). Our results met prespecified criteria for the noninferiority of daptomycin. The success rates were similar in subgroups of patients with complicated bacteremia, right-sided endocarditis, and methicillin-resistant S. aureus. Daptomycin therapy was associated with a higher rate of microbiologic failure than was standard therapy (19 vs. 11 patients, P=0.17). In 6 of the 19 patients with microbiologic failure in the daptomycin group, isolates with reduced susceptibility to daptomycin emerged; similarly, a reduced susceptibility to vancomycin was noted in isolates from patients treated with vancomycin. As compared with daptomycin therapy, standard therapy was associated with a nonsignificantly higher rate of adverse events that led to treatment failure due to the discontinuation of therapy (17 vs. 8, P=0.06). Clinically significant renal dysfunction occurred in 11.0 percent of patients who received daptomycin and in 26.3 percent of patients who received standard therapy (P=0.004). CONCLUSIONS: Daptomycin (6 mg per kilogram daily) is not inferior to standard therapy for S. aureus bacteremia and right-sided endocarditis. (ClinicalTrials.gov number, NCT00093067 [ClinicalTrials.gov].).

Adult↗
PubMed1993

Infective endocarditis in children: profile in a developing country.

With the object of studying the profile of infective endocarditis in Indian children younger than 16 years of age, a retrospective study of 37 patients with infective endocarditis admitted to this hospital between January 1984 and December 1990 was carried out. There were 26 boys and 11 girls (aged 2-16 years (mean (SD) 10.3 (3.8)). Eighteen (48.6%) patients had underlying congenital heart disease, 13 (35.1%) had associated rheumatic heart disease whilst the remaining six had no pre-existing heart disease. All six patients with a normal heart and infective endocarditis had preceding extra-cardiac bacterial illnesses (epididymitis and orchitis in one, pneumonia in five). Blood cultures were positive in only 16 (43.2%): Staphylococcus aureus was grown in nine, Streptococcus viridans in six and Candida albicans in one. Sixteen (43.2%) of the 37 patients died owing to worsening cardiovascular haemodynamics, uncontrolled septicaemia and our inability to offer emergency surgery. The profile of infective endocarditis in developing countries is different from that in Europe and the United States of America, and the disease carries a very high mortality.

Adolescent↗
PubMed2001

Enterococcal endocarditis in Sweden, 1995-1999: can shorter therapy with aminoglycosides be used?

A 5-year nationwide prospective study in Sweden during 1995-1999 identified 881 definite episodes of infective endocarditis. Definite enterococcal endocarditis was diagnosed in 93 episodes (11%), the largest series of enterococcal endocarditis so far presented. Mortality during treatment was 16%, the relapse rate was 3%, and clinical cure was achieved in the remaining 81% of the episodes. Clinical cure was achieved with a median duration of cell wall-active antimicrobial therapy of 42 days combined with an aminoglycoside (median treatment time, 15 days). International guidelines generally recommend a 4-6-week combined synergistic treatment course with a cell wall-active antibiotic and an aminoglycoside. Treatment regimens in Sweden often include a shortened aminoglycoside treatment course in order to minimize adverse effects in older patients. Fatal outcome seemed not to be due to the shortened aminoglycoside therapy course. In many enterococcal endocarditis episodes, duration of aminoglycoside therapy could probably be shortened to 2-3 weeks.

Adolescent↗
PubMed1992

Operative intervention in active endocarditis in children: report of a series of cases and review.

We describe in detail 14 children (age, less than or equal to 19 years) who underwent operative intervention during active infection of the heart and/or great vessels. The series included five children less than 6 years old, who constitute 10% of all such cases reported in this age group to date. We also review the 132 published reports in which children underwent operative intervention during active endocarditis. We found the following: (1) The survival rate for all cases was 77%. (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antibiotic treatment. (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation. (5) The perioperative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old. (8) Staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.

Adolescent↗
PubMed1995

A review of endocarditis in acquired immunodeficiency syndrome and human immunodeficiency virus infection.

Non-bacterial thrombotic endocarditis (NBTE) was frequently identified in early post-mortem studies of patients with HIV infection, but has not been reported since 1989. The reason for this apparent decline is not clear, but it is possible that the prevalence of the condition was overestimated in the past. We have found no evidence of NBTE in our series of 110 autopsies on subjects from all major risk groups and at various stages of immune deficiency [intravenous drug user (IVDU)-AIDS 35% (39/110), IVDU-pre AIDS 36% (40/110), homosexual-AIDS 25% (28/110), blood product recipients-AIDS 1.8% 2/110), African 0.9% (1/110)]. Infective endocarditis (IE) in HIV infection occurs almost exclusively in intravenous drug users and is rare in other HIV-positive patients. However, asymptomatic HIV infection appears to have little effect on the susceptibility to or the mortality from endocarditis and it is, therefore, appropriate to institute antimicrobial treatment in these cases. The majority (54.4%) of the 960 HIV-positive individuals in the Lothian region of Scotland are young adults who contracted the virus through IVDU around 1983. However, a prospective echocardiological study of 269 patients over four years (IVDU 69%, homosexual 18%, heterosexual 8%, bisexual 3%, multiple risk factors 1%) has demonstrated only four cases of infective endocarditis. We believe this reflects the prevalence of current parenteral drug use in our cohort which has fallen with the introduction of an oral drug replacement programme.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗