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PubMed1984

Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases.

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

Endocarditis, Bacterial↗
PubMed1986

Coagulase-negative staphylococcal endocarditis: a view from the community hospital.

Review of our experience with infectious endocarditis at a single community hospital showed coagulase-negative staphylococci to be our leading cause of endocarditis. The pathogenesis of coagulase-negative staphylococcal endocarditis (CNSE) involved either hematogenous seeding of native or prosthetic valves, or direct implantation at surgery. Cases involving native valves demonstrated an acute onset and rapidly deteriorating course, while prosthetic valve endocarditis was more indolent; both types were associated with multiple complications. Although the number of our cases is small, mortality from native valve CNSE was higher than that of prosthetic valve endocarditis. Patients treated medically fared better than those receiving both medical and surgical treatment, though the medically treated group may not have been as ill as those having valve replacement. Vancomycin caused serious adverse effects in two of the five patients receiving it.

Adult↗
PubMed1997

[Postoperative mortality in infective endocarditis: determinant factors].

The factors leading to high postoperative mortality in active infectious endocarditis (IE) are poorly defined. We studied patients operated at an University Hospital between March 1978 and April 1992. We hypothesized that the summation of potential adverse factors would strongly increase mortality after surgery. We studied 39 patients (28 men), age range 13-70 years (mean +/- SD = 32 +/- 16) operated during active IE (time from onset 52 +/- 48 days). Predisposing factor: rheumatic valvar disease in 14 cases, intravenous drug use in 5. Affected valves: aortic in 14, mitral in 10, tricuspid in 8, multiple structures in 7. In most cases, S aureus (12) or Streptococcus sp (10) was isolated in blood cultures. Surgery was indicated in most patients because of heart failure (30), multiple embolic complications (17) or treatment failure (14). The possible adverse influence of specific demographic characteristics, clinical features and surgical variables was assessed by the Student t test or the chi 2 test. Also, multiple regression analysis was performed in order to identify independent adverse factors for increased mortality. Positive correlations were further investigated with the chi 2 test to assess whether an increasing number of adverse factors could identify a special subset of patients with markedly elevated death risk. Fourteen patients (36%) died after surgery. Emergency surgery (p = 0.001), the presence of coma 6 hours after surgery (p = 0.0015) and S. aureus infection (p = 0.023) were all associated with increased mortality. The presence of neurological complications was correlated with a high mortality (54% vs. 27%). However this increase was of dubious statistical significance (p = 0.097). Multiple regression analysis confirmed S. aureus and emergency surgery as independent adverse factors for increased mortality. When put together, an increasing number of adverse factors was highly predictive of a fatal outcome, even after exclusion of that evaluated after surgery (level of consciousness). Patients with two or three adverse factors had a very high mortality rate (> 76.9%). Mortality following surgery for active IE is increased in patients operated on an emergency basis especially if the infection is caused by S. aureus. The presence of neurological complications may also be associated with worse outcome. Early consideration of surgery should reduce the high mortality in patients with active IE.

Adolescent↗
PubMed1996

[Enterococcal endocarditis: clinical and microbiological features of our series].

Of 81 cases of infectious endocarditis seen at our institution from 1988 to 1995, 61 had positive culture (75%) and, of these, 10 (16%) were caused by enterococcal strains (9 by Enterococcus faecalis, 1 by Enterococcus faecium). The 10 cases consisted of 5 native valve endocarditis and 5 late prosthetic valve endocarditis. Median age of patients was 50 years (range 21-58); 6, were males. Diagnostic or surgical procedures on the abdomen, genito-urinary tract, or chest preceded the onset of fever in almost all cases. Nine enterococcal strains showed low-level resistance to aminoglycosides and one was highly resistant. Seven patients were treated with ampicillin and gentamicin and 2 with teicoplanin and gentamicin. The patient, whose infection was caused by an high gentamicin-resistant E. faecalis, was treated with the combination of ciprofloxacin and cotrimoxazole chosen on the basis of the in vitro susceptibility tests. Congestive heart failure occurred in 4 patients and major embolic events in 3. All patients were cured; 4, with medical therapy alone and 6, with antimicrobials associated with surgical substitution of the valve. The data indicate that enterococcal endocarditis, when treated with appropriate antimicrobial regimens, associated with surgical treatment when necessary, has a very low mortality rate. The conventional treatment, -lactams plus gentamicin is usually effective. However, for high-level gentamicin-resistant strains alternative treatments must be selected on the basis of the in vitro susceptibility tests.

English Abstract↗
PubMed1998

[Subacute bacterial endocarditis: diagnostic aspects].

AIM: To compare the proposed diagnostic criteria of subacute infectious endocarditis (SIE) to criteria developed by von Reyn et al. and by Duke Endocarditis Service. MATERIALS AND METHODS: 69 SIE cases and suspected recurrences have been analysed for patients observed in the Therapeutic Clinic of the Moscow medical University in 1990-1997. RESULTS: According to the authors' criteria accurate and tentative SIE diagnosis were made in 82 and 18% of patients, respectively. The other two diagnostic approaches in this situation increase the percentage of presumptive diagnosis and decrease that of the definite one. CONCLUSION: The criteria proposed by the authors are more sensitive in diagnosis of definite SIE, are less dependent on echocardiography quality and bacteriological diagnosis.

Adolescent↗
PubMed2003

Differences between endocarditis with true negative blood cultures and those with previous antibiotic treatment.

BACKGROUND AND AIM OF THE STUDY: High morbidity and mortality are attributed to patients with culture-negative endocarditis. The main reason for negative blood culture in infectious endocarditis (IE) is administration of antibiotics before sample withdrawal. The study aim was to determine any difference in prognosis between patients with 'aborted' culture-negative endocarditis (A-CNE) and those with true culture-negative endocarditis (T-CNE). METHODS: A total of 107 patients with a diagnosis of IE was studied retrospectively. Diagnosis was confirmed pathologically during surgery, at post-mortem examination, or by fulfillment of Duke's criteria. Twenty patients (18.7%) had negative-culture endocarditis and comprised the study population. Of these patients, 14 (70%) had received previous antibiotic therapy (A-CNE), and six (30%) were considered T-CNE cases. In-hospital outcome and clinical characteristics were compared between both patient groups. The main end-point was death or need for surgical repair of the heart valves during hospitalization. RESULTS: There were no significant inter-group differences with respect to mean age, gender distribution, and other clinical characteristics. The composite endpoint of death or surgical repair occurred more frequently in T-CNE patients (100% versus 64%, p = 0.0394). Anatomic complications also occurred more frequently in T-CNE patients, but the difference was statistically not significant. CONCLUSION: Among patients with IE and a negative blood culture, those without previous antibiotic therapy (T-CNE) have the worse prognosis.

Antibiotic Prophylaxis↗
PubMed1990

Increasing frequency of staphylococcal infective endocarditis. Experience at a university hospital, 1981 through 1988.

To determine the characteristics of infective endocarditis in our hospital, we reviewed all patients with that diagnosis at the University of Massachusetts Medical Center, Worcester, between 1981 and 1988. Of 113 patients with infective endocarditis, 56 (50%) had staphylococcal endocarditis. Despite aggressive medical and surgical therapy, in-hospital mortality was 25%. Forty-five (80%) of the 56 cases of staphylococcal endocarditis involved Staphylococcus aureus with a mortality of 28% vs 9% in the non-S aureus group. Mortality was higher in patients with congestive heart failure (35%), atrioventricular block (45%), atrial fibrillation (42%), and prosthetic valve endocarditis (50%). Seventy-six percent of the patients with congestive heart failure required surgery. Patients with congestive heart failure and S aureus infection had a mortality of 45%. Thirty-six patients (64%) were alive at late follow-up (mean, 28.6 months). Mortality was highest (23%) during the first 3 months following diagnosis of staphylococcal endocarditis. Staphylococcal endocarditis represents an increasingly large proportion of patients with infectious endocarditis. Mortality rates remain high despite aggressive management of the patient's condition.

Adolescent↗
PubMed2005

[Whipple's disease endocarditis: report of 5 cases and review of the literature].

PURPOSE: Endocarditic lesions (infectious endocarditis) associated with Whipple's disease are exceptional. We report five cases from the cardiovascular and pneumologic hospital Louis Pradel in Lyon. METHOD: We have collected all cases of Tropheryma whipplei endocarditis diagnosed between 1995 and 2004. RESULTS: Five men with a mean age of 53 years at time of diagnosis. The symptoms were essentially cardiovascular: murmur, embolism in 3 cases, and heart failure secondary to valvular insufficiency in 2 cases. The valvular involvement, double in 3 cases, was more often aortic. Vegetations were present in all patients and valvular destruction sometimes very important. A low grade fever was present in 4 cases, associated with weight loss in 2 cases. The only extra-cardiac symptoms were arthralgias or arthritis in all cases, considered in 3 patients as seronegative rheumatoid arthritis, B27+ spondylarthritis, and psoriasic arthritis. Their was no other clinical manifestations of Whipple's disease, particularly digestive, ocular, neurologic or adenopathy, and duodenal biopsies secondarily performed in 4 cases were non contributive. This differs from literature as an extra-cardiac location was identified in 11 out of 17 cases. The diagnosis was obtained by histology and PCR on the cardiac valves, as all the patients underwent surgery. The evolution was favourable with a prolonged antibiotic therapy. CONCLUSIONS: These report confirms the existence of endocarditic forms of the Whipple's disease, in which the single extra-cardiac manifestation is rheumatologic, and reminds us the usefulness of histology and PCR on the cardiac valves at the time of valvular surgery.

Actinobacteria↗
PubMedDate not supplied

Vascular encephalopathy associated with bacterial endocarditis in four dogs.

Vascular encephalopathy is a commonly encountered clinical complication of infectious endocarditis in humans, but it has been infrequently reported in dogs. A series of four dogs with bacterial endocarditis that subsequently developed acute onset of neurological deficits is described. Clinical signs, diagnostic test results, and outcomes for each case are presented and compared with the human clinical syndrome.

Animals↗
PubMed2000

[Glucocorticosteroids in bacterial endocarditis: is it beneficial or harmful?].

AIM: Analysis of results of treatment of infectious endocarditis (IE) with glucocorticosteroids in combination with antibiotics. MATERIAL AND METHODS: 128 IE patients received antibiotics (control group). Glucocorticosteroids were added to antibiotics in 44 IE patients (study group). RESULTS: Valvular replacement, congestive heart insufficiency, thromboembolic complications, suppression of cellular and humoral immunity occurred more frequently in patients of the study group. CONCLUSION: It was found that glucocorticosteroids affect IE negatively, especially in the dose 30 mg/day and higher. Glucocorticosteroids are indicated in allergic reactions to the antibacterial drugs, severe renal damage (proteinuria < 1 g/l), myocardial defects; contraindicated in non-eradicated IE causative agent, in recurrent IE.

Adolescent↗
PubMed2000

[Infective endocarditis: quality of diagnosis and clinical features].

AIM: To review current course of infectious endocarditis (IE), time and quality of the diagnosis, results of hospital treatment. MATERIAL AND METHODS: 30 cases of IE have been analysed (17 males, 13 females, mean age 37.6 +/- 2.3 years. The patients were admitted to hospital in 1997-1998. RESULTS: Late diagnosis registered in many IE cases is explained by low quality of history data and of heart auscultation responsible for late start of conservative treatment. Some specific features of the disease course, visceral lesions, efficacy of the treatment are outlined. CONCLUSION: IE morbidity is still high and prognosis in many cases if unfavourable.

Adult↗
PubMedDate not supplied

[Actinobacillus actinomycetem comitans endocarditis. Report of a case and review of the literature].

A case of infectious endocarditis caused by Actinobacillus actinomycetem comitans in a young male is presented. The clinical features and the microbiologic data are reviewed as well as the diagnostic and therapeutic procedures including the echocardiographic findings. A review of the literature is presented with 23 cases of endocarditis caused by this bacterium. An analysis of the cases with special emphasis in clinical presentation, predisposing factors, complications and antimicrobial therapy is made. A. actinomycetem comitans could be a cause of blood culture negative endocarditis due to the slow growth of the bacterium and the subacute course of the disease.

Actinobacillus Infections↗
PubMed1986

[Pseudotumoral mitral endocarditis. Diagnostic and therapeutic problems apropos of a case report with review of the literature].

The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.

Adolescent↗
PubMed1990

[Ventricular arrhythmias disclosing myocardial abscess in infectious mitro-aortic endocarditis].

The authors report the case of a myocardial abscess in an infectious endocarditis with a double localization, mitral and aortic. The way it is revealed, by severe and recurring ventricular arrhythmias, differs from the conduction disorders usually described. The diagnosis is suspected by non-invasive examinations, echocardiography and nuclear magnetic resonance. It is backed up by angiographic exploration. The intervention confirms the data obtained by cardiac imaging, and enables the ablation of the abscess which is cleaned out, and the cure of the valvular lesions. Taking into account the gravity of this complication, a close clinical, electrocardiographic and echocardiographic surveillance of all infectious endocarditis is necessary.

Abscess↗
PubMed1998

Review of pneumococcal endocarditis in adults in the penicillin era.

Streptococcus pneumoniae is an infrequent cause of infectious endocarditis in adults. In the past 2 years, however, we have encountered several cases at our institution, and additional cases have been reported in the literature. This infection typically follows pneumonia in the setting of chronic alcoholism and may additionally be complicated by meningitis. Less commonly, pneumococcal endocarditis occurs in other hosts or follows primary infection at other extrapulmonary sites. In such cases, the diagnosis may be initially missed, with a resultant delay in institution of appropriate therapy. Moreover, there are controversies regarding the optimal therapy for infections of this nature in the era of penicillin resistance. Since a comprehensive review of this topic has not been published since 1990, we reviewed cases of pneumococcal endocarditis in the penicillin era, with particular attention to disease recognition, the role of echocardiography, and the dilemmas surrounding medical and surgical therapeutic interventions.

Adolescent↗
PubMed2005

[Do patients with ventricular septal defect need endocarditis prophylaxis?].

BACKGROUND: Patients with ventricle septal defect are considered at higher risk of infectious endocarditis than the population in general. According to guidelines, these patients should receive prophylactic antibiotics prior to invasive procedures. Recently, several studies have been published that challenge this view. MATERIAL AND METHODS: Based on searches in Medline, we discuss the risk of endocarditis and indication for antibiotic prophylaxis in patients with this defect. RESULTS: Patients with perimembranous and subvalvular defects have higher risk of endocarditis than the population in general. The proportion of patients developing endocarditis in relation to invasive procedures is low. Prophylactic antibiotics are only partially effective. INTERPRETATION: The proportion of preventable cases of endocarditis is low, and the prophylaxis does not give sufficient protection. Studies suggest that only patients at the highest risk should receive prophylactics.

Antibiotic Prophylaxis↗
PubMed2002

Ga-67 SPECT to detect endocarditis after replacement of an aortic valve.

Ga-67 SPECT was crucial in making the diagnosis of infectious endocarditis in a 28-year-old man with a history of aortic valve replacement who was referred to the nuclear medicine service because of persistent fever. In the planar left anterior oblique view, an area of slight, diffuse activity was noted. The shape and site of the infectious focus were well defined by Ga-67 SPECT. After Ga-67 imaging, results of a computed tomographic (CT) scan were negative and the patient was treated with antibiotics and discharged from the hospital after showing clinical improvement. However, the fever returned and he was readmitted. A second Ga-67 SPECT was also positive, but a spiral CT scan showed only minor inflammatory changes. Finally, transesophageal ultrasonographic images suggested vegetation on the prosthetic valve. Cultures of the graft and the valve were obtained surgically and showed staphylococcal endocarditis. Exaggerated confidence in negative CT scan results led to unnecessarily delayed surgical treatment of the infection. Ga-67 SPECT was a powerful noninvasive tool in the diagnosis of infectious complications after prosthetic valve surgery.

Adult↗
PubMed1992

Pneumothorax in a dog with a pulmonary abscess and suspected infective endocarditis.

Nontraumatic pneumothorax was diagnosed in a dog with a pulmonary abscess and evidence of infectious endocarditis, including fever, mitral murmur, and vegetative lesion of mitral valve leaflets. Pneumothorax persisted after 4 days of continuous thoracic drainage. At exploratory thoracotomy, the diaphragmatic lung lobe was identified as the source of air leakage and was excised. Results of culturing of blood and lung tissue for aerobic and anaerobic bacteria were negative. Antibiotics were administered because of suspected bacterial endocarditis. Pneumothorax and fever resolved after surgical and medical treatments.

Animals↗