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PubMed1993

[Right-sided endocarditis caused by Staphylococcus aureus during the neonatal period. (A case report)].

Right-sided infectious endocarditis in the neonate, due to staphylococcus aureus, is a rare entity. A high index of suspicion should be used when dealing with a very sick neonate, especially with aggressive reanimation. Although the diagnosis is clinical, echocardiography is essential to confirm the diagnosis and also is an excellent mean to follow the evolution of the disease. The pathogenesis of the infection is due to bacteremia with implantation of the staphylococcus on a normal endothelium. The prognosis is poor with a high mortality rate and possibility of sequelae (essentially cardiac and neurologic). The prognosis depends essentially on early diagnosis and treatment which should last for at least 4-6 weeks. The authors present the case of a 2-week-old girl who developed a right-sided staphylococcal endocarditis following treatment of neonatal jaundice with i.v. perfusion of albumin. The patient survived with cardiac and central nervous system sequelae.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comamonas (Pseudomonas) testosteroni endocarditis.

Comamonas testosteroni has rarely been implicated as a human pathogen. We report a case of infectious endocarditis due to this organism, occurring in a 49-year-old man. The posterior leaflet of the mitral valve contained a 1 x 1 cm vegetation and showed myxoid degeneration and acute inflammation. The patient had no evidence of reinfection after 32 months. The infection was almost certainly community acquired, as is usually true for this organism.

Anti-Bacterial Agents↗
PubMed1999

Acetylsalicylic acid reduces vegetation bacterial density, hematogenous bacterial dissemination, and frequency of embolic events in experimental Staphylococcus aureus endocarditis through antiplatelet and antibacterial effects.

BACKGROUND: Platelets are integral to cardiac vegetations that evolve in infectious endocarditis. It has been postulated that the antiplatelet aggregation effect of aspirin (ASA) might diminish vegetation evolution and embolic rates. METHODS AND RESULTS: Rabbits with Staphylococcus aureus endocarditis were given either no ASA (controls) or ASA at 4, 8, or 12 mg. kg-1. d-1 IV for 3 days beginning 1 day after infection. Vegetation weights and serial echocardiographic vegetation size, vegetation and kidney bacterial densities, and extent of renal embolization were evaluated. In addition, the effect of ASA on early S aureus adherence to sterile vegetations was assessed. In vitro, bacterial adherence to platelets, fibrin matrices, or fibrin-platelet matrices was quantified with either platelets exposed to ASA or S aureus preexposed to salicylic acid (SAL). ASA at 8 mg. kg-1. d-1 (but not at 4 or 12 mg. kg-1. d-1) was associated with substantial decreases in vegetation weight (P<0.05), echocardiographic vegetation growth (P<0.001), vegetation (P<0.05) and renal bacterial densities and renal embolic lesions (P<0.05) versus controls. Diminished aggregation resulted when platelets were preexposed to ASA or when S aureus was preexposed to SAL (P<0.05). S aureus adherence to sterile vegetations (P<0.05) or to platelets in suspension (P<0.05), fibrin matrices (P<0.05), or fibrin-platelet matrices (P<0.05) was significantly reduced when bacteria were preexposed to SAL. CONCLUSIONS: ASA reduces several principal indicators of severity and metastatic events in experimental S aureus endocarditis. These benefits involve ASA effects on both the platelet and the microbe.

Animals↗
PubMed1982

Spectrum of the infective endocarditis in the past five years.

One hundred and thirty patients at our Heart Institute with infectious endocarditis during the past 5 years were reviewed to provide an overview of the spectrum of infective endocarditis and to assess the accuracy of echocardiography in detecting the infective valvular and endocardial lesions. Of the 130 patients, 36 (28%) had the previous cardiovascular surgery. The mean age of the patients was 34 years, and only 11% of the patients were over 50 years of age. Of the 94 patients who had no cardiovascular surgery before developing infective endocarditis, 6 underwent urgent surgery, 49 had elective surgery and the remaining 39 were followed up with medical treatment. The mortality rate of the 55 patients who were operated on was 5.5% as against 18.0% in 39 without surgery. Half of the 36 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of the 5 patients with bioprosthetic valve endocarditis, only one survived as a result of prompt medical and surgical treatment. Streptococci were still commonly found, about 75% in the group without surgery and 50% in the group with surgery. Gram-negative bacilli and fungi were found in patients with prosthetic valve endocarditis. In 61 patients, morphologic abnormalities confirmed at surgery or necropsy were compared with the preoperative echocardiograms. Vegetations were identified preoperatively in 50 (95%) of the 53 valves involved, and valve destruction was correctly predicted in all 23 cases. Mycotic aneurysm was detected preoperatively in only 3 of the 12 patients in whom it occurred. Thirteen patients, in whom vegetation was recorded, were treated successfully with antibiotics alone and they needed no surgical intervention during the 2-year follow up period. The presence of a vegetation in an echocardiography does not necessarily require surgical intervention in itself or predict the ultimate course.

Adolescent↗
PubMed1986

[Results of surgical treatment in acute native endocarditis. Apropos of 41 patients].

This study was based on the analysis of 41 cases of infectious endocarditis of native valves operated during the acute phase. Patients with bacteriological cures, prosthetic valve endocarditis and endocarditis on congenital non-valvular lesions were excluded. There were 32 men and 9 women with an average age of 49 years. The valve lesions were aortic incompetence, mitral incompetence, mitro-aortic disease and mitro-tricuspid disease. Fourteen patients had preexisting valvular disease (rhumatic in 12 and congenital in 2 cases). These patients were in an advanced clinical state at the time of operation: 23 Class IV, 16 Class III and 2 Class II operated for systemic embolism. The surgical indications were severe cardiac failure in 30 cases, systemic embolism in 2 cases and persistance of septicaemia with worsening cardiac function in 9 cases. The causal organism was isolated from blood cultures in 34 cases (83%) and from the excised valve in 13 cases. The early postoperative mortality during the first month was 5 patients (3 cases of aortic incompetence associated with mitral incompetence and 2 cases of aortic incompetence alone). Death was caused in most cases by irreversible cardiac failure related to the advanced preoperative cardiac failure. All the other patients were followed up for 1 to 102 months (average 44 months). There were 7 late postoperative deaths. The mortality rate was 3.4% per patient year including patients undergoing chronic haemodialysis. The actuarial survival was 79% at 78 months excluding the operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

Infective endocarditis--changes in the microbiological profile.

The clinical material from 120 patients, with clinical diagnosis of infectious endocarditis (IE) (65 patients with IE on native valves and 55 patients with IE on artificial valves, i.e. mechanical or biological prosthesis) treated during the period of 1986-1994 was investigated. Sixty positive cultures were obtained from the valves and 40 positive cultures from the blood, which accounted for 76% and 60% of the confirmed IE cases, respectively. Bacteriological confirmation of IE was obtained in 91 (75.8%) patients, 80.2% of the isolated microorganisms being gram-positive bacteria, 17.6% gram-negative, and 2.2%-fungi. The most frequently isolated bacteriawere coagulase-negative staphylococci. They accounted for 40.5% of infections in the IE patients on native valves, and for 63.3% in those with artificial valves. Streptococci were isolated from 11.8% of the patients with IE on native valves and from only 2% of cases of IE on artificial valves. The multiresistant strains were most frequently isolated from the patients with IE on artificial valves.

Endocarditis, Bacterial↗
PubMed2002

Infective endocarditis caused by unusual gram-positive pathogens.

Of a total of 81 patients hospitalized in the infectious diseases department in 1990-2000 with infectious endocarditis caused by Gram-positive pathogen, unusual etiological agents were found in several cases: Streptococcus pyogenes, Streptococcus pneumoniae, Corynebacterium diphtheriae, and Gemella morbillorum. Cardiac defects were present in the latter two patients: bicuspid aortic valve and tetralogy of Fallot. Two patients were successfully treated with antibiotics only and one patient with antibiotics and surgery. The patient with C. diphtheriae endocarditis died due to progressive sepsis and multiple organ failure.

Adult↗
PubMed2003

Does assessment of pretest probability of disease improve the utility of echocardiography in suspected endocarditis in children?

OBJECTIVE: To compare the yield rate (YR) of echocardiography when evaluating children with suspected infectious endocarditis (IE) in both the actual clinical setting and in the hypothetic setting where strict clinical criteria are applied. Study design Medical records of 101 children undergoing echocardiography for suspected IE were reviewed. Echocardiograms with positive findings were identified and the actual diagnostic YR was calculated. With the use of clinical criteria proposed by von Reyn (VR), the probability of IE was retrospectively classified as (1) rejected, (2) possible, or (3) probable. Theoretic YR of echocardiography was calculated for each classification. RESULTS: The actual YR of echocardiography was 12% (12/101). The YR of echocardiography by VR class was 0% in rejected, 20% in possible, and 80% in probable cases (chi(2) = 55.1, P <.0001). Echocardiography did not change the probability of IE in any patient classified as rejected, but allowed reassignment of disease probability in a significant proportion of patients with possible or probable IE. CONCLUSIONS: The YR of echocardiography was significant when clinical probability of IE was intermediate-to-high, and low, with marginal clinical utility, when clinical probability was low. Strict pretest assessment of disease probability may lead to more effective utilization of echocardiography in this population.

Bacteria↗
PubMed2006

Infective endocarditis with congenital heart disease.

From 1988 to 2005, seven patients were operated at our hospital because of infectious endocarditis (IE) with congenital heart disease (CHD). Underlying CHD included ventricular septal defect (VSD) in 4 (2 previous operations with residual region), atrial septal defect (ASD) in 2 and bicuspid aortic stenosis (AS) in 1. No cases had preventive antibiotic prophylaxis for dental procedures. We could confirm bacteria origin from blood culture in all cases, but two patients had operations without gaining control of the infection. VSD or ASD closure and valve surgery were performed in four patients. One patient had a VSD closure, two patients had valve surgery. There were no operative or hospital deaths and there were no recurrences of IE during the study period. We successfully treated IE with CHD by enough debridement of the infective focus of IE, and valve surgery. It is important for patients with CHD to have preventive antibiotic prophylaxis for dental procedures.

Adolescent↗
PubMed1989

[Surgical treatment of high-risk valvular endocarditis].

The authors have studied the short and long term results of surgical treatment of acute phase of infectious endocarditis in a group of 33 high risk patients with valvular heart disease. The age varied from 2 to 68 years; 18 patients were male and 22 were of the white race. The aortic valve was most frequently involved (18/54.5%), followed by the mitral valve (13/39.3%) and tricuspid valve (2/6.0%). Twenty four patients (72.7%) were in functional class III and seven (21%) in functional class IV. The noninvasive studies in those patients revealed 13 cases (39.4%) with normal cardiac size. The ECG was abnormal in 27 cases (81.8%) mostly with left atrial and ventricular hypertrophy. The echocardiogram revealed the presence of vegetations in 27 patients (81.8%) and blood cultures were positive in 22 cases (66.6%). All patients were treated with antibiotics. The pathologic analysis revealed the presence of vegetations in 94% and structural alterations in 16.5%. Twenty-one patients had heart valve replacement with mechanical prosthesis (63.6%), 11(33.3%) had bioprosthesis and one had tricuspid excision without replacement (3.0%). The hospital mortality was 12% and the late mortality 3%. Three deaths occurred in patients who had prolonged clinical treatment (more than 65 days) and one patient died of severe fungal endocarditis. The follow-up of the remaining 26 patients varied from 01 to 448 weeks (mean 183) demonstrating important clinical improvement and a normally functioning valve prostheses. All patients are in functional class I and II. The analysis of our data indicates that surgical treatments is the best option for high risk endocarditis and should be undertaken earlier in all patients in this risk group.

Adolescent↗
PubMed1982

Blood culture positivity: suppression by outpatient antibiotic therapy in patients with bacterial endocarditis.

Recognition of the increasing prevalence of outpatient antibiotic use prompted this review of 32 patients with verified infectious endocarditis. The results of 161 quantitative blood cultures obtained before definitive therapy were correlated with clinical information to determine whether outpatient antibiotic administration influenced blood culture positivity. In 17 patients receiving outpatient antibiotics, 56 (64%) of 88 blood cultures obtained before definitive treatment were positive, whereas all cultures obtained from 15 patients without recent antibiotic exposure were positive. Notably, seven patients showed a phase of total suppression, and two patients showed a phase of partial suppression of blood culture positivity after discontinuation of outpatient antibiotic treatment. Consequently, patients with recent antibiotic exposure and suspected endocarditis should have blood cultures obtained initially and periodically throughout the phase of potential suppression of bacteremia to optimize the chance of obtaining a positive result.

Ambulatory Care↗
PubMed1997

[Surgical treatment of acute endocarditis--which preoperative diagnosis does the surgeon need?].

In a group of 140 patients undergoing operation for acute infectious endocarditis in an 8-year period, the value of preoperative diagnostic procedures was analyzed in a retrospective study. Echocardiography was sufficient to establish the diagnosis in each case, angiography did not add any information about the endocarditis, but detected severe coronary heart disease in 19 patients. Abdominal sonography is mandatory to exclude intestinal foci, while CT scan of the brain only has to be performed in patients with neurologic deficits.

Acute Disease↗
PubMed1995

The use of technetium-99m hexamethylpropylene amine oxime labelled granulocytes with single-photon emission tomography imaging in the detection and follow-up of recurrence of infective endocarditis complicating transvenous endocardial pacemaker.

In this case report we present a patient with a recurrence of subacute bacterial infectious endocarditis (IE) complicating a transvenous endocardial pacemaker. Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) labelled granulocytes were used for diagnosis and follow-up under medical treatment only, since surgical removal of the pacemaker lead was ruled out because of the general condition of the patient. Single-photon emission tomography (SPET) imaging displayed the active lesion previously suspected on echography. At the end of antibiotic therapy, SPET indicated a favourable disease outcome whereas echocardiographic abnormalities remained nearly unchanged. The medical treatment had eradicated the IE, and the patient did well for more than 1 year thereafter.

Aged↗
PubMed2004

[Arteriovenous fistula of the renal vessels due to septic embolism in a patient with bacterial endocarditis].

A 27 year-old woman developed acute pain of the right flank during the course of an infectious endocarditis. A septic arteriovenous fistula of the renal vessels of a solitary functioning kidney was demonstrated. The cardiac valvular lesions required a prosthetic aortic and mitral replacement valves. An attempt to occlude the fistula by embolization with several coils was unsuccessful and led to surgery: extracorporeal repair enabled complete closure of the fistula. During the long-term follow-up, the aortic prosthetic valve had to be changed. Renal function was satisfactory and remained stable over time. Renal arteriovenous fistula is an exceptional complication of bacterial endocarditis despite the frequency of septic emboli during the course of the disease.

Adult↗
PubMed2002

[Clinical characteristics of endocarditis running with viral hepatitis in intravenous drug abusers].

Viral hepatitis (VH) was diagnosed in 65% of patients with infectious endocarditis (IE) abusing intravenous narcotic drugs. VH caused recurrent course of IE in 8% examinees. The virusological tests of the blood for HBs-antigen or antibodies to viral hepatitis C were positive in 39 patients (group 1) and negative in 21 patients (group 2). VHB, VHC, VHB + VHC were diagnosed in 15, 57 and 28% patients, respectively. An acute course of IE was observed in 72% patients from group 1 and 76% patients from group 2, respectively, subacute course--in 20 and 24%, respectively, recurrent in 8% and 0%, respectively. IE patients with VH often had thrombohemorrhagic complications. DIC syndrome was detected in 25 and 4% patients, hemophthisis--in 33 and 28%, nephritis--in 71 and 48% patients, acute cerebral ischemia--in 7 and 4%, acute myocardial infarction--in 71 and 4%, hypocoagulation--in 53 and 8%, hypercoagulation--in 29 and 50% patients from group 1 and 2, respectively.

Adolescent↗
PubMed2005

Austrian syndrome: report of two new cases and literature review.

In April 2004, Rammeloo et al. reported a child-aortic-valve endocarditis following pneumococcal meningitis. Classically, the association of pneumococcal pneumonia along with meningitis and infectious endocarditis (IE) is known as Austrian syndrome. We assessed the incidence, clinical manifestations and follow-up of patients diagnosed with Austrian syndrome in Lugo (Northwest Spain) between 1987 and 2002. A computerized MEDLINE search was also performed for literature review. During the study period 165 Lugo patients met criteria for definite IE. Two of the 3 patients with definite streptococcus pneumoniae IE also met definitions for Austrian syndrome. The incidence of this syndrome in Lugo patients with definite IE was 1.2%. In the literature review 48 cases, including our two patients, were found. Complete clinical information was only available on 16 patients. Alcoholism constituted the most common predisposing factor. Aortic valve involvement and high grade of valve regurgitation leading to cardiac failure and the need of cardiac surgery during the admission were common in these patients. This review confirms that Austrian syndrome is a rare but severe disease. Early recognition of these patients is required to avoid ominous complications.

Alcoholism↗