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PubMed2004

[Anticoagulation with bemiparina after intracerebral hemorrhage as complication of bacterial endocarditis on metallic prosthetic valve].

We present the case of a patient with an intracerebral hemorrhage as complication of an infectious endocarditis (EI) produced by Neisseria sicca on a prosthetic mitral valve. The patient was anticoagulated previously with Acenocumarol as prophylaxis of thrombosis of the prosthetic valve. He was diagnosed as having IE and later he presented neurological symptoms as consequence of several intracerebral hemorrhagic foci. We decided to continue the anticoagulation with sodium heparin followed of Bemiparina and no new hemorrhagic complications nor thrombosis of the valve were observed after three months of the event. We have not found in the literature any case where low molecular weight heparin has been used as method of anticoagulation in these cases beyond two weeks.

Cerebral Hemorrhage↗
PubMed1993

[Mitral endocarditis caused by Staphylococcus aureus resistant to methicillin, aminoglucosides and rifampicin: description of 2 cases with fatal course].

Two patients with infectious endocarditis (IE) by Staphylococcus aureus resistant to methicillin, aminoglucosides and rifampicin (SARMAR) acquired in hospital during the course of an epidemic outbreak of this microorganism in the Hospital Clínic i Provincial of Barcelona. Both patients had undergone surgery of the lower limbs. The entrance of the microorganism was the infection of the surgical wound, with bacteriemia, followed by mitral IE after a short time interval (20 days). Despite adequate treatment with vancomycin both patients died. The culture of mitral vegetation was positive for SARMAR in one. Analysis of the chromosomic DNA of all the isolations from the patients was identical and coincided with that of the SARMAR strains isolated in the epidemic outbreak of the hospital. The current situation of IE by SARMAR is reviewed and the therapeutic implications commented upon suggesting that treatment of this entity should simultaneously include the administration of vancomycin and phosphomycin or cotrimoxazole, with surgery being considered if infection persists.

Aged↗
PubMed1996

Acute infective endocarditis. Diagnostic and therapeutic approach.

Acute bacterial endocarditis (ABE) is clinically distinct from subacute bacterial endocarditis in terms of pathologic virulence, acuteness and severity of illness, complications, and prognosis. The term infectious endocarditis may be useful as a general term but conveys no meaningful clinical information. ABE presents as an acute, fulminant intracardiac infection with fevers (temperature > 102 degrees F) that are caused by highly virulent known pathogens. Septic embolic phenomena, valve dysfunction, and congestive heart failure are characteristic. Parenteral and oral antibiotic treatment regimens are discussed.

Acute Disease↗
PubMed1994

[Beta-hemolytic streptococcus endocarditis in an adolescent with hypertrophic cardiomyopathy].

A 15 year-old male adolescent was hospitalized in a severe septic condition, due to infectious endocarditis which abided for 20 days. The admittance echocardiogram displayed a mitral valve vegetation in conjunction to a hypertrophic cardiomyopathy. In spite of applied antibiotics the patient expired. The authors emphasize the diagnostic difficulties of this compound entity and stress the need of antibiotic prophylaxis for patients who bear a hypertrophic cardiomyopathy, even in those with a non-obstructive disposition.

Adolescent↗
PubMed1994

[Tricuspid endocarditis caused by penicillin-resistant Staphylococcus aureus: 2 cases in parenteral drug addicts].

BACKGROUND: Staphylococcus aureus is the main causal agent of infectious endocarditis (IE) in intravenous drug addicts (IVDA) with most of the strains, isolated in Spain being resistant to penicillin and sensitive to methycillin, although the latter condition varied in recent years. Two cases of IE caused by S. aureus strains sensitive to penicillin in IVDA are presented. METHODS: All bacteremia episodes diagnosed in the Hospital General Penitenciario (Madrid) over a 33-month period (March 1991 to December 1993) were prospectively studied. Special attention was given to patients diagnosed of IE. Blood cultures were processed according to the usual technique by a non radiometric system. RESULTS: One hundred and four bacteremias were detected with 14 being produced by S. aureus. Ten episodes of the total number of bacteremias fulfilled criteria for IE with 2 being produced by strains of S. aureus sensitive to penicillin (CMI < 0.06 mu/ml). Both patients had coinfection by HIV. The clinical evolution prior to diagnosis was prolonged although clinical and microbiologic cure were achieved with intravenous beta-lactam antibiotics treatment, without complications. CONCLUSIONS: Despite the low incidence of the isolation of Staphylococcus aureus sensitive to penicillin (< 3%) recently observed in Spain, strains producing severe infections, showing patterns of sensitivity such as those found during the preantibiotic era, may still be isolated.

Adult↗
PubMed1989

Endocarditis from a dental focus. Importance of oral hygiene in valvar heart disease.

Fastidiously growing bacteria more and more are recognised as a source of infectious endocarditis. Over recent years, three new cases of endocarditis caused by Actinobacillus actinomycetemcomitans were diagnosed in our institution. The rise in frequency is possibly secondary to better laboratory skills. Two patients with Actinobacillus (Haemophilus) actinomycetemcomitans endocarditis presented the classical history of preexisting valvar disease together with poor dental hygiene. The third patient had no congenital or rheumatic preexisting lesion to the valves. The distal part of a ventriculo-atrial drainage device had caused microtrauma to the tricuspid valve. The right-sided endocarditis in this patient was complicated by pulmonary septic emboli. Dental origin of the infection was very likely in this patient too. No dental procedure had been performed in the months preceding the endocarditis of our three patients. They presented endocarditis with an oral microorganism in the absence of any dental manipulation. All three had very poor dental hygiene. Better dental care could possibly have prevented this serious complication.

Actinobacillus Infections↗
PubMed1998

[Endocarditis caused by Staphylococcus lugdunensis. Hospital incidence].

BACKGROUND: Staphylococcus lugdenensis is a coagulase negative staphylococcus (CNS) associated with a wide spectrum of infections among which infectious endocarditis may be found and in which it is an aggressive pathogen. METHODS: Since 1993 a systematic search for S. lugdenensis in all the staphylococci isolated in blood cultures and the possibility of endocarditis en all of these was determined. A review of all the cases of endocarditis in the literature was performed. RESULTS: Three cases of endocarditis by S. lugdenensis on the native valve were detected from January 1993 to June 1997. None of the patients presented previous heart disease or risk factors. In all the cases, at least three blood cultures were positive for S. lugdenensis and vegetations were observed by echocardiogram. Despite correct antibiotic treatment, disappearance of fever, negativization of control blood cultures and in the third case, valve replacement, two patients presented heart failure and all died. On review of the literature 31 cases of endocarditis were found with valve replacement and mortality being 55%. It should be indicated that 85% of the patients who survived required surgery. CONCLUSIONS: Endocarditis by S. lugdenensis is a severe infection frequently requiring valve replacement and is associated with a high mortality. Therefore, adequate early identification of the microorganism is necessary distinguishing it from the remaining CNS.

Adult↗
PubMedDate not supplied

[A 35-year-old woman with fever, dyspnea, and pain in the left thigh].

A thirty-five years old woman during her twelfth pregnancy presented fever and pain at the left thigh. After cesarean delivery dyspnea added to the first two symptoms and pulmonary embolism was suspected. A clinical history revaluation suggested a diagnosis of infectious endocarditis and femoural osteomielitis due to a septic embolus.

Adult↗
PubMed2006

Endocarditis caused by Cardiobacterium valvarum.

A fastidious, gram-negative bacterium was isolated from the blood of a 51-year-old man who had acute infectious endocarditis (IE). Characterization of the organism through phenotypic and genotypic analyses revealed the causative role of Cardiobacterium valvarum. This is the third reported case of IE caused by C. valvarum.

Cardiobacterium↗
PubMed1996

[Infectious diseases as a cause and risk factor for cerebrovascular ischemia].

Cerebrovascular ischemia can be caused by infectious diseases which involve cerebral arteries or the heart, including infectious endocarditis, bacterial and fungal meningitis, neurosyphilis, neuroborreliosis, herpes zoster, the acquired immunodeficiency syndrome, cat scratch disease and other rare infectious diseases. Presently, there is increasing evidence that infection in general and mainly respiratory infection is a risk factor for ischemic stroke. Case reports and smaller case series reported an association of cerebrovascular ischemia and recent infection in children and younger adults. Two case control studies from Helsinki (54 patients under the age of 50) and from Heidelberg (197 patients aged 80 or less) identified recent infection as an important risk factor for ischemic stroke. Febrile, bacterial and respiratory infections were most important in this respect. In the study from Heidelberg, the neurological deficit was more severe and cardioembolism was more frequent in infection-associated stroke than in stroke without preceding infection. This review summarizes the association of infectious diseases and cerebrovascular ischemia and discusses potential pathogenetic mechanisms linking both diseases.

Adult↗
PubMed2000

[Some problems of the current therapy of infective endocarditis].

AIM: To analyse clinical characteristics of endocarditis for the last 10 years, treatment difficulties and how to overcome them. MATERIAL AND METHODS: 135 patients with infectious endocarditis (IE) were examined according to the routine scheme using modern methods of diagnosis and therapy control: transthoracic and transesophageal echo-CG, test for antibiotics sensitivity of the microflora, etc. Immediate results were assessed in all the patients, some of them were followed up for maximum 5 years. RESULTS: Last decade was marked for growing difficulties in the treatment of IE related to its polyetiology. It can be caused by such therapy-resistant microbes as Staphylococcus aureus, Pseudomonas aeruginosa, anaerobic infection, nosocomial infection, injections of narcotic drugs, etc. CONCLUSION: Current course of IE dictates the necessity of fighting resistant microflora especially in case of nosocomial disease. Recurrences become more frequent. Indications to surgery did not change for the last decade. The best treatment results are achieved after antibacterial treatment of the valve.

Adult↗
PubMed2006

[Pneumococcal endocarditis in children: report of a case due to penicillin resistant Streptococcus pneumoniae].

Despite S. pneumoniae is one of main etiologies of invasive bacterial infection in children, it rarely causes infectious endocarditis in children. Pneumococcal endocarditis is a serious condition that affects mainly the mitral valve, with a rapidly destructive nature and a high fatality rate, demanding prompt medical and surgical treatment. We report a case of pneumococcal endocarditis in a school girl coming from extreme rurality who presented both meningitis and endocarditis, and whose blood cultures isolated penicillin resistant S. pneumoniae.

Anti-Bacterial Agents↗
PubMed1990

[Surgical treatment of infectious aneurysm of the popliteal artery. Description of a case caused by Campylobacter jejuni and a review of the literature].

The authors describe a case of mycotic aneurysm of the popliteal artery secondary to Campylobacter jejuni-derived infectious endocarditis treated by excision and in situ femoro tibial venous bypass, and take the opportunity to review 14 literature cases of infectious aneurysm of popliteal artery. This diagnosis is most frequently evoked by the development in an infectious setting of a throbbing inflammatory mass in the popliteal fossa. Management is aimed at controlling the infection and insuring proper distal vascularization. Eradication of the infection rests with the excision of the aneurysm and adequate antibiotherapy for at least 6 weeks. Distal vascularization is best provided (2 cases) by extra-anatomical bypass. However, in situ bypassing (9) is possible provided apyrexia and negative blood cultures have been obtained by preoperative antibiotherapy. The material used must be a venous autograft, whenever possible.

Adult↗
PubMed1990

[10 fatal endocarditis: autopsy observations, causes of death].

Among 841 autopsies realized between january 1982 and september 1988, by the Pathological the department of Amiens University Hospital the ten patients dead of infectious endocarditis have been autopsied. Macroscopic and microscopic observations have two cases of acute endocarditis and eight of subacute endocarditis. For the two patients dead of acute endocarditis, autopsy affirms the cardiovascular etiology of death. For the eight cases of subacute endocarditis, necropsic findings differs from the germs. In the three cases where the germ is a Staphylococcus aureus, the diagnosis of endocarditis was made before death and the cardiovascular etiology of death was affirmed by autopsy. For the other germs (3 Streptococcus sp, 1 Salmonella typhimurium, and 1 germ unknown), the diagnosis of endocarditis was made by autopsy, but necropsy disclosed the cause of death in only two cases.

Adult↗
PubMed1994

[Granulomatous endocarditis caused by streptococcus].

Two cases of granulomatous endocarditis are reported. The patients developed aortal endocarditis refractory to antibiotics. Therefore, aortal valve replacement was performed. In both cases, Streptococcus viridans was demonstrated in culture and bacterioscopically to be the cause of infection. Histological examination of the valves showed characteristic endocarditis with fibrinoid necrosis and histiocytic granulomas. Streptococci were found in the cytoplasm of macrophages. The possible causes of this special form of infectious endocarditis are discussed.

Adolescent↗
PubMedDate not supplied

Valvular heart disease and systemic lupus erythematosus: therapeutic implications.

Valvular involvement is the most encountered form of heart disease in systemic lupus erythematosus (SLE). Immunoglobulin and complement deposition in the valvular structure will subsequently lead to Libman-Sacks vegetations, valve thickening, and valve regurgitation. Valvular stenosis is rarely seen. Involvement of the mitral valve is most frequently encountered. Valve disease for most patients is mild and asymptomatic, but patients in whom severe mitral regurgitation develops will present with symptoms of congestive heart failure. A heart murmur will be heard in almost all patients with moderate or severe regurgitation. Transesophageal echocardiography is the most sensitive method to detect the valvular involvement. The valvular changes, the hemodynamic status, or the symptomatology have been shown to progress, remain stable, or sometimes improve. Severe regurgitation, infective endocarditis, and thromboembolic events (mostly stroke or transitory ischemic attacks) are complications of valvular involvement in SLE. In treatment of these patients, prophylaxis of infectious endocarditis, selective antiaggregant and anticoagulant medication, and valve replacement are currently offered. The role of corticosteroid treatment is still unclear in the outcome of SLE valvulopathy.

Heart Valve Diseases↗
PubMed1983

Yersinia enterocolitica endocarditis.

A patient with Yersinia enterocolitica endocarditis was seen with bacteremia, valvular vegetation, new heart murmur, and septic embolism. To our knowledge, this is the first reported case of Y enterocolitica infectious endocarditis and is yet another clinical manifestation of disease produced by this organism.

Aged↗