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PubMed1999

Staphylococcus aureus endocarditis presenting as meningitis and mimicking meningococcal sepsis.

A case of Staphylococcus aureus meningitis (SAM) secondary to endocarditis is presented. The presence of a petechial rash affecting the lower limbs led to an initial presumptive diagnosis of meningococcal meningitis. There were no stigmata of endocarditis at presentation, though these subsequently developed. Underlying endocarditis should be diligently sought in any patient presenting with spontaneous SAM, even if typical stigmata are initially absent. In view of the association with skin lesions and neurological complications, S. aureus endocarditis may mimic the classical presentation of meningococcal sepsis.

Bacteremia↗
PubMed1998

Infective endocarditis in a tertiary-care hospital in southern Israel.

During the years 1980-1994, 84 patients were treated in our institution due to suspected infective endocarditis (IE). Seventy-one of these episodes occurring in 71 patients, classified definite or possible according to the Duke criteria, were retrospectively analyzed in this study. There were 52 cases of native valve endocarditis, 7 cases of early prosthetic valve endocarditis, and 12 cases of late prosthetic valve endocarditis. The incidence of IE did not change significantly during the study period. The overall mortality rate was 15%. Only one case of drug addiction appeared in our series despite its growing frequency in Israel. Rheumatic heart disease remained the main underlying cardiac condition and Streptococcus viridans remained the most common pathogen. Streptococcus bovis was found to be a significant pathogen causing IE in our patient population, while Staphylococcus aureus appeared to be less frequent. The Duke criteria significantly classified a greater proportion of cases as definitive, as opposed to the von Reyn criteria. Fewer cases were rejected by the Duke criteria, especially culture-negative cases, and those without histopathological confirmation. Application of the Duke criteria permits a more consistent approach to the diagnosis of IE, even in a non-drug-addict patient population.

Adolescent↗
PubMed2000

[Staphylococcus aureus endocarditis in Denmark 1982-1991. Clinical picture, complications and antibiotic therapy in non-drug addicts].

The central S. aureus surveillance in Denmark made it possible to analyze the clinical features of S. aureus endocarditis in a nation-wide population of non-drug addicts. Almost all cases of bacteraemia with S. aureus are reported to the Staphylococcus laboratory, Copenhagen. The medical records were reviewed in cases from 1982 to 1991 in which the diagnosis of endocarditis was reported or suspected. Two hundred and sixty patients fulfilled the diagnostic criteria. In 83 patients the diagnosis of endocarditis was not suspected clinically. The overall mortality rate among those patients whose disease was diagnosed clinically was 46% and significantly associated with late congestive heart failure, age and involvement of the central nervous system. A more frequent use of echocardiography as a screening method seems essential to improve the prognosis of patients with S. aureus endocarditis. Involvement of the CNS constitutes a relative indication for early valve replacement.

Adolescent↗
PubMed1999

[Endocarditis caused by Actinobacillus actinomycetemcomitans].

The HACEK group endocarditis are infrequent in general population. They usually develop subacute endocarditis with large vegetations, peripheral emboli, heart failure, requiring frequent valvular replacement. We report a clinical case of endocarditis caused by Actinobacillus actinomycetemcomitans (AA), without the typical findings of the HACEK group endocarditis and with a successful evolution with medical treatment.

Actinobacillus Infections↗
PubMed2000

[A case of heart operation in infective endocarditis after brain surgery for mycotic cerebral aneurysm].

Complications of infective aneurysm are not rare in patients with infective endocarditis. An optimal timing of heart operation after brain surgery for hemorrhage is controversial. We reported a 19-year-old woman with ventricular septal defect (type II), mitral regurgitation and ruptured cerebral aneurysm with infective endocarditis. Cerebral aneurysm had been ruptured during infective endocarditis treatment. Resection of the aneurysm was performed next day. Vessel spasm occurred, resulting in cerebral infarction 7 days after the operation. Conservative therapy was continued for infective endocarditis until heart failure appeared. Heart operation was successfully performed 41 days after brain surgery without cerebral complication. This report indicates that heart operation might be avoided at the early postoperative stage of brain surgery for cerebral aneurysm with hemorrhage.

Adult↗
PubMed2000

Staphylococcus aureus bacteremia and endocarditis.

Staphylococcus aureus bacteremia is a serious and common disease often associated with infective endocarditis. It occurs in both healthy, immunologically competent people in the community and compromised patients in the hospitals. For S. aureus bacteremia, questions on clinical issues such as antimicrobial treatment are raised. Is nafcillin/oxacillin superior to vancomycin? Does the addition of rifampin improve outcome? Does addition of aminoglycoside improve the outcome? Does increasing duration of therapy (> 4 weeks versus < 2 weeks) improve outcome? How many cases of community-acquired S. aureus bacteremia have endocarditis on admission? What are the risk factors that would separate bacteremia from endocarditis? What is the role of echocardiography? What are the indications for routine echocardiography? Are methicillin-resistant S. aureus (MRSA) more virulent than methicillin-susceptible S. aureus (MSSA)? What factors predict mortality in S. aureus bacteremia? Herein, the above important issues on S. aureus bacteremia and endocarditis are critically reviewed.

Animals↗
PubMed2000

[Valvular tumor: diagnostic trap. Report of a case of marastic endocarditis].

Marastic endocarditis is a rare clinical condition described in cases of cancer or other severe inflammatory diseases. The authors report the case of a young patient in good general condition, admitted after a cerebro-vascular accident. Investigations showed an isolated mitral valvular mass on transoesophageal echocardiography which, after unsuccessful medical therapy, was operated. It was, in fact, a case of marastic endocarditis, and a pulmonary tumour was discovered one month after surgery. The bronchopulmonary adenocarcinoma had remained infraclinical beforehand. The advances in echocardiographic imaging will probably lead to an increase in such cases of early diagnosed thrombotic non-bacterial endocarditis (ETNB. This case suggests that it is justified to carry out an aetiological investigation of thrombotic non-bacterial endocarditis in all cases of isolated mitral valve masses.

Adenocarcinoma↗
PubMedDate not supplied

[Infective endocarditis in intravenous drug addicts].

Infective endocarditis is a frequent complication in intravenous drugs abusers. It is evident that in recent years this problem has increases as a consequence of the growing number of drug addicts. We review the clinical files of patients who entered the Regional General Hospital No. 20 IMSS in the City of Tijuana Mexico between May 1994 and May 1998 with diagnosis of infective endocarditis and had evidence intravenous abuse. Eight patients were included in the study. None of them had preexisting valve abnormalities. The infection involved right-sided values in 62.5% of cases left-sided values in 12.5%, and both sides in 12.5% of cases Staphylococcus aureus was the infecting germ in 50% of the cases. Survival of patients with right infective endocarditis was 75% and only 25% of them required surgical intervention. The mortality of infection in left side was 75% and 100% if infection involved both sides. Infective endocarditis in drugs abusers has a favorable prognosis when right sided valves are affected. Mortality rates are higher in patients with left-sided involvement.

Adolescent↗
PubMed2001

[Long-term results of the surgical treatment in acute aortic valve endocarditis].

Late results after surgery for acute infectious aortic endocarditis using allografts are compared with those achieved with bioprostheses or mechanical heart valves. Cryopreserved allografts were used in 74 (22%) and prosthetic heart valve in 262 out of 336 (78%) patients presenting acute aortic endocarditis. Prosthetic (p = 0.001) and destructive endocarditis (p = 0.001) were more frequent in patients receiving allografts. Mean follow-up time was 6.6 +/- 4 years (range, 3 to 28 years). The 30-day-mortality was 19% for allograft patients and 6% for those receiving prosthetic heart valves (p = 0.002). Early reoperation, postoperative renal failure and sepsis did not differ between groups. After 20 years, actuarial survival was 60% for mechanical heart valves, 44% for bioprosthesis and 38% for allografts (p = 0.003), reoperation was unnecessary in 52% of mechanical heart valves and 10% of bioprostheses and allografts (p = 0.0007). Acute infection at the time of operation (p = 0.0001), redo surgery (p = 0.0006), staphylococci (p = 0.0003), older age (p = 0.004) and mitral valve involvement (p = 0.004) were risk factors for late death, irrespective of preoperative antibiotic treatment and type of prosthesis used. A longer bypass and aortic cross-clamp time predicted early (p = 0.0001) and late survival (p = 0.0001), independently. Destructive aortic endocarditis has a poor long-term outcome irrespective of the use of allografts. Acute infection at the time of surgery predicted early and late death; however, surgery is indicated prior to secondary involvement of the mitral valve. The duration of preoperative antibiotic treatment did not affect outcome. A thorough surgical technique directly influences early and late survival.

Acute Disease↗
PubMed2002

The advantage of repair of mitral valve in acute endocarditis.

BACKGROUND AND AIM OF THE STUDY: Mitral valve repair offers a survival benefit compared with valve replacement in surgery for non-infectious mitral regurgitation. It is unclear whether repair offers an advantage for patients undergoing mitral valve surgery for active endocarditis. Morbidity and mortality (early and late) and event-free survival were compared between the repair and replacement groups. METHODS: Between September 1986 and July 1999, 44 patients with acute native mitral valve endocarditis underwent surgery; 28 patients had valve replacement, and 16 underwent repair. Nine patients had complex repairs including replacement of a portion of the leaflet with prosthetic patch, placement of artificial chordae, resection of a portion of both leaflets, and/or reconstruction of a commissure. The remainder had simple repairs. RESULTS: Preoperative characteristics and indications for surgery between the two groups were similar. There were six in-hospital (21%) and six late cardiac deaths (21%) in the valve replacement group, but no early deaths or late cardiac deaths in the repair group (p <0.05). Independent risk factors for early and late death were need for associated procedures (p <0.03) and mitral valve replacement (p <0.05). Additional risk factors for late death were diabetes mellitus (p = 0.005) and hemodynamic instability as an indication for surgery (p = 0.047). Five patients undergoing valve replacement required reoperation due to recurrent endocarditis, compared with none in the repair group (p = 0.065). Mean follow up was 39+/-33 months in the repair group, and 57+/-51 months in the replacement group. CONCLUSION: Early and late mortality and event-free survival were better in patients undergoing mitral valve repair compared with replacement for acute endocarditis. Valve repair should be carried out whenever possible in this patient group.

Acute Disease↗
PubMed1979

Scanning electron microscopy of infective endocarditis.

As part of a study of the development of infective endocarditis in ncarcotic addicts, we sought to establish the feasibility of using scanning electron microscopy (SEM) to view the surface characteristics of human heart valves obtained at autopsy. Normal and infected heart valves from humans and animals were obtained at autopsy, fixed in formalin, and processed for SEM. Parallel samples from immediately adjacent regions were processed for light microscopy. Active and healed endocarditis were readily recognizable by SEM, and the observations correlated well with those made by light microscopy. The advantage of SEM in the study of endocarditis is that it provides significant information about damage to the endocardial surface across the entire valve. The relative proportions of fibrin, platelets, leukocytes, exposed stromal connective tissue and bacteria on the surface of a lesion can easily be analysed. SEM may prove particularly useful in the study of the pathogenesis of the early lesions of infective endocarditis on previously "undamaged" valves.

Animals↗
PubMed2001

Streptococcus agalactiae endocarditis.

Streptococcus agalactiae (S. agalactiae) is a rare cause of infective endocarditis, which is associated with a high mortality rate. Endocarditis in adults is generally related to immunocompromised states. We hereby report the case of a 35 year old man who presented with fever and delirium in whom aortic valve endocarditis due to S. agalactiae was detected. Though most patients with S. agalactiae endocarditis need surgical intervention along with antibiotics, our patient improved with medical therapy alone.

Adult↗
PubMed2001

[Vegetations associated with infective endocarditis in children].

OBJECTIVE: The purpose of this study were clinical analysis of vegetations associated with infective endocarditis. MATERIAL AND METHODS: Between 1990-1999 years 7 children (aged 2-17 years) with infective endocarditis were study in the Cardiology Department Children's Memorial Health Institute. Analysed clinical features of vegetations associated with endocarditis. MAIN OBSERVATIONS AND RESULTS: The most of them vegetations were localized on the mitral valve and in children without congenital heart disease (CHD). Remaining patients were: girl with bicuspidal aortic valve-vegetation on the aortic valve, boy with simple ventricle, pulmonary stenosis and atrial septal defect-vegetation on the pulmonary valve, boy with double outlet right ventricle, pulmonary stenosis and atrial septal defect-vegetation on the tricuspid valve, boy with patent ductus arteriosus-vegetation on the pulmonary valve. In all patients were regurgitations of this valves (> II degree). 71% patients had fever, 57% another murmur in the heart, 43% hepatosplenomegalia. Positive result of the blood sowing was in 72% patients. After medical treatment of vegetations good result was in 4 children. Chirurgical treatment were performance in 3 children. CONCLUSIONS: 1. Vegetations in the echocardiographic examination were in 21.8% children associated with infective endocarditis. 2. The most of them vegetations were localized on the mitral valve and in children without CHD. 3. Good result after medical treatment of vegetations was in 57% patients.

Adolescent↗
PubMed1979

[Therapy of bacterial endocarditis].

The successful treatment of bacterial endocarditis requires a close cooperation to a clinical microbiological laboratory. This performs blood cultures, estimation of sensitivity to the different antibiotics, if anyhow possible also quantitatively, and supervision of therapy by serum bactericidal tests. Synergistic combinations by adding one of the aminoglycosides bring the best chances for therapeutic success. Special advices are given in dependence of the numerous causative bacterial agents. Rare ones are sufficiently taken into consideration. If blood cultures remain negative, empiricial chemotherapy is recommended. Surgical treatment by operative replacement of the infected heart valves and insertion of prosthetic ones is indicated in uncontrolled infection, in severe heart failure caused by valve perforation, and in recurrent embolism. Early interventions have a much better prognosis. Special problems are connected to bacterial endocarditis in prosthetic valves. Bacterial endocarditis in drug addicts is of relatively good prognosis in spite of the frequent complications. Patients with suspicious or evident bacterial endocarditis should be transferred to centers owing sufficient diagnostic and therapeutic experiences.

Administration, Oral↗
PubMed2002

[Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users].

BACKGROUND: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. RESULTS: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. CONCLUSIONS: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

Adult↗
PubMed1975

[Proceedings: Surgical treatment of infectious endocarditis].

Surgical therapy of infective endocarditis can be undertaken as a prophylactic measure to avoid infection, e.g. in patent ductus arteriosus. In the majority of cases operations are done electively for correction of residual valvular defects ensuing on healed endocarditis. The most challenging problem is cardiac failure in the presence of active infection. While the surgical indication for life-threatening failure is generally recognized, the necessity of early operation, i.e. for acute valvular insufficiency with only mild cardiac failure, is still controverted. Valve replacement to remove a valvular form refractory to antibiotic therapy is less frequently necessary. In fungal endocarditis surgical intervention is recommended as soon as the diagnosis is established. Seven personal cases operated on in the presence of active infection are presented. All survived, but in one patient with fungal endocarditis the infected valve had to be replaced three times before healing was achieved.

Adult↗
PubMed2002

[Intractable infective endocarditis associated with supraaortic stenosis in Williams syndrome: a case report].

A 17-year-old man with supravalvular aortic stenosis associated with Williams syndrome was admitted to our hospital for intensive treatment for intractable infective endocarditis. The patient had a history of percutaneous balloon valvuloplasty for aortic stenosis in 1992. He was well until late in 1999, when he had a high temperature after dental work-up. The diagnosis was infective endocarditis but antibiotic therapy was not effective. He was transferred to our clinic. Transthoracic echocardiography demonstrated bicuspid aortic valve, supraaortic stenosis, mitral valve prolapse with severe regurgitation and scattered vegetations on the anterior mitral and aortic valves. In addition, transesophageal echocardiography showed innumerable mobile vegetations located from Valsalva's sinus to the descending aorta. Aortic root and arch replacement with a homograft and mitral valve replacement with an artificial valve were successfully performed to eliminate the infective endocarditis. In the present patient, the flow jet across the supraaortic stenosis seemed to cause a predisposition to severe endocarditis.

Adolescent↗
PubMed2002

[Endocarditis and congenital heart disease in the adult].

The prevalence of congenital cardiopathy is approximately 8% of live births, and 80 to 85% of patients reach adulthood thanks to the progress in the management of even complex malformations. Congenital cardiopathies represent 10 to 18% of adulthood cardiopathies complicated by infectious endocarditis, and in the specialist units for adolescent and adult congenital cardiac patients, 5% of admissions are provoked by endocarditis. The majority of malformations have a risk of infected graft, but patients who have a complex cyanogenic cardiopathy or an operated cardiopathy requiring insertion of prosthetic material, and those who have already had previous episodes of endocarditis are at a very high risk. Longitudinal studies show evolution of the responsible microbes, with an increase of the HACEK group; nevertheless, the streptococci and staphylococci remain uppermost. Diagnosis relies on the classic Duke University criteria but Doppler echocardiography is sometimes difficult to interpret in complex malformations or extra-cardiac sites of infection, and in 6 to 11% of cases the microbe is not identified. Infectious endocarditis remains a particularly serious complication: 50% of patients have aggravation of their cardiopathy and 20 to 30% require surgery; however the mortality has fallen by 20% to a little less than 5% in the most recent series. It is vital that patient education should be pursued even if, in certain circumstances, prophylaxis is not always either possible or effective....

Diagnosis, Differential↗