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PubMed1989

[Staphylococcal endocarditis on a heart valve prosthesis. Apropos of 28 cases].

The purpose of this retrospective study of 28 cases of staphylococcal endocarditis on cardiac valve prosthesis was to evaluate the prognosis of that disease and the possible causes of its recent improvement. Between March 1977 and May 1987, 69 patients were treated for bacterial endocarditis on cardiac valve prosthesis. Among these, 28 patients (19 men, 9 women, mean age 53.2 +/- 14.3 years) had staphylococcal endocarditis (Staph. epidermidis in 18 cases, Staph. aureus in 10 cases) of early (10 cases) or late (18 cases) onset. Complications were present in no less than 27 out of 28 patients, the most frequent being heart failure, embolism or neurological disorders. The mortality rate was high (61 p. 100). Among the clinical variables studied, only a state of shock seemed to be predictive of death. Mortality was higher in the group treated medically (100 p. 100) than in the group treated surgically (50 p. 100). Since 1984, however, a significant decrease of mortality was noted; it coincided with the systematic use of vancomycin but also with surgical treatment in all cases. As a result of this study, we suggest that all patients with staphylococcal endocarditis on cardiac valve prosthesis should be operated upon and that this should be done as soon as possible, before the end of the classical antibiotic therapy period.

Adolescent↗
PubMed1989

[Recurrent infective endocarditis].

Between August, 1974 and May, 1987, 486 patients were treated for infective endocarditis. In 16 of these patients (12 men, 4 women, mean age 44.3 +/- 18.0 years at the time of the first episode) the endocarditis recurred: once in 14 patients, twice in 2 patients. The time elapsed between recovery from the first episode and onset of the recurrence varied from 6 to 159 months (mean 54.3 +/- 35.1 months). Among the 18 recurrences, 10 affected native valves (mitral 6, aortic 4) and 8 aortic prostheses. In all but one case the organism isolated during the recurrence (Streptococcus in 14 cases, Staphylococcus in 3 cases, Rickettsia in 1 case) was different from the organism responsible for the previous infection. The 16 patients were followed up for periods of 28 to 203 months (mean 107.0 +/- 58.0 months), counting from the onset of the first episode. Ten patients were treated medically during the second episode: 4 died and 2 had a second recurrence, lethal in one of them (time elapsed between the onset of the first episode and the date of death: 32 to 149 months). Six patients were operated upon (valve replacement in 5 cases, closure of a left aorto-ventricular fistula in 1 case) without deaths. Nine of the 11 survivors are now asymptomatic. The actuarial survival rate in recurrent endocarditis (75 p. 100, 10 years after the onset of the first episode) is not different from that observed in non-recurrent endocarditis.

Adult↗
PubMed1989

[Infective endocarditis caused by coagulase-negative staphylococci: a review of 19 cases].

The clinical, microbiological and echocardiographical features as well as the response to therapy of 19 cases of infective endocarditis (IE) caused by coagulase-negative staphylococci (CNS) are reported. Six patients had native valve IE, 11 had prosthetic valve endocarditis and 2 were associated with catheters in right cardiac chambers. In the group of native valve IE, 11 patients were heroin abusers and 4 had previous valvular disease. IE was left sided in 3 cases, mixed in 2 and right sided in 1. All CNS were methicillin-sensitive. The echocardiogram detected vegetations in 5 of the 6 cases. One patient required surgery and another died. In the group of prosthetic valve IE, 5 patients had early endocarditis and 6 had late endocarditis. A bioprosthesis was involved in 5 cases, a mechanical prosthesis in another 5, and an annuloplasty annulus in one. The involved prosthesis was aortic in 5 cases and mitral in 6. The echocardiogram detected vegetations in 3 cases (27%) and prosthetic dysfunction in 4. One patient had a relapse, 8 (73%) required valve replacement and 3 died. Although the greatest incidence of IE caused by CNS is found among patients with prosthetic valves, it can also be seen in patients with underlying valvular heart disease, drug abusers and patients with indwelling catheters in right cardiac chambers.

Adult↗
PubMed1989

[The incidence of endocarditis caused by a prosthetic valve and its risk factors].

UNLABELLED: To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacement from January 1, 1981 through December 31, 1985, for 1 to 6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): p less than 0.25. PVE developed in 19 out of 329 patients with bioprostheses (5.8%) and in 8 out of 583 patients with mechanical valves (1.4%): p less than 0.005. Actuarially at 5 years follow-up 90.7% of the bioprosthetic group and 98.4% of the mechanical valve group was free of PVE (p less than 0.01). Bioprosthetic valve replacement in infective endocarditis further increased the risk of PVE compared to valve replacement by mechanical prostheses. IN CONCLUSION: in order of importance antecedent endocarditis, bioprostheses, male sex and aortic position are risk factors in the development of PVE. In patients requiring operation for infective endocarditis, mechanical valves are recommended. As the outcome of PVE is still very grave, authors stress the importance of prophylaxis, early diagnosis and timely operation.

Bioprosthesis↗
PubMed1989

[Spondylodiscitis disclosing bacterial endocarditis. Apropos of a case. Review of the literature].

The authors report a case of infectious spondylodiscitis revealing a staphylococcal endocarditis in a patient with a Carpentier aortic heterograft. This case, along with 60 descriptions from the literature, has enabled them to specify the characteristics of occurrence of endocarditis during a spondylodiscitis. The clinical factors in favor of this association are: a pre-existing cardiopathy, an oral port of entry, occurrence of other rheumatoid manifestations, even more the presence of complications of endocarditis. The laboratory factors in favor of an association are: discovery of an inflammatory anemia, of circulating immune complexes, of a cryoglobulinemia, of a rheumatoid factor, of hematuria. But it is mostly the demonstration of streptococcus in blood cultures and other samples that should be an indication to search for an endocarditis, the course of which dominates the prognosis.

Discitis↗
PubMed1989

[Right heart endocarditis].

Symptoms, cause and survival in 11 patients with right heart endocarditis hospitalized from 1973 to April 1989 were analyzed. The main symptoms were high fever, chest pain and dyspnea due to septic pulmonary emboli. The age of the 6 men and 5 women ranged from 19 to 66 years. 9 intravenous drug abusers and a patient with a pacemaker and carcinoma of the colon had tricuspid valve endocarditis. In another patient without known risk factors the aortic valve was affected as well. Staphylococcus aureus was isolated in 9 cases, in two as a double infection with Candida albicans and streptococcus group G respectively; beta-hemolytic streptococci group A and enterococci were found in the two remaining patients. Based on the well known high sensitivity of 2D-echocardiography, only cases with detectable tricuspid valve vegetations have been included in this retrospective study since this method became available. 10 patients were treated by antibiotics. In a single patient the tricuspid valve was removed after antibiotic pretreatment and an artificial valve was implanted 7 months later. Two patients died, one a few days after admission due to overwhelming sepsis, and one from intracerebral hemorrhage caused by an embolized aortic valve vegetation. The other patients have survived for a mean 44 months (range 2 to 183 months). Endocarditis of the right heart differs from left heart endocarditis through its typical clinical presentation, a different spectrum of microorganisms and a favourable outcome under antibiotic treatment.

Adult↗
PubMed1989

[Production of experimental infective endocarditis in rabbit mitral valve prolapse induced by vagus stimulation].

An experimental model of bacterial endocarditis was developed in rabbits with mitral valve prolapse which was induced by vagus stimulation. Endocarditis was produced by injecting bacteria including pseudomonas pseudoalkaligenes (pathogenic for rabbits) and streptococcus viridans taken from human beings. Both bacteria induced bacterial endocarditis with high incidence, which was augmented by higher dose or earlier administration of bacterial after producing mitral valve prolapse. Similarly, verruca was produced more frequently by higher dose of bacteria or earlier administration of bacteria. The present data are similar to those of human beings, so that it is helpful to a study of bacterial endocarditis in a clinical setting.

Animals↗
PubMed1989

[Successful surgical treatment of infective endocarditis complicated with DIC and intracerebral hemorrhage].

This is a case report of a 61-year-old man, suffering from infective endocarditis of mitral valve in association with DIC and intracerebral hemorrhage. He was treated symptomatically and conservatively for 80 days after the onset of the DIC. His multiple cerebral hematomas gradually disappeared 2 months after conservative management. Then the diseased mitral valve was replaced with a Duromedics valve. He is doing well at present. In a review of the literature it appears that there is some room for surgical intervention in endocarditis despite the complication of coagulopathy. We feel that one of the most serious complications of infective endocarditis is DIC. Operative management of endocarditis with this complication is recommended to be followed by medical management.

Cerebral Hemorrhage↗
PubMed1986

[Infectious endocarditis, complication of mitral valve prolapse].

Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse. This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis. Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration. Although cardiac signs were sometimes minimal. Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus. Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism. These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.

Adult↗
PubMed1987

[Loeffler's endocarditis and disseminated viral infection].

We report a case of Löffler's endocarditis in a 60-year-old woman with multiple lymphadenopathies, blood eosinophilia and acute heart failure. The eosinophilia developed over a six-month period to a maximum of 54.5% eosinophiles for 7600 X 10(9) leukocytes/l. Five weeks before death lymph node biopsy revealed Hodgkin's disease with mixed cellularity. Autopsy disclosed parietal endocarditis with endomyocardial fibrosis and mural thrombi, principally in the inflow tract of the left ventricle, lesions typical of the fibroplastic parietal endocarditis described by Löffler. Examination of the lymph nodes at autopsy showed a disseminated viral infection probably due to a virus of the herpes group, as was confirmed by electron microscopy. Since these findings disagree with the interpretation of the lymph node biopsy we think the diagnosis of Hodgkin's disease should be withdrawn. Löffler's endocarditis is discussed with reference to pathological features, differential diagnosis and lymph node changes in the patient.

Diagnosis, Differential↗
PubMed1986

[Indications and results of surgery in native valve infectious endocarditis. Apropos of 104 surgically-treated cases].

From 1972 to 1984, 104 cases of aortic valve infectious endocarditis were treated surgically. The average age of the patients was 40 years and the majority were men (69/104). Forty patients had no previous cardiac disease; 44 patients had documented valvular heart disease, which was unlikely in the remaining 20 patients. There were 16 mitral valve, 55 aortic valve, 1 tricuspid, 30 mitro-aortic, 1 mitro-tricuspid and 1 mitro-aorto-tricuspid valve infections. Aerococcus viridans was isolated in only 4 out of 71 positive cultures: the prevalence of the infecting organisms was otherwise normal (30 staphylococcus, 30 streptococcus, 7 rare organisms). Forty one patients were operated because of haemodynamic deterioration, 13 for resistant infection and 13 for an association of both indications; 37 patients were operated for embolism or threatening vegetations. Eight patients were in functional Class I, 26 in Class II, 52 in Class III and 17 in Class IV. The patients were divided into 4 groups according to the degree of surgical emergency (26 extremely urgent, 26 semi urgent, 32 controlled endocarditis and 20 chronic endocarditis). The actuarial survival rate was 70% at 5 years. Poor prognostic factors were the presence of previous valve disease, the isolation of a staphylococcus and an aortic valve localisation. The degree of emergency and the precise surgical indication did not seem to be important. Most patients at long term were in functional Classes I or II. There was no preferential indication for bioprosthetic or mechanical valve replacement in endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

In vitro correlation of platelet aggregation with occurrence of disseminated intravascular coagulation and subacute bacterial endocarditis.

Platelet-bacterial interactions were examined in vitro by incubating organisms isolated from patients with septicemia with normal platelet-rich plasma. The potency of various species of gram-positive and gram-negative bacteria to induce irreversible platelet aggregation was then determined in an aggregometer. The aggregation curves produced by the bacteria resembled the normal platelet response to collagen and were impeded by the presence of aspirin. Strains of Staphylococcus aureus and Pseudomonas aeruginosa isolated from 25 different patients produced maximum increases in light transmission and irreversible platelet aggregation with relatively rapid mean aggregation times; six of these patients had clinical and laboratory evidence of disseminated intravascular coagulation. In contrast, isolates of alpha streptococcus and Staphylococcus epidermidis induced irreversible platelet aggregation much less commonly and were associated with considerably longer mean aggregation times. None of the latter group of patients had evidence of disseminated intravascular coagulation. Isolates of bacteria from a small number of patients with subacute bacterial endocarditis uniformly induced irreversible platelet aggregation. Addition of paired bacterial isolates to normal platelet-rich plasma demonstrated a synergistic aggregation response. These data suggest that a relative hierarchy exists in bacterial strain potency to induce irreversible platelet aggregation. The rapidity and degree of aggregation in vitro correlated well with the clinical and laboratory evidence for subacute bacterial endocarditis and disseminated intravascular coagulation in vivo. These observations may provide useful adjunctive laboratory information to help establish the diagnosis of subacute bacterial endocarditis, especially in the clinical setting where the classical findings of endocarditis are not obvious during initial presentation.

Blood Platelets↗
PubMed1987

[Endocarditis caused by Haemophilus parainfluenzae and Neisseria gonorrhoeae].

Infective endocarditis due to gramnegative bacteria is rare. Overall, its relative frequency seems to be much lower than 10 percent. According to the extensive literature reviewed most often the causative microorganisms belong to the families of enterobacteriaceae and pseudomonads. Extremely rare, however, are cases where certain fastidious gramnegative bacteria such as hemophili, neisseria and others are the causative organisms. We report two cases of infective endocarditis due to Haemophilus parainfluenzae and to Neisseria gonorrhoeae. Despite their fastidious growth, both organisms could rapidly be isolated from venous blood cultures. Both were sensitive to ampicillin or penicillin respectively, and adequate antimicrobial therapy could early be initiated. As compared to reports in the literature both cases showed typical valve involvement and took a relatively typical course under medical treatment. The Haemophilus parainfluenzae endocarditis presented as a subacute illness following a tooth extraction and showed large vegetations on a prolapsed mitral valve. In contrast to the findings of others signs of slight renal involvement but no signs of major arterial embolization were noted. Medical treatment with ampicillin plus an aminoglycoside was effective as in most other reported cases. Vegetations were echocardiographically no longer seen after five weeks. The gonococcal endocarditis early led to destructive lesions of the aortic valve, significant regurgitation, vascular congestion and complicating pneumonia. Medical treatment alone was not effective despite the high susceptibility to antibiotics ot the strain isolated. As reported für the majority of cases reviewed in the literature early valve replacement became necessary for a favourable outcome.

Adult↗
PubMed1988

Endocarditis caused by Lactobacillus casei subspecies rhamnosus. A case report.

A case of subacute endocarditis in a 66-year-old man with mitral incompetence is described. The causative agent was identified as Lactobacillus casei subspecies rhamnosus, which is a normal commensal in the mouth. Despite the ubiquitous presence of these mouth commensals, this type of endocarditis appears to be rare. It is emphasised that a Lactobacillus species should be considered in cases of clinically obvious endocarditis with 'negative' blood cultures, including 'negative' subcultures following a significant radioactive count in the Bactec system. Suitable media for subculture should be used and incubation for at least 48 hours is required. Other possible reasons for the rarity of this type of endocarditis are discussed.

Aged↗
PubMed1988

Echocardiographic and clinical correlates in drug addicts with infective endocarditis. Implications of vegetation size.

Thirty-four drug addicts with endocarditis were studied to evaluate the prognostic significance of vegetation size and its short-term changes, as determined by two-dimensional echocardiography. Among 43 episodes of endocarditis, vegetations were detected in 27 (63%), confined to the tricuspid valve in 20 patients, mitral valve in one, aortic valve in two, and both tricuspid and mitral valves in four. All vegetations were large (greater than or equal to 1 cm) (mean maximal dimension, 1.7 +/- 0.5 cm). Medical cure was achieved in all 16 patients without vegetations and in 18 (90%) of 20 patients with tricuspid valve vegetations. One patient with tricuspid vegetation and polymicrobial infection died of respiratory failure. Surgery was required for one patient with tricuspid vegetation, all three patients with isolated left-sided endocarditis, and two of four patients with multivalve involvement. Short-term changes of tricuspid valve vegetations during therapy (one to eight weeks) did not correlate with clinical outcome. Although large tricuspid vegetations may occasionally identify a subset at risk for complications, most patients with isolated tricuspid valve endocarditis have a benign prognosis.

Adult↗
PubMed1987

[Endocarditis with unusual causative agents].

In the period 1947-1985, 601 patients with infective endocarditis were seen at the University Hospital Zurich and the Kantonsspital Lucerne. Streptococci, enterococci and staphylococci were the predominant causative organisms in two-thirds of all cases. In more than 25% of the patients blood cultures remained negative. In 6 patients endocarditis was caused by very rare organisms, viz. Coxiella burnetii (2 cases), Hemophilus parainfluenzae, Corynebacterium bovis (diphtheroids), Brucella melitensis and Aspergillus terreus. The clinical and microbiological characteristics of these cases are described and compared with the results in the literature. Diagnostic and therapeutic problems are discussed. Only with special awareness of the role of these unusual organisms in causing infective endocarditis, especially Q fever endocarditis with its notoriously atypical course, can the number of "culture negative" cases be diminished and the prognosis thereby improved.

Adult↗
PubMedDate not supplied

Successful surgical treatment of a case of listeria monocytogenes endocarditis.

Endocarditis due to listeria monocytogenes is rare with only twenty one cases to our knowledge appearing in the world's literature to date. We report a further case with a successful surgical outcome and stress the importance of surgery in the treatment of infective endocarditis. There is a clear predilection of this organism for the left side of the heart and systemic embolization is frequent. In contrast to other clinical forms of listeriosis, endocarditis has not been associated with debilitating states or immunosuppressive treatments. Though clinical and laboratory data suggest a similarity with other types of bacterial endocarditis, the prognosis is more unfavorable and the mortality rate higher.

Aortic Valve↗
PubMed1988

[Bacterial intracranial aneurysms associated with infectious endocarditis--report of 3 cases].

Three cases of bacterial intracranial aneurysms associated with infective endocarditis are reported. All of the patients were successfully treated by various combinations of cardiac surgery, neurosurgery and chemotherapy with antibiotics. Case 1: A 39-year-old female was admitted with the complaint of sudden onset of severe headache following persistent fever of several month's duration. CT scan revealed a left frontal old hematoma and angiography detected an aneurysm located in the frontal ascending branch of the left middle cerebral artery. After 2 weeks' antibiotic therapy, the second angiography showed the aneurysm to be decreased in size. The third angiography, performed 2 weeks after cardiac valve replacement for infective endocarditis, demonstrated complete resolution of the aneurysm. Case 2: A 19-year-old male entered hospital with high fever and chills. In addition to infective endocarditis, CT scan and angiography revealed an aneurysm arising from the distal portion of the left posterior cerebral artery. The patient was treated with high dose antibiotics and then his general condition improved. However, angiography examined 4 weeks after the initial study demonstrated the aneurysm to be apparently enlarged. Therefore, the aneurysm was excised before cardiac surgery. Repeated angiography after valve replacement showed no further aneurysm. Case 3: A 30-year-old female was admitted on the diagnosis of infective endocarditis and meningitis. CT scan showed abnormal density areas in the right frontal lobe and the left temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗