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PubMedDate not supplied

Q fever endocarditis: relapse five years after successful valve replacement for a first unrecognized episode.

A 59-yr-old man presented with mitral endocarditis and negative blood cultures. Antibodies to phase 2 and phase 1 antigens of Coxiella burneti were detected and a diagnosis of Q fever endocarditis was made. Five years earlier, this patient had been successfully treated by aortic valve replacement for a first episode of endocarditis with negative blood cultures. Giemsa and Machiavello stains of the native aortic valve were made retrospectively and showed coccobacilli highly suggestive of Coxiella organisms. It is concluded that the first episode was Q fever endocarditis and that the failure to recognize this aetiology at that time, and the absence of adequate medical therapy, is the cause of the present episode.

Aortic Valve↗
PubMed1986

[Infectious endocarditis in hypertrophic obstructive cardiomyopathy].

Clinical and pathological findings in a 37-year-old female patient with HOCM and infective endocarditis of the aortal and mitral valves were reported. The patient died of septic shock. Infective endocarditis with acute insufficiency of the aortal and/or mitral valves is a severe complication in patients with HOCM, because the left ventricle with a disturbed compliance is unable to compensate the acute volume overload. The standard use of nitrates for congestive lung failure and catecholamines for septic shock is problematic. As with other valvular heart diseases, preventive treatment for infective endocarditis is also recommended for patients with HOCM. In the case of acute endocarditis combined with HOCM early surgical intervention must be discussed.

Adult↗
PubMed1987

Efficacy of ciprofloxacin in animal models of infection: endocarditis, meningitis, and pneumonia.

Animal models of infection are very useful tools for identifying those situations in which antibacterial drugs, including the quinolones, may play special roles, i.e., for positioning a drug correctly for its role in the treatment of human disease. Ciprofloxacin has been studied extensively in discriminative animal models of infection, and its efficacy in the treatment of these infections has been compared with that of standard therapy. In a rabbit model of staphylococcal endocarditis, ciprofloxacin was as effective as nafcillin alone, as well as nafcillin and gentamicin in combination, in treating rabbits with methicillin-susceptible Staphylococcus aureus endocarditis. Additionally, its activity was equal to that of vancomycin in reducing vegetation titers in rabbits with methicillin-resistant staphylococcal endocarditis. In a rabbit model of pseudomonal meningitis, ciprofloxacin was as effective as the combination of ceftazidime and tobramycin in lowering bacterial titers. However, in this model, serum levels of ciprofloxacin (6 micrograms/ml) necessary to achieve a bactericidal effect in the cerebrospinal fluid were slightly higher than levels targeted for humans. In a model of pseudomonal pneumonia in neutropenic guinea pigs, the efficacy of ciprofloxacin was compared with that of tobramycin and ceftazidime, both alone and in combination: ciprofloxacin was as effective in lowering bacterial counts as was the combination of ceftazidime plus tobramycin and its activity was superior to that of either drug alone. Thus, data from studies of ciprofloxacin in the treatment of endocarditis, meningitis, and pneumonia in animal models of infection suggest that this quinolone may play an important role in the therapy of these difficult-to-manage infections in humans.

Animals↗
PubMedDate not supplied

[Parietal fibroplastic endocarditis].

Parietal fibroplastic endocarditis is commonly observed in two main diseases: Löffler' endocarditis and Davies' endomyocardial fibrosis. Endocarditis' damage is explained by the cytolytic effects of basic proteins present in eosinophil granules (major basic protein and cationic protein); long standing and amount of eosinophilic cells condition anatomic lesions. The clinical features are explained by the ventricular seat of endocarditis lesions (right, left, or both). They include in all cases: tricuspid and/or mitral insufficiency, adiastolic syndrome. Two-dimensional echocardiography has improved the diagnosis; ventricular angiocardiography remains the reference examination. Prognosis has been largely improved these recent past years by surgical endocardiectomy and valvular conservative surgery among children.

Endocarditis↗
PubMed1987

[Endocarditis and meat inspection in slaughtering pigs. 2. Various aspects of meat inspection].

The results of meat inspection in 599 slaughtered pigs with endocarditis were studied. Of the pigs examined, 65 per cent were condemned. Condemnation was based on a positive bacteriological examination (Article 2 of the Meat Inspection Regulations) in almost every case. When bacteriological examination was negative, the animal was passed unqualified in nearly every case, regardless of the fact that symptoms were or were not detected in ante-mortem inspection and whether or not signs of sepsis were observed. Subsequently, efforts were made to determine the possible effects of omitting incisions into the hearts of pigs in which neither clinical nor morbid-anatomical examination suggested the presence of endocarditis. It was concluded that endocarditis would have passed unnoticed in 25 per cent of the pigs examined in this case. Of these pigs, fifty per cent were found to be positive on bacteriological examination. Finally, the financial consequences of condemning all pigs showing endocarditis were examined. Compared with current practice in meat inspection, this would result in an annual loss of Dfl. 60,000 in the situation prevailing in the Netherlands. However, if Articles 13, 17 and 18 of the Meat Inspection Regulations were strictly observed, the yield of the pigs passed would not offset the costs of examination.

Animals↗
PubMed1987

[Aspergillotic septic endocarditis of the mitral and trigeminal valves as a complication of silicotuberculosis].

Fungal endocarditis is caused by fungi Candida and Aspergillus. Continuous intravenous infusions, catheterization, open-heart surgery, tracheal injuries, artificial heart valves can serve as predisposing factors. Aspergillus endocarditis is more common in severe infectious diseases after a prolonged use of antibiotics, cytostatics, glucocorticoids. A case of aspergillus endocarditis of mitral and tricuspid valves is described in a 55-year old patient. The man had been long suffering from silicotuberculosis and had been on a prolonged antibacterial therapy. The aspergillus endocarditis must have developed in the patient due to marked dysbacteriosis.

Aspergillosis↗
PubMedDate not supplied

Limited reliability of the "negative" two-dimensional echocardiogram in the evaluation of infectious vegetative endocarditis: diagnostic and surgical implications.

Three patients with vegetative endocarditis involving a native valve, a mechanical prosthesis and a bioprosthetic valve respectively are presented. Each underwent emergency surgical exploration and prosthetic valve replacement based on clinical evidence of vegetative endocarditis after an initial delay following a report of a negative two-dimensional echocardiographic study. These cases emphasize the fact that within the clinical setting in which vegetative endocarditis is strongly suspected a negative two-dimensional echocardiographic study must be interpreted with caution. This is particularly true in patients with fungal, embolic or prosthetic valvular endocarditis. A decision to delay surgical consultation and therapy based upon a negative two-dimensional echocardiographic study in these patients is ill advised and may result in serious thromboembolic complications or even death.

Aged↗
PubMed1986

[Acute Neisseria subflava endocarditis].

A 50-year-old woman who developed acute endocarditis on a mitral Starr valve due to Neisseria subflava is reported. This microorganism, which belongs to the normal flora of the upper respiratory tract, is a very rare cause of endocarditis since only 9 cases have been described. The patient developed various complications including right hemiplegia. Cure was obtained by medical therapy alone due to the high susceptibility of the bacteria to a third generation cephalosporin (moxalactam). This is the third time a neurological complication of this kind is reported during N. subflava endocarditis. A high frequency of neurological and systemic embolic complications appears to be an important feature of endocarditis due to N. subflava and other saprophytic Neisseria.

Echocardiography↗
PubMed1979

Infective endocarditis at the Johannesburg Hospital. A retrospective analysis of 40 patients.

The records of 40 patients admitted to the Johannesburg Hospital with a total of 44 episodes of endocarditis were analysed. Pyrexia, albeit often low grade and intermittent, was the most consistent physical sign. The classic symptoms and signs of infective endocarditis were uncommon. Blood cultures were positive in 56% of episodes. However, in 6 out of 9 patients with 'culture-negative' endocarditis, infective endocarditis was confirmed at surgery or necropsy. For haemodynamic reasons, 10 patients (25%) were subjected to valve replacement and 1 to a mitral valvuloplasty. In 2 of these the infection was still active at the time of surgery. Five patients (12,5%) died; in 4 the cause of death was neurological and in the remaining patient the aortic valve ruptured and he died within 30 minutes.

Adolescent↗
PubMed1973

Gram-negative bacterial endocarditis in narcotic addicts.

The number of cases of bacterial endocarditis in drug addicts seen at UCLA and Wadsworth Veterans Administration hospitals increased sharply in 1971 over the average of the four preceding years. Enteric Gram-negative bacilli were the infecting organism in three of the seven cases seen in 1971 but were not found in any cases of endocarditis in the 1967-70 period. Medical treatment of the patients was, in general, unsuccessful in spite of the intensive use of newer antimicrobials active against enteric Gram-negative bacilli. One patient died with fulminant Pseudomonas endocarditis and two others (Pseudomonas and Serratia endocarditis) eventually required operations on the heart before a cure was achieved.

Adult↗
PubMed1978

Clindamycin in infective endocarditis.

Because of problems of penicillin allergy or lack of veins for intravenous administration of antibiotics, nine patients with endocarditis were treated with clindamycin, administered intramuscularly. Five patients were heroin addicts with staphylococcal endocarditis and four had alpha-streptococcal endocarditis. The only therapeutic failure occurred in a patient with a strain of Staphylococcus aureus that became resistant to clindamycin in vivo. Such resistance has been reported to occur in vitro, and testing for it should prove useful in proper selection of cases for treatment with clindamycin, an agent that appears to be effective in selected cases of endocarditis.

Clindamycin↗
PubMed1978

The species of viridans streptococci associated with microbial endocarditis: incidence and antimicrobial susceptibility.

Streptococcal endocarditis has been well recognized for decades and over the years investigators at The New York Hospital have defined many of the diagnostic and therapeutic modalities currently employed in patients with this disease. In this study, speciation of the viridans streptococci has provided new insights into the relative frequency and antimicrobial susceptibility patterns of these organisms. Indeed, recent studies also suggest that S. milleri endocarditis is associated with a high incidence of suppurative complications and that patients with S. bovis endocarditis may have a significant incidence of underlying but asymptomatic lower gastrointestinal malignancies. Further studies correlating viridans streptococcal species with other clinical and laboratory parameters of endocarditis should provide additional insights into this disease.

Culture Media↗
PubMed1984

[Chronic endocarditis on valve prosthesis. 6 cases].

Six cases of chronic endocarditis (more than 1 year duration) have been extracted from a series of 72 cases of endocarditis (delayed in 49) associated with intracardiac prosthesis observed over a 15-year period. In these 6 cases endocarditis developed 6 months to 2 years after valve replacement. The prosthetic material included 3 Starr-Edward's valves, 2 Hancock's valves and 1 intracardiac patch. The micro-organism isolated were Streptococcus in 3 cases, Serratia and Corynebacterium in 1 case each. The 18-month to 5-year course of the disease was marked by 2 to 5 relapses separated by long periods of apyrexia. The most significant complications were dysimmune syndrome (5 cases), embolic accidents (2 cases) and prosthesis disinsertion (4 cases). Five patients benefited from antibiotic therapy; 4 were operated upon with recurrent disinsertion in 2 cases. Two patients died, one of repeated disinsertion, the other of myocardial dysfunction. Bacteriostatic antibiotics were administered continuously to 3 patients whose endocarditis persisted or relapsed, with satisfactory results in two cases followed-up for more than 2 years.

Adult↗
PubMed1978

Diagnostic clues in metastatic lesions of endocarditis in addicts.

Gram stains and cultures of multiple extravascular sites showed the infecting organisms in 17 of 26 heroin addicts with endocarditis. In addition to routine blood cultures, the etiologic agent was cultured from Osler nodes and Janeway lesions in ten patients, subcutaneous abscesses in eight, pleural fluids in eight, joint aspirates in three, spinal fluids in three, pericardial fluids in two, muscle abscesses in two and endometrium in one patient. Gram-positive cocci were found in extravascular lesions in 11 of 12 patients with staphy-lococcal endocarditis and from as many as four different sites. In contrast, no Gram-positive cocci were seen in extravascular sites in any of eight patients with enterococcal endocarditis although six of them had peripheral lesions. Gram stain and culture of multiple extravascular sites appears to provide a valuable early clue to the nature of the etiologic agent in addict endocarditis.

Diagnosis, Differential↗
PubMed1983

Löffler's endocarditis. Occurrence with malignant lymphoma with a high content of epithelioid histiocytes ('Lennert's lymphoma').

In a patient who had malignant lymphoma with a high content of epithelioid histiocytes (so-called Lennert's lymphoma), Löffler's endocarditis developed 18 months after her diagnosis of lymphoreticular malignant neoplasm. She died of refractory congestive heart failure, and an autopsy showed the typical gross and microscopic findings of Löffler's endocarditis. To our knowledge, this is the first reported association of these two diseases. We noted nine autopsy cases in the literature of Löffler's endocarditis occurring in patients with lymphoreticular malignant neoplasms (acute lymphoblastic leukemia and lymphoma). Löffler's endocarditis with eosinophilia may be a relatively uncommon but significant complication in patients with malignant lymphoproliferative disorders. The peripheral blood eosinophilia probably represents a reactive response to tumor antigen.

Autopsy↗
PubMed1984

Acute infective endocarditis.

Acute infective endocarditis is an important cardiovascular emergency that can be detected with improved diagnostic techniques. In the last few decades we have witnessed a changing spectrum of microorganisms causing infective endocarditis. Successful treatment of infective endocarditis is enhanced by the combined and cooperative efforts of the internist and the surgeon. In this article, we have discussed the clinical evaluation, laboratory techniques, and noninvasive studies by which proper diagnosis can be made and appropriate antimicrobial therapy instituted. We have also reviewed the indications for surgical intervention. With careful clinical evaluation and proper application of the diagnostic and therapeutic modalities, acute infective endocarditis can often be cured.

Acute Disease↗
PubMed1984

[Diagnostic value of echocardiographic examinations in the evaluation of patients with infectious endocarditis of aortic and/or mitral valve localization].

We estimated sensitivity, specificity, predictive value and efficiency of echocardiography in detecting vegetations and ruptured valves in patients with aortic and/or mitral valves infective endocarditis. We studied two groups of patients, in whom both high quality echocardiography examination and surgical inspection of heart valves were available. Group I: 16 patients (32 valves) with aortic and/or mitral valves endocarditis and surgical demonstration of vegetations and/or ruptured valves. In this group the prevalence of vegetations was 65.6%, the prevalence of ruptured valves was 43.7%. Group II was composed of the 16 patients of group I with endocarditis and of 93 other patients without endocarditis. In this group (139 valves) the prevalence of vegetations was 15%, the prevalence of ruptured valves was 13.6%. Echocardiographic detection of valve vegetations. Sensitivity (71.4%) was the same in group I and II. Specificity was 91% in group I and 91.5% in group II. The positive predictive value was 93.7% in group I and 60% in group II. The negative predictive value was 62.5% and 94.7% respectively. Echocardiographic detection of ruptured valves: sensitivity was 50% in I and 42% in group II. Specificity was 94.4% in group I and 99% in group II. The positive predictive value was 87.5% in group I and 89% in group II. The negative predictive value was 70.8% in group I and 91.5% in group II. The echocardiographic efficiency was higher in group II: 88.4% for vegetations and 91.3% for ruptured valves. This reflects the high specificity and the high definition of normal valves in this unselected low-risk group. The efficiency was lower in group I: 78% for vegetations and 75% for ruptured valves. This reflects the poor sensitivity and the failure of the test to identify all the vegetations or the ruptured valves in this selected high-risk group.

Adolescent↗
PubMed1984

Staphylococcus aureus tricuspid valve endocarditis in young women after gynaecological events. A report of 3 cases.

Three cases of Staphylococcus aureus tricuspid valve endocarditis are reported; each was preceded by a gynaecological event. In 2 cases there was no overt pelvic sepsis and there had been no operative or instrumental intervention, but in the 3rd pelvic inflammatory disease was present, probably not as a result of interference. There are few reports in the recent literature of gynaecological events precipitating this condition; in contrast, intravenous narcotic abuse is well documented. In the literature there is insufficient stress laid on the fact that non-septic gynaecological events may cause the endocarditis. The difficulties in diagnosing tricuspid endocarditis, especially in a milieu where intravenous narcotic abuse is virtually unknown, are noted. When endocarditis is present in women known not to abuse narcotics, the absence of signs of pelvic inflammation may also cause difficulties in diagnosis.

Abortion, Spontaneous↗