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PubMed2000

Occlusion of the common iliac artery secondary of fungal endocarditis: report of a case.

Fungal endocarditis becomes complicated by peripheral arterial embolization of the lower limbs in 33%-75% of cases. Although the prognosis of patients with fungal endocarditis has improved somewhat over recent years, it remains poor, especially when the disease is associated with peripheral arterial embolization. We report herein our experience of treating a patient in whom occlusion of the right common iliac artery developed secondary to endocarditis caused by Candida parapsilosis, and review the literature on this subject.

Adult↗
PubMed2002

Changing epidemiology of infective endocarditis: a retrospective survey of 108 cases, 1990-1999.

The aim of this study was to report the experience with infective endocarditis over the past decade, describe the changing clinical and epidemiological features of the disease, and attempt to determine the optimal number of blood culture sets required for diagnosis. All cases diagnosed during a 10-year period were reviewed clinically and microbiologically. In addition, a retrospective assessment of blood culture data was performed. From the period 1990-1999, 108 cases that met the von Reyn or Duke's criteria were recorded. The major underlying cardiac condition was the presence of a prosthetic valve ( n=33 patients, 31%). Among patients with native valves, nonrheumatic valvular heart disease of the elderly was the most common underlying factor ( n=19 patients, 25%). Overall, 13 patients (11%) died. Predictors on admission for increased mortality were shortness of breath, age >60 years, time to defervescence, erythrocyturia, hemoglobin level <10 g/dl, and leukocytosis >15,000 (all P<0.05). Analysis of blood culture data showed that the diagnostic yield among groups from whom either only one or more than six blood culture sets were drawn was reduced compared with that among groups from whom between two and five culture sets had been taken. The outcome of endocarditis in this series from a community hospital was much more favorable compared with that reported in surveys from large tertiary centers. Moreover, obtaining more than two or three blood cultures is neither helpful nor cost-effective in the initial assessment of patients with suspected endocarditis.

Aged↗
PubMed2003

Brucella endocarditis: clinical, diagnostic, and therapeutic approach.

Brucella endocarditis is an uncommon focal complication of brucellosis. Presented here are 11 cases of Brucella endocarditis, all managed uniformly. The median duration of symptoms prior to diagnosis was 3 months. Five patients (45%) had underlying valvular damage, and in six (55%) endocarditis involved a normal valve. There was a predominance of aortic involvement (82%) and a high incidence of left ventricular failure (91%). Diagnostic suspicion was essential in order to test blood cultures correctly, which in this series were positive in 63% of the patients. Surgical treatment was undertaken in eight patients (72%), all with aortic involvement and left ventricular failure impossible to control with medication. One patient died during the immediate postoperative period. All the other patients received antibiotic therapy for 3 months, with no signs of relapse of the infection or malfunction of the prosthesis during a minimum follow-up period of 24 months.

Adult↗
PubMed2005

Escherichia coli endocarditis: seven new cases in adults and review of the literature.

Described here are seven new cases of infective endocarditis due to Escherichia coli, including four involving prosthetic valves, followed by a review of similar cases in the literature. The review identified cases according to the modified Duke's criteria and revealed 16 cases reported before 1960, 5 between 1960 and 1980, and 11 after 1980. Currently, patients diagnosed with E. coli endocarditis are older than the patients diagnosed before 1960 (p<0.05), and they are often diabetic with underlying heart disease. Prosthetic valves are frequently involved (p<0.05), and the principal source of infection is the urinary tract. Surgery is often necessary. The mortality rate associated with this type of infection has decreased since 1960, but it remains high, with 17% calculated for the present series of seven new cases. The data presented here suggest that elderly patients with prior valve disease or prosthetic valve and E. coli urinary tract infection should be examined for endocarditis.

Adult↗
PubMed2000

Prosthetic valve endocarditis caused by Mycoplasma hominis.

Mycoplasma hominis endocarditis is extremely uncommon and difficult to diagnose. Atypical growth characteristics in routine bacterial culture and an inability to demonstrate the organism using Gram staining can lead to a delayed diagnosis of Mycoplasma hominis infections, and the organism is often missed. This report describes a patient with Mycoplasma hominis prosthetic valve endocarditis. The microorganism was recovered from the mitral prosthesis but was missed in blood cultures. This finding suggests that Mycoplasma hominis should be considered in the differential diagnosis of culture-negative endocarditis.

Endocarditis, Bacterial↗
PubMed2002

Aerococcus urinae endocarditis: case report and review of the literature.

Aerococcus urinae is a rare cause of urinary tract infections, mainly in elderly men with underlying urinary tract pathologies. In addition, it has been described as a pathogen in balanitis, soft tissue infections, septicemia and endocarditis. To date ten cases of A. urinae endocarditis have been reported in the literature with a high rate of mortality (7/10) and morbidity, as two out of three survivors suffered from neurovascular complications. Here we present the case of an additional patient who was successfully treated with surgical valve replacement and antibiotic therapy consisting of ceftriaxone and netilmicin for 6 weeks. Furthermore, we review all reported cases of A. urinae endocarditis with emphasis on predisposing factors and therapeutic options.

Aged↗
PubMedDate not supplied

Double prosthetic valve endocarditis caused by Streptococcus pneumoniae.

Infective endocarditis (IE) caused by Streptococcus pneumoniae is a rare disease. Only eight cases of pneumococcal prosthetic valve endocarditis have been described in the literature. In this report we describe the first case of pneumococcal endocarditis involving two prosthetic heart valves. The patient had pneumonia as the probable portal of entry but no predisposing conditions for invasive pneumococcal disease. Our case also illustrates the importance of transesophageal echocardiography (TEE) for the early diagnosis of IE and a timely decision for cardiac surgery.

Echocardiography, Transesophageal↗
PubMed1999

Diagnosis of Cardiobacterium hominis endocarditis by broad-range PCR from arterio-embolic tissue.

A case of culture-negative endocarditis is reported, in which the diagnosis of Cardiobacterium hominis endocarditis was made from arterio-embolic tissue removed by percutaneous transluminal embolectomy by broadrange polymerase chain reaction amplification of the 16 rRNA gene, followed by single-strand sequencing. The use of this technique to identify etiologic agents from arterio-embolic material has not been reported so far. A serologic assay employing complement fixation against a crude antigen of Cardiobacterium hominis confirmed the diagnosis of endocarditis caused by this unusual fastidious etiologic agent.

Adult↗
PubMed1978

Bacterial endocarditis: an analysis of factors affecting long-term survival.

The records of 108 patients treated for bacterial endocarditis were reviewed. Six were diagnosed at autopsy and had not been treated for endocarditis. Of the 102 treated patients, 32 died during the first 30 days and 32 more were dead by 365 days. Although some reports indicate a much greater survival rate, our findings are more in keeping with those reports giving a rather poor long-term outlook for patients with endocarditis.

Adolescent↗
PubMed1993

A new model for infective endocarditis of the mitral valve in rabbits.

To produce an experimental model of infective endocarditis without inserting catheters into the heart, we injected a bacterial suspension into rabbits in which mitral complex lesions had been induced by electrical stimulation of the cervical vagus. Typical infective vegetations grew on the surface of the mitral valves 1 week later. The formation of vegetations was related to the timing of the inoculation. Streptococcus viridans injected just after vagal stimulation produced vegetations in 10 of 17 animals (58.8%), but the same bacteria injected 14 days after vagal stimulation did so in only 2 of 11 animals (18.2%). The incidence of infective endocarditis was significantly higher after early inoculation compared with delayed inoculation (p < 0.01). The susceptibility to infection depended on the species of bacteria injected. Both S. viridans and Pseudomonas pseudoalkaligenes injected just after vagal stimulation produced vegetations in 10 of 17 (58.8%) and 6 of 13 (46.2%) animals, respectively, but Staphylococcus epidermidis injected just after vagal stimulation did not produce vegetations in any of the 10 animals. S. viridans injected into nine normal animals never produced vegetations. These findings indicate that infective endocarditis develops after intravenous injection of bacterial suspensions alone in rabbits with mitral complex lesions.

Animals↗
PubMed1994

Natural history of vegetations during successful medical treatment of endocarditis.

Although initial morphologic features of vegetations have been related to the risk of early complications, there is little information about the natural history of the vegetations during medical treatment or the relation of morphologic changes in vegetation to late complications. To assess the evolution of valvular vegetations by echocardiography during treatment of infective endocarditis and to relate the morphologic changes in vegetation to late prognosis, serial echocardiograms of patients with successful medical treatment for native valve infective endocarditis were reviewed to assess the presence and morphologic features of valvular vegetations at the onset and at the end of therapy. The evolution of vegetation size, mobility, consistency, the extent of the disease, and the severity of valvular regurgitation were related to late complications such as embolism, valve replacement, or death occurring after the end of therapy. Forty-one vegetations were identified in 32 patients on initial echocardiograms. At the end of treatment, 29 vegetations were still present; 59% had no significant change in size and 52% appeared to be denser in consistency. Morphologic changes did not relate to late complications, but the presence of severe valvular regurgitations was associated with late valve replacement. The echocardiographic persistence of vegetations is common after successful medical treatment of infective endocarditis. In the absence of severe valvular dysfunction, however, persistent vegetations are not independently associated with late complications.

Adult↗
PubMed1975

Bacterial endocarditis with ruptured sinus of Valsalva and aorticocardiac fistula.

A case is presented of bacterial endocarditis with a ruptured sinus of Valsalva and formation of an aorticocardiac fistula from the right coronary sinus into the right atrium and right ventricle. The pathologic, clinical and surgical aspects of bacterial endocarditis complicated by a ruptured sinus of Valsalva and an aorticocardiac fistula are analyzed. This complication of bacterial endocarditis is still uncommon, but alertness to its diagnosis makes possible early and successful surgical treatment.

Adult↗
PubMed1975

Hemophilus aphrophilus endocarditis: review of 23 cases.

A case of bacterial endocarditis caused by Hemophilus aphrophilus is described, and 22 previously reported cases are reviewed. Eleven patients died and 12 survived; comparison of these two groups reveals that the patients who died were in the older population. The male/female ratio was 3.6:1. The organism was difficult to identify but had a wide range of in vitro bacteriologic sensitivities. This type of endocarditis is frequently associated with emboli and congestive heart failure; each occurred in 9 of 11 fatal cases and 3 of 12 nonfatal cases. Among the nonfatal cases, two patients had both emboli and congestive heart failure, requiring aortic valve replacement despite their precarious clinical condition. Initial drug therapy before results of antibiotic sensitivity tests are known should consist of penicillin combined with streptomycin. When emboli or congestive heart failure appears in Hemophilus aphrophilus endocarditis, early surgical intervention with valve replacement is indicated.

Adolescent↗
PubMed1979

Comparison of two-dimensional and M-mode echocardiography in the evaluation of patients with infective endocarditis.

M-mode and two-dimensional echocardiographic evaluation of infectious endocarditis and its complications was reviewed. In 21 consecutive patients with clinical endocarditis, 22 valves were involved (12 aortic, 5 mitral and 5 tricuspid). M-mode echocardiography detected vegetations in 10 patients (four aortic, two mitral and four tricuspid) and detected complications of endocarditis in 2 patients (one aortic root abscess and one flail aortic cusp). Two-dimensional echocardiography detected vegetations in 9 patients (four aortic, one mitral and four tricuspid) and detected complications in ten patients (five flail aortic cusps, one aortic root abscess, one sinus on Valsalva aneurysm, two flail mitral leaflets and one flail tricuspid valve). Thus, although M-mode and two-dimensional echocardiography had a similar ability to detect actual vegetations, two-dimensional echocardiography was superior to M-mode echocardiography in diagnosing complications of the destructive process.

Aortic Valve↗
PubMed1980

Mitral valve prolapse: jet stream causing mural endocarditis.

A 53 year old man died of cerebral hemorrhage while being treated for Streptococcus mutans endocarditis. At autopsy the only endocarditic lesion was on the left atrial mural endocardium. The noninfected mitral valve demonstrated prolapse and mucinous degeneration. The latter had led to rupture of several chordae tendineae, with the resultant jet stream predisposing to endocarditis at its point of atrial impact. The case provides confirmation of current concepts of the pathogenesis of endocarditis and has important therapeutic implications.

Arteriosclerosis↗
PubMed1981

Noninvasive methods for detection of valve vegetations in infective endocarditis.

To determine the optimal noninvasive method for the demonstration of endocarditic vegetations, 35 consecutive episodes of clinically diagnosed endocarditis in 33 patients were studied with M mode and two dimensional echocardiography, and with gallium-67 citrate and technetium-99m stannous pyrophosphate cardiac scanning. Clinical criteria for the diagnosis of endocarditis were: temperature higher than 38 degrees C; sustained bacteremia with at least three positive blood cultures; no extracardiac focus of bacteremia; and known underlying heart disease, a new or changing murmur or a history of intravenous drug abuse with radiologic evidence of septic pulmonary emboli. M mode echocardiography detected 18 vegetations in 17 of the 35 episodes of endocarditis studied (49 percent positive); two dimensional echocardiography detected 30 vegetations in 28 of the 35 episodes studied (80 percent positive). In contrast, no vegetations were detected with technetium-99m stannous pyrophosphate scanning,, and only two gallium-67 citrate scans were positive. The advantage of the two dimensional echocardiographic technique over all others tested was particularly notable for the identification of aortic and tricuspid valve vegetations.

Adolescent↗
PubMed1982

Natural history of tricuspid valve endocarditis: a two dimensional echocardiographic study.

Sixteen patients with tricuspid valve endocarditis were studied to define (1) what clinical or echocardiographic subsets are at risk for complications or need for tricuspid valve surgery, and (2) the long-term two dimensional echocardiographic course of tricuspid vegetations. There were 18 episodes of tricuspid endocarditis in the 16 patients; 12 patients had a history of intravenous drug abuse. Staphylococcus aureus was the most common infecting organism (11 patients). Persistent infection, cardiomegaly or radiography and right-sided heart failure were present in all patients undergoing tricuspid valve surgery and in none of the medically treated patients. Echocardiographic studies demonstrated tricuspid vegetations in 10 patients by M mode and in all 16 by two dimensional technique. Vegetation size, right ventricular enlargement and abnormal septal motion were not of prognostic significance. Two dimensional echocardiographic measurements of vegetation size correlated with surgical pathologic measurements in the four patients who underwent surgery. Serial two dimensional echocardiographic studies were available in eight patients a mean of 10.6 (range 2 to 19.5) months after the initial study: Vegetations had decreased in size or disappeared in seven patients and were essentially unchanged in one patient. It is concluded that (1) two dimensional echocardiography increases the detection of tricuspid valve vegetations and accurately estimates their size; (2) persistent infection, cardiomegaly and right-sided heart failure identify a subgroup of patients with tricuspid endocarditis who may have increased risk; (3) no M mode or two dimensional echocardiographic feature is a predictor of outcome; and (4) tricuspid valve vegetations tend to resolve with time.

Adult↗
PubMed1982

Valve ring abscess in infective endocarditis: visualization with wide angle two dimensional echocardiography.

Two dimensional echocardiography permitted visualization of a valve ring abscess complicating infective endocarditis in four patients. Abscess formation was defined as an echo-free cavity within tissues surrounding the infected valve. Abscess in the valve ring extended into the perivalvular structures, including the upper ventricular septum (one patient), left ventricular myocardium (one patient) and contiguous fibrous structures (three patients). Two dimensional echocardiography is the only noninvasive technique for direct visualization of the abscess cavity complicating infective endocarditis and may allow better appreciation of incidence, evolution and natural (or unnatural) course of this heretofore seldom recognized complication of infective endocarditis.

Abscess↗