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PubMed1985

Clinical and diagnostic features of pulmonary valve endocarditis in the setting of congenital cardiac malformations.

We studied the clinical and diagnostic features of 5 cases of pulmonary valve endocarditis where morphologic documentation was available. All patients had congenital cardiac disease as the predisposing factor and the infectious process involved only the pulmonary valve. None of the patients was addicted to drugs. Absence of systemic emboli, lack of pulmonary symptoms, acute course and high frequency of sterile cultures made the clinical recognition difficult and was possible only in three cases. The clinical picture of pulmonary valve endocarditis was characterised by fever, right-sided congestive cardiac failure and pulmonary incompetence. Echocardiography assumes a specific diagnostic role in such cases and cross-sectional echocardiography provides more information than M-mode echocardiography. Pulmonary valve endocarditis carries a high mortality and 3 patients died. Two patients underwent successful surgery of their underlying defect and excision of the pulmonary valve. Staphylococcus aureus was the organism grown from autopsy or surgical material in 3 cases.

Adolescent↗
PubMed1987

Association of brucella endocarditis with intracerebral haemorrhage.

We describe a case of brucella endocarditis which was strongly suspected on clinical grounds and subsequently confirmed by bacteriological, serological and echocardiographic investigations. The endocarditis, in a 42-year-old Saudi male, was complicated by intracerebral haemorrhage, presumably from a ruptured mycotic aneurysm. Although such a complication is well documented in other forms of infective endocarditis, it has not been reported in brucellosis.

Adult↗
PubMed1988

The impact of a policy of collaborative management on mortality and morbidity from infective endocarditis.

The present study represents a comprehensive retrospective review of endocarditis in a large district general hospital since the inception of a formalized policy involving collaborative management a decade ago. The principle was to involve a recognised team of cardiologists, specialists in infectious disease and microbiologists in the treatment of the disease from the moment of its diagnosis. The pattern of infection has not altered in terms of prevalent organisms and valves infected since the change in management policy. There has, however, been a significant decline in the mortality, from 34 to 24% for all patients with endocarditis. Amongst those referred for collaborative management, the mortality has fallen to 6%. The single greatest improvement is a reduction in the number of patients dying of heart failure, the number of patients developing systemic emboli or requiring prosthetic valve replacement remaining unchanged. The results indicate that early referral to, and treatment by, a multidisciplinary team can significantly reduce the mortality from bacterial endocarditis.

Adolescent↗
PubMed1995

Early identification of patients with native valve infectious endocarditis at risk for major complications by initial clinical presentation and baseline echocardiography.

Early identification of a high risk patient subgroup with infective endocarditis which develops a major complication (emboli, congestive heart failure, surgery for valve replacement, or death) during hospitalization would reduce morbidity, mortality and cost. Thus, for 74 patients with native valve infective endocarditis with documented vegetation by transthoracic two-dimensional echocardiogram, we reviewed 67 variables: history (15), physical examination (9), hematology/miscellaneous (7), chest X-ray (2), electrocardiogram (4), transthoracic two-dimensional echocardiograms (15) and hospital course (15). There were 48 men and 26 women, ages 45 +/- 19 years: 35 intravenous drug abusers and 39 non-users. There were 32 mitral, 21 tricuspid, 20 aortic, and 1 pulmonic valve vegetations; mean vegetation size was 1.4 +/- 0.9 cm2. Over the course of their hospitalization, 14 patients died (19%), 27 developed congestive heart failure (36%), 27 had systemic emboli (36%), and 22 required surgery (30%). The incidence of complications (death, heart failure or embolic events) did not differ between the drug abusers and non-users. Initial complaint of dyspnea on admission predicted the subsequent development of heart failure (P < 0.001), and a pre-admission embolus predicted a second in-hospital embolus (P < 0.001). Left atrial size, ventricular systolic or diastolic dimension did not effect prognosis. Importantly, a vegetation > 1.8 cm2 was 100% specific but only 30% sensitive for predicting the development of a complication. Vegetation mobility, shape, and number of cusps involved were not predictive. However, aortic valve vegetations had significantly more complications than those on the mitral valve (P < 0.03). By discriminant function analysis, 87% of major complications were predicted with the patient profile of having aortic valve vegetation, dyspnea on admission, prolonged preadmission fever, and no history of drug abuse; 75% of patients who developed heart failure were predicted by their having aortic valve vegetation, dyspnea, hypotension (systolic < 90 mm Hg), and no history of drug abuse; and 77% of patients requiring surgery were predicted by their having larger vegetation size, rales, and leftward shift of white blood cells. Thus, in native valve bacterial endocarditis with transthoracic echocardiographic documented vegetations, non-drug abusers with aortic vegetations, preadmission prolonged fevers, dyspnea, emboli and larger sized vegetations are at high risk for developing a major complication during their hospitalization.

Echocardiography↗
PubMed1996

Successful treatment of Staphylococcus lugdunensis endocarditis complicated by multiple emboli: a case report and review of the literature.

We describe the prompt diagnosis and successful treatment of mitral valve endocarditis in a 52-year-old woman due to a recently described coagulase negative staphylococcus, Staphylococcus lugdunensis. Endocarditis due to this organism has a high mortality rate with 8 out of 12 published cases ending in fatality. Review of the literature revealed that use of commercial identification systems can lead to misidentification of Staphylococcus lugdunensis and consequently delay appropriate treatment. It is clinically important to distinguish Staphylococcus lugdunensis from other coagulase negative staphylococci by detailed microbiological testing. The awareness of this from of endocarditis and its natural history is important since it differs significantly from other coagulase negative staphylococci. It highlights the need for early surgical intervention not only for haemodynamic complications but also for recurrent emboli. Multiple emboli appears to be a frequent finding on review of the literature.

Anti-Bacterial Agents↗
PubMed1984

Characters of coagulase-negative staphylococci and micrococci from cases of endocarditis.

Strains of coagulase-negative staphylococci and micrococci submitted to a reference laboratory from 137 cases of endocarditis over a 5 year period were reviewed. Staphylococcus epidermidis biotype 1 (SII) was the commonest biotype in all groups of patients but exceeded 80 per cent in the 61 patients who had undergone prosthetic valve surgery and the 16 patients who had undergone other forms of surgery. Biotype 4 (SVI) was recovered from 10 of the 34 patients without surgery. Strains from prosthetic valve endocarditis were frequently resistant to many antibiotics while strains from natural valve endocarditis were frequently sensitive to all, or resistant only to penicillin. The value of bacteriophage typing was confirmed.

Adult↗
PubMed1988

Staphylococcus aureus endocarditis in a previously healthy adolescent.

Infectious endocarditis is occasionally a complication of Staphylococcus aureus sepsis in previously well individuals with no heart disease or history of intravenous drug use. We report a case of a 16 year old who developed Staphylococcal sepsis and endocarditis probably as the result of neglected paronychia of her toes. Despite adequate antibiotic therapy, the infectious process destroyed her aortic valve, thereby producing aortic regurgitation complicated by cerebral embolism. Aortic valve replacement surgery was required. Endocarditis should always be sought with S. aureus bacteremia. Intravenous high-dose antibiotic therapy for at least 4 weeks is the recommended therapy.

Adolescent↗
PubMed1985

Maxillary nerve involvement in bacterial endocarditis.

A case of right maxillary nerve paresthesia during an active phase of bacterial endocarditis probably due to embolic occlusion of the nerve's vascular supply is reported. The authors suggest that infective endocarditis be considered as a rare but potential cause of unexplained trigeminal nerve branch lesions, and that such lesions be sought in cases of established endocarditis.

Embolism↗
PubMed1996

Listeria monocytogenes endocarditis in a patient with an aortic prosthetic valve.

Patients with prosthetic cardiac valves have an increased risk of developing bacterial endocarditis. The causative micro-organism in bacterial endocarditis may be a guide to the portal of entry. In this case report, we describe a patient with a prosthetic cardiac valve who suffered from recurrent endocarditis with different micro-organisms from the gastrointestinal tract.

Adenocarcinoma↗
PubMedDate not supplied

Corynebacterium jeikeium (group JK diphtheroids) endocarditis. A report of five cases.

Corynebacterium jeikeium is the name recently given to a group of coryneform rods, formerly known as the JK group, and associated with a wide range of serious infections. We describe five patients with C. jeikeium endocarditis observed in two Belgian hospitals over a period of 5 years. In three cases, the infection occurred on prosthetic heart valves between 1.5 and 5 months after surgery. The two other patients, with known mitral insufficiency, presented with endocarditis on native valves. In four patients, bacteriologic and clinical cure followed treatment with vancomycin. The fifth patient died despite eradication of the coryneforms by combination antibiotic therapy. We know of no previous reports of C. jeikeium endocarditis on native heart valves.

Aged↗
PubMed1992

Neisseria sicca endocarditis with embolic phenomena.

Two patients with poor oral hygiene developed Neisseria sicca endocarditis, one after probable intravenous drug abuse and Staphylococcus aureus endocarditis and the other after a periodontal surgical procedure. Both experienced significant embolic phenomena and both required 6 or more weeks of intravenous antibiotic therapy. The diagnosis of N. sicca endocarditis must be considered when this organism is isolated from blood cultures in patients with emboli.

Adult↗
PubMedDate not supplied

Salmonella prosthetic valve endocarditis.

Four cases of Salmonella prosthetic valve endocarditis have been reported previously in the English medical literature (Fraser et al. 1967; Yamamoto et al., 1974; Shanson et al., 1977; Bassa et al., 1989). This report describes a fifth case in a 62-year-old woman who developed tricuspid valve endocarditis after an episode of Salmonella gastroenteritis, and reviews prior cases of Salmonella prosthetic valve endocarditis.

Bioprosthesis↗
PubMed1991

A case for early surgery in native left-sided endocarditis complicated by heart failure: results in 203 patients.

From January 1982 to December 1988, 203 consecutive patients were selected for early valve replacement (mean 10 days from time of admission) if they had clinical evidence of native valve endocarditis with 1) vegetations on echocardiography, 2) severe valvular lesions, and 3) heart failure. Surgery was performed within 7 days of admission in 56% of patients and was done urgently because of hemodynamic deterioration in 108 (53%). All vegetations were identified by echocardiography and confirmed macroscopically at surgery. One hundred ten patients had isolated aortic valve infection, 50 had isolated mitral valve infection (p less than 0.05 for aortic vs. mitral) and 43 had double-valve infection. Mean aortic cross-clamp time was 57, 38 and 67 min, respectively. Sixty-four patients (32%) had extensive infection involving the anulus or adjacent tissues, or both; such infection more frequently involved the aortic than the mitral valve (p less than 0.05). Thirty-eight patients (35%) with aortic valve infection had abscess formation compared with 1 patient (2%) with mitral valve infection (p less than 0.05). Only eight patients (4%) died in the hospital. There were seven patients (3%) with a periprosthetic leak and five patients (3%) with early prosthetic valve endocarditis. Long-term follow-up, available in 174 hospital survivors (89%), revealed 10 deaths and two new ring leaks at 38 +/- 22 months. In conclusion, among patients with endocarditis who need surgery for heart failure, aortic valve infection is more prevalent than mitral valve infection and is more often associated with extensive infection, including abscess formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement.

The outcome of 30 consecutive patients with active aortic prosthetic valve endocarditis and root abscesses treated by the technique of homograft aortic root replacement with reimplantation of the coronary arteries is detailed. The principles of this technique are the removal of all abscesses and infected areas likely to drain into the infected mediastinum, excision of infected tissues down to healthy noninfected tissue and replacement with an antibiotic-impregnated homograft aortic root. All patients had evidence of progressive cardiac failure and ongoing sepsis. Mean patient age (+/- SD) at the time of operation was 42 +/- 18 years. The mean number of previous aortic valve replacements per patient was 1.6 +/- 0.7; 14 patients (47%) had undergone greater than or equal to 2 previous replacements. At operation, aortic root abscesses were found in all patients; abscess extension to adjacent structures and partial valve dehiscence had occurred in 23. In-hospital death occurred in 9 (30%) of the 30 patients. The 21 hospital survivors have been followed up for a mean of 66 +/- 42 months (range 9 to 144). Overall, 17 (81%) of the 21 hospital survivors have remained free of major adverse events (recurrence of endocarditis, need for reoperation or death). The results of our study suggest that homograft aortic root replacement should be considered favorably in the treatment of patients with aortic prosthetic valve endocarditis and root abscesses.

Abscess↗
PubMedDate not supplied

Electrocardiographic findings in infective endocarditis.

Management of infective endocarditis includes early recognition of complications and prompt intervention when necessary to avert an untoward result. Among the most serious potential complications of this disorder are those that involve the heart itself. Although the ECG is often normal or nearly so in patients with endocarditis, at other times apparently minor abnormalities may be harbingers of potentially fatal complications. The ECG therefore plays an important role in the initial and ongoing evaluation of patients in whom endocarditis is suspected.

Electrocardiography↗
PubMed1988

Nutritionally variant streptococci develop ultrastructural abnormalities during experimental endocarditis.

Nutritionally variant streptococci (NVS) are fastidious micro-organisms responsible for most of the so-called negative blood culture endocarditis. In patients, the relative resistance of these bacteria to antibiotic treatment may be relevant to bacterial alterations in infected tissues. We used here a rabbit experimental model of endocarditis in order to examine, under scanning and transmission electron microscope, the NVS ultrastructure inside cardiac vegetations and to follow alterations at the different stages of the disease. In the early phase (day 7) of endocarditis, NVS were found dispersed inside vegetations and exhibited a typical streptococcal morphology similar to that observed during an in vitro balanced growth. In contrast, on day 11 and day 18, bacteria were found gathered as large and numerous clusters, in which they exhibited abnormal ultrasturctural features similar to those previously described during in vitro unbalanced growth. At this stage, ruthenium red staining revealed a large amount of exopolysaccharide surrounding the bacteria. None of these bacterial alterations were observed inside the vegetations of rabbits treated from day 7 to day 11 with penicillin or vancomycin. These abnormalities might be mainly related to nutrient limitation inside the clusters and could contribute to the pathogenicity of these micro-organisms.

Animals↗
PubMed1995

Valve replacement for acute left heart endocarditis.

Between January 1982 and June 1993, 66 patients (48 men and 18 women of mean (range) age 50 (21-77) years) underwent valve replacement for acute infective endocarditis. There were 45 aortic valve and 17 mitral valve infections. Four patients had bivalvular involvement. Fifty-three patients suffered from native valve endocarditis, with underlying valvular lesions documented for 31 patients. Staphylococci and Streptococci spp. were responsible for 68% of infection, and 20% of blood and valve cultures were negative. Refractory congestive heart failure was the leading surgical indication in 86% of patients. The mean follow-up period was 44 months. The perioperative mortality rate was 6%. Actuarial survival rates were 88.5% at 1 year and 83% at 3 years. No early recurrence of infection was noted. Six patients (9%) needed reoperation. Satisfactory results confirm that early surgical management should be considered in patients with complicated infective endocarditis.

Acute Disease↗
PubMed2004

Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis.

The goal of our study was to determine the prevalence of older patients with cardiac valvular abnormalities warranting endocarditis prophylaxis. We performed a retrospective analysis of 1,000 randomly selected echocardiograms (inpatients and outpatients) from our tertiary care institution. We found that the prevalence of valvular abnormalities increased significantly with age, and that 50% of patients > or =60 years of age warranted endocarditis prophylaxis using current guidelines. With the aging population of the United States and the negative consequences of widespread antibiotic prophylaxis, further investigation is needed to identify patients who are truly at risk for infectious endocarditis.

Adolescent↗