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PubMed2005

Recurrent embolism in the course of marantic endocarditis.

Marantic or nonbacterial thrombotic endocarditis (NBTE) associated with systemic embolism is usually a complication of advanced or terminal malignancies. We report on the case of a 46-year-old woman in whom nonbacterial thrombotic endocarditis (NBTE)-related cerebral embolism was the first clinical sign of ovarian neoplasm, which was diagnosed after cardiac surgery. Marantic endocarditis should alert the physician to make every effort to diagnose the possible background of this clinical phenomenon. Early identification of NBTE, treatment of the underlying disease, and the associated coagulopathy could possibly prevent cardiac surgery.

Blood Coagulation Disorders↗
PubMed2005

Infective endocarditis associated with a scorpion sting.

We report the successful surgical intervention in two cases of aortic valve bacterial endocarditis after scorpion stings. Infective endocarditis developed in both patients several weeks after they suffered repeated scorpion stings. Both patients had similar, but uncommon features: (1) the isolated organisms were unusual causes of infective endocarditis (streptococcus group G and Streptococcus milleri), (2) annular abscesses developed that required either aortic root replacement with a homograft or annular patch repair with pericardium, and (3) complete heart block developed postoperatively, requiring permanent pacemaker implantation. Both patients completed a 6-week postoperative course of antibiotic therapy and are without recurrent infection.

Adult↗
PubMedDate not supplied

Pathology and pathogenesis of infective endocarditis in native heart valves.

Infective endocarditis is an endovascular microbial infection of cardiovascular structures, including large intrathoracic vessels and intracardiac foreign bodies. The characteristic lesions consist of vegetations composed of platelets, fibrin, microorganisms, and inflammatory cells, as well as leaflet disruption. The commonly accepted pathogenetic theory is herein reported, from endothelial injury with deposition of noninfective sterile thrombotic vegetations to transient bacteremia with microorganism adhesion (injury-thrombus-infection theory). This review addresses the pathology of native valve endocarditis, including local (valvular and perivalvular destruction) and distal (embolism, metastatic infection, and septicemia) complications. Old and new cardiac conditions and patients at risk, predisposing to the occurrence of infective endocarditis, are then discussed. Particular emphasis is given to hidden bicuspid aortic valve and the need of early carrier identification for prophylaxis.

Bacterial Infections↗
PubMedDate not supplied

Fatal ascending aorta-to-right ventricle fistula formation after Staphylococcus aureus endocarditis of bicuspid aortic valve.

We present a case of a 46-year-old man with advanced acquired immunodeficiency syndrome and congenitally bicuspid aortic valve endocarditis caused by methicillin- and gentamicin-resistant Staphylococcus aureus. Endocarditis led to root abscess formation, a complete heart block, and fistulous tract formation between the ascending aorta and the right ventricle. Although perivalvular abscess is not an unusual complication of native valve endocarditis, a fatal fistulous communication between the ascending aorta and the right ventricle is exceedingly rare.

Aorta, Thoracic↗
PubMed2005

Superiority of surgical versus medical treatment in patients with Staphylococcus aureus infective endocarditis.

BACKGROUND: We present here the clinical features and outcome of 54 patients affected by a Staphylococcus aureus infective endocarditis at the Amiens hospital between 1990 and 2000. The patients operated-on, group A (20 patients), were compared to the population of patients treated by exclusive antibiotherapy, group B (34 patients). PATIENTS AND METHOD: The male gender predominated with a sex ratio of 2.6. The mean age of the global population was 58.7+/-1.6 years. Time between onset of endocarditis symptoms and treatment (entire group) ranged from 1 to 120 days (mean 14.4 days). The main portal of entry were, respectively, for group A and group B: cutaneous 55% and 44.1%; intravascular material 5% and 8.8%; and rhinopharynx 5% and 8.8%. Seventy-five percent of the Staphylococcus aureus isolated were Methi-S. The main surgical treatment indication were: hemodynamic failure (HF) (30%), unstable infection with collapse (UI) (30%), UI+HF (10%), voluminous vegetation (20%) and embolism event (10%). RESULTS: The hospital mortality rate were respectively for the entire group, group A and group B: 25%, 35% and to 41% (ns). For group A, the operative mortality was lower(21%) after the first week. The actuarial survival rate (Kaplan-Meier) after 24 months was 54./+/-6.9% for the global population and 74+/-10.6% for group A and 43+/-8.5 for group B (p<0.001). The multivariate analysis finds severe sepsis and index of comorbidity as independent factors related to the global late mortality and, respectively, the age and the severe sepsis for group A, and the cardiac insufficiency for group B. CONCLUSION: The surgical treatment seems to be the best way to improve the results after Staphylococcus aureus endocarditis. The severity of the sepsis remains the most severe prognostic element, whatever the treatment adopted may be.

Anti-Bacterial Agents↗
PubMed2005

Clinical course and complications of infective endocarditis in patients growing up with congenital heart disease.

BACKGROUND: Although a high number of patients with congenital heart disease (CHD) undergo surgical palliation or definite correction up to adolescence, adult congenital heart disease (ACHD) may remain a potential lifelong risk factor for infective endocarditis (IE) in patients growing up with congenital heart disease (GUCH). METHODS: In a retrospective case study of a tertiary care center long-term clinical course and complications of patients with IE and GUCH were analysed. RESULTS: Data of 52 patients with CHD, who fulfilled the Saiman criteria for infective endocarditis and were treated between April 1986 and March 2001, were identified: Risk factors for infective endocarditis were previous cardiovascular operation (51.9%), use of foreign material (38.5%), dental or other surgical procedures without recommended antibiotic prophylaxis (25.0%), or cardiac catheterization (5.8%). Staphylococcal (38.9%) or streptococcal species (35.2%) were cultivated in most cases as causative microorganisms. Complications were: recurrence of IE (7.7%), septic embolisms (30.8%) leading to central nervous complications (7.7%), embolism of pulmonary arteries (7.7%), renal arteries (1.9%), arteries of the extremities (9.6%), or infarction of spleen (1.9%). Other cardiac (23.1%) or extracardiac (13.5%) complications were frequent. The need of re-operations during or after IE was high (67.3%). The hospital mortality was 1.9%, late mortality was 7.7%. CONCLUSIONS: Patients with IE and CHD show a broad clinical spectrum of cardiac and extracardiac complications. They may lead to a complicative short- and long-term course with the potential risk of death and a high number of re-operation. Efforts have to be made to improve long-term outcome of patients with ACHD by an interdisciplinary cooperation.

Adolescent↗
PubMed2007

Staphylococcus lugdunensis endocarditis following lower extremity revascularization.

We describe a fatal case of Staphylococcus lugdunensis aortic valve endocarditis that was diagnosed in a 75-year-old man approximately 6 months following a lower extremity by-pass surgery. A relatively indolent clinical course in the early phase following the suspicious exposure may have contributed to a delay in the diagnosis. At the time of presentation the patient had evidence of rapidly progressive congestive heart failure with anasarca, dyspnea and low grade fevers. Blood cultures were positive for coagulase-negative staphylococci and a transthoracic echocardiogram was not clearly suggestive of infective endocarditis. Despite intense medical treatment the patient expired on day four of hospitalization. On post-mortem examination, multiple vegetations were observed on the aortic valve and culture identification showed S. lugdunensis. Early detection of coagulase-negative bacteremia from multiple blood culture samples in this clinical setting is critical and should give rise to a suspicion of this rare but often fatal form of infective endocarditis. Besides appropriate antibiotic treatment, early surgical referral for valve replacement should be considered since it appears to be the only treatment positively affecting survival. Finally, further studies are needed to establish the efficacy of antibiotic prophylaxis in patients undergoing angiograms with a femoral approach.

Aged↗
PubMed2006

A case of Guillain-Barrè syndrome following Staphylococcus aureus endocarditis.

Guillain-Barrè syndrome (GBS) is the most important cause of acute neuromuscular paralysis in western countries and it is preceded in almost all cases by an infectious disease such as Campylobacter Jejuni or Cytomegalovirus. However, GBS associated with previous bacterial endocarditis is very rare. We report the case of a 74-year-old man with GBS following Staphylococcus Aureus endocarditis affecting aortic valve. Although the absolute incidence of GBS is low, the present case stresses the need to consider GBS in patients developing neurological symptoms following any infectious illness, such as endocarditis, and highlights the challenging problem of rehabilitation and surgical management in these patients.

Aged↗
PubMed2006

Presentation and outcome of infective endocarditis in Spain: a retrospective study.

OBJECTIVE: To analyze cases of infective endocarditis in patients who attended the Hospital General de Castellón, Spain, between 1999 and 2004. METHODS: This was a retrospective study. Demographic and clinical characteristics were assessed, variation in presentation over time was analyzed, and factors influencing outcome were determined. RESULTS: A total of 54 cases in 48 patients were included; 33 (61%) were in men. The median patient age was 62 years. Infective endocarditis occurred on a native valve in 36 cases (67%), a mechanical prosthetic valve in 12 (22%), and a pacemaker in six (11%). The mitral valve was the most commonly affected site. Transthoracic and/or transesophageal echocardiography showed a vegetation in 45 (83%) cases, moderate or severe valvular regurgitation in 27 (50%), and intracardiac destructive lesions in five (9%). The outcome in 15 (28%) cases was death, and multivariate analysis disclosed significantly increased risk of death associated with older age, lower serum albumin, and higher white blood cell count. CONCLUSIONS: This study confirmed the protean nature of infective endocarditis, and identified several factors predictive of mortality including advanced age, low serum albumin, and high white blood cell count.

Adult↗
PubMed2005

Prosthetic valve endocarditis caused by Veillonella parvula.

Veillonella species is a rare cause of endocarditis. We report a case of a 49-year-old man with Veillonella parvula prosthetic valve endocarditis who presented with acute cardiac failure due to valvular dehiscence. His clinical course was complicated by cortical blindness and limb paresis as a result of cerebral embolism. The endocarditis was successfully treated with urgent valve replacement surgery and a prolonged course of metronidazole.

Endocarditis, Bacterial↗
PubMed2004

Prosthetic valve endocarditis from Granulicatella adiacens (nutritionally variant streptococci).

Nutritionally variant streptococci (NVS) are an unusual but significant cause of endocarditis, with increased morbidity and mortality compared to those caused by enterococci or viridans streptococci. For many reasons, NVS endocarditis has remained very difficult to treat medically with antibiotics, and when the bacteria infect prosthetic valves, surgical intervention has historically been required to effect cure. We report the first case of Granulicatella adiacens prosthetic valve endocarditis (PVE) in a patient with congenital heart disease who was successfully treated with a regimen of vancomycin, gentamicin, and rifampin and provide the first review of the literature on NVS PVE, as well as discussion of logistics behind the use of this antibiotic regimen.

Adolescent↗
PubMed2005

Candida albicans endocarditis treatment with caspofungin in an HIV-infected patient--case report and review of literature.

Caspofungin has recently been introduced for the treatment of invasive candidiasis, however, there is limited data on its use in endocarditis. We report a 22-year-old male HIV-infected patient on methadone maintenance therapy that developed right-sided Candida albicans endocarditis. Caspofungin treatment and vegetectomy, followed by fluconazole, was successful in the treatment of our patient. We also review all previous cases of Candida endocarditis treated with caspofungin.

AIDS-Related Opportunistic Infections↗
PubMed2006

Successful ceftriaxone therapy of endocarditis due to penicillin non-susceptible viridans streptococci.

Viridans streptococci are a major cause of infective endocarditis, and penicillin non-susceptibility is increasing in these organisms. We present the initial reported case of infective endocarditis due to penicillin non-susceptible viridans streptococci successfully treated with ceftriaxone monotherapy. The lack of evidence supporting the recommendations for treatment of endocarditis due to penicillin non-susceptible viridans streptococci is discussed.

Anti-Bacterial Agents↗
PubMed2005

[Endocarditis due to Pasteurella sp. Two cases].

Human pasteurellosis is, in general, a locoregional infection due to contact with an animal. Systemic infections are rare and endocarditis is exceptionally described. The authors report two new cases of endocarditis due to Pasteurella spp, they then review 29 other published cases. Pasteurella spp. endocarditis presents as an acute form in 64% of cases and affects the aortic as often as the mitral valves. Contact with an animal is documented in 65% of cases. Pasteurella multocida is the most frequent species in this infection. The total death rate is 40% and can reach 57% of cases in case of immunodepression. The bad prognosis of this infection, justifies an early diagnosis and a rapid and adapted but not yet consensual medicosurgical treatment.

Aged↗
PubMedDate not supplied

Brucella endocarditis: the importance of surgical timing after medical treatment (five cases).

INTRODUCTION: Brucella endocarditis is a disease that is hard to treat medically and has a high mortality. Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair. METHODS: Five patients who were admitted to our institution with a diagnosis of Brucella endocarditis were medically treated with doxycycline (200 mg/d), rifampin (600 mg/d), and ceftriaxone (2 g/d). Preoperative mean medical treatment time was 5.2 weeks (range, 4-6 weeks). The patients were taken for operation when their general status improved. We report in this study the results of these patients. RESULTS: Three patients had aortic valve replacement whereas 2 had both aortic and mitral valve replacements. No mortality or morbidity was encountered in the patients. Mean postoperative hospitalization time was 15 days (range, 12-19 days). The patients were discharged with doxycycline (200 mg/d) and rifampin (600 mg/d) but without antipyretic medication. Postoperative antibiotherapy was continued up to a mean of 3.6 months (range, 2-6 months). Mean postoperative follow-up time was 15.8 months. None of the patients needed hospitalization in their follow-up time. CONCLUSION: Adequate preoperative antibiotherapy, immediate surgery, and continuation of postoperative antibiotherapy according to clinical progress seem to be a convenient treatment strategy for Brucella endocarditis.

Adult↗
PubMed2005

[Meningeal febrile syndrome and hemiplegia revealing infectious endocarditis: the story of a catheter-related infection].

INTRODUCTION: We report the case of a 48-years patient who is under chimotherapy because of a breast cancer. She was initially found at her place in coma with hyperthermia and neurological deficiency signs. The clinic history and the paraclinical investigations have enabled to detect a catheter-related infection (CRI) as soon as the diagnosis of disseminated infectious endocarditis was made. The resonance imaging confirmed the cerebral blow when it found suspicious images of septic embolus. EXEGESIS: The CRI are usually detected at an early stage and if the classical association CRI-infectious endocarditis-systemical embolus is well known, the discovery on a CRI not treated at the stade of a febril coma is exceptional. CONCLUSION: More than ever the taking care of infectious endocarditis, still delicate and sometimes perilous, requires a global taking care of the patient.

Catheterization↗
PubMed2003

Risk factors for "major" embolic events in hospitalized patients with infective endocarditis.

BACKGROUND: Infective endocarditis often is complicated by embolic events after hospital admission. Identifying patients at higher risk may improve the disease outcome. This study was aimed at identifying predictors of embolic risk among the clinical and laboratory data obtained on hospital admission in patients diagnosed as having definite infective endocarditis according to the Duke criteria. METHODS: Ninety-four patients were enrolled in a prospective study. The results of hematologic, echocardiographic, and microbiological investigations were analyzed, using statistical methods as appropriate. Multivariate analysis was applied to variables significantly associated with embolism in univariate analysis. RESULTS: Forty-six percent of patients had a major embolic complication after admission. No association was found between embolism and sex, site of infection, or microorganism involved. Patients with embolism were significantly younger, had larger vegetation, and showed a significantly higher level of serum C-reactive protein and lower albumin concentrations than those without embolism. Young age, larger vegetation size, and high levels of C-reactive protein were the independent variables associated with an increased incidence of embolic events in the multivariate logistic regression analysis. CONCLUSIONS: Our data indicate that patients with infective endocarditis with young age and/or with large vegetation and/or with high serum levels of C-reactive protein are at increased risk of major embolic complications during the in-hospital course of the disease.

Adolescent↗