Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial infection is a serious and often fatal complication of patients with liver disease and can prove fatal either directly or by precipitation of gastrointestinal bleeding, renal failure, or hepatic encephalopathy. At greatest risk are patients with alcoholic cirrhosis or decompensated chronic liver disease, or cases of acute liver disease who progress to fulminant hepatic failure or subacute hepatic necrosis. Infection appears to be unusual in patients with primary biliary cirrhosis. The site and type of infection is unrelated to the aetiology of the liver disease. Bacteraemia, pneumonia, urinary tract infection and spontaneous bacterial peritonitis are most common but infective endocarditis and meningitis, especially with pneumococci, are easily overlooked. Clinical suspicion of infection must be high as the only indication may be a general deterioration in the patients' clinical state, increasing encephalopathy or renal impairment. In the case of patients with fulminant hepatic failure, infection may precipitate the initial or recurrent encephalopathy and contributes to death in 10% of fatal cases. Spontaneous bacterial peritonitis is now recognized to occur in the absence of clinical features of peritonitis. The PMN content of the ascitic fluid may provide the only indication of infection and is the most readily available screening test. The most common types of organism responsible for all types of infection are Gram-negative enteric and streptococci, especially pneumococci, while infection with anaerobes is rare. Risk factors for infection include decompensated alcoholic liver disease, fulminant hepatic failure, gastrointestinal bleeding, invasive practical procedures and impaired host defence mechanisms against infection. Of the host defence mechanisms, impaired function of the reticuloendothelial system, complement, and PMNs represent the most common and serious defects. Defects of humoral immunity are present in ascitic fluid from patients with cirrhosis and are probably a major reason for development of spontaneous bacterial peritonitis. Diuresis improves these functions and reduces the risk of peritonitis. Treatment of infections even with the appropriate antibiotic is still associated with a high mortality but the use of adjuvant gut sterilization is promising, particularly in cases infected with Gram-negative enteric organisms. Infusions of fresh frozen plasma, blood and cryoprecipitate improve some systemic host defences and may be beneficial in the treatment and reduction of risk of infection.
 ...
PMID:Bacterial infections complicating liver disease. 265 49

The incidence and prevalence of antimitochondrial antibody-positive primary biliary cirrhosis (PBC) has been studied within a defined area in Sweden served by one hospital. During the period 1976-1983 the yearly incidence of PBC was 1.4/10(5) inhabitants, and on 31 December 1983 the prevalence was 12.8/10(5) inhabitants. The prevalence is the highest reported so far. At the time of diagnosis half of the patients were clinically asymptomatic. Two of the patients also had celiac disease with osteomalacia responding to a gluten-free diet. Gallstone disease occurred in 30% of the patients. Four patients died--two of liver-related complications, one of colonic carcinoma, and one of staphylococcal septicemia and endocarditis. One further patient, who is still alive, developed hypernephroma. Our results indicate that PBC is a fairly benign disease in most patients, with a slow progress during which they lead a fairly normal life.
 ...
PMID:Incidence and prevalence of primary biliary cirrhosis in a defined population in Sweden. 402 28

Context Early prosthetic valve endocarditis is a deadly disease and blood cultures remain negative in 14-30% of cases. Objectives To analyse the clinical and microbiological profile of patients with blood culture-negative (BCN) early prosthetic valve endocarditis (PVE) in order to define the most appropriate empiric treatment. Design, Setting and Participants From June 2001 to February 2009, a prospective multimodal strategy incorporating serological, molecular and histopathological assays was performed in all the samples referred to the laboratory for a suspicion of blood culture-negative endocarditis (BCNE) from France and abroad (n=718). A total of 31 patients with BCN early PVE was identified. Their microbiological profile was compared with that of 22 patients with blood culture-positive (BCP) early PVE and 628 patients with community-acquired BCNE identified during the same period. Results A pathogen was identified in 10 patients (32%) with BCN early PVE. Fungi were the most common pathogens identified, being found in 16% versus 4.5% in the case of PBC early PVE and 0.5% in community-acquired BCNE (p<0.001). The global microbiological profile of BCN early PVE differed strongly from that of PBC early PVE and community-acquired BCNE. A higher rate of microbiological diagnosis was obtained in patients who underwent surgery (9/21 (43%) vs 1/10 (10%), p=0.07) and an increased rate of recurrences was observed when a pathogen could not be identified (9/21 (43%) vs 1/10 (10%), p=0.07). Conclusions BCN early PVE exhibits specific aetiologies as fungi are the most frequent pathogens identified. Therefore, fungi should be investigated particularly by molecular methods on surgical specimens and an antifungal drug might be added to the empiric treatment.
 ...
PMID:Investigation of blood culture-negative early prosthetic valve endocarditis reveals high prevalence of fungi. 2044 21