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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.
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PMID:Rheumatic manifestations of infective endocarditis. 141 Oct 84

Kingella kingae is a fastidious gram-negative rod related to the Neisseriae. Together with data from published cases of K. kingae infection, we report the clinical and laboratory findings from 10 cases in western Sweden; a specific serological reaction is also described. The diagnoses were osteomyelitis, septic arthritis, discitis, endocarditis, occult bacteraemia and phlegmon. The data from the Swedish cases, together with those from previous reports in the literature provided the basis for an analysis of a total of 33 cases, ranging from self-limiting to potentially fatal infections. In orthopaedic infections (n = 19), including 3 cases of discitis, the course was usually protracted but subacute and benign, although the full-blown, acute septic arthritis was also encountered. Endocarditis (n = 10) was characterized by a stormy clinical course and the development of significant sequelae. The majority of the patients were previously healthy children. 42% of them had a current or recent upper respiratory tract infection. After start of antibiotic treatment patients were afebrile within a few days. Betalactam antibiotics should be regarded as the drugs of choice for coping with K. kingae. We stress the insidious course of skeletal infections in children and urge the importance of early puncture of a suspected focus to establish a correct diagnosis without delay. The clinical data suggest that K. kingae should be regarded as a significant pathogen.
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PMID:Kingella kingae infections: a review and a presentation of data from 10 Swedish cases. 405 64

Five cases of Aspergillus discitis in male patients are reported. Three patients had impaired immune responses as a result of immunosuppressive therapy following a heart transplant (two cases) or hairy cell leukemia (one case). Two patients had a recent history of mycobacterial infection. All five patients were hospitalized for severe spinal pain suggestive of an inflammatory disease with no neurological abnormalities. Erythrocyte sedimentation rate was elevated in every case. The diagnosis of discitis was suspected on spinal roentgenograms and established by computed tomography and/or magnetic resonance imaging. In three patients the spine was the only site of Aspergillus infection (lumbar discitis in two cases and thoracic discitis in one case). One patient developed Aspergillus infection of several disks (L1-L2, L2-L3, and L4-L5) after Aspergillus endocarditis with embolization to the left lower limb. Another patient developed discitis after an Aspergillus lung infection. In every case, Aspergillus fumigatus was recovered in cultures of specimens harvested by a percutaneous needle biopsy of the intervertebral disk. All five patients were treated by itraconazole which was given as single drug therapy in one case and in combination with 5-flucytosine and amphotericin B in four cases. Recovery was achieved in every case after four to six months of this drug therapy. In contrast to most previously reported cases, none of the five patients reported herein required surgical treatment. Efficacy of conservative treatment in this study may be related to the use of itraconazole in every case.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Aspergillus spondylodiscitis. Apropos of 5 cases]. 824 25

A randomized open prospective study with antibodies was conducted on 398 cases of TURP to compare the efficacy of either 250 mg of ciprofloxacin twice daily (CF) or 500 mg/160mg of sulfadiazine-trimethroprim twice daily (ST) in the prevention of urinary and other infection complications. The medication was started on the evening preceding the operation and continued up to the day following the removal of an indwelling catheter. The preoperative risk factors were similar in both groups. The groups did not differ in terms of the duration of the operation, the volume of irrigation fluid or the weight of the resected chips. The incidence of immediate complications was 26% in the CF group and 20% in the ST group. All the complications were minor. There were three serious late complications, one intertervertebral discitis and one coxitis in the CF group and one endocarditis in the ST group. The patient with endocarditis died. One the removal of the indwelling catheter on the third postoperative day, bacteriuria was detected in 3% of the patients in the CF group and in 9% in the ST group. The difference was statistically significant (p < 0.05). One month after TURP, bacteriuria was detected in 7% in both study groups. It is concluded that ciprofloxacin may be more effective to preventing immediate urinary tract infections after TURP than a combination of sulfadiazine and trimethoprim. There were three serious late complications. As late as one month after TURP, bacteriuria was still diagnosed in about 7% of all patients, which is post-TURP monitoring of urinary values is important.
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PMID:Prospective randomized open study between ciprofloxacin and a combination of sulfadiazine and trimethoprim in antibiotic prophylaxis in connection with transurethral prostatectomy. 872 63

Fever of unknown origin is defined as a temperature above 39.0 degrees C together with a white blood cell count > or = 15,000 mm-3, the duration of fever exceeding 2 weeks and a correct diagnosis not being obtained in the first week of hospitalization. In neonates and infants with fever of unknown origin, the localization of the infectious focus is often difficult and unsatisfactory. In this retrospective study, the clinical value of 99Tcm-labelled antigranulocyte antibodies for this group of patients was investigated. Thirty-two immunoscintigrams were performed using 185-259 MBq 99Tcm-labelled antigranulocyte antibodies (BW 250/183) in 30 neonates and infants (21 boys, 9 girls, mean age 29.4 +/- 2 months), who had fever of unknown origin. Immunoscintigraphy was carried out as whole-body images (n = 7) or single planar images (n = 25) 4 h and 24 h post-injection. In children with known cardiac failure, single photon emission tomography of the thorax was performed to diagnose endocarditis (n = 2). For verification, the results of the immunoscintigrams were compared with radiology (conventional radiography = 14, MRI = 5, CT = 3), biopsy (n = 2), blood culture (n = 10) and clinical follow-up after specific therapy. In 11 of 30 children (36%), the diagnosis of an infective focus was possible with immunoscintigraphy. The sensitivity and specificity of diagnosing infective foci was 72% and 95% respectively (n = 11; colitis = 2, infection of the central permanent catheter tip = 2, middle ear infection = 1, spondylitis/discitis = 3, osteomyelitis = 2, umbilical infection = 1). In vertebral body infections, all lesions were photopenic. In 18 children (60%), no infective focus was found on immunoscintigraphy. In this group of children, the main reason (n = 5) for fever of unknown origin was chronic juvenile rheumatoid arthritis. No uptake was seen in two infants with cardiac failure and suspected endocarditis on SPET. In 3 of the 18 patients (17%), localization of an infective focus was not possible with immunoscintigraphy or on other examinations. In these patients, the fever disappeared spontaneously after a few days of antibiotic therapy. In conclusion, we have shown that 99Tcm-anti-NCA-95 scanning is a safe method with a high sensitivity and specificity for detecting infectious foci in neonates and infants with fever of unknown origin. Furthermore, this method is easy to perform, since no withdrawal of blood is necessary.
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PMID:Immunoscintigraphy (BW 250/183) in neonates and infants with fever of unknown origin. 986 20

Spondylodiscitis is rarely observed in association with infective endocarditis (IE). In the study presented here, 92 cases of definite IE were examined. Spondylodiscitis was present in 14 (15%) cases. The mean age of patients with spondylodiscitis was 69.1+/-13.6 years (range, 33-87 years). The male-to-female ratio was 8:6. Predisposing heart disease was found in nine (64.3%) cases. Back pain was reported in all cases. Spondylodiscitis was diagnosed before endocarditis in all cases. The infection affected the lumbar spine in 10 (71%) cases. A bacterium was isolated in all cases: group D Streptococcus ( n=5; 35.7%), coagulase-negative Staphylococcus ( n=4; 28.6%), and others ( n=5). Endocarditis affected predominantly the aortic valve (43%). The outcome was favourable in 12 cases. No differences in clinical features, evolution of disease, or laboratory values were found between IE patients with and IE patients without spondylodiscitis. Spondylodiscitis does not appear to worsen prognosis of IE, although the need for cardiac valve replacement seems to be more frequent in IE patients with spondylodiscitis. IE should be included in the differential diagnosis in patients with infectious spondylodiscitis and risk factors for endocarditis. In such patients, echocardiography should be performed routinely.
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PMID:Clinical and laboratory characteristics of infective endocarditis when associated with spondylodiscitis. 1237

Infection of a total knee arthroplasty with Streptococcus bovis in a 76-year-old man that led to the diagnosis of a bowel carcinoma is reported. Investigation revealed a malignancy in the ascending colon with extension into the adrenal gland. S bovis in conjunction with colonic neoplasia has been reported in several orthopedic conditions: vertebral osteomyelitis, discitis, lateral neck abscess, and osteomyelitis of the ileum. The relationship of S bovis to endocarditis, meningitis, brain abscesses, and peritonitis has also been well described. However, S bovis is a rare pathogen infecting joint prostheses and should raise the possibility of a gastrointestinal lesion.
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PMID:Late infection of a total knee arthroplasty with Streptococcus bovis in association with carcinoma of the large intestine. 1451 61

Staphylococcus warneri is a coagulase-negative staphylococcus that is a normal inhabitant of the skin but occasionally causes septicemia and endocarditis. We report a case of multifocal discitis caused by S. warneri in an immunocompetent patient. Only three cases of spinal S. warneri infections have been reported in the literature. They illustrate the atypical clinical presentation, with chronic pain of increasing severity in the thoracic or lumbar spine instead of the abrupt onset that characterizes S. aureus discitis. In our patient, despite the multifocal distribution of the lesions, heretofore unreported, clinical presentation suggested common low back pain. This presentation may be ascribable to the unique bacteriological characteristics of S. warneri. The case reported here illustrates the diagnostic challenges sometime raised by discitis due to coagulase-negative staphylococci.
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PMID:Multifocal discitis caused by Staphylococcus warneri. 1518 99

Haemophilus aphrophilus, an oral fastidious Gram-negative commensal with low pathogenicity, is a member of the HACEK group (H. aphrophilus, H. paraphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella spp.), and a rare cause of human infections. We reviewed the characteristics of 8 cases of H. aphrophilus infections diagnosed in our hospital from 1990-2003, and an additional 20 cases identified from the MEDLINE database, from 1990 to 2003. Their mean age was 47.4 years (range, 7-73 years), and 21 cases (75%) were male. The major manifestation was bone and joint infections (9 cases, 32%), including osteomyelitis, discitis, epidural abscess, spondylodiscitis, septic arthritis and prevertebral infection. Seven cases (25%) presented with infective endocarditis, involving native valves, and one underwent valvular replacement. Of note, 3 cases (10%) had ophthalmic infections (endophthalmitis in 2 cases and canaliculitis in 1), and 2 of them had previous ophthalmic procedures. Other manifestations included bacteremia, meningitis, brain abscess, cervical lymphadenitis, facial cellulitis, empyema, and purulent pericarditis and tamponade. All patients except 1 survived. Recent dental procedure was recalled by 11 cases (39%), and may be a predisposing factor for invasive H. aphrophilus infection. Appropriate antimicrobial therapy, such as a beta-lactam/beta-lactamase inhibitor, ceftriaxone or cefotaxime or a fluoroquinolone, can lead to a favorable clinical outcome.
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PMID:Clinical characteristics of invasive Haemophilus aphrophilus infections. 1611 75

A 68-year-old man with septic discitis of low lumbar spine is presented. The patient suffered an acute hemorrhagic stroke due to rupture of mycotic aneurysm. Streptococcus bovis biotype I was found in blood cultures. Echocardiography showed bioprosthesis aortic endocarditis. Cardiac surgery was not performed because of normal bioprosthesis function and absence of peri-annular complications. The patient was discharged after 6 weeks of antibiotic treatment.
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PMID:Septic discitis as initial manifestation of streptococcus bovis endocarditis. 1651 10


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