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Query: UMLS:C0014118 (endocarditis)
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The problem of drug abuse in America encompasses all ages, economic, and ethnic groups. The Office of the Chief Medical Examiner (OCME) has recorded a continuous increase in drug abuse deaths in Maryland over the past seven years. This report focuses on the epidemiological characteristics and pathological findings of victims of fatal drug abuse in Maryland investigated by the OCME in 1992 and 1993. A retrospective study of OCME cases in 1992 and 1993 yielded a total of 605 deaths caused by drugs of abuse. 426 deaths were the result of narcotic drug use, 66 deaths due to cocaine, 102 deaths involved both narcotics and cocaine, 6 deaths were due to phencyclidine (PCP) and 5 involved both PCP and narcotic drugs. Drug abuse deaths most often involved individuals who were male (86%) and black (64%). Their ages ranged from 15 to 68 years with the majority (58%) of victims being in their 30's. Of the 605 drug deaths, 393 (65%) had a known history of drug abuse. 279 (46%) exhibited needle tracks, of which only 94 (16%) had identifiable fresh needle puncture marks. Drug paraphernalia (needles, syringes, etc.) was found at the scene in 22% of the cases. Twenty-nine (4.8%) cases showed complications of drug abuse which included pneumonia, endocarditis or myocarditis, pulmonary embolism, AIDS and intracerebral hemorrhage. 87 (14.4%) were positive for HIV antibodies, an incidence much higher than that identified in our general autopsy population (2.6%). Drugs of abuse were also found in a significant portion of the homicides examined at this office in 1992 and 1993. 323 of the 1265 homicide victims (25%) showed evidence of some form of illicit drug activity.
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PMID:Observations on drug abuse deaths in the State of Maryland. 893 5

A 52-year-old man with neither congenital heart disease nor history of drug abuse had a spiking fever after dental treatment and was diagnosed with pneumonia at a local clinic. He was treated with antibiotics and his fever went down. Ten months later, he had again pyrexia and suffered from congestive heart failure. He admitted to our hospital and tricuspid valve endocarditis was proved by echocardiography. He was treated with penicillin. However, during the treatment, he developed a pulmonary embolism. So he underwent surgical treatment. We should take dental treatment into account one of predisposing causes of tricuspid endocarditis.
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PMID:Tricuspid valve infectious endocarditis associated with dental treatment. 938 93

Infective endocarditis (IE) is a pathologic condition of native or prosthetic heart valves or endocardium, which may result in valve destruction and congestive heart failure. It occurs more frequently in men than in women, and there is an increased trend in the elderly. The following conditions predispose patients to IE: congenital and rheumatic heart disease, calcification or stenosis of a valve, prosthetic valve surgery, a previous episode of endocarditis, poor dentition, parenteral drug abuse, and placement of intravascular lines or devices. Effective treatment frequently involves a combination of intense antibiotic therapy and surgical repair. Risk of death from IE is related to age over 60, diagnosis of staphylococcal infection, involvement of an aortic or prosthetic valve, and the presence of any of the following sequelae of endocarditis: congestive heart failure, embolic phenomenon, and neurologic deficit. Clinicians should suspect endocarditis in patients presenting with fever of unknown origin and who are at risk for endocarditis. Timely evaluation with transthoracic or transesophageal echocardiography may identify patients in the early stages of endocarditis and direct the patient to definitive therapy. Early treatment of native and prosthetic valve endocarditis may decrease its overall morbidity and mortality. This case study illustrates some of the challenges in effectively managing prosthetic valve endocarditis.
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PMID:Prosthetic valve endocarditis leading to valve replacement: a case study. 988 66

The use of a peripherally inserted central catheter (PICC) is occasionally complicated by intravascular fracture and central embolization of the catheter fragment. We present a patient in whom a PICC fragment was retrieved from the pulmonary artery 11 years after embolization following its incidental detection. Despite a history of IV drug abuse and mitral regurgitation, this patient remained asymptomatic and without complications. The catheter fragment was retrieved since the patient was believed to be at risk for endocarditis. This may be the longest duration reported of an embolized catheter fragment that was successfully removed. As the natural history of asymptomatic-retained central venous foreign bodies remains unclear, the decision to remove them should be individualized. In selected cases, these foreign bodies may be retrieved without complications even several years after embolization.
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PMID:Retrieval of an IV catheter fragment from the pulmonary artery 11 years after embolization. 1076 67

We analyzed 270 cases of fungal endocarditis (FE) that occurred over 30 years. Vascular lines, non-cardiac surgery, immunocompromise and injection drug abuse are increasing risk factors. Delayed or mistaken diagnosis (82% of patients), long duration of symptoms before hospitalization (mean +/- standard deviation, 32+/-39 days) and extracardiac manifestations were characteristic. From 1988 onwards, 72% of patients were diagnosed preoperatively, compared with 43% before 1988 (P=.0001). The fungi most commonly isolated were Candida albicans (24% of patients), non-albicans species of Candida (24%), Apergillus species (24%), and Histoplasma species (6%); recently-emerged fungi accounted for 25% of cases. The mortality rate was 72%. Survival rates were better among patients who received combined surgical-antifungal treatment, were infected with Candida, and had univalvular involvement. Improvement in the survival rate (from <20% before 1974 to 41% currently) coincided with the introduction of echocardiography and with improved diagnostic acumen. Fungal endocarditis recurs in 30% of survivors. It is recommended that fungal endocarditis be diagnosed early through heightened diagnostic acumen; that patients be treated with combined lipid-based amphotericin B and early surgery; and that patients be followed up for > or =4 years while on prophylactic antifungal therapy.
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PMID:Fungal endocarditis: evidence in the world literature, 1965-1995. 1111 86

Drug abuse is associated with a variety of neurological complications. The use of certain recreational drugs shows a marked temporal association with the onset of both haemorrhagic and ischaemic strokes, the majority of which develop within minutes to 1 h after the administration of the index drug. Delayed onset of stroke has also been observed. Acute, severe elevation of blood pressure, cardiac dysrhythmias, cerebral vasospasm, vasculitis, embolization due to infective endocarditis or dilated cardiomyopathy, embolization due to foreign material injected with the diluents under non-sterile conditions and 'street drug' contaminants with cardiovascular effects have been suggested as possible underlying mechanisms. Rupture of aneurysms and arteriovenous malformations have been detected in up to half of the patients with haemorrhagic stroke due to cocaine abuse. The less common findings reported have included a mycotic cerebrovascular aneurysm in a patient with infective endocarditis and haemorrhagic stroke. In addition to stroke, cocaine seems to provoke vascular headache. Seizures precipitated by recreational drug abuse are usually caused by acute intoxication in contrast to the withdrawal seizures encountered in subjects with alcohol abuse. Movement disorders and cerebral atrophy correlating with the duration of abuse have been described. Snorting of organic solvents may cause encephalopathy. Cases of spongiform leukoencephalopathy in heroin addicts have also been reported. Peripheral neuropathy is occasionally precipitated by drug poisoning after intravenous administration. Impurities of the drug, risky administration techniques, and the use of mixtures of various drugs, frequently with simultaneous alcohol drinking, should be taken into account when assessing the background of the adverse event as well as the overall lifestyle of the addicted subjects.
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PMID:Neurological complications of drug abuse: pathophysiological mechanisms. 1113 45

A 39-year-old man with a history of injection drug abuse was given a diagnosis of Nocardia asteroides native aortic valve endocarditis, and he required valve replacement therapy, despite having received potent antimicrobial therapy. This is the first reported proven case of native valve endocarditis due to Nocardia species.
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PMID:Nocardia asteroides native valve endocarditis. 1118 Nov 35

In our series, including 1053 cases of infective endocarditis (IE) collected from 86 Infectious Diseases Centres in Italy between 1984 and 1999, we identified 34 cases (3.2%) with a polymicrobial etiology. Intravenous drug abuse was the most important risk factor for the development of polymicrobial IE. Twenty three patients had a left sided-IE and 6 patients had a right-sided IE. The most commonly encountered microorganisms were Staphylococci and Streptococci and the most frequently observed associations of microorganisms were those between Staphylococci and Gram-negative bacteria and between Staphylococci and fungi. Twelve patients (35.3%) underwent surgery, and 5 patients (16.7%) died. Polymicrobial endocarditis did not differ clinically from IE caused by a single microorganism, and the prognosis seems to be related to the site of infection and to some specific pathogens.
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PMID:[Polymicrobial infective endocarditis in Italy]. 1188 51

Infective endocarditis (IE) is one of the most severe complications of parenteral drug abuse. The incidence of IE in intravenous drug abusers (IVDAs) is 2% to 5% per year, being responsible for 5% to 20% of hospital admissions and 5% to 10% of the overall death rate. IVDAs often develop recurrent IE. The prevalence of HIV infection among IVDAs with IE ranges between 30% and 70% in urban areas in developed countries. The incidence of IE in IVDAs is currently decreasing in some geographical areas, probably due to changes in drug administration habits undertaken by addicts in order to avoid HIV transmission. Overall, Staphylococcus aureus is the most common etiological agent, being in most geographical areas sensitive to methicillin (MSSA). The remainder of cases is caused by streptocococci, enterococci, GNR, Candida spp, and other less common organisms. Polymicrobial infection occurs in 2% to 5% of cases. The tricuspid valve is the most frequently affected (60% to 70%), followed by the mitral and aortic valves (20% to 30%); pulmonic valve infection is rare (< 1%). More than one valve is infected in 5% to 10% of cases. HIV-positive IVDAs have a higher ratio of right-sided IE and S. aureus IE than HIV-negative IVDAs. Response to antibiotic therapy is similar among HIV-infected or non-HIV-infected IVDAs. Drug addicts with non-complicated MSSA right-sided IE can be treated successfully with an i.v. short-course regimen of nafcillin or cloxacillin for 2 weeks, with or without addition of an aminoglycoside during the first 3 to 7 days. Surgery in HIV-infected IVDAs with IE does not worsen the prognosis. The prognosis of right-sided endocarditis is generally good; overall mortality is less than 5%, and with surgery less than 2%. In contrast, the prognosis of left-sided IE is less favorable; mortality is 20% to 30%, and even with surgery is 15% to 25%. IE caused by GNB or fungi has the worst prognosis. Mortality between HIV-infected or non-HIV-infected IVDAs with IE is similar. However, among HIV-infected IVDAs, mortality is significantly higher in those who are most severely immunosuppressed, with CD4+ cell count < 200/microL or with AIDS criteria. Finally, IE in HIV-infected patients who are not drug abusers is rare.
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PMID:Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. 1209 73

Alcohol abuse has been linked to intracranial hemorrhage, both intracerebral and subarachnoid. Some studies have found a dose-response relationship, so that increasing levels of abuse are associated with greater risk of hemorrhage. However, alcohol abuse has not been clearly linked to cerebral infarction, and some studies find that mild-to-moderate drinking appears to be associated with a decreased risk of cerebral infarction. Intravenous administration of drugs of abuse predisposes to endocarditis, which may lead to embolic stroke. Associations have been reported between various sympathomimetic drugs and cerebral infarction. A possible mechanism for cerebral infarction is focal arterial vasoconstriction and occasionally cerebral vasculitis. Associations have also been reported between various sympathomimetic drugs and intracranial hemorrhage. A likely mechanism for intracranial hemorrhage is acute arterial hypertension. With the exception of endocarditis, management of stroke related to drug abuse is largely supportive, with emphasis on supportive care to prevent stroke complications, physical and occupational therapy, and aggressive addiction rehabilitation.
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PMID:Cerebrovascular complications of alcohol and sympathomimetic drug abuse. 1250 9


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