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

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases]. 308 10

This study was based on the analysis of 41 cases of infectious endocarditis of native valves operated during the acute phase. Patients with bacteriological cures, prosthetic valve endocarditis and endocarditis on congenital non-valvular lesions were excluded. There were 32 men and 9 women with an average age of 49 years. The valve lesions were aortic incompetence, mitral incompetence, mitro-aortic disease and mitro-tricuspid disease. Fourteen patients had preexisting valvular disease (rhumatic in 12 and congenital in 2 cases). These patients were in an advanced clinical state at the time of operation: 23 Class IV, 16 Class III and 2 Class II operated for systemic embolism. The surgical indications were severe cardiac failure in 30 cases, systemic embolism in 2 cases and persistance of septicaemia with worsening cardiac function in 9 cases. The causal organism was isolated from blood cultures in 34 cases (83%) and from the excised valve in 13 cases. The early postoperative mortality during the first month was 5 patients (3 cases of aortic incompetence associated with mitral incompetence and 2 cases of aortic incompetence alone). Death was caused in most cases by irreversible cardiac failure related to the advanced preoperative cardiac failure. All the other patients were followed up for 1 to 102 months (average 44 months). There were 7 late postoperative deaths. The mortality rate was 3.4% per patient year including patients undergoing chronic haemodialysis. The actuarial survival was 79% at 78 months excluding the operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Results of surgical treatment in acute native endocarditis. Apropos of 41 patients]. 308 15

Platelet-bacterial interactions were examined in vitro by incubating organisms isolated from patients with septicemia with normal platelet-rich plasma. The potency of various species of gram-positive and gram-negative bacteria to induce irreversible platelet aggregation was then determined in an aggregometer. The aggregation curves produced by the bacteria resembled the normal platelet response to collagen and were impeded by the presence of aspirin. Strains of Staphylococcus aureus and Pseudomonas aeruginosa isolated from 25 different patients produced maximum increases in light transmission and irreversible platelet aggregation with relatively rapid mean aggregation times; six of these patients had clinical and laboratory evidence of disseminated intravascular coagulation. In contrast, isolates of alpha streptococcus and Staphylococcus epidermidis induced irreversible platelet aggregation much less commonly and were associated with considerably longer mean aggregation times. None of the latter group of patients had evidence of disseminated intravascular coagulation. Isolates of bacteria from a small number of patients with subacute bacterial endocarditis uniformly induced irreversible platelet aggregation. Addition of paired bacterial isolates to normal platelet-rich plasma demonstrated a synergistic aggregation response. These data suggest that a relative hierarchy exists in bacterial strain potency to induce irreversible platelet aggregation. The rapidity and degree of aggregation in vitro correlated well with the clinical and laboratory evidence for subacute bacterial endocarditis and disseminated intravascular coagulation in vivo. These observations may provide useful adjunctive laboratory information to help establish the diagnosis of subacute bacterial endocarditis, especially in the clinical setting where the classical findings of endocarditis are not obvious during initial presentation.
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PMID:In vitro correlation of platelet aggregation with occurrence of disseminated intravascular coagulation and subacute bacterial endocarditis. 310 30

To better understand the microbiology, anatomy, and demography of infectious endocarditis, we devised a prospective statewide reporting system to study these infections. Because our study design required accurate diagnosis, reliable case reporting, and a high probability of physician-to-case exposure, we enlisted the help of cardiologists, cardiovascular surgeons, and infectious disease specialists throughout Louisiana. All Louisiana members of the American College of Cardiology and the Infectious Diseases Society of America were invited to participate. Participants were supplied with a brief endocarditis report form and asked to complete the form as they saw patients with infective endocarditis. Seventy-five patients with infective endocarditis were reported for a case rate of 1.7 per 100,000 persons per year. This report analyzes the results from this one-year study.
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PMID:Results of a prospective statewide reporting system for infective endocarditis. 313 47

In a retrospective study of 39 patients with infective endocarditis (IE) all had elevated concentrations of C reactive protein (CRP) at presentation, patients with the acute variety having significantly higher values than patients with the subacute variety. In addition, the majority of patients with subacute bacterial endocarditis had elevated concentrations of circulating immune complexes (CICs) and rheumatoid factor (RF), both of which were absent in all but one of nine patients with acute bacterial endocarditis. Two patients with subacute and one with acute bacterial endocarditis had low values of C3 and C4. Measurement of CRP, CICs, and RF did not distinguish between patients with and without extracardiac manifestations. Sequential analysis of patients revealed that a successful response to antimicrobial treatment was indicated by a striking and rapid decline in CRP, with less striking declines in CICs, RF, and IgM. Antibiotic failure was indicated by the persistence of high concentrations of CRP and CICs. We conclude that the measurement of C reactive protein is of some value in the diagnosis and management of infective endocarditis. A normal CRP concentration excludes this diagnosis. The measurement of CRP alone appears sufficient for monitoring most cases of infective endocarditis with the sequential measurement of rheumatoid factor and circulating immune complexes adding no useful information except where the CRP remains elevated despite treatment. In this latter instance, persisting high levels of CRP and circulating immune complexes together herald an ominous course.
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PMID:Serological investigations in the diagnosis and management of infective endocarditis. 347 Nov 92

Patients usually provisionally diagnosed as having typhoid fever or pneumonia are regularly admitted to the Rietfontein Fever Hospital suffering from psittacosis. The main symptoms are intense headache, chills and fever and an irritating non-productive cough. Later most patients develop signs of pneumonitis most clearly seen on radiographic examination. An important clue to the diagnosis is a history of contact with birds, most often budgerigars and more recently cockatiels. The diagnosis may be confirmed by the isolation of Chlamydia psittaci, the causative organism, but more usually reliance is placed on the results of serological tests revealing the development of chlamydial antibodies. None of the patients in this series developed serious complications, but if not treated psittacosis sufferers may develop severe pneumonitis, hepatitis and gastro-enteritis; the mortality rate is up to 20%. A rare but fatal complication is chlamydial endocarditis, presenting with the signs and symptoms of subacute bacterial endocarditis, but giving repeated negative blood cultures. The illness responds specifically to treatment with tetracycline antibiotics within 48 hours. Chlamydial infections are widespread among avian species. In the RSA most cases of psittacosis have resulted from contact with budgerigars and cockatiels, but outbreaks have been associated with imported batches of birds including South American parrots and Australian finches, emphasizing the need for vigilance at seaports.
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PMID:Psittacosis in the RSA. 370 61

Splenic and renal tissues from a 61-year-old man with subacute bacterial endocarditis and acute renal failure were studied. Immune complex deposits were found both within glomeruli and splenic venous sinus basement membranes, substantiating the systemic nature of the immune injury in this disorder. The splenic deposits may, in part, be responsible for the splenomegaly often present in endocarditis.
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PMID:Splenic immune deposits in bacterial endocarditis. 372 24

The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.
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PMID:[Pseudotumoral mitral endocarditis. Diagnostic and therapeutic problems apropos of a case report with review of the literature]. 374 Jul 77

For one year all narcotic addicts admitted to the Detroit Medical Center with infectious endocarditis (74 cases) were compared with a control group of bacteremic addicts who had other infections (106 cases). Endocarditis was caused by Staphylococcus aureus (60.8% of cases), streptococci (16.2%), Pseudomonas aeruginosa (13.5%), mixed bacteria (8.1%), and Corynebacterium JK (1.4%). S. aureus endocarditis most frequently involved the tricuspid valve; streptococci infected left-sided valves significantly more often than other organisms (P = .001). Biventricular and multiple-valve infections were commonest in patients with pseudomonas endocarditis (P = .05). Two-dimensional echocardiography, when combined with an abnormal chest roentgenogram, was highly predictive of endocarditis. Bacteremia in the absence of endocarditis was associated with primary skin and soft tissue infection, mycotic aneurysm at the site of narcotic injection, septic arthritis, septic thrombophlebitis, pneumonia, osteomyelitis, mediastinal abscess, and unclassified infection. Polymicrobial bacteremia in the nonendocarditis group was associated with markedly increased morbidity. Mild hyponatremia occurred in 41% of all patients and was also associated with significantly increased morbidity. Analysis of the two groups disclosed similarities and differences with implications for the pathophysiology and treatment of addicts with bacteremic infection.
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PMID:Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study. 375 55

Review of our experience with infectious endocarditis at a single community hospital showed coagulase-negative staphylococci to be our leading cause of endocarditis. The pathogenesis of coagulase-negative staphylococcal endocarditis (CNSE) involved either hematogenous seeding of native or prosthetic valves, or direct implantation at surgery. Cases involving native valves demonstrated an acute onset and rapidly deteriorating course, while prosthetic valve endocarditis was more indolent; both types were associated with multiple complications. Although the number of our cases is small, mortality from native valve CNSE was higher than that of prosthetic valve endocarditis. Patients treated medically fared better than those receiving both medical and surgical treatment, though the medically treated group may not have been as ill as those having valve replacement. Vancomycin caused serious adverse effects in two of the five patients receiving it.
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PMID:Coagulase-negative staphylococcal endocarditis: a view from the community hospital. 377 65


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