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

A patient with two prosthetic valves had clinical evidence of infectious endocarditis caused by Clostridium perfringens. The diagnosis was made by routine examination of the peripheral blood smear. To our knowledge, no previous reports have been made of clostridial endocarditis in prosthetic valves with the presence of clostridia in the peripheral blood smear.
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PMID:Clostridium perfringens bacteremia in prosthetic valve endocarditis. Diagnosis by peripheral blood smear. 632 7

In the period from 1968 to November 1980, 1 023 patients underwent surgery for single or multiple valve replacement. Fifty three patients (6,6% of the follow-up population) had to be reoperated, including 5 patients who had to be reoperated twice, giving a total of 58 reoperations. The average interval before reoperation was 30 months. The incidence was similar in monovalvular (7,5 p. 100 mitral valves, 5 p. 100 aortic valves) and polyvalvular (7 p. 100) cases. On the other hand, the incidence of reoperation of tricuspid prostheses (17 p. 100) was significantly superior to that of mitral valve (5,3 p. 100) or aortic valve (3,8 p. 100) prostheses. In 91 p. 100 of cases, the indication for reoperation was prosthetic valve dysfunction related to endocarditis in over a third of cases (21). In 32 cases, reoperation was required in the absence of any infectious process: 13 spontaneous perivalvular leaks, 10 thromboses, and 9 stenosing prostheses. There were no reoperations for wear of the prosthetic material. Only 9 p. 100 of patients were reoperated for uncorrected valvular disease. The prognosis of these reoperations was poor; hospital mortality being 42,5 p. 100. This high mortality rate is explained by the frequency of reoperation for infective endocarditis (36 p. 100) in our series, the mortality of which was 73,6 p. 100 and even higher when reoperation was an emergency for infectious or hemodynamic reasons. There was also a high mortality rate with reoperation for thrombosis (30 p. 100) because of the severe myocardial dysfunction in thrombosis of tricuspid prostheses and the emergency situation associated with mitral prosthetic valve thrombosis. Excluding these two complications, the average mortality was 21 p. 100. Although the surgical indications are relatively easy for thrombosis, perivalvular leak and stenosing prostheses, they are particularly difficult in infectious endocarditis especially with regards to the timing of reoperation. We believe that, ideally, reoperation should be delayed as long as possible to allow the antibiotic therapy the maximum time to take effect. Surgery can then be performed after controlling the infection and before the installation of severe hemodynamic distress.
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PMID:[Reoperations on heart valve prostheses. Apropos of 58 cases]. 640 15

In a discussion of infectious endocarditis (IE), the clinical picture, current most important diagnostic methods (especially echocardiography) and prognosis under conservative therapy and valve replacement are described in detail, in the light of experience at the Hanover Medical School in recent years. While the clinical picture is usually typical, at any rate in the early stages of the disease, antibiotic therapy (when started without blood cultures and exact characterization of the germs involved) or severe complications can change the symptoms to the extent that diagnosis becomes very difficult. Apart from blood cultures, echocardiography, is of prime importance in diagnosis, the latter allows demonstration of vegetations either by M-mode or two-dimensional echocardiography (conventional or esophageal) in some 80% of cases. A special situation is encountered in prosthetic valve endocarditis (PVE): although the incidence of early PVE (which follows hard on the heels of valve replacement) is decreasing, mortality is still high despite early reoperation. Late PVE (after a free interval of approximately 2 months to years) resembles IE of the native valves and often allows medical treatment, especially in the presence of biological valves. The prognosis in IE is still poor and depends mainly on early diagnosis, i.e. a very early start with antibiotic treatment, which must be based on a positive bacterial diagnosis.
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PMID:[Infectious endocarditis: clinical aspects and diagnosis]. 651 53

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.
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PMID:Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases. 651 81

Three hundred and seventy eight patients with infectious endocarditis (IE) were studied, including 299 cases of native IE [154 subacute (SIE), 145 acute (AIE)] and 79 cases of prosthetic endocarditis (PIE). One hundred and fifty patients were operated on (40%): 117 for haemodynamic complications, 10 for bacteriological indications and 23 for mixed indications (112 patients in the acute phase). Complications were more frequent in AIE than in SIE, in PIE than in native IE. Surgery is more urgent in aortic insufficiency and in Oslerian mitral stenosis (7 cases) than in mitral insufficiency. Eight tricuspid valvulectomies were performed. In 5 cases out of 11 rupture syndrome was cured without surgery. The patient's clinical condition contra-indicated surgery in 63 cases. The surgical mortality was 51/150 (34%). It was significantly lower in SIE (21%) than in AIE (39%), in native IE than in PIE (53%), after antibiotic therapy than in the acute phase. Mortality was not higher when surgery was performed before the 8th day of antibiotherapy but perivalvular leaks were more common (31% vs 4%, P less than 0.01). Mortality was higher when the culture of valve was positive than when it was negative (45% vs 26%, P less than 0.06). However, surgery should be immediately considered in cases of haemodynamic complications.
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PMID:Surgery in infective endocarditis. 651 92

A patient with Yersinia enterocolitica endocarditis was seen with bacteremia, valvular vegetation, new heart murmur, and septic embolism. To our knowledge, this is the first reported case of Y enterocolitica infectious endocarditis and is yet another clinical manifestation of disease produced by this organism.
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PMID:Yersinia enterocolitica endocarditis. 663 36

A case of infectious endocarditis caused by Actinobacillus actinomycetem comitans in a young male is presented. The clinical features and the microbiologic data are reviewed as well as the diagnostic and therapeutic procedures including the echocardiographic findings. A review of the literature is presented with 23 cases of endocarditis caused by this bacterium. An analysis of the cases with special emphasis in clinical presentation, predisposing factors, complications and antimicrobial therapy is made. A. actinomycetem comitans could be a cause of blood culture negative endocarditis due to the slow growth of the bacterium and the subacute course of the disease.
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PMID:[Actinobacillus actinomycetem comitans endocarditis. Report of a case and review of the literature]. 665 90

For a modern assessment of the clinical and morphologic features of glomerulonephritis accompanying bacterial endocarditis, postmortem and renal biopsy files were reviewed for the years 1965 to 1979, a period of changing epidemiology, etiology, and therapeutic regimens in infective endocarditis. The incidence of glomerulonephritis in 107 patients examined at postmortem was 22.4%; focal glomerulonephritis was present in 8.4%, diffuse glomerulonephritis in 14%. Glomerulonephritis occurred as frequently in acute as in subacute bacterial endocarditis. Staphylococcus aureus, which has replaced Streptococcus viridans as the predominant etiology of fatal bacterial endocarditis, was frequently associated with glomerulonephritis, especially in parenteral drug abusers. Renal functional impairment due to focal glomerulonephritis did not necessitate dialysis or contribute to the death of any patient. Presentation with advanced renal insufficiency due to diffuse glomerulonephritis was associated with both failure of antibiotic therapy to eradicate infection and failure to recover renal function. In patients with diffuse glomerulonephritis and less severe impairment of renal function, antibiotic therapy was successful in achieving bacteriologic cure, and complete recovery of renal function occurred in the majority. Features of persistent glomerular disease were frequent in patients with diffuse glomerulonephritis long after bacteriologic cure of endocarditis.
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PMID:Glomerulonephritis in bacterial endocarditis. 670 24

One hundred and thirty patients at our Heart Institute with infectious endocarditis during the past 5 years were reviewed to provide an overview of the spectrum of infective endocarditis and to assess the accuracy of echocardiography in detecting the infective valvular and endocardial lesions. Of the 130 patients, 36 (28%) had the previous cardiovascular surgery. The mean age of the patients was 34 years, and only 11% of the patients were over 50 years of age. Of the 94 patients who had no cardiovascular surgery before developing infective endocarditis, 6 underwent urgent surgery, 49 had elective surgery and the remaining 39 were followed up with medical treatment. The mortality rate of the 55 patients who were operated on was 5.5% as against 18.0% in 39 without surgery. Half of the 36 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of the 5 patients with bioprosthetic valve endocarditis, only one survived as a result of prompt medical and surgical treatment. Streptococci were still commonly found, about 75% in the group without surgery and 50% in the group with surgery. Gram-negative bacilli and fungi were found in patients with prosthetic valve endocarditis. In 61 patients, morphologic abnormalities confirmed at surgery or necropsy were compared with the preoperative echocardiograms. Vegetations were identified preoperatively in 50 (95%) of the 53 valves involved, and valve destruction was correctly predicted in all 23 cases. Mycotic aneurysm was detected preoperatively in only 3 of the 12 patients in whom it occurred. Thirteen patients, in whom vegetation was recorded, were treated successfully with antibiotics alone and they needed no surgical intervention during the 2-year follow up period. The presence of a vegetation in an echocardiography does not necessarily require surgical intervention in itself or predict the ultimate course.
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PMID:Spectrum of the infective endocarditis in the past five years. 689 50

Staphylococcus aureus causes an acute endocarditis, often involving previously normal valves. The criteria used for diagnosis of subacute bacterial endocarditis are frequency absent, and distinguishing acute endocarditis from bacteremia without valvular involvement is difficult. In vitro studies, including teichoic acid antibody assay and bactericidal tolerance, have been developed to aid in making the diagnosis and planning the treatment. Cases of native valve, prosthetic valve, and addict-associated endocarditis are considered separately because of differences in prognosis and approach. Use of two synergistic antibiotics has not been proved clinically superior to use one agent, and surgical intervention during treatment may be necessary in some cases. Despite prompt treatment recognition of complications, the morbidity and mortality associated with this infection remain high.
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PMID:Staphylococcal infective endocarditis. 703 83


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