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

Recognition of the increasing prevalence of outpatient antibiotic use prompted this review of 32 patients with verified infectious endocarditis. The results of 161 quantitative blood cultures obtained before definitive therapy were correlated with clinical information to determine whether outpatient antibiotic administration influenced blood culture positivity. In 17 patients receiving outpatient antibiotics, 56 (64%) of 88 blood cultures obtained before definitive treatment were positive, whereas all cultures obtained from 15 patients without recent antibiotic exposure were positive. Notably, seven patients showed a phase of total suppression, and two patients showed a phase of partial suppression of blood culture positivity after discontinuation of outpatient antibiotic treatment. Consequently, patients with recent antibiotic exposure and suspected endocarditis should have blood cultures obtained initially and periodically throughout the phase of potential suppression of bacteremia to optimize the chance of obtaining a positive result.
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PMID:Blood culture positivity: suppression by outpatient antibiotic therapy in patients with bacterial endocarditis. 705 54

Subacute bacterial endocarditis involving the common atrioventricular (AV) valve is a rare complication of complete endocardial cushion defect. This report describes our experience with an 18-year-old patient who was seen with this problem. Diagnosis was established by two-dimensional echocardiography. The operative findings and technique of repair are described. We believe this to be among the first successful reports of complete repair of active endocarditis involving the common AV valve in this congenital anomaly.
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PMID:Subacute bacterial endocarditis and complete endocardial cushion defect. 713 16

Bacterial endocarditis in pregnancy is uncommon but serious. A case is presented of subacute bacterial endocarditis with severe aortic and mitral valvular insufficiency and with associated multiple systemic and cerebral emboli. Therapy consisted of cesarean section at 33 weeks' gestation followed by aortic and mitral valve replacement; there was no maternal or fetal mortality. The English literature on infective endocarditis complicating pregnancy is reviewed.
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PMID:Bacterial endocarditis in pregnancy. 715 87

A total of 63 patients, who survived mitral valve replacement with the Kay--Shiley caged disc mitral valve prosthesis, were followed for 11 years by single clinic group to assess long-term results post valve replacement. Sixty-one patients (97%) received a muscle guard type Kay--Shiley prosthesis. All patients received oral anticoagulation therapy. The valvular damage was caused by rheumatic disease in 51 patients, infectious endocarditis in six patients, myxomatous degeneration in two patients, coronary artery disease in two patients, and idiopathic ruptured chordae tendineae in two patients. Late death occurred in 21 patients (33%); the 10-year actuarial survival was 65%. Twenty-six patients had at least one thromboembolic event, and the total number of thromboembolic events was 10.3 per 1000 patient months. Two patients developed prosthetic valve endocarditis. Both patients were heroin addicts and died of valve ring abscess. Long-term periods of clinical observation are necessary to assess the effects and benefits of prosthetic valve implantation. These data are important for comparison with other "10-years" valves.
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PMID:Clinical experience with the Kay-Shiley mitral valve prosthesis: an eleven-year follow-up study. 722 98

A 19 month-old girl diagnosed of truncus arteriosus with absence of the left pulmonary artery and severe truncal valve insufficiency underwent total correction. A non previously diagnosed severe mitral insufficiency required a new operation to implant a Bjork-Shiley supraanular mitral prosthesis. The postoperative period was hemodynamically normal, except for the presence of persistent fever of unexplained origin. The clinical picture was thought to be an infectious endocarditis due to the late appearance of an aortic prosthetic leak. Because of failure to medical treatment a reoperation was performed to replace aortic prosthesis. Patient died eight hours postoperatively. Autopsy revealed a correct surgical repair, absence of endocarditis and severe miliary disseminated tuberculosis. Authors consider of interest to present this case-report due to the rarity of: a) correction of truncus with a single pulmonary artery under two years of age; b) associated mitral insufficiency; c) the presence of tuberculosis, difficult differential diagnosis with infectious endocarditis in a patient with valvular prosthesis.
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PMID:[Fever of undetermined origin in a case of total correction of persistent truncus arteriosus with agenesis of the left pulmonary artery (author's transl)]. 725 48

A 33-yr-old male ran 10 miles, drank some beer, and developed pain in his left knee and ankle. He took some leftover antibiotics but was no better after 6 d, when a heart murmur and an aortic valve nodule were discovered. He was presumed to have endocarditis with septic arthritis and was started on intravenous antibiotics. On the second hospital day, synovial fluid analysis revealed acute gout, and the patient improved very rapidly on anti-gout therapy. The valvular nodule remained unexplained, but one very rare cause of valvular heart nodules is visceral gout. An unsuccessful attempt to resorb the nodule was made by using allopurinol. This patient demonstrates several points about gout in endurance athletes: 1) acute gout can mimic infectious endocarditis, 2) misdiagnosed or undertreated gout often leads to multiple joint involvement and sometimes to visceral tophi, and 3) athletes who exercise in warm weather and quench their thirst with cold beer are at risk for acute gout.
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PMID:Runner with gout and an aortic valve nodule. 767 64

To assess the most relevant features of hospital-acquired endocarditis, we conducted a retrospective study of cases of infectious endocarditis at a single university hospital from 1978 through 1992. During this period 248 episodes of infectious endocarditis were documented; 23 (9.3%) of these episodes were hospital-acquired and were not associated with cardiac surgery. (This figure represented a remarkable rise in the frequency of nosocomial endocarditis, only one case of which was identified among 101 cases of endocarditis treated at the same institution between 1960 and 1975.) In each of the 23 nosocomial cases, endocarditis was the result of bacteremia associated with a hospital-based procedure: intravenous catheterization (15 cases), instrumentation of a diseased urogenital tract (seven cases), or liver biopsy (one case). Staphylococcus aureus and Enterococcus faecalis were the predominant organisms isolated from intravenous catheters and the urogenital tract, respectively. Two of seven enterococcal isolates were highly resistant to gentamicin (MIC, > 2,000 micrograms/mL). Overall mortality was 56%. Two subsets of at-risk patients with different anatomic and clinical manifestations were identified. Our results emphasize that infectious endocarditis must be considered a serious nosocomial hazard against which preventive measures must be implemented.
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PMID:Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. 772 42

Survival of patients with increasingly complex congenital heart disease has produced a population of children and adolescents who are susceptible to subacute bacterial endocarditis (SBE). We report a child whose endocarditis went unrecognised, and who developed amyloidosis. Asymptomatic proteinuria, haematuria and renal impairment are occasionally seen in SBE and usually indicate glomerulonephritis. Amyloidosis should also be suspected in children with long-standing bacterial endocarditis with proteinuria or other evidence of renal impairment, especially if associated with organomegaly. The diagnosis is made by renal biopsy.
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PMID:Secondary amyloidosis from long-standing bacterial endocarditis. 774 18

Fourteen patients with mitral regurgitation resulting from infectious endocarditis underwent mitral valve repair between December 1988 and July 1994. There were nine males and five females aged from 14 to 70 years (mean 40.2 +/- 19.7 years). Three patients had active endocarditis. Time between the onset of endocarditis symptoms and surgery ranged from 1 to 24 months (mean 8.3 months). Bacterial findings were Streptococcus in eight patients, Staphylococcus in one, and unknown in five. All macroscopically infected tissue was excised in patients with active endocarditis. Carpentier's reconstructive techniques were mainly used. There were no hospital deaths. Mean follow-up was 29 months and complete. Thirteen patients were in New York Heart Association functional class I and one in class II. There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidity. We conclude that mitral valve repair is an attractive procedure in patients with mitral regurgitation resulting from infectious endocarditis.
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PMID:[Mitral valve repair for infectious endocarditis]. 777 93

A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France. This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations. One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental. In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC. The echocardiographic appearances are non-specific. The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere. Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%). Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological. The hospital mortality was 9%; late mortality was 6%. Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms. A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective. The complementary surgical indications are the same as for other forms of infectious endocarditis. Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.
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PMID:[Infectious endocarditis induced by Actinobacillus actinomycetemcomitans. 8 new cases]. 778 13


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