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

Forty-nine patients with disseminated gonococcal infection (DGI) hospitalized at Boston City and University Hospitals over a 7-year period were studied. Patients with clinical manifestations of DGI and with cervical, urethral, rectal, pharyngeal, synovial or blood cultures positive for Neisseria gonorrhoeae were separated into two groups based on the presence or absence of suppurative arthritis. There were 19 cases of suppurative arthritis (Group II) and 30 cases with only tenosynovitis, skin lesions, or both (Group I). Blood cultures were positive only in Group I patients (43%) and synovial fluid cultures only in Group II patients (47%). Polyarthralgia was the most common initial symptom in both groups of patients. Twenty-six Group I patients had tenosynovitis (87%), while only 4 Group II patients (21%) had tenosynovitis (p less than 0.001). The knee was the most commonly involved suppurated joint. Twenty-seven Group I patients (90%) had skin lesions compared to 8 Group II patients (42%) (p less than 0.001). Some of these lesions progressed on treatment; some patients were unaware of their lesions. Genitourinary symptoms were unusual in both groups of patients. Eleven women (33%) were menstruating or were pregnant at the onset of DGI. Thirteen patients had histories suggestive of previous gonococcal infections; one had recurrent DGI. This patient and one other were found to have complement abnormalities. There were no cases of endocarditis or meningitis. Four patients had unexplained liver function abnormalities. All patients recovered uneventfully. Strains isolated from disseminated sites were predominantly of the transparent phenotype (90%). Many strains (58%) required arginine, hypoxanthine and uracil for growth. They were also more susceptible to penicillin than reported strains that cause pelvic inflammatory disease. Most strains were of a single outer membrane protein coagglutination serogroup, WI (85%). These characteristics did not vary between the Group I and Group II isolates. The two groups of strains, however, did vary in their complement-dependent bactericidal reactivity to normal human sera. Eighteen of 24 Group I strains (75%) versus 9 of 19 Group II strains (47%) resisted killing by all normal human sera tested (p less than .05). Likewise, convalescent sera from Group II patients were able to kill their infecting strains more often than did sera from Group I patients (70% vs 17%) (p less than 0.01). Thus, variations in the clinical expression of disease in patients with DGI may be explained, in part, by differences in certain phenotypic and immunologic features of infecting strains.
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PMID:Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. 641 61

Gonococcal endocarditis appeared with striking frequency in the preantibiotic era compared with its surprising rarity today. We present a series of four episodes of gonococcal endocarditis, which presented to our institution in the last 2 years, after no cases in the previous decade. Three episodes involved the aortic valve and required emergency aortic valve replacement. One episode involved the tricuspid valve and was successfully cured with antibiotic infusion alone. Combining our four patients with the available 25 well-documented gonococcal endocarditis cases reported in the English medical literature during the antibiotic era, we demonstrated that the disease incidence may be increasing, that infections more often involve left-sided cardiac structures (particularly the aortic valve), and that the association with a quotidian fever curve, rash and arthritis, and overt gonococcal infection is less common than previously reported. These patients frequently present with fulminant and dramatic valvular insufficiency without immediately positive blood cultures and complete echocardiographic evaluation seems to provide a valuable aid in making a presumptive diagnosis of endocarditis and directing appropriate clinical management.
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PMID:Gonococcal endocarditis: a case series demonstrating modern presentation of an old disease. 643 1

A case is described in which chronic gonococcemia probably resulted in endocarditis, nephrotic syndrome and diffuse immune-complex glomerulonephritis. This is the 11th case of gonococcal endocarditis reported since 1948 and the first report with accompanying immunofluorescence and electron microscopy of the kidney. These studies revealed immune-complex nephritis to be the likely cause of the patient's deteriorating renal function.
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PMID:Gonococcal endocarditis associated with immune complex glomerulonephritis. 644 84

Although gonococcal infections of the pulmonary valve were common before the introduction of antibiotics, such infections have rarely been reported since penicillin became available. In an elderly man with gonococcal endocarditis of the pulmonary valve the non-specific signs and symptoms, the late appearance of a pulmonary murmur, and the sterility of early blood cultures made the diagnosis unclear until three weeks after admission. Endocarditis was localised to the pulmonary valve by M-mode and cross-sectional echocardiography. Echocardiography may be useful for diagnosing endocarditis in patients with fever of unknown origin. Gonococcal infection should be suspected in patients with pulmonary vegetations and sterile blood cultures.
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PMID:Pulmonary valve gonococcal endocarditis. A forgotten disease. 661 65

The authors report the case of a 35 year old female hospitalised for gonococcal endocarditis with mitral valve vegetations infecting pre-existing asymptomatic rheumatic mitral incompetence. Apyrexia was rapidly obtained with antibiotic therapy; the valvulopathy was well tolerated from the hemodynamic viewpoint; the echocardiographic appearances of the vegetations were stable. However, the patient died during the third week of a cerebral haemorrhage, probably due to rupture of a mycotic arterial aneurysm. The authors suggest that the difficulties encountered in the fight against sexually transmitted diseases may result in a recrudescence of this type of disseminated gonococcal infection.
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PMID:[Gonococcal endocarditis. A new case]. 685 31

Chlamydia trachomatis is being recognized as an important sexually transmitted disease in adolescents and young adults. This report reviews the recent literature regarding the many clinical entities encompassed by this organism; this includes urethritis and cervicitis as well as epididymitis, salpingitis, peritonitis, perihepatitis, urethral syndrome, Reiter syndrome, arthritis, endocarditis, and others. It is emphasized that many aspects of chlamydial infections parallel those of gonorrhea, including incidence, transmission, carrier state, reservoir, complications, (local and systemic), and others. A paragonococcal spectrum of sexual chlamydial disorders is discussed as well as effective antibiotic therapy. This microbiological agent must always be considered if venereal disease is suspected by the clinician in teenagers or adults. Mixed infections with Chlamydia trachomatis and Neisseria gonorrhoeae are common in both males and females. It may be preferable to treat gonorrhea with tetracycline to cover for this possibility.
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PMID:Chlamydia trachomatis: an important sexually transmitted disease in adolescents and young adults. 689 12

The first case of gonococcal endocarditis on a prolapsing mitral valve is reported. The organism was found to be highly sensitive to penicillin G, Arg- Hyp- Ura-, and sensitive to the bactericidal action of normal serum. This combination of characteristics in a strain of Neisseria gonorrheae causing systemic disease is distinctly unusual. With high dose penicillin therapy the immunologic parameters returned to normal and the patient made an uneventful recovery. High levels of circulating immune complexes were detected in the patient's serum.
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PMID:Gonococcal endocarditis in a patient with mitral valve prolapse: study of host immunology and organism characteristics. 708 Dec 90

Infection with Chlamydia trachomatis is an important cause of nongonococcal urethritis and cervicitis, and may be the most common sexually transmitted disease in the United States. Associated complications include epididymitis, proctitis, salpingitis, bartholinitis, arthritis, perihepatitis, and endocarditis. Perinatal transmission of infection may result in neonatal inclusion conjunctivitis and/or pneumonia of infancy. Chlamydial genital infection should be suspected in a patient (male or female) who presents with a gonorrhea-like syndrome but whose laboratory studies fail to demonstrate Neisseria gonorrhoeae. Such patients, together with their sex partners, should receive antichlamydial therapy; the uncomplicated genital infections respond well to oral treatment with tetracycline, erythromycin, and sulfonamide. The most important cause of treatment failure in nongonococcal urethritis is lack of simultaneous treatment of both patient and partner.
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PMID:Chlamydial genital infections: manifestations and management. 725 29

Serum and subcutaneous chamber fluid (CF) dynamics of penicillin G, ampicillin, and amoxicillin were studied in rabbits after single large parenteral doses comparable to doses used in treating gonorrhea and endocarditis. The effects of parenteral probenecid and of injection of an antibiotic directly into a subcutaneous chamber ("intrachamber" injection) also were studied. Peak serum antibiotic concentrations exceeded peak CF concentrations and occurred sooner. Antimicrobial activity persisted longer in CF than in serum. Percent penetration [100 x (CF peak/serum peak)] of CF was least after intramuscular ampicillin and amoxicillin, was greatest after intrachamber ampicillin and intramuscular aqueous procaine penicillin G, and was related to duration of antibiotic concentration gradients from serum to CF. Intramuscular aqueous crystalline penicillin G resulted in higher serum and CF penicillin G concentrations than intramuscular aqueous procaine penicillin G, which prolonged the duration of penicillin G in serum and CF. Amoxicillin diffused into CF more readily than ampicillin. Probenecid resulted in higher early serum and CF antibiotic concentrations, but had little or no effect on duration of antibiotic activity. Intrachamber ampicillin resulted in more prolonged serum and CF ampicillin activity than intramuscular ampicillin, but much lower peak serum concentrations. The data suggest a possible means by which probenecid improves the efficacy of gonorrhea therapy with aqueous procaine penicillin G. Intrachamber administration of penicillins could be useful in treating experimental infections requiring prolonged therapy.
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PMID:Serum and subcutaneous chamber fluid dynamics of penicillins after single large parenteral doses. 738 44

Non-specific urethritis (NSU) is a sexually transmitted disease; 50% of cases are due to Chlamydia trachomatis, so that this is the commonest sexually transmitted infection in the developed world. Chlamydial infection is now readily diagnosable and the evidence increasingly suggests that it is underdiagnosed. Chlamydial conjunctivitis (in the newborn baby or the adult) in the developed world is a complication of sexually transmitted genital infection by C trachomatis and it indicates a large reservoir of such infections. Because of the association of sexually transmitted diseases, systemic treatment for such chlamydial conjunctivitis should not be given until full genital and serological investigators have been carried out. Chlamydial infection causes serious complications (that were formerly often thought to be gonococcal), such as epididymitis in young men and salpingitis on young women. It may cause local complications in the eye of the newborn baby and even pneumonia in babies and fatal endocarditis in adults. The diagnosis of NSU should lead to the correct treatment of the male patient and of his sexual partners. It is the promiscuous woman, who does not have a regular sexual partner to report back to her that he has NSU, who is at particular risk of undiagnosed chlamydial infection. Routine genital investigations for chlamydia are particularly indicated in her case. Following the parallel of gonorrhoea, it seems that the use of contact tracers may be an effective method for controlling chlamydial infection.
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PMID:Epidemiology of infection by serotypes D to K of chlamydia trachomatis. 742 89


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