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

We studied the activity of cefotaxime both microbiologically and clinically. 138 blood cultures positive for gram-positive cocci were evaluated (90 strains of Staphylococcus aureus, 25 of Streptococcus faecalis, 13 of Streptococcus alpha and ten of Streptococcus mutans). Cefotaxime showed good activity against all strains with the exception of S. mutans, of which only 30% were sensitive. Ten cases of gram-positive infections were studied clinically: six sepsis cases and one endocarditis case due to S. aureus, two sepsis cases caused by Streptococcus alpha and one Enterococcus endocarditis case. Therapy was successful in nine; the S. aureus endocarditis failed. The local and general tolerance of cefotaxime was good.
Infection 1985
PMID:Clinical experience of cefotaxime in infections caused by gram-positive pathogens. 405 40

Staphylococcus aureus strains were exposed in vitro to continuously decreasing cefotaxime concentrations. The initial concentration was approximately 4 X MIC and decreased at t1/2 = 60 min. A reduction in the colony count was seen even after the concentration had dropped below the MIC level. Sixteen patients with blood cultures positive for S. aureus were treated with cefotaxime. Four patient died of underlying diseases. The condition of one patient with staphylococcal endocarditis under treatment with vancomycin in combination with cefotaxime deteriorated when cefotaxime was discontinued, suggesting possible synergism between these two drugs against staphylococci.
Infection 1985
PMID:Staphylococcus aureus septicaemia treated with cefotaxime. 405 53

Group G streptococci were isolated from various clinical sites in 64 patients hospitalized between 1979 and 1983. Oropharyngeal and wound infections occurred most commonly, although some of these isolates represented colonization. Ten patients had serious infections including five with endocarditis. Patients with endocarditis tended to be older, had underlying conditions predisposing them to infection, and responded poorly to single agent therapy with penicillin G or other beta-lactam agents, despite exquisite in vitro susceptibility. Patients with serious infections but without endocarditis tended to be younger, had fewer underlying disorders and responded rapidly to therapy with beta-lactam antibiotics. All isolates were susceptible to penicillin G, cephalothin, vancomycin and newer beta-lactam agents. Occasional tolerance was observed. Combinations of penicillin G with an aminoglycoside and of vancomycin with an aminoglycoside or rifampin were bactericidal against the tolerant strains. Although none of the organisms isolated from patients with endocarditis were tolerant, this infection should be treated with combination antibiotic therapy.
Infection
PMID:Clinical features and antimicrobial therapy of infections caused by group G streptococci. 406 43

Human infections due to group C streptococci are rare. We describe here a patient with endocarditis caused by this organism. A review of 16 other cases of group C streptococcal endocarditis reported in the literature suggests that this organism has a high potential for attachment to and destruction of normal heart valves. Major emboli to vital organs are frequently observed and the mortality has been high. Synergistic combinations of penicillin and an aminoglycoside appear to result in lower morbidity as compared to penicillin used alone. Early valve replacement may reduce the mortality in this extremely serious infection.
Infection
PMID:Group C streptococcal endocarditis: case report and review of the literature. 407 71

During a period of 21 months an analysis was made of bacteremia caused by Staphylococcus aureus in a teaching hospital for adults. During the observation period staphylococcal bacteremia was detected in 77 patients, i.e. in 1.83 cases per 1,000 admissions. Not less than 81.8% of staphylococcal bacteremia cases were hospital-acquired. The age-specific attack rate increased consistently from the sixth decade onwards. The male/female ratio was 1.96: 1. If this ratio was related to the sex ratio of patients admitted to the hospital during the observation period, statistical significance was reached for the surplus of males. Staphylococcal bacteremia contributed to death in 14 of 47 patients, i.e. 18.2%. Intravascular infection was the most prevalent source of infection (25 of 77 cases, i.e. 32.5%). Serious complications were observed in 14 cases of staphylococcal bacteremia. Eight of these patients had endocarditis and four died. Tolerance was observed with nine of 77 strains and may have influenced the reaction to antimicrobial therapy in at least one case.
Infection
PMID:Staphylococcus aureus bacteremia in a Dutch teaching hospital. 407 69

In a patient with spondylodiscitis secondary to cardiac valve prosthesis infection with endocarditis the fungus Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests.
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PMID:[First human case of Drechslera longirostrata mycosis. Spondylodiscitis complicating prosthesis endocarditis. Treatment with combined ketoconazole and amphotericin B]. 629

Fifty patients with acquired immune deficiency syndrome had complications affecting the central or peripheral nervous systems or both. The patients were either male homosexuals, intravenous drug abusers, or recently arrived Haitian refugees. They ranged in age from 25 to 56. Central nervous system complications were of four kinds: (1) Infections included Toxoplasma gondii abscesses in 5 patients, progressive multifocal leukoencephalopathy in 2, cryptococcal meningitis in 2, Candida albicans in 1, and possible Mycobacterium avium intracellulare in 3. Eighteen patients suffered a subacute encephalitis possibly attributable to cytomegalovirus infection. (2) Tumors consisted of primary lymphoma of the brain in 3 patients and meningeal invasion by systemic lymphoma in 4. (3) Vascular complications included nonbacterial thrombotic endocarditis in 2 patients and cerebral hemorrhages in the setting of thrombocytopenia in 3. (4) Undiagnosed central nervous system problems were evidenced as focal brain lesions in 3 patients and self-limiting aseptic meningitis in 4. Peripheral neuropathy occurred in 8 patients.
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PMID:Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. 631 74

Although Neisseria species other than N gonorrhoeae and N meningitidis normally comprise part of the commensal bacterial flora of the oropharynx, they may occasionally act as opportunistic pathogens. Infections in which these organisms have been implicated include cases of endocarditis, meningitis, septicaemia, otitis, bronchopneumonia and possibly genital tract disease. In this paper, the clinical and pathological features of such infections are described, together with a discussion of factors that may contribute to their development.
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PMID:The pathogenic potential of commensal species of Neisseria. 633 50

One hundred twenty-five cases of disease due to rapidly growing mycobacteria were observed over a four-year period. Cutaneous infections accounted for 74 cases (59%). Of these, 40 followed surgical procedures (especially augmentation mammaplasty or median sternotomy), and 34 were due to accidental penetrating trauma. Among the 24 patients with pulmonary disease, the mean age was approximately 60 years, the majority of patients (63%) were women, and most had unilateral noncavitary disease. Other infections included disseminated disease with multiple nodular skin lesions and positive blood cultures, cervical lymphadenitis, keratitis, and endocarditis associated with a prosthetic valve. Infected tissues showed mixed acute and granulomatous inflammation; acid-fast bacilli, when present, occurred in extracellular clumps within microabscesses. Mycobacterium fortuitum and Mycobacterium chelonei were encountered with approximately equal frequency; 80% of isolates of M. chelonei were subspecies abscessus, and 83% of isolates of M. fortuitum were biovariant fortuitum. The outcome in these infections was generally good, although 9% of the patients, including all those with endocarditis, died. Infections due to M. fortuitum and M. chelonei are probably markedly under-diagnosed, and these organisms are capable of causing a wide spectrum of clinical disease.
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PMID:Spectrum of disease due to rapidly growing mycobacteria. 635 28

Infection of an intracardiac prosthesis, the incidence of which is about 2.5% among patients having undergone valve replacement, is a serious complication with considerable morbidity and mortality. Early prosthetic valve endocarditis (PVE), with an onset within 60 days of valve replacement, accounts for approximately one-third of all cases, while the remaining two-thirds, occur more than two months postoperatively (late prosthetic valve endocarditis). Prosthetic valve endocarditis is most commonly caused by Staphylococcus epidermidis, less frequently by viridans streptococci, Staphylococcus aureus, and gram-negative bacilli. The most likely pathogenetic mechanisms in prosthetic valve endocarditis are intraoperative contamination and postoperative infections at extracardiac sites. Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria. The etiologic microorganism can be isolated in more than 90% of all cases. Patients with proven prosthetic valve endocarditis should be examined daily to detect signs of congestive heart failure and changes in murmurs; electrocardiographic monitoring is essential for documentation of arrhythmias. With limitations, echocardiography, especially two-dimensional, may help to demonstrate vegetations or valvular dehiscence. Cinefluoroscopy may reveal loosening or dehiscence of the sewing ring or impaired motion of a radio-opaque poppet due to thrombus or vegetation. Cardiac catheterization, not always necessary even when surgical intervention is anticipated, may provide valuable information on the degree of dysfunction, multiple valve involvement, left ventricular function and extent of concomitant coronary artery disease. In patients with mechanical valves, prosthetic valve endocarditis may be associated with a high incidence of valve ring and myocardial abscesses; the reported frequency of valve ring abscesses is lower with porcine heterografts. Infections on mechanical valves characteristically localize to the sewing ring with subsequent detachment of the prosthesis and valvular incompetence; infections on porcine heterografts tend to localize to the cusps, leading to valvular incompetence because of leaflet destruction. Large vegetations may result in functional stenosis. Over the last ten years the overall mortality of prosthetic valve endocarditis was 53.8%; 73.6% in early and 43% in late prosthetic valve endocarditis. More recently, however, the survival rate appears to be improving. In general, the mortality associated with prosthetic valve endocarditis caused by fungi and Staphylococcus aureus is highest and that of streptococci lowest.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prosthetic valve endocarditis: an overview. 636 38


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