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

This paper describes a case of disseminated gonococcal infection, a rare disease in France. A 41 year-old woman was hospitalised with acute polyarthritis and characteristics skin lesions. Jaundice and liver function abnormalities are difficult to interpret due to a preexisting alcoholic cirrhosis. The possibility of an endocarditis is raised because of a systolic murmur heard at the base of the heart. Bacteriological identification of N. Gonorrhoeae is carried out in blood culture; it has also been recovered by scrapings of a cutaneous bullae by staining only. Therapy was instituted by daily intravenous penicillin G sodium 50 000 000 u. and intramuscular gentamicin 160 mg for 45 days. There resulted good clinical and bacteriological response. The elements of clinical and bacteriological diagnosis, as well as the therapy are discussed.
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PMID:[Gonococcal septicemia. 1 case]. 81 66

Meningitis caused by Streptococcus is uncommon in adults. Otitis media, mastoiditis, sinusitis, or trauma has antedated most cases reported in the past. Data on 10 recent cases suggest changes in the current pathogenesis of streptococcal meningitis in adults and emphasize the importance of accurate streptococcal speciation. Endocarditis was present in five cases; trauma played a role in two others. Brain abscess, corticosteroids, alcoholic cirrhosis, and peritonitis secondary to chronic peritoneal dialysis were etiologic factors in five patients. Otitis media, mastoiditis, and sinusitis were conspicuously absent. Streptococcus agalctiae accounted for purulent meningitis in two postmenopausal women. Both strains of group B Streptococcus were bacitracin-sensitive and were thus mislabeled group A. Recognition of Streptococcus bovis spared two patients unnecessary aminoglycoside adminstration. Nine of the 10 patients survived, including a women with prosthetic mitral valve endocarditis and a man with a ruptured brain abscess. Differentiation of these streptococci from Streptococcus pneumoniae was seldon possible on the basis of the spinal fluid gram stain alone.
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PMID:Meningitis caused by Streptococcus in adults. 109 75

Between 1987 and 1990, seven patients hospitalized in our hospital had bacteremia caused by Streptococcus bovis. Complete gastrointestinal evaluation was routinely carried out for digestive portal of entry and liver disease screening. In four cases (2 bacteremia, 2 endocarditis), a colonic growth was detected: sigmoid adenoma (n = 1) and rectosigmoid carcinoma (n = 4); in one case (endocarditis), several rectosigmoid carcinomas were associated with alcoholic cirrhosis; in one case (bacteremia), alcoholic cirrhosis was diagnosed; in one case (endocarditis), no gastrointestinal or hepatic portal of entry was found. These cases emphasize the need for simultaneous detection of endocarditis and gastrointestinal portal of entry such as colonic tumor and/or cirrhosis, in case of Streptococcus bovis bacteremia.
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PMID:[Prospective study of routine screening for cirrhosis and colonic tumors associated with Streptococcus bovis bacteremia]. 206 Jul 42

Bacterial infection is a serious and often fatal complication of patients with liver disease and can prove fatal either directly or by precipitation of gastrointestinal bleeding, renal failure, or hepatic encephalopathy. At greatest risk are patients with alcoholic cirrhosis or decompensated chronic liver disease, or cases of acute liver disease who progress to fulminant hepatic failure or subacute hepatic necrosis. Infection appears to be unusual in patients with primary biliary cirrhosis. The site and type of infection is unrelated to the aetiology of the liver disease. Bacteraemia, pneumonia, urinary tract infection and spontaneous bacterial peritonitis are most common but infective endocarditis and meningitis, especially with pneumococci, are easily overlooked. Clinical suspicion of infection must be high as the only indication may be a general deterioration in the patients' clinical state, increasing encephalopathy or renal impairment. In the case of patients with fulminant hepatic failure, infection may precipitate the initial or recurrent encephalopathy and contributes to death in 10% of fatal cases. Spontaneous bacterial peritonitis is now recognized to occur in the absence of clinical features of peritonitis. The PMN content of the ascitic fluid may provide the only indication of infection and is the most readily available screening test. The most common types of organism responsible for all types of infection are Gram-negative enteric and streptococci, especially pneumococci, while infection with anaerobes is rare. Risk factors for infection include decompensated alcoholic liver disease, fulminant hepatic failure, gastrointestinal bleeding, invasive practical procedures and impaired host defence mechanisms against infection. Of the host defence mechanisms, impaired function of the reticuloendothelial system, complement, and PMNs represent the most common and serious defects. Defects of humoral immunity are present in ascitic fluid from patients with cirrhosis and are probably a major reason for development of spontaneous bacterial peritonitis. Diuresis improves these functions and reduces the risk of peritonitis. Treatment of infections even with the appropriate antibiotic is still associated with a high mortality but the use of adjuvant gut sterilization is promising, particularly in cases infected with Gram-negative enteric organisms. Infusions of fresh frozen plasma, blood and cryoprecipitate improve some systemic host defences and may be beneficial in the treatment and reduction of risk of infection.
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PMID:Bacterial infections complicating liver disease. 265 49

The case is reported of a 66-year old man who developed Streptococcus bovis endocarditis on a fairly loose aortic stenosis and who also presented with alcoholic cirrhosis complicated by an ultimately lethal hepatoma. On this occasion, comments are made on the following points: -Str. bovis is increasingly responsible for bacterial endocarditis. This micro-organism is now rapidly and reliably identified. -Str. bovis endocarditis has some clinical features of its own. -Patients in whom the usual portals of entry of bacterial infection (i.e. benign or malignant tumours of the colon or rectum) cannot be identified should be investigated systematically for hepatic cirrhosis. -Drug sterilization of the gut is useful to prevent bacteremia of intestinal origin in cirrhotic patients.
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PMID:[Infectious endocarditis caused by Streptococcus bovis and alcoholic cirrhosis complicated by hepatoma]. 282 37

Twelve patients presented to the hospitals of the Auckland Hospital Board with bacteraemia caused by Streptococcus bovis in the years 1979-84. Ten had endocarditis, affecting homograft valves in two cases and the tricuspid valve in one case. Of nine patients who underwent investigation of the large bowel, only one did not have a colorectal tumour. Three had colonic adenocarcinoma and three had colorectal villous adenoma. Two, including a patient with acute hepatic failure from alcoholic cirrhosis, had colonic adenomata. Colonoscopy provided a tissue diagnosis of colorectal neoplasia despite negative radiological studies in three patients. Bacteraemia due to S. bovis should prompt rigorous investigation to exclude both endocarditis and tumours of the large bowel.
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PMID:Streptococcus bovis bacteraemia requires rigorous exclusion of colonic neoplasia and endocarditis. 404 86

We describe two patients with alcoholic cirrhosis in whom staphylococcal right-sided endocarditis developed after insertion of a peritoneovenous shunt (PVS). Massive pulmonary embolism caused early death in one patient. In the other patient, staphylococcal septicemia was cured after shunt removal and antibiotic treatment; recurrent endocarditis due to Corynebacterium xerosis ultimately caused the patient's death. No clinical manifestation of tricuspid valve dysfunction was noted in either patient, and right-sided endocarditis was recognized only at autopsy. The protracted contact of the tip of the venous line of PVS with the atrial wall is likely to be a major factor in the development of right-sided endocarditis in these patients.
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PMID:Right-sided endocarditis complicating peritoneovenous shunting for ascites. 661 6

Although in the last few years several cases of bacterial endocarditis have been reported in patients with obstructive hypertrophic cardiomyopathy, such as association is still infrequent and only in rare instances has pathologic examination of the cardiac lesions been possible. In this work a brief comment is made on the different forms of clinical presentation of the disease. The type of endocarditis, the relative incidence of responsible germs, and the prognosis are similar to those of other endocarditis. The clinical and autopsy findings of a female patient with alcoholic liver cirrhosis and symptomatic obstructive hypertrophic cardiomyopathy who developed a bacterial endocarditis of the mitral valve due to Staphylococcus aureus are reported. The patient died of an infected ascites. Some recent reports point to a higher incidence of bacterial endocarditis in cirrhotic patients, and this fact is felt to be an argument in favour of the hematogenous origin of spontaneous bacterial peritonitis.
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PMID:[Bacterial endocarditis and its relationships with obstructive hypertrophic cardiomyopathy and hepatic cirrhosis (author's transl)]. 719 67

Splenic arterial aneurysms (SAA) are rare and are usually atherosclerotic and/or related to pregnancy. Because pregnancy is the most important predisposing factor, the strong predilection of SAA for women is not surprising. The authors report a case of SAA rupture in a man with chronic pancreatitis as the predisposing factor. A 56-year-old man with abdominal pain and hematemesis was resuscitated and underwent endoscopy, but he died 18 hours later of massive hematemesis before definitive surgery could be carried out. At autopsy, there was chronic pancreatitis with fibrous adhesions tethering the tail of the pancreas, spleen, and posterior wall of the stomach together. The SAA was indented into the posterior wall of the stomach, into which it had ruptured from without. He also had alcoholic cirrhosis but no esophageal varices or conventional gastric ulcers. Other important predisposing factors such as abdominal trauma, infective endocarditis, polyarteritis nodosa, and segmental medial arteriopathy were absent. Histologic examination confirmed the rupture of the SAA. The SAA had Monckeberg medial calcinosis but little evidence of atherosclerosis. The well-documented complications of acute and chronic pancreatitis include shock, abscess, pseudocyst formation, and duodenal obstruction. This report describes the rare complication of SAA rupture, which may be fatal.
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PMID:Fatal splenic arterial aneurysmal rupture associated with chronic pancreatitis. 1219 58

Patients with infective endocarditis usually developed persistent fever and heart failure, especially when the valve structures are invaded and destroyed. Persistent bacteremia often leads to severe sepsis or overwhelming septic shock. Septic emboli from the vegetation will possibly result in systemic thromboembolism with multiple organ infarction. Patients with infective endocarditis have been reported to present with either ruptured sinus of Valsalva or complete atrioventricular block. However, both of these serious complications occurring in a single patient is rare. In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis. Simultaneously, ruptured sinus of Valsalva and complete atrioventricular block further complicated the preexisting septic shock and multiple organ failure.
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PMID:Ruptured sinus of valsalva and complete atrioventricular block complicating fulminant course of infective endocarditis: a case report and literature review. 1691 22


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