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

Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, three received medical therapy alone and six required valve replacement as well. Antibiotics have been discontinued in four patients who have had valve surgery and three others. Six patients had received antibiotics for continuous periods varying from 29-62 months. In the period after stopping therapy varying from 15-21 months, no relapse has occured. A seventh patient, who had received antibiotics for four months prior to valve replacement, has survived 43 months after the withdrawal of antibiotics...
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PMID:Chronic Q fever. 94 Sep 18

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

In a five-year prospective study of blood culture-positive septicaemia in a Hong Kong teaching hospital there were 2211 clinically-significant episodes, of which 16% occurred in children less than 15 years old. The microbiology and clinical features were broadly similar to those seen in Europe and North America, but with some important differences. Two-thirds of episodes were community-acquired. The most common organism isolated from community-acquired septicaemias was Escherichia coli and the source, most commonly, the urinary tract. However, the biliary tract was the second most common source of community-acquired infection (25%), reflecting the frequency of liver disease in Hong Kong. Three per cent of community-acquired septicaemias were associated with endocarditis; half of these were with viridans streptococci, usually in patients with rheumatic heart disease, and 40% were in drug addicts with methicillin-sensitive Staphylococcus aureus. The commonest organisms causing community-acquired childhood infections were Salmonella spp. (27%) and Streptococcus pneumoniae (22%), whereas pneumococci accounted for only 3% of adult community-acquired micro-organisms. Haemophilus influenzae infections were uncommon and there was no case of meningococcal or gonococcal septicaemia. The commonest cause of hospital-acquired septicaemia was Staph. aureus (24%), of which 46% were methicillin-resistant. The characteristics of septicaemia in Hong Kong are influenced by the patient population structure, endemic disease patterns, local medical practice and socio-economic factors, but the rarity of Str. pneumoniae in adults and of H. influenzae and Neisseria meningitidis in children is unexplained.
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PMID:Septicaemia in Hong Kong. 234 72

The association of Streptococcus bovis endocarditis and colon carcinoma has been reported previously in small series in the medical, but not surgical, literature. Although the fecal carriage rate of S. bovis increases with colonic pathology, no explanation exists for the development of bacteremia in these cases. To explore the possible contribution of hepatic dysfunction to the development of portal and systemic bacteremia, the incidence of both colonic pathology and liver disease or dysfunction was determined in 92 patients with S. bovis endocarditis and/or bacteremia. Colonic and liver evaluation had been undertaken in 47% and 93% of patients, respectively. Among these patients, colonic pathology was identified in 51%, and liver disease or dysfunction was documented in 56%. Either the underlying colonic disease or alterations in hepatic secretion of bile salts or immunoglobulins may promote the overgrowth of S. bovis and its translocation from the intestinal lumen into the portal venous system. A compromised hepatic reticuloendothelial system may then contribute to the development of S. bovis septicemia and subsequent endocarditis. We conclude that S. bovis bacteremia is an indication to the clinician of the possibility of underlying liver disease as well as colon pathology.
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PMID:The triad of Streptococcus bovis bacteremia, colonic pathology, and liver disease. 235 41

To evaluate the clinical and microbiological features of infective endocarditis in patients with cirrhosis we compared 18 episodes of endocarditis in these patients with a control group of patients without liver disease. In 61% of patients with cirrhosis the origin of infection was unknown. Four patients developed endocarditis as a consequence of bladder catheterizations and two after hepatic biopsy. None of the four with previously known valvular heart disease had received antibiotic prophylaxis during these procedures. As compared with the control group, the patients with cirrhosis had more infections by enterococci (38.8% vs 11%; p less than 0.007) and non-viridans streptococci (38.8% vs 7.4%; p less than 0.001) and significantly less infections by viridans streptococci (11% vs 42.5%; p less than 0.01). The mortality rate associated with endocarditis was 38.8% and 22% in patients with and without cirrhosis, respectively (less than 0.1; NS). Infective endocarditis in patients with cirrhosis is often a complication of diagnostic or therapeutic procedures and has distinctive microbiological features.
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PMID:[Infectious endocarditis in patients with liver cirrhosis]. 262 60

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

Group B streptococcal bacteremia outside the perinatal setting is not commonly emphasized. This report reviews all episodes of group B streptococcal bacteremia during a four and a half year period in a large community teaching hospital. Fourteen episodes occurred in neonates, four in parturient women, and 28 in other adults. Bacteremic adults were usually elderly with an average age of 68 years. Group B streptococcal bacteremia occurred in adults with various underlying diseases, including diabetes mellitus, liver disease, peripheral vascular disease, and hematologic disease, and in those receiving long-term steroid therapy. Infections causing group B streptococcal bacteremia in adults included decubitus ulcers, pneumonia, endocarditis, cellulitis, arthritis, osteomyelitis, and meningitis. Thirteen of 28 episodes of group B streptococcal bacteremia in adults were hospital-acquired. Overall mortality in adults was 70 percent. Group B streptococcal bacteremia in adults outside of the perinatal setting is associated with significant underlying diseases and has a high mortality.
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PMID:Group B streptococcal bacteremia in a community teaching hospital. 388 11

Up to 10% of patients may have bacteremia after rigid sigmoidoscopy. The aim of our study was to determine the frequency of bacteremia accompanying flexible sigmoidoscopy. Blood samples for aerobic and anaerobic cultures were obtained before, during, and after flexible sigmoidoscopy in 100 patients who were examined a mean distance of 49.5 cm, range 15-60 cm, after a bowel preparation of two Fleet enemas. In one patient, a transient bacteremia with Streptococcus intermedius was documented and was attended by no associated clinical manifestations. This organism has been previously isolated from patients with endocarditis, peritonitis, emphysema, and hepatic and appendiceal abscesses. There was no association in our study with bacteremia and such factors as length of bowel examined and duration of procedure, the presence of bowel pathology, performance of endoscopic biopsies, liver disease, and portal hypertension or poor bowel preparation. We conclude that the extremely low incidence of significant bacteremia with flexible sigmoidoscopy may be related to the smaller diameter of the instrument and provides further support for the routine use of flexible rather than rigid sigmoidoscopy.
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PMID:Does bacteremia occur during flexible sigmoidoscopy? 402 78

Endocarditis was recorded in 92 (11%) of 839 confirmed Q-fever infections reported for the Communicable Disease Report by laboratories between 1975 and 1981; Q-fever endocarditis accounted for approximately 3% of all cases of endocarditis reported. Two-thirds of the 92 reports were of men, and in both men and women endocarditis affected mainly young and middle-aged adults. Only one-third of Q-fever endocarditis patients were noted to have an underlying heart-valve lesion. There were also 30 reports of chronic Q-fever infection, and in 10 the primary clinical feature was liver disease. The laboratory data do not support the view that Q-fever endocarditis is a rare compilation of Coxiella burnetii infection, and the condition may be considerably underdiagnosed. Joint veterinary and medical investigations should be undertaken to establish the natural history of Coxiella burnetii infection in the U.K. in order to formulate policies for prevention of acute and chronic infection.
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PMID:Q-fever endocarditis in England and Wales, 1975-81. 612 19

To determine the incidence of transient bacteremia associated with laparoscopy, a prospective study was carried out in 113 patients with diverse liver diseases. Blood samples for aerobic and anaerobic cultures were obtained for each patient immediately before laparoscopy, within three minutes after creation of pneumoperitoneum and within three minutes after needle biopsy of the liver. Five subjects were culture positive, and all isolates were of the propionibacterium species. Positive cultures did not correlate with the nature of underlying liver disease, and none of these patients developed clinical evidence of bacterial infection. Positive isolates might be assumed to be contaminants, but the fact propionibacterium has been known to cause endocarditis cannot be ignored. Until further evidence accumulates, antibiotic coverage in "high risk" patients with cardiac lesions who are predisposed to endocarditis undergoing laparoscopy may be warranted.
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PMID:Evaluation of blood cultures following laparoscopy. 645 17


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