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

Human infections due to fungi belonging to the genus Acremonium occur uncommonly, but unlike infections due to other filamentous fungi, usually affect immunocompetent individuals. Mycetoma, which usually develops following trauma, is the most common infection caused by Acremonium spp. Other sites of infection include the eye (generally following abrogation of ocular defenses), colonizing disease of the lung and gastrointestinal tract, as well as locally invasive infections such as osteomyelitis, sinusitis, arthritis, and peritonitis. Pneumonia and disseminated infections including meningitis, endocarditis, and cerebritis rarely have been reported. Optimal treatment of acremonium infections is not well defined both because infections due to these organisms are rare, and because many reports antedate effective antifungal therapy. In addition, susceptibility testing of filamentous fungi is poorly standardized, and in vitro sensitivity may not correlate with clinical response. Based on anecdotal reports, treatment of most invasive acremonium infections requires a combination of surgical intervention, when possible, and a regimen of amphotericin B. Some azoles also display inhibitory activity. Until more details are available regarding susceptibility of these organisms to antifungal agents, amphotericin B is recommended as initial therapy with the addition of either ketoconazole or fluconazole in infections of a life-threatening nature.
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PMID:Infection due to the fungus Acremonium (cephalosporium). 195 81

Eosinophils (EOs) participate in a variety of inflammatory states characterized by endothelial cell damage, such as vasculitis, pneumonitis, and endocarditis. We find that 100 U/ml TNF-alpha/cachectin (TNF), a concentration attainable in the blood of humans with parasitic infestations, stimulates highly purified populations of EOs to damage human umbilical vein endothelial cells (HUVEC), a model of human endothelium. This TNF-dependent EO cytotoxicity is strongly inhibited by heparin and methyprednisolone but unaffected by the platelet-activating factor antagonist BN52012 or scavengers of superoxide anion and H2O2, superoxide dismutase and catalase. However, addition of a physiologically relevant concentration of Br- (100 microM) enhances EO/TNF damage to HUVEC, implicating the possible participation of EO peroxidase (EPO) in the killing mechanism. EOs adherent to FCS-coated plastic wells more than double their production of superoxide anion and the cytotoxic EPO-derived oxidant HOBr when exposed to TNF, showing that TNF activates the respiratory burst of EOs attached to a "physiologic" surface. Unlike PMNs, EOs were not irreversibly activated to kill unopsonized endothelium by previous exposure to TNF, and did not degranulate or upregulate CR3 expression as detected by Mo1 in the presence of 100 U/ml TNF. HUVEC exposed 18 h to TNF were considerably more susceptible to lysis by PMA-activated EOs and reagent H2O2, demonstrating a direct effect of TNF upon endothelium, perhaps through inhibition of antioxidant defenses. These findings suggest that abnormally elevated serum levels of TNF may provoke EOs to damage endothelial cells and thereby play a role in the pathogenesis of tissue damage in hypereosinophilic states.
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PMID:Tumor necrosis factor alpha/cachectin stimulates eosinophil oxidant production and toxicity towards human endothelium. 197 79

A study of 37,156 blood cultures over a 3-year period yielded 1,972 positive blood culture episodes, of which 63% were of clinical significance, 26% represented contamination, 7% represented transient bacteremia, and 3% were of indeterminate significance. Mortality curves were calculated for clinically significant bacteremia according to etiologic organism and source. Several curves with different shapes were demonstrated. Quantitative differences were noted between cases of bacteremia arising from different sources and caused by different organisms. No mortality was associated with bacteremia of bone and joint origin. Mortality from bacteremic pneumococcal pneumonia, bacteremia with Escherichia coli of urinary tract origin, endocarditis, and beta-hemolytic streptococcal bacteremia showed an early plateau effect, with a drop before day 20. Cases of bacteremia from intravascular sources other than endocarditis were associated with no initial mortality, but mortality rose progressively after day 5. Bacteremia related to most organisms and sources was associated with mortality that continued until at least day 20.
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PMID:A three-year study of positive blood cultures, with emphasis on prognosis. 201 29

The clinical features of 101 Melanesian patients with Staphylococcus aureus bacteraemia observed during two 2-year periods (1977-1979 and 1985-1987) in a university teaching hospital in Papua New Guinea are reviewed. The age of the patients ranged from 12 to 70 years. There were 69 males and 32 females. Diabetes mellitus, found in 15 patients, was the most common predisposing factor. Most of the patients (87%) had community-acquired infection. Soft-tissue infection, pneumonia, arthritis, osteomyelitis, intravenous-site thrombophlebitis, cerebral abscess, endocarditis and cavernous sinus thrombosis were among the clinical entities observed. Soft tissues and lungs were the most common sites of primary and secondary foci of infection, respectively. All but 1 of the 101 blood isolates were resistant to penicillin G and none was resistant to methicillin. The overall case fatality rate was 24%. These data demonstrate that staphylococcal bacteraemia in adult Papua New Guineans is mostly community acquired and has a high mortality. Skin and soft tissues are the major primary foci of infection leading to staphylococcal bacteraemia.
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PMID:The clinical spectrum of staphylococcal bacteraemia: a review of 101 Melanesian patients from Papua New Guinea. 208 Jun 75

Histopathologic studies and isolation of virus and bacteria in culture were carried out for 71 children less than 5 years of age with fatal pneumonia. A potential microbial etiology was identified for 61 children (86%): bacteria for 19 (27%), virus for 16 (23%), and virus plus bacteria for 26 (37%). Staphylococcus was the most prevalent pathogen, alone or in combination with other organisms, followed by Pseudomonas aeruginosa. Viral infection may predispose to bacterial infection in some children. A correlation of clinical course, results of cultures, and morphologic changes revealed cofactors that may have contributed to a fatal outcome. Lung abscess, pericarditis, myocarditis, endocarditis, and meningitis were associated with bacterial infection. Many patients in this study had severe bronchopneumonia, with a high prevalence of complications such as abscess (62%), atelectasis (40%), pericarditis (28%), and empyema (7%). Such complications added to multiple infections, measles, and malnutrition contributed to the fatal outcome in these children.
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PMID:Etiology of infection and morphologic changes in the lungs of Filipino children who die of pneumonia. 212 58

Streptococcus pneumoniae was isolated from 43 children and 143 adults in a ten year period from 1977 through 1986. There was a high incidence in the males, in the extremes of ages and in the Indian and Others racial groups. The overall mortality rate was 29.5% with a higher rate associated in those with chronic obstructive lung disease, smoking, malignancy and alcoholism, 0.5% of the isolates were resistant to penicillin (of intermediate resistance only) and 16% resistant to tetracycline. Common serotypes isolated were types 1, 4, 14, 3 and 6B, all of which are covered by the pneumococcal vaccine. In children, the common serotypes associated with primary bacteraemia were types 14 and 20; with pneumonia, types 6B, 14, 19A and with meningitis, types 6B, 19F and 19A. In adults, the common serotypes associated with primary bacteraemia were types 20, 11A and 1; with pneumonia, types 3, 4, 7F, 14; with meningitis, types 1, 13, 34 and with endocarditis, type 13. Characteristics of pneumococcal infection, the organism's antibiogram and the serotype distribution are discussed in relation to the work of other investigators.
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PMID:Epidemiology of pneumococcal infection in Singapore (1977-1986). 213 Jul 39

A case of Erysipelothrix rhusiopathiae endocarditis involving the aortic and mitral valves in a 70-year-old male farmer is reported. The onset of infection was insidious, with a five-month history of low grade fever, malaise and a 20 kg weight loss. The patient eventually developed severe heart failure requiring surgery and died postoperatively of Pseudomonas aeruginosa pneumonia. In vitro studies showed the isolate to be highly susceptible to penicillin, ciprofloxacin and ofloxacin, and resistant to vancomycin.
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PMID:Erysipelothrix rhusiopathiae endocarditis. 213 14

The enterococcus has been relegated to a position of unimportance in the pathogenesis of surgical infections. However the increasing prevalence and virulence of these bacteria prompt reconsideration of this view, particularly because the surgical patient has become increasingly vulnerable to infectious morbidity due to debility, immunosuppression, and therapy with increasingly potent antibiotics. The enterococcus is a versatile opportunistic nosocomial pathogen, causing such diverse infections as wound, intra-abdominal, and urinary tract infections; catheter-associated infection; suppurative thrombophlebitis; endocarditis; and pneumonia. Although surgical drainage remains the cornerstone of therapy for enterococcal infections involving a discrete focus, in the circumstances typified by the compromised surgical patient, specific antibacterial therapy directed against the enterococcus is warranted. Recent evidence indicates that parenteral antibiotic therapy for enterococcal bacteremia is mandatory and that appropriate therapy clearly reduces the number of deaths.
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PMID:Pathogenicity of the enterococcus in surgical infections. 219

Actinobacillus actinomycetemcomitans (AA), is a cocobacillus thin and small, non motile, uncapsulate and capnophilic. AA, is: one of the species encountered in the mouth's comensal flora being able to be isolated in gingival crevices culture and oral mucosa in a 20% of the healthy population. An important number of pathogenic factors make it well equipped, to protect itself from host's defense mechanisms, and to destroy the periodontal tissue. Between the most important we find lipopolisacarides and leucotoxines which promote tisular invasion and destructive qualities of this microorganism. Since 1912, there are numerous reports of infectious process associated to it, between which we find: endocarditis in native and prothesic valve, soft tissues abscess, pneumonia, brain's abscess, urethritis, vertebral osteomielitis, thyroid's abscess, pericarditis and periodontal juvenile illness, being this one in which its isolation is more frequent. In vitro, AA is very susceptible to tetracicline. This antibiotic reaches high concentrations in gingival crevices, has significant affinity to the alveolar bone and contributes to protect the collagen. These special feature make them the election drug in periodontal disease produced by this microorganism.
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PMID:[Role of Actinobacillus actinomycetemcomitans in human infection]. 221 24

Thrombosis in hemophilia is very rare and is usually associated with the administration of prothrombin complex concentrates. We describe a severe hemophiliac with P. carinii pneumonia who had clinical and laboratory evidence of acute myocardial infarction and disseminated intravascular coagulation, and at autopsy, nonbacterial thrombotic endocarditis as well. We suggest that prothrombin complex concentrates should be used cautiously in the setting of acute infection, and perhaps be given with appropriate doses of anticoagulants such as heparin.
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PMID:Acute myocardial infarction, non-bacterial thrombotic endocarditis, and disseminated intravascular coagulation in a severe hemophiliac. 222 Jul 67


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