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

We report a case of Coxiella burnetii endocarditis in a 42-year old man presenting with a long-known cardiac murmur and an infectious syndrome of several months duration. The aetiological diagnosis, delayed by the lack of knowledge of a primary Q fever, was established by serology. The infection responded to tetracycline combined with cotrimoxazole, but a valve replacement performed for haemodynamic reasons was followed by serious complications. We remind the readers that Q fever endocarditis must be considered as a possible diagnosis in all cases of endocarditis with negative blood cultures and that specific serological examinations in search of anti-phase I antibodies of the IgA type should be performed as soon as possible, using the indirect immunofluorescence technique. Attention is drawn to the different serological responses of the three clinical types of Q fever infection and to the cellular immunity associated with that disease.
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PMID:[Q fever infectious endocarditis. Apropos of a new case]. 250 89

Q fever is an zoonosis caused by Coxiella burnetti, the clinical features of which are often nonspecific and self-limited. Involvement of the central nervous system is rare and is usually seen as a complication of endocarditis caused by this rickettsial organism in the chronic disease. Specific neurological manifestations in the course of the acute illness aseptic meningitis, encephalitis, toxic confusional states, extrapyramidal signs, dementia and behavioral disturbances. We describe a patient who developed reversible bilateral abducens nerve paralysis and bilateral optic neuritis in the course of acute Q fever meningoencephalitis.
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PMID:Q fever meningoencephalitis associated with bilateral abducens nerve paralysis, bilateral optic neuritis and abnormal cerebrospinal fluid findings. 261 30

Endocarditis is a rather frequent complication of Q fever caused by Coxiella burnetii. We examined the ability of phase I (virulent) or phase II (avirulent) C. burnetii to coagulate blood in the presence of human blood mononuclear cells in vitro. After incubation for 4 h, virulent phase I C. burnetii was an effective stimulant for mononuclear cells. Since this interaction is a potent trigger of blood coagulation through the extrinsic pathway, it could be responsible for the local deposition of fibrin on the surface of infected valves and the development of large vegetations in cases of endocarditis complicating Q fever.
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PMID:The ability of mononuclear cells to coagulate blood in response to Coxiella burnetii. 272 27

The authors compared two groups of 20 patients suffering from Q fever using microimmunofluorescence (micro IF) serology. One group had endocarditis and the other conventional symptoms of acute Q fever but no endocarditis. Determination of the levels of antibodies against the two phases of rickettsiae in each of the three immunoglobulin classes (IgG, IgM and IgA), allowed to determine the type of infection using a single serum sample. Patients having IgA class antiphase I antibodies at a level equal to/or higher than 1:25 as well as those whose antibody levels fulfilled the conditions for the equation (IgG anti-phase I greater than or equal to IgG anti-phase II) + (IgA anti-phase I greater than or equal to IgA anti-phase II) were suffering from endocarditis. The positive predictive value of these tests was 100% and 94.1%, respectively.
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PMID:Diagnosis of endocarditis in acute Q-fever by immunofluorescence serology. 289 75

An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis. We report 3 cases of Q fever endocarditis. In 2 of these patients endocarditis developed on cardiac valve prosthesis. The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory. A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis. It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures.
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PMID:[Q fever infectious endocarditis. 3 cases]. 295 20

Chromosomal and plasmid DNA have been extracted from six isolates of Coxiella burnetii, the aetiological agent of Q fever. Restriction fragment length polymorphisms detected after HaeIII digestions of chromosomal DNA revealed four different patterns that distinguished the American from the European isolates, and the Nine Mile phase I prototype strain from a spontaneously derived, isogenic phase II nonrevertant variant. At least one of the HaeIII fragments visible in the pattern from Nine Mile phase I and not in that from Nine Mile phase II could not be detected by DNA-DNA hybridization, and thus may have been deleted during the phase transition. Comparison of Nine Mile phase II, which does not survive animal passage, with Grita M44 phase II, which does, indicated that the HaeIII fragment was present in the Grita strain. These results suggest that this HaeIII fragment may be concerned with functions necessary to survive the cellular immune response in vivo. Isolates from two human endocarditis cases showed the greatest divergence from all the other isolates, having at least five fragments of unique mobility in the HaeIII digestion pattern of their chromosomal DNA. Also, a plasmid obtained from these two isolates was 2 to 3 kb larger than the plasmid present in the other five isolates, and its restriction pattern could be distinguished from that of the other plasmids by several endonucleases. Detection of chromosomal and plasmid restriction fragment length polymorphisms among strains of phase I or phase II C. burnetii from various geographical locations and environmental sources will facilitate Q fever diagnosis and strain identification.
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PMID:Genetic heterogeneity among isolates of Coxiella burnetii. 301 63

From 1982 through 1987 we diagnosed 13 chronic Q fever cases. Clinically these patients presented a culture-negative endocarditis, and all but two had high complement-fixing antibody titers to Coxiella burnetii phase I (reciprocal titer above 200). With the enzyme-linked immunosorbent assay (ELISA), titers of immunoglobulin G (IgG) to phases I and II of C. burnetii averaged 158,000 and 69,900, respectively, whereas they reached 300 and 3,200 in acute Q fever cases. Similarly, IgA to both phases of C. burnetii and IgM to phase I were consistently higher during chronic than acute Q fever. The serological follow-up of one patient with chronic Q fever over a 4-year period showed a good correlation between the titers of IgG and IgM antibody titers detected by ELISA and indirect fluorescent-antibody test (IFA) to both phases of C. burnetii. Few discrepancies appeared with IgA. Shortly after initiation of antibiotic treatment, a slow and steady decrease of the antibody titers to C. burnetii phases I and II was observed. The complement fixation, IFA, and ELISA tests showed the same type of antibody response. The ELISA proved to be an excellent diagnostic test for chronic Q fever. It distinguished negative from positive reactions clearly, and results were highly reproducible. The reading is objective, and the test is simple to perform and more sensitive than the IFA and complement fixation tests. The ELISA is recommended for serologic evaluation of patients with chronic Q fever.
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PMID:Enzyme-linked immunosorbent assay for diagnosis of chronic Q fever. 305 57

A patient with culture-negative infective endocarditis is presented in whom detailed serological studies were indicative of acute infection with murine typhus. The patient had aortic and mitral regurgitation with congestive heart failure and typical peripheral manifestations of subacute endocarditis, but no documented fever. Aortic and mitral valve replacement surgery and a 6-week course of doxycycline therapy produced a clinical cure in this patient, as well as a diagnostic fall in markedly elevated preoperative typhus indirect fluorescent antibody (IFA) and complement fixation (CF) titers. Serological studies were consistently negative for Q fever.
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PMID:Serologic evidence of acute murine typhus infection in a patient with culture-negative endocarditis. 310 41

About 2% of patients with a prosthetic valve will develop endocarditis. This may occur within a few weeks of the valve replacement operation (early) or many months or years later (late). The infecting organisms, pathogenicity and prognosis differ in the two groups. The incidence of early prosthetic valve endocarditis (PVE) is under 1%; the predominant organisms are staphylococci that are acquired in the operating theatre or in the intensive therapy unit. Early PVE usually follows wound sepsis that may initially appear trivial. The mortality rate is around 70%, but such infections should be preventable by stringent antisepsis, good surgical technique and (perhaps) perioperative antistaphylococcal antibiotics. The incidence of late PVE is about 1% per annum. The infecting organisms are similar to those causing native valve endocarditis, predominantly streptococci. The commonest source of these organisms is the mouth and regular dental care and appropriate prophylactic antibiotics should help to prevent infection. The mortality rate of late PVE is around 10%. Failure of medical treatment in PVE is an indication for surgery to remove the infected valve(s) and this should not be delayed. The optimum length of treatment for PVE is unknown but it is seldom necessary to give antibiotics for more than 6 weeks except in Coxiella burnetii infection.
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PMID:Prosthetic valve endocarditis. 331 60

A vast literary review on Q-rickettsial endocarditis is presented--spread, frequency, predilection, clinical course, laboratory findings, diagnosis, treatment, prognosis. The first case of Q-rickettsial endocarditis in Bulgaria is reported. The case was proved by the high titre of the specific antibodies while the patient was still alive and post mortem by visualizing the causative agent in the aortic valve and by its isolation through inoculation of material from the aortic valve. The infection was not influenced by high doses of penicillin, gentamycin and brulamycin but was suppressed by vibramycin in combination with lincomycin and biseptol. The lethal outcome was due to severe heart failure. It is suggested that other cases of Q-rickettsial endocarditis should be expected since Q-fever is widely spread in Bulgaria and the characteristics of the disease, its diagnosis and treatment ought to be well known.
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PMID:[Current status of the Q-rickettsial endocarditis problem and the 1st case reported in Bulgaria]. 332 86


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