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

Hemostatic physiology involves a complex interlinking of blood and endothelial factors. Its pharmacological manipulation invariably impacts at multiple molecular sites. Herein is reported an unusual case of coexistent warfarin-induced skin necrosis and heparin-induced thrombocytopenia following mitral valve replacement for thromboembolic phenomena associated with marantic endocarditis and bronchial adenocarcinoma. Thrombophilia in the face of endocarditis should be treated with a suspicion of underlying cancer.
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PMID:Warfarin-induced skin necrosis and heparin-induced thrombocytopenia following mitral valve replacement for marantic endocarditis. 1704 80

The pathogenesis of very severe thrombocytopenia in bacterial endocarditis is uncertain. We report a 50-year-old male with platelet counts < 10 x 10(9)/l and fragmentation hemolysis complicating Staphylococcus epidermidis pacemaker endocarditis with a giant vegetation. Antibiotics, corticosteroids, high-dose intravenous gammaglobulin, and plasmapheresis (for initially-suspected thrombotic thrombocytopenic purpura) failed to produce significant platelet count increase. However, therapeutic-dose heparin anticoagulation was associated with a platelet count increase from <10 to approximately 40 x 10(9)/l, with parallel reduction in thrombin-antithrombin complexes (from 8.9 to 3.5 microg/l), facilitating surgical intervention. The thrombocytopenia promptly resolved following surgical removal of the vegetation. Culture supernatant from S. epidermidis isolated from the patient's blood induced monocytes to express procoagulant activity (assessed by factor Xa generation) equivalent to lipopolysaccharide (1 microg/ml), with half-maximal activation seen with culture supernatant diluted to 1:12,800. These data are consistent with previous animal models of endocarditis demonstrating staphylococci-induced procoagulant changes in monocytes. This case demonstrates that heparin anticoagulation can be therapeutic in infective endocarditis-associated severe thrombocytopenia in a non-bleeding patient, and that such therapy may ameliorate the platelet count enough to permit surgical intervention.
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PMID:Very severe thrombocytopenia and fragmentation hemolysis mimicking thrombotic thrombocytopenic purpura associated with a giant intracardiac vegetation infected with Staphylococcus epidermidis: role of monocyte procoagulant activity induced by bacterial supernatant. 1716 Sep 89

The diagnosis and treatment of type II heparin-induced thrombocytopenia (HIT) after valvular surgery raise difficult issues due to the substitution of heparin by other anticoagulants. A 50-year-old man with hepatic cirrhosis and acute infective endocarditis underwent aortic valve replacement. On the 4th postoperative day platelet count decreased to 50 g/l. Platelet aggregation was demonstrated in vitro with unfractioned and low molecular weigh heparins and danaparoid sodium. As serum creatinine was 94 micromol/l, lepirudine (r-hirudin) was administered at recommended doses. However, six hours later hirudinaemia estimated by ecarin-clotting time was 3 mg/l and lepirudine dose had to be divided by 15 in order to reach therapeutic levels. Similarly, INR increased up to 6,7 on the 11th postoperative day after acenocoumarol 1 mg daily was administered. Despite the presence of oesophageal, gastric and duodenal lesions at risk of haemorrhage no bleeding was detected. The reasons for overdosage are discussed. The necessity of measurement or calculation of creatinine clearance before lepirudine prescription and frequent hirudinaemia during treatment is emphasized.
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PMID:[Treatment by lepirudin and acenocoumarol of heparin induced thrombocytopenia after valvular surgery: a word of caution]. 1717 12

Ischaemic stroke in thromboembolic mechanism may be a first sign of neoplastic disease, as in the presented case of a 56-year-old woman. Progressive trombocytopenia, anaemia with reticulocytosis and schistocytes in peripheral blood smear, elevated serum LDH activity as well as coexisting myocardial infarction initially suggested Moschcowitz syndrome. However, plasma exchange did not improve her neurological status and D-dimer values increase in subsequent evaluations indicated chronic DIC. At the same time, on transesophageal echocardiography, thrombotic endocarditis was diagnosed. Screening for cancer showed high CA 125 marker and chest computed tomography revealed lung tumor, not visible on earlier chest X-ray. In further treatment she underwent palliative radiotherapy and continued low molecular weight heparin. The neoplastic process had an unfavorable course and she died after four months. The authors point out that in case of multifocal ischaemic stroke and coexistent thrombocytopenia, neoplastic hypercoagulable state and thrombotic endocarditis should be considered.
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PMID:[Multifocal ischaemic stroke and myocardial infarction in a woman with occult lung cancer complicated with chronic DIC and thrombotic endocarditis]. 1719 80

We report on a 66-year-old patient originating from Greece and living in Germany with a prosthetic mitral valve because of a combined vitium following juvenile rheumatic fever. The patient fell ill with acute fever, splenomegaly, and pancytopenia. After unsuccessful antibiotic therapy because of presumed endocarditis or sepsis with unknown focus, visceral leishmaniasis was suspected because of recent travel to Greece. Subsequently, this diagnosis was confirmed by serology. Considering thrombocytopenia and concurrent anticoagulation after prosthetic mitral valve replacement, we avoided a bone marrow biopsy usually required for definite proof of leishmania infection. Instead, infection with Leishmania infantum was diagnosed by PCR of a peripheral blood sample. After treatment with liposomal amphotericin B the patient recovered fully.
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PMID:[Acute febrile disease with splenomegaly and pancytopenia. A 66-year-old Greek patient with a prosthetic mitral valve]. 1754 31

Venous thromboembolism (VTE) is a common occurrence in patients with cancer, and can sometimes precede the development of the clinical manifestations of cancer. The pathogenetic mechanisms of thrombosis involve a complex interaction between tumour cells and the host haemostatic system, in addition to cancer-related clinical risk factors. The risk of VTE increases in presence of distant metastases. The development of VTE in patients with cancer is a strong predictor of decreased survival. The most common medical situations that make cancer patients at a higher risk of VTE include immobilization and chemotherapy with or without adjuvant hormone therapy. Recent findings suggest that heparin-induced thrombocytopenia (HIT) and HIT-related thrombotic complications may occur in cancer patients with a higher frequency than in patients free from malignancy. Thromboembolism is a well-recognised complication of malignant disease. Clinical manifestations vary from venous thromboembolism (VTE) to disseminated intravascular coagulation, more commonly observed in patients with haematological malignancies and those with widespread metastatic cancer, to arterial embolism, more commonly observed in patients undergoing chemotherapy and in those with non-bacterial thrombotic endocarditis.
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PMID:Cancer, thrombosis and heparin-induced thrombocytopenia. 1802 9

Bartonella species are important emerging zoonotic pathogens. Transmission of these organisms in nature may be much more complex than is currently appreciated. Cats can be infected with five Bartonella species, including, Bartonella henselae, Bartonella clarridgeae, Bartonella bovis, Bartonella koehlerae and Bartonella quintana. In addition to cats, numerous domestic and wild animals, including bovine, canine, human, and rodent species can serve as chronically infected reservoir hosts for various intra-erythrocytic Bartonella species. In addition, an increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflys and potentially ticks have been implicated in the transmission of various Bartonella species to animals or human beings. In the reservoir host, Bartonella species cause chronic intra-erythrocytic and vascular endothelial infections, with a relapsing bacteremia documented in experimentally infected cats. Although the immunopathology induced by Bartonella infection requires additional study, the organisms can localize to the heart valve (endocarditis), cause granulomatous inflammation in lymph nodes, liver or spleen, induce central nervous system dysfunction with or without cerebrospinal fluid changes, and may contribute to inflammatory polyarthritis. Hematological abnormalities are infrequent, but thrombocytopenia, lymphocytosis, neutropenia, and eosinophilia have been reported in B. henselae-infected cats. Serology, PCR and culture can be used to support a diagnosis of feline bartonellosis, however, due to the high rate of sub-clinical infections among various cat populations, documenting causation in an individual cat is difficult, if not impossible. Response to treatment can be used in conjunction with serology or organism isolation to support a clinical diagnosis of feline bartonellosis. As fleas are involved in the transmission among cats, the use of acaracide products to eliminate fleas from the environment is of critical importance to decrease the risk of B. henselae transmission among cats and to humans.
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PMID:Feline bartonellosis and cat scratch disease. 1829 47

Heparin-induced thrombocytopenia (HIT) might be life-threatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302,000 mm3 to 11,000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin (intravenous bolus 0.4 mg/kg, in CPB prajming solution 0.4 mg/kg and continuous infusion during CPB 0.15 mg/kg/h) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21st postoperative day without any complication.
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PMID:[Cardiac surgery in patients with heparin-induced thrombocytopenia (HIT II)]. 1950 89

A 74 year old male patient with weight loss, diarrohea, loss of appetite, anemia, thrombocytopenia and culture negative endocarditis was diagnosed to have Whipple's disease. We are reporting this case, as it is a rare disease with fewer than 1000 validated cases reported in literature.
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PMID:Whipple's disease. 2084 23

Antiphospholipid syndrome (APS) is an autoimmune condition with a myriad of clinical manifestations ranging from cardiovascular, neurologic, renal involvement to cutaneous manifestations and thrombocytopenia. We describe a young woman who presented with fever, cough and dyspnea. She had a history of recurrent pregnancy losses and her antiphospholipid antibodies and lupus serologies were positive. Echocardiography showed mobile mitral and aortic valve vegetations. She was treated as for infective endocarditis and diagnosed with primary APS with lupus-like disease. Vigilance is required to establish if there is an underlying rheumatological condition in a patient who presents with presumptive infective endocarditis in the absence of risk factors. Treatment for systemic lupus erythematosus and primary APS are distinct.
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PMID:The autoimmunity conundrum: clotting or inflammation. 2119 56


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