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

Although cerebral angiography should be approached with caution in the diagnosis of inflammatory cerebro-vascular disease there are some characteristic angiographic findings which may be helpful for classification and differential diagnosis. The proximal cerebral arteries are favourably affected by basal meningitis and thrombangiitis obliterans with resulting stenoses and occlusions. Whereas those inflammations originating from neighbouring skull structures mostly involve the intracavernous parts of the carotid artery, the tuberculous and mycotic arteritis prefer the supraclinoid carotid siphon. Peripheral vascular changes are found in luetic endangiitis, necrotizing and toxic angiitis and in collagenoses. Simultaneous involvement of the temporal arteries is of great diagnostic importance demonstrating the systemic character of the inflammatory process; in Horton's arteritis it can be a pathognomonic finding. Infectious endocarditis, some mycoses and malaria may lead to embolic occlusion of cerebral vessels. Mycotic aneurysms mostly have a broad base or a fusiform shape and do not prefer the localizations of congenital aneurysms. Angiographically, abscesses, tuberculomas and viral encephalitis may result in circumscribed hypervascularized areas. The characteristic angiographic findings are exemplified and discussed on the basis of 8 cases of inflammatory cerebro-vascular disease (tuberculosis, pneumococcal and unspecific bacterial meningitis, syphilis, mycosis, Takayasu-syndrome, panarteritis nodosa, temporal arteritis).
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PMID:[Inflammatory cerebro-vascular disease: angiographic findings and distribution patterns (author's transl)]. 0 27

Although hyperthermia is a component of many endocrine diseases, it is uncommon for fever to be the presenting manifestation of hormonal disorders. During a four year period we encountered six patients, hospitalized principally because of fever, who were found to have endocrine causes for the fever. In all, the admitting diagnosis was infection; three were suspected of having tuberculosis, two of gram-negative bacteremia and one of endocarditis. Except for asymptomatic bacteriuria in one patient (who remained febrile despite appropriate antibiotic therapy) infection was ruled out in all cases, and fever was attributed to "masked" thyrotoxicosis, triiodothyronine (T3) toxicosis, subacute thyroiditis, primary adrenal insufficiency, secondary adrenal insufficiency and pheochromocytoma. In a seventh patient, extreme pyrexia developed in the setting of the thyroid storm. The importance of hormonal mechanisms in thermoregulation is discussed.
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PMID:Hormonal hyperthermia: endocrinologic causes of fever. 21 48

The aminoglycoside antibiotics are reviewed with regard to mechanism of action, bacterial resistance, antimicrobial spectrum, combinations with other agents, pharmacology, dosages in patients with normal and impaired renal function, adverse reactions, therapeutic use, prophylatic use and selection. Streptomycin is suggested in the therapy of tuberculosis, brucellosis, tularemia and yersinia infections; several of these require the coadministration of another agent. The choice between streptomycin and gentamicin for combination therapy of enterococcal endocarditis may be simplified by knowledge of the prevalence of high-level streptomycin-resistant strains in the hospital or by use of an in vitro screening test. Neomycin is the agent used orally in the treatment of hepatic encephalopathy. Paromomycin is indicated only for the treatment of amebic infections. The major difference among gentamicin, tobramycin and amikacin lies in the low but increasing prevalence of gram-negative bacilli which are resistant to gentamicin and tobramycin and susceptible to amikacin. In those institutions in which gentamicin-resistant strains are of concern, amikacin is the aminoglycoside of choice in high-risk patients until the infecting bacterium has been determined.
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PMID:Drug therapy reviews: Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics--part 4: aminoglycosides. 40 90

Terminal endocarditis develope in cancer patients almost latently. There is no difference between the so-called "tumor-endocarditis" and other verrucous endocarditis associated with terminal tuberculosis, sepsis or rheumatism. It is more frequent in cases with large or ulcerated primary tumours and multiple metastases than in cases with early cancer. It also develope more frequently in well differentiated cancer (squamous and adenocarcinoma) than in indifferentiated forms of cancer. Terminal endocarditis is often seen in patients with cancer of the gallbladder, pancreas, liver, stomach, rectum, and ovary. In carcinoma of the liver, pancreas and biliary tract the trend to embolism is more reduced through icterus than the trend to terminal endocarditis.
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PMID:[Endocarditis in cancer necropsies (author's transl)]. 47 52

Postoperative septicaemia with infective endocarditis is a recognized complication of open-heart surgery, in particular homograft or prosthetic replacement of cardiac valves. Several infective organisms, both bacterial and fungal, have been incriminated but infection due to tubercle bacilli has not, to our knowledge, been reported. The clinicopathological features of this condition are discussed. During a five-year period, over 800 homograft replacements in the aortic and/or mitral positions have been performed at Harefield Hospital. Seven cases of miliary tuberculosis following homograft valve replacement are descrbied here. In three, there was a past history suggestive of tuberculosis infections but necropsy failed to reveal any caseous or other tuberculous lesion apart from recent miliary tuberculosis. Vegetations on the homograft valves contained microcolonies of acid-fast bacilli in most cases. Tubercle bacilli of the human type were recovered by culture or guinea-pig inoculation in six of the seven cases, and in three the diagnosis was established during life; two of these survived on antituberculosis chemotherapy. The onset of symptoms varied from a few weeks to 12 months after operation. The main presenting symptom was intermittent pyrexia. In two patients the diagnosis was made on radiological and clinical grounds and in both, tubercle bacilli were grown from drill biopsy specimens of lung tissue. The source of infection was presumed to be the homograft valves contaminated in the postmorten room. The antibiotic mixture used in the sterilization of the homografts was not effective against tubercle bacilli.
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PMID:Miliary tuberculosis following homograft valve replacement. 81 28

Two cases of disseminated histoplasmosis caused by H. capsulatum in Nigerian children are reported. This is a rare infection in this part of the world. The main clinical features were fever, weight loss, lassitude, lymphadenopathy, hepatosplenomegaly and severe anaemia, features indistinguishable from those of tuberculosis, Hodgkins and other reticuloses. Recognition of this infection in this environment is possible if it is considered in the differential diagnosis of pyrexia of undetermined origin and appropriate laboratory tests carried out on suitable specimens such as bone marrow, splenic aspirate or biopsy material. Treatment of choice is amphotericin B given intravenously, starting with 0-25 mg/kg. and increasing slowly to 1 mg/kg. Other useful drugs are Septrin and rifampicin which can be given concurrently. Subcutaneous abscesses and multiple bone lesions occurred in both our cases presumably as a result of blood stream infection, or embolisation from endocarditis.
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PMID:Disseminated histoplasmosis due to histoplasma capsulatum in two Nigerian children. 122 26

Mycobacterial infection is an uncommon but very serious complication of heart valve replacement and other forms of cardiac surgery. Tuberculosis has been a rare complication of valve replacement in the industrially developed countries owing to the low incidence of that disease in such countries. Most reported cases are associated with the insertion of human allograft valves. Valvular tuberculosis could become a more serious problem if heart valve replacement surgery is used to any extent in countries where tuberculosis is common. The majority of other mycobacterial infections occurring after heart surgery have, for unknown reasons, been due to the rapid growers M. chelonae and M. fortuitum. Porcine xenograft valves have been contaminated by M. chelonae, possibly during manufacture as this is not a natural pathogen of pigs. A minority of patients receiving valves known to be contaminated by M. chelonae subsequently developed valve disease. Mycobacterial disease following insertion of mechanical valves is a very uncommon occurrence but the prognosis is poor. There have been several outbreaks of infection of the sternotomy wound by M. chelonae and M. fortuitum and, although the prognosis is better than for mycobacterial endocarditis, treatment, especially for infections due to M. chelonae, often involves extensive debridement including removal of the entire sternum. In view of the poor response to therapy, prevention by avoidance of contamination of all surgical materials, including implanted valves, by environmental mycobacteria is of paramount importance.
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PMID:Mycobacterial infections following heart valve replacement. 134 Dec 13

A retrospective study of drug resistance of Mycobacterium tuberculosis in patients simultaneously affected by tuberculosis (TB) and HIV was conducted in a Spanish university hospital. 39 of the 287 patients (13.6%) were also HIV seropositive. Mycobacterium tuberculosis with primary resistance to at least one of the major antitubercular drugs was isolated in 4 of the 39 (10.3%). The 4 patients (3 males, 1 female) demonstrating primary drug resistance were intravenous drug users aged 23-30 years. 3 were resistant to isoniazid, 1 to rifampin, 1 to streptomycin, and 1 to pyrazinamide. None was resistant to ethambutol. 2 were resistant to one drug and 2 were resistant to 2 drugs. Resistance to streptomycin in 1 patient may have been secondary to treatment with aminoglucosides for endocarditis. It is recommended that diagnostic suspicion of TB be maintained in management of HIV infected patients because of the possibility of drug resistance and of in-hospital transmission. Shortened or simplified treatment regimens should be avoided in seropositive patients.
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PMID:[Isolation of Mycobacterium tuberculosis with primary resistance to chemotherapeutic agents in patients with HIV infection]. 145 Feb 61

This study examines a population of inner-city crack cocaine users in Miami, Florida. Many study participants were also injection drug users; others were the sexual partners of injection drug users. In general, the self-reported health status of the study population was good, but men perceived their health in a more positive light than did women. HIV-seronegative men were most likely to report excellent or good health, and seropositive women reported the greatest incidence of poor health, regardless of the amount of crack use. Serostatus was statistically significant for women but not for men. Pneumonia was reported more frequently by women, while hepatitis and tuberculosis were reported more frequently by men. There was a significant gender difference in reported endocarditis among light users of crack, with more women that men reporting a history of endocarditis. Among sexually transmitted diseases, men reported more gonorrhea and women reported more syphilis. These gender differences were statistically significant only for heavy users of crack. A gender difference was evident in the HIV seropositivity rates, with 25.7% of men and 32.2% of women testing positive for antibodies to HIV. While this difference held true when frequency of crack use was controlled, the difference was not statistically significant. Women were significantly more likely than men to trade sex for drugs and/or money. Women who were heavy crack users traded most often and would be expected to be at correspondingly increased risk for HIV infection or transmission.
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PMID:A gender comparison of health status among users of crack cocaine. 149 Dec 88

The prophylactic use of antimicrobial agents is recommended for prevention of numerous infections, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, and bite wounds. In addition, the prophylactic use of antimicrobial agents has proved effective in certain surgical procedures such as various abdominal operations, hysterectomy, and major operations that involve the head and neck. Except for oral bowel preparations, antimicrobial prophylaxis should be limited, in general, to the operative period. Prolonged perioperative prophylaxis has not been shown to enhance effectiveness and may result in increased toxicity, resistant superinfections, and inflated costs. The investigation of antimicrobial prophylaxis necessitates adequate evaluation of the potential advantages and disadvantages in a prospective, double-blind fashion.
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PMID:Prophylactic use of antimicrobial agents in adult patients. 140 80


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