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

In a prospective clinical and bacteriological study of 192 consecutive patients with septicemia admitted during the period 1967--1971 to a hospital for infectious diseases, 31 cases of proved (group I) and 10 with probably (group II) bacterial endocarditis were observed and analysed with regard to a variety of factors. The incidence of bacterial endocarditis was 3 per 1 000 admissions. The mean age of the patients was 52.6 years; there was no sex predominance. In about one third of the patients apparently normal valves were involved. Underlying non-cardiac factors were present in two thirds, even in younger age groups, in which chronic alcoholism and intravenous drug abuse were frequent. Secondary manifestations from various organs were noted in about three quarters of the patients, in one quarter already on admission. alpha-Hemolytic streptococci and staphylococci were most commonly isolated, followed by gram-negative enteric rods, beta-hemolytic streptococci, enterococci, and pneumococci. A probable portal of entry could be assumed in 80% of the patients and could often be related to the type of bacteria involved. In some cases, diagnostic or therapeutic procedures preceded the disease. A subacute course of the endocarditis was observed in one third of the patients and all these had alpha-hemolytic streptococci or enterococci. The aortic and mitral valves were equally often involved and equally often infected by alpha-hemolytic streptococci. In 4 patients, 3 of whom were drug addicts, the tricuspid valve was probably involved; all were infected by staphylococci. In one case autopsy revealed a mural endocarditis.
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PMID:Bacterial endocarditis. I. A prospective study of etiology, underlying factors and foci of infection. 71 83

The association of Pseudomonas maltophilia endocarditis in three patients with recent history of intravenous drug abuse is reported. All three patients had abnormal heart valves (two prosthetic and one rheumatic). A prominent characteristic of this uncommon pathogen is its in vitro resistance to the commonly used antimicrobials. Cure was achieved in all three cases. In two cases, synergistic antibiotic combinations were used. In one case, plasmid-mediated resistance to amikacin sulfate (Amikan, British; no comparable US product) emerged during therapy. The two patients with prosthetic valves received combined surgical and antibiotic therapy.
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PMID:Pseudomonas maltophilia causing heroin-associated infective endocarditis. 71 16

Pulmonary morphologic alterations secondary alterations secondary to intravenous drug abuse have been previously identified by histopathologic study of autopsy and biopsy material. Recent investigative efforts have been directed toward defining functional abnormalities that would allow for early clinical diagnosis. For this reason, 12 asymptomatic addicts were studied with roentgenography, spirometry, single breath diffusing capacity (DLco), 99Tc perfusion and 133 Xe ventilation scanning. Nine of the twelve were heavy cigarette smokers. None reported historical evidence of chronic bronchitis or right-sided endocarditis. The DLco was the only significant routine pulmonary function abnormality (p less than .001) observed in these patients. The DLco was significantly reduced even after correction for smoking habits (p less than .001). The decrease in DLco correlated with the number of perfusion defects detected by 99Tc scanning (r = -.560). There was no correlation between DLco and the number of defects on the 133Xe ventilation scan, age, pack-years smoked, or other routine pulmonary function tests. Further, there was no correlation between the number of perfusion and the number of ventilation defects. The data suggest that the decrease in DLco found in these addicts is the result of reduction of the pulmonary capillary bed secondary to vascular or interstitial granulomatosis.
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PMID:Lung disease in reformed drug addicts: diagnostic and physiologic correlations. 87 58

The nephropathy associated with methicillin sodium therapy is considered to be rare, but its prevalence is unknown. We reviewed the antibiotic therapy of 81 cases of Staphylococcus aureus bacteremia to establish the frequency and determinants of methicillin nephropathy in that disease. Fifty-two patients received methicillin; nine (17%) experienced the characteristic clinical signs previously associated with drug-induced acute interstitial nephritis. This nephropathy uniformly subsided after methicillin was withdrawn, and did not always include deterioration of renal function. Factors that correlated with methicillin nephropathy were endocarditis and prolonged treatment, but not intravenous drug abuse. There was only one adverse reaction among 29 patients treated with a cephalosporin. It was similar to the nephropathic reactions to methicillin. Thus, reversible renal abnormalities are prevalent during methicillin therapy, particularly among patients with staphylococcal infections such as endocarditis. When prolonged therapy with methicillin is required, the urinary sediment and renal excretory function should be monitored.
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PMID:Nephropathy associated with methicillin therapy. Prevalence and determinants in patients with staphylococcal bacteremia. 87 56

Clinical data from 186 patients (133 males and 53 females) with 190 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essential differences from those reported in the West. The mean age was much lower (25 +/- SD 12 years, range 2 to 75 years). Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%). This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%). Twenty-four patients had either aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etiology. Prosthetic valve infection and mitral valve prolapse were present in only 2 patients each. A definite predisposing factor could be identified in only 28 patients (15%). Postabortal sepsis and sepsis related to childbirth accounted for 6 and 5 cases, respectively. Only 1 patient had history of intravenous drug abuse. Two-dimensional echocardiography showed vegetations in 121 patients (64%). Blood cultures were positive in only 87 (47%), with a total of 90 microbial isolates. Commonest infecting organisms were staphylococci (37 cases) and streptococci (34 cases). Except for a significantly higher number of patients with neurologic complications in the culture-negative group, there were no differences between patients with culture-positive and culture-negative IE. Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (58%) instances. A significantly greater number of culture-negative patients had received antibiotics than did culture-positive patients (87 vs 23, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Active infective endocarditis observed in an Indian hospital 1981-1991. 144 18

The incidence, characteristics, and pathogenesis of pleural effusions in patients with right-sided endocarditis (RSE) are poorly defined. We have recently observed four patients with a history of intravenous drug abuse and bacteremia due to Staphylococcus aureus who had pleural effusions during an episode of RSE. We report the pleural fluid characteristics of five effusions in these four patients and attempt to define the pathogenesis of each. We found that (1) an exudative, sterile, serosanguineous, or bloody effusion is common in RSE, (2) empyema occurred in only one patient, and (3) transudative effusions due to CHF were not observed. Possible mechanisms of pleural fluid formation in RSE include parapneumonic effusion, septic pulmonary emboli with or without infarction, and empyema. Congestive heart failure does not appear to be a common cause of pleural effusion in pure right-sided endocarditis.
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PMID:Pleural effusions in right-sided endocarditis: characteristics and pathophysiology. 147 Sep 58

Intravenous drug abusers are subject to infective endocarditis from unusual pathogens, including the saprophytic species of Neisseria, sometimes transmitted by needles contaminated with oral secretions. We have recently encountered such a case, in which a 37-year-old man with vegetations on the anterior leaflet of the tricuspid valve had blood cultures positive for N sicca. A history of intravenous drug abuse using needles contaminated with oral secretions should alert clinicians to the possibility of infective endocarditis due to saprophytic Neisseria species.
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PMID:Infective endocarditis due to Neisseria sicca and associated with intravenous drug abuse. 152 57

Two patients with poor oral hygiene developed Neisseria sicca endocarditis, one after probable intravenous drug abuse and Staphylococcus aureus endocarditis and the other after a periodontal surgical procedure. Both experienced significant embolic phenomena and both required 6 or more weeks of intravenous antibiotic therapy. The diagnosis of N. sicca endocarditis must be considered when this organism is isolated from blood cultures in patients with emboli.
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PMID:Neisseria sicca endocarditis with embolic phenomena. 157 42

We studied retrospectively 23 consecutive patients seen at our centre with right heart endocarditis. None of the patients had a history of intravenous drug abuse. All patients were found to have underlying congenital heart disease as a predisposing factor, of which ventricular septal defect (26%) and Fallot's tetralogy (26%) were the commonest. Postoperative endocarditis (26%) also constituted an important clinical subset. Fever (100%) and predominant pulmonary symptoms (69.5%) were the important presenting features. Congestive heart failure was present in 15 patients (65.2%) and predicted an adverse in-hospital outcome. Both the pulmonary and the tricuspid valves were affected equally with presence of vegetations at multiple sites in 10 patients (43.4%). Seven patients (30%) also had concomitant left-sided endocarditis. Medical therapy alone was successful in 15 patients (68.1%) with an overall in-hospital mortality of 31.8%. Five of 6 patients with postoperative endocarditis died, signifying an ominous prognosis of this subgroup when treated medically. The clinical spectrum of right-sided endocarditis in our country differs from the West. The frequent presence of underlying congenital heart disease, the rarity of drug abuse as a predisposing factor, equal involvement of the tricuspid and pulmonary valves and a greater incidence of congestive heart failure are some of these differences.
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PMID:Spectrum of right-sided infective endocarditis: an Indian experience. 157 39

The microorganism responsible for infective endocarditis may not be grown on blood culture in as many as 25% of cases. While this is to be expected with such relatively uncommon organisms as Coxiella burnetti, in most cases failure to grow the organism is likely to be due to either a low concentration of bacteria in the blood or because antibiotics were given before blood was taken for culture. The antibiotic treatment of culture-negative cases should be based on the assumption that the organisms responsible are the same as those found in cases with positive cultures, covering the most likely possibilities in such different circumstances as spontaneous infections of natural valves, endocarditis following cardiac surgery, early and late prosthetic valve endocarditis and infections associated with intravenous drug abuse.
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PMID:Rational approaches to the treatment of culture-negative infective endocarditis. 171 7


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