Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the period 1947-1985, 601 patients with infective endocarditis were seen at the University Hospital Zurich and the Kantonsspital Lucerne. Streptococci, enterococci and staphylococci were the predominant causative organisms in two-thirds of all cases. In more than 25% of the patients blood cultures remained negative. In 6 patients endocarditis was caused by very rare organisms, viz. Coxiella burnetii (2 cases), Hemophilus parainfluenzae, Corynebacterium bovis (diphtheroids), Brucella melitensis and Aspergillus terreus. The clinical and microbiological characteristics of these cases are described and compared with the results in the literature. Diagnostic and therapeutic problems are discussed. Only with special awareness of the role of these unusual organisms in causing infective endocarditis, especially Q fever endocarditis with its notoriously atypical course, can the number of "culture negative" cases be diminished and the prognosis thereby improved.
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PMID:[Endocarditis with unusual causative agents]. 332 31

A 59-yr-old man presented with mitral endocarditis and negative blood cultures. Antibodies to phase 2 and phase 1 antigens of Coxiella burneti were detected and a diagnosis of Q fever endocarditis was made. Five years earlier, this patient had been successfully treated by aortic valve replacement for a first episode of endocarditis with negative blood cultures. Giemsa and Machiavello stains of the native aortic valve were made retrospectively and showed coccobacilli highly suggestive of Coxiella organisms. It is concluded that the first episode was Q fever endocarditis and that the failure to recognize this aetiology at that time, and the absence of adequate medical therapy, is the cause of the present episode.
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PMID:Q fever endocarditis: relapse five years after successful valve replacement for a first unrecognized episode. 337

Q fever endocarditis occurs in up to 11% of patients infected by Coxiella burnetti. Major clues for the diagnosis are culture-negative endocarditis, hepatic involvement, rash, and thrombocytopenia. Characteristically, the diagnosis is delayed. In our patient, Q fever endocarditis occurred without previously recorded signs of infection. Fever, rash, and hepatic involvement all occurred following aortic valve replacement. The histologic picture of the excised valve was consistent with endocarditis, and serologic tests disclosed elevated IgA and IgG antiphase 1 antibody titers against C burnetti, compatible with Q fever endocarditis. It is assumed that the exacerbation of quiescent Q fever endocarditis was caused by cardiac surgery and steroid therapy.
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PMID:Quiescent Q fever endocarditis exacerbated by cardiac surgery and corticosteroid therapy. 338 99

Indirect enzyme-linked immunosorbent assays (ELISAs) specific for IgG and IgM antibodies against Coxiella burnetii were applied to test 208 serum samples collected within 1983 to 1986 from 128 individuals suspected of having Q fever, and from 1611 serum samples of normal blood donors. Among them were 2 patients with Q fever endocarditis, one patient with myocarditis, one patient with chronic hepatitis, 3 patients with pneumonia, one woman who had aborted a monstrous child, 38 state veterinarians, 26 farms workers, 21 persons employed in veterinary medicine, and 4 laboratory workers. Comparison with the complement fixation test (CF) revealed 46 (38%) subjects seropositive by CF and 77 (60%) seropositive by IgG and/or IgM ELISA. Among the normal blood donors 22% had antibodies to C. burnetii by ELISA. With exception of two CF titers of 1:2 and 1:8, all positive results detected by CF were confirmed by ELISA. Early stages of C. burnetii infections could be diagnosed in four cases with a single serum sample through demonstration of specific IgM by ELISA before appearance of CF antibodies. In 9 patients with acute Q fever and rising CF titers or IgG levels, diagnosis was already possible with the first serum sample by demonstration of high IgM levels by ELISA. In the two cases of endocarditis investigated, high CF titers against phase I antigen of C. burnetii confirmed the diagnosis "chronic Q fever".
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PMID:Serodiagnosis of Q fever by enzyme-linked immunosorbent assay (ELISA). 343 17

A man with blood culture negative endocarditis since 1983 received in October 1984 a mitral valve bioprosthesis. Reintervention in April 1985 was performed because of a paravalvular leak. In September 1985, mitral insufficiency reappeared and high-titer phase II Q fever antibody was detected, which has since then persisted with concomitant high-titers of phase I antibody. In serum from 1983, phase II antibody was detected on reexamination in September 1985. For unexplained reasons this antibody had not been detected in 1983. The patient has since September 1985 been successfully treated with doxycycline. The current literature is reviewed. Q fever endocarditis should be considered also in Belgium in culture negative endocarditis even in persons with no previous history of valvular disease and no known exposure to animals or unpasteurized dairy products. Quality of viral reagents and diagnosis present sometimes a challenge.
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PMID:An unexpected Q fever endocarditis. Report of a case. 350 54

The diagnosis of Q fever endocarditis cannot be made by bacterial cultures and necessitates serological identification of specific antibodies to Coxiella burnetii which stimulates mainly the production of anti-phase II antibodies during the acute disease, but primarily anti-phase I antibodies in endocarditis. Indirect microimmunofluorescence allows rapid detection of specific IgA, IgG and IgM. The results of serological analyses of 191 acute cases of Q fever were compared with those of 8 cases of Coxiella burnetii endocarditis. All sera were evaluated by complement fixation and microimmunofluorescence tests. The highest titre differences between primary Q fever and Q fever endocarditis were observed with anti-phase I IgA and IgG antibodies measured by microimmunofluorescence followed by anti-phase I antibodies measured by complement fixation tests. Antiphase I IgG and IgM titres were consistently higher than anti-phase II titres in endocarditis. The reverse is true in acute Q fever. In addition, anti-phase I IgA appeared to be diagnostic for Coxiella burnetii endocarditis. Accordingly we recommend the testing of these specific IgA, IgG, and IgM by microimmunofluorescence in cases of culture-negative endocarditis. These tests could also prove useful for following the development of Coxiella burnetii endocarditis in patients under treatment.
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PMID:Serological diagnosis of Q fever endocarditis. 354 13

Q fever endocarditis, which is seen most often in Great Britain and Australia, has been rarely observed in the United States. A patient with an eight month febrile illness who had signs and symptoms of endocarditis and serologic studies diagnostic of Q fever endocarditis is reported. A history of extensive travel makes it unclear where he originally contracted the disease. Q fever endocarditis is probably underdiagnosed and should be looked for in any case of culture negative endocarditis or chronic fever of unknown origin.
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PMID:Q fever endocarditis. 372 57

Thirty one (78%) of 40 consecutive patients (aged 13-79, mean 44 years) with infective endocarditis had congestive heart failure at presentation. Twenty six (65%) had had rheumatic heart disease and 17 (43%) patients had prosthetic valves. Eight (20%) patients had undergone dental procedures within three months of presentation. Blood cultures were positive in only 22 (55%) of the patients. In nine (41%) of them streptococci of the viridans group were isolated and in seven (32%) patients endocarditis was due to Staphylococcus aureus. Eight patients had Q fever endocarditis. Sixteen patients required operation because of haemodynamic deterioration while they were in hospital; 11 patients had native valves and five had prosthetic valves. Seven had emergency operations and were pyrexial at that time. Four of the seven died in hospital. Of the 12 who were alive and well after surgery only two required further surgery two and three years after the initial operation. Twelve (30%) of the 40 patients died in hospital; in 10 death was mainly due to left ventricular failure or congestive heart failure. All patients died who had renal failure (four cases), myocardial infarction (two cases), complete heart block (one case), or ventricular fibrillation (two cases) before operation. Six (33%) of the 18 patients with culture negative endocarditis died. Two of the four patients seen and treated more than 12 weeks after the onset of symptoms died, as did three of the five patients with prosthetic valves who required surgery while in hospital. Three patients with neurological complications survived and only two (29%) of the seven patients with blood cultures that were positive for Staphylococcus aureus died. Of these 40 high risk patients optimal antibiotic treatment and early surgery for haemodynamic difficulty ensured that 28 (70%) were discharged from hospital alive and well.
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PMID:Heart failure associated with infective endocarditis. A review of 40 cases. 394 52

A 39-year-old man with aortic stenosis and regurgitation developed Q fever endocarditis. After 15 weeks of chemotherapy with tetracycline the damaged aortic valve was replaced with a homograft. Organisms were present in the excised valve. Some months later the valve began to leak and the endocarditis recurred fatally. Because of the nature of rickettsial infection neither a course of chemotherapy nor an operation can guarantee a cure of Q fever endocarditis. Chemotherapy should be continued indefinitely even after operation.
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PMID:Apparent recurrence of Q fever endocarditis following homograft replacement of aortic valve. 543 45

The application of an indirect ELISA for detection of IgM and IgG antibodies against Coxiella burnetii in five Q fever patients--among them one with endocarditis and one with hepatitis--is described. In the acute phase of infection, within a few days after onset of clinical symptoms, a significant rise of IgM antibodies could be detected. It was followed by a rise of IgG in the second and third week. In chronic Q fever endocarditis, IgM antibodies persisted over a period of nine months. High IgM and low IgG values indicated acute infection, while in convalescent sera the IgM/IgG relationship was vice versa. In a comparative investigation with complement fixation (CF) test it could be shown that CF antibodies were associated exclusively with immunoglobulin G. IgM separated from IgG by gel chromatography did not fix complement. So, the CF test does not appear to be suitable for detection of antibodies against Coxiella in the early stages of the disease. Because of the persistence of IgG antibodies over a longer period of time, sole detection of a titer against the agent is insufficient for diagnosis of current disease, if not a rise or fall in titer can be detected in a second serum sample. Using the sensitive ELISA technique, a diagnosis is usually possible with one serum sample--in connection with history and clinical investigation--by differentiation of IgM and IgG antibodies.
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PMID:[Serodiagnosis of human Q-fever--demonstration of non-complement binding IgM antibodies in the enzyme-linked immunosorbent assay (ELISA)]. 633 14


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