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

To elucidate clinical features of infective endocarditis in the elderly, 20 elderly patients aged > or = 60 years were compared in detail with 30 others aged < 60 years retrospectively. Twelve of the 20 elderly patients had a calcific aortic valve or an artificial device as a predisposing heart disease, whereas 16 middle-aged patients had mitral valve prolapse or congenital heart disease (p = 0.001). The prevalence of major extracardiac disorders such as neurological disease were higher in the elderly than in the middle (9/20 vs 3/30; p < 0.01). The frequency of infected valve was similar; mitral in 8, aortic in 11 and other valves or congenital defect in 2 in the elderly versus 14, 11 and 6, respectively in the middle. Among 39 patients in whom causative microorganisms were identified, staphylococcus epidermidis was most frequently identified in the elderly (5/20), whereas streptococcus species was found in the middle (12/30). Time from the onset of symptoms to correct diagnosis was usually delayed in the entire group; the delay was longer particularly in the elderly than in the middle-aged patients (72 +/- 87 vs 36 +/- 32 days; p < 0.1). Maximal body temperature was less in the elderly than in the middle-aged patients (38.5 +/- 0.7 vs 39.3 +/- 1.1 degrees C; p < 0.01), whereas peak level of C-reactive protein (10.4 +/- 6.1 vs 13.0 +/- 7.9 mg/dL), the incidences of heart failure (9/20 vs 10/30), and embolic complications (7/20 vs 10/20) were similar in the 2 groups. Cardiac operation was performed less in the elderly than in the middle-aged patients (9/20 vs 21/30; p < 0.08). Five elderly patients had disease-related mortality, whereas only one middle-aged patient died (p = 0.02). These results suggest that although predisposing heart disease and causative microorganism in infective endocarditis are different between the elderly and middle-aged patients, the incidence of major complications are similar. However, due to the delay of correct diagnosis in the elderly who usually have major extracardiac disorders, the prognosis of infective endocarditis in the elderly is poor.
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PMID:[Infective endocarditis in the elderly]. 1143 69

Infection with varicella zoster virus, leading to chicken pox in susceptible hosts, is usually a benign self-limiting disease conferring immunity in those affected. Cardiac complications are rare, but when present may lead to severe morbidity or mortality. We have recently encountered three children, all of whom developed significant cardiac complications secondary to infection with varicella. Myocarditis has long been associated with such infection. The pathological mechanism is presumed similar to other cardiotropic viruses, where both direct cytopathic and secondary auto-immune effects contribute to myocardial cellular destruction and ventricular dysfunction. Complications include arrhythmias and progression to dilated cardiomyopathy. Pericarditis, and secondary pericardial effusion, related to infection with the virus is most commonly associated with secondary bacterial infiltration. Both cardiac tamponade and chronic pericardial constriction may result. Endocarditis complicating varicella has only been described in the last fifteen years, and is associated with the emergence of virulent strains of both streptococcus and staphylococcus, the two organisms most commonly associated with endocarditis. The exact mechanism by which varicella causes secondary bacterial endocarditis remains unclear. Whilst cardiac complications of infection with the varicella zoster virus are rare, the resulting complications are potentially life threatening. Evidence of varicella-induced carditis must be aggressively pursued in any child with signs of acute cardiac decompensation in whom chicken pox is confirmed or suspected.
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PMID:Cardiac complications in children following infection with varicella zoster virus. 1181 17

Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated. Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%). An obvious predisposing cardiac lesion could not be ascertained in 22%. Blood culture positivity was 44% with streptococcus heading the list. The incidence of the staphylococcal (25%) and gram negative bacillary endocarditis (15%) were found to be increasing. Streptococci were susceptible to penicillin with minimum bactericidal concentration: minimum inhibitory concentration within acceptable limits. However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem. With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.
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PMID:Infective endocarditis: report of a prospective study in an Indian hospital. 1193 Dec 7

We report a case of staphylococcus endocarditis of the mitral and aortic valves in an intravenous drug user (IVDU) complicated by abscess of the aortic root and aorto-left atrial fistula. Interestingly, the tricuspid valve was free of vegetation. Infective endocarditis in IVDUs more commonly involves right-sided valves; left-sided endocarditis is rare, indicates severe disease, or is a postmortem finding. This case illustrates the need for considering left-sided valve endocarditis in IVDU with septicemia, even if the tricuspid valve shows no evidence of vegetation.
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PMID:Left-sided endocarditis in intravenous drug users: a case report and review of the literature. 1235 47

A child with congenital heart disease developed infective endocarditis caused by Staphylococcus lugdunensis. Despite an apparent excellent response to initial antibiotic treatment in clinical, inflammatory and echocardiographic indices, the patient's valve damage progressed silently and surgical intervention was required. This case highlights the potential for misidentification of S. lugdunensis, its usual susceptibility to penicillin and in particular the aggressive nature of endocarditis caused by this coagulase-negative staphylococcus. The epidemiology and treatment of endocarditis caused by this organism are reviewed.
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PMID:The "surreptitious Staphylococcus": Staphylococcus lugdunensis endocarditis in a child. 1240 May 33

We present here a patient with acute myeloid leukemia (M2) who developed fatal infective endocarditis. On admission, the patient (67-year-old male) had mitral stenosis and atrial fibrillation. Complete remission was achieved after induction chemotherapy. During the course of consolidation therapy, he developed sepsis caused by coagulase-negative staphylococcus, which was successfully treated with antibiotics. Thereafter, blood culture yielded multidrug-resistant staphylococcus epidermidis. An echocardiogram revealed mitral valve regurgitation with vegetation. He was diagnosed as having infectious endocarditis. In spite of prolonged antibiotic therapy, destruction of the mitral valve progressed, and the patient underwent valve replacement therapy. He died of cardiac tamponade 5 days after the surgery.
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PMID:[Acute myeloid leukemia with infective endocarditis]. 1241 86

The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.
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PMID:[Infectious endocarditis. A study of 50 patients in a non-university hospital]. 1274 5

Active infection in the area of the tracheostomy during cardiac surgery presents a high risk. We successfully performed urgent aortic valve replacement for an endocarditis patient with active infection of methicillin resistance staphylococcus aureus in the tracheostoma. To avoid wound infection, a 2nd J-limited sternotomy was used during the operation. Despite malnutrition, the patient showed no wound infection after surgery and recovered smoothly.
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PMID:Aortic valve replacement by limited sternotomy for infective endocarditis in a patient with a tracheostomy. 1462 Oct 18

A 48-year-old woman on hemodialysis developed congestive heart failure, neurologic deficits and disseminated intravascular coagulopathy (DIC) caused by methicillin resistant staphylococcus aureus infective endocarditis. Echocardiography showed large vegetation attached to the anterior leaflet of the mitral valve, severe mitral and aortic regurgitation, and poor left ventricular function. Computed tomography findings revealed recurrent embolic events including cerebral and splenic infarction, but no evidence of intracranial bleeding. Abnormal laboratory findings included DIC in addition to the administration of the daily dose of ticlopidine hydrochloride. Aortic and mitral valves were urgently replaced with bioprosthetic valves after the transfusion of fresh frozen plasma and platelet. During the follow-up period of one year, she was free from any cardiac events and infectious signs. Even though this report is limited to a case and its follow-up, it is sensible to conclude that only aggressive and timely surgical intervention can be the only lifesaving action for patients with highly infective endocarditis.
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PMID:Successful surgical intervention for active infective endocarditis on a hemodialysis patient with cerebral infarction and disseminated intravascular coagulopathy. 1499 86

Catheter-related infections (CRI) are a leading cause of morbidity and sometimes a cause of death in cancer patients. For preventive strategies, intra- and extra-luminal colonization pathways should be taken into account. A definite diagnosis of CRI requires usually the removal of the catheter for culture of the catheter-tip. However, only about 20% of the catheters removed for suspicion of CRI actually prove infected. The diagnosis of CRI is likely when a bloodstream infection due to coagulase negative staphylococcus, S. aureus or Candida spp occurs, without other infectious focus. Among the catheter-tip culture techniques, quantitative methods offer the better sensitivity-specificity/complexity-cost compromise, and should be preferred to semi-quantitative ones. When a venous access port is removed because of suspected CRI, the catheter tip and the port itself should be both cultured. Immediate removal of the catheter and urgent antibiotic treatment are mandatory when severe local infection (such as tunnelitis or cellulitis) or severe sepsis occurs. Usually, a CRI due to S. aureus, Pseudomonas spp or Candida spp requires also the removal of the catheter. Diagnostic techniques without catheter removal may be only proposed when local or systemic severity signs are lacking. Recently, the measurement of the differential time to positivity between paired blood cultures drawn simultaneously on the catheter and on a peripheral vein has been proposed. Finally, the direct examination of blood drawn from the catheter using acridine-orange leucocyte cytospin test seems to be a promising and rapid method for the diagnosis of CRI. When a CRI is diagnosed, a treatment without catheter removal may be proposed when local or systemic severity signs are lacking mainly if coagulase negative staphylococci are involved; in such case, both systemic antibiotic therapy and lock-therapy should be associated. In case of clinical failure of this strategy after 48-72 hours, the catheter should be removed. If the sepsis persist, a residual infectious focus (thrombophlebitis, endocarditis, secondary localisation) should be investigated.
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PMID:[Infections of intravascular perfusion sets]. 1500 68


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