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

Staphylococcus warneri is a coagulase-negative staphylococcus that is a normal inhabitant of the skin but occasionally causes septicemia and endocarditis. We report a case of multifocal discitis caused by S. warneri in an immunocompetent patient. Only three cases of spinal S. warneri infections have been reported in the literature. They illustrate the atypical clinical presentation, with chronic pain of increasing severity in the thoracic or lumbar spine instead of the abrupt onset that characterizes S. aureus discitis. In our patient, despite the multifocal distribution of the lesions, heretofore unreported, clinical presentation suggested common low back pain. This presentation may be ascribable to the unique bacteriological characteristics of S. warneri. The case reported here illustrates the diagnostic challenges sometime raised by discitis due to coagulase-negative staphylococci.
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PMID:Multifocal discitis caused by Staphylococcus warneri. 1518 99

To assess the effect of our new, more aggressive approach to treating infective endocarditis, we retrospectively reviewed our recent experience with this disease. Between 1983 and 1989, we treated 100 patients with endocarditis, in 94 of whom the diagnosis was confirmed. Fifty-four (57%) of the 94 patients had native valve endocarditis, and the other 40 patients (43%) had prosthetic valve endocarditis. The patients' mean ages were 50 years for native valve disease and 58 years for prosthetic valve disease (p < 0.05). The male-to-female ratio was 4:1. Among the patients with confirmed endocarditis, 87 (93%) had significant underlying risk factors for endocarditis. Upon physical examination of the 94 patients, 16 (17%) were afebrile, 15 (16%) had negative blood cultures, and 26 (28%) had no cardiovascular symptoms or immunologic findings. Echocardiography was of limited value: its sensitivity was 56% for native valve endocarditis and 33% for prosthetic valve endocarditis. The ratio of affected valves was 5 aortic:4 mitral: 1 tricuspid in both forms of the disease. Viridans streptococcus was isolated in 23 (25%) of the confirmed cases, Enterococcus faecalis in 17 (18%), Staphylococcus aureus in 13 (14%), and coagulase-negative staphylococcus in 14 (15%). Gram-negative, anaerobic, and fungal organisms accounted for only 13 (14%) of the confirmed cases. The mean duration of intravenous therapy was 29 days. Twenty (37%) of the native valve patients and 16 (40%) of the prosthetic valve patients received antibiotics on an outpatient basis. Vancomycin was used in 44 (47%) of the cases, nafcillin or ampicillin in 40 (44%), and other beta-lactam agents in 9 (10%). The mean hospital stay was significantly longer for prosthetic valve endocarditis patients than for those with native valve disease (29 versus 23 days; p < 0.01). Cardiac catheterization was performed in 9 native valve patients (17%) and 6 prosthetic valve patients (15%). Valve surgery was performed in 33 native valve patients (61%) and 22 prosthetic valve patients (55%). Failure, defined as in-hospital death or recurrent endocarditis, accounted for 14 (28%) of the native valve cases (17% death and 11% relapse) and 8 (20%) of the prosthetic valve cases (10% death and 10% relapse), for an overall failure rate of 24%. The rate of failure was independent of the infecting pathogen or the type of antimicrobial therapy applied. Our experience verified that, in many patients with significant underlying risk factors, the diagnosis of endocarditis may be made on an empiric basis.
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PMID:New approaches to the diagnosis and treatment of infective endocarditis: review of 100 consecutive cases. 1522 77

A patient with infective endocarditis (IE) due to methicillin-resistant staphylococcus aureus (MRSA) was found to have conversion of the hypoechoic region of the posterior mitral valve ring apparatus into a clearly delineated echolucent space by repeating transthoracic echocardiography at an interval of 1 week. Color Doppler showed features of blood entry into this space. Abscess formation in IE due to MRSA may be quick and repeated echocardiography may help detect the complications of IE. Semiurgent mitral valve plasty was performed for the associated prolapse of the posterior mitral leaflet using a hand-made, rolled, twisted autologous pericardial ring.
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PMID:Extremely rapid formation of mitral valve ring abscess in infective endocarditis. 1529 89

Infectious complications are one of the most important causes of morbi-mortality in oncology patients. Neutropenia is the most important risk factor for developing infection in the oncology patient. Although the highest mortalities continue to be associated with infections due to enterobacterias and Pseudomonas aeruginosa, the frequency of infections due to gram-positives is higher. Deep fungic infections, like those produced by resistant or infrequent bacteria usually occur in late periods of protracted neutropenias. In recent years different studies have shown the efficiency of antibiotic patterns in monotherapy in the treatment of the neutropenic patient with fever. Cellular immunosuppression is not usually as relevant as neutropenia in oncology patients without complications. However, the use of high doses of steroids in some patients and above all the use of purine analogues and monoclonal antibodies has changed this situation in recent years. With these patients it is recommendable to use prophylactic measures directed against Cytomegalovirus, Varicela-zoster virus, P.carinii (or jirovecii) and fungic infections. Bacteraemia associated with endovascular catheterisation is the principal cause of bacteraemia in these patients, above all due to gram-positive micro-organisms. In case of infection, it is always advisable to remove the catheter. However, under certain circumstances, where the placing of a new catheter might be risky given the patient's characteristics and where there are agents of low virulence (e.g. coagulase-negative staphylococcus), a conservative treatment can be tried. A persistence of fever or bacteraemia following removal of the catheter should lead to suspicion of the presence of a deep infection, fundamentally suppurated thrombophlebitis or endocarditis. An adequate understanding of the infectious complications in these patients and their correct treatment and prevention are decisive in reducing the high mortality associated with these clinical manifestations.
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PMID:[Principal infections in the oncology patient: practical treatment]. 1572 2

Wall teichoic acids (WTAs) are major surface components of gram-positive bacteria that have recently been shown to play a key role in nasal colonization by Staphylococcus aureus. In the present study, we assessed the impact that WTAs have on endovascular infections by using a WTA-deficient S. aureus mutant ( Delta tagO). There were no significant differences detected between the isogenic parental strain (SA113) and the Delta tagO mutant in polymorphonuclear leukocyte-mediated opsonophagocytosis; killing by a prototypic platelet microbicidal protein; or binding to platelets, fibronectin, or fibrinogen. However, compared with the parental strain, the Delta tagO mutant adhered considerably less well to human endothelial cells, especially under flow conditions (70.3% reduction; P<.05). Beads coated with WTA bound to endothelium in a dose-dependent manner, suggesting that WTA contributes specifically to this interaction. These in vitro data closely paralleled those from a rabbit model of infective endocarditis in which the Delta tagO mutant was compared with the parental strain. Clearances of staphylococcus from the bloodstream were equivalent, but the Delta tagO mutant showed a significantly reduced capacity to both colonize sterile cardiac vegetations (P<.05) and proliferate within these vegetations, the kidneys, and the spleen (P<.001). We conclude that WTA is an important factor in the induction and progression of endovascular S. aureus infection, likely through a specific interaction with endothelial cells.
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PMID:Lack of wall teichoic acids in Staphylococcus aureus leads to reduced interactions with endothelial cells and to attenuated virulence in a rabbit model of endocarditis. 1583 6

With infective endocarditis afflicting 15,000 patients each year and with a mortality rate that still hovers at almost 40%, the disease remains a very serious health problem. Surprisingly, the incidence has not declined over the last 30 years, and now with more health care interventions, such as pacer/defibrillators, and an increasingly elderly population with degenerative valvular heart disease, the number susceptible to endocarditis is actually increasing. Given the weak evidence for endocarditis prophylaxis, there remains a large population at risk. Much has been learned recently about the pathogenesis of endocarditis, including the role of endothelial damage, platelet adhesion, and microbial adherence to the vegetation or intact valvular tissue. Three-fourths of patients have preexisting structural heart disease. Once infection is manifest, major cardiac complications include congestive heart failure, embolization, mycotic aneurysms, renal dysfunction, and abscess formation. The diagnosis of endocarditis has been enhanced recently by modifications in the Duke criteria to include the use of transesophageal echocardiography and microbial antibody titers. Surgery continues to play an important role, with criteria for emergency, urgent, and early surgery now defined. The major organisms involved in infective endocarditis include streptococci and staphylococcus (representing 75% or so of all cases). Enterococcal infections account for many of the remaining cases, although small series and case reports suggest almost all organisms that infect humans can be implicated at times. A sizeable number of "culture-negative" cases still occur despite all the improvements in diagnostic methodology. Recent guidelines for the diagnosis, treatment, and management of infective endocarditis from the American Heart Association are reviewed and the issues surrounding prophylaxis are summarized. International cooperative databases are now being developed that hold promise for a continual reexamination of the epidemiology of this highly aggressive disease and may help provide sorely needed prospective trial data that will enhance our understanding and treatment.
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PMID:Update on infective endocarditis. 1654 54

Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone-patellar-tendon-bone allograft.
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PMID:Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft. 1768 31

As the usual pathogen spectrum of a late-onset (>12 month post-operatively) prosthetic valve endocarditis is similar to normal valve endocarditis, with the exception of coagulase-negative staphylococcus, a prosthetic valve endocarditis caused by unusual bacterial pathogens represents a therapeutic and diagnostic dilemma. The lack of well established criteria or clinical experience for the management of such infections makes therapy and prognosis difficult to determine. A case of successfully treated Gemella morbillorum prosthetic valve endocarditis and a review of the relevant literature are presented.
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PMID:Mechanical valve endocarditis caused by Gemella morbillorum. 1803 41

Acute postinfectious glomerulonephritis (APIGN) is uncommon in adults, and its incidence is progressively declining in developed countries. To our knowledge there are no modern North American series addressing epidemiology and outcome. Here we report the clinical and pathologic findings in 86 cases of adult APIGN diagnosed by renal biopsy in a large New York referral center between 1995 and 2005. The male:female ratio was 2:1, and mean age was 56 years, with 33.7% aged older than 64 years. Of the patients, 38.4% had an immunocompromised background, including diabetes (29.1%), malignancy (4.7%), alcoholism (2.3%), acquired immunodeficiency syndrome (AIDS) (2.3%), and intravenous drug use (1.2%). The most common sites of infection were upper respiratory tract (23.3%), skin (17.4%), lung (17.4%), and heart/endocarditis (11.6%). The 2 most frequently identified infectious agents were streptococcus (27.9%) and staphylococcus (24.4%). Hypocomplementemia was present in 73.9% of patients. The most common histologic patterns were diffuse (72.1%), focal (12.8%), and mesangial (8.1%) proliferative glomerulonephritis. Outcome analysis was performed on the 52 patients with a follow-up of >/=3 months (mean, 25 mo). Among the 41 patients without underlying diabetic glomerulosclerosis, 23 (56.1%) achieved complete remission, 11 (26.8%) had persistent renal dysfunction, and 7 (17.1%) progressed to end-stage renal disease (ESRD). Of the 11 patients with underlying diabetic glomerulosclerosis, 2 (18.2%) had persistent renal dysfunction, and the remaining 9 (81.8%) progressed to ESRD (p < 0.001). In patients without underlying diabetic glomerulosclerosis, correlates of complete remission were younger age, female sex, lower serum creatinine at biopsy, and absence of immunocompromised state. By multivariate analysis, age and serum creatinine at biopsy inversely correlated with complete remission, and serum creatinine at biopsy was the only correlate with ESRD. Outcome did not correlate with any pathologic feature (including crescents) or steroid treatment. Diabetes and aging have emerged as major risk factors for adult APIGN. Full recovery of renal function can be expected in just over half of patients, and prognosis is dismal in those with underlying diabetic glomerulosclerosis.
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PMID:Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. 1820 67

The aim of the study was to describe the epidemiological and clinical aspects of native valve infective endocarditis (IE) in a Tunisian high-volume tertiary care center and to identify the predictors of outcome. Demographic, clinical, laboratory, and echocardiographic characteristics were examined in 134 patients who fulfilled the modified Duke criteria for native valve IE between January 1997 and December 2006. Logistic regression analysis was used to identify prognostic factors for death. Mean age was 34.22 years. Diagnosis was definite in 93% of cases. Median time to diagnosis was 21 days. Rheumatic heart disease (RHD) was the predominant (45%) underlying heart condition. One or more vegetations were detected in more than 93% of cases. The median size of vegetation was >15 mm in 28% of cases. In 66 cases (49%), cultures remained negative. Serology was positive in 15 cases, and in 4 cases leaflet culture identified the agent. The infective agent was identified in 87 cases (65%), causative microorganisms were mainly Staphylococci (n = 30, including 6 coagulase-negative Staphylococcus), and Streptococci (n = 32). Overall mortality was 19%. On multivariate analysis, congestive heart failure (hazard ratio = 5.34, 95% confidence interval 1.67 to 17.15, p = 0.005) and large vegetations (>15 mm; hazard ratio = 5.78, 95% confidence interval 1.84 to 18.32, p = 0.002) were predictive of in-hospital mortality but not neurological complications or staphylococcus IE. In conclusion, IE remains a serious disease affecting a young population in Tunisia, with RHD as still the most common underlying heart disease, and it is associated with a high mortality.
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PMID:Native valve infective endocarditis in a tertiary care center in a developing country (Tunisia). 1894 Mar 1


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