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

The clinical profile of 28 consecutive patients admitted with infective endocarditis (IE) between 1987 and 1988 was studied. There were 21 males and seven females with a mean age of 24 +/- 11 years. Rheumatic heart disease (RHD) was the commonest underlying disease (68%) followed by congenital heart disease (CHD). Mitral regurgitation with aortic regurgitation were the commonest valvular lesions (47%) in those with RHD while ventricular septal defect was the commonest (43%) in those with CHD. A younger age of onset, complicated course and high mortality were seen in these six patients with acute IE. Persistently positive blood cultures during life or at autopsy were obtained in 21%. Strep viridans was the commonest isolate and was often resistant to streptomycin. 2D echocardicgram revealed vegetations in 96% of patients, the aortic valve (39%) being more commonly affected than the mitral valve (11%). ESR of more than 20 mm drop 1st hour (Wintrobe) was seen in 96%. Thrombophlebitis was a common complication of therapy and cloxacillin the commonest drug implicated. A mortality of 21% as a result of refractory congestive heart failure (CHF) (50%), uncontrolled sepsis (33%) and embolic events (17%) was seen. A rising incidence of culture negative IE, combined aortic and mitral valve disease and CHF is noted.
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PMID:Changing spectrum of clinical and laboratory profile of infective endocarditis. 130 28

A total of 99 cases of viridans streptococcal endocarditis encountered during the period of 1973 and 1990 at the Veterans General Hospital-Taipei were reviewed to evaluate its prognostic factors. Applying strict clinical and laboratory criteria, 24 cases were categorized as definite, 44 probable, 23 possible and 8 likely. The symptoms were frequently subtle and atypical but initial laboratory tests gave useful indications: 69.1% with leukocytosis, 78% with anemia, 58.5% with elevation of LDH level, 88.9% with elevation of ESR value and 100% with elevation of CRP level. Furthermore, 32.4% of the cases demonstrated proteinuria and 67.4% microscopic hematuria. Seventy-three of the subjects had a history of underlying heart disease, predominantly rheumatic heart disease. Histological examination and echocardiography revealed that 51 patients suffered from vegetative endocarditis, 7 (13.7%) of whom were found to have anatomically confirmed vegetations without initial echocardiographic evidence, Vascular events were seen in 61 cases (61.6%): peripheral stigmata (32 cases), cerebral vascular accidents (17 cases), pulmonary embolism (10 cases) and others (2 cases). The overall mortality rate was 18.2%. Congestive heart failure with embolization was the most common cause of death in this group. The presence of vegetation was not well correlated with embolic events. There was no statistically significant association between the mortality and the following characteristics: age, sex, underlying heart disease, evidence of echocardiographically detected vegetations, major surgical intervention and recurrent cases except for embolic events (p less than 0.01). In conclusion, viridans streptococcal endocarditis complicated embolic events usually presented with a fulminant course and a grave outcome.
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PMID:Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases. 165 35

A 69-year-old man without previous cardiac disease was found over the last 9 months to have a markedly elevated erythrocyte sedimentation rate (ESR: 120 mm/1. h), haemolytic anaemia (haemoglobin 8.2 g/dl, lactate dehydrogenase 304 U/l), markedly reduced exercise tolerance, backache and weight loss of 5 kg. Radiological, biochemical and endoscopic examinations failed to provide a diagnosis. Nine blood cultures grew, at normal body temperature, Cardiobacterium hominis, a rare Gram-negative organism which can cause endocarditis. Echocardiography revealed endocarditis of the aortic valve with regurgitation. Despite protracted and high-dosage antibiotics (4 times daily 10 million U penicillin G for 6 days, followed by four times 5 million U penicillin G for 6 days, followed by four times 5 million U daily for five weeks, and three times daily 60 mg gentamycin for 10 days), as well as treatment of extensive chronic parodontitis, anaemia, haemolysis and increased ESR have now persisted for over a year, with negative blood cultures. Immune-complex phenomena are thought to be the reason for the persistence of signs of infection.
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PMID:[A protracted course in Cardiobacterium hominis endocarditis]. 182 63

We present a case history of 29-year old female with infective endocarditis, who was admitted 15 months after neurosurgical treatment of disruption of cerebral aneurysm. The diagnosis of organic heart disease had been established in her childhood. 6 months after discharge from neurosurgery she developed marked dyspnoea on exertion and became febrile (up to 39.0 C). The presumptive diagnosis of infective endocarditis was established 6 months later, when she developed the symptoms and signs of severe anaemia with ESR 170 mm/hr although blood cultures were negative. The patient underwent treatment with Penicillin and Debecillin. On admission to our Institute echocardiography showed a very large, mobile vegetation in the left ventricle, connected to the anterior leaflet of mitral valve. Decision of mitral valve replacement was made, but rupture of the next cerebral aneurysm was the reason of unexpected, sudden death of the patient. The postmortem examination revealed 7 x 4 cm large vegetation, with the mass of 7.0 g. Histologically the vegetation consisted of mass of fibrin strands, platelets and blood cell with inflammatory cells. On its base the signs of the process of organization were marked. This vegetation was the largest one that we found in literature on this subject.
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PMID:[Unusually large vegetation on the mitral valve in a patient with bacterial endocarditis]. 194 48

Corynebacterium sp. are found as normal flora in skin and mucosal sites. They have been isolated in empyemas, brain abscesses, blood cultures and ventricular shunts. About 9-10% of early-onset and 4-5% late-onset prosthetic valve endocarditis are due to different species of the so-called "diphteroids". A 30 year-old white female was admitted after 30 days with fever of undetermined origin. A mitral prosthesis had been fitted in 1977. On physical examination a protomesosystolic mitral murmur, petechiae, retinal hemorrhages and hepatosplenomegaly were detected. Laboratory tests showed 37% hematocrit, 14,800/mm3 white blood cells, 78 mm ESR, urinary sediment: less than 30/h.p.f. red blood cells. A new first-degree A-V block was detected. Blood cultures were negative. Due to persistent fever, progressive anemia, leukocytosis and new vegetations on echocardiogram, surgery was performed. A mitral valve ring abscess was found. Corynebacterium xerosis was isolated from surgical specimens. The strain was found susceptible to penicillin, ampicillin, oxacillin, ticarcillin, piperacillin, cephalotin, cefoxitin, cefoperazone, rifampin, gentamicin, amikacin, and norfloxacin. Studies with clindamycin, disclosed MIC and MBC = 0.25 mg/l. The patient received 1800 mg/day clindamycin for 4 weeks. Serum cidal studies showed a peak concentration 1/128 and a titre of trough 1/4. Negative control blood cultures were obtained. She has remained well for nine months after treatment. Corynebacterium sp. can cause "apparently" negative blood cultures. Blood samples should be incubated for more than 15 days before they can be considered negative. Almost 50% of previously described cases have been detected during the six months after cardiac surgery. Mortality has been high (48%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Endocarditis due to Corynebacterium xerosis]. 263 Aug 75

In 851 predominantly adult patients with septicaemia or endocarditis data regarding white blood cell (WBC) count, platelet count, ESR and C-reactive protein (CRP) obtained within 3 days of admission were analyzed retrospectively. Among 232 patients with complete laboratory data none had the combination of normal ESR, negative CRP and lack of both leukocytosis and thrombocytopenia. CRP was positive (greater than 10 mg/l) in 93%, ESR was elevated (greater than 20 mm/h) in 90%, leukocytosis (WBC greater than 9 X 10(9)/l) was present in 60% and thrombocytopenia (platelets less than 150 X 10(9)/l) in 35% of the patients. Patients with pneumococcal infection had generally higher ESR and CRP values and WBC counts than patients with other infections.
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PMID:Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis? 377 77

An analysis was made of 91 cases of infective endocarditis (IE) with regard to causative organisms and their sensitivities to various antibiotics, the clinical features of the disease, the laboratory test results and other items were important in establishing a diagnosis of IE. The number of cases of IE has shown a tendency to increase in recent years, particularly in the number of elderly patients, and the ratio of total cases consisting of prosthetic valve endocarditis (PVE) has shown a sharp increase. The most common causative organism is still Streptococcus viridans, but there has been an increase in the incidence of IE due to benzyl-penicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis and other fastidious organisms. The percentage of underlying diseases represented by combined valvular diseases has been increasing, while the primary known cause of the infection of IE was dental treatments. A positive value for CRP, an accelerated value for ESR, leukocytosis, anemia, a decrease in serum Fe, a positive value for RA-T, were all parameters which showed a high correlation with IE, and these should be useful in establishing the diagnosis of IE. The use of cardioechography to detect cardiac vegetation is important in relation to establishing the diagnosis and prognosis of IE, and the evaluation of the therapeutic results.
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PMID:Current diagnosis of infective endocarditis. 389 10

The authors describe 3 cases of left atrial myxoma confirmed by two-dimensional echocardiography and at operation. One patient had the symptoms of embolisms to the cerebral and renal vessels in the absence of heart disease, 2 patients presented with the symptoms of congestive heart failure. In one patient, loud first sound as well as systolic and diastolic murmur at the heart apex were documented. The nonspecific manifestations (weight loss, fever, high ESR, dysproteinemia, and rheumatoid factor) were observed in all the cases. The difficulties encountered in the clinical diagnosis of heart myxoma are discussed. The differential diagnosis is made between valvular heart disease and infective endocarditis, systemic vasculitis, cardiomyopathy, etc. Echocardiography to exclude myxoma should be performed in patients with thromboembolism, rheumatic valvular disease, subacute endocarditis (particularly in the absence of the classical symptoms) and in those with fever of unknown origin.
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PMID:[Clinical characteristics of myxoma of the heart]. 401 32

We conducted a retrospective study to characterize the clinical course, microbiologic spectrum, and risk factors for endocarditis and for associated mortality in a large series of patients with documented pacemaker endocarditis. Using a computerized search through the medical records of 10 major hospitals in Israel from 1982 to 1992, and carefully reviewing the charts, we identified 44 patients with pacemaker endocarditis. The cases were categorized as definite (n = 25), probable (n = 12), or possible (n = 7) infective endocarditis based on strict case definition. Fever and chills were the most common symptoms. Increased ESR, leukocytosis, microscopic hematuria, and anemia were the most common laboratory findings. A relatively high proportion of the patients were diabetic. The most common source of endocarditis was infection acquired by the placement procedure or infection of the pacemaker pouch. Demographic, clinical, and laboratory features were similar to those of endocarditis patients of a similar age range without pacemakers, although the frequency of fever and chills was higher in our patients than in those patients and splenomegaly, vascular embolic phenomena, and new or changing murmurs were rare in our patients. The major pathogens were Staphylococcus aureus and Staphylococcus epidermidis, similar to other series of pacemaker-associated bacteremia and similar to the microbiologic findings of early prosthetic-valve endocarditis. However, this microbiologic profile is different from that of native-valve endocarditis. Although the present series did not show a statistically significant advantage to electrode removal over conservative treatment, when analyzed together with pooled data from other studies, it suggests that the surgical approach is preferable.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pacemaker endocarditis. Report of 44 cases and review of the literature. 798 81

We describe a case of enterococcus endocarditis in a 74-year-old woman with hypercholesterolemia, porcine aortic valve, and osteoarthritis. She presented with the abrupt onset of severe back pain, proximal myalgia, and left knee synovitis, associated with an anemia and marked elevation of ESR. She was misdiagnosed as having polymyalgia rheumatica until both the synovial fluid and blood cultures grew enterococcus. Her musculoskeletal symptoms totally resolved with antibiotic treatment. Septic arthritis is a rare manifestation of bacterial endocarditis. However, one-third of all cases of bacterial endocarditis have musculoskeletal symptoms. These include backache, arthritis of the peripheral joints, and diffuse myalgia and arthralgia. Unexplained rheumatic complaints should alert us to the possibility of bacterial endocarditis.
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PMID:Bacterial endocarditis and septic arthritis presenting as polymyalgia rheumatica. 811 70


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