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

The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.
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PMID:Endocarditis due to rare and fastidious bacteria. 1114 9

Infection with Lactobacillus is rare, and only a handful of species have been identified as being clinically significant: Lactobacillus casei, Lactobacillus rhamnosus, and Lactobacillus leichmannii. The literature contains one case report of bacteremia caused by Weissella confusa (basonym: Lactobacillus confusus), but the clinical significance of the infection was unclear. We describe a case of W. confusa bacteremia in a 46-year-old man with a history of abdominal aortic dissection and repair. This procedure was complicated by gut ischemia, which necessitated massive small bowel resection. He subsequently developed short-bowel syndrome, which required him to have total parenteral nutrition. He later developed an Enterococcus faecalis aortic valve endocarditis that required a coronary artery bypass graft and aortic root replacement with homograft and 6 weeks of intravenous ampicillin and gentamicin. Three months prior to his most recent admission, he was diagnosed with Klebsiella pneumoniae bacteremia and candidemia. At the present admission, he had fever (T(max), 39.5 degrees C) and chills of 2 days' duration and was admitted to the intensive care unit because of hemodynamic instability. Blood cultures grew K. pneumoniae and W. confusa in four of four blood culture bottles (both aerobe and anaerobe bottles). Imaging studies failed to find any foci of infection. A transesophageal echocardiogram revealed no vegetations. A culture of the patient's Hickman catheter tip was negative. The patient was treated with piperacillin-tazobactam and gentamicin. His condition improved, and he was discharged home, where he completed 4 weeks of piperacillin-tazobactam therapy. Lactobacillemia seldom results in mortality; however, it may be a marker of a serious underlying disease. It is usually seen in patients who have a complex medical history or in patients who receive multiple antibiotics. Lactobacillus spp. are generally associated with polymicrobial infections, and when isolated from the blood, they need to be considered possible pathogens. The presence of a vancomycin-resistant, gram-positive coccobacilli on a blood culture should alert clinicians to the possibility of bacteremia caused by W. confusa or other small gram-positive rods.
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PMID:Weissella confusa (basonym: Lactobacillus confusus) bacteremia: a case report. 1128 96

Bacteremia is associated with high morbidity and mortality. Nosocomial bacteremia is associated with an attributable mortality of 35%. In order to characterize the etiological agent of bacteremia cases during two time periods, 6605 patients were studied as follows: 1) from 1980 to 1982 (n = 2401) and 2) from 1988 to 2000 (n = 4204). A total of 596 cases of bacteremia were detected. The most frequent agents were Staphylococcus aureus, negative coagulase (CNS) Staphylococcus, Klebsiella pneumoniae and Escherichia coli. In the second period, an increase in the frequency of bacteremia caused by gram positive bacteria, particularly gram-positive cocci, was noted. Conversely, gram negative bacteria diminished significantly in the second period, specially enterobacterial species. Methicillin-resistant S. aureus and CNS were significantly more frequently isolated in the second period. Infrequent agents of endocarditis, such as Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and Corynebacterium urealyticum, were isolated.
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PMID:[Bacteremia in 2 hospitals in Rosario, Argentina]. 1458 80

Klebsiella pneumoniae is the leading cause of liver abscess in diabetic patients in Taiwan. We report the case of a diabetic patient with a history of four episodes of K. pneumoniae liver abscess within 3 years. The patient later developed Streptococcus bovis bacteremia originating from a colon tumor with complications of endocarditis, osteomyelitis, and silent splenic abscess. Occult colon tumor may have played an important role in our case, with recurrent infection arising from colonizers of the gastrointestinal tract. As our case shows, the possible association between occult colon tumor and K. pneumoniae liver abscess in diabetic patients should be surveyed.
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PMID:Recurrent Klebsiella pneumoniae liver abscess in a diabetic patient followed by Streptococcus bovis endocarditis--occult colon tumor plays an important role. 1585 82

We report the case of a 71-year-old woman who presented with persistent high fever and progressive weakness for 10 days. Klebsiella oxytoca infective endocarditis was diagnosed based on four sets of positive blood culture of K. oxytoca together with fluttering vegetation (0.6 cm in diameter x 1.3 cm long) on the base of the anterior mitral leaflet. The diagnosis was documented using transthoracic and transesophageal echocardiograms. After 4 weeks of intravenous cefazolin therapy, the patient completely recovered.
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PMID:Community-acquired Klebsiella oxytoca endocarditis: a case report. 1623 15

Three episodes of bacteremia occurred in the course of prosthetic valve endocarditis caused by an extended-spectrum-beta-lactamase (ESBL)-producing Klebsiella pneumoniae strain. The second isolate developed resistance to ciprofloxacin and the third isolate to piperacillin-tazobactam (PIP-TZ) following sequential therapy with each agent. The first isolate was resistant to PIP-TZ only at high inocula, the second isolate acquired increased transcription of the acrA gene, and the third isolate became resistant to PIP-TZ due to loss of beta-lactamase inhibition by TZ. We question if and how PIP-TZ susceptibility should be reported for ESBL-producing Enterobacteriaceae.
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PMID:Endocarditis caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: emergence of resistance to ciprofloxacin and piperacillin-tazobactam during treatment despite initial susceptibility. 1694 Jan 24

Eustachian valve endocarditis is a rare condition that affects mostly injectable drug users and patients using pacemakers or central venous catheter. We describe the case of a patient who underwent myocardial revascularization with extracorporeal circulation and who presented Eustachian valve endocarditis in the postoperative period, diagnosed by echocardiogram. The blood culture identified Klebsiella pneumoniae. He received appropriate antibiotic therapy and presented resolution of the condition within four weeks.
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PMID:Eustachian valve endocarditis. 1754 56

Tigecycline has been investigated in combination with other antibacterials against a wide range of susceptible and multiresistant Gram-positive and Gram-negative bacteria. Combinations have been analysed in vitro, in animal models and in human case reports. In vitro, tigecycline combined with other antimicrobials produces primarily an indifferent response (neither synergy nor antagonism). Nevertheless, synergy occurred when tigecycline was combined with rifampicin against 64-100% of Enterococcus spp., Streptococcus pneumoniae, Enterobacter spp. and Brucella melitensis isolates. Combinations of tigecycline with amikacin also showed synergy for 40-100% of Enterobacter spp., Klebsiella pneumoniae, Proteus spp. and Stenotrophomonas maltophilia isolates. Moreover, bactericidal synergisms occurred with tigecycline plus amikacin against problematic Acinetobacter baumannii and Proteus vulgaris, and with colistin against K. pneumoniae. Data from animal experiments and case reports, although limited, displayed consistent beneficial activity of tigecycline in combination with other antibacterials against multiresistant organisms, including vancomycin against penicillin-resistant S. pneumoniae in experimental meningitis, gentamicin against Pseudomonas aeruginosa in experimental pneumonia, daptomycin against Enterococcus faecium endocarditis, and colistin against K. pneumoniae bacteraemia and P. aeruginosa osteomyelitis. Antagonism was extremely rare in vitro and was not reported in vivo. Thus, tigecycline may be combined with a second antimicrobial as part of a combination regimen.
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PMID:Tigecycline in combination with other antimicrobials: a review of in vitro, animal and case report studies. 1916 49

Klebsiella pneumoniae primary liver abscess (KPLA) is an emerging disease that is associated with distant septic complications. We report the first case of KPLA associated with infective endocarditis. The K. pneumoniae strain was a hypermucoid K2 serotype carrying the rmpA virulence-associated gene.
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PMID:K2 serotype Klebsiella pneumoniae causing a liver abscess associated with infective endocarditis. 2000 81

The authors report a rare presentation of bilateral Klebsiella pneumoniae endophthalmitis in an ambulatory patient without other known medical conditions. A 51-year-old Chinese woman presented with severe bilateral reduction in vision, photophobia, pain, and eyelid swelling. Hospital admission and evaluation revealed vitreous, blood, and urine cultures positive for K. pneumoniae (K1 serotype). Additional work-up revealed endocarditis, multiple liver abscesses, brain abscesses, and left lobar pneumonia. The patient underwent multiple bilateral intravitreal antibiotic injections. Ultimate visual acuity was no light perception in both eyes. K. pneumoniae endogenous endophthalmitis is a severe but potentially subclinical disease. Early diagnosis requires a high index of suspicion and recognition of risk factors including Asian ancestry and other sources of systemic infection including, most commonly, liver abscess.
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PMID:Bilateral Klebsiella pneumoniae (K1 serotype) endogenous endophthalmitis as the presenting sign of disseminated infection. 2132 88


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