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

Infective endocarditis, a microbial infection of the endocardium, is a complex multifaceted disease that may affect any organ system. Despite advances in diagnostic technology and treatment, overall mortality rates from infective endocarditis remain between 15-45%, and as high as 40-70% among the elderly. Explanations for the persistence of high mortality rates have focused on delays or errors in diagnosis. The classic diagnostic triad of fever, cardiac murmur, and positive blood cultures are not always present. Elderly patients often have more non-specific symptoms than do younger patients. Infective endocarditis should be considered in conditions dominated by the insidious onset of congestive heart failure, acute mental status or neurological changes, or the acute onset of arthralgias or myalgias. This article reviews the pathogenesis, epidemiology and etiology, risk factors, and clinical presentations of infective endocarditis, as well as current recommendations for antibiotic prophylaxis.
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PMID:The prevention and diagnosis of infective endocarditis. The primary care provider's role. 797 Mar 20

Infective endocarditis remains a common condition for pathologists interested in cardiology who fortunately examine more infected valves excised surgically (66 in 1992) than observed at autopsy after death from this condition (2 in 1992). The authors discuss the elementary valvular lesions (ulceration and vegetations), the severity of which affects the prognosis, and the special aspects of these ulcerating vegetations with respect to their location (aortic, mitral, pulmonary and tricuspid), to the type of underlying valvular disease (rheumatic, myxoid or calcific) and infecting organism. The extravalvular complications are then reviewed: annular abscess (and possible extensions), purulent pericarditis, parietal endocarditis, myocarditis and coronary embolism. The authors attempt to answer questions about infective endocarditis from the pathologist's viewpoint: the difference between acute and subacute endocarditis, the reality of infective lesions of "healthy hearts", the role of the pathologist in the detection of pathogenic organisms, the evolution of lesions after sterilisation. The particular situation of prosthetic valve (biological or mechanical) endocarditis is treated in detail. The role and possibilities of surgery, the value of which is now universally accepted (the mortality of severe infective endocarditis has been lowered from 50-60% to 10-20% by a good operative strategy) are emphasised throughout.
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PMID:[Cardiac lesions in bacterial endocarditis: from findings of pathology to possibilities and limits of surgery]. 802 86

Streptococcus viridans continues to be the most frequent causal agent of infective endocarditis. Treatment has become more complicated due to the increase in resistance to penicillin and cephalosporins. In order to study the possible efficacy of teicoplanin at low and high doses, this antibiotic was investigated in rabbits as a monotherapy and in association with gentamicin. The effects were compared with a control group and a group given classical penicillin-gentamicin treatment. Infective endocarditis was induced in 120 rabbits with a clinical isolate of Streptococcus sanguis. Treatment was started 48 h after infection, and lasted 5 days. Animals were divided into 6 groups of 20 rabbits each: G1, untreated controls; G2, penicillin+gentamicin; G3 low-dose teicoplanin; G4, low-dose teicoplanin+gentamicin; G5, high-dose teicoplanin; and G6, high-dose teicoplanin+gentamicin. Response to therapy was evaluated with mortality curves, negativization of blood cultures, concentration of S. sanguis in aortic vegetations and rate of sterilization of vegetations. Vegetation weight was significantly lower in treated groups than in controls; lower weights were found in G4, the only treatment that sterilized 65% of vegetations. Death occurred only in the control group (10% mortality). Negativization of blood cultures was greatest and most rapid in G4, followed by G6. Concentrations of S. sanguis in aortic vegetations were significantly lower in all treated groups compared with controls, with the lowest being in groups G4 and G6. Combined treatment with teicoplanin+gentamicin may be highly efficacious in patients with endocarditis caused by penicillin-resistant Streptococcus sanguis. High-dose teicoplanin+gentamicin does not seem to be more efficacious than low-dose teicoplanin+gentamicin.
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PMID:Treatment of experimental endocarditis caused by penicillin-resistant Streptococcus sanguis with different doses of teicoplanin. 805 83

Infective endocarditis of the aortic prosthesis is a serious complication of valve surgery. The correction of this condition is difficult and complex procedures are often required. Two patients with aortic bioprosthetic endocarditis complicated with annular abscesses were operated on. The aortic valve was replaced with a bioprosthesis and the annular abscesses were debrided and closed with the aid of gelatin-resorcin-formalin (GRF) glue, which completely sealed the abscess cavities. One year later the patients were asymptomatic and had no clinical or echocardiographic signs of aortic incompetence.
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PMID:Annular abscesses and GRF glue. 805 32

Infective endocarditis continues to be a cause of significant cardiac morbidity and mortality. To improve the prognosis of patients with this disorder, early diagnosis is crucial but difficult to establish on the basis of clinical parameters alone. Echocardiography, both transthoracic and transesophageal techniques, has a major role in the detection of vegetations that are the hallmark of endocarditis. Valvular and perivalvular complications can also be well assessed by echocardiography. With the improved resolution provided by recent technologic advances in echocardiography, vegetations can be reliably detected in most patients with endocarditis. We propose that present diagnostic criteria for endocarditis be revised to include echocardiographic findings as a major parameter in the diagnosis. Finally, a diagnostic approach incorporating transthoracic and transesophageal echocardiography in these patients will be discussed taking into consideration the different degrees of clinical suspicion for the existence of the disease.
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PMID:Application of transthoracic and transesophageal echocardiography in the diagnosis and management of infective endocarditis. 806 Jun 46

Infective endocarditis (IE) may be considered as a disease in evolution because of changes occurred in the last decades in epidemiologic and clinical aspects. M-mode, two-dimensional, Doppler and color Doppler echocardiography allowed major advances in diagnosis and management of patients with IE. More recently, transesophageal echocardiography has been introduced in clinical practice with excellent results, because of unsurpassed quality of images able to early recognize small vegetations and complications of infective process. The authors report 13 cases of IE observed from March 1991 to March 1993. Streptococcus viridans was detected in 46% of cases and enterococcus species in 23%. Culture negative endocarditis represented 31% of total cases. Mitral valve was most frequently involved (67% of cases of native valves), followed by aortic valve (22%) and tricuspid valve (11%). In 30% of cases a prosthetic valve was involved. A presumed portal of entry has been identified, in 69% of cases, in oral cavity during dental procedures; in 2 cases an asymptomatic colonic carcinoma was detected. Diagnostic sensitivity of transesophageal echocardiography was 100%. Only 1 patient died during hospitalization. Cardiac surgery was performed in 4 patients (33%). The antibiotic drug teicoplanine has been successfully employed in 54% of cases.
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PMID:[Infective endocarditis. Recent progress in its epidemiology, clinical picture and therapy. Comments on cases]. 807 37

Bacterial endocarditis may present with acute chest pain due to coronary embolization and mimics acute myocardial infarction secondary to coronary atherosclerosis. We present the first case report of coronary embolization secondary to aortic valve endocarditis treated with standard doses of streptokinase and aspirin. The patient survived but sustained a large myocardial infarction and a major gastrointestinal bleed. Infective endocarditis should be considered in all patients presenting with acute chest pain. When myocardial infarction is due to coronary embolism from endocarditic valves standard thrombolysis regimes should be avoided.
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PMID:Acute coronary embolism complicating aortic valve endocarditis treated with streptokinase and aspirin. A case report. 808 59

Infective endocarditis, resulting from deposition of circulating microorganisms during a period of bacteremia on damaged endothelial heart valves, remains a serious disease. Its overall incidence did not decline in recent years, 24 cases/year/million inhabitants, in France. This can be explained by a modification of the type of underlying cardiac conditions with regression of rheumatic fever and increase of degenerative heart diseases, prosthetic valves and mitral valve prolapse. The risk of bacterial seeding on a damaged valve remains difficult to evaluate, the highest risk being for patients with prosthetic valve, previous infective endocarditis and cyanotic congenital heart disease. A case-control study, done in 1991, confirmed that procedures are risk factors for infective endocarditis and that the multiplicity of procedures increases the risk. A French consensus conference on the prophylaxis of infective endocarditis has updated the recommendations for antibiotic prophylaxis. Two groups of cardiac patients were identified, based on the incidence and the severity of endocarditis occurring in patients with these conditions, 1) patients considered at risk which require specific prophylaxis, and 2) patients considered non at risk which do not require antibiotic prophylaxis. Procedures which require antibiotic prophylaxis are dental procedures and specific gastrointestinal and urologic procedures. As complex protocols are associated with poor compliance by practitioners and patients, the jury has aimed for simplicity and feasibility.
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PMID:[Infectious endocarditis, risk factors, prevention. Research group for infectious endocarditis and jury of the consensus conference]. 819 Nov 7

Infective endocarditis in pregnancy is uncommon. A 37-week pregnant woman presented with infective endocarditis. Echocardiography revealed prominent mitral valve vegetations. The patient underwent cesarean section and a 2,800 g male infant was delivered. In order to prevent embolization, mitral valve replacement was performed 3 days after cesarean section with SJM valve. Both mother and child are doing well now.
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PMID:[A case report of mitral valve replacement for infective endocarditis in pregnancy]. 820 89

Infective endocarditis is a serious disease associated with high mortality. Patients surviving recurrent bouts of infective endocarditis are reported infrequently. We report on a non-drug abuser patient who experienced seven episodes of infective endocarditis--the largest number reported to our knowledge in a single non-drug abuser patient.
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PMID:Recurrent infective endocarditis. 829 Apr 17


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