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

Marantic endocarditis (ME) is defined by noninfectious valvular vegetations. The most common disorders associated with ME are malignancy with or without hypercoagulable state, intercardiac instrumentation, residual vegetations from previously treated infective endocarditis (IE), renal insufficiency, and burns. Another important cause of ME is systemic lupus erythematosus when accompanied by vegetations, that is, Libman-Sacks endocarditis. ME should be differentiated from IE because they may present with similar clinical features. Both ME and IE may present with fever and a heart murmur with or without embolic phenomenon. Leukocytosis and elevated erythrocyte sedimentation rate suggest the diagnosis of IE. The hallmark of IE is a cardiac vegetation and continuous high-grade bacteremia. After exclusion of the causes of culture negative endocarditis, the absence of bacteremia clearly differentiates ME from IE. We present a case of ME mimicking acute bacterial endocarditis (ABE). The differential diagnostic features of ME versus IE are discussed. To the best of our knowledge, this is the first reported case of quadrivalvular ME with massive vegetations on all cardiac valves, as well as the aorta, atria, and pulmonary artery.
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PMID:Quadrivalvular marantic endocarditis (ME) mimicking acute bacterial endocarditis (ABE). 1736 97

Little is known about the incidence and clinical outcomes of infective endocarditis (IE) involving native valves in Asian countries. This nationwide study investigated epidemiologic features and in-hospital mortality associated with IE in adults (age > or =18 years) based on Taiwan's National Health Insurance database from 1997 through 2002. Of 7,240 enrolled patients with IE involving native valves, the mean age was 53 +/- 19 years and 70% were men. The mean annual crude incidence was 7.6 per 100,000 inhabitants. The incidence was significantly higher in men than in women (10.4 vs 4.6 per 100,000; p <0.001). The incidence of IE increased steadily with age, ranging from 3.8 per 100,000 persons in patients <30 years of age to 33 per 100,000 persons in patients > or =80 years of age (p <0.001). Staphylococcal (32%) and streptococcal species (61%) were the most common causative pathogens. The mean in-hospital mortality rate was 18%. Multivariate analysis showed that male gender, older age (> or =50 years), diabetes mellitus, heart failure, neurologic complications, renal insufficiency, respiratory failure, shock, and Staphylococcus species as the causative microorganism were independent predictors of in-hospital mortality. In conclusion, this Taiwanese study revealed a high incidence of IE in men and elderly subjects. The in-hospital mortality rate remained high. Patients with IE who also developed shock and respiratory failure were the most likely to have a poor outcome.
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PMID:Epidemiologic features of infective endocarditis in Taiwanese adults involving native valves. 1792 Mar 71

In the study we described severe adverse events such as sepsis and bacterial endocarditis in the patient treated because of chronic hepatitis C (CHC). A case of 57 year old man with CHC, with recurring increased aminotransferases up to 100 IU/l; histological result of liver biopsy--G3, S2, HCV-RNA positive, genotype--HCV1b. The therapy with peginterferon alfa and ribavirin was introduced. The negative result of HCV RNA was obtained in 12th week of treatment. In the 7th month the patient was admitted to the hospital because of sepsis due to Escherichia coli, acute renal insufficiency and right orchitis. In spite of the treatment and general clinical improvement, the patient was still febrile. The bacterial endocarditis was found after number of diagnostic procedures. The treatment of endocarditis lasted 6 weeks in the hospital. During the hospitalization and 6 months after the HCV-RNA were performed with the negative results. The therapy of CHC with peginterteron and ribavirin is save in most cases however requires increased clinical surveillance, especially in the second half-year.
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PMID:[Bacterial endocarditis in the course of sepsis in 7th month of treatment with peginterferon alfa and ribavirin in patient with chronic hepatitis C]. 1835 Jul 23

In the last 30 years, major improvements have been made in understanding the pathogenesis, diagnosis and treatment of infective endocarditis. Nevertheless, mortality still remains high, close to 30-40% at 1 year, and its reduction remains the main challenge. Moreover, important epidemiological changes have been recorded. Social changes in Western countries have led to an increase in the mean length of life, and thus in degenerative valvular diseases, whereas rheumatic heart disease has almost disappeared. Increasing medicalization has led to a rise in complications and diseases related to longer hospital stay, surgical therapies and other invasive interventions. At the same time, there is an increase in immunosuppressive therapies, diseases such as cancer, diabetes mellitus and renal insufficiency that may enhance the disease. Further knowledge is needed for specific subgroups to improve both treatment and prognosis. Nevertheless, randomized trials are lacking to guide the management of the disease, and the role and indications of antibiotic prophylaxis are still the subject of debate. International multicenter studies are providing new important findings based on the experience of tertiary centers; these results may reflect referral biases. The proposal of an Italian national registry on infective endocarditis (RIEI) will overcome these limitations and provide a wide picture of the national presentation of the disease. The aim of the registry is to improve the management of infective endocarditis, through a better understanding of demographic, clinical, therapeutic and prognostic features of the disease in the real world. The background, rationale, aims and expected results of the registry are reviewed.
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PMID:Infective endocarditis in the real world: the Italian Registry of Infective Endocarditis (Registro Italiano Endocardite Infettiva - RIEI). 1840 5

Infective endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA) is increasing. Vancomycin and teicoplanin are 2 intravenous glycopeptides appropriate for its treatment. There is no human study comparing teicoplanin and vancomycin for the treatment of MRSA endocarditis. Between 1996 and 2006, 51 MRSA endocarditis patients were treated at the authors' hospital. There were 29 patients with nosocomial infection; 15 were treated with teicoplanin. Teicoplanin was used as the first therapeutic agent in 3 patients because of renal insufficiency. Vancomycin was used as the first therapeutic agent in 12 patients. Treatment was changed to teicoplanin because of adverse reactions in 10 and persistent bacteremia in 2 patients. Early operation was performed in 2 patients because of persistent MRSA bacteremia. Overall, 7 patients died in hospital. There was no statistically significant difference in hospital mortality rate (42% vs 47%) and bacteriologic failure rate (34% vs 40%) between 36 patients treated with vancomycin and 15 patients treated with teicoplanin. Teicoplanin can be an alternative therapy of MRSA infective endocarditis.
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PMID:Treatment of infective endocarditis caused by methicillin-resistant Staphylococcus aureus: teicoplanin versus vancomycin in a retrospective study. 1858 32

Severe mechanical hemolysis after cardiac surgery is a rare occurrence but one of the most common complications leading to reoperation. The aim of this study was to assess the efficiency and safety of plasma exchange (PE) during cardiopulmonary bypass (CPB). Five patients required PE because of severe hemolysis after cardiac surgery in Fuwai Hospital from January 2002 to December 2007: two with periprosthetic leakage and infective endocarditis, one with periprosthetic leakage, one with unsatisfied right ventricular outflow tract patching, and one with thromboses during extracorporeal membrane oxygenation (ECMO). They all needed blood purification to avoid acute renal insufficiency. The amount of transfused crystalloid solution, nonprotein colloid, plasma, and blood were 1,620+/-906.6 mL, 1,960+/-939.7 mL, 2,240+/-844.4 mL, and 680+/-228.1 mL. The volume of PE was 3,800+/-1,701.5 mL, and the volume of ultrafiltrate was 2,470+/-1,327.4 mL. The concentration of free hemoglobin (FHb) before PE, after PE, and before discharge were 3,840+/-538 mg/L, 325+/-27 mg/L, and 60.4+/-27 mg/L, respectively. Five patients were successfully treated with PE during CPB without major complications. All patients recovered well. Plasma exchange during CPB for severe hemolysis is a safe technique. Acute renal failure induced by severe hemolysis can be prevented by PE.
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PMID:Plasma exchange during cardiopulmonary bypass in patients with severe hemolysis in cardiac surgery. 1909 58

We describe a case of acute renal failure with crescentic glomerulonephritis, due to pneumococcal infective endocarditis on an endoprosthetic pulmonary valve. The patient's renal insufficiency subsequently improved following eradication of the microbe with antibiotics alone. Moreover, this is the first description of pneumococcal PVE leading to a crescentic glomerulonephritis.
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PMID:Pneumococcal endoprosthetic pulmonary valve endocarditis with crescentic glomerulonephritis and acute renal failure. 1928 44

Irritable urological symptoms with gross hematuria and bilateral lumbar pain developed when the patient received penicillin G for endocarditis. These symptoms were followed by renal insufficiency. A contrast-enhanced abdominal computed tomography (CT) scan revealed a thickened bladder wall, bilateral hydroureter and hydronephrosis, suggesting hemorrhagic cystitis complicated with urinary tract obstruction. Urine culture was negative. After discontinuation of penicillin G, all symptoms subsided and renal function recovered; hence, penicillin G seems to have been associated with hemorrhagic cystitis and acute kidney injury. Positive findings in the drug lymphocyte stimulation test (DLST) for penicillin G were consistent with this diagnosis.
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PMID:Penicillin G-induced hemorrhagic cystitis with hydronephrosis. 1975 71

We report a previously healthy 21-year-old man who developed disseminated varicella zoster infection complicated with encephalitis, acute renal insufficiency, liver dysfunction, and an apparent pustular skin superinfection with Staphylococcus aureus. He later developed an extensively destructive endocarditis affecting a congenital bicuspid aortic valve, accompanied with leaflet perforation, complete atrio-ventricular (AV) block, and invasion of vegetation to both left and right atrium; the endocarditis was attributed to the same skin pathogen, S. aureus. He underwent radical debridement of the aortic valve, membranous ventricular septum, and mitral anterior fibrous trigone, followed by reconstruction of intracardiac defects with 2 autologous pericardial patches and aortic valve replacement. After a permanent pacemaker implantation and 4 weeks of antibiotic treatment, he was discharged after an uneventful postoperative course.
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PMID:Adult bicuspid aortic valve endocarditis with extensive paravalvular invasion attributable to disseminated varicella zoster infection. 2215 84

Cardiac device infections (CDIs) represent a serious complication after the implantation of pacemakers and defibrillators. In addition to antimicrobials, complete hardware removal, mostly with percutaneous lead extraction (PLE), is necessary to limit recurrences. However, CDI diagnosis is often difficult and is sometimes delayed, and scarce data exist on how the timing of PLE may affect clinical outcomes. In this study, the in-hospital outcomes of 52 consecutive patients with CDIs who underwent PLE were retrospectively analyze. Co-morbidities such as diabetes mellitus, congestive heart failure, renal insufficiency, and end-stage renal disease were highly prevalent in the study cohort. Patients were divided into group A (bacteremia or device endocarditis) and group B (localized pocket infection). In-hospital mortality was 29% in group A and 5% in group B (p = 0.02) and was due mostly to sepsis. Hospital stays were shorter in group B patients (5.7 vs 21.7 days, p <0.001). Presentation with hypotension was more commonly observed in group A patients and was associated with higher in-hospital mortality, whereas pocket findings correlated with better survival. Postoperative courses after PLE were uneventful in most patients, and no fatal complications were observed. PLE was performed significantly earlier in group B patients (hospitalization day 1.3 vs 7.6, p <0.001). PLE performed within 3 hospitalization days was associated with lower in-hospital mortality (p = 0.01). In conclusion, PLE performed within 3 days from admission is associated with shorter hospitalization and better survival. A timely diagnosis is crucial, particularly in the absence of local findings, because early treatment with PLE is likely to prevent the catastrophic outcomes of unrelenting CDIs.
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PMID:Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections. 2235 96


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