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

A patient with Staphylococcus aureus bacteremia associated with an infected intravenous catheter was treated with oxacillin for two weeks. During that period all blood cultures were sterile, he rapidly became afebrile, and there were no signs of endocarditis or metastatic abscesses. However, serum antibodies against staphylococcal teichoic acid, initially undetectable by the agar gel immunodiffusion technic, became positive during the second week of treatment. Three weeks after discharge, the patient was readmitted to the hospital because of back pain and weakness in the lower extremities. Vertebral osteomyelitis and a spinal epidural abscess caused by Staph. aureus of the same phage type as the bacteremic isolate were demonstrated. This case illustrates the importance of careful follow-up of patients with Staph. aureus bacteremia and the potential value of serial measurement of teichoic acid antibodies in detecting clinically inapparent complications of infection.
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PMID:Association of teichoic acid antibody with metastatic sequelae of catheter-associated Staphylococcus aureus bacteremia: a failure of the two-week antibiotic treatment. 42 75

Bacterial endocarditis is an elusive disease that challenges clinicians' diagnostic capabilities. Because it can present with various combinations of extravalvular signs and symptoms, the underlying primary disease can go unnoticed.A review of the various extracardiac manifestations of bacterial endocarditis suggests three main patterns by which the valvular infection can be obscured. (1) A major clinical event may be so dramatic that subtle evidence of endocarditis is overlooked. The rupture of a mycotic aneurysm may simulate a subarachnoid hemorrhage from a congenital aneurysm. (2) The symptoms of bacterial endocarditis may be constitutional complaints easily attributable to a routine, trivial illness. Symptoms of low-grade fever, myalgias, back pain and anorexia may mimic a viral syndrome. (3) Endocarditis poses a difficult diagnostic dilemma when it generates constellations of findings that are classic for other disorders. Complaints of arthritis and arthralgias accompanied by hematuria and antinuclear antibody may suggest systemic lupus erythematosus; a renal biopsy study showing diffuse proliferative glomerulonephritis may support this diagnosis. The combination of fever, petechiae, altered mental status, thrombocytopenia, azotemia and anemia may promote the diagnosis of thrombotic thrombocytopenic purpura. When the protean guises of bacterial endocarditis create these clinical difficulties, errors in diagnosis occur and appropriate therapy is delayed. Keen awareness of the varied disease presentations will improve success in managing endocarditis by fostering rapid diagnosis and prompt therapy.
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PMID:Extracardiac manifestations of bacterial endocarditis. 51 15

A 61 year old woman presented with back pain and clinical signs of meningitis. Pleocytosis in the cerebrospinal fluid was found, but although Streptococcus pneumoniae was cultured from her blood it failed to grow from the cerebrospinal fluid. An echocardiogram detected vegetations on the mitral valve and a lesion at S1/S2 was demonstrated on a bone scan. Treatment for one month with benzylpenicillin (1200 mg four hourly) was successful for both the cardiac and neurological components of her infection, but her back pain only resolved after treatment was changed to clindamycin. The clinical presentation and metastatic spread of the S pneumoniae infection is much more commonly seen in the context of S aureus endocarditis. It is rare for the pneumococcus to be associated with endocarditis and when it is mortality is usually high. This case shows the metastatic potential of the organism and the requirement for appropriate antibiotics with regard not only to the sensitivity of the organism, but also for the site of infection.
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PMID:Pneumococcal endocarditis and disseminated infection. 145 81

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

Neurologic syndromes often complicate the management of infective endocarditis (IE). We retrospectively reviewed 166 episodes of native valve endocarditis to assess the occurrence and implications of nonfocal encephalopathy, meningitis, salient headache, back pain, and brain abscess. Neurologic complications occurred in 35% (58/166) of patients: 41% (54/133) of mitral or aortic valve IE and 12% (4/33) of tricuspid valve IE. Of 133 cases of mitral or aortic valve IE, encephalopathy occurred in 14%, meningitis in 5%, and salient headache in 3%. All neurologic complications occurred more often with Staphylococcus aureus infection (67%) than with viridans streptococci (22%), including encephalopathy (22% versus 7%), meningitis (17% versus 0%), stroke (39% versus 16%), and death (39% versus 9%). Encephalopathy was associated with virulent organisms, increased patient age, and uncontrolled infection. Clinical, radiologic, and neuropathologic data all suggest that infective microemboli are often etiologic in IE-related encephalopathy. There were no macroscopic brain abscesses clinically identified. Meningitis occurred only with virulent organisms. While many clinical aspects of IE have changed in recent years, the frequency and gravity of neurologic complications have not.
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PMID:Neurologic complications of infective endocarditis. 182 93

The nervous system is frequently involved in patients with infective endocarditis. When a careful review of presenting complaints is undertaken, neurological symptoms have been found in as high as 29% of patients. Because these manifestations may be so protean in nature, for example, stroke or transient ischaemic attack (the most common), toxic encephalopathy, meningitis, brain abscess, visual loss, seizures, headache, backache, or acute mononeuropathy, the neurologist needs to consider infective endocarditis as a possible diagnosis in many patients. During the past two decades, infective endocarditis has occurred in an ever widening clinical setting. It may often be found in persons unknown to have predisposing cardiac disease. This is particularly true in certain subsets of the population, including the elderly, patients subjected to various invasive procedures leading to nosocomial infection, and drug abusers. New diagnostic studies, including refined bacteriological culture techniques, echocardiography, computed tomography, magnetic resonance imaging, and greater availability of skillful cerebral angiography, make earlier diagnosis of infective endocarditis possible. Despite this, patients with neurological complications continue to have an uncertain prognosis.
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PMID:Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges. 267 68

Streptococcus pneumoniae is an important pathogen in many serious infections, such as pneumonia, sinusitis, and meningitis. It uncommonly causes infective endocarditis and only rarely produces spinal epidural abscesses. This report describes a patient who had pneumococcal infection presenting as an acute epidural abscess and who was subsequently found to have endocarditis. S. pneumoniae was cultured from both blood and abscess material. A high level of clinical suspicion of endocarditis is important in all cases of bacteremic pneumococcal illness; patients with such an illness and back pain may harbor potentially catastrophic epidural abscesses.
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PMID:Streptococcus pneumoniae endocarditis presenting as an epidural abscess. 270 29

Frequently, the presence of endocarditis is disguised. The emphasis of this description of the clinical manifestations of endocarditis is on the various modes of presentation, rather than on individual symptoms and signs. Endocarditis can manifest with cardiac, pulmonary, ophthalmic, central nervous system, renal, orthopedic, phthisic, and peripheral vascular disorders. The following clinical data are most useful in helping to establish a diagnosis of endocarditis: a history of fever, anorexia, weight loss, and back pain; a search for petechiae; splenomegaly; and daily examination, especially cardiac auscultation and funduscopic examination, of those patients in whom incomplete evidence exists at admission. The most helpful laboratory tests include those revealing anemia, increased erythrocyte sedimentation rate, abnormalities in the urine compatible with nephritis, or embolization. In patients who have not received antimicrobial therapy just before the diagnostic workup, one set of three blood cultures is sufficient to isolate the offending microorganism in about 95% of cases.
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PMID:The clinical manifestations of infective endocarditis. 705 20

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

We studied 210 episodes of infective endocarditis in 204 patients. The prevalence of this disease in our series ranged from 0.32 to 1.30 (mean, 0.75) episodes per 1000 admissions per year. There were 115 male and 89 female patients, whose ages ranged from newborn to 91 years (median, 60-70). One-hundred-and-forty-eight episodes involved host valves and another 33 episodes occurred in intravenous drug users. There were 2 episodes of early and 27 episodes of late prosthetic valve endocarditis. Staphylococcus aureus accounted for 99 episodes (47.1%), alpha-hemolytic streptococci for 29 episodes (13.8%), enterococci for 11 episodes (5.2%), culture-negative endocarditis for 11 episodes (5.2%), and other organisms for 60 episodes (28.6%). Severe back pain was the chief complaint in 15 patients. 2-D echocardiography was performed in 164 episodes, results in 67 (40.9%) of which were positive. Valve surgery was performed in 29 episodes (23 host valves and 6 prosthetic valves). The overall mortality was 21.4%. Autopsy was performed in 22 of the 45 patients who died (48.9%). The mortality rate increased with age, (10.1% and 31.5% for patients < 60 years old and 60 years or older, respectively (p < 0.001).
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PMID:Infective endocarditis at a large community teaching hospital, 1980-1990. A review of 210 episodes. 847 27


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