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

In this study we aimed to investigate the findings in patients with adult-onset Still's disease (AOSD) admitted with fever of unknown origin (FUO) during the last 18 years in our unit, in order to discover the ratio of such patients to all patients with FUO during the same period, and to determine the clinical features of AOSD in FUO. The number and the aetiologies of the patients with FUO diagnosed between 1984 and 2001, and the clinical features of those with AOSD, were taken from the patient files. The diagnosis of AOSD was reanalysed according to the diagnostic criteria of Cush et al. [11]. The presumed diagnoses before a diagnosis of AOSD was established were also noted. The chi(2) and Fisher's exact tests were used for statistical analysis. We studied 130 patients with a diagnosis of FUO, 36 (28%) of whom had collagen vascular diseases. Of these 36 patients, 20 (56%, 12 female, 8 male, mean age 34 years, range 16-65) had AOSD. Clinical and laboratory findings were as follows: fever (100%), arthralgia (90%), rash (85%), sore throat (75%), arthritis (65%), myalgia (60%), splenomegaly (40%), hepatomegaly (25%), lymphadenopathy (15%), anaemia (65%), neutrophilic leukocytosis (90%), increased erythrocyte sedimentation rate (100%), elevated transaminase levels (65%), a negative RF (100%), and a negative FANA (80%). Antibiotics had been prescribed in 18 (90%) of cases. The presumed infectious diagnoses were streptococcal tonsillitis/pharyngitis (50%), infective endocarditis (four patients), sepsis (two patients) and acute bacterial meningitis (two patients). The presumed non-infectious diagnoses were acute rheumatic fever (three patients), seronegative rheumatoid arthritis (two patients) and polymyositis (two patients). Sixteen patients were followed for a mean duration of 30 months (range 2-59). A remission was obtained with indomethacin in three cases (19%), and with prednisolone in the remainder. Relapse was detected in three cases (19%). AOSD is one of the most frequent aetiologies of FUO. During the diagnostic course of a patient with FUO, a maculopapular rash and/or arthralgia and/or sore throat should raise the suspicion of AOSD. Because the disease has heterogeneous clinical findings, certain bacterial infections (e.g. streptococcal pharyngitis and sepsis) are generally considered and the prescribing of antibiotics is common.
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PMID:Fever of unknown origin: a review of 20 patients with adult-onset Still's disease. 1274 Jun 70

Despite the decline in rheumatic heart disease worldwide and the use of antibiotic prophylaxis, there is no evidence that the incidence of infective endocarditis is decreasing. In fact, some data suggest it may be increasing. The classical fever of unknown origin presentation represents a minority of infective endocarditis cases today; thus, clinicians need to be vigilant about keeping infective endocarditis in mind with some of these more unusual presentations. This article focuses on the various presentations of infective endocarditis, which are organized into three groups of presenting symptoms and signs: nonspecific, cardiac, and embolic.
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PMID:Clinical presentation of infective endocarditis. 1287 90

A 41-year-old male patient presented with fever of unknown origin which had been present for 5 months. The primary diagnostic procedures did not identify an infectious focus. After a lag phase of 13 days, blood cultures became positive for Actinobacillus actinomycetemcomitans, which belongs to the HACEK group of microorganisms. According to the DUKE criteria, infective endocarditis was diagnosed despite negative transesophageal echocardiography (TEE). The sensitivity of TEE is estimated between 86 and 94%. An infected tooth was extracted as a possible focus, and the patient was treated with i.v. antibiotics for 5 weeks according to the guidelines of the AHA and ACC. The fever was permanently terminated, and the further course of the patient was uneventful. Despite negative TEE, the diagnosis "infective endocarditis" should not be rejected, and blood cultures should be grown for up to 30 days.
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PMID:[A 41 year-old male patient with fever of unknown origin and bacteremia with actinobacillus actinomycetemcomitans]. 1456 69

We report the case of a 41-year-old woman with severe mitral regurgitation due to infective endocarditis caused by a rare zoonotic microorganism (Capnocytophaga canimorsus). She had had a rheumatic mitral endocarditis successfully treated with antibiotics when she was 13 years old. She arrived to our attention for a fever of unknown origin. She had been bitten by her dog and medicated the wound herself. About 2 weeks later she developed a fever with values up to 39.5 degrees C. Blood cultures were initially negative but in view of her particular history (dog bite), the samples were sent to a specialized center where a Capnocytophaga canimorsus (a commensal bacterium contained in the saliva of dogs and cats) infection sensitive to ceftriaxone was detected. The antibiotic therapy was consequently modified and the patient's fever resolved. At echocardiography a mild mitral stenosis with severe regurgitation (3-4+/4+) was detected. We planned surgical mitral repair but the operative findings clearly showed the need for mitral replacement and a 29 mm size bileaflet mechanical prosthesis was implanted. The postoperative course was regular and the patient was discharged on the fifth day. We highlight the importance of a careful history and correct work-up for the diagnosis and treatment of false negative blood culture endocarditis.
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PMID:Infective endocarditis due to Capnocytophaga canimorsus. 1466 87

Fever of unknown origin is one of the most intriguing issues in clinical practice. One of the most feared diagnoses, especially in patients with known valvular disease, is endocarditis. The differential diagnosis of fever is often complicated by the clinical-pathological overlap between the systemic inflammatory response in different types of pathologies such as infectious, autoimmune or neoplastic disorders. We report a case of a patient presenting with fever, cutaneous nodules and malaise, with a known mitral valve prolapse and moderate regurgitation, in which the diagnosis of Wegener's granulomatosis was finally made.
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PMID:Vasculitis mimicking bacterial endocarditis. 1469 14

Bacterial endocarditis due to Pseudomonas aeruginosa arising from arteriovenous (AV) fistula and graft infection is unusual. We report an uncommon case of a 55-year-old woman housewife with chronic glomerulonephritis who had received hemodialysis (HD) for 5 years. She was admitted due to frequent episodes of AV fistula and graft infections in the past 5 years. She was admitted to our hospital because of a fever of unknown origin. During hospitalization, cardiac sonography and transesophageal echocardiography (TEE) confirmed a vegetation over the mitral valve. Blood culture yielded Pseudomonas aeruginosa. Endophthalmitis of the right eye was diagnosed by funduscopy because of painful redness of the right eye with exudative discharge. The patient was treated with ceftazidime for 9 weeks. Since then, she has been well, without any sequale after 1 year of following up. Physicians should be aware of the possibility of infective endocarditis in an uremic patient who suffers from fever of unknown origin. Early diagnosis with an adequate tool such as TEE and appropriate treatment will lead to an excellent prognosis.
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PMID:Pseudomonas aeruginosa endocarditis associated with endophthalmitis caused by arteriovenous fistula and graft infection. 1470 80

To elucidate the causes of fever of unknown origin (FUO) in Taiwan, we retrospectively analyzed the characteristics of 78 adult patients meeting the classic criteria for fever of unknown origin who were treated at National Taiwan University Hospital from July 1999 through June 2002. Cause of FUO was due to infections in 42.3% of patients, neoplasms in 6.4%, noninfectious inflammatory diseases in 20.5%, and miscellaneous causes in 7.7%, whereas the cause was not established in 23.1% of patients despite every effort. Tuberculosis (14.1%) and acquired immunodeficiency syndrome (7.7%) were the most common causes of infection in patients with FUO, while intraabdominal abscess, infective endocarditis, and tumor were less frequently found. Noninfectious inflammatory diseases were still a very important cause of FUO and were difficult to diagnose. In conclusion, infection remains the most important cause of classic FUO in Taiwan, confirming the findings in previous series. The importance of tuberculosis and AIDS as frequent causes of FUO should be emphasized.
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PMID:Fever of unknown origin: a retrospective study of 78 adult patients in Taiwan. 1472 52

A case of a 75-year-old male with a history of aortic valve disease hospitalised due to pyrexia of unknown origin is reported. Initially the patient was diagnosed with infective endocarditis due to persistent pyrexia, history of valve disease, single positive blood culture and echocardiographic scan suggesting infective endocarditis. Treatment with two strong antibiotics did not bring expected amelioration. Patient's hemodynamic status remained unchanged. After several weeks of hospitalization X-ray scan revealed involved hilar lymph nodes, which was confirmed by CT scan of the chest. The patient was diagnosed with Hodgkin's disease. He died three months after initiation of chemotherapy.
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PMID:[Hodgkin's disease as a cause of pyrexia in a patient with valvular heart disease and suspicion of infective endocarditis--a case report]. 1500 32

Fever of unknown origin (FUO) is not infrequently a diagnostic dilemma for clinicians. Common infectious causes include endocarditis and abscesses in adults, and noninfectious causes include neoplasms and certain collagen vascular diseases, for example, polymyalgia rheumatica, various vasculitides, and juvenile rheumatoid arthritis (adult Still's disease). Subacute thyroiditis is a rare cause of FUO. Among the infectious causes of FUO, typhoid fever is relatively uncommon. We present a case of FUO in a traveler returning from India whose initial complaints were that of left-sided neck pain and angle of the jaw pain, which initially suggested the diagnosis of subacute thyroiditis. After an extensive FUO workup, when typhoid fever is a likely diagnostic possibility, an empiric trial of anti- Salmonella therapy has diagnostic and therapeutic significance. The presence of relative bradycardia, and response to quinolone therapy, was the basis of the clinical diagnosis of typhoid fever as the explanation for this patients FUO. This case illustrates the diagnostic difficulties in assessing patients with FUO with few diagnostic findings.
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PMID:Fever of unknown origin: subacute thyroiditis versus typhoid fever. 1576 61

Infective endocarditis is the most common condition predisposing a patient to splenic abscess. We report the case of man aged 65 who was admitted to the Internal Medicine Department to diagnose the fever of unknown origin. The fever lasted longer than one year. Clinical status and executed diagnostics, among others: echocardiography, blood cultures, abdominal ultrasonography, abdominal computed tomography allowed to give the diagnosis splenic abscess caused by Acinetobacter Baumanii in the course of infective endocarditis. Patient was treated by splenectomy and antibiotics. As a result of the treatment normalization of temperature and recovery was obtained.
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PMID:[Splenic abscess in the course of infective endocarditis--report of a case]. 1577 18


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