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Query: UMLS:C0014118 (endocarditis)
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Bacillus bacteremias occurred in two heroin addicts. The first patient had one day of fever and chills after intravenous heroin use. Persistent cereus bacteremia consistent with endocarditis was documented and responded to four weeks of antibiotic therapy. The second patient had non-cereus Bacillus species isolated from blood cultures three times over eight days, each time after renewed heroin use. The patient remained well, and the bacteremias cleared spontaneously. Because Bacillus species frequently contaminate heroin injection materials and because the Bacillus bacteremias were temporally associated with intravenous heroin use, Bacillus bacteremias in both patients probably eventuated from heroin abuse. These cases, in conjunction with two previously reported cases of Bacillus endocarditis in heroin addicts, suggest that heroin addicts are at risk for developing Bacillus bacteremias, which may vary in severity from endocarditis to benign transient bacteremias.
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PMID:The spectrum of Bacillus bacteremias in heroin addicts. 10 84

The clinical and pathological findings in two recent patients with non-salmonella enterobacterial endocarditis are described, and those of 42 patients in the literature are summarized. Most of the patients acquired their endocarditis secondary to urinary tract infection and had an acute clinical course characterized by high fever and chills. Thirty-two of these patients died, and all except one had a postmortem examination. The most frequent pathological finding was the occurrence of very large vegetations which caused relatively little destruction of the underlying valve. Prompt diagnosis and antibiotic therapy chosen on the basis of bactericidal as well as bacteriostatic activity against the individual bacterium may improve the prognosis in this disease. Results of tricuspid and pulmonic valvulectomies for bacteriologic failure in pseudomonas and in a few cases of enterobacterial endocarditis appear to warrant a surgical approach in patients with right-sided enterobacterial endocarditis who fail to respond to vigorous medical therapy.
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PMID:Endocarditis due to enteric bacilli other than Salmonellae: case reports and literature review. 32 80

We have evaluated three patients with Haemophilus parainfluenzae endocarditis. Two of the three had underlying heart disease. All presented with fever, chills and malaise of less than two weeks' duration. Mitral valve involvement led to congestive heart failure in two of three cases. Treatment proved difficult, despite normally adequate dosages of antibiotics to which the pathogens were sensitive in vitro (ampicillin, 12-20 gm/dag; gentamicin, 3-5 mg/kg/day). Two patients were cured; one died. There was a suggestion of an inverse correlation between vegetation mass and favorable clinical response. Review of the English literature disclosed 22 documented cases of H parainfluenzae endocarditis, including 12 in the antibiotic era.
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PMID:Bacterial endocarditis due to Haemophilus parainfluenzae. 83 83

We have described a 28-year-old male sheepfarmer who had fever, headache, chills, malaise, and aortic insufficiency. Echocardiography revealed a tricuspid aortic valve with a large vegetation on the right cusp, an enlarged left ventricle, and diastolic flutter of the mitral valve. Repeated blood cultures were negative. Seroconversion of IgG and IgM to Rickettsia typhi was found on the 13th day of hospitalization. The patient was treated with tetracycline for 1 year and remained afebrile and free of symptoms for 9 months, when he was lost to follow-up. IgM and IgG fluorescent antibodies to R typhi remained positive during 8 months of the follow-up period. We believe this to be the second reported case of endocarditis due to R typhi and the first not treated surgically.
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PMID:Murine typhus endocarditis. 163 93

Endovascular infections that involve the right side of the heart present their own unique etiologies, pathophysiologies, clinical manifestations, and therapeutic issues. The pathology of the vegetations of right-sided endocarditis is identical to that of left-sided endocarditis. These vegetations are irregular, friable masses of varying size the contain platelets, fibrin, RBCs, and microorganisms. These lesions serve as a nidus for deep-seated infection and produce sustained bacteremia. Right-sided endocarditis occurs in 5% to 10% of all cases of endocarditis. The most common predisposing factors are IV drug abuse and congenital heart disease. S. aureus is the most common pathogen. The clinical manifestations include fever, chills, rigor, dyspnea, pleuritic pain, productive cough, and hemoptysis. The cardiac manifestations can be notably absent early in the course of the disease, with only 20% of patients initially showing a significant murmur on physical examination. Peripheral embolic lesions can be seen. Echocardiography is helpful in identifying vegetations on the tricuspid valve in a significant proportion of patients. The chest radiograph is characteristic, showing features typical of multiple septic pulmonary emboli. The radiograph shows multiple, small, fuzzy, patchy, peripherally located densities that can change rapidly on serial films. Complications of right-sided endocarditis include pulmonary infarction, pulmonary abscess, progressive right-sided heart failure, and renal abnormalities. The treatment of right-sided endocarditis includes prolonged therapy, with high doses of IV bactericidal antibiotics. Four weeks of antibiotic therapy is generally required, but newer regimens using combination antibiotic therapy can be successful in sensitive strains of viridans group streptococci and S. aureus. Surgical resection of the tricuspid valve is recommended for organisms that do not respond to initial antibiotic therapy, fungal endocarditis, resistant relapsing organisms, or coexistent infection with S. aureus and P. aeruginosa. The prognosis of right-sided endocarditis is generally favorable when compared with left-sided endocarditis. The prognosis is especially favorable in IV drug abusers infected with S. aureus. Patients infected with fungal organisms, Pseudomonas or Serratia, have a worse prognosis. The presence of significant right-sided heart failure also imparts a worse prognosis.
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PMID:Endovascular infections arising from right-sided heart structures. 173 55

Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmonary embolus. The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations. In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II. The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90%. The specificity was 98%. The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94%. Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.
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PMID:The role of two-dimensional echocardiology in the diagnosis of infective endocarditis [corrected]. 186 15

Two young men presented with prolonged hectic fever and chills followed by chest pain, dyspnea and hemoptysis. The chest films revealed multiple lung infiltrates, and blood cultures yielded Staphylococcus aureus. Echocardiographic examination confirmed the diagnosis of tricuspid valve endocarditis. Multiple punctate lesions in the bilateral inguinal areas and dragon tattoos over the forechest gave rise to the suspicion of drug abuse. After prolonged antimicrobial therapy, bacteremia was eliminated, and elective vegetectomy and valvuloplasty were performed on one of the patients. The other one suffered recurrent episodes of pulmonary embolism. Disappearance of the large vegetation was disclosed by echocardiography. Both of them eventually regained their health with the abstinence of drugs. This report illustrates two typical cases of infective endocarditis in drug addicts.
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PMID:Staphylococcus aureus endocarditis in drug addicts: report of 2 cases. 198 79

Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case. A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb. 7, 1987. He was diagnosed as having ischemic heart disease by electrocardiogram. Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP). The echo cardiogram showed mitral regurgitation (MR) and aortic regurgitation (AR), but neither vegetation nor pericardial effusion was observed. On Feb. 16, he was admitted with shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade. On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies. The rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space. It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole. On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.
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PMID:[An autopsied case of infective endocarditis with cardiac tamponade due to myocardial rupture]. 207 73

A 49-year-old man was admitted to Mitsui Memorial Hospital because of fever of unknown origin. Since one year ago, he had often used intravenous narcotic drugs. Ten months before his admission, he had his first experience of fever and a chill. Four months later, he was admitted to a hospital under the diagnosis of pneumonia and he was treated successfully. After his discharge, he began to use drugs again, which resulted in the repetition of fever and chills during four months prior to his admission to our hospital. On admission, physical findings concerning the patient were unremarkable, except for mild hepatomegaly. ECG and chest X-ray were normal. Laboratory data revealed marked inflammatory changes and severe liver injury. Blood culture disclosed Campylobacter fetus and two dimensional echocardiography showed a large vegetation on the anterior tricuspid valve. He was diagnosed as isolated tricuspid infective endocarditis accompanied with acute hepatitis due to drug abuse. Moreover pulmonary perfusion scintigraphy showed decreased perfusion in the right lower lung field, which suggested that pneumonia of six months ago was due to septic pulmonary emboli from the infected tricuspid valve. The combined antibiotics therapy was successful. By the follow-up echocardiographic studies, the size of vegetation was observed to decrease progressively.
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PMID:[A case of right-sided infective endocarditis in a drug addict]. 233 Apr 63

Three cases of bacterial intracranial aneurysms associated with infective endocarditis are reported. All of the patients were successfully treated by various combinations of cardiac surgery, neurosurgery and chemotherapy with antibiotics. Case 1: A 39-year-old female was admitted with the complaint of sudden onset of severe headache following persistent fever of several month's duration. CT scan revealed a left frontal old hematoma and angiography detected an aneurysm located in the frontal ascending branch of the left middle cerebral artery. After 2 weeks' antibiotic therapy, the second angiography showed the aneurysm to be decreased in size. The third angiography, performed 2 weeks after cardiac valve replacement for infective endocarditis, demonstrated complete resolution of the aneurysm. Case 2: A 19-year-old male entered hospital with high fever and chills. In addition to infective endocarditis, CT scan and angiography revealed an aneurysm arising from the distal portion of the left posterior cerebral artery. The patient was treated with high dose antibiotics and then his general condition improved. However, angiography examined 4 weeks after the initial study demonstrated the aneurysm to be apparently enlarged. Therefore, the aneurysm was excised before cardiac surgery. Repeated angiography after valve replacement showed no further aneurysm. Case 3: A 30-year-old female was admitted on the diagnosis of infective endocarditis and meningitis. CT scan showed abnormal density areas in the right frontal lobe and the left temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Bacterial intracranial aneurysms associated with infectious endocarditis--report of 3 cases]. 337 48


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