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

(1) Neurologic complications remain a significant problem in bacterial endocarditis. Of 218 patients with endocarditis, 84 (39%) had a neurologic complication and 58% of these 84 patients died. In contrast, the mortality rate was only 20% among those endocarditis patients without neurologic complications. (2) Of the neurologic complications, cerebral embolism is the most frequent and important. An embolic stroke occurred in 37 (17%) of our patients, with 30 of these patients dying. Emboli are important not only in terms of the direct morbidity and mortality they cause via cerebral infarction, but also because of their role in the causation of mycotic aneurysms, brain abscesses, and abnormal CSF formulae. (3) Cerebral emboli are particularly common in patients with mitral valve infection, and in patients with infection due to virulent organisms, particularly S. aureus and enteric gram-negative bacilli. (4) Mycotic aneurysms occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Management of angiographically demonstrated mycotic aneurysms is dependent upon the presence or absence of hemorrhage, the anatomic location of the aneurysm, and the clinical course of the patient. Healing of mycotic aneurysms can occur during the course of effective antimicrobial therapy, thus obviating the need for neurosurgical intervention in all such patients. (5) Macroscopic brain abscess is a rare complication of bacterial endocarditis. Miliary microscopic abscesses are more common than larger abscesses, particularly in patients with acute disease and miliary infection in other organs of the body. (6) Focal seizures occur most commonly in endocarditis patients with acute embolic disease; generalized seizures are of diverse etiologies, with metabolic factors being most important. Penicillin neurotoxicity should be considered in patients with impaired renal function who are receiving high dose penicillin. (7) With the exception of hemorrhagic complications, lumbar puncture results tend to reflect the nature of the infecting organism rather than the nature of the neurologic complication. Endocarditis due to virulent organisms such as S. aureus is usually associated with a purulent CSF formula while nonvirulent organisms, such as viridans streptococci, susually have aseptic or normal CSF formulae.
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PMID:Neurologic complications of bacterial endocarditis. 58 Jul 94

Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.
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PMID:Rifampin therapy of Staphylococcus epidermidis. Use in infections from indwelling artificial devices. 67 4

A 17-year-old man presented with acute febrile illness with jaundice, embolic skin lesion, heart murmur, renal insufficiency and abnormal CSF. Pasteurella multocida was isolated from blood cultures. In spite of adequate antibiotic treatment for endocarditis of the mitral valve, he developed a fatal ruptured cerebral mycotic aneurysm. Post mortem examination revealed an atrial septal defect, vegetation at the anterior mitral leaflet, intraventricular, subarachnoid and intracerebral hemorrhage.
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PMID:Pasteurella multocida infective endocarditis: a case report. 208 20

We describe 2 cases of Streptococcus bovis meningitis and review the 9 cases previously reported. This microorganism is a rare cause of meningitis in which there are no distinctive clinical or laboratory features. The Gram stain of the CSF is usually negative. Ten of the 11 cases had some underlying disease or comorbid condition that predisposed to S bovis infection: gastrointestinal disorder, endocarditis, CSF leak, polymyalgia rheumatica, and mandibular block. Treatment with high-dose penicillin is usually adequate.
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PMID:Streptococcus bovis meningitis: report of 2 cases. 223 37

Animal models have proven to be invaluable in bridging the gap between in vitro susceptibility testing of an antibiotic and anticipating results obtained in clinical studies. Variables such as antibiotic concentration, inoculum of organism, and pharmacokinetic parameters of the drug can be carefully controlled to provide information about the principles of treating infectious diseases as well as an evaluation of specific antimicrobial agents. End points of treatment can be precisely defined (that is, CSF sterility in meningitis, vegetation counts of bacteria in endocarditis) to allow a quantitative evaluation of a new antibiotic. However, it is important to realize that there may be differences in disease pathogenesis and antibiotic pharmacokinetics between experimental infections in animal models and infections in humans. Therefore, results in animal models should be interpreted with caution and compared with results obtained with antimicrobial regimens in clinical studies. Perhaps one of the most useful features of animal models is suggesting which antimicrobials would not be expected to be of therapeutic benefit in man.
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PMID:Applications of therapy in animal models to bacterial infection in human disease. 250 10

Neurologic complications continue to occur in approximately 30 per cent of all patients with infective endocarditis and represent a major factor associated with an increased mortality rate in that disease. Of these complications, cerebral embolism is the most common and the most important, occurring in as many as 30 per cent of all patients, most of whom ultimately die. Emboli that are infected also account for all the other complications (mycotic aneurysm, meningitis or meningoencephalitis, brain abscess) that may develop. Emboli are more common in patients with mitral valve infection and in those infected with more virulent organisms. Mycotic aneurysms (often preceded by an embolic event) occur more frequently and earlier in the course of acute endocarditis, rather than later, which is more common in the course of subacute disease. The management of a cerebral mycotic aneurysm depends on the presence or absence of hemorrhage, its anatomic location and the clinical course. Healing can occur during the course of effective antimicrobial therapy and thus will preclude the need for automatic surgery in all angiographically demonstrated aneurysms. The indication for surgical intervention must be evaluated on an individual basis. Meningitis is usually purulent when associated with virulent organisms, but the CSF may present an aseptic formula when associated with subarachnoid hemorrhage or multiple microscopic embolic lesions, infected or otherwise. Macroscopic brain abscesses are rare, but multiple microscopic abscesses are not uncommon in patients with acute endocarditis due to virulent organisms. Seizures are not uncommon in patients with infective endocarditis. Focal seizures are more commonly associated with acute emboli, whereas generalized seizures are more commonly associated with systemic metabolic factors. Penicillin neurotoxicity should be considered in seizure patients with compromised renal function who are receiving high doses of penicillin. The CSF tends to reflect the nature of the infecting organism rather than the nature of the neurologic complication, except when hemorrhage is present. Endocarditis due to virulent organisms, such as Staphylococcus aureus, is usually associated with a purulent CSF formula, whereas non-virulent organisms, such as "viridans" streptococci, usually have aseptic or normal CSF formulas.
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PMID:Neurologic complications of infective endocarditis. 383 85

Aminoglycosides still play a major role int e treatment of severe infections, especially those due to Gram-negative bacilli. They are usually administered together with a beta-lactam antibiotic, either to cover a wide antibacterial spectrum, or to obtain a better bactericidal effect, or to prevent the emergence of resistant mutants. They are mainly used in severe urinary tract infections and/or in those due to multiresistant organisms and in Gram-negative pneumonia and meningitis (intrathecally, since they poorly diffuse into the CSF). Combined with cephalosporins they constitute the first-line treatment of severe, life-threatening infections caused by Gram-negative aerobes. Given simultaneously with penicillinase-resistant semi-synthetic penicillins or with vancomycin they act synergistically against staphylococci and can be used initially for a few days in the treatment of severe staphylococcal infections. It is also for this synergistic action that they are combined with penicillin G or ampicillin in the treatment of endocarditis. The ototoxic or nephrotoxic effects common to all aminoglycosides can be avoided by adjusting the doses to the degree of renal function, by limiting their use to about a fortnight (except for endocarditis) and by monitoring blood levels.
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PMID:[Current therapeutic indications of aminoglycosides]. 623 28

Streptococcus bovis was isolated from the CSF of a 66-year-old man with meningitis. His clinical appearance was unusual in that he lacked typical signs and symptoms of pyogenic meningitis. Streptococcus bovis was also recovered from his blood, which suggested that bacterial endocarditis was the source of his CNS infection. He was cured after four weeks of therapy with intravenous penicillin G potassium. This is the fourth reported case of meningitis caused by S bovis. The previous three patients also had endocarditis caused by S bovis. Because of the reported propensity of S bovis to infect heart valves and the frequent association of S bovis bacteremia with malignant gastrointestinal (GI) tract tumors, recovery of this organism form CSF should prompt a search for bacterial endocarditis and occult GI cancer.
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PMID:Meningitis caused by Streptococcus bovis. 707 53

Seven patients with Bacteroides fragilis infections were treated with intravenous and/or oral metronidazole. Infections treated included endocarditis, osteomyelitis, lung abscess, empyema, peritonitis, septicemia, and pelvic infection. Some patients had failed to respond to therapy with chloramphenicol or clindamycin or both. Metronidazole was used alone or in combination with aminoglycosides. Serum levels of metronidazole several times in excess of the minimal inhibitory concentrations for the organisms were easily achieved and in one patient the CSF metronidazole level was equal to that of the serum. Response to therapy with metronidazole was considered to be excellent. The only serious side effect noted was hypotension, which occurred in the last patient. Therapy was discontinued, and therefore therapeutic results could not be evaluated. Metronidazole appears to be a safe and effective agent in the treatment of B fragilis infections.
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PMID:Metronidazole treatment of Bacteroides fragilis infections. 745 95

Intramedullary spinal cord abscesses are an uncommon entity with 73 cases reported in the literature; the first case was reported in 1830. Sixty-seven percent of abscesses occur in the first 4 decades of life. Staphylococcus and Streptococcus are the most common organisms; 25% of patients have negative intraoperative cultures. The primary source of the infection could be found, in only 45% of patients. Most of these infections are secondary to metastatic spread from infections of the lung, endocarditis, genitourinary tract; 10 reports have described an intramedullary abscess secondary to a dermal sinus. The signs and symptoms depend on the location of the lesion; the thoracic spine is the most commonly area involved. Patients are usually divided into three clinical groups; acute onset (symptoms less than 1 wk), subacute onset (symptoms up to 6 wk), and chronic course (symptoms more than 6 wk). Patients with the acute form are more likely to have a fever and an elevated white blood cell count and may show either a partial or complete transverse myelitis picture. The patients with chronic abscesses are less likely to have fever and leukocytosis, and their symptoms often mimic those of an intramedullary spinal tumour. The erythrocyte sedimentation rate tends to be elevated in all patients regardless of their clinical findings. CSF cultures are usually sterile. Plain x-rays of the spine are often normal. A myelogram in conjunction with a computed tomographic scan may show the intramedullary lesion. MRI studies usually demonstrate intramedullary lesions with exceptional clarity; the use of gadolinium with T1-weighted MRI studies enhances the abscess wall.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Bacterial abscesses of the spinal cord. Review of the literature (73 cases)]. 787 24


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