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

Catheter-related infections (CRI) are a leading cause of morbidity and sometimes a cause of death in cancer patients. For preventive strategies, intra- and extra-luminal colonization pathways should be taken into account. A definite diagnosis of CRI requires usually the removal of the catheter for culture of the catheter-tip. However, only about 20% of the catheters removed for suspicion of CRI actually prove infected. The diagnosis of CRI is likely when a bloodstream infection due to coagulase negative staphylococcus, S. aureus or Candida spp occurs, without other infectious focus. Among the catheter-tip culture techniques, quantitative methods offer the better sensitivity-specificity/complexity-cost compromise, and should be preferred to semi-quantitative ones. When a venous access port is removed because of suspected CRI, the catheter tip and the port itself should be both cultured. Immediate removal of the catheter and urgent antibiotic treatment are mandatory when severe local infection (such as tunnelitis or cellulitis) or severe sepsis occurs. Usually, a CRI due to S. aureus, Pseudomonas spp or Candida spp requires also the removal of the catheter. Diagnostic techniques without catheter removal may be only proposed when local or systemic severity signs are lacking. Recently, the measurement of the differential time to positivity between paired blood cultures drawn simultaneously on the catheter and on a peripheral vein has been proposed. Finally, the direct examination of blood drawn from the catheter using acridine-orange leucocyte cytospin test seems to be a promising and rapid method for the diagnosis of CRI. When a CRI is diagnosed, a treatment without catheter removal may be proposed when local or systemic severity signs are lacking mainly if coagulase negative staphylococci are involved; in such case, both systemic antibiotic therapy and lock-therapy should be associated. In case of clinical failure of this strategy after 48-72 hours, the catheter should be removed. If the sepsis persist, a residual infectious focus (thrombophlebitis, endocarditis, secondary localisation) should be investigated.
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PMID:[Infections of intravascular perfusion sets]. 1500 68

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.
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PMID:Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience. 1973 90