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

Antibiotic-induced growth inhibition and killing of a non-mucoid strain of Pseudomonas aeruginosa (PA-96) in vitro and ex vivo were studied at oxygen tensions approximating those of the right and left cardiac ventricles in vivo (pO2 = 40 VS. 80 mm Hg). This pseudomonal strain grew equally at the two oxygen tensions, yet only bacteria exposed to pO2 80 mm Hg revealed significant exopolysaccharide production as shown by PAS and ruthenium red staining. Similarly, scanning electron microscopy of pseudomonal cells within aortic (but not tricuspid) vegetations revealed surface excrescenses compatible with surrounding exopolysaccharide (glycocalyx). Amikacin at 10 x MIC caused significantly less in-vitro killing of pseudomonal cells at pO2 80 VS. 40 mm Hg. In vitro and ex vivo (within experimental aortic and tricuspid vegetations), post-antibiotic effect durations were about 50% shorter for cells exposed to amikacin at pO2 80 mm Hg than 40 mm Hg. These data demonstrate suboptimal aminoglycoside-induced growth inhibition and killing, as well as enhanced exopolysaccharide production of a non-mucoid P. aeruginosa strain at oxygen tensions reflective of the left side of the heart. These findings may in part explain the better results seen in aminoglycoside-treated right compared to left-sided pseudomonal endocarditis in man.
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PMID:Oxygen-dependent differences in exopolysaccharide production and aminoglycoside inhibitory-bactericidal interactions with Pseudomonas aeruginosa--implications for endocarditis. 250 Dec 67

A 65-year-old man who had lived in several tropical countries, particularly in Brazil, is observed for an ulcerative lesion of the mouth that appeared two months ago. The biopsy reveals polymorphic granuloma with numerous giant cells. PAS and Gomori-Grocott stains show very numerous roundish structures of variable size (3 microns to 15 microns). There are multiple buds like in paracoccidioidomycosis but culture reveals Histoplasma capsulatum. These abnormal forms have been described in large necrotic zones and especially in endocarditis (intravascular proliferations). To our knowledge, it is the first description of these forms in primary infestation. This case shows the necessity to control histological diagnosis of mycosis. Culture and biological identification are absolutely necessary for specific diagnosis.
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PMID:[Buccal histoplasmosis. Apropos of a case with a difficult histopathologic diagnosis]. 321 2

Rabbits and Wistar rats developed myocarditis after intramyocardial inoculation with Cryptococcus neoformans. Myocardial lesions were observed on the 1st, 2nd, 3rd, and 4th week after the inoculation in all animals. The cardiac lesion consisted of focal necrosis with accompanying lymphocytes, macrophages, and rare fibroblasts in the myocardium. Cryptococcus neoformans itself was found by PAS stain and indirect immunofluorescence stain by the 2nd week after the inoculation. Maximal cardiac lesions were observed in the 2nd week and thereafter, the lesions showed progressive scarring. In the 9th week there were fibrotic lesions, and we were not able to demonstrated cryptococcal antigens in these lesions. Fungemia and antibody for Cryptococcus neoformans were not found over the entire period. Cryptococcal meningeal lesions were observed in all animals. In the animals given an intramyocardial inoculation of saline, Pseudomonas aeruginosa, and Serratia marcescens there were no myocardial lesions. The relationship of this experimental cryptococcal myocarditis and fungal endocarditis in humans is discussed.
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PMID:Experimental cryptococcal myocarditis. 701 Apr 78

Rabbits and Wistar rats developed myocarditis after intracardiac inoculation with Cryptococcus neoformans. Myocardial lesions were observed on the 1st, 2nd, 3rd and 4th weeks after this inoculation in all animals. The cardiac lesions consisted of focal necrosis with mononuclear inflammatory cells infiltration in the myocardium. Cryptococcus neoformans itself was found by PAS stain and indirect immunofluorescence stain by the 2nd week after the inoculation. Maximal cardiac lesions were observed in the 2nd week and thereafter, the lesions showed progressive scarring. In the 9th week, there were fibrotic lesions and we were not able to demonstrate cryptococcal antigens in these lesions. Fungemia and antibody for Cryptococcus neoformans were not found over the entire period. Cryptococcal meningeal lesions were observed in all animals. In the animals given an intracardiac administration of saline. Pseudomonas aeruginosa, and Serratia marcescens, there were no myocardial lesions. The relationship of this experimental fungal myocarditis and fungal endocarditis in human is discussed.
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PMID:Experimental cryptococcal-induced myocarditis. 701 58

Mb. Whipple is a rare systemic disorder with multiple manifestations. We present a case-story demonstrating the typical course: migrating, non-deforming arthralgies are years later followed by diarrhoea, loss of weight, fatigue and pronounced biochemical disturbances. Intestinal biopsy shows numerous PAS-positive, diastaseresistent macrophages, and antibiotic treatment is initiated. After a somewhat prolonged course, complicated with Giardiasis and endocarditis, the patient recovers. Four months after the cessation of antibiotic treatment, however, the patient shows clinical signs of relapse, and treatment is restarted. The etiological agent has recently been identified as a gram-positive actinomycete called Tropheryma Whippleii. There are some, but not unequivocal, signs of a cellular immunodeficiency, perhaps predestinating certain patients to the disease. The course is usually favourable, when treated with relevant antibiotics. Relapse is not uncommon, and is very problematic when the CNS is involved. Therefore, a combination treatment with good penetration of the blood-brain barrier is recommended--e.g. two weeks treatment with parenterally administered streptomycin and benzylpenicillin followed by sulphamethoxazole-trimethoprim orally for one year.
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PMID:[Whipple disease. A rare systemic disorder with multiple manifestations]. 750 46

IE is a serious, life-threatening disease. Because treatment must often be adapted to the pathogen involved, rapid identification of the etiologic agent is critical to successful management of each patient. When difficult-to-culture pathogens are involved, routine microbiologic tests, including blood culture, may remain negative. Because such cases may account for up to 31% of all IE cases, alternative diagnostic approaches are necessary. Among the etiologic agents of culture-negative endocarditis, C burnetii and Bartonella spp play a major role; each is responsible for up to 3% of episodes of IE. The authors therefore recommend the systematic use of specific serologies in all cases of clinically suspected endocarditis. The cross-reactivity between C burnetii, Bartonella spp, and Chlamydia spp is of diagnostic importance because all are potential etiologic agents of endocarditis. However, given that the levels of specific antibodies observed in Bartonella endocarditis are extremely high, low-level cross-reactions with other antigens should not lead to misdiagnosis, provided serology for all suspected agents is performed. When serologic test results are negative for both Bartonella spp and C burnetii, special staining by the Gram, Giemsa, Gimenez, PAS, Warthin-Starry, and Grocott methods may guide the use of new diagnostic tools such as PCR and tissue culture for isolation and identification of the causative agent. Such novel approaches may lead to more comprehensive patient evaluations and the discovery of new etiologic agents of IE.
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PMID:Diagnostic methods. Current best practices and guidelines for identification of difficult-to-culture pathogens in infective endocarditis. 1287 94

The Whipple' Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.
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PMID:Whipple's disease infection surgical treatment: presentation of a rare case and literature review. 2366 Jan 63

Staphylococcus aureus infections can lead to diseases that range from localized skin abscess to life-threatening toxic shock syndrome. The SrrAB two-component system (TCS) is a global regulator of S. aureus virulence and critical for survival under environmental conditions such as hypoxic, oxidative, and nitrosative stress found at sites of infection. Despite the critical role of SrrAB in S. aureus pathogenicity, the mechanism by which the SrrAB TCS senses and responds to these environmental signals remains unknown. Bioinformatics analysis showed that the SrrB histidine kinase contains several domains, including an extracellular Cache domain and a cytoplasmic HAMP-PAS-DHp-CA region. Here, we show that the PAS domain regulates both kinase and phosphatase enzyme activity of SrrB and present the structure of the DHp-CA catalytic core. Importantly, this structure shows a unique intramolecular cysteine disulfide bond in the ATP-binding domain that significantly affects autophosphorylation kinetics. In vitro data show that the redox state of the disulfide bond affects S. aureus biofilm formation and toxic shock syndrome toxin-1 production. Moreover, with the use of the rabbit infective endocarditis model, we demonstrate that the disulfide bond is a critical regulatory element of SrrB function during S. aureus infection. Our data support a model whereby the disulfide bond and PAS domain of SrrB sense and respond to the cellular redox environment to regulate S. aureus survival and pathogenesis.
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PMID:The SrrAB two-component system regulates Staphylococcus aureus pathogenicity through redox sensitive cysteines. 3235 97