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

Ninety-nine patients treated with penicillin G potassium, cephalothin sodium, or vancomycin hydrochloride were studied to evaluate single-drug therapy for nonenterococcal streptococcal endocarditis. Eighty-six patients survived; of these, 66 received penicillin alone. The maximum serum bactericidal titer obtained at the expected nadir of serum antibiotic concentration was 1:8 or greater in 70 (95%) of the 74 patients studied. No relapse occurred among the 66 patients treated wih penicillin. Only one patient experienced a relapse that occurred following therapy with suboptimal doses of vancomycin. Distinct second episodes of endocarditis occurred in five patients. While 13 patients died, none died of intractable infection. The treatment of endocarditis due to penicillin-susceptible streptococci with high-dose parenteral penicillin or a bactericidal penicillin substitute for four weeks or longer results in bacteriologic cure rates comparable with those achieved with combined penicillin-streptomycin regimens.
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PMID:Single-antibiotic therapy for streptococcal endocarditis. 10 35

Bacterial endocarditis of the tricuspid valve was diagnosed in a cow with weight loss, reduced milk production, and intermittent fever. Clinical signs of disease included jugular and mammary vein pulses, tachycardia, large cardiac silhouette, and grade-III/V holosystolic murmur. The diagnosis was also supported by echocardiographic findings and isolation of Streptococcus viridans from blood samples. The cow was treated with penicillin, furosemide, acetylsalicylic acid, heparin, and potassium chloride and survived 14 months after the diagnosis, producing 1 live calf and 4 viable embryos. The cow's heart rate exceeded an upper normal limit of 80 beats/min during most of the initial 4 months of treatment. Additional clinical signs of disease that were observed during treatment included diarrhea, ventral edema, and coughing. General medicine and cardiology textbooks have previously minimized the potential benefits of anticoagulant use in cases of septic endocarditis. The advent of routinely performed embryo transfer procedures may make treatment of endocarditis feasible in cattle with exceptional genetic merit.
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PMID:Endocarditis in a cow. 191 33

An 18-year-old woman who underwent an elective second-trimester abortion developed Streptococcus agalactiae (group B streptococcus) endocarditis characterized by a large, pedunculated vegetation involving a previously normal tricuspid valve. Polyarthritic symptoms, as well as multiple pulmonary emboli, were experienced, and cure followed a course of treatment using intravenous penicillin G potassium combined with gentamicin sulfate. Endocarditis caused by this pathogen usually occurs among individuals compromised by underlying chronic disorders and, today, is a rare sequela of pregnancy and abortion. When planning therapy, consideration should be given to the possibility of tolerance among clinical isolates and the need for operative intervention in selected patients.
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PMID:Group B streptococcus endocarditis following second-trimester abortion. 224 76

A case of Clostridium bifermentans endocarditis occurred in a 23-year-old man who was an intravenous drug user. There was no history of preexisting valvular heart disease. He was initially treated with high-dose penicillin G potassium but remained bacteremic for a ten-day period. The bacteremia resolved when the therapy was changed to metronidazole hydrochloride. A review of the 16 reported cases of clostridial endocarditis showed no predisposing host factor to the development of the disease. Penicillin is the treatment of choice for clostridial endocarditis, but metronidazole should be considered as an alternate therapy for treatment that fails.
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PMID:Clostridial endocarditis. Report of a case caused by Clostridium bifermentans and review of the literature. 264 5

Actinobacillus actinomycetemcomitans is a fastidious, facultative gram-negative rod associated with endocarditis, certain forms of periodontal disease, and other focal infections. Human neutrophils have demonstrated bactericidal activity against A. actinomycetemcomitans, and much of the oxygen-dependent killing has been attributed to the myeloperoxidase-H2O2-halide system. However, the contribution of other neutrophil components to killing activity is obscure. Lactoferrin, an iron-binding glycoprotein, is a major constituent of neutrophil-specific granules and is also found in mucosal secretions. In this report, we show that human lactoferrin is bactericidal for A. actinomycetemcomitans. Killing activity required an unsaturated (iron- and anion-free) molecule that produced a 2-log decrease in viability within 120 min at 37 degrees C at a concentration of 1.9 microM. Besides exhibiting concentration dependence, killing kinetics were affected by minor variations in temperature and pH. Magnesium, a divalent cation thought to stabilize lipopolysaccharide interactions on the surface of gram-negative organisms, enhanced lactoferrin killing of A. actinomycetemcomitans, while other cations, such as potassium and calcium, had no effect. Our data suggest that lactoferrin contributes to killing of A. actinomycetemcomitans by human neutrophils and that it may also play a significant role in innate secretory defense against this potential periodontopathogen.
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PMID:Killing of Actinobacillus actinomycetemcomitans by human lactoferrin. 341 49

Seventeen patients with Streptococcus mitis endocarditis were treated at a municipal hospital over a three-year period. Thirteen patients were intravenous drug addicts. Streptococcus mitis has a predilection for right-sided endocarditis in intravenous drug addicts and left-sided endocarditis in non-drug addicts. Streptococcus mitis is highly susceptible to therapy with penicillin G potassium (minimal inhibitory concentration less than or equal to 0.1 mg/L of penicillin in all of these 17 cases), and four to six weeks of therapy is safe and effective.
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PMID:Streptococcus mitis endocarditis. Report of 17 cases. 377 70

Kingella (Moraxella) kingae occasionally colonizes the nasopharynx and rarely causes serious infections. Three children with K kingae infections treated over a two-month period were studied. Epidemiologic investigation concluded that infection was community acquired, not pseudoinfection or nosocomial infection. Except for prompt laboratory recognition of the organism, no identifiable factors explained the observed prevalence. Five additional K kingae infections were reviewed. Affected sites included blood (two), valves (two), bone (two), joint (one), and disk space (one). Three patients had underlying disease; one was immunosuppressed. Kingella kingae resembles other members of the Neisseriaceae family and causes similar infections except meningitis. It is differentiated by colonial characteristics and standard biochemical tests. Treated infections responded to penicillin G potassium. Gram-negative bacteria uncommonly are implicated in endocarditis, arthritis, osteomyelitis, and diskitis; K kingae deserves recognition as a pathogen in these pediatric infections.
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PMID:Kingella (Moraxella) kingae infections in children. 685 76

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

We have treated 35 cases of staphylococcal endocarditis in 33 patients with intravenous followed by oral antimicrobial therapy. All patients had three or more blood cultures positive for Staphylococcus aureus, and all had cardiac murmurs characteristic of valvular insufficiency. The mean total duration of antimicrobial therapy was 42.4 d, consisting of a mean of 16.4 d of intravenous therapy followed by a mean of 26 d of oral therapy. Intravenous antimicrobial therapy included sodium nafcillin (32 cases; mean dose 9.2 g daily) and clindamycin (three cases). Oral therapy included dicloxacillin or oxacillin (30 cases; mean dose 4.5 g daily), clindamycin (four cases), and potassium penicillin V (one case). Serum bactericidal titers using the blood culture isolates showed similar activity with both intravenous and oral drugs. All patients treated with this sequential intravenous and oral regimen were cured. A regimen of initial intravenous followed by oral antimicrobial therapy, monitored with serum antibacterial activity studies, is a safe, effective, well-tolerated, and economical treatment for staphylococcal endocarditis.
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PMID:Intravenous followed by oral antimicrobial therapy for staphylococcal endocarditis. 744 89

A 71-year-old high-risk fourth-time redo male patient was diagnosed with prosthetic valve endocarditis of both aortic and mitral valves, and subsequently required a re-operative aortic and mitral valve replacement. He was placed on cardiopulmonary bypass (CPB) and arrested with normothermic hyperkalemic all-blood cardioplegia (microplegia) containing adjunctive adenosine-lidocaine-magnesium (adenocaine); aerobic arrest was maintained with near-continuous retrograde low potassium (approximately 2 mEq/L) adenocaine microplegia. After 4 hours of arrest on CPB, the aortic valve was found to be incompetent and was resected. A root replacement was required utilizing a Medtronic Freestyle Root prosthesis. Four separate periods of cross-clamp were required during the course of the entire operation. The patient was on CPB for 9.8 hours with a total cross-clamp time of 7 hours, during which he received 72 liters of all-blood adenocaine microplegia. After a terminal "hot shot" with adenocaine microplegia and no added potassium, CPB was discontinued with no systemic hyperkalemia (5.1 mmol/L), no hemodilution (hematocrit, 24%), no balloon pump, no antiarrhythmic agents, and modest inotropic support. The patient was hemodynamically stable, was extubated in 12 hours, and was transferred out of the cardiac ICU after 48 hours with a subsequent uneventful recovery.
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PMID:Excellent outcomes in a case of complex re-do surgery requiring prolonged cardioplegia using a new cardioprotective approach: adenocaine. 1885 34


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