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Query: UMLS:C0014118 (endocarditis)
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Our patient, with cirrhosis and chronic renal failure, represents an example of the susceptibility of a compromised host to Aeromonas infections. This patient, however, differs from previously reported cases in at least two important aspects. First, it is possible that her portal of entry was a fresh A-V fistula puncture site rather than an intestinal site. The temporal relationship of exposure to flood water prior to the onset of sepsis lends support to this possibility. Epidemiologic investigation of the dialysis center failed to reveal Aeromonas isolates from cultures of the water supply, machinery, or other patients. Second, this case is unique in that our patient developed a destructive aortic valve endocarditis resulting in valvular perforations and acute aortic insufficiency. Furthermore, this infection was initiated on what appears to have been a previously normal valve. Based on a review of the literature and the virulence demonstrated by A. hydrophila in our patient, we conclude that organisms of the genus Aeromonas are capable of inducing serious human infection. Such infections are more likely to occur in compromised hosts. A. hydrophila has accounted for the majority of reported infections.
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PMID:Human aeromonas infections: a review of the literature and a case report of endocarditis. 34 23

Pseudomonas mendocina has been isolated from soil and water samples. Although it has been recovered from some human clinical samples, its pathogenic role has not yet been documented. We report the first known case of endocarditis in humans due to P. mendocina.
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PMID:Pseudomonas mendocina, an environmental bacterium isolated from a patient with human infective endocarditis. 162 80

Pseudomonas aeruginosa is an opportunistic, gram negative bacillus that causes serious hospital acquired infections. However, it also causes infections with unusual presentations which are acquired in a non-hospital environment. This report will discuss the pathogenesis, clinical manifestations, and therapy of this uncommon infection, such as: 1) Pseudomonas folliculitis: a superficial or deep bacterial infection associated with the use of public hot tubs, whirlpools and swimming pools. 2) Invasive external otitis: an infection that can progress to skull base mostly associated to elderly diabetic patients. It is usually secondary to aural irrigation with contaminated water. 3) Pseudomonas osteomyelitis: an infection usually associated with nail puncture wounds especially if wearing tennis shoes. 4) Toe with infection: mostly associated with individuals using topical antibacterial agents. 5) Green nail syndrome: a non tender paronychia lesion that appears most often in persons whose hands are constantly exposed to water, soaps and detergents or are subject to mechanical trauma. 6) Corneal ulcer keratitis: mostly associated with the use of soft lenses, eye drops, mascara or contaminated whirlpools. This condition may terminate in panophthalmitis. 7) Endocarditis: most commonly associated with intravenous drug addicts.
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PMID:Unusual presentation of Pseudomonas aeruginosa infections: a review. 181 75

We reported a 29-year-old man with active endocarditis complicating aortic and mitral valve regurgitation. The echocardiogram showed a mycotic aneurysm at aortic valvular annulus and a aneurysm of mitral valve. Heart failure was progressive and caused anuria. Prior to emergent double valve replacement, 2,500 ml of water was removed. Then hemodynamics became stationary. Urination was good during and after operation. In this case, complicating acute renal failure, dehydration with extracorporeal ultrafiltration method was very effective for improvement of hemodynamics.
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PMID:[An emergent aortic and mitral valve replacement for active infective endocarditis preoperatively using extracorporeal ultrafiltration method]. 202 Jan 51

Aeromonas, a genus of gram-negative bacteria normally found in water and soil, is well established as a pathogen in the animal kingdom. Often considered as a pathogen of low virulence, its role in human infections has recently been recognised. Aeromonas infections in humans range from cellulitis to septicaemia. Endocarditis is rare. We describe here a patient with a chronic liver disease with aeromonas bacteremia and endocarditis.
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PMID:Aeromonas endocarditis in a patient with chronic hepatitis-B infection. 261 4

A 40-year-old woman with staphylococcus aureus endocarditis of the mitral valve associated with acute pulmonary edema and renal dysfunction is presented. The patient was admitted to Hiroshima University Hospital with infective endocarditis. On the 14th day after admission, she suffered from severe cardiac failure and oligouria, then she was transferred ICU. Chest X-ray film showed pulmonary congestion and echocardiogram revealed 4th grade of mitral valve regurgitation. Emergent mitral valve replacement was performed and rupture of anterior mitral chorda was found as the cause of acute pulmonary edema. Postoperative care was difficult because of advanced renal failure and cardiac failure not responded to diuretics. Extracorporeal ultrafiltration method was effectively used on the 1st and the 2nd postoperative days and 3000 ml of water was filtered without hemodynamic change. Symptoms of renal and cardiac failure recovered promptly after ultrafiltration. Emergent operative and postoperative use of ultrafiltration method is effective in some cases of infective endocarditis complicated with cardiac and renal failure.
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PMID:[A case report of infective endocarditis with acute pulmonary edema and renal dysfunction treated by emergent mitral valve replacement and postoperative extracorporeal ultrafiltration]. 280 98

A review of atypical mycobacterial infections complicating cardiac operations is presented. Proven sources of infections at different institutions include contaminated porcine valves and municipal water supply, but the mode of transmission in the great majority of patients remains unclear. There are two principal clinical forms of atypical mycobacterial infections after cardiac operations--endocarditis and sternal osteomyelitis. The latter has characteristics resembling tuberculotic "cold abscess." Specialized laboratory testing is necessary to confirm the diagnosis, and surgeons may have to take the initiative to request special microbiological investigation in cases where infection is clinically suspected but routine cultures are reported as "negative." The prognosis for patients who have any atypical mycobacterial infection after a heart operation is severe. Those infected with the strain chelonei and those whose cardiac chambers were entered during operation fare worse. This dim clinical prognosis may be improved by appropriate and aggressive antibiotic and surgical therapy. Awareness of the urgency of special bacteriological studies is the key to successful management.
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PMID:Rapidly growing nontuberculous mycobacteria: a new enemy of the cardiac surgeon. 305 65

Greened or sprouted potatoes contain increased concentrations of steroidal alkaloids that have caused intoxication and death in a wide variety of animal species, however, the cause of death in these animals has not been determined. Potato alkaloids can cause death when parenterally administered, and is attributed to the acetylcholinesterase inhibitory activity of solanine and chaconine. To determine the cause of death in animals ingesting potato sprout material, 40 Syrian hamsters were divided into 4 equal groups and gavaged once on day 0 either water, 300 mg of potato sprout material, 400 mg of potato sprout material, or 500 mg of potato sprout material. Tissues were examined grossly and microscopically at 72 hr post-gavaging and brain acetylcholinesterase activity of each hamster was measured. The 300-mg dose group had increased mean acetylcholinesterase activity compared with control hamster mean activity, and the 400-mg and 500-mg dose groups had 90% and 84% of the mean acetylcholinesterase activity of the control hamster mean activity. There was severe gastric and proximal small intestinal mucosal necrosis in those hamsters which died prior to euthanasia. Additionally, several hamsters had valvular endocarditis and infarcts. Death could not be attributed to the slight acetylcholinesterase inhibition in the 2 higher dose hamster groups and was related to the severe gastrointestinal necrosis which occurred in hamsters of these groups.
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PMID:Mechanism of death in Syrian hamsters gavaged potato sprout material. 319 55

After a pathogen has been identified and the antibiotic susceptibility determined, parenteral antibiotic administration can be replaced by the oral route for certain patients with meningitis, brain abscess, endocarditis, and skeletal infections. Antibiotics should be administered with the stomach empty and accompanied by 3 ml/kg of water. Direct instillation into the lumen of the small intestine may be advantageous with selected patients. Documenting adequate antibiotic absorption and ensuring compliance are essential to efficacious therapy.
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PMID:Oral antibiotic therapy for serious infections. 328 69

Since 1982 seven patients at Stanford University Medical Center have been shown to have prosthetic-valve endocarditis caused by Legionella pneumophila or L. dumoffii. We studied the clinical features of legionella endocarditis at the time of diagnosis and performed a case-control study to analyze risk factors for the infection. All patients with endocarditis had a chronic course (3 to 19 months after surgery) of fever, night sweats, weight loss, and anemia, but no embolic events or immune-complex deposition disease. Five patients required surgical replacement of their infected prosthetic valves. The case-control study revealed that during the early postoperative period, patients who later contracted legionella endocarditis were more likely to have had symptoms and signs attributable to postcardiomyotomy syndrome than were patients who did not contract endocarditis (P less than 0.013). Examination of the legionella isolates by means of molecular techniques demonstrated that the Stanford L. pneumophila isolates were genotypically identical to isolates from the hospital drinking water. L. dumoffii isolates from patients with endocarditis were derived from a single strain apparently unique to this medical center. We conclude that legionella infection was nosocomially acquired in the perioperative period. These cases demonstrate an expanding spectrum of illness caused by legionella species and emphasize the need to consider legionella as a cause of "culture-negative" endocarditis.
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PMID:Legionella prosthetic-valve endocarditis. 334 Jan 36


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