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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.
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PMID:Prosthetic valve endocarditis due to Haemophilus parainfluenzae biotype II. 44 17

The study was performed on 612 routine cultures of material obtained from root canals of teeth at the time of filling (r-cultures) by students at the Department of Endodontics during a continuous period of one year. Twenty-nine isolates from 27 (29.3%) of the 92 positive cultures filled the criteria of enterococci (Sherman, 1937) and had demonstrable group D-antigen. With a set of tests these isolates were identified as follows: Strep. faecalis subsp. faecalis (10), Strep. faecalis subsp. zymogenes (3), Strep. faecalis subsp. liquefaciens (8), atypical variants of Strep. faecalis (6), Strep. faecium var. faecium (1) and Strep. faecium var. durans (1). Five tests in the present study clearly differentiated Strep. faecalis from Strep. faecium i.e. fermentation of sorbitol, glycerol (anaerobic) and melezitose, tolerance to potassium tellurite (0.1%) (positive for Strep. faecalis) and production of hydrogen peroxide (positive for Strep. faecium). In the inocula 10(3) or more colony forming units of enterococci were found more often of other identified microorganisms. This means that enterococci are of special interest in studies on the influence of infection at the time of filling of root canals on the prognosis of root canal therapy. The isolates were also tested for susceptibility to azidocillin, ampicillin, penicillin-G, penicillin-V and erythromycin with the paper disc method. All the isolates were susceptible to azidocillin and ampicillin (sensitivity group I), while the majority of the isolates showed a lower susceptibility to the other three antibiotics (sensitivity group II). The significance of these findings in the choice of prophylactic antibiotic to prevent bacterial endocarditis in patients with a history of rheumatic or congenital heart disease are discussed, when bacteremia from dental procedures may be expected.
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PMID:Streptococcus faecalis and Streptococcus faecium in infected dental root canals at filling and their susceptibility to azidocillin and some comparable antibiotics. 81 Jul 53

Transient, usually asymptomatic bacteremia occurs in a wide variety of procedures and manipulations, particularly those associated with mucous membrane trauma. It may also occur with such daily functions as tooth brushing and bowel movements. These brief bacteremias are especially common in tooth extraction and other dental procedures. Although numerical risk is uncertain, these bacteremias can occasionally give rise to infective endocarditis in the susceptible patient. While no proof exists that antibiotics given prior to procedures causing bacteremia prevent endocarditis in humans, experimental evidence in rabbits supports their use. Therefore, in situations where bacteremia is highly predictable, it would seem wise to administer prophylactic antimicrobials. Procedures in the susceptible host where prophylactic antibiotics seem prudent include dental manipulations and urinary tract instrumentation. Whether patients with acquired valvular or congenital heart disease who are to undergo abdominal surgical procedures should routinely receive prophylactic antibiotics is unclear. However, until the incidence of transient bacteremia associated with various abdominal procedures is further defined, endocarditis-prone patients should probably receive prophylaxis. Furthermore, patients with prosthetic valves who are subjected to upper gastrointestinal endoscopy, sigmoidoscopy, liver biopsy, or barium enema should also probably have antibiotic pretreatment. For dental procedures and for upper gastrointestinal endoscopy in patients with prosthetic valves, a combination of penicillin and streptomycin or vancomycin alone is recommended. For urinary tract instrumentation in all patients and for sigmoidoscopy, liver biopsy, or barium enema in patients with prosthetic valves, prophylaxis should be with ampicillin and gentamicin or vancomycin and gentamicin.
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PMID:Transient bacteremia and endocarditis prophylaxis. A review. 83 37

Thirty-one patients with systemic candidiasis at postmortem examination were found to have Candida involvement of the myocardium without valvulitis. Retrospective examination of their clinical course demonstrated that a new conduction disturbance was seen in 10, supraventricular arrhythmias in 5,QRS changes mimicking myocardial infarction in 3, and pronounced T wave changes in 13. Hypotension or shock was seen in 13 patients and could not be explained by coexistent bacteremia or blood loss in 8. One patient died suddenly. Of 19 patients with systemic candidiasis without myocardial invasion, 4 had minor T wave changes and one had a supraventricular arrhythmia. Candida invasion of the heart significantly complicates the clinical course in systemic candidiasis and should be suspected when a young person without preexistent heart disease has cultures positive for a Candida organism, a significant arrhythmia, conduction distrubance or other dramatic QRS change. The effect of therapy on Candida invasion of the heart is unknown.
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PMID:Candida myocarditis without valvulitis. 99 27

Endovascular infections that involve the right side of the heart present their own unique etiologies, pathophysiologies, clinical manifestations, and therapeutic issues. The pathology of the vegetations of right-sided endocarditis is identical to that of left-sided endocarditis. These vegetations are irregular, friable masses of varying size the contain platelets, fibrin, RBCs, and microorganisms. These lesions serve as a nidus for deep-seated infection and produce sustained bacteremia. Right-sided endocarditis occurs in 5% to 10% of all cases of endocarditis. The most common predisposing factors are IV drug abuse and congenital heart disease. S. aureus is the most common pathogen. The clinical manifestations include fever, chills, rigor, dyspnea, pleuritic pain, productive cough, and hemoptysis. The cardiac manifestations can be notably absent early in the course of the disease, with only 20% of patients initially showing a significant murmur on physical examination. Peripheral embolic lesions can be seen. Echocardiography is helpful in identifying vegetations on the tricuspid valve in a significant proportion of patients. The chest radiograph is characteristic, showing features typical of multiple septic pulmonary emboli. The radiograph shows multiple, small, fuzzy, patchy, peripherally located densities that can change rapidly on serial films. Complications of right-sided endocarditis include pulmonary infarction, pulmonary abscess, progressive right-sided heart failure, and renal abnormalities. The treatment of right-sided endocarditis includes prolonged therapy, with high doses of IV bactericidal antibiotics. Four weeks of antibiotic therapy is generally required, but newer regimens using combination antibiotic therapy can be successful in sensitive strains of viridans group streptococci and S. aureus. Surgical resection of the tricuspid valve is recommended for organisms that do not respond to initial antibiotic therapy, fungal endocarditis, resistant relapsing organisms, or coexistent infection with S. aureus and P. aeruginosa. The prognosis of right-sided endocarditis is generally favorable when compared with left-sided endocarditis. The prognosis is especially favorable in IV drug abusers infected with S. aureus. Patients infected with fungal organisms, Pseudomonas or Serratia, have a worse prognosis. The presence of significant right-sided heart failure also imparts a worse prognosis.
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PMID:Endovascular infections arising from right-sided heart structures. 173 55

Infective endocarditis is a serious disease and should be, if possible, prevented. Two risk groups are classified in relation to the patient's underlying cardiac lesions. At high risk are patients with prosthetic valves or with a previous infective endocarditis. Patients with congenital and acquired heart disease, mitral valve prolapse with regurgitation and hypertrophic obstructive cardiomyopathy are at moderate risk. Patients of these two groups should receive antibiotic prophylaxis before dental or surgical procedures that cause bacteremia. For patients at moderate risk a single dose of an orally administered antibiotic should be given one hour before the procedure (e.g. amoxicillin 3 g for procedures of the oropharyngeal, gastrointestinal or genitourinary tract, where the causitive agents of endocarditis are Viridans streptococci or enterococci). Multiple doses are recommended for patients at high risk. The combination of amoxicillin and gentamicin (vancomycin and gentamicin in penicillin-allergic patients) offers the widest margin of safety in high-risk patients.
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PMID:[Antibiotic prevention of bacterial endocarditis]. 185 64

We have evaluated 44 cases of Serratia marcescens bacteremia (SB). Most took place in surgical services (57%) and the ICU (34%). In one occasion, the cases developed as an epidemic outbreak. SB basically developed in patients with underlying diseases (neoplasia in 32%, heart disease in 16%, chronic bronchitis in 14% and miscellaneous in 20%) in whom some invasive procedure had been carried out (98%). The most common complication was septic shock. In 17 cases the infection was polymicrobial. The most common serogroup was 0:5 (41%). 98% of strains were resistant to cephalothin, 78% to ampicillin and 29% to tobramycin. The mortality rate was 39% and the most common cause of death was septic shock. The factors which adversely influenced prognosis were as follows, in order of decreasing importance: leukocytosis, thrombopenia, associated gram-positive infection, age older than 65 years, "non-typable" serogroup, unknown portal of entry, epidemic case and septic shock.
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PMID:[Nosocomial bacteremia caused by Serratia marcescens: analysis of 44 cases]. 209 56

68 patients presented to the Veterans General Hospital, Taipei with nonenterococcal group D streptococcal septicemia in the years 1985-1987. 36 patients (53%) had nonenterococci as part of a polymicrobial bacteremia. The large intestine was not examined in most patients. Five patients (7%) had associated colonic carcinoma, and 17 patients (25%) had colorectal diseases. Only 7/68 patients (10%) were clinically diagnosed as having infective endocarditis by the doctors in charge. The others were regarded as having septicemia. The charts of these patients were reviewed retrospectively to diagnose infective endocarditis based on strict definitions. One (1%) had definite endocarditis proved at autopsy. 16 patients (24%) had probable endocarditis due to the presence of either a new regurgitant murmur or both a predisposing heart disease and embolic phenomena; 39 (57%) had possible endocarditis based on evidence of having either a predisposing heart disease or embolic phenomena; and only 12 (18%) had no evidence of endocarditis. 27 patients (40%) had at least one predisposing heart disease associated with endocarditis. 51 patients (75%) had at least one lesion suggesting embolic phenomena. 30 patients (44%) had electrocardiographic abnormalities. This high incidence of arrhythmia in nonenterococcal septicemia is of particular interest and could be related to cardiac involvement in some patients. The overall mortality, 62% (42/68), was extremely high in our series, but in those who were clinically diagnosed and treated as infective endocarditis, the mortality was low, 14% (1/7). We suggest all patients with nonenterococcal septicemia associated with either heart disease or lesions of CNS, lung, heart, kidney or limbs suggesting embolic phenomena should be regarded as having possible or probable endocarditis. Treating such patients as having infective endocarditis may reduce the mortality in nonenterococcal septicemia.
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PMID:Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis. 212 42

From October 1987 to December 1989, bacteriological surveillance was done after open heart surgery in 100 patients with cardiovascular diseases (54 with congenital, 44 with rheumatic, and 2 with other types of heart disease). The time of bypass was 58 to 234 minutes (mean = 98.7 minutes). The positive rate of culture was 5% for blood, 40% for sputum, and 15% for pericardial drainage. Many types of bacteria were separated. Most of them were conditional pathogenic bacteria. Postoperative infection was found in 9 patients, (bacteremia in 1 and pulmonary infection in 8.) Tracheostomy was done in 5 cases. In discussion, the authors think that the low defensive ability of the patients with serious heart disease is usually further damaged by bacterial invasion after open heart surgery and that bacterial contamination should be reduced in order to prevent postoperative infection.
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PMID:[Surveillance and prevention of infections after open heart surgery]. 212 62

We report two different cases of bacteremia caused by two recently described Selenomonas species, Selenomonas artemidis and Selenomonas infelix. Both species are normally found in human buccal flora. S. artemidis bacteremia appeared in a patient (number 1) who presented with an air-fluid pulmonary cavity and clinical conditions consistent with an anaerobic lung abscess. While the patient improved with antibiotic therapy, cultures of respiratory secretions yielded Mycobacterium tuberculosis. This case demonstrated a strong possibility of a coexisting lung abscess due to S. artemidis. S. infelix bacteremia appeared in a cancer patient (number 2) with heart disease during preterminal acute respiratory distress. It was more difficult in this case to assess the clinical impact of the Selenomonas organisms on the patient.
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PMID:Bacteremias caused by Selenomonas artemidis and Selenomonas infelix. 240 9


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