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

The authors report a case of isolated infective endocarditis of the pulmonary valve due to Streptococcus bovis in a 62-year-old male presented with delayed fever of unknown origin. There were no predisposing factors such as i.v. drug abuse or congenital heart disease. The clinical course was complicated with an epidose of pulmonary emboli occurring after the onset of treatment. The patient responded to the appropriate antibiotics without requiring valve surgery. The association of Streptococcus bovis endocarditis and bacteremia with colonic neoplasia has been reported in the literature. In this case the evaluation of the colon was negative.
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PMID:[Pulmonary valve endocarditis caused by Streptococcus bovis]. 791 82

All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. MRSA-infected persons were more likely to have received steroids before developing infection (relative risk [RR] = 3.45, 95% confidence interval [CI] = 1.38-8.59), to have been ventilated > 6 d (RR = 2.03, 95% CI = 1.36-3.03), to have been older than 25 yr (RR = 1.50, 95% CI = 1.09-2.06), and to have had preceding chronic obstructive pulmonary disease (RR = 2.76, 95% CI = 0.89-8.56) than MSSA-infected patients. MSSA-infected persons were more likely than MRSA-infected patients to have cranioencephalic trauma (RR = 1.94, 95% CI = 1.22-3.09). All patients with MRSA VAP had previously received antibiotics, compared with only 21.1% of those with MSSA infection (p < 0.000001). The incidence of empyema was similar in both groups; nevertheless, the presence of bacteremia and septic shock was more frequent in the MRSA group. Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. 795 12

Infection is a serious cause of morbidity and mortality in the cardiac transplant patient. Early infections within the first month after transplantation are usually caused by nosocomial pathogens, such as Pseudomonas aeruginosa, Staphylococcus aureus, Enterococci, and members of Enterobacteriaceae and include pneumonia, urinary-tract and would infections, and bacteremia associated with the use of intravascular devices. Late infections, usually occurring after the first month and within the first year of transplantation, are commonly caused by cytomegalovirus, Pneumocystis carinii, Legionella, and fungi. Because cardiac transplantation has become a well-established treatment for patients with end-stage heart disease, more physicians will be treating these patients and will need to be familiar with the types of infectious complications associated with transplantation.
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PMID:Cardiac transplantation and related infections. 801 80

Eighteen cyanotic congenital heart disease (CCHD) and 17 acyanotic congenital heart disease (ACHD) patients in the age range of 2 months to 10 years along with their age and nutrition matched controls were studied for bactericidal, chemotactic and phagocytic functions. Bactericidal and phagocytic functions were significantly depressed in CCHD (p < 0.001) as well as ACHD group (p < 0.001) compared with controls. Chemotactic function was not significantly affected in either. Arterial oxygen content (as a measure of hypoxia) was calculated for each patient and correlated with each immune parameter by univariate linear regression analysis. In CCHD patients linear correlation of borderline significance (p = 0.07) was found between arterial oxygen content and bactericidal activity, but no correlation could be established with phagocytic and chemotactic functions. No correlation was obtained between hematocrit and any of the immune parameters. In ACHD patients no correlations were obtained between the immune parameters and arterial oxygen content or hematocrit. Iron deficiency anemia, known to affect bactericidal function, did not seem to affect the immune parameters in CCHD and ACHD groups. Altered oxygen content of the blood owing to hypoxia in CCHD patients may be an important etiological factor in the genesis of bacteremia and cerebral abscess. The affection of immune functions in ACHD cannot be adequately explained.
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PMID:Polymorphonuclear leukocyte functions in children with cyanotic and acyanotic congenital heart disease. 813 80

The use of antibiotics in patients who undergo cardiac catheterization, by percutaneous approach, using re-sterilized catheters, is controversial, and there is not clear information in this regard. We investigated the frequency of bacteremia during cardiac catheterization and the evidence of later infection, using re-sterilized material. We studied 227 consecutive patients over one year, and we obtained 200 blood cultures of the beginning and the end of the procedure. All the cultures were negative and there was not evidence of clinical infection in the year following the study. These results indicated that bacteremia is rare during cardiac catheterization, if aseptic technics are followed. Based on these result we do not recommend the use of antibiotics in patients undergoing cardiac catheterization. The sex, age, type of heart disease and re-sterilized material do not alter this recommendation.
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PMID:[Is the use of prophylactic antibiotics of benefit in patients undergoing heart catheterization?]. 817 39

Infective endocarditis, resulting from deposition of circulating microorganisms during a period of bacteremia on damaged endothelial heart valves, remains a serious disease. Its overall incidence did not decline in recent years, 24 cases/year/million inhabitants, in France. This can be explained by a modification of the type of underlying cardiac conditions with regression of rheumatic fever and increase of degenerative heart diseases, prosthetic valves and mitral valve prolapse. The risk of bacterial seeding on a damaged valve remains difficult to evaluate, the highest risk being for patients with prosthetic valve, previous infective endocarditis and cyanotic congenital heart disease. A case-control study, done in 1991, confirmed that procedures are risk factors for infective endocarditis and that the multiplicity of procedures increases the risk. A French consensus conference on the prophylaxis of infective endocarditis has updated the recommendations for antibiotic prophylaxis. Two groups of cardiac patients were identified, based on the incidence and the severity of endocarditis occurring in patients with these conditions, 1) patients considered at risk which require specific prophylaxis, and 2) patients considered non at risk which do not require antibiotic prophylaxis. Procedures which require antibiotic prophylaxis are dental procedures and specific gastrointestinal and urologic procedures. As complex protocols are associated with poor compliance by practitioners and patients, the jury has aimed for simplicity and feasibility.
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PMID:[Infectious endocarditis, risk factors, prevention. Research group for infectious endocarditis and jury of the consensus conference]. 819 Nov 7

The incidence of endocarditis is increased in patients with cardiac lesions causing turbulent flow. A 400-fold increase is observed in patients with prosthetic valves and a prior history of endocarditis. Other high risk lesions include rheumatic valvular disease, cyanotic congenital heart disease, and degenerative valve lesions. The smaller increased incidence in patients with mitral valve prolapse is important because of the high prevalence of mitral valve prolapse in the population. In addition, intravenous drug use and nosocomial bacteremia have emerged as important factors among patients with endocarditis.
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PMID:Risk factors for infective endocarditis. 846 56

Infective endocarditis is a rare, serious, and sometimes fatal heart disease that can be caused by bacteremia from the mouth, especially by Streptococcus viridans. As a result, dental procedures have often been blamed for cases of infective endocarditis but poor oral health and hygiene may actually cause more cases of infective endocarditis than do dental procedures. The American Heart Association and other groups have published recommendations for the prevention of infective endocarditis in dental patients and advise specific antibiotic regimens for certain dental procedures in cardiac-abnormal patients. The most recent (1990) American Heart Association recommendations are the most conservative yet, reflecting concern about the prevention of not only infective endocarditis, but also problems resulting from the antibiotics themselves. Clinicians should carefully consider not only the patient's medical history, but also the types of dental procedures planned.
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PMID:Prevention of infective endocarditis: an update for clinicians. American Heart Association. 851 Dec 76

Capnocytophaga sp. is a gram-negative bacilli, scarcely documented as the cause of bacteremias. Two cases of bacteremia caused by Capnocytophaga sp, one of them with endocarditis, are reported here. A review of previous published cases is also presented. One of the patients was immunocompromised, because of chemotherapy, the other, suffered from a rheumatic-cardiopathy which was complicated with endocarditis. Both patients developed an alteration of the oral mucosa. Antibiotic therapy proved to be effective with two patients.
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PMID:[Bacteremia caused by Capnocytophaga sp: presentation of 2 cases, one with endocarditis. Review of the literature]. 868 78

It is accepted medical practice to prevent bacterial endocarditis in patients with susceptible congenital or acquired cardiac malformations who are likely to experience predictable procedure-related bacteremia. Patients in general, those with congenital heart disease specifically, are insufficiently aware of the need for such prophylaxis. It is responsibility of the physician to determine which patients are susceptible to endocarditis and the need for endocarditis prophylaxis for each patient for any given instance and to educate the patient as to this need. The American Heart Association provides wallet-sized cards that may be given to each patient. Those patients not previously known to have heart disease are, of course, not eligible for chemoprophylaxis. Because these represent many of the patients with endocarditis each year, it can be argued that only a minority of patients have preventable cases. Regarding the clinical application of anti-infective endocarditis prophylaxis, the American Heart Association gives this perspective: This statement represents recommended guidelines to supplement practitioners in the exercise of their clinical judgement and is not intended as a standard of care for all cases.... Because no adequate, controlled clinical trials of antibiotic regimens for the prevention of bacteria endocarditis in humans have been done, recommendations are based on vitro studies, clinical experience, data from experimental animal models, and assessment of both the bacteria most likely to produce bacteremia from a given site and those most likely to result in endocarditis. Bacterial endocarditis is one of the few infectious disease that almost always result in death unless treated. The dramatic nature of the morbidity and mortality of infective endocarditis in those so afflicted makes the prevention of even a few cases worth the effort.
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PMID:Risks for and prevention of infective endocarditis. 885 28


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