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

The advances in the antibiotic therapy of acute bacterial infections can be shown by the decreasing frequency of complications and fatalities in children. The annual death-rate from pneumonia in children aged one month to 15 years has fallen in Schleswig-Holstein from 1.8 (1954-1958) to 0.6 per 10,000 (1969-1973). At the same time the total death-rate in the same age group has fallen from 14.5 to 9.3 per 10,000 children. The percentage of pneumonia in the total death-rate was 5.3% in 1971-1973: 1.6% in the first month of life and after the sixteenth year 2.3%. Pneumonia was in fourth place (after accident, malformation and neoplasm) as a cause of death in children more than one month old. Of 245 children operated on for congenital heart disease in 1983-1984, bacterial and fungal infections occurred in 3.6% compared to 17.8% of 469 in 1968-1972. Staphylococcal infections decreased from 3.4% to 0.8% and those caused by gram-negative bacteria from 6.9% to 0. Perioperative prophylaxis was performed with cefotaxime plus piperacillin in 1983-1984 versus oxacillin plus ampicillin in 1968-1972. Between 1984 and 1989, 944 children (premature babies and term babies) were treated in the intensive care unit of the University Children's Hospital of Kiel. The incidence of sepsis was 5% (congenital sepsis 4%, sepsis acquired after birth 1%). Early diagnosis and treatment of severe bacterial infections with cefotaxime plus piperacillin reduced the mortality rate of sepsis to 2%. Sepsis never developed under treatment with cefotaxime plus piperacillin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Progress of antibiotic therapy in pediatrics]. 200 18

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

We report a case of Haemophilus aphrophilus endocarditis involving mitral and tricupsid valves in a boy with congenital heart disease. He had received dental treatment without antibiotic cover. Prolonged high-dose ampicillin with gentamicin was necessary for cure. Short courses of ampicillin alone may not successfully treat H. aphrophilus.
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PMID:Haemophilus aphrophilus endocarditis. 220 42

Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.
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PMID:Treatment of AIDS-associated heart disease. 281 20

While salmonellosis is often considered to affect primarily the gastrointestinal tract, infection at other sites may occur, producing characteristic clinical syndromes. We reviewed cases from our institutions and the literature on focal manifestations of salmonella infections. In the past, most extra-intestinal salmonella infections were caused by S. choleraesuis; however, we found S. typhimurium to be the predominant serotype. The mortality rate for patients in our series was considerably lower than the rate described for focal infections in other reviews. This may in part be due to lower proportion of infections due to S. choleraesuis, improved microbiologic and diagnostic techniques, increased use of ampicillin, and improved surgical techniques. Salmonella endocarditis usually occurs in patients with preexisting heart disease. Unlike other salmonella infections, S. choleraesuis is the most frequent serotype. Salmonella endocarditis is often very destructive, with a fatality rate of 70%. Nonvalvular (mural) endocarditis occurs in one-fourth of patients and survival has not been reported. While antibiotic therapy should be tried initially, if response is not prompt the clinician should look for an associated site of infection (intra- or extra-cardiac abscess), which will often require surgery. Salmonella pericarditis often presents with cardiac or pulmonary symptoms, but typical signs of pericardial disease (pulsus paradoxus, friction rub) or characteristic electrocardiographic changes (low voltage, elevated ST segments) are uncommon. Early diagnosis, before infection involves other areas of the heart, is crucial for survival. In addition to antibiotic therapy, pericardiocentesis or pericardiectomy is required. Salmonella may infect the peripheral or visceral arteries, but the abdominal aorta is the most frequent site of vascular infection. Most patients are men over age 50 with preexisting atherosclerosis of the aorta who do not have a previous history of gastroenteritis. About one-fourth of patients have associated lumbar osteomyelitis. No patients have been reported to survive with medical therapy alone. Specific guidelines for surgical removal of infected aneurysms have been proposed and these (in addition to increased use of ampicillin) may be responsible for higher survival rates in recent years. Due to the high incidence of relapses, postoperative blood cultures should be done routinely. Arterial infection should be considered in any elderly patient with salmonella bacteremia especially with prolonged fever or bacteremia after an "adequate course" of antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Extra-intestinal manifestations of salmonella infections. 330 60

A 4-month-old infant with congenital heart disease and sepsis and arthritis, and subsequently meningitis, caused by an antibiotic-resistant strain of Haemophilus influenzae type b, failed to respond to sequential therapy with ampicillin and trimethoprim/sulfamethoxazole. Following treatment with ceftizoxime, the infant was well for 42 days, until he returned to the hospital and died. A total of 10 Haemophilus influenzae type b isolates, all outer membrane protein subtype 51, was isolated from the pretreatment blood and synovium, cerebrospinal fluid and subdural fluids, and the petrous pyramids at autopsy. Pretreatment isolates had no detectable plasmid DNA, chloramphenicol acetyltransferase or beta-lactamase; the minimal inhibitory concentration for ampicillin (AM) and chloramphenicol (CM) was 0.2 and 0.8 microgram/ml, respectively. However, all cerebrospinal fluid isolates had a 42-44 mD plasmid and produced chloramphenicol acetyltransferase and beta-lactamase; the minimal inhibitory concentration of these isolates to AM and CM were 12.5 and 25 micrograms/ml, respectively, and were also resistant to tetracycline and sulfonamide. Resistance to AM and CM was cotransferred by filter-mating conjugation at a frequency of one to two transconjugants per 10(5) to an Rd haemophilus recipient. Posttreatment isolates from the petrous pyramids also were resistant to AM and CM and produced chloramphenicol acetyltransferase and beta-lactamase activity, but had no plasmid DNA. These findings and data from genetic studies suggested that plasmid-bearing antibiotic-resistant Haemophilus influenzae type b was selected from a heterogenous population, and that the AM/CM resistance transposons were incorporated into the bacterial chromosome.
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PMID:Ampicillin-chloramphenicol-resistant Haemophilus influenzae: plasmid-mediated resistance in bacterial meningitis. 350 Apr 49

Catheterization of the umbilical artery is a common procedure in neonatal intensive care units. The authors studied the records of 100 consecutive newborns who underwent this procedure to review the indications for and complications of umbilical artery catheterization and to discuss preventive measures and alternative techniques. Only polyvinylchloride barium-impregnated catheters were used (nos. 3.5 and 5.0 French). The commonest indications were respiratory distress syndrome, asphyxia and congenital heart disease. Of the 100 infants, 75 weighed less than 2500 g. Ampicillin and calcium were the commonest medications infused (70 and 65 babies respectively). There were three major complications, two of which were gangrene of the lower extremity. Amputation of the foot was necessary in one and amputation of the toes in the other. The third complication was the development of gluteal necrosis. In all three cases, catheter placement was low and the infusion was ampicillin. In two of the babies, calcium was also administered. Minor complications were seen in 32 cases, with vascular spasm in the lower limb being the most common. All catheter tips were cultured; there was bacterial colonization in 13%, Staphylococcus epidermidis being the commonest organism. Proven necrotizing enterocolitis was seen in eight infants and was suspected in eight others. Blanching is a serious sign and was seen in the three infants with major complications. The infusion should be stopped immediately. When necrotizing enterocolitis is suspected, the catheter should be removed.
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PMID:Catheterization of the umbilical artery in neonates: surgical implications. 397 Dec 40

A case of meningitis and brain abscess due to Haemophilus paraphrophilus in a patient with congenital heart disease is reported. The abscess communicated with the cerebral ventricular system. Although the infecting strain was found to be highly sensitive to ampicillin, the patient died despite appropriate antimicrobial therapy. Characteristics distinguishing Haemophilus paraphrophilus and related species are discussed.
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PMID:Meningitis and brain abscess due to Haemophilus paraphrophilus. 404 61

Endocarditis and unilateral endophthalmitis due to Actinobacillus actinomycetemcomitans heart disease. The ocular infection was notable for its localized presentation and slow evolution. Treatment with systemic, subconjunctival, and topical gentamicin sulfate and ampicillin sodium achieved 20/20 acuity with a residual chorioretinal scar in the nasal periphery. Intravitreal injection of the organism into a rabbit confirmed its minimal pathogenicity within the eye. This organism must now be considered in patients with differential diagnosis of endogenous endophthalmitis complicating endocarditis and septicemia.
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PMID:Actinobacillus actinomycetemcomitans endophthalmitis with subacute endocarditis. 660 7

Blood levels of ampicillin (ABPC) were measured in 10 childish patients with heart disease after the rectal administration of KS-R1 at doses of 125 mg and 250 mg. Average blood levels of ABPC at 15, 30 minutes, 1, 2 hours and 4 hours after the administration of KS-R1 were 6.8, 6.9, 3.1, 1.1 mcg/ml and 0.1 mcg/ml with half-life of 0.64 hours in patients of age from 1 year to 4 years 7 months old (dose level 8.9 approximately 13.9 mg/kg, average 10.5 mg/kg), and 5.2, 6.1, 3.4, 1.0 mcg/ml and 0.1 mcg/ml with half-life of 0.65 hours in patients of age from 7 years 10 months to 10 years 7 months old (dose level 8.3 approximately 13.9 mg/kg, average 9.8 mg/kg), respectively. Clinical effective rate (excellent and good) was 87% in 55 childish patients with infections. Bacteriologically, 13 strains (74%) out of 18 strains which were isolated from the patients were eradicated. No severe side effects were observed. Diarrhea was observed in 3 cases.
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PMID:[Experimental and clinical studies of an ampicillin suppository (KS-R1) in pediatrics]. 665 10


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