Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

he recent advances in surgical treatment of congenital heart disease, permits the survival of those cases to adult life. Infective endocarditis in the childhood is becoming increasingly important. We studied 32 cases in the pediatric cardiology ward at the INC between 1977 and 1981. There was a male predominance of 62.5%. Rheumatic heart disease (40.7%), congenital heart disease (15.6%) and postoperative cases (43.7%) were the underlying conditions. There was an average time of 43 days delay from the first symptom to diagnosis. Blood cultures were taken in 29 cases (90.6%). Only half of them were positive. Staphylococcus and streptococcus were the commonest isolates. Peripheral and pulmonary embolism (11 cases-34.4%) were the most frequent complications. In those cases with negative blood culture the most successful antibiotic combination was ampicillin or oxacillin plus aminoglucosides (56%). There were 17 deaths (53%).
 ...
PMID:[Infectious endocarditis in children]. 674 35

6 cases of endocarditis and 1 of septicemia caused by Haemophilus parainfluenzae have been observed in our hospital from 1970 to 1977, as against no case from 1957 to 1969. The mean age of the patients was 46 years. The clinical picture did not differ from that seen in cases of septicemia and endocarditis from other cases. In 4 cases no underlying heart disease was known. In 2 of them, endocarditis developed in the mitral and in 1 in the aortic valve. Of 3 patients with preexisting heart disease, 2 had involvement of the aortic valve and 1 of the mitral valve. Six patients were cured, 2 or possible 3 by treatment with ampicillin, 2 with cephalothin, and 1 with co-trimoxazole. In 2 patients intractable heart failure necessitated the insertion of prosthetic valves, and 1 patient died. Thus, cases of septicemia and endocarditis due to H. parainfluenzae have been observed only in recent years and they appear to be serious infections.
 ...
PMID:Haemophilus parainfluenza--an uncommon cause of septicemia and endocarditis. 737 29

Cerebral abscess is a classical complication of cyanotic congenital heart disease. The authors report 7 cases of cerebral abscess diagnosed since 1982. One asymptomatic patient died of a postoperative cerebral haemorrage. The child was repatriated from Africa for complete correction of his cardiac lesion. The presentation of the other 6 cases was quite typical : headaches, pyrexia and vomiting with a neurological deficit in 4 cases : two hemiparesias and two homonymous lateral hemianopsia. These 6 patients recovered without sequeilae. Four underwent surgical drainage of the abscess with antibiotic therapy. Two recovered with antibiotic therapy alone. The causal organism was only identified in patients undergoing surgical drainage and then only in 3 cases. They were gram positive cocci, in particular the streptococcus. The association ampicillin-chloramphenicol has often been proposed as the treatment of first intention. Adaptation of antibiotic therapy then depends on clinical, biological, bacteriological (CSF, blood cultures, portal of entry) outcomes and the results of CT scanning. The association of a third generation cephalosporin and an imidazole may be proposed as treatment of second intention. The minimal duration of treatment is generally acknowledged to be 4 weeks for intravenous therapy in cases of medical therapy alone, and 2 to 3 weeks in cases with surgical drainage. The age of apparition of this complication seems to be increasing as the average age was 16 in this series (cerebral abscess is classically described as occurring between 8 and 12 years of age). This may be due to palliative surgery which reduces systemic hypoxia and polycythaemia. It also appears that neurological drainage is not systematic now because of early diagnosis of this complication. Finally, in the last few years, a new population of patients is becoming more common : patients repatriated by humanitary organisations in the third world, which should incite great vigilance in the preoperative period in this pathology.
 ...
PMID:[Cerebral abscess and cyanotic congenital heart disease]. 929 46

There are currently no randomized and carefully controlled human trials to definitively prove that endocarditis prophylaxis is efficient. Furthermore, most cases of endocarditis are not attributable to a medical procedure. Thus, even with a high level of application of endocarditis prophylaxis only a minority of cases could be prevented. Endocarditis is a rare disease. On the other hand, its morbidity is increasing! In addition, infective endocarditis remains still a major medical concern because of its mortality between 5% and 76%. In addition, in up to 40% of all patients suffering from endocarditis one or more heart valves have to be replaced in the following 5 to 8 years. Without treatment endocarditis has a lethality of 100%. Therefore, there is worldwide agreement that endocarditis prophylaxis is necessary. Combining the recommendations of the German and the American Heart Association, as well as the results of the European consensus conferences, with newer insights into the pathophysiology of endocarditis the following aspects are elucidated: depending on their risk of endocarditis patients are allocated into 3 groups. In the first group there are patients with prosthetic cardiac valves, patients who suffered from previous endocarditis and patients with complex cyanotic congenital heart disease and surgically constructed shunts or conduits of the aorta and/or pulmonary circulation. In these high-risk patients the prophylactic regimen for dental, oral, respiratory tract procedures is oral amoxycillin. In genitourinary and gastrointestinal procedures ampicillin and gentamicin i.v. is recommended. In patients with mostly congenital cardiac malformations, acquired valvular dysfunction, hypertrophic obstructive cardiomyopathy and mitral valve prolapse or thickened leaflets and valvular regurgitation oral amoxycillin is recommended for all medical procedures (second group). The third group consists of patients with isolated secundum atrial defect, previous coronary bypass graft surgery, patients with cardiac pacemakers or defibrillators. In this patient cohort the individual risk of endocarditis is not higher than in the general population. Therefore, endocardits prophylaxis is not recommended.
 ...
PMID:[Current status of endocarditis prevention]. 1148 72

Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children. This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management. The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci. There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae. The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology. The therapeutic goal is to achieve sterilisation of the cardiac vegetations. The choice of antibacterial is dependent upon the susceptibility profile of the causative organism. Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association. For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice. In the case of endocarditis caused by methicillin-resistant S. aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material. Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci. While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis. Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis. These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures. Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy. Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures. In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended. The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, and in fact propagates bacterial resistance.
 ...
PMID:Antibacterials for the prophylaxis and treatment of bacterial endocarditis in children. 1170 22

Among the bacteria of the HACEK group, Actinobacillus actinomycetemcomitans is the organism involved most commonly in infective endocarditis. However, the epidemiological and clinical features specifically associated with this species have not been evaluated adequately. Three patients with infective endocarditis caused by A. actinomycetemcomitans seen at the Hospital La Timone (Marseille, France) between 1994 and 2001 are reported. Of 99 cases in the literature, 75% of patients had previous heart disease before infective endocarditis, the portal of entry of which was usually the oral cavity. Among the total of 102 cases, 27 had prosthetic valves. Intermittent fever was observed in all cases, and weight loss and peripheral signs of endocarditis were noteworthy in this study. Anaemia and microscopic haematuria were frequently noted. The disease is insidious, with a mean duration of symptoms of 13 weeks before diagnosis, as confirmed by blood cultures incubated for > 5 days. The aortic valve is most commonly involved, and echocardiographic findings were non-specific. Complications occurred in 63% of patients, with emboli being the most common. The surgery rate was 23.5%. The overall mortality rate was 18%. Of the cases, 76.5% were cured with antibiotics alone, including a simple third-generation cephalosporin or a combination of ampicillin and an aminoglycoside. An antibiotic therapy duration of at least 4 weeks is recommended. Surgical therapy is usually required for haemodynamic reasons. Prophylaxis of A. actinomycetemcomitans endocarditis relies on antibiotic therapy for all cardiac patients at risk before dental procedures. Among 17 patients undergoing dental manipulations, only eight received amoxycillin before the procedure, demonstrating that prophylaxis is far from being systematically prescribed. In conclusion, A. actinomycetemcomitans endocarditis should be highly suspected in patients with previous cardiac disease and for whom symptoms have evolved over a number of weeks or even months.
 ...
PMID:Actinobacillus actinomycetemcomitans endocarditis. 1475 35

A 3.4-kg, 6-day-old infant presented to the pediatric intensive care unit with a 2-day history of poor feeding and tachypnea. Care at an outside hospital included endotracheal intubation, the administration of isotonic fluid (20 mL/kg), and antibiotics (ampicillin and gentamicin) for presumed sepsis. After arrival at our institution, physical examination revealed absent femoral pulses and hepatomegaly. Cerebral oximetry revealed a right-sided reading of 51% and a left-sided reading of 15%. Given the diminished femoral pulses and the disparity in the cerebral oximetry values, a tentative diagnosis of congenital heart disease with an obstructive left-sided lesion was entertained, and a prostaglandin E1 infusion was started at 0.05 microg/kg/min. The diagnosis of a type C interrupted aortic arch and a ventricular septal defect was confirmed by echocardiography. After stabilization and correction of metabolic abnormalities, the infant was taken to the operating room for repair of the interrupted aortic arch and placement of a pulmonary artery band.
 ...
PMID:Cerebral oximetry using near-infrared spectroscopy aids in the diagnosis of interrupted aortic arch. 1870 27

We report the case of a 62-year-old woman with Acinetobacter baumannii bacteremia. She was admitted to our hospital with ventricular tachycardia and was subsequently diagnosed with idiopathic ventricular tachycardia, with no structural heart disease. However, 12 days after admission, she suddenly developed a high-grade fever with chills and diarrhea. Her blood cultures revealed A. baumannii, and the patient was treated with meropenem and amikacin sulfate. Yet, the patient's symptoms and clinical signs became worse. We then began to administer a large quantity of intravenous ampicillin-sulbactam, and the patient improved dramatically. Although rare, bloodstream infection caused by A. baumannii tends to be severe. Therefore, when A. baumannii is found in a patient's bloodstream, clinicians should start appropriate treatment immediately and should recall ampicillin-sulbactam as a sensible option for treatment.
 ...
PMID:A case of unforeseen intractable severe bacteremia due to Acinetobacter baumannii--an efficacy of sulbactam--. 1993 40

Infections caused by vancomycin-resistant enterococci (VRE) may be difficult to treat because of the limited armamentarium of antimicrobial agents. The difficulty is compounded in pediatric patients in general and neonates in particular because many of the newer antimicrobials have not been studied or approved for children. We report a 3-week-old infant who developed enterococcal bacteremia on post-operative day 10 after a surgical palliation for complex congenital heart disease that was complicated by acute renal failure. Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted. It was not cleared until daptomycin (in combination with doxycycline) was started. This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.
 ...
PMID:Successful treatment of a neonate with persistent vancomycin-resistant enterococcal bacteremia with a daptomycin-containing regimen. 2169 74


<< Previous 1 2 3