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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Human infection with Pasteurella multocida is the leading cause of animal bite wound infection. Life-threatening infection may occur in patients with a variety of underlying disorders and an immunocompromised state. Infective endocarditis with P. multocida is very rare and only a few clinically diagnosed cases have been reported. Described here is an autopsy case of a 61-year-old man with polycystic kidney disease who had P. multocida bacteremia and acute infective endocarditis with multiple bacterial clumps involving bicuspid aortic valve. The organisms were gram negative. Apparently the sepsis with P. multocida was acquired via licking of leg ulcers by his pet dog, establishing an animal-related causal relationship. Because P. multocida is a very common flora of many animals, infection with this organism probably occurs more frequently than is commonly appreciated. High index of suspicion and early diagnosis, especially in immunocompromised patients, are warranted because the disease is potentially life threatening, yet is a readily treatable infection.
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PMID:Pasteurella multocida endocarditis. 146 53

Infective endocarditis is uncommon in young children, especially in the absence of structural heart disease. We report the case of a 2-year-old boy who presented with acute rupture of the mitral valve chordae 6 weeks after an episode of Fusobacterium necrophorum septicemia. His heart had been structurally normal before. Mitral valve replacement was successfully performed. This is the first recorded case of endocarditis in a child caused by necrobacillosis.
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PMID:Endocarditis with acute mitral regurgitation caused by Fusobacterium necrophorum. 151 43

Infective endocarditis is a serious disease with a continuing mortality of approximately 20%. Risk factors include a variety of congenital and acquired heart diseases. Infection follows an episode of bacteraemia which is most commonly due to oral bacteria, notably streptococci. Less commonly bacteraemia may arise from surgical procedures or diseases of the gastrointestinal and genitourinary tracts or from sepsis at other body sites, including intravenous drug abuse. Several societies and associations have published recommendations for the prevention of bacteraemia in those at risk from endocarditis through the use of perioperative antibiotic chemoprophylaxis. The recommendations are targetted at patients with defined cardiovascular lesions undergoing dental and other procedures known to predictably produce bacteraemia. The major recommendations for standard risk patients undergoing dental procedures without general anaesthesia is high-dose oral penicillin or amoxycillin. Alternative agents include erythromycin and clindamycin. For those requiring general anaesthesia, parenteral regimens are generally recommended although the British Society for Antimicrobial Chemotherapy permits an oral amoxycillin regimen 4 hours preoperatively. For specified gastrointestinal and genitourinary procedures a 2-drug regimen of ampicillin/amoxycillin (or vancomycin for penicillin-allergic patients) plus an aminoglycoside is generally recommended. The emphasis has been to simplify the earlier regimens without compromising the antimicrobial protection with a view to encouraging maximum compliance. The latter continues to be a problem where drug recommendations are either complex or include multiple drug or dosage recommendations. The emphasis on maintaining good dental health is endorsed by all authorities.
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PMID:Chemoprophylaxis of infective endocarditis. 228 93

Infective endocarditis, both in the native and prosthetic valve, presents a tremendous challenge to the cardiologist and cardiovascular surgeon, as well as the infection specialist. The timing of surgery is critical but it would appear that aggressive surgical intervention is indicated when there is persistent sepsis, continuing congestive heart failure, signs of nonfatal emboli, or in association with certain organisms such as staphylococcus, pseudomonas, or fungal organisms. Cardiac catheterization would not appear to add greatly to the diagnosis except to document the presence of coronary artery disease. The risk of surgery in patients with no annular abscess is low but the recurrence rate tends to be highly dependent on the organism. Similarly, patients who have annular abscesses tend to provide the greatest challenge for the surgeon and despite the use of newer prosthetic and biological prostheses and an overall more aggressive approach, this pathological entity, particularly in conjunction with prosthetic valve endocarditis, has a high mortality and a high recurrence rate.
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PMID:Valve replacement for infective endocarditis: an overview. 252 13

A 64-year-old woman developed septicemia and a generalized peripheral neuropathy while being ventilated postoperatively. No cause for the neuropathy could be found during life. At autopsy she was found to have infective endocarditis and multifocal inflammatory lesions in the central and peripheral nervous systems, consistent with damage due to septic emboli. Infective endocarditis may be a cause of a generalized polyradiculoneuropathy and could be responsible for a proportion of cases of "critical illness polyneuropathy".
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PMID:Infective endocarditis with inflammatory lesions in the peripheral nervous system. 254 70

Candidosis was recognized retrospectively in the hearts of 20 of 8,975 patients (0.2%) who had complete postmortem examinations done in Central Kentucky and South Florida. This mycosis, characterized by myocardial micro-abscesses with yeasts and pseudohyphal elements in 18 patients, was the most common fungal cardiac infection. Noncaseating granulomas were seen in only one patient. Infective endocarditis due to Candida species was found in seven individuals and involved the mitral valve most frequently. The 20 infected persons varied in age from 20 days to 65 years, with a mean age of 37 years, and included 11 males and nine females. All had compromising, usually benign, underlying diseases complicated by antibiotic therapy for suspected or proven Gram-negative sepsis. Typically, these patients were extremely ill, and eight had recognized conduction disturbances including altered heart rates and rhythms. Deep candidosis was considered a major factor in every patient's death. Experimental deep candidosis in 12 infected, adult laboratory rats was characterized by similar haphazardly scattered myocardial microabscesses with fungal elements in eight (67%). Endocarditis in the rats was not seen in this intracardiac injection model. Widespread antibiotic exposure in patients who have compromising underlying diseases portends an increasing incidence of deep candidosis, which as the potential to infect any tissue, particularly the heart, and to create cardiac arrhythmias and death.
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PMID:The potentially lethal problem of cardiac candidosis. 698 62

We report a case of staphylococcus endocarditis of the mitral and aortic valves in an intravenous drug user (IVDU) complicated by abscess of the aortic root and aorto-left atrial fistula. Interestingly, the tricuspid valve was free of vegetation. Infective endocarditis in IVDUs more commonly involves right-sided valves; left-sided endocarditis is rare, indicates severe disease, or is a postmortem finding. This case illustrates the need for considering left-sided valve endocarditis in IVDU with septicemia, even if the tricuspid valve shows no evidence of vegetation.
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PMID:Left-sided endocarditis in intravenous drug users: a case report and review of the literature. 1235 47

Severe thrombocytopenia is a life-threatening condition. It is often associated with immune-mediated platelet destruction or myeloablative chemotherapy. Infective endocarditis has been associated with thrombocytopenia, which, as in sepsis, tends to be mild and is often the result of several pathological mechanisms. We report a case of Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and bleeding in a patient who refused platelet transfusion. Platelet autoantibodies directed against glycoprotein (Gp) IIb/IIIa and Gp Ib/IX were detected during active infection using a glycoprotein-specific assay. Successful treatment of C. hominis endocarditis was associated with loss of platelet autoantibodies and recovery of the platelet count. This report illustrates that the development of platelet autoantibodies can contribute to very severe thrombocytopenia in occasional patients with infective endocarditis.
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PMID:Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and platelet autoantibodies. 1528 72

Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.
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PMID:Endocardial pacemaker implantation in infants weighing < or = 10 kilograms. 1554 99

Infective endocarditis, a serious microbial infection of the cardiac endothelial surface, may involve any heart valve. However, right-sided endocarditis is uncommon in non-intravenous drug abusers without underlying heart disease, and the contextual involvement of the left-sided valve is exceptional. A 63-year-old man with no evidence of intravenous drug abuse or heart disease, presented with persistent fever, worsening of breath, and aphasia. His medical history was notable for mild arterial hypertension and serious lymphangitis with cutaneous erosions on the legs. Transesophageal echocardiography was performed for suspicious endocarditis and showed a pedunculated and highly mobile vegetation adhered to the atrial portion of the posterior leaflet of the mitral valve, protruding into the left ventricle through the valvar orifice. Another large vegetation was seen at the tricuspid valve surface and protruded into the right ventricle during diastole. Cerebral and thoraco-abdominal computed tomography scan revealed multiple embolism to the left kidney, spleen, lungs and central nervous system. Blood cultures identified Staphylococcus aureus. The only risk factor was large skin sepsis. Despite successful antibiotic therapy, the patient died for development of renal and respiratory failure.
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PMID:[Widespread embolism in tricuspid and mitral endocarditis caused by chronic lymphangitis. Case report]. 1653 26


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