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Cleveland Clinic Journal of Medicine Sep 1990Advances in chemotherapy and surgery have significantly improved the outcome of infective endocarditis, but the disease remains a therapeutic challenge with an overall... (Review)
Review
Advances in chemotherapy and surgery have significantly improved the outcome of infective endocarditis, but the disease remains a therapeutic challenge with an overall mortality of 20%. More cases of infective endocarditis seen today are associated with prosthetic heart valves, intravenous drug abuse, or complications of medical and surgical technology. Prosthetic valve endocarditis occurs in 1% to 4% of patients with prosthetic valves. Echocardiography is not a precise diagnostic test for endocarditis, but it helps detect a variety of cardiac lesions, including valvular incompetence, annular ring abscesses, and sometimes vegetations. Serum bactericidal titers are predictive of neither cure nor treatment failure. The principal indication for urgent surgical intervention is acute valvular dysfunction. Other considerations for surgery include evidence of myocardial invasion, infection by antibiotic-resistant organisms, and large vegetations. For patients at risk of infective endocarditis, antibiotic prophylaxis during invasive procedures is an accepted practice.
Topics: Echocardiography; Endocarditis, Bacterial; Humans
PubMed: 2268967
DOI: 10.3949/ccjm.57.6.558 -
Revista Espanola de Cardiologia 1998Infective endocarditis occurs in 4% of prosthetic valve carriers. The infection is related to both the injured endocardium and circulating microorganisms. Early... (Comparative Study)
Comparative Study Review
Infective endocarditis occurs in 4% of prosthetic valve carriers. The infection is related to both the injured endocardium and circulating microorganisms. Early prosthetic endocarditis, occurring in the first 12 months after valvular surgery is mainly caused by staphylococci, and late prosthetic endocarditis has a similar etiology as native valve endocarditis. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction. In late cases the clinical picture is similar to native valve disease. Mortality in prosthetic endocarditis remains high, especially in early cases, despite combined medical and surgical treatment.
Topics: Echocardiography; Electrocardiography; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections; Replantation; Risk Factors; Time Factors
PubMed: 9658950
DOI: No ID Found -
BMJ Case Reports May 2022We present a case of endocarditis secondary to disseminated infection affecting the native tricuspid valve. After a thorough workup, our patient was treated...
We present a case of endocarditis secondary to disseminated infection affecting the native tricuspid valve. After a thorough workup, our patient was treated conservatively with appropriate intravenous antibiotic therapy for 6 weeks. A follow-up echocardiogram showed resolution of the vegetation without any residual valvular involvement. Literature review reveals 99 cases of infective endocarditis which occurred secondary to infection, of which, only 4 cases (6%) affected the tricuspid valve. Through this case report, we highlight the importance of thorough history taking including a sexual and social history, as well as careful recognition of the clinical signs, which helped us reach this uncommon diagnosis while always maintaining a high clinical suspicion of rare causes of endocarditis.
Topics: Endocarditis; Endocarditis, Bacterial; Gonorrhea; Humans; Neisseria gonorrhoeae; Tricuspid Valve
PubMed: 35537765
DOI: 10.1136/bcr-2022-249723 -
Medicina Oral, Patologia Oral Y Cirugia... Jan 2014Numerous systemic diseases may affect the oral cavity and vice versa,in particular severe diseases that involve the heart valve. In these cases, additional measures or a... (Review)
Review
Numerous systemic diseases may affect the oral cavity and vice versa,in particular severe diseases that involve the heart valve. In these cases, additional measures or a modification to our dental treatment need to be taken. We are aware of various diseases that can cause the emergence of bacterial endocarditis (BE), such as; rheumatic fever, valve lesions due to intravenous drug use, Kawasaki disease and valve surgery, among others. Due to its severity when it is not taken into account in dental treatment, we intend to show the evolution of the antimicrobial prophylaxis towards this condition. Furthermore, we intend to publish the current guidelines of institutions and societies which increasingly encourage rational antimicrobial use. In addition, we intend to examine the evidence of the possible origins of this disease during dental treatment and at the same time describe the necessary considerations that need to be taken during dental treatment.
Topics: Antibiotic Prophylaxis; Bacteremia; Endocarditis, Bacterial; Humans; Oral Surgical Procedures
PubMed: 24121925
DOI: 10.4317/medoral.19562 -
JAMA Network Open Jul 2023It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed...
IMPORTANCE
It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement.
OBJECTIVE
To assess the clinical characteristics and outcomes of patients with C acnes endocarditis.
DESIGN, SETTING, AND PARTICIPANTS
A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for C acnes, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022.
MAIN OUTCOMES AND MEASURES
Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates.
RESULTS
A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg/dL (IQR, 1.2-7.5 mg/dL), and the median leukocyte count was 10.0 × 103/µL (IQR, 8.2-12.2 × 103/µL). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]).
CONCLUSIONS AND RELEVANCE
This case series suggests that C acnes endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing C acnes endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.
Topics: Humans; Male; Middle Aged; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Communicable Diseases; Electrocardiography
PubMed: 37436747
DOI: 10.1001/jamanetworkopen.2023.23112 -
Infectious Disease Clinics of North... Dec 1996Acute bacterial endocarditis (ABE) is clinically distinct from subacute bacterial endocarditis in terms of pathologic virulence, acuteness and severity of illness,... (Review)
Review
Acute bacterial endocarditis (ABE) is clinically distinct from subacute bacterial endocarditis in terms of pathologic virulence, acuteness and severity of illness, complications, and prognosis. The term infectious endocarditis may be useful as a general term but conveys no meaningful clinical information. ABE presents as an acute, fulminant intracardiac infection with fevers (temperature > 102 degrees F) that are caused by highly virulent known pathogens. Septic embolic phenomena, valve dysfunction, and congestive heart failure are characteristic. Parenteral and oral antibiotic treatment regimens are discussed.
Topics: Acute Disease; Anti-Bacterial Agents; Diagnosis, Differential; Endocarditis, Bacterial; Humans; Risk Factors
PubMed: 8958170
DOI: 10.1016/s0891-5520(05)70328-7 -
Clinical Microbiology and Infection :... Jan 2006Infective endocarditis is a microbial infection of the endocardial surface and, despite improvements in diagnostic accuracy, medical therapy and surgical techniques,... (Review)
Review
Infective endocarditis is a microbial infection of the endocardial surface and, despite improvements in diagnostic accuracy, medical therapy and surgical techniques, mortality remains high. This review focuses on changes in epidemiology, microbiology and diagnosis, as well as changes in medical and surgical management of infective endocarditis affecting native and prosthetic valves in adults, that have evolved during the past two decades. Significant changes have included an increasing involvement of prosthetic valves and nosocomially-acquired disease, an increased involvement of staphylococci as the causative agents, and a recognition that elderly individuals with degenerative valvular disease are the most vulnerable population. Topics still requiring study include whether and when valve replacement should be performed, and how to predict perivalvular complications or embolisation based on echocardiography findings. Optimisation of antimicrobial treatment schemes (choice of the antibiotic, dose and duration) also requires further investigation.
Topics: Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Heart Valve Diseases; Heart Valves; Humans; Prosthesis-Related Infections
PubMed: 16460540
DOI: 10.1111/j.1469-0691.2005.01289.x -
British Heart Journal Sep 1987Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The... (Review)
Review
Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The development of a new valvar lesion and bulky vegetations seen on echocardiography helped to identify Brucella endocarditis occurring during systemic brucellosis. The aortic valve was affected in all four patients, and in one the mitral valve was also affected. Medical treatment did not cure the patients and all needed valve replacement--for haemodynamic deterioration in three and because a further embolism was feared in one. Antibiotics were continued for six to nine months after operation. There was no early or late mortality and no recurrence after a follow up of 15 months.
Topics: Adult; Anti-Infective Agents; Brucellosis; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Period
PubMed: 3311098
DOI: 10.1136/hrt.58.3.279 -
British Medical Journal (Clinical... Feb 1981
Topics: Endocarditis, Bacterial; Female; Humans; Male; United Kingdom
PubMed: 6781611
DOI: No ID Found -
BMJ (Clinical Research Ed.) Aug 2006
Review
Topics: Anti-Bacterial Agents; Bacteriological Techniques; Echocardiography; Endocarditis, Bacterial; Forecasting; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections
PubMed: 16902214
DOI: 10.1136/bmj.333.7563.334