scholarly journals Pediatric infective endocarditis initially presenting as hemorrhagic stroke

2020 ◽  
Vol 60 (3) ◽  
pp. 167-72
Author(s):  
Emir Yonas ◽  
Raymond Pranata ◽  
Vito Damay ◽  
Nuvi Nusarintowati
Keyword(s):  
Infective Endocarditis ◽  
Heart Valves ◽  
Hemorrhagic Stroke ◽  
Prognostic Markers ◽  
Antimicrobial Prophylaxis ◽  
Common Complication ◽  
Patients At Risk ◽  
Considerable Controversy ◽  
Frequent Site ◽  
The Brain

Infective endocarditis refers to infection of the heart valves. While its incidence is low, it may cause serious complications. Despite advances in its management and diagnosis, this condition still retains high mortality and significant morbidity. Considerable controversy remains regarding antimicrobial prophylaxis to prevent infective endocarditis in patients with congenital heart disease. Neurologic complications are the second most common complication in patients with infective endocarditis, occurring in approximately 33% of cases.1 These include encephalopathy, meningitis, stroke, brain abscess, cerebral hemorrhage, and seizures. The vegetation formed as a consequence of endocarditis may dislodge and cause embolization. Vegetation size alone is an unreliable marker for embolization risk, however, size, in addition to location, mobility, infecting agent, and presence of antiphospholipid antibodies have the potential to be prognostic markers. The brain is the most frequent site of embolization. Furthermore, advances in medical approaches have resulted in an increase of patients at risk of endocarditis due to the now common and widely available indwelling intravascular approaches in medicine. In this report, we present a case of infective endocarditis in a child first presenting with hemorrhagic stroke.1,2

scholarly journals The liver as an organ at risk for Toxoplasma transmission during transplantation: myth or reality?

2018 ◽  
Vol 71 (9) ◽  
pp. 763-766 ◽  
Author(s):  
Brice Autier ◽  
Sarah Dion ◽  
Florence Robert-Gangneux
Keyword(s):  
At Risk ◽  
Parasite Load ◽  
Liver Weight ◽  
Parasite Strain ◽  
Serological Screening ◽  
Patients At Risk ◽  
Life Threatening ◽  
Frequent Site ◽  
Organ At Risk ◽  
The Brain

AimToxoplasmosis following liver transplant with donor–recipient mismatch is rare, but is often life-threatening. However, there are no data on the frequency of cyst carriage in the liver, nor consensual chemoprophylaxis guidelines. This study aimed at describing frequency and localisation of Toxoplasma cysts in the liver in a mouse model of chronic infection to predict the risk in liver transplantation.MethodsHeart, brain and liver lobes of 21 mice chronically infected with Toxoplasma were collected for DNA extraction and amplification of Toxoplasma gondii rep529 sequence by real-time PCR.ResultsParasite DNA was detected in the liver of 19/21 mice (90.5%), with no preferential anatomical localisation, but with higher parasite loads in the papillary process. Parasite loads in the liver were far lower than in brain and heart. The number of infected lobes was inversely correlated to the total liver weight, but was independent of the brain parasite load and of the parasite strain.ConclusionsThe liver is a frequent site of cyst carriage, confirming that transplantation of an organ from a seropositive donor to seronegative recipient is at high risk for acquired toxoplasmosis. Systematic serological screening prior to transplantation and chemoprophylaxis in patients at risk are fully justified.

scholarly journals Infective Endocarditis in Children — New Approach in Antimicrobial Prophylaxis

2016 ◽  
Vol 1 (1) ◽  
pp. 9-11
Author(s):  
Rodica Togănel
Keyword(s):  
Infective Endocarditis ◽  
Heart Valves ◽  
Task Force ◽  
Antimicrobial Prophylaxis ◽  
Bacterial Endocarditis ◽  
New Approach ◽  
Secondary Damage ◽  
Risk Patients ◽  
European Society Of Cardiology ◽  
Significant Mortality

Abstract Infective endocarditis (IE) is an infection of the endocardium and/or heart valves with the formation of a thrombus and secondary damage of the involved tissue, with significant mortality and severe complications. The prevention of bacterial endocarditis is of great controversy. Antimicrobial prophylaxis is usable in the prevention of endocarditis by killing bacteria before or after their extension to the damaged endocardium. No human studies offer strong evidence to support the efficacy of antibiotic prophylaxis so far, thus it could be potentially dangerous. Therefore, the European Society of Cardiology (ESC) may need to reconsider and update the previous guidelines with the proposal of reducing the prophylactic approach of IE. The 2015 Task Force recommends prophylaxis for highest risk patients undergoing highest risk procedures, focused on prevention rather than prophylaxis of IE, especially in nosocomial endocarditis.

Infective and inflammatory cardiac conditions

2010 ◽  
pp. 191-224
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Clinical Practice ◽  
Infective Endocarditis ◽  
Heart Valves ◽  
Antimicrobial Prophylaxis ◽  
Current Clinical Practice ◽  
Cardiac Tissues ◽  
Prosthetic Valves ◽  
Fungal Endocarditis ◽  
Culture Negative

Infective endocarditis 192 Treatment of endocarditis 194 Enterococcal endocarditis 204 Endocarditis caused by HACEK organisms 210 Fungal endocarditis 212 Culture-negative endocarditis 214 Antimicrobial prophylaxis 218 Pericarditis 220 Myocarditis 223 Infective endocarditis is an infection of the endocardium which usually involves the heart valves. In current clinical practice, endocarditis encompasses a heterogeneous collection of infections that may involve native cardiac tissues, prosthetic valves, pacing systems, and a variety of intracardiac implants. Endocarditis is mainly caused by bacteria, but fungi are occasionally implicated....

scholarly journals Disseminated nocardiosis with infective endocarditis of a transplanted heart

2018 ◽  
pp. bcr-2018-225046 ◽  
Author(s):  
Antonious Ziad Hazim ◽  
André Martin Mansoor
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Infective Endocarditis ◽  
Heart Valves ◽  
Immunocompromised Patients ◽  
Therapeutic Guidelines ◽  
Subcutaneous Tissues ◽  
Disseminated Nocardiosis ◽  
The Brain

Nocardiosis is caused by various species of Nocardia and typically occurs as an opportunistic infection. It frequently disseminates, most often involving the lungs, subcutaneous tissues and central nervous system. It has rarely been reported to affect native heart valves. We report the case of a 64-year-old man with disseminated nocardiosis involving the brain, lungs, muscle and tricuspid valve of a transplanted heart. Following antimicrobial therapy, the patient improved clinically and there was no evidence of residual infection on follow-up imaging. This case highlights the presentation of nocardiosis, current therapeutic guidelines and the question of prophylaxis against Nocardia in immunocompromised patients.

scholarly journals Cytokine-Laden Extracellular Vesicles Predict Patient Prognosis after Cerebrovascular Accident

2021 ◽  
Vol 22 (15) ◽  
pp. 7847
Author(s):  
Anthony Fringuello ◽  
Philip D. Tatman ◽  
Tadeusz Wroblewski ◽  
John A. Thompson ◽  
Xiaoli Yu ◽  
...  
Keyword(s):  
Extracellular Vesicles ◽  
Inflammatory Cytokines ◽  
Hemorrhagic Stroke ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Interleukin 7 ◽  
Poor Outcomes ◽  
Patient Prognosis ◽  
The Brain

Background: A major contributor to disability after hemorrhagic stroke is secondary brain damage induced by the inflammatory response. Following stroke, global increases in numerous cytokines—many associated with worse outcomes—occur within the brain, cerebrospinal fluid, and peripheral blood. Extracellular vesicles (EVs) may traffic inflammatory cytokines from damaged tissue within the brain, as well as peripheral sources, across the blood–brain barrier, and they may be a critical component of post-stroke neuroinflammatory signaling. Methods: We performed a comprehensive analysis of cytokine concentrations bound to plasma EV surfaces and/or sequestered within the vesicles themselves. These concentrations were correlated to patient acute neurological condition by the Glasgow Coma Scale (GCS) and to chronic, long-term outcome via the Glasgow Outcome Scale-Extended (GOS-E). Results: Pro-inflammatory cytokines detected from plasma EVs were correlated to worse outcomes in hemorrhagic stroke patients. Anti-inflammatory cytokines detected within EVs were still correlated to poor outcomes despite their putative neuroprotective properties. Inflammatory cytokines macrophage-derived chemokine (MDC/CCL2), colony stimulating factor 1 (CSF1), interleukin 7 (IL7), and monokine induced by gamma interferon (MIG/CXCL9) were significantly correlated to both negative GCS and GOS-E when bound to plasma EV membranes. Conclusions: These findings correlate plasma-derived EV cytokine content with detrimental outcomes after stroke, highlighting the potential for EVs to provide cytokines with a means of long-range delivery of inflammatory signals that perpetuate neuroinflammation after stroke, thus hindering recovery.

Differential diagnosis of spontaneous intracranial hemorrhage in young

2021 ◽  
Vol 22 (1) ◽  
pp. 83-86
Author(s):  
O. A. Kicherova ◽  
◽  
L. I. Reikhert ◽  
O. N. Bovt ◽  
◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Young Patients ◽  
Vascular Diseases ◽  
Cerebrovascular Diseases ◽  
Intracerebral Hematoma ◽  
Toxic Substances ◽  
Brain Substance ◽  
Secondary All ◽  
Visualization Techniques ◽  
The Brain

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

Stroke in Patients with Infective Endocarditis: A 15-Year Single-Center Cohort Study

2018 ◽  
Vol 80 (3-4) ◽  
pp. 171-178 ◽  
Author(s):  
Gui-fang Cao ◽  
Wei Liu ◽  
Qi Bi
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Hemorrhagic Stroke ◽  
Hospital Deaths ◽  
Independent Risk Factors ◽  
The Mean ◽  
Medical University ◽  
The Relationship ◽  
Rheumatic Valvular Disease ◽  
Mitral Valve Vegetation

Objective: To explore the relationship between infective endocarditis (IE) and stroke. Methods: The clinical data of patients diagnosed with IE from January 2003 to December 2017 in Beijing Anzhen Hospital Affiliated to Capital Medical University were retrospectively analyzed. Results: A total of 861 patients (mean age: 40.79 ± 16.27 [SD]) with IE was recruited. Vegetations were confirmed in 97.32% of all the patients, among whom 296 were diagnosed with congenital heart disease and another 53 with rheumatic valvular disease. The most common pathogens were Streptococcus, Staphylococcus, and various types of fungi (13.12, 7.31, and 1.16% respectively). Out of the 138 patients diagnosed with stroke, 101 cases were of ischemic stroke, 23 cases were of hemorrhagic stroke, and 12 cases were of concurrent ischemic and hemorrhagic stroke. There were 31 patients who had infarction lesions in more than 2 vascular systems. The mean age of stroke patients was significantly higher than that of patients without stroke (45.76 ± 17.88 vs. 39.83 ± 15.77, p = 0.000). The incidence of mitral valve vegetation (57.24 vs. 43.01%, p = 0.002), atrial fibrillation (4.34 vs. 1.38%, p = 0.018), fungal infection (2.89 vs. 0.83%, p = 0.038) in patients with stroke was significantly higher than those without stroke. Mitral valve vegetation (OR 1.648; 95% CI 1.113–2.442) and age (OR 1.019; 95% CI 1.007–1.032) were independent risk factors for stroke in IE patients. Stroke increased the risk of hospital deaths (OR 7.673 95%CI 3.634–16.202). Conclusion: Stroke is a common complication of IE. Mitral valve vegetation and old age may incerease the risk of stroke in patients with IE.

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