scholarly journals Infective Endocarditis: A Case with Prolonged Fever

2021 ◽  
Vol 2 (2) ◽  
pp. 84
Author(s):  
Maulia Prismadani ◽  
Agus Subagjo
Keyword(s):  
Infective Endocarditis ◽  
Heart Valves ◽  
High Rate ◽  
Structural Abnormality ◽  
Severe Mitral Regurgitation ◽  
Mortality And Morbidity ◽  
Prolonged Fever ◽  
Duke Criteria ◽  
History Of ◽  
Major Criterion

Infective endocarditis (IE) is associated with a high rate of mortality and morbidity in patients with anomalies of heart valves. We present a case of a 23-year-old male known to have severe mitral regurgitation (MR) with a history of prolonged fever for 5 months. According to The Modified Duke Criteria, clinical sign and symptoms fulfilled one major criterion (echocardiography finding of vegetation on mitral valve) and three minor (fever of at least 380 Celsius, valvular heart disease as a predisposing heart condition, and positive blood culture for Lactococcus sp. and Pediococcus sp.) considered as definite IE. Fever is one of the most common symptoms of IE (>90% of cases). Patient with prolonged fever and structural abnormality of heart valve should be considered for acute or subacute of IE. Establishing an diagnosis of IE and appropriate antibiotic therapy will improve the patient's clinical condition, and reduce morbidity and mortality.

Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

2019 ◽  
Author(s):  
Yuanfang Wang ◽  
Mei Kang ◽  
Ya Liu ◽  
Siyin Wu ◽  
Weili Zhang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Resistance Rate ◽  
Native Valve ◽  
Duke Criteria ◽  
Preventive Medication ◽  
History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

P1802Management and outcomes of infective endocarditis in adults with congenital heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Ly ◽  
D Lebeaux ◽  
F Pontnau ◽  
F Compain ◽  
B Gaye ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Hospital Death ◽  
Oral Streptococci ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Duke Criteria ◽  
Increased Risk

Abstract Background Causes, epidemiology and microbiology of infective endocarditis (IE) have evolved in recent decades. Although novel tools for the diagnosis and therapeutic strategies have emerged, mortality and morbidity remain high. These trends may particularly concern the growing population of adults with congenital heart disease (CHD) who are at increased risk for IE. Purpose We aimed to characterize IE in CHD patients and describe management and outcome in this setting. We also sought to determine the risk factors associated with in-hospital death in CHD patients. Methods From January 2000 to June 2018, 666 consecutive episodes of IE in adults were recorded in our center. Among them, 143 concerned CHD, including 5 implantable cardiac electronic devices-lead infections, all managed by an IE team including CHD specialists. Cases were classified according to modified Duke criteria. Results CHD patients were significantly younger (37 years IQR [26–52]), with a more common history of cardiac reoperations (numbers of sternotomies≥2 in 35.7%) and infective endocarditis (19.7%, p<0.01) compared to non-CHD patients. There were more infections of valve-containing prosthetics (44% vs. 30%, p<0.04), and the right heart side (41.5%, p<0.01) in CHD patients. Forty-nine percent of them had a simple CHD, 12.7% a moderate, and 36.4% a complex. A predisposing event could be identified in only 34% of cases. Oral streptococci/Streptococci bovis and Staphylococcus aureus were the most frequently microorganisms isolated (32.4% and 20.4%, respectively). Surgery was performed in 90 episodes (62%), and was selected in emergency (<24h) in 61% (figure 1). In-hospital mortality was 12.7% and was directly related to IE in 10/18 cases. CHD patients had a significant lower risk of death compared to non-CHD patients (OR=0.47, p=0.026, p<0.01), even after adjustment for age, and the infected heart side. On multivariate analysis the complexity of CHD (if simple CHD: OR=0.07 IQR [0.01 to 0.44], p<0.01) and the white blood cell count (OR=1.18 IQR [1.04 to 1.33], p=0.01) were the strongest predictive factors of in-hospital death in the CHD group. Conclusions Mortality associated with IE in CHD patients is lower than in acquired heart disease. The multidisciplinary approach by IE team and CHD specialists may have improved management and outcome in this setting. However, risk for death remains high in complex lesions. Larger prospective studies on IE in adults with CHD are needed to develop guidelines in these complex patients.

scholarly journals A Complicated Case of Triple Valve Infective Endocarditis in an IV Drug User with a Bicuspid Aortic Valve Requiring Three Separate Salvage Operations: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Shahzad Khan ◽  
Athanasios Smyrlis ◽  
Dmitry Yaranov ◽  
David Oelberg ◽  
Eric Jimenez
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Heart Valves ◽  
Patch Repair ◽  
Complicated Case ◽  
Emergent Operation ◽  
History Of ◽  
Triple Valve

Infective endocarditis (IE) is an infection of the endocardium that involves valves and adjacent mural endocardium or a septal defect. Local complications include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. Diagnosing IE can be straightforward in patients with the typical oslerian manifestations such as bacteremia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to aS. aureusinfection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valveMSSA(methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications.

scholarly journals Streptococcus gallolyticus endocarditis on a prosthetic tricuspid valve: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Raz Shapira ◽  
Tamir Weiss ◽  
Elad Goldberg ◽  
Eytan Cohen ◽  
Ilan Krause ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Heart Valves ◽  
Relevant Literature ◽  
Streptococcus Gallolyticus ◽  
Causative Microorganism ◽  
History Of ◽  
Laboratory Examinations ◽  
High Index Of Suspicion ◽  
Physical Findings

Abstract Background Streptococcus gallolyticus subspecies gallolyticus is a known pathogen that causes infective endocarditis, and most cases involve the left heart valves. We present the first reported case of prosthetic tricuspid valve endocarditis caused by this microorganism. Relevant literature is reviewed. Case presentation A 67-year-old Jewish female with a history of a prosthetic tricuspid valve replacement was admitted to the emergency department because of nonspecific complaints including effort dyspnea, fatigue, and a single episode of transient visual loss and fever. No significant physical findings were observed. Laboratory examinations revealed microangiopathic hemolytic anemia and a few nonspecific abnormalities. Transesophageal echocardiogram demonstrated a vegetation attached to the prosthetic tricuspid valve. The involved tricuspid valve was replaced by a new tissue valve, and Streptococcus gallolyticus subspecies gallolyticus was grown from its culture. Prolonged antibiotic treatment was initiated. Conclusions Based on this report and the reviewed literature, Streptococcus gallolyticus should be considered as a rare but potential causative microorganism in prosthetic right-sided valves endocarditis. The patient’s atypical presentation emphasizes the need for a high index of suspicion for the diagnosis of infective endocarditis.

scholarly journals Refractory Spontaneous Bacterial Empyema in Cirrhotic Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Erica Chow ◽  
Bashar Khiatah ◽  
Amanda Frugoli
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Relevant Literature ◽  
High Rate ◽  
Case Vignette ◽  
Timely Initiation ◽  
Mortality And Morbidity ◽  
Bacterial Peritonitis ◽  
High Clinical Suspicion ◽  
History Of ◽  
Spontaneous Bacterial Empyema

Spontaneous bacterial empyema (SBEM), also called spontaneous bacterial pleuritis, is an infection of the pleural space that arises in the setting of cirrhosis and, by definition, the absence of pneumonia. It is likely underdiagnosed as its symptoms are nonspecific and it lacks standardized diagnostic and therapeutic recommendations. SBEM represents a distinct complication of hepatic hydrothorax with different pathogenesis, presentation, and treatment strategy from those of empyema secondary to pneumonia. Surprisingly, nearly 40% of episodes of spontaneous empyema are not associated with spontaneous bacterial peritonitis. Although SBEM is amenable to prompt antibiotic therapy, it has a high rate of mortality and morbidity. A high clinical suspicion is crucial for patient survival and timely initiation of appropriate antibiotics. Increased understanding, recognition, and standardization of treatment would help alleviate the relatively high burden of SBEM. In this case vignette, we provide a review of the relevant literature, and we describe a rare case of SBEM in a patient with a history of alcohol-associated liver cirrhosis and prior episode of spontaneous bacterial peritonitis (SBP). SBEM was diagnosed with thoracentesis and analysis of the aspirate, and he was treated with ceftriaxone with resolution of his presenting abdominal pain and leukocytosis.

scholarly journals The Transcriptional Programme of Human Heart Valves Reveals the Natural History of Infective Endocarditis

PLoS ONE ◽  
2010 ◽  
Vol 5 (1) ◽  
pp. e8939 ◽  
Author(s):  
Marie Benoit ◽  
Franck Thuny ◽  
Yannick Le Priol ◽  
Hubert Lepidi ◽  
Sonia Bastonero ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Natural History ◽  
Human Heart ◽  
Heart Valves ◽  
History Of

scholarly journals Infektif Endokarditis Pada Penyakit Jantung Tiroid

2020 ◽  
Vol 9 (1) ◽  
pp. 113
Author(s):  
Pradita Diah Permatasari
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Mitral Regurgitation ◽  
Heart Valves ◽  
Clinical Symptoms ◽  
Predisposing Factor ◽  
Duke Criteria ◽  
Cardiac Lesions ◽  
Endocardial Surface

Infective endocarditis is an endocardial surface infection of the heart including heart valves that can be fatal. Occurs because there is damage to the surface of the endocardium and the entry of bacteria into the circulation. The presence of cardiac lesions such as mitral regurgitation can be a predisposing factor for infective endocarditis. Patients were diagnosed with infective endocarditis based on a scoring system consisting of clinical symptoms, imaging, and blood culture findings, namely: modified Duke criteria. Treatment of infective endocarditis consists of giving antibiotics and evacuating vegetation by surgery. Surgical action is indicated if there is symptoms of heart failure, uncontrolled infections and vegetation size are too large, causing the risk of embolism.

scholarly journals 1074. Management and Outcomes of Infective Endocarditis Due to Nutritionally Variant Streptococci

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S321-S322
Author(s):  
Madiha Fida ◽  
Tarab Mansoor ◽  
Omar Abu Saleh ◽  
Ahmed Hamdi ◽  
Daniel C Desimone ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Case Series ◽  
High Rate ◽  
In Vitro Susceptibility ◽  
Duke Criteria ◽  
Significant Difference

Abstract Background Nutritionally variant streptococci (NVS) are an infrequent cause of infective endocarditis (IE) and management recommendations are based on weak levels of evidence largely derived from case reports, small case series, and animal models of experimental endocarditis. Moreover, taxonomic changes have led to some confusion in designation of these organisms. Methods We retrospectively collected and analyzed data from 33 patients with NVS IE from 1970 to 2017. Only patients who met modified Duke Criteria for IE were included. Results Mean patient age was 55 years and 61% were males. The most common comorbidities included diabetes mellitus (12%), malignancy (3%), heart failure (16%), coronary artery disease (25%), and chronic liver disease (9%). Predisposing valve abnormalities included rheumatic heart disease (11%), bicuspid aortic valve (22%), transplant valvulopathy (3%), mitral valve prolapse (3%), and congenital heart disease (11%). Cultures were reported as NVS (70%), Granulicatella species (18%) and Abiotrophia species (12%). Echocardiogram findings included vegetations (67%), new regurgitation (55%), perivalvular abscess (3%), mitral valve prolapse (3%), and ruptured mitral valve chordae (3%). Both prosthetic (26%) and native valve IE (74%) was seen, and the valves involved were aortic (37%), mitral (50%) and both aortic and mitral (13%). Complications were seen in 27% of patients, including heart failure (17%), splenic infarct (11%), stroke (8%), mycotic aneurysm (3%), and glomerulonephritis (2%). In vitro susceptibility to penicillin, ceftriaxone, and vancomycin was 88%, 80%, and 100%, respectively. The majority (77%) of patients were treated with a combination of β-lactam and aminoglycoside. Median duration of treatment was 33 days. Surgery was performed in 50% of patients with no significant difference in survival between those who were treated with combined medical/surgical treatment and those treated with medical therapy alone. Overall survival at 1, 4, and 10 years was 93%, 83%, and 66%, respectively. Conclusion IE due to NVS is a rare entity and is associated with a high rate of serious complications and may involve multiple valves. Long-term, two-thirds of the patients survived more than 10 years. Disclosures All authors: No reported disclosures.

scholarly journals Contemporary and Evolving Treatment of Tricuspid Endocarditis

2021 ◽  
Author(s):  
Vira I. Ayzenbart ◽  
Mark Joseph
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Medical Therapy ◽  
Surgical Therapy ◽  
Current Treatment ◽  
High Rate ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Mortality And Morbidity ◽  
Treatment Paradigm

The current treatment paradigm for right sided infective endocarditis is rapidly evolving. The existing recommendations for right sided infective endocarditis include medical therapy with surgical therapy used in certain situations. Surgical therapy is based on the size of the vegetation, presence of infective complications and certain causative organisms as well the retention of intracardiac devices. Unfortunately, medical therapy alone is usually not enough to clear the infection, especially when intravenous drug use is associated as the etiology. Intravenous drug use is associated with a high rate of recidivism in tricuspid valve endocarditis. Even with indications for surgery, these patients present an ethical dilemma as most of these patients will re-infect their valves post-surgery. This often provides little option than for the surgeon to re-operate in a setting with a higher risk of mortality and morbidity. We present an evolving technique of percutaneous extirpation of vegetation, allowing for rapid clearance of endocarditis, less chance of failure of medical therapy with a lower risk profile for complication.

Advances in the Diagnosis and Treatment of Infective Endocarditis

2017 ◽  
pp. 175-193
Author(s):  
R. Brigg Turner ◽  
Jacqueline Schwartz
Keyword(s):  
Infectious Disease ◽  
Infective Endocarditis ◽  
Adverse Events ◽  
Physical Examination ◽  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Heart Valves ◽  
Drug Resistant ◽  
Mortality And Morbidity ◽  
Causative Microorganism

Infective endocarditis is a relatively uncommon infectious disease that leads to substantial mortality and morbidity. This disease primarily involves bacterial infection of the heart valves. Diagnosis is contingent upon excellent physical examination and radiological and microbiological evidence. While failure to identify the causative microorganism does not preclude the diagnosis of infective endocarditis, management is more difficult. Recent advances have improved the etiological identification and allowed for shorter time to optimal antibiotic therapy. Advances in treatment have focused on therapies to combat drug-resistant microorganisms as well as mitigate adverse events. While new therapies are available, there exists a paucity of clinical evidence and further studies are required.

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