scholarly journals Infective Endocarditis in a ?-thalassemia Major Child

2015 ◽  
Vol 7 (2) ◽  
pp. 145-149
Author(s):  
Sri Endah Rahayuningsih ◽  
Rahmat Budi Kuswiyanto ◽  
Herdiana Elizabeth Situmorang ◽  
Evelyn Phangkawira
Keyword(s):  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Heart Defects ◽  
Good Condition ◽  
Left Lung ◽  
Thalassemia Major ◽  
Sternal Border ◽  
History Of ◽  
Grade 3 ◽  
Almost All

Almost all patients who develop infective endocarditis (IE) had history of congenital or acquired heart disease.We report a 9 years old boy who was diagnosed as ?-thalassemia major since age 1.5 years, admitted to hospital with chief complaint of difficulty of breathing for 1 week before admission, accompanied by fever. Holosystolic murmur of grade 3/6 was found in the lower left sternal border along with hepatosplenomegaly. Chest x-ray depicted right ventricle enlargement and opaque densities in the middle field of left lung. Blood culture showed growth of Staphylococcus aureus. Echocardiography detected thickening tricuspid valve with oscillating mass in the tricuspid valve, severe pulmonary hypertension, and minimal pericardial effusion. Diagnosis of IE was made. After clinical improvement he was discharged with good condition. The diagnosis of IE in children without heart defects is difficult to establish and right-sided IE is rare in children that a high suspicion index should be considered. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22263 Cardiovasc. j. 2015; 7(2): 145-149

scholarly journals EPIDEMIOLOGICAL STUDY OF PERIORBITAL HYPERMELANOSIS

2020 ◽  
pp. 1-4
Author(s):  
Sonal Khade Ahuja ◽  
Ashish Deshmukh ◽  
Sanmitra Aiholli ◽  
Omkar Kulkarni
Keyword(s):  
Quantitative Assessment ◽  
Medical Center ◽  
Sun Exposure ◽  
Age Group ◽  
Single Patient ◽  
Psychosocial Consequences ◽  
History Of ◽  
Grade 3 ◽  
Almost All ◽  
Sleeping Habits

Background: Periorbital hypermelanosis also called dark circles form the major percentage of dermatology consultations. Importance of these disorders is growing as they cause easy visible cosmetic disfigurement and significant psychosocial consequences. Aims: To assess the patients of POH disorders for demographic, etiological and clinical profile. Methods: This prospective hospital-based clinical study, conducted in a tertiary medical center over a period of two years, involved 200 patients with POH disorders, assessed using detailed history taking and clinical examination for demographic, etiological and clinical data. Data is statistically described in frequencies (number of cases) and percentages(%) . Results: Majority of patients were in age group 18-40 years. Females dominated the study with a number of 169 (84.5%) , only 31 (15.5%) were males. Most of the patients belonged to Grade 2 (53%), grade 3 was seen in 27% patients followed by grade 1 (16.5% ) and grade 4 (3.5% ) POH. Family history was positive in 81.5% patients. POH was observed mostly in housewives 93 (46.5%) and patients with indoor occupation 69 (34.5%) and less commonly in patients with outdoor occupation 29 (14.5%). Almost all cases of POH gave history of exacerbation following sun exposure. Not a single patient showed hepatic, renal complaints, hypothyroidism or ecchymosis. Majority of patients (86.5%) had altered Sleeping habits. Alcohol and smoking did not have a significant co-relation with POH. It was found that only five percent females on oral contraceptives developed POH and there was no change in Pigmentation of POH in relation to menstrual cycle in any of the females. Limitations: The quantitative assessment of melanin by specialized instrument ( mexameter) could not be done because of lack of resources.

scholarly journals Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Heerani Woodun ◽  
Sarah Bouayyad ◽  
Sura Sahib ◽  
Nadir Elamin ◽  
Steven Hunter ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Intravenous Drug User ◽  
Blood Cultures ◽  
Topical Steroids ◽  
Foramen Ovale ◽  
History Of ◽  
The Right ◽  
Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

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 Pediatric Tricuspid Valve Infective Endocarditis- Insite into a challenging management

2020 ◽  
Author(s):  
Amitabh Satsangi ◽  
DHARAMRAJ SINGH
Keyword(s):  
Infective Endocarditis ◽  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Heart Block ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Complete Heart Block ◽  
Heart Defects ◽  
Diagnostic Methods ◽  
Tricuspid Valve Endocarditis

:Pediatric tricuspid vavle endocarditis is an uncommon entity which is now becoming prevalent oweing to improved diagnostic methods and increase number of cardiac surgeries.Paediatric right sided infective endocarditis are mostly secondary to structural heart defects or indwelling venous catheters .We present a case of paeditric tricuspid valve endocarditis presenting with complete heart block,septic arthritis, pulmonary abcess with no structural heart defect diagnosted preoperatively.Intra-operatively a ventricular septal defect was diagnosed and managed .We present the difficult management of the case by medical and surgical intervention and management of secondary fungal infective endocarditis with repeated successful surgical intervention . We also emphasize on lack of established guidelines for management of right -sided infective endocarditis.

scholarly journals Ebstein's anomaly repair in infant and adult: Report of two cases

2012 ◽  
Vol 3 (2) ◽  
pp. 48-52
Author(s):  
Jahangir Kabir ◽  
Rezoana Rima ◽  
Soofia Khatoon ◽  
Rezaul Hassan ◽  
Md. Zakir Hossain
Keyword(s):  
Tricuspid Valve ◽  
Congenital Heart ◽  
Heart Defects ◽  
Young Infant ◽  
Ventilatory Support ◽  
Ebstein’S Anomaly ◽  
Tricuspid Valve Repair ◽  
Ebstein's Anomaly ◽  
Bidirectional Glenn Shunt ◽  
Grade 3

Ebstein's anomaly (EA) is a rare but fascinating congenital heart disorder accounting for <1% of all congenital heart defects. It is a complex congenital anomaly with a broad pathologic-anatomical and clinical spectrum and no two patients are alike. Moderate to severe Ebstein's malformation remains a surgical challenge. We report our institutional experience with the surgical management of Ebstein's anomaly in a severely symptomatic four months old infant and a twenty year old grown up adult. The young infant with Ebstein's anomaly had severe tricuspid valve dysplasia, cyanosis, and gross cardiomegaly, hepatomegaly. Echocardiography severity score was 1.1 in infant (grade 3/4). Repair consisted of tricuspid valve repair, reduction annuloplasty, partial closure of atrial septal defect, and correction of all associated cardiac defects (PDA ligation).Adult Ebstein's anomaly patient underwent One and half ventricle repair which includes De-Vega repair of tricuspid valve, plication of atrialized RV , closure of ASD and a bidirectional Glenn shunt as part of the repair. The postoperative course was uneventful in adult patient except mild RV diastolic dysfunction. The infant required prolonged mechanical ventilatory support. She also developed lungs collapse-consolidation following extubation and septicaemia. At 2 years follow-up both patients showed improved exercise tolerance, infant showed significant weight gain. Echocardiographic studies reveal satisfactory monocusp valve function in both patients, with mild non- coaptation of the anterior leaflet and the septal structures with mild tricuspid valve regurgitation. Ebstein's repair has a good functional and hemodynamic outcome in infant and adult patients. One and one-half ventricular repair can be performed with an acceptable risk in adult and a biventricular repair is feasible and safe in a symptomatic infant. J Shaheed Suhrawardy Med Coll, 2011;3 (2): 48-52 DOI: http://dx.doi.org/10.3329/jssmc.v3i2.12079

scholarly journals P1299 Right sided infective endocarditis with paradoxical embolization

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Hammad ◽  
R Abayazeed ◽  
A Elbadry ◽  
N Hisham ◽  
E Elsharkawy
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Left Ventricle ◽  
Tricuspid Valve ◽  
Contrast Study ◽  
Inferior Wall ◽  
Iv Drug Abuse ◽  
History Of ◽  
Rule Out

Abstract Background Right sided infective endocarditis (IE) accounts for 5-10% of IE cases, systemic embolization is uncommon and if present it is linked to the presence of shunt or concomitant left sided IE. Clinical presentation A 35-years old gentleman with history of heroin intravenous drug abuse (IV), presented with a history of unexplained fever for two weeks along with exertional dyspnea, productive cough, chest pain and severe left hypochondria pain. On examination he had a blood pressure of 130/80 mmHg, a heart rate of 130 bpm, a temperature of 40oC, elevated jugular venous pressure and a harsh pansystolic murmur over the lower left sternal border. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for methicillin-resistant staphylococcus aureus (MRSA), electrocardiography showed sinus tachycardia and abdomen computed tomography scan revealed multiple splenic infarctions. Methods and results 2D&3DTrans-Thoracic Echocardiography (TTE) revealed the presence of an echogenic elongated highly mobile mass measures 2.0 cm in maximum dimension attached to the atrial surface of the anterior tricuspid valve leaflet a long with severe valvular regurgitation. Patent foramen ovale (PFO) was visualized by Color Doppler and right to left shunt was confirmed by contrast study with a complete opacification of the left side. The left ventricle dimensions were normal , there was an evidence of hyokinesis of inter-ventricular septum (IVS) and inferior wall and function was reduced, estimated LVEF = 45%. Hence, coronary angiography was done and revealed normal coronaries. 3D Trans-esophageal Echocardiography(TEE) was done for better visualization of the interatrial septum (IAS), vegetation and to rule out complications. The study confirmed the presence of PFO, there was no concomitant IAS defects, the vegetation is highly mobile and facing the IAS. Accordingly, patient was diagnosed with tricuspid infective endocarditis complicated with paradoxical embolization, anti-biotics were commenced and patient underwent successful tricuspid valve replacement and PFO closure. Discussion Tricuspid valve endocarditis has been linked to IV drug abuse and staphylococcus aureus has been recognized as the most commonly implicated organism. While systemic emboli are rare in right sided IE, our patient represent this uncommon complication. He had multiple splenic infractions and TTE contrast study showed PFO with a high degree of right to left shunt. Coronary embolization was a suspect in our patient as well given the presence of regional wall motion abnormalities involving the left ventricle inferior wall and IVS. Conclusion Echocardiography is a crucial imaging modality in patient with long standing fever and history of IV drug abuse to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations and detection of infective endocarditis complication. Abstract P1299 Figure. Tricuspid valve infective endocarditis

scholarly journals Unusual Presentation of Aortic Valve Infective Endocarditis in a Dog: Aorto-Cavitary Fistula, Tricuspid Valve Endocarditis, and Third-Degree Atrioventricular Block

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 690
Author(s):  
Giovanni Romito ◽  
Alessia Diana ◽  
Antonella Rigillo ◽  
Maria Morini ◽  
Mario Cipone
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Atrioventricular Block ◽  
Tricuspid Valve ◽  
Subaortic Stenosis ◽  
Echocardiographic Examination ◽  
History Of ◽  
Echocardiographic Findings ◽  
Tricuspid Valve Endocarditis ◽  
Third Degree Atrioventricular Block

A 2-year-old Boxer with a history of subaortic stenosis and immunosuppressant therapy developed aortic valve infective endocarditis. On echocardiographic examination with simultaneous electrocardiographic tracing, multiple uncommon periannular complications of the aortic valve endocarditis were found, including aorto-cavitary fistula with diastolic left-to-right shunt, tricuspid valve endocarditis, and third-degree atrioventricular block. Necropsy confirmed the above echocardiographic findings. Although aortic valve endocarditis represents a well-known disease entity in dogs, the dynamic nature of this condition may allow development of complex and uncommon echocardiographic features.

scholarly journals Pseudotumor cerebri secondary to secondary hypoparathyroidism and association to Fahr´s yndrome: a case report

2020 ◽  
pp. 68-71
Author(s):  
Patrick Giordanni Gomes Sampaio ◽  
Hiago Diniz Maracajá ◽  
Francielle Lopes de Araújo Batista ◽  
Virgínia Gabriela Nóbrega Figueiredo ◽  
Nátalia Meg Adijuto de Melo
Keyword(s):  
Case Report ◽  
Clinical Presentation ◽  
Nodular Goiter ◽  
Signs And Symptoms ◽  
Pseudotumor Cerebri ◽  
Horizontal Position ◽  
History Of ◽  
Grade 3 ◽  
Orthostatic Position ◽  
Almost All

Introduction Headaches are extremely common complications in emergency departments, accounting for up to 16% of visits, according to some studies and are observed in almost all patients with Idiopathic Intracranial Hypertension (IIH), which is characterized by signs and symptoms that include, in addition to headache, nausea, vomiting, diplopia, decreased visual acuity, pulsatile tinnitus, back and neck pain, among other possible manifestations. However, the clinical presentation is highly variable, which can delay diagnosis. Case report A.T.F, female, 33 years old, BMI 40.17 kg / m², with grade 3 obesity, caucasian, single, with Down Syndrome. Presents a history of post-surgical hypothyroidism, whose thyroidectomy was performed 10 years ago, due to nodular goiter. This patient presented subacute nausea, visual turbidity, diarrhea and pulsatile holocranial headache, which worsened in the horizontal position and presented slight relief in the orthostatic position. Conclusion The conduct of Fahrs Syndrome, in this case, was focused on the treatment of hypoparathyroidism and which consists of correcting metabolism disorders of phosphorus and calcium, which naturally resulted in clinical and radiological improvement, however, without definitive resolution of the condition.

Atypical presentation of right-sided native valve infective endocarditis

2021 ◽  
pp. e20200033
Author(s):  
Daniel Doyle ◽  
Raynell Lang ◽  
Oscar E Larios
Keyword(s):  
Infective Endocarditis ◽  
Transesophageal Echocardiogram ◽  
Native Valve ◽  
Severe Tricuspid Regurgitation ◽  
Progressive Dyspnea ◽  
Night Sweats ◽  
Sternal Border ◽  
History Of ◽  
Haemophilus Species ◽  
Neurological Infection

A previously healthy 55-year-old man presented to hospital with 10 days of progressive dyspnea with fever, night sweats, and a productive cough and no history of recreational drug use or occupational or animal exposures. His wife had developed similar symptoms 2 weeks earlier but had since recovered. Physical exam revealed a new systolic murmur best heard at the left lower sternal border. Transesophageal echocardiogram demonstrated severe tricuspid regurgitation with a small vegetation. Blood cultures were positive for non-typeable Haemophilus influenzae. This case illustrates the necessity of both timely and proficient diagnosis of H. influenzae infection and the unique challenges associated with detecting H. influenzae–related pathology. Clinicians should be aware of the variable presentations of Haemophilus infection, including respiratory infection, neurological infection, and infective endocarditis. Given the fastidious nature of H. influenzae and variability between subtype pathogenicity, microbiology laboratories require tools to culture and differentiate Haemophilus species.

scholarly journals P1694 Prosthetic mitral valve infective endocarditis complicated by left ventricle to right atrial fistula

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R M Abayazeed ◽  
H Shehata ◽  
O Elgebaly ◽  
M A Abdel-Aziz ◽  
M A Abdel-Hay
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tricuspid Valve ◽  
Left Ventricular ◽  
Right Atrial ◽  
History Of ◽  
Prosthetic Mitral Valve

Abstract Left ventricle (LV) to right atrial (RA) shunt is a rare type of ventricular septal defect. Acquired LV-RA shunt is rare and may occur as complication of cardiac surgery, endocarditis, thoracic trauma or myocardial infarction. Infective endocarditis is the second most important cause of this type of shunt. Case presentation A 44 year old female patient presented to our hospital complaining of progressive exertional dyspnea and palpitations for 6 months, and high grade fever for 2 weeks. The patient had history of mitral valve replacement with mechanical prosthesis 16 years ago. The patient had no history of recent invasive procedures or dental interventions. General examination revealed an irregular pulse at rate of 100 beats per minute (bpm), blood pressure of 100/60 mmHg, temperature of 38.5 ͦ C and congested neck veins. Cardiac examination revealed an audible prosthetic mitral click with a harsh pansystolic murmur heard on the apex and left sternal border, and an accentuated P2 over the pulmonary area. Her resting electrocardiogram (ECG) showed atrial fibrillation with ventricular response of 110 bpm. Her laboratory investigations revealed normochromic normocytic anemia with Hemoglobin level of 8 g/dl (13-16), and leucocytosis with white blood cell count of 16.24 103 cell/ ul (4.00-11.00); as well as elevated C-reactive protein (CRP) level of 73 (0-3). Her international normalized ratio (INR) was 3 (1-1.3) on warfarin 5 mg. Transthoracic echocardiography (TTE) revealed a dehiscent prosthetic mitral valve with severe paravalvular regurgitation, severe tricuspid valve regurgitation and pulmonary hypertension with predicted resting pulmonary artery systolic pressure of 60 mmHg. It also showed an abnormal jet passing from the LV into the RA above the tricuspid valve during systole, both right and left ventricular systolic functions were preserved. Subsequent 2D/3D transoesophageal echocardiography (TEE) confirmed the TTE findings with detection of LV-RA fistula with significant left to right shunt; it also visualized multiple vegetations attached to the mitral annulus at the site of the valve dehiscence. The patient was diagnosed with prosthetic mitral valve infective endocarditis, empirical antibiotics were started and the patient was referred for another center for urgent surgery. Redo mitral valve replacement, tricuspid valve repair and closure of the defect were done; the patient developed complete heart block postoperatively and permanent pacemaker was inserted. Conclusion Infective endocarditis remains a major health problem with high mortality and severe complications. It is important to keep high index of suspicion in high risk patients for infective endocarditis as delayed diagnosis increases the risk of serious complications and mortality, and makes surgical intervention, if indicated, more demanding with increased incidence of perioperative complications. Abstract P1694 Figure. TTE&TEE of prosthetic mitral IE

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