Endocarditis de la válvula aórtica causada por Brucella melitensis / Aortic valve endocarditis caused by Brucella melitensis

La endocarditis bacteriana secundaria a la infección por Brucella spp., en este caso B. melitensis, como complicación de la brucelosis humana tiene una incidencia baja y, aunque es la presentación clínica con la que se asocia más frecuentemente la mortalidad, no todos los casos son letales, si son tratados oportunamente. Se describe el caso clínico de una endocarditis bacteriana por B. melitensis, diagnosticada en un adulto por el aislamiento del microorganismo en el hemocultivo. Paciente del sexo masculino, de 40 años, con antecedentes de realizar partos en el ganado bovino y consumir leche no pasteurizada. Acudió al médico por presentar durante siete días de evolución de las siguientes manifestaciones clínicas: fiebre, mialgias, artralgias, tos seca y pérdida de peso (15 kg). El hemograma informa: leucopenia, trombocitopenia y anemia; mientras que en un ecocardiograma transesofágico se observó vegetación en la válvula aórtica con una disminución de la función sistólica y en el hemocultivo se aisló B. melitensis. Debido a estos antecedentes, se inició el tratamiento antibacteriano con rifampicina, doxiciclina y gentamicina. El paciente se recuperó y tuvo una evolución clínica satisfactoria. La brucelosis es una enfermedad infrecuente. Debe considerarse en toda persona con fiebre de foco desconocido que resida en zonas endémicas o esté expuesto al cuidado de animales de granja. En esta enfermedad se impone un diagnóstico y tratamiento preciso, por ser una complicación con alta letalidad.

Bacterial endocarditis, secondary to Brucella spp. infection, in this case by B. melitensis, as a complication of human brucellosis has a low incidence. Although it is the clinical presentation most frequently associated with mortality, not all cases are lethal if timely treatment is provided. We describe a clinical case of bacterial endocarditis due to B. melitensis in a 40-year-old male patient with a history of conducting cattle deliveries and consuming unpasteurized milk, diagnosed after isolating the microorganism in blood culture. He presented with the following clinical manifestations after seven days of evolution: fever, myalgias, arthralgias, dry cough and weight loss (15 kg). The hemogram revealed leukopenia, thrombocytopenia, and anemia; while a transesophageal echocardiogram showed vegetation on the aortic valve with decreased systolic function, and B. melitensis was isolated in a blood culture. Considering this medical history, antibacterial treatment was initiated with rifampicin, doxycycline and gentamicin. The patient recovered and had satisfactory clinical evolution. Brucellosis is a rare disease. It should be considered in any person with a fever of unknown origin who lives in endemic areas or is exposed to the care of farm animals. Endocarditis is a highly lethal complication of human brucellosis; therefore, it requires a precise diagnosis and treatment.

Endocarditis infecciosa con compromiso bivalvular por Erysipelothrix rhusiopathiae / Infective endocarditis with bivalvular involvement due to Erysipelothrix rhusiopathiae. Report of one case

The microbiology of infective endocarditis (IE) varies in different populations and depends on public health conditions and socioeconomic status. In low-income countries, oral Streptococci affect hearts with rheumatic valve disease in patients with poor dentition. In high-income countries, Staphylococci are the most common cause, affecting elderly and immunocompromised patients, or those with invasive devices. Gram - positive bacili as IE pathogens are unusual. Erysipelothrix rhusiopathiae is a Gram positive bacili. It causes skin diseases in domestic and farm animals, but in humans, is a very unusual pathogen. This infection is considered a zoonosis, since most cases are linked to direct contact with vector animals. We report a 62 year-old male patient with a history of exposure to animals, who developed an infective endocarditis with severe bivalve regurgitation and septic shock, requiring antimicrobials and surgical resolution. Erysipelothrix rhusiopathiae was isolated from blood and valve vegetation cultures. The patient had a successful evolution and was discharged from the hospital.

Incidencia de endocarditis infecciosa en un servicio de neonatología centro de referencia nacional en el período 2009-2019 / Incidence of infective endocarditis in a national reference neonatology department in 2009-2019 / Incidência de endocardite infecciosa no departamento de neonatologia de referência nacional no período 2009-2019

La endocarditis infecciosa es una enfermedad rara en pediatría, principalmente en la etapa neonatal pero con una importante morbimortalidad. Existen factores de riesgo definidos, sin embargo el diagnóstico, principalmente en recién nacidos, continúa siendo un desafío. En este trabajo se presenta un relevamiento en 10 años, 5 casos de endocarditis infecciosa confirmada en recién nacidos y se analizan las características clínicas, estudios paraclínicos, agentes infeccioso, tratamiento realizado y asociación con factores de riesgo en esta población.

Infective endocarditis is a rare disease in pediatrics, mainly in neonates, even though it involves significant morbidity and mortality. There are defined risk factors; however, regarding diagnosis and mainly for the case of newborns, it continues to be a challenge. In this paper, we present a 10-year research and follow-up of 5 confirmed cases of infective endocarditis in newborns and their clinical characteristics, paraclinical studies, infectious agents, treatment and association with risk factors in this population

A endocardite infecciosa é uma doença rara em pediatria, principalmente na fase neonatal, mas apresenta significativa morbidade e mortalidade. Existem fatores de risco definidos, porém o diagnóstico, principalmente em recém-nascidos, continua sendo um desafio. Este paper apresenta uma pesquisa de 10 anos de 5 casos de endocardite infecciosa confirmada em recém-nascidos e analisa as suas características clínicas, estudos para clínicos, agentes infecciosos, tratamento e associação com fatores de risco nesta população.

Plastia mitral en endocarditis infecciosa: reporte de un caso / Mitral valve repair in infective endocarditis: a case report / Plastia mitral em endocardite infecciosa: relato de um caso

La endocarditis infecciosa es una patología heterogénea con una alta mortalidad y requiere tratamiento quirúrgico en al menos la mitad de los casos. Cuando asienta en posición mitral, la reparación valvular en lugar de su sustitución, si bien representa un desafío técnico, ha ido ganando terreno en los últimos años. Describimos el caso de un paciente que se presentó con una endocarditis sobre válvula nativa mitral en quien se realizó una plastia valvular exitosa. Revisaremos la evidencia acerca de su beneficio.

Infective endocarditis is a heterogeneous disease with a high mortality and that requires surgical treatment in at least half of cases. When seated in mitral position, valve repair rather than replacement, while technically challenging, has been gaining popularity in recent years. We describe the case of a patient who presented with a mitral valve endocarditis in whom a successful valve repair was performed. Evidence supporting its use will be reviewed.

A endocardite infecciosa é uma doença heterogênea com alta mortalidade que requer tratamento cirúrgico em pelo menos metade dos casos. Quando sentado na posição mitral, o reparo da válvula, em vez da substituição da válvula, embora seja um desafio técnico, tem ganhado espaço nos últimos anos. Descrevemos o caso de um paciente que apresentou endocardite valvar mitral nativa, no qual foi realizada plastia valvar com sucesso. Vamos revisar as evidências sobre o seu benefício.

Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation / 中华心血管病杂志

Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.

Caries Experience and Knowledge About Oral Health Importance Among Children with Congenital Heart Diseases in Kosovo

Abstract Objective: To determine the dental health of children with Congenital Heart Diseases (CHD) and to evaluate the parents' knowledge of the importance of oral health and the risk of Bacterial Endocarditis. Material and Methods: This research included 140 children divided into the study group (80 children with CHD) and the control group (60 healthy children). The children were from different parts of Kosova, aged between 3-15. The parents were asked to complete a questionnaire containing demographic data (age and gender), general and special medical history (CHD types), knowledge about oral health importance and risk of bacterial endocarditis, and data about the daily oral hygiene child. The caries experience was reported using the DMFT/dmft index. Results: The average value of the dmft index was 6.7 for the study group and 5.62 for the control group, while the average value of DMFT index for the study group was 4.1, and for the control group was 3.47 (p>0.05). About 68.7% of parents of children with CHD were informed about their risk during dental interventions. However, knowledge was insufficient about the importance of oral health and dental prophylactic measures once only 32.7% of them were aware of those measures. Conclusion: No difference was observed between healthy and CHD children in caries experience and frequency of daily tooth brushing. Our findings provide evidence of a lack of knowledge about the importance of oral health and dental prophylactic measures among parents with CHD children (AU).

Infective endocarditis in pregnancy: A case report / 北京大学学报(医学版)

Infective endocarditis in pregnancy is extremely rare in clinical practice. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. Due to increased blood volume and hemodynamic changes in late pregnancy, endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism, respiratory, cardiac arrest and sudden death may occur in pregnant women, the fetus can suffer from intrauterine distress and stillbirth at any time, leading to adverse outcomes for pregnant women and fetuses. The disease is dangerous and difficult to treat, which seriously threatens the lives of mothers and babies. Early diagnosis and reasonable treatment can effectively improve the prognosis of patients. The most important method for the treatment of infective endocarditis requires early, adequate, long-term and combined antibiotic therapy. Moreover, surgical controversies regarding indication and timing of treatment exist, especially in pregnancy. In terms of the timing of termination of pregnancy, the timing of cardiac surgery, and the method of surgery, individualized programs must be adopted. A pregnant woman with 30+5 weeks of gestation is reported. She was admitted to hospital due to intermittent chest tightness, suffocation and fever, with grade Ⅲ cardiac insufficiency. Imaging revealed large mitral valve vegetation, 22.0 mm×4.1 mm and 22.0 mm×5.1 mm, respectively, and severe valve regurgitation. Mitral valve perforation was more likely, blood culture suggested Staphylococcus epidermidis infection, after antibiotic conservative treatment, the effect was poor. After the joint consultation including cardiology, neonatology, interventional vascular surgery, anesthesiology, and obstetrics, the combined operation of obstetrics and cardiac surgery was performed in time. The heart was blocked for 60 minutes, the bleeding was 1 200 mL, the newborn was mildly asphyxiated after birth, and the birth weight was 1 890 g. Nine days after the operation, the patient was discharged from the hospital, and the newborn was discharged with the weight of 2 020 g. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child. An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication, informed consent of the patient, and concerted action among the specialists involved.

Melioidosis con endocarditis de válvula protésica / Prosthetic valve endocarditis in melioidosis: case report

Resumen La melioidosis es endémica en varias regiones, con predominio en el Sudeste Asiático, norte de Australia, sur de Asia, China y Taiwán. En Sudamérica, Colombia ocupa el segundo lugar de casos de melioidosis, después de Brasil. Su manifestación clínica es variable, desde una infección asintomática hasta un compromiso multiorgánico con formación de abscesos múltiples y choque séptico. El compromiso cardiaco es inusual, con una incidencia menor del 1%. Se presenta el caso de un varón de 51 años, colombiano, con antecedente de una valvula aórtica mecánica, quien presentó un absceso en la pierna derecha y en la válvula cardiaca protésica, aislándose Burkholderia pseudomallei en hemocultivos y en el cultivo de secreción de la pierna. Fue tratado con meropenem y cotrimoxazol, con una adecuada respuesta clínica, requiriendo un reemplazo valvular aórtico.

Abstract Melioidosis is an endemic disease to several regions and occurs predominantly in Southern Asia, Northern Australia, China and Taiwan. In South America, Colombia is second after Brazil in number of melioidosis cases reported. Clinical manifestation varies from asymptomatic infection to multiorgan compromise involving multiple abscesses and septic shock. Cardiac compromise is infrequent, with an incidence of <1%. We report the case of a 51-year-old patient from Colombia with a mechanical aortic valve who had an abscess in right leg and in the prosthetic valve. Burkholderia pseudomallei was isolated in blood cultures and drained pus from the leg cultures. Patient was treated with meropenem and cotrimoxazole and required aortic valve replacement, resulting in adequate improvement in clinical symptoms.

Uso de implantes dentales en paciente con compromiso cardiovascular: reporte de caso / Use of dental implants in patients with cardiovascular involvement. Case report

Los implantes dentales son diseños utilizados para sustituir la raíz que falta y mantener el diente artificial en su sitio. Habitualmente tiene forma roscada y está fabricado con materiales biocompatibles que no producen reacción de rechazo y permiten su unión al hueso. La superficie del implante puede presentar diferentes texturas y recubrimientos, utilizadas habitualmente para aumentar su adhesión al hueso. El objetivo es demostrar basado en la evidencia científica que la colocación de implantes dentales en pacientes con compromiso cardiovascular puede ser seguro, siempre y cuando se sigan protocolos específicos para el cuidado y prevención de cualquier complicación. La literatura nos demuestra que la tasa de éxito de los implantes dentales es la misma en paciente con o sin compromiso sistémico por lo que se considera una opción para este tipo de pacientes. Caso: paciente femenina de 61 años de edad, con múltiples compromisos sistémicos, específica- mente cardiovascular y con motivo de consulta reemplazar dientes perdidos por medio de la colocación de implantes múltiples. Se realizó historia clínica, análisis clínico y radiográfico e interconsulta con el especialista cardiovascular para seguir con los protocolos pre-quirúrgicos y posquirúrgicos adecuados a la paciente. En el abordaje quirúrgico se realizó una exodoncia y la colocación de seis implantes dentales sin ninguna complicación antes, durante y después del procedimiento. Por lo que se puede ver en este caso que si es un tratamiento viable para pacientes con este tipo de compromiso sistemico...(AU)

Endocarditis infecciosa por Neisseria gonorroheae / Infectious endocarditis due to Neisseria gonorrhoeae

Resumen Se presenta un caso de endocarditis infecciosa por Neisseria gonorrhoeae, en un paciente masculino de 38 años, sin factores de riesgo cardiovascular ni otros antecedentes previos. La sospecha diagnóstica comienza por síndrome febril prolongado, astenia y pérdida de peso, confirmada con rescate de gonococo en los hemocultivos. Cumplió tratamiento antibiótico con ceftriaxona por 29 días. Evoluciona con insu ficiencia aórtica grave por lo cual se realiza cirugía de reemplazo valvular por prótesis mecánica bidisco exitosa, con una evolución favorable.

Abstract We report a case of infectious endocarditis due to Neisseria gonorrhoeae in a 38-year-old male patient with no cardiovascular risk factors or past medical history who presented with prolonged febrile illness, asthenia and weight loss. The blood cultures were positive for gonococcus. He received antibiotic treatment with ceftriaxone for 29 days. The patient developed severe aortic regurgitation and underwent surgical aortic valve replacement with a bileaflet mechanical prosthesis, with favorable outcome.

Aortic Root Replacement for Destructive Endocarditis - Clinic and Microbiology

Abstract Introduction: Destructive aortic root endocarditis is associated with high mortality rates. The objective of this article was to characterize the clinical and microbiological profiles of these patients, especially concerning an already implanted aortic valve prosthesis. We also focused on prognostic factors. Methods: Eighty patients underwent aortic root replacement due to destructive endocarditis from 1999 to 2018 in our institution. We analyzed their pre, intra, and postoperative data, outcomes, and predictors of mortality. Results: Thirty-one patients had native valve endocarditis (NVE), eight patients had early-onset prosthetic valve endocarditis (PVE), and 41 patients had late-onset PVE. Streptococcus was found in 19.4% of NVE cases and no PVE case. Coagulase-negative Staphylococcus was responsible for 62.5% of the cases of early-onset PVE. Thirty-four (42.5%) patients had received inappropriate antibiotics before admission. No microorganism was associated with higher risk of mortality. Aortoventricular dehiscence was identified as an independent risk factor of mortality along with PVE, concomitant bypass surgery, and delayed diagnosis. The incidence of postoperative complications was similar in all three groups. Rates of long-term survival (P=0.044) and freedom from the composite endpoint (P=0.024) defined as death, stroke, aortic valve reinfection, and aortic valve reoperation were the lowest within the NVE group and the highest among the PVE patients. Conclusion: In endocarditis, prolonged diagnostics, inadequate antimicrobial treatment, and late surgery led to destructive local complications and worsened the prognosis. PVE is associated with higher mortality than NVE.

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal - How do Women and Men Compare?

Abstract Background: The impact of gender on the outcome of patients hospitalized with infective endocarditis (IE) is not fully understood. Objective: To verify the association between gender and the clinical profile of patients hospitalized with IE, treatment strategies, and clinical outcomes. Methods: This is a retrospective nationwide study of patients hospitalized with IE, based on hospital admissions between 2010 and 2018 in Portugal. Descriptive statistics were used to present variables. An inferential analysis was performed using multiple logistic regression. A 95% confidence interval and a 5% significance level were considered. Results: In total, 3266 (43.1%) women and 4308 (56.9%) men were hospitalized with IE. The women were older (76 vs 69 years old, p<0.001), more frequently presented arterial hypertension (39.8% vs 35.4%, p<0.001) and atrial fibrillation (29.5% vs 21.2%, p<0.001), and had less cardiovascular comorbidities. Acute heart failure was more common in women (32.9 vs 26.9%, p<0.001) and acute renal failure (13.6% vs 11.7%, p<0.001) and sepsis (12.1% vs 9.1%, p<0.001), in men. Women were less likely to undergo cardiac surgery (OR 0.48 - 95%CI 0.40-0.57, p<0.001) and had a higher postoperative mortality (OR 1.84, 95% CI 1.19-2.84, p=0.006). In-hospital mortality rates were comparable between genders (20.3% vs 19.6%, p=0.45). Conclusions: Women were less likely to undergo cardiac surgery when hospitalized with IE, and the female gender was a predictor factor for postoperative mortality. Overall, in-hospital mortality was not influenced by gender. Further research is necessary to fully clarify the impact of gender on IE management and outcomes.

Tratamiento quirúrgico de la endocarditis infecciosa activa / Active infective endocarditis: surgical treatment

Resumen: La endocarditis infecciosa, la infección cardiovascular en general, es una enfermedad médico-quirúrgica compleja que requiere un tratamiento multidisciplinario precoz, específico y agresivo. A pesar de los avances médicos, ésta sigue siendo una enfermedad con una morbi-mortalidad elevada, por lo que el tratamiento antibiótico se complementa en un 40-50% de los pacientes mediante intervención quirúrgica. Por lo tanto, es necesario conocer las opciones que pueden llegar a ser utilizadas para extirpar el tejido infectado. El objetivo de este trabajo es discutir aspectos de interés en la cirugía de la endocarditis infecciosa.

Abstract: Infective endocarditis (IE) is a complex disease that requires a multidisciplinary approach and early and aggressive treatment. Despite médical and surgical advances, this disease still has high morbidity and mortality. The antibiotic treatment is complemented in 40-50% of the cases with surgical intervention. Thus, it is useful to be aware of the possibilities that might be contemplated in order to excise the infected tissues. The aim of this work is to discuss current surgical aspects of interest in the surgery IE.

Imágenes en endocarditis infecciosa: no todo es ecocardiografía / Imaging in infective endocarditis: not all is ultrasonography

Resumen La endocarditis infecciosa (EI) es una enfermedad de alta mortalidad, caracterizada por una infección endocárdica y frecuentes complicaciones multiorgánicas, que requiere un diagnóstico rápido y preciso, y un manejo agresivo, ya sea médico o quirúrgico. Su diagnóstico se realiza tomando en cuenta criterios bacteriológicos, clínicos y ecocardiográficos. Es objetivo de este artículo realizar una actualización del estudio imagenológico en paciente con EI, con especial énfasis en aquellos exámenes no ecocardiográficos disponibles en nuestro medio. En los últimos años, estudios de imagen avanzados han adquirido un rol creciente en su estudio inicial, particularmente la tomografía computada multicorte (TCMC) cardiaca y el positron emission tomography/computed tomography (PET/CT), y han sido recomendados como criterios diagnósticos en las guías recientes para el manejo de esta entidad. La TCMC cardiaca proporciona información anatómica detallada de las válvulas cardiacas y tejido perivalvular, identificando pseudoaneurismas, abscesos y dehiscencias valvulares. El PET/CT con F18-fluorodeoxiglucosa (F18-FDG) permite aumentar la sensibilidad en la detección de EI, y pesquisar con alta eficiencia fenómenos embólicos sistémicos, de elevada frecuencia en esta población. Ambos métodos prestan particular utilidad en EI de válvula protésica, donde la ecocardiografía presenta menor rendimiento diagnóstico. La resonancia magnética (RM) cerebral es el mejor método de imagen para descartar eventos isquémicos/embólicos del sistema nervioso central.

Abstract Infective endocarditis (IE) is an entity characterized by endocardial infection and frequent multiorgan complications, resulting in high mortality. It requires a rapid and accurate diagnosis, and a medical or surgical aggressive treatment. Currently, IE diagnosis rests on bacterial, clinical and ultrasonographic criteria. The objective of this article is to update the imaging study in patients with IE, with special emphasis on those non-echocardiographic examinations available in our environment. Last years, advanced imaging had achieved a growing role in IE diagnosis, especially cardiac multislice computed tomography (MSCT) and positron emission tomography/computed tomography (PET/CT), which have been recommended in recent clinical guidelines to be included as part of diagnostic criteria. Cardiac MSCT provides detailed anatomic information of cardiac valves and perivalve tissue, allowing identification of pseudoaneurysm, abscess and valve dehiscence. F18-FDG PET/CT increases sensitivity for IE detection and shows high accuracy in searching for extracranial systemic embolic events. Both MSCT and PET/CT have particular utility in cases of prosthetic valve endocarditis, where cardiac ultrasonography shows lower performance. Brain magnetic resonance imaging (MRI) is the best imaging method for evaluating ischemic/embolic events of central nervous system.

Infective endocarditis in childhood: a single-center experience of 18 years

Abstract Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.

Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário / Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Resumo Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Background: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. Objective: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. Methods: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. Results: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). Conclusions: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.