In-hospital mortality risk factors for patients with cerebral vascular events in infectious endocarditis: A correlative study of clinical, echocardiographic, microbiologic and neuroimaging findings / Factores de riesgo de mortalidad intrahospitalaria en pacientes con endocarditis infecciosa y accidentes cerebrovasculares: Estudio correlativo de hallazgos clínicos, ecocardiográficos, microbiológicos y neuroimágen

Objective: Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. Methods: From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. Results: Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n = 8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n = 7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p = 0.005) and moderate to severe cerebral edema were more frequent (p = 0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p = 0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). Conclusions: In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality.

Objetivo: Las complicaciones cardíacas por endocarditis infecciosa (EI) se presentan en casi 50% de los casos y pueden presentarse complicaciones generalizadas. El interés del estudio fue determinar las características de los pacientes hospitalizados con EI que presentaron complicaciones neurológicas agudas y factores asociados a mortalidad temprana. Métodos: Revisamos expedientes y estudios de imagen desde enero del 2004 hasta mayo del 2010 de todos los pacientes con EI y complicaciones neurológicas evaluadas con tomografía computarizada o resonancia magnética durante la primera semana después de la complicación. El estudio fue descriptivo y retrolectivo. Resultados: De 325 casos con EI, incluimos 35 (10.7%) [varones 19 (54%), media 44 años]. La cardiopatía subyacente más frecuente fue valvulopatía reumática (n = 8, 22.8%). Veinte pacientes sobrevivieron (57.2%, grupo A) y 15 fallecieron (42.8%, grupo B) durante su hospitalización. La principal causa de muerte fue choque séptico (n = 7, 20%). No hubo significado estadístico entre ambos grupos independientemente de presentación clínica, tamaño de vegetación, agente infeccioso o territorio vascular del ACV. La cantidad total de lesiones cerebrales fue mayor en el grupo B (3.1 vs. 1.6, p = 0.005) y el edema cerebral moderado a grave fue más frecuente (p = 0.09). Dieciséis pacientes (45.7%) (12 grupo A y 4 grupo B, p = 0.05) fueron tratados con cirugía cardiaca. Sólo 2 pacientes tuvieron resultados favorables con tratamiento conservador (5.7%). Conclusiones: En pacientes hospitalizados por EI complicada con ACVs, la cantidad de lesiones observadas en estudios de neuroimágen y el tratamiento conservador se asociaron a una mayor tasa de mortalidad intrahospitalaria.

Increased levels of Porphyromonas gingivalis are associated with ischemic and hemorrhagic cerebrovascular disease in humans: an in vivo study

OBJECTIVE: This study investigated the role of periodontal disease in the development of stroke or cerebral infarction in patients by evaluating the clinical periodontal conditions and the subgingival levels of periodontopathogens. MATERIAL AND METHODS: Twenty patients with ischemic (I-CVA) or hemorrhagic (H-CVA) cerebrovascular episodes (test group) and 60 systemically healthy patients (control group) were evaluated for: probing depth, clinical attachment level, bleeding on probing and plaque index. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were both identified and quantified in subgingival plaque samples by conventional and real-time PCR, respectively. RESULTS: The test group showed a significant increase in each of the following parameters: pocket depth, clinical attachment loss, bleeding on probing, plaque index and number of missing teeth when compared to control values (p<0.05, unpaired t-test). Likewise, the test group had increased numbers of sites that were contaminated with P. gingivalis (60 percentx10 percent; p<0.001; chi-squared test) and displayed greater prevalence of periodontal disease, with an odds ratio of 48.06 (95 percent CI: 5.96-387.72; p<0.001). Notably, a positive correlation between probing depth and the levels of P. gingivalis in ischemic stroke was found (r=0.60; p=0.03; Spearman's rank correlation coefficient test). A. actinomycetemcomitans DNA was not detected in any of the groups by conventional or real-time PCR. CONCLUSIONS: Stroke patients had deeper pockets, more severe attachment loss, increased bleeding on probing, increased plaque indexes, and in their pockets harbored increased levels of P. gingivalis. These findings suggest that periodontal disease is a risk factor for the development of cerebral hemorrhage or infarction. Early treatment of periodontitis may counteract the development of cerebrovascular episodes.

Chlamydia pneumoniae and stroke: is there a direct relationship? / Chlamydia pneumoniae e acidente vascular cerebral aterotrombótico: existe relação direta?

OBJECTIVE: To investigate the possible relationship between atherothrombotic stroke and Chlamydia pneumoniae. METHOD: 150 patients with carotid atherothrombosis were enrolled. The casuistic was divided in three groups: ischemic stroke (IS): 65 patients; transient ischemic attack (TIA): 26 patients; and control: 59. The IS or TIA onset was up to 30 days from the beginning of the study. Carotid atheromatoses was diagnosed by Doppler-ultrasonography. Patients with cardioembolic risk or non-atherothrombotic origin were excluded. Comparisons were done between the three groups, and within each group according to the different age sub-groups, to the main arteries affected, and to the atherogenic risk factors. Bacteria detection was done using polimerase chain reaction. RESULTS: Only one patient tested positive for C. pneumoniae belonging to the control group. CONCLUSION: These results do not suggest that C. pneumoniae participated in the onset of IS or TIA or that it has a role in carotid plaque destabilization.

OBJETIVO: Investigar a possível relação entre Chlamydia pneumoniae e acidente vascular cerebral aterotrombótico (AVC). MÉTODO: 150 pacientes com aterotrombose carotídea foram estudados. A casuística foi dividida em 3 grupos: AVC: 65 pacientes; ataque isquêmico transitório (AIT): 26 pacientes e controles: 59. O início do AVC ou AIT era até 30 dias da inclusão no estudo. A ateromatose carotídea foi diagnosticada por ultrassonografia com Doppler. Os pacientes com risco cárdio-embólico ou sem evidência de aterotrombose foram excluídos. Foram estabelecidas comparações entre os 3 grupos e dentro de cada grupo, formado sub-grupos de acordo com diferentes idades, território arterial comprometido e fatores de risco. A detecção da bactéria foi feita por reação de polimerização em cadeia. RESULTADOS: Somente um paciente, pertencente ao grupo controle, teve resultado positivo. CONCLUSÃO: Estes achados não sugerem que a C. pneumoniae participe no desencadeamento do AVC ou AIT ou que tenha papel na desestabilização da placa.

Association between infection with Helicobacter pylori and cerebral noncardioembolic ischemic stroke.

BACKGROUND: Helicobacter pylori infection has been associated epidemiologically and pathogenetically with atherosclerosis of coronary arteries but data regarding chronic infection with this organism and cerebral noncardioembolic ischemia are not clear. AIMS AND DESIGN: In this study we have investigated the association of this pathogen and noncardioembolic ischemic stroke under a case-control study. METHODS AND MATERIAL: Samples are taken among patients who were admitted in our hospital due to their first ischemic stroke during 2003-04. Patients with a known cardiac origin for cerebral emboli and those with major risk factors of ischemic strokes were excluded. Controls were selected from the study population and matched for age, sex, and area of residence. IgG and IgA antibodies to H. pylori were measured by enzyme immunoassay. STATISTICAL ANALYSIS: The t and c - tests and Odds ratio were applied to examine variables differences. RESULTS: A total of 91 cases (43 women, 48 men) and 80 controls (40 women, 40 men) were included for analysis (P = 0.8). The mean age of cases was 64.3+/-10 years and of controls was 61.73 +/- 10.3 years (P = 0.1, CI = 95%). There was seropositivity for H. pylori (IgG or IgA) in 66 patients (72.5%) but they were positive only in 45 controls (56.3%) (P =0.04). Mean of serum IgG levels was significantly high in stroke group (P < 0.005) but the IgA antibody elevation against H. pylori did not show any risk. CONCLUSIONS: Our case-control study provides evidence of an association between the immune response to H. pylori , a marker of prior infection with this organism and noncardioembolic ischemic stroke.