Granulicatella adiacens subacute bacterial endocarditis as the underlying cause of type II mixed cryoglobulinaemia.

A 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing-remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yielded Granulicatella adiacens which was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grew G. adiacens. The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia.

18F-fluoro-2-deoxyglucose positron emission tomography-negative endocarditis lenta caused by Bartonella henselae.

It has been suggested that 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) might serve as a tool for the often difficult diagnosis of infective endocarditis. The case is described of a patient with a Bartonella henselae endocarditis with a negative FDG-PET. This case report demonstrates that negative FDG-PET findings do not rule out the presence of endocarditis.

Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature.

We report a case of subacute bacterial endocarditis associated with small vessel vasculitis and a strongly positive cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) test. It is important to recognize this cause of positive c-ANCA because infectious endocarditis may closely mimic the clinical manifestations of ANCA-associated vasculitides such as Wegener granulomatosis or microscopic polyangiitis. Furthermore, ANCA-associated vasculitis may result in noninfectious endocarditis, which may be confused with bacterial endocarditis. In this paper, we review reported cases of ANCA-positive bacterial endocarditis and compare them to the reported cases of ANCA-associated idiopathic vasculitis with endocardial compromise.

[Endocarditis caused by Coxilla burnetii]. / Endokarditis uzrokovan Coxiellom burnetii.

Q-fever is antropozoonosis caused by Coxiella burnetii. The microorganism usually transmitted to humans through the inhalation of infected dust from sub clinical infected mammals. The most common reservoirs for Coxiella burnetii are large numbers domestic and wild animals. The illness can occur by farmers or slaughterhouses, or veterinarian and laboratories workers. In this report we presented case of endocarditic caused by Coxiella burnetii. The patient is driver 43 years old, who lived in the countryside Nahorevo. He hospitalized in May, 2002. He had symptoms of hepatitis, with elevation of transaminases in sera. Endocarditic was diagnosed by echosonografy. The patient is controlled by infectologist, cardiologist by cardio-surgeon, but since disease is in progress and operation treatment will be probably necessary.

Infective endocarditis associated with a scorpion sting.

We report the successful surgical intervention in two cases of aortic valve bacterial endocarditis after scorpion stings. Infective endocarditis developed in both patients several weeks after they suffered repeated scorpion stings. Both patients had similar, but uncommon features: (1) the isolated organisms were unusual causes of infective endocarditis (streptococcus group G and Streptococcus milleri), (2) annular abscesses developed that required either aortic root replacement with a homograft or annular patch repair with pericardium, and (3) complete heart block developed postoperatively, requiring permanent pacemaker implantation. Both patients completed a 6-week postoperative course of antibiotic therapy and are without recurrent infection.

[Subacute bacterial endocarditis due to Pasteurella pneumotropica. Case Report]. / Endocardita bacteriana subacuta determinata de Pasteurella pneumotropica. Studiu de caz.

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.

[The role of transesophageal echocardiography in the assessment of the embolic risk during infective endocarditis: a critical review]. / Revisione critica del ruolo dell'ecocardiografia transesofagea nella valutazione del rischio embolico nell'endocardite batterica subacuta.

Embolic events are a frequent and life-threatening complication of infective endocarditis. This review is focused on the role of echocardiography, especially transesophageal echocardiography, in predicting embolic events and in the clinical and therapeutic management of patients with infective endocarditis.

Streptococcal viridans subacute bacterial endocarditis associated with antineutrophil cytoplasmic autoantibodies (ANCA).

We report an illustrative case of a 60-year-old man with Streptococcus viridans subacute bacterial endocarditis (SBE) and positive antineutrophil cytoplasmic autoantibodies (c-ANCA). C-ANCA positivity has been associated with a variety of rheumatic and infectious disease areas, but has been rarely associated with SBE. The patient had mitral valve prolapse with mitral regurgitation, and S viridans SBE developed after a dental procedure. Laboratory abnormalities included anemia, elevated erythrocyte sedimentation rate, positive rheumatoid factor, positive anticardiolipin antibody, positive lupus anticoagulant, and highly elevated c-ANCA level. We believe this is only the ninth reported case of S viridans SBE with a positive c-ANCA, and the third with mitral valve prolapse and vegetations.

Henoch-Schonlein purpura secondary to subacute bacterial endocarditis.

Henoch-Schönlein purpura (HSP), a systemic, small-vessel vasculitic syndrome, is characterized by a nonthrombocytopenic purpuric rash, arthralgia, abdominal pain, and nephritis. These signs and symptoms may occur in any order, and not all are necessary for the diagnosis. Although most common in 4- to 7-year-olds, HSP is well documented in adults and is often preceded by a history of mucosal-based infections, especially of the upper respiratory tract. We report a case of HSP that occurred coincident with the onset of subacute bacterial endocarditis (SBE) in an otherwise healtny 41-year-old white woman. The patient presented with a purpuric rash and arthralgia and was found to have left-sided streptococcal SBE. She subsequently developed abdominal pain and immune complex glomerulonephritis. The bacterial endocarditis was treated with antibiotics and mitral valve replacement, followed by a spontaneous resolution of the associated signs and symptoms of HSP.

[A rare cause of Pierre Marie hypertrophic osteoarthropathy: subacute infectious endocarditis]. / Une cause rare d'ostéoarthropathie hypertrophiante de Pierre Marie: l'endocardite infectieuse subaiguë.

Secondary hypertrophic osteoarthropathy occurred in a patient with subacute endocarditis. Chest x-ray in this smoker with ethylic cirrhosis showed a pulmonary opacity. Clinical signs of osteoarthropathic inflammation resolved with antibiotics before surgical cure of the aortic insufficiency. The diagnosis was retained on the basis of outcome after antibiotic therapy and the absence of any other etiology, notably bronchogenic cancer. Endocarditis or infectious endarteritis should be entertained in case of hypertrophic osteoarthropathy in patients with an infectious syndrome. Pathogenic hypotheses are discussed. In congenital cardiopathies, intrapulmonary shunts, megacaryocytes and activation of the vascular-platelet endothelium unit may be involved. Bacterial factors and platelet aggregation could play a role in initiating hypertrophic osteoarthropathy in patients with infectious endocarditis.

[Infectious endocarditis]. / Infektiöse Endokarditis.

The diagnosis of infective endocarditis remains a challenge to physicians providing primary care. On one hand this type of infection will be rarely encountered in primary care, but on the other hand this disease carries an enormous detrimental potential. Furthermore infective endocarditis, particularly in its initial phase, often has an uncharacteristic presentation with findings and symptoms shared with many much more frequent and often harmless diseases. To confront these difficulties, which are responsible for the often delayed diagnosis of infective endocarditis, strict rules must be applied. In patients at risk for infectious endocarditis no antibiotic therapy should be instituted without prior cultures. Also, in all other patients aimless, "blind" antibiotic therapy without diagnosis of a bacterial infection should be avoided. In patients with uncharacteristic symptoms and findings compatible with the diagnosis of infective endocarditis that persist for more than 5 days, blood cultures prior to any antibiotic therapy are warranted in addition to other clinical exams and tests. The sensitivity of echocardiography in detecting infective endocarditis is frequently overestimated. Furthermore, transesophageal echocardiography in endocarditis high-risk patients requires antibiotic prophylaxis which would obscure bacteriological diagnosis. For these reasons echocardiography should not be used as first test method when considering the diagnosis of infective endocarditis.

[Endocarditis caused by Brucella melitensis on a mitral valve prosthesis presenting as an ischemic cerebrovascular accident]. / Endocarditis por Brucella melitensis sobre válvula mitral protésica que comienza como accidente cerebrovascular isquémico.

A new case of endocarditis by Brucella melitensis on a mitral valve prosthesis in a 15 year old patient, whose first manifestation was an ischemic cerebrovascular accident is reported. The patient presented with daily fever only two months later. Medical treatment alone was not sufficient to avoid valvular failure and substitution of the prosthesis was required. The clinical manifestations and complications of this infrequent condition is discussed. Treatment, which often requires the combination of surgery and antibiotics administered over a prolonged period, is highly recommended.

Ventriculo-atrial shunt causing tricuspid endocarditis: its percutaneous removal.

A 21-year-old patient developed tricuspid endocarditis with the distal sections of two redundant ventriculo-atrial shunts remaining in the right atrium. We report their percutaneous removal using a Dotter basket.

Gonococcal endocarditis: report of a case and review of the literature.

Gonococcal endocarditis may appear in the extremes of cardiogenic and septic shock. These patients must be quickly stabilized and evaluated by echocardiography and cardiac catheterization where possible. Urgent surgical intervention for valve replacement may be necessary before complete stabilization of the patient's cardiac hemodynamics status is accomplished. Although the aortic valve is most commonly involved with gonococcal endocarditis, the mitral valve is involved as well and may present as a true emergency situation. Right-sided valve infections may be treated by a more conservative medical means if the patient does not deteriorate into a hemodynamic instability. Deterioration of the patient requires immediate intervention with catheterization and surgery in the absence of positive blood cultures to confirm the diagnosis of gonococcal endocarditis. Once the need for emergency surgical valve replacement has been determined the rules of complete debridement of all infected tissues, insertion of sutures into healthy annular tissue, and selection of an appropriate mechanical valve apply. Long-term antibiotic therapy is included in post-operative management.

[Subacute infectious endocarditis in the elderly. Retrospective study of 33 cases]. / L'endocardite infectieuse subaiguë du sujet âgé. Etude rétrospective de 33 cas.

The authors reviewed 33 cases of infectious endocarditis in patients over 65 years of age and classified according to Von Reyn's diagnostic criteria. Twenty-four patients had organic valvular disease, 4 had a prosthetic valve, and in 4 cases the diagnosis of the murmur was uncertain. Positive blood cultures were obtained in 79 p. 100 of cases. The commonest infecting organism was the streptococcus (21 out of 26). In 11 patients, it was a Group D streptococcus and a recto-sigmoid colonic tumour was found in 3 cases. A dental portal of entry was suspected in 55 p. 100 of patients and this should guide the choice of prophylactic antibiotic therapy. The initial choice of antibiotic had to be changed in 19 patients, usually because of poor tolerance. Eight patients died and one underwent valve replacement within two months of hospital admission.