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1.
Int Heart J ; 62(2): 432-436, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731527

RESUMO

Embolic myocardial infarction (MI) caused by infective endocarditis (IE) is rare, but it is increasingly recognized as an important complication. This complication typically occurs in patients with aortic valve endocarditis during the acute phase of the infection. It is also known to have a high mortality rate; however, the best practice for its management is unclear owing to scarce available data. In addition, most cases of embolic acute MI (AMI) caused by IE are indirectly diagnosed with a combination of angiographic examination such as coronary angiography or cardiac computed tomography. Herein, we report a case of fatal embolic ST-elevation MI (STEMI) caused by mitral valve IE during the healed phase, which was clearly proven by the pathology findings.


Assuntos
Embolia/complicações , Endocardite Bacteriana/complicações , Valva Mitral/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Idoso , Angiografia Coronária , Ecocardiografia , Embolia/diagnóstico , Endocardite Bacteriana/diagnóstico , Evolução Fatal , Feminino , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
2.
Mayo Clin Proc ; 96(1): 132-146, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33413809

RESUMO

OBJECTIVE: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. PATIENTS AND METHODS: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en España [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. RESULTS: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. CONCLUSION: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.


Assuntos
Neoplasias Colorretais/etiologia , Endocardite Bacteriana/complicações , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/complicações , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/microbiologia , Endocardite Bacteriana/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
3.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495169

RESUMO

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.


Assuntos
Lesão Renal Aguda/diagnóstico , Endocardite Bacteriana/diagnóstico , Dermatopatias Vasculares/diagnóstico , Infecções Estafilocócicas/diagnóstico , Vasculite/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/imunologia , Lesão Renal Aguda/terapia , Idoso , Antibacterianos/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Diálise Renal , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Rifampina/uso terapêutico , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/imunologia , Dermatopatias Vasculares/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/patologia
4.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495170

RESUMO

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.


Assuntos
Bacteriemia/diagnóstico , Disenteria/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Pneumonia/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Bacteriemia/complicações , Hemocultura , Proteína C-Reativa , Diagnóstico Diferencial , Diarreia/fisiopatologia , Escore de Alerta Precoce , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/fisiopatologia , Humanos , Hipóxia , Ácido Láctico , Leucocitose , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Infecções Estafilocócicas , Insuficiência da Valva Tricúspide/etiologia , Vômito/fisiopatologia
5.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495173

RESUMO

Surgery for prosthetic valve endocarditis in the mitral valve position is still challenging for surgeons. Reconstruction of the mitral annulus is useful for patients with a mitral annulus disputed by infection. Here, we report a redo mitral valve replacement using a collar-reinforced tissue valve, which was inserted into a mitral annulus reconstructed with a bovine patch. Though the preoperative blood culture detected Streptococcus anginosus, the intraoperative culture detected methicillin-resistant coagulase-negative staphylococci (MRCNS). MRCNS is rarely detected because of its indolent nature.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/terapia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Infecções Estreptocócicas/terapia , Idoso , Ampicilina/uso terapêutico , Hemocultura , Daptomicina/uso terapêutico , Desbridamento , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Imagem por Ressonância Magnética , Resistência a Meticilina/fisiologia , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Staphylococcus/isolamento & purificação , Staphylococcus/fisiologia , Streptococcus anginosus/isolamento & purificação , Streptococcus anginosus/fisiologia , Sulbactam/uso terapêutico
6.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148560

RESUMO

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Assuntos
Aspirina/administração & dosagem , Fibrilação Atrial , Cegueira , Infartos do Tronco Encefálico , Infecções por Coronavirus , Diplopia , Endocardite Bacteriana , Oftalmoplegia , Pandemias , Pneumonia Viral , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Oclusão da Artéria Retiniana , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diplopia/diagnóstico , Diplopia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Inibidores do Fator Xa/administração & dosagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Oclusão da Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Oclusão da Artéria Retiniana/etiologia , Oclusão da Artéria Retiniana/fisiopatologia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
7.
Kyobu Geka ; 73(10): 731-737, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130757

RESUMO

Surgery for active infective endocarditis( IE) carries the greatest risk of any valve surgery, especially when complicated by cerebral infarction or bleeding. Surgical candidates with IE associated with neurologic symptoms should have a neurologic evaluation and brain imaging either by computed tomography (CT) or magnetic resonance imaging (MRI). Even among patients without neurologic symptoms, routine preoperative screening can be justified, especially those with high-risk vegetation. Current recommendations indicate that surgery should be delayed for 1 to 2 weeks in patients with non-hemorrhagic strokes and 3 to 4 weeks in patients with hemorrhagic strokes. If patients have suffered from stroke, any anticoagulation increases the risk of hemorrhagic conversion, and if bleeding has already occurred, this risk further increases. Accordingly, the treatment team has to make a difficult decision whether anticoagulation should be withheld or decreased. Transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) play a major role in determining the size of vegetation, abscess and fistula formation, and severity of regurgitation during the pre- and intra-operative periods. Cerebral MRI/CT are also important to diagnose the severity of cerebral infarction or bleeding before and after surgery. The risk of IE patients with cerebral complication may change by the hour, so a solid heart team approach is mandatory to make a prompt diagnosis and determine the optimal timing for surgery.


Assuntos
Endocardite Bacteriana , Endocardite , Infarto Cerebral , Ecocardiografia , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos
8.
Pol Merkur Lekarski ; 48(287): 346-348, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130797

RESUMO

Peripheral arteries embolism can be located in various organs. It can be caused by many medical conditions, diagnosis and treatment of which allows to prevent further complications. A CASE REPORT: 26-year-old male patient was admitted to the Department of Internal Medicine, Hypertension and Vascular Diseases due to lasting over two months fatigue, recurrent pyrexia, weight loss and abdominal pain. Prior to that, he presented to physician several times. First time because of left foot pain with oedema and fever. USG revealed embolus in anterior tibial artery. Outpatient antibiotic, antithrombotic and anti-inflammatory treatment was given. The symptoms subsided, but appeared in other limb. After a while patient presented with pyrexia, fatigue, abdominal and lumbar region pain and melaena. CT showed infarction of spleen and left kidney. Once again outpatient treatment with amoxicillin with clavulanate was administered. Eventually, at admission to the clinic, infective endocarditis (IE) with dental origin was suspected. Echocardiography showed vegetation on bicuspid aortic valve, causing regurgitation. Blood culture was taken and empiric antimicrobial therapy with ampicillin, gentamicin and cloxacillin was administered. Blood culture was positive for Streptococcus sanguinis. Carious teeth were extracted, then the aortic valve replacement surgery was performed. Ampicillin was replaced with vancomycin, and gentamicin was continued. After the surgery, patient's condition improved. He was discharged on demand without completing antibiotic treatment, so he had follow-up appointment and IE prophylaxis recommended. CONCLUSIONS: Despite peripheral embolism is common manifestation of IE, this disease is relatively rare and not suspected in young people. The symptoms can be non-specific, what makes diagnosis challenging, as described in this case.


Assuntos
Embolia , Endocardite Bacteriana , Endocardite , Doenças das Valvas Cardíacas , Adolescente , Adulto , Antibacterianos/uso terapêutico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Febre/etiologia , Humanos , Masculino
9.
Rev. bras. oftalmol ; 79(5): 333-335, set.-out. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1137995

RESUMO

Abstract This report presents a rare case of endogenous endophthalmitis due to Kingella kingae infectious endocarditis. Endogenous endophthalmitis is a rare condition that has a systemic underlying cause, with hematogenic dissemination of a pathogen that will eventually reach and infect the eye. In this article, we present a case of a 54-year-old woman with fever, chills and decreased visual acuity and pain in the right eye. The slit-lamp exam showed conjunctival injection, anterior chamber reaction with a great amount of fibrinous material obscuring her visual axis. Ultrasound echography revealed profuse exudates and scarce membranous formation in the posterior segment. Blood culture was positive for Kingella kingae, and the patient was treated with intravenous ceftriaxone, along with topic dexamethasone and mydriatic. After 15 days of intravenous antibiotic therapy, the patient exhibited best visual acuity of 20/60. Endogenous endophthalmitis is an ocular emergency that demands quick diagnosis and aggressive intervention in order to preserve vision. Therefore, it is important to recognize its signs and symptoms with no retard.


Resumo O presente relato apresenta um raro caso de endoftalmite endógena por endocardite devido à Kingella kingae. Endoftalmite endógena é uma doença pouco comum com uma causa sistêmica subjacente. A disseminação hematogênica de um microrganismo infeccioso leva à infecção ocular. Nesse artigo, apresentamos o caso de uma mulher com 54 anos, febre, calafrios, baixa da acuidade visual e dor em olho direito. Ao exame na lâmpada de fenda apresentava injeção conjuntival, reação de câmara anterior e acúmulo de fibrina no eixo visual. Ultrassonografia revelou exsudatos profusos e escassa formação membranosa em segmento posterior.A hemocultura foi positiva para Kingella kingae e a paciente foi tratada com ceftriaxone venoso conjuntamente com dexametasona e midriático tópicos. Após 15 dias de terapia antibiótica endovenosa, a paciente apresentou acuidade visual corrigida de 20/60. Endoftalmite endógena é uma emergência ocular que demanda rápido diagnóstico e intervenção agressiva para preservar a visão. Portanto, é importante o reconhecimento precoce dos sinais e sintomas.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Ceftriaxona/uso terapêutico , Infecções Oculares Bacterianas/tratamento farmacológico , Endoftalmite/tratamento farmacológico , Endoftalmite/epidemiologia , Kingella kingae , Endocardite Bacteriana/complicações , Injeções Intravenosas
10.
Rev. esp. cardiol. (Ed. impr.) ; 73(9): 734-740, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197858

RESUMO

INTRODUCCIÓN Y OBJETIVOS: En endocarditis infecciosa (EI), la decisión quirúrgica es difícil. Un alto porcentaje de pacientes con indicación quirúrgica no son intervenidos. El objetivo fue evaluar el pronóstico a corto y largo plazo de los pacientes con indicación quirúrgica, comparando los que se sometieron a cirugía con los que no lo hicieron. MÉTODOS: Se incluyeron 271 pacientes con EI izquierda e indicación quirúrgica tratados en el centro desde 2003 a 2018. Ochenta y tres pacientes (31%) no fueron finalmente operados. El objetivo primario fue la mortalidad a 60 días y el secundario desde el día 61 a los 3 años de seguimiento. Se realizó regresión de Cox multivariable y emparejamiento por puntuación de propensión. RESULTADOS: A los 60 días, 40 (21,3%) pacientes operados y 53 (63,9%) pacientes no intervenidos fallecieron (p <0,001). El riesgo de mortalidad a 60 días fue superior en los pacientes no intervenidos (HR = 3,59; IC95%, 2,16-5,96; p <0,001). La ausencia de diagnóstico microbiológico, la insuficiencia cardiaca, el shock y el bloqueo auriculoventricular fueron otros predictores independientes del objetivo primario. Del día 61 a los 3 años del seguimiento no hubo diferencias significativas del riesgo de muerte entre el grupo operado y los no intervenidos (HR = 1,89; IC95%, 0,68-5,19; p = 0,220). Las variables independientes asociadas con el objetivo secundario fueron los antecedentes de EI, diabetes mellitus y el índice de Charlson. Los resultados fueron consistentes tras el emparejamiento por puntuación de propensión. CONCLUSIONES: Dos tercios de los pacientes con indicación quirúrgica no intervenidos fallecieron antes de 60 días. Entre los supervivientes, la mortalidad a largo plazo depende más de factores relacionados con comorbilidad previa que del tratamiento recibido durante el ingreso


INTRODUCTION AND OBJECTIVES: In infective endocarditis (IE), decisions on surgical interventions are challenging and a high percentage of patients with surgical indication do not undergo these procedures. This study aimed to evaluate the short- and long-term prognosis of patients with surgical indication, comparing those who underwent surgery with those who did not. METHODS: We included 271 patients with left-sided IE treated at our institution from 2003 to 2018 and with an indication for surgery. There were 83 (31%) surgery-indicated not undergoing surgery patients with left-sided infective endocarditis (SINUS-LSIE). The primary outcome was all-cause death by day 60 and the secondary outcome was all-cause death from day 61 to 3 years of follow-up. Multivariable Cox regression and propensity score matching were used for the analysis. RESULTS: At the 60-day follow-up, 40 (21.3%) surgically-treated patients and 53 (63.9%) SINUS-LSIE patients died (P <.001). Risk of 60-day mortality was higher in SINUS-LSIE patients (HR, 3.59; 95%CI, 2.16-5.96; P <.001). Other independent predictors of the primary endpoint were unknown etiology, heart failure, atrioventricular block, and shock. From day 61 to the 3-year follow-up, there were no significant differences in the risk of death between surgically-treated and SINUS-LSIE patients (HR, 1.89; 95%CI, 0.68-5.19; P=.220). Results were consistent after propensity score matching. Independent variables associated with the secondary endpoint were previous IE, diabetes mellitus, and Charlson index. CONCLUSIONS: Two-thirds of SINUS-LSIE patients died within 60 days. Among survivors, the long-term mortality depends more on host conditions than on the treatment received during admission


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Endocardite Bacteriana/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Infecções Relacionadas à Prótese/mortalidade , Endocardite Bacteriana/complicações , Efeitos Adversos de Longa Duração/epidemiologia , Prognóstico , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos
11.
Rev. esp. cardiol. (Ed. impr.) ; 73(9): 711-717, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197855

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El objetivo del estudio fue determinar la prevalencia de patología colorrectal en los pacientes con endocarditis infecciosa por Enterococcus faecalis (EIEF). MÉTODOS: Se realizó un estudio observacional, retrospectivo y multicéntrico en 4 hospitales de referencia. Se incluyeron todos los episodios consecutivos de EIEF definitivas en adultos desde el momento en que se empezó a realizar una colonoscopia por protocolo en cada centro participante hasta octubre de 2018. Se recogieron los hallazgos endoscópicos de patología colorrectal potencialmente causante de una bacteriemia. RESULTADOS: Se incluyeron 103 pacientes con EIEF; 83 (81%) eran varones, la edad mediana era 76 [rango intercuartílico, 67-82] años, y la mediana del índice de Charlson ajustado por edad fue 5 [rango intercuartílico, 4-7]. El presunto origen de la infección fue desconocido en 63 (61%), urinario en 20 (19%), digestivo en 13 (13%), bacteriemia de catéter en 5 (5%), y otros en 2 (2%). En 78 (76%) pacientes se realizó una colonoscopia, y en 47 (60%) había hallazgos endoscópicos que indicaban un potencial foco de bacteriemia. Treinta y nueve (83%) tenían una enfermedad colorrectal neoplásica, y 8 (17%) no neoplásica. De los 45 pacientes con puerta de entrada desconocida y colonoscopia, un posible origen gastrointestinal se identificó en 64%. En el subgrupo de 25 con foco de entrada conocido y colonoscopia, excluyendo aquellos con enfermedad colorrectal ya previamente diagnosticada, 44% tenían patología colorrectal. CONCLUSIONES: Realizar una colonoscopia en la EIEF, sin tener en cuenta la puerta de entrada, puede ayudar a diagnosticar la enfermedad colorrectal en estos pacientes y evitar una nueva bacteriemia (y eventualmente endocarditis infecciosa) por el mismo u otro microorganismo


INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the prevalence of colorectal disease in Enterococcus faecalis infective endocarditis (EFIE) patients. METHODS: An observational, retrospective, multicenter study was performed at 4 referral centers. From the moment that a colonoscopy was systematically performed in EFIE in each participating hospital until October 2018, we included all consecutive episodes of definite EFIE in adult patients. The outcome was an endoscopic finding of colorectal disease potentially causing bacteremia. RESULTS: A total of 103 patients with EFIE were included; 83 (81%) were male, the median age was 76 [interquartile range 67-82] years, and the median age-adjusted Charlson comorbidity index was 5 [interquartile range, 4-7]. The presumed sources of infection were unknown in 63 (61%), urinary in 20 (19%), gastrointestinal in 13 (13%), catheter-related bacteremia in 5 (5%), and others in 2 (2%). Seventy-eight patients (76%) underwent a colonoscopy, and 47 (60%) had endoscopic findings indicating a potential source of bacteremia. Thirty-nine patients (83%) had a colorectal neoplastic disease, and 8 (17%) a nonneoplastic disease. Of the 45 with an unknown portal of entry who underwent a colonoscopy, gastrointestinal origin was identified in 64%. In the subgroup of 25 patients with a known source of infection and a colonoscopy, excluding those with previously diagnosed colorectal disease, 44% had colorectal disease. CONCLUSIONS: Performing a colonoscopy in all EFIE patients, irrespective of the presumed source of infection, could be helpful to diagnose colorectal disease in these patients and to avoid a new bacteremia episode (and eventually infective endocarditis) by the same or a different microorganism


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/epidemiologia , Endocardite Bacteriana/complicações , Enterococcus faecalis/patogenicidade , Estudos Retrospectivos , Endocardite Bacteriana/microbiologia , Bacteriemia/complicações , Colonoscopia/métodos
12.
Am J Trop Med Hyg ; 103(4): 1435-1438, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32748780

RESUMO

Acute Q fever is usually asymptomatic or is associated with a mild self-limited course and a favorable outcome. The occurrence of endocarditis during acute infection by Coxiella burnetii is an emerging clinical entity observed in adults that has been attributed to an autoimmune complication of early infection. Herein, we report the first case of a previously healthy 2-year-old child with endocarditis complicated by septic embolic stroke, in which the identified microbiological evidence was suggestive of acute rather than chronic C. burnetii infection. The development of endocarditis in this case occurred in the absence of any autoimmune reaction, but in the context of a very mild form of congenital heart disease, a small ventricular septal defect, which might serve as a predisposing factor for endocarditis. This case suggests that acute Q fever endocarditis may affect children as well and can be attributed not only to autoimmune mechanisms but also to a potential effect of the infectious agent per se on the cardiac endothelium in patients with underlying heart defects, regardless of their severity.


Assuntos
Coxiella burnetii/isolamento & purificação , Endocardite Bacteriana/complicações , Febre Q/patologia , Acidente Vascular Cerebral/etiologia , Doença Aguda , Causalidade , Pré-Escolar , Anormalidades Congênitas , Comunicação Interventricular , Humanos , Febre Q/microbiologia
13.
J Card Surg ; 35(10): 2829-2831, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678968

RESUMO

BACKGROUND: Surgery for failed homograft aortic root replacement with extensive calcification in the setting of endocarditis alone is very challenging. CASE SUMMARY: We report the case of redo aortic valve replacement and mitral valve replacement, in a 39 years old presenting with a rare Streptococcus constellatus endocarditis of a previously implanted homograft root and native mitral valve, where conventional valve replacement proved nonfeasible. S. constellatus had caused severe tissue destruction and the extensive calcification in the homograft prevented conventional valve replacement with sutures. In this case, a sutureless valve provided a useful alternative surgical strategy. DISCUSSION: We consider heavily calcified failed homografts to be a good indication for sutureless (rapid deployment) valves.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Endocardite Bacteriana/complicações , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Desenho de Prótese , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estreptocócicas/cirurgia , Streptococcus constellatus , Procedimentos Cirúrgicos sem Sutura/métodos , Adulto , Aloenxertos , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
14.
J Cardiothorac Surg ; 15(1): 135, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522279

RESUMO

BACKGROUND: The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with in-hospital mortality. METHODS: A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included. RESULTS: A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy. CONCLUSIONS: Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.


Assuntos
Endocardite Bacteriana/microbiologia , Mortalidade Hospitalar , Infecções Estreptocócicas/complicações , Estreptococos Viridans , Adulto , Fatores Etários , Idoso , China/epidemiologia , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Centros de Atenção Terciária
15.
J Card Surg ; 35(7): 1717-1720, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32598498

RESUMO

We present a 57-year-old man with recent Streptococcus viridans endocarditis on mitral and aortic valves who had a mycotic aneurysm of the left anterior descending (LAD) coronary artery and associated superior mesenteric and cerebral artery aneurysms. The patient had preoperative renal failure and the infection was controlled with ceftriaxone. Mitral and aortic valve replacement were performed using tissue valves and the LAD aortic aneurysm was ligated and the patient had saphenous venous graft to the LAD. The postoperative course was complicated by pleural effusion and the patient had antibiotic therapy for 6 weeks postoperatively.


Assuntos
Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Veia Safena/transplante , Infecções Estreptocócicas , Resultado do Tratamento , Estreptococos Viridans
16.
Kyobu Geka ; 73(2): 135-137, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393723

RESUMO

A 52-year-old woman with mitral valve insufficiency and congestive heart failure due to infective endocarditis was treated by mitral valve replacement with a mechanical valve. Warfarin was started on postoperative day (POD) 3, but sudden onset of anemia with left abdominal pain presented on POD 8. Abdominal apoplexy was diagnosed by computed tomography (CT) and ultrasonographic imaging, but active bleeding was not evident. She was hemodynamically stable and her prothrombin time-international normalized ratio(PT-INR) at that time was 1.70 (compared with 2.56 on POD 7). To avoid repeated bleeding, PT-INR was controlled at around 1.5. Other complications did not arise, and thereafter her postoperative course was favorable.


Assuntos
Endocardite Bacteriana , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Endocardite Bacteriana/complicações , Feminino , Humanos , Coeficiente Internacional Normatizado , Pessoa de Meia-Idade , Valva Mitral , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Acidente Vascular Cerebral
19.
JAAPA ; 33(5): 1-4, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32345952

RESUMO

A patient who presented after falling out of bed had signs of right-sided stroke, which, after imaging, was suspicious for embolism with cardiac origin. Further investigation revealed a large aortic valve vegetation with mild aortic insufficiency, and the patient eventually developed heart failure requiring surgical intervention. Infective endocarditis is slowly becoming more prevalent, and clinicians should have a high index of suspicion when patients present with common complications of this disease, such as valvular dysfunction, heart failure, or stroke. Early diagnosis has been shown to reduce time to appropriate antibiotic treatment and definitive care, which can lead to better outcomes.


Assuntos
Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Infecções Estreptocócicas , Streptococcus agalactiae , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Doença das Coronárias/etiologia , Ecocardiografia , Embolia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/terapia , Evolução Fatal , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X
20.
JAMA Netw Open ; 3(4): e202401, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32271391

RESUMO

Importance: Echocardiography to detect infective endocarditis is regarded as a key quality indicator in the care of patients with Staphylococcus aureus bacteremia, but its application varies markedly between reported series. Understanding the reasons for this variation in practice is important to improve the use of this investigation. Objective: To identify expert clinicians' preferred echocardiography strategy for a variety of S aureus bacteremia scenarios in a hypothetical setting free from extrinsic constraints. Design, Setting, and Participants: Anonymous web-based survey study comprising 50 text-based scenarios describing patients with S aureus bacteremia and various combinations of risk factors for endocarditis. Other variables included patient age and the presence of an extracardiac focus of infection warranting prolonged treatment. The survey was emailed to participants between September 2018 and March 2019. Each respondent was asked to recommend 1 of 6 echocardiography strategies for up to 8 randomly selected scenarios. Respondents were primarily infectious diseases physicians, and more than half reported an annual caseload of more than 20 cases of S aureus bacteremia. Main Outcomes and Measures: The proportion of respondents selecting each of the 6 echocardiography strategies was calculated alongside Wilson score confidence intervals. Modified Fleiss κ statistics were used to described interrespondent variability. Generalized estimating equations were used to assess the associations between respondent- and scenario-level variables and the recommendation of an echocardiography strategy with a low negative likelihood ratio for infective endocarditis (ie, a highly exclusionary strategy). Results: A total of 656 respondents from 24 countries provided 4837 echocardiography recommendations across the 50 scenarios. Echocardiography recommendations were associated with scenarios' burden of endocarditis risk (multivariate odds ratio per point of the VIRSTA score, 1.4; 95% CI, 1.4-1.5; P < .001). Poor interrespondent agreement was seen across all scenarios (modified Fleiss κ, 0.06; 95% CI, 0.05-0.07) but was most notable for scenarios with a lower risk of endocarditis (modified Fleiss κ, 0.04; 95% CI, 0.03-0.05). The presence of an extracardiac focus of infection was also associated with the choice of echocardiography strategy (odds ratio for highly exclusionary strategy, 0.51; 95% CI, 0.45-0.58). Respondent location in continental Europe was associated with recommendations in favor of a highly exclusionary strategy (odds ratio, 1.8; 95% CI, 1.3-2.5) compared with location in Australia or New Zealand. Conclusions and Relevance: In this study, expert clinicians demonstrated active stratification by risk of endocarditis when making echocardiography recommendations for hypothetical patients with S aureus bacteremia. Substantial disagreement existed as to whether patients at lower risk of endocarditis should undergo transesophageal echocardiography-based echocardiography strategies.


Assuntos
Bacteriemia/complicações , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Infecções Estafilocócicas/complicações , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Humanos , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fatores de Risco , Staphylococcus aureus , Inquéritos e Questionários
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