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1.
Rev Med Liege ; 75(2): 94-99, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030933

RESUMO

Infectious endocarditis is a rare pathology whose mortality is high and whose diagnosis is still difficult by the usual clinical, biological and ultrasound tools. We report the case of a patient, drug addict, suffering from an infectious endocarditis of the aortic valve at Streptococcus agalactiae. This germ is rarely at the origin of cardiac infection but it is responsible for quickly destructive lesion by its pathophysiological mechanisms. In this case, the infection unfortunately caused the death of the patient.


Assuntos
Endocardite Bacteriana , Infecções Estreptocócicas , Streptococcus agalactiae , Valva Aórtica , Endocardite Bacteriana/diagnóstico , Humanos , Infecções Estreptocócicas/diagnóstico
2.
Medicine (Baltimore) ; 98(51): e18270, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860973

RESUMO

RATIONAL: Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium. PATIENT CONCERNS: A 53-years-old man with a history of alcohol abuse was admitted in hospital for fever, paroxysmal atrial fibrillation cardioverted by Amiodarone and pulmonary infection. DIAGNOSIS: A case of recurrent severe endocarditis, with neurological complications both ischemic and hemorrhagic and heart failure caused by Streptococcus agalactiae in healthy man we reported. INTERVENTIONS: Surgery was performed 2 weeks after admission. OUTCOMES: The onset of intracranial hemorrhage delayed second cardiac surgery and the patient died because of end-stage heart failure. CONCLUSIONS: Infective endocarditis caused by S. agalactiae is very rare, particularly in patients without underlying structural heart disease. This study showed that IE due to S. Agalactiae is a disease with high mortality when associated with neurological complication, heart failure but especially when it is recurrent and hits valve prosthesis.


Assuntos
Alcoolismo/complicações , Endocardite Bacteriana/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus agalactiae , Alcoolismo/microbiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia
3.
BMC Infect Dis ; 19(1): 957, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31707976

RESUMO

BACKGROUND: Patients with multiple myeloma (MM) are known to be immune incompetent and experience higher incidences of infectious diseases. However, infective endocarditis (IE) is rarely observed in patients with MM and Morganella morganii (M. morganii) has rarely been associated with IE. CASE PRESENTATION: A 72-year-old female receiving 4th line treatment for MM presented with fever and concomitant confusion. Urinary culture revealed growth of Escherichia coli, wherefore broadspectrum penicillin and high-dose corticosteroids were initiated. However, blood cultures showed growth of M. morganii. Fluoroquinolone was added due to penicillin-resistance of the Morganella species. Two days after admission, the patient acutely deteriorated with hemodynamic instability. Gentamicin and high dose corticosteroids were added. Echocardiography showed marked aortic valve vegetation with severe aortic valve regurgitation, leading to the diagnosis of bacterial endocarditis of the native aortic valve. Shortly after diagnosis, the patient died. At autopsy, vegetation with gram-negative rods in the native aortic valve was observed, confirming the diagnosis of M. morganii-endocarditis. Additional staining for amyloid confirmed advanced light-chain (AL) amyloidosis with extensive amyloid depositions of the aortic valve and valvular damage as complications of her MM. CONCLUSIONS: Our case suggests that IE with M. morganii was facilitated by the combination of the cardiac amyloidosis with valvular impairment and the profound immune deficiency caused by the several chemo-immunomodulatory treatment lines and the MM itself. This case further illustrates that awareness for rare opportunistic infections in an era with growing potential of combined chemoimmunotherapy is warranted.


Assuntos
Endocardite Bacteriana/diagnóstico , Morganella morganii/isolamento & purificação , Mieloma Múltiplo/patologia , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Mieloma Múltiplo/complicações
4.
Tex Heart Inst J ; 46(3): 215-218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708707

RESUMO

Infected cardiac myxomas are rare and can have disastrous sequelae; urgent surgical resection is typically indicated. We report the case of a 43-year-old user of intravenous heroin who presented with weakness and dyspnea. He was diagnosed with infective endocarditis of a myxoma attached to the left ventricular lateral wall. The patient underwent successful surgical resection of the myxoma and then completed 4 weeks of antibiotic therapy. In addition to discussing this patient's case, we briefly review the relevant medical literature, in which we found only 4 previous reports of left ventricular myxoma associated with infective endocarditis.


Assuntos
Endocardite Bacteriana/etiologia , Neoplasias Cardíacas/complicações , Dependência de Heroína/complicações , Mixoma/complicações , Infecções Estafilocócicas/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Mixoma/diagnóstico , Mixoma/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
5.
Bratisl Lek Listy ; 120(7): 510-515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31602986

RESUMO

PURPOSE: Early identification of specific patient subgroups at high risk of developing life-threatening infective endocarditis (IE) complications is of paramount importance. Better stratification may allow more intensive treatment of these patients and positively influences clinical outcomes. METHODS: We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p<0.0001). Valve prolapse/perforation during IE episodes was significantly associated with mitral valve IE (OR 2.136, p=0.026) and vegetation length (OR 1.055, p=0.009). Septic shock was significantly related to two main risk factors: S. aureus infection (OR 8.459, p=<0.0001) and smoking (OR 8.403, p=0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p=0.001), followed by S. aureus infection (OR 3.59, p=0.002). Finally, septic shock (OR 6.000, p=0.001) represented the most important risk factor of in-hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left-sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).


Assuntos
Endocardite Bacteriana/complicações , República Tcheca , Endocardite Bacteriana/diagnóstico , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/complicações , Fumar , Infecções Estafilocócicas/complicações , Staphylococcus aureus
6.
BMC Infect Dis ; 19(1): 816, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533642

RESUMO

BACKGROUND: Cellulosimicrobium species, formely known as Oerskovia species, are gram-positive bacilli belonging to the order Actinomycetales. They rarely cause human infections. The genus comprises two pathogenic species in humans: C. cellulans and C. funkei. Based on a case report, we provide a review of the literature of infections caused by Cellulosimicrobium/Oerskovia, in order to improve our knowledge of this unusual infection. CASE PRESENTATION: An 82-year-old woman with aortic prosthetic valve presented to the hospital with fever and heart failure. Further work up revealed the diagnosis of C. cellulans infective endocarditis (IE). The strain was identified by MALDI-TOF MS, API Coryne and 16S rRNA sequencing. The patient was deemed not to be an operative candidate and died despite the antibiotic therapy 35 days after admission. CONCLUSIONS: Reviewing cases of Cellulosimicrobium species infections and communicating the successful and unsuccessful clinical experiences can assist future healthcare providers. Our case and those previously reported indicate that Cellulosimicrobium species usually infect immunocompromised patients or foreign body carriers. The most frequent pattern of infection is central venous catheter related bacteremia. The optimal treatment should include foreign body removal and valve surgery should be considered in case of IE.


Assuntos
Infecções por Actinomycetales/diagnóstico , Actinomycetales/isolamento & purificação , Actinomycetales/efeitos dos fármacos , Actinomycetales/genética , Infecções por Actinomycetales/complicações , Infecções por Actinomycetales/tratamento farmacológico , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 16S/química , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
7.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444523

RESUMO

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/tratamento farmacológico , Adulto , Comorbidade , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Incidência , Micoses/diagnóstico , Micoses/epidemiologia
8.
Congenit Heart Dis ; 14(4): 671-677, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31368237

RESUMO

BACKGROUND: Since routine clinical use of antibiotics as well as surgical and catheter-based closure of a patent arterial duct (PDA), PDA-associated infective endarteritis (PDA-IE) is rare but can still occur when the ductus is still open or as it closes. Thus, clinicians should maintain a high index of concern for patients with unexplained fever. METHODS: We report on a PDA-IE in a young infant shortly after potentially delayed obliteration of a PDA. We discuss this case report by reviewing the literature in regard to the pathogenesis (infection primary or secondary to PDA thrombus formation), clinical (new heart murmur) and diagnostic findings (transthoracic echocardiography, total body MRI, laboratory findings), and clinical outcome during mid-term follow-up after successful antibiotic treatment. RESULTS: A 7-week-old term infant with Staphylococcus aureus sepsis and a new heart murmur was diagnosed with PDA-IE by transthoracic echocardiography at the pulmonary artery end of an obliterated PDA. Broad diagnostic workup excluded other reasons for sepsis. After 4 weeks of antibiotic treatment the vegetation reduced in size and the infant recovered completely. A review of all cases of PDA-IE (in pediatric and adult patients) previously published was performed. CONCLUSION: Nowadays, a PDA-IE is an extremely rare, but still life-threating condition that may even affect patients with a nonpatent ductus arteriosus shortly after its obliteration and should be considered as infective complication in preterms, neonates, and small infants. Therefore, in septic neonates with bacteremia, transthoracic echocardiography may be integrated in the diagnostic workup, especially by fever without source and clinical signs of IE such as a new heart murmur.


Assuntos
Permeabilidade do Canal Arterial/complicações , Endocardite Bacteriana/etiologia , Infecções Estafilocócicas/etiologia , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia Doppler , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Seguimentos , Humanos , Lactente , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
9.
Int J Infect Dis ; 88: 21-26, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382048

RESUMO

BACKGROUND: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Cardiopatias/cirurgia , Febre Q/complicações , Adolescente , Adulto , Criança , Doxiciclina/uso terapêutico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Cardiopatias/congênito , Humanos , Hidroxicloroquina/uso terapêutico , Veias Jugulares/cirurgia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Febre Q/diagnóstico , Febre Q/epidemiologia , Febre Q/microbiologia , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
11.
Pan Afr Med J ; 32: 134, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303907

RESUMO

This study reports the case of a 3-year old female child with a 1-year history of rash manifesting as discoid plaques with pink, non-itchy, rounded and oval, polycyclic, confluent macular areas measuring 1-3 cm in diameter, with central clearing evolving in stages, with repeated regression and reappearance. The child was admitted to the Emergency Department with respiratory distress, fever and aggravation of pre-existing skin lesions becoming diffuse. Mitral holosystolic murmur with an intensity of grade 4/6 was recorded by cardiac auscultation. Cardiac ultrasound showed acute massive mitral insufficiency with valvular vegetations. Laboratory tests showed inflammation with a CRP level of 300 mg/l and a sedimentation rate of 60 mm in the first hour and ASLO levels were very high (1600 IU/ml). The diagnosis of infectious endocarditis due to valvular rheumatic heart disease was retained. After stabilization, antibiotic therapy and mitral valve surgery in emergency, the dermatological lesions regressed in a few days but the haemodynamic condition of the child deteriorated rapidly with sudden death. Besnier erythema is a rare cutaneous manifestation of acute articular rhumatism. Physicians should not neglect this rare but useful clinical sign, especially in patients with subclinical valvular involvement in order to avoid potential late cardiac complications. The three differential diagnoses included: ringworm, urticaria, and erythema due to hereditary angioedema.


Assuntos
Endocardite Bacteriana/diagnóstico , Eritema/etiologia , Inflamação/diagnóstico , Cardiopatia Reumática/diagnóstico , Proteína C-Reativa/metabolismo , Pré-Escolar , Diagnóstico Diferencial , Endocardite Bacteriana/etiologia , Eritema/patologia , Feminino , Humanos , Inflamação/etiologia , Cardiopatia Reumática/complicações
12.
Pan Afr Med J ; 32: 157, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303927

RESUMO

Infectious endocarditis is regarded as a potentially serious pathology despite the advances in diagnostic and treatment options. Valves on the left side of the heart are most affected and embolic events, mycotic aneurysms, abscesses as well as valve perforations are life-threatening consequences of this disease. We here report a case of endocarditis with aortic and mitral valve involvement complicated by splenic and renal infarction, cerebral mycotic aneurysm and mitral valve perforation. The interest in the subject of this case study is the positive medico-surgical treatment outcome obtained despite a multitude of complications.


Assuntos
Valva Aórtica/microbiologia , Endocardite Bacteriana/diagnóstico , Aneurisma Cardíaco/diagnóstico , Valva Mitral/microbiologia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Valva Aórtica/patologia , Endocardite Bacteriana/microbiologia , Aneurisma Cardíaco/microbiologia , Humanos , Masculino , Valva Mitral/patologia , Infarto do Baço/diagnóstico
14.
Medicine (Baltimore) ; 98(24): e15961, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192934

RESUMO

INTRODUCTION: Right-sided native endocarditis is a difficult case with fewer cardiac symptoms and fewer classic signs of cutaneous vascular lesions compared with left-sided endocarditis. PATIENT CONCERNS: A 68-year-old Taiwanese man with a history of gouty arthritis, hyperlipidemia, and adrenal insufficiency presented to our ED and complained dyspnea and low back pain for 1 month. DIAGNOSIS ASSESSMENT: The PE showed bilateral crackles on chest auscultation and a palpable fluctuant mass over the anterior chest wall. The chest and abdominal CT scan showed multiple abscess formations involving pulmonary, sternal, and paraspinal areas. The TEE being performed and an oscillating mass over the anterior and septal leaflets of the tricuspid valve and moderate tricuspid regurgitation. INTERVENTIONS: Only pharmacologic treatment without surgical interventions. OUTCOMES: Deceased, patient expired on day 4 after ED visit. CONCLUSION: This case arose as a sequela of staphylococcal endocarditis associated with persistent bacteremia and immunological dysregulation. The diagnosis of right-sided endocarditis is easily missing, multidisciplinary approach should be triggered as soon as possible, which might lead to a better outcome. Right-sided IE is still an important public health issue in southern Taiwan.


Assuntos
Abscesso/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico , Valva Tricúspide/diagnóstico por imagem , Abscesso/etiologia , Idoso , Ecocardiografia Transesofagiana , Evolução Fatal , Humanos , Masculino , Taiwan
15.
J Invasive Cardiol ; 31(6): E148-E153, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158811

RESUMO

Treatment of acute coronary syndromes secondary to septic coronary valvular embolism in endocarditis patients remains unclear. Several revascularization strategies have been described, including thromboaspiration, stent implantation, balloon angioplasty, and surgical intervention. We herein present an illustration of an atypical case of an acute coronary syndrome related to a coronary bifurcation occlusion due to a septic embolism in a patient presenting with infective endocarditis. We also summarized previous similar cases and their management.


Assuntos
Síndrome Coronariana Aguda/etiologia , Embolia/complicações , Endocardite Bacteriana/complicações , Revascularização Miocárdica/métodos , Sepse/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Embolia/diagnóstico , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/normas , Sepse/diagnóstico
17.
Rev Soc Bras Med Trop ; 52: e2018375, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31188916

RESUMO

INTRODUCTION: Infective endocarditis (IE) is a systemic infectious disease requiring a multidisciplinary team for treatment. This study presents the epidemiological and clinical data of 73 cases of IE in Rio de Janeiro, Brazil. METHODS: This observational prospective cohort study of endocarditis patients during an eight-year study period described 73 episodes of IE in 70 patients (three had IE twice). Community-associated (CAIE) and healthcare-acquired infective endocarditis (HAIE) were diagnosed according to the modified Duke criteria. The collected data included demographic, epidemiologic, and clinical characteristics, including results of blood cultures, echocardiographic findings, surgical interventions, and outcome. RESULTS: Analysis of data from the eight-year study period and 73 cases (70 patients) of IE showed a mean age of 46 years (SD=2.5 years; 1-84 years) and that 65.7% were male patients. The prevalence of CAIE and HAIE was 32.9% and 67.1%, respectively. Staphylococcus aureus (30.1%), Enterococcus spp. (19.1%), and Streptococcus spp. (15.0%) were the prevalent microorganisms. The relevant signals and symptoms were fever (97.2%; mean 38.6 + 0.05°C) and heart murmur (87.6%). Vegetations were observed in the mitral (41.1%) and aortic (27.4%) valves. The mortality rate of the cases was 47.9%. CONCLUSIONS: In multivariate analysis, chronic renal failure (relative risk [RR]= 1.60; 95% confidence interval [CI] 1.01-2.55), septic shock (RR= 2.19; 95% CI 1.499-3.22), and age over 60 years (RR= 2.28; 95% CI 1.44-3.59) were indirectly associated with in-hospital mortality. The best prognosis was related to the performance of cardiovascular surgery (hazard ratio [HR]= 0.51; 95% CI 0.26-0.99).


Assuntos
Endocardite Bacteriana/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Estafilocócicas , Staphylococcus aureus/isolamento & purificação , Centros de Atenção Terciária , Adulto Jovem
18.
Rev Cardiovasc Med ; 20(1): 35-39, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-31184094

RESUMO

Coronary artery septic embolization is a rare, but severe complication of infective endocarditis involving the leftside of the valves. The first case mentioned in the literature was a postmortem finding of a left anterior descending coronary artery occlusion by a vegetation fragment. Since this case, there have been several therapeutic strategies published with this clinical setting including medical treatment, percutaneous coronary angioplasty addressing coronary occlusion, surgical intervention for both the infected valve and coronary embolization, and hybrid procedures with transcatheter septic embolus aspiration followed by surgical valvular interventions. Out of the three interventions mentioned, the latter provided the best results and was in concordance with results observed in a case of mitral valve infected endocarditis complicated with acute occlusion of the left anterior descending coronary artery in patient whose comorbidities included hypertrophic obstructive cardiomyopathy. A transcatheter left anterior descending coronary artery embolus aspiration was performed , followed by a surgical mitral valve replacement and septal myectomy with an uneventful postoperative course. Although rare, this severe complication of infective endocarditis has a specific clinical course and therapeutic strategy, and in our opinion, it could be mentioned as a separate entity among embolic complications of infective endocarditis in future guidelines. Previously published cases suggest that the hybrid intervention might be the therapy of choice for this clinical setting; however, larger studies are necessary for confirmation.


Assuntos
Oclusão Coronária/microbiologia , Embolia/microbiologia , Endocardite Bacteriana/microbiologia , Valva Mitral/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Cateterismo Cardíaco , Oclusão Coronária/diagnóstico , Oclusão Coronária/terapia , Embolia/diagnóstico , Embolia/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Sucção , Resultado do Tratamento
19.
Am J Health Syst Pharm ; 76(14): 1033-1036, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31201773

RESUMO

PURPOSE: A case report of the use of linezolid and daptomycin for the treatment of multidrug-resistant right-sided infective endocarditis is presented. SUMMARY: A 36-year-old patient with a history of intravenous drug use was hospitalized for treatment of native tricuspid valve endocarditis resulting in persistent methicillin-resistant Staphylococcus aureus bacteremia. During the admission the patient was unsuccessfully treated with vancomycin monotherapy (final E-test minimum inhibitory concentration, 4 µg/mL). The patient's treatment was switched to daptomycin and gentamicin, with no improvement in blood culture results over 4 days. Gentamicin was discontinued, and linezolid was administered in combination with daptomycin; bacteremia was cleared after 13 days of linezolid and daptomycin combination therapy. Due to daptomycin resistance (minimum inhibitory concentration, 4 µg/mL), gentamicin was substituted for daptomycin due to the former agent's synergistic effects with linezolid. After 23 days of therapy the patient was transferred to another facility for a tricuspid valve replacement procedure, which was completed without complications. The patient was transferred in stable condition to a skilled nursing facility to continue antibiotic therapy lasting 6 weeks from the date of surgery. The patient's blood cultures remained negative. CONCLUSION: A 36-year-old woman with resistant tricuspid valve endocarditis was successfully treated with linezolid in combination with daptomycin.


Assuntos
Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Linezolida/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Antibacterianos/farmacologia , Daptomicina/farmacologia , Farmacorresistência Bacteriana Múltipla , Substituição de Medicamentos , Sinergismo Farmacológico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Gentamicinas/farmacologia , Gentamicinas/uso terapêutico , Humanos , Linezolida/farmacologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Valva Tricúspide/microbiologia , Vancomicina/farmacologia , Vancomicina/uso terapêutico
20.
J Stroke Cerebrovasc Dis ; 28(8): e123-e125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230823

RESUMO

Ischemic stroke is one of the most common complications of infective endocarditis (IE). IE must be considered as one of the causes of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), but early diagnosis of IE is difficult. AIS with ELVO must be treated using endovascular thrombectomy (EVT), with or without intravenous thrombolysis (IVT). IVT for AIS due to IE is not well established and remains controversial because of the risk of intracranial hemorrhage. A 42-year-old man suffered from right hemiparesis and disorientation, and AIS with ELVO was diagnosed. EVT with IVT was successfully performed and recanalization was achieved, but catastrophic multiple cerebral microbleeds appeared after treatment. EVT without IVT could be chosen for AIS caused by IE to avoid hemorrhagic complications. Hypointense signal spots on T2*-weighted magnetic resonance imaging (MRI) and susceptibility-weighted MRI could facilitate early diagnosis of IE.


Assuntos
Isquemia Encefálica/terapia , Endocardite Bacteriana/complicações , Procedimentos Endovasculares/efeitos adversos , Hemorragias Intracranianas/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Endocardite Bacteriana/diagnóstico , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
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