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1.
Kyobu Geka ; 74(11): 950-953, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34601480

RESUMO

Isolated pulmonary valve infective endocarditis is rare and accounts for only 1.5% to 2.0% of all cases of infective endocarditis. We present a case of isolated pulmonary valve endocarditis, which was successfully treated by pulmonary valve replacement. A 69-year-old man presented with fever and was diagnosed with active pulmonary valve infective endocarditis. He had no apparent predisposing factors. Blood cultures were positive for Streptococcus viridans, and transesophageal echocardiography showed mobile vegetation. His condition improved transiently with intravenous antibiotic therapy;however, high fever and reduced oxygen saturation recurred. Computed tomography showed multiple infiltrative shadows suggesting septic pulmonary embolisms. Urgent surgery was indicated because antibiotic treatment was ineffective. During the operation, we found that vegetation had destroyed all pulmonary leaflets. We performed pulmonary valve replacement with a stented bioprosthetic valve as well as enlargement of the right ventricular outflow tract with a bovine pericardial patch. The postoperative course was uneventful. Antibiotic therapy was continued for six weeks after surgery. For two years since surgery, the patient has experienced no recurrence of infection.


Assuntos
Endocardite Bacteriana , Endocardite , Embolia Pulmonar , Valva Pulmonar , Idoso , Animais , Bovinos , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia
2.
Am J Case Rep ; 22: e932387, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625525

RESUMO

BACKGROUND Infective endocarditis (IE) is an infectious disease that occurs in valves, centered on the endocardium and ventricular septal defects. It is a serious disease that is easily misdiagnosed and has a high mortality rate if left untreated. Edwardsiella tarda is an extremely rare cause of IE, especially in young and non-immunocompromised hosts. CASE REPORT A woman in her 20s presented to our hospital with fever of unknown cause and liver dysfunction. She was admitted to the Department of Gastroenterological Medicine owing to suspicion of gastrointestinal infection. Gastrointestinal examination, including contrast-enhanced computer tomography and endoscopic ultrasonography, was performed; however, there were no significant findings. Liver dysfunction improved spontaneously, but her fever did not improve with antibiotic treatment. Transthoracic echocardiography was performed on day 9 of hospitalization because E. tarda was detected in a blood culture test, revealing vegetation at the mitral valve. Asymptomatic cerebral infarction was shown by brain magnetic resonance imaging, and mitral valvuloplasty was performed on day 14. After surgery, transthoracic echocardiography was performed on day 22, showing no vegetation or mitral regurgitation. However, postoperative transesophageal ultrasonography performed on day 29 revealed severe mitral regurgitation. Redo mitral valvuloplasty was performed on day 38. She clinically improved and was discharged on day 67. CONCLUSIONS This is the first case in which E. tarda was diagnosed as the causative agent of IE on a native valve in a young and non-immunocompromised host. Aggressive source control resulted in a good clinical outcome.


Assuntos
Endocardite Bacteriana , Endocardite , Insuficiência da Valva Mitral , Edwardsiella tarda , Endocardite Bacteriana/diagnóstico , Feminino , Humanos , Valva Mitral
3.
Mo Med ; 118(5): 446-449, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34658438

RESUMO

This article provides data on oral diseases as they relate to systemic health conditions. Research continues to identify biologic mechanisms that link oral diseases to systemic disease and vice versa. The Smiles for Life curriculum, developed for physicians, provides a systematic approach for incorporating an oral exam into your physical evaluation. Guidelines for the use of antibiotics for tooth pain and swelling, to prevent infective endocarditis, and for patients for total joint replacements are provided.


Assuntos
Endocardite , Saúde Bucal , Antibacterianos/uso terapêutico , Currículo , Humanos , Atenção Primária à Saúde
4.
Mikrobiyol Bul ; 55(4): 642-647, 2021 Oct.
Artigo em Turco | MEDLINE | ID: mdl-34666663

RESUMO

Q fever is a zoonosis caused by Coxiella burnetii. In this report, a case of chronic Q fever endocarditis with pancytopenia and hypergammaglobulinemia mimicking a lymphoproliferative disease was presented. A 39-years-old male living in Çatalca and whose family is engaged in animal husbandry admitted with the complaints of weakness and fatigue. The patient had aortic valve replacement 29 years ago and had aortic valve re-replacement, and ascending aorta grafting because of endocarditis three years ago. It was revealed that the second operation of the patient was due to possible infective endocarditis, but no definitive agent could be identified. He was evaluated for massive hepatosplenomegaly, pancytopenia, hypergammaglobulinemia, presence of M-spike and elevated ß-2 microglobulin levels and was referred to our hematology clinic with a preliminary diagnosis of lymphoproliferative disease. Lymphoplasmacytic lymphoma was excluded with the result of bone marrow biopsy and he was referred to our clinic for the investigation of possible infectious etiologies. We detected hepatosplenomegaly and finger clubbing. His blood analyses were normal except for the following: leukocyte count 3800/µl, platelet count 148000/µl, gamma globulin 5.9 gr/dl, rheumatoid factor (RF) and antinuclear antibody (ANA) positivity. Chronic Q fever endocarditis was suspected and C.burnetii Phase I IgG test was found positive in 1/132071 titers. Although transesophageal echocardiography showed no lesion of endocarditis, positron emission tomography/computed tomography revealed increased fluorodeoxyglucose uptake around the prosthetic heart valve and graft. The patient was diagnosed as having Q fever endocarditis and graft infection. He refused hospitalization and was started on hydroxychloroquine and doxycycline treatment. The patient stopped taking these antibiotics by himself seven days after the diagnosis. He was admitted with a headache to another hospital and operated for an intracranial hemorrhage and died shortly after. Apart from unfamiliarity, wide range of clinical presentations of disease could also lead to delayed diagnosis. Among patients with chronic Q fever, continuous bacteremia and antigenic stimulus causes inflammatory syndrome with hepatosplenomegaly, hypergammaglobulinemia and, presence of autoantibodies which leads to misdiagnoses of rheumatologic, autoimmune or hematologic diseases Chronic Q fever should be investigated in patients with known valvulopathy and chronic hepatomegaly or splenomegaly, pancytopenia, hypergammaglobulinemia, and unexplained autoantibody positivity.


Assuntos
Coxiella burnetii , Endocardite Bacteriana , Endocardite , Transtornos Linfoproliferativos , Febre Q , Adulto , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Febre Q/diagnóstico
6.
Clin Infect Dis ; 73(5): e1151-e1157, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34492692

RESUMO

BACKGROUND: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography. METHODS: Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated. RESULTS: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT. CONCLUSIONS: In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Infecções Estafilocócicas , Bacteriemia/diagnóstico , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Infecções Estafilocócicas/diagnóstico por imagem , Staphylococcus aureus
7.
BMJ Case Rep ; 14(9)2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489253

RESUMO

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.


Assuntos
Endocardite Bacteriana , Endocardite , Insuficiência da Valva Mitral , Ruptura Esplênica , Endocardite/diagnóstico , Endocardite/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia
9.
BMC Infect Dis ; 21(1): 1010, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579674

RESUMO

BACKGROUND: Intravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE. METHODS: We retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020. RESULTS: Patients reporting IDA (N = 54; 12.2%) were significantly younger (p < 0.001) and presented fewer comorbidities (p < 0.001). IDA was associated with a higher proportion of relapses (27.8 vs. 3.3%, p < 0.001) and, at multivariable analysis, was an independent predictor of long-term mortality (HR 2.3, 95%CI 1.1-4.7, p = 0.015). We did not register multiple relapses in non-IDA patients. Among IDA patients, we observed 1 relapse after discharge in 9 patients, 2 relapses in 5 patients and 3 relapses in 1 patient. In IDA patients, neither clinical and laboratory variables nor the occurrence of even multiple relapses emerged as indicators of an adverse risk-benefit ratio of surgery in patients with surgical indication. CONCLUSIONS: IE secondary to IDA affects younger patients than those with IE not associated with IDA. Probably due to this difference, IE secondary to IDA is not associated with significantly higher mortality, whereas the negative, long-term prognostic impact of IDA emerges in multivariate analysis. Considering the good prognosis of patients with uncomplicated IE treated medically, surgery should be reserved to patients with a strict- guidelines-based indication. However, since there are no clear predictors of an unfavourable risk-benefit ratio of surgery in patients with surgical indication, all patients with a complicated IE should be operated, irrespective of a history of IDA.


Assuntos
Usuários de Drogas , Endocardite Bacteriana , Endocardite , Abuso de Substâncias por Via Intravenosa , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações
11.
Am J Case Rep ; 22: e933089, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34520449

RESUMO

BACKGROUND Viridans group streptococci (VGS) are commensal organisms in humans that are considered contaminants when isolated from culture specimens. However, VGS can be pathogenic when recovered multiple times from blood cultures or when in immunocompromised hosts. VGS are the leading cause of dental abscesses and infective endocarditis in children with underlying congenital heart diseases. They are not commonly involved in meningeal infections, but meningitis due to VGS can be fatal if not treated. The onset is usually preceded by an upper respiratory tract infection or in association with neurological surgical procedures. CASE REPORT Our patient was a 14-month-old girl with no significant past medical history who presented with fevers and irritability for 2 weeks. A full sepsis workup, including blood, urine, and cerebrospinal fluid (CSF) cultures, was obtained. Culture results were notable for the abundant growth of VGS in the CSF. However, brain imaging and echocardiogram were normal, with no evidence of brain abscesses or cardiac vegetations, respectively. The patient had shown marked clinical improvement after receiving 2 weeks of intravenous ceftriaxone, which was selected based on the VGS susceptibility profile. CONCLUSIONS Bacterial meningitis is one of the most burdensome infectious diseases worldwide, despite improvements in diagnostic methods, management, and national immunization programs. Clinicians should consider VGS in the differential diagnosis of potential infections that can cause meningitis.


Assuntos
Endocardite Bacteriana , Endocardite , Meningites Bacterianas , Infecções Estreptocócicas , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Lactente , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Estreptococos Viridans
12.
Front Cell Infect Microbiol ; 11: 722482, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527603

RESUMO

Enterococcus faecalis is a major opportunistic bacterial pathogen of increasing clinical relevance. A substantial body of experimental evidence suggests that early biofilm formation plays a critical role in these infections, as well as in colonization and persistence in the GI tract as a commensal member of the microbiome in most terrestrial animals. Animal models of experimental endocarditis generally involve inducing mechanical valve damage by cardiac catheterization prior to infection, and it has long been presumed that endocarditis vegetation formation resulting from bacterial attachment to the endocardial endothelium requires some pre-existing tissue damage. Here we review both historical and contemporary animal model studies demonstrating the robust ability of E. faecalis to directly attach and form stable microcolony biofilms encased within a bacterially-derived extracellular matrix on the undamaged endovascular endothelial surface. We also discuss the morphological similarities when these biofilms form on other host tissues, including when E. faecalis colonizes the GI epithelium as a commensal member of the normal vertebrate microbiome - hiding in plain sight where it can serve as a source for systemic infection via translocation. We propose that these phenotypes may allow the organism to persist as an undetected infection in asymptomatic individuals and thus provide an infectious reservoir for later clinical endocarditis.


Assuntos
Infecções Bacterianas , Endocardite , Infecções por Bactérias Gram-Positivas , Animais , Biofilmes , Modelos Animais de Doenças , Enterococcus faecalis , Humanos
13.
J Cardiothorac Surg ; 16(1): 268, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563221

RESUMO

BACKGROUND: Open heart surgery during pregnancy is relatively rare at home and abroad, and there is a higher risk and probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the premise of ensuring the safety of mother and child is the focus of attention at home and abroad. CASE INTRODUCTION: We reported four cases of cardiac surgeries under CPB during pregnancy performed in our hospital from March 2020 to March 2021. Two of the patients continued their pregnancy after cardiac surgery under CPB. Three patients had infective endocarditis and the other one had an ascending aortic aneurysm. Three patients underwent heart valve placement with the mechanical mitral valve when the other one underwent Bentall surgery. The operations of four cases were all successful, and further follow-up evaluation of the pregnant women and fetuses showed no abnormalities. The patients' detailed information is shown in the following table. CONCLUSION: Heart disease during pregnancy should be treated actively and proactively when the patient has obvious symptoms. Heart valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart disease during pregnancy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite , Cardiopatias , Ponte Cardiopulmonar , Feminino , Humanos , Gravidez , Estudos Retrospectivos
14.
J Med Case Rep ; 15(1): 450, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34507614

RESUMO

INTRODUCTION: Coinfection with dengue and hepatitis A is rare and challenging for physicians since their clinical features can be overlapping. These infections are self-limiting but can become complicated by subsequent infective endocarditis. We report a case of infective endocarditis following a coinfection with dengue and hepatitis A. CASE PRESENTATION: A 17-year-old Yemeni male patient was admitted to the hospital complaining of yellowish discoloration of the skin and sclera associated with dark urine and a diffuse skin rash on the trunk and upper limbs followed by intermittent high-grade fever. Coinfection was confirmed by hepatitis A immunoglobulin M and dengue immunoglobulin M. At the time of diagnosis, white blood cells were normal, with mild neutrophilia and thrombocytopenia along with elevated C-reactive protein. Five days later, the patient was readmitted to the emergency department, complaining of high-grade fever, fatigue, myalgia, nausea, and vomiting. A systolic heart murmur was heard, and infective endocarditis was confirmed by the visualization of two vegetations on the mitral valve and coagulase-negative staphylococci after blood culture. Supportive therapies were initiated for hepatitis A and dengue fever, whereas infective endocarditis was treated with antibiotics for 4 weeks. The patient recovered completely from dengue, hepatitis A, and infective endocarditis. CONCLUSION: In endemic areas, it is reasonable to screen for coinfection with dengue and hepatitis A since they are superimposed on each other. Subacute infective endocarditis may occur following initial dengue and hepatitis A coinfection, especially among patients with rheumatic heart disease. An echocardiogram is a pivotal workup for evaluating a patient with persistent fever of unknown origin.


Assuntos
Coinfecção , Dengue , Endocardite Bacteriana , Endocardite , Hepatite A , Adolescente , Dengue/complicações , Dengue/diagnóstico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Hepatite A/complicações , Hepatite A/diagnóstico , Humanos , Masculino
15.
Am J Case Rep ; 22: e934383, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34400602

RESUMO

Figure Legends Corrected: Figure 1. Intraoperative transesophageal echocardiogram, midesophageal right ventricular infow-outflow view, initial operation September 2018. Figure 2. Intraoperative transesophageal echocardiogram, midesophageal right ventricular inflow-outflow view, second operation January 2019. Figure 3. Intraoperative transesophageal echocardiogram, midesophageal right ventricular inflow-outflow view, third operation March 2019. Reference: Jeffrey W. Cannon, J.W. Awori Hayanga, Thomas B. Drvar, Matthew Ellison, Christopher Cook, Muhammad Salman, Harold Roberts, Vinay Badhwar, Heather K. Hayanga. A 34-Year-Old Male Intravenous Drug User with a Third Episode of Tricuspid Valve Endocarditis Treated with Repeat Valve Surgery. Am J Case Rep. 2021; 22: e927385, 10.12659/AJCR.927385.


Assuntos
Usuários de Drogas , Endocardite Bacteriana , Endocardite , Abuso de Substâncias por Via Intravenosa , Adulto , Ecocardiografia Transesofagiana , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/complicações , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
16.
BMC Infect Dis ; 21(1): 884, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454421

RESUMO

BACKGROUND: Transcatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism. CASE PRESENTATION: An 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later. CONCLUSIONS: Despite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.


Assuntos
Endocardite , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Idoso de 80 Anos ou mais , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Streptococcus oralis , Resultado do Tratamento
17.
J Vet Intern Med ; 35(5): 2094-2101, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34374458

RESUMO

BACKGROUND: Infective endocarditis (IE) in dogs is associated with severe disease and a high case fatality rate but often presents with nonspecific clinical signs. HYPOTHESIS/OBJECTIVES: Serum concentration of cardiac troponin-I (cTnI) is elevated in dogs with IE and can differentiate dogs with IE from dogs with other diseases with similar clinical features. Concentration of serum cTnI is negatively correlated with survival time in dogs with IE. ANIMALS: Seventy-two client-owned dogs; 29 with IE, 27 with stage-B myxomatous mitral valve disease (MMVD), and 16 with immune-mediated disease (IMD). METHODS: Retrospective clinical cohort study. Concentration of serum cTnI was measured in all dogs at time of diagnosis. Clinical findings and echocardiographic interpretation were also recorded. Statistical analyses included Kruskal-Wallis test, pairwise Mann-Whitney U tests, receiver operator characteristic, and Cox proportional hazards. RESULTS: Serum concentration of cTnI was significantly higher in the IE group (0.69 ng/mL [0.03-80.8]) than in the MMVD (0.05 ng/mL [0.02-0.11], P < .001) and IMD groups (0.05 ng/mL [0.03-0.57], P < .001). Increased cTnI was a moderately accurate predictor of IE (area under the curve 0.857 (95% confidence interval [CI] 0.745-0.968, P < .001). A cTnI cutoff of 0.625 ng/mL had 100% specificity (95% CI 90%-100%) and 52% sensitivity (95% CI 33%-70%) in this study sample. There was no association between cTnI concentration and survival time in dogs with IE (hazard ratio 1.013, 95% CI 0.993-1.034, P = .2). CONCLUSIONS AND CLINICAL IMPORTANCE: Cardiac troponin-I concentrations are higher in dogs with IE compared to dogs with preclinical MMVD or IMD. In dogs with a compatible clinical presentation, serum cTnI concentrations >0.625 ng/mL are supportive of IE.


Assuntos
Doenças do Cão , Endocardite , Animais , Biomarcadores , Estudos de Coortes , Doenças do Cão/diagnóstico , Cães , Endocardite/diagnóstico , Endocardite/veterinária , Estudos Retrospectivos , Troponina I
18.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413036

RESUMO

Klebsiella pneumoniae is responsible for about 1.5% of infective endocarditis (IE) cases. IE caused by community-acquired K. pneumoniae infection has rarely been reported. An 80-year-old man presented at our hospital with hypotension and hypoxaemia, and a history of aortic valve stenosis and no history of recent dental treatment. Transthoracic echocardiography at admission showed no signs of heart failure or vegetation. CT revealed typical signs of emphysematous cystitis (EC). The patient was treated for EC-associated septic shock. K. pneumoniae was detected in urine and blood cultures on day 3. Symptoms of heart failure developed on day 6 and clinical examination revealed a heart murmur. An identification of vegetation and perforation of the mitral valve on repeat echocardiography confirmed the diagnosis of IE secondary to K. pneumoniae infection. A surgical valve replacement was performed on day 7. Repeated point-of-care ultrasound played a role in the early diagnosis of IE.


Assuntos
Cistite , Endocardite Bacteriana , Endocardite , Idoso de 80 Anos ou mais , Cistite/complicações , Cistite/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Klebsiella pneumoniae , Masculino , Valva Mitral
19.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433540

RESUMO

A young man presented early in the UK's second COVID-19 pandemic surge with a twelve-day history of fever, dry cough, breathlessness, myalgia and loss of smell and taste. His chest X-ray showed bilateral ground-glass opacities. He was treated for COVID-19 pneumonitis but covered for bacterial infection with antibiotics. He developed shock and respiratory failure, requiring vasopressors and continuous positive airway pressure. He improved but experienced transient visual disturbances and headache. Nasopharyngeal swabs and antibody tests for COVID-19 were negative. Blood cultures grew Haemophilus parainfluenzae A new murmur prompted an echocardiogram. This confirmed a large, mobile mitral valve vegetation. An MRI of the brain showed bilateral embolic infarcts. He underwent urgent mitral valve repair and made an excellent recovery. Whether COVID-19 caused his presenting symptoms or facilitated the bacteraemia remains unclear. It seems more likely that infective endocarditis masqueraded as COVID-19. Clinicians should be aware of how context of the pandemic can bias diagnostic reasoning.


Assuntos
COVID-19 , Endocardite , Haemophilus parainfluenzae , Humanos , Masculino , Pandemias , SARS-CoV-2
20.
Med Sci Monit ; 27: e930596, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34433799

RESUMO

BACKGROUND The aim of this study was to measure sleep quality among patients who underwent infective endocarditis (IE) surgery and identify the risk factors involved in sleep disorders. MATERIAL AND METHODS In this study, we used actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleep Scale (ESS) to determine the clinical characteristics of sleep disorders in 116 patients with IE who were in rehabilitation after surgery. RESULTS Our results showed that 46 (39.7%) patients had sleep efficiency over 85%, while 70 (60.3%) patients had sleep efficiency below 85%. The correlation analysis showed that sleep efficiency was related to the duration of the disease, with a longer duration leading to lower sleep efficiency (P=0.031). The sleep efficiency of patients with IE following surgery was also affected by alcohol consumption; however, surprisingly, patients with "heavy" alcohol consumption had higher sleep efficiency (P=0.030). We found a significant correlation between sleep efficiency and postoperative interleukin-6 (IL) levels, C-reactive protein (CRP) levels, and preoperative erythrocyte sedimentation rate (P<0.05). No significant correlation was found between brain natriuretic peptide levels and sleep efficiency, PSQI score, or ESS score. Postoperative hemoglobin (Hb) level was associated with sleep efficiency (R=0.194, P=0.036), but there was no statistically significant correlation between the PSQI and ESS scores. Postoperative alanine transaminase (ALT) showed a significant negative correlation with sleep efficiency (R=-0.27, P=0.003). CONCLUSIONS We found a high prevalence of sleep disorders in patients with IE along with an increase in inflammatory factors, including postoperative IL-6, CRP, ALT, and Hb levels.


Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/efeitos adversos , Endocardite/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/patologia , Transtornos do Sono-Vigília/patologia , Adulto , Valva Aórtica/lesões , Endocardite/patologia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
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