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1.
Medicine (Baltimore) ; 98(38): e17141, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567953

RESUMO

The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients' heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.


Assuntos
Endocardite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Ecocardiografia , Endocardite/diagnóstico , Endocardite/patologia , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Adulto Jovem
2.
Clin Microbiol Infect ; 25(10): 1246-1252, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31055167

RESUMO

OBJECTIVES: The aim was to describe the impact of infective endocarditis (IE) on functional, cognitive and nutritional statuses, and to estimate the influence of these parameters on surgical management and mortality. METHOD: This was a prospective study over 13 months in 14 French hospitals, including patients ≥75 years of age with definite or possible IE. A comprehensive geriatric assessment (CGA) was performed during the first week of hospitalization, including a retrospective estimation of functional status 2 months before hospitalization, and 3 months after. RESULTS: A total of 120 patients were included (mean age 83.1 ± 5.0 (75-101) years). IE was associated with a dramatic impairment of functional status between 2 months prior hospitalization and the first geriatric evaluation (90.8% able to walk vs. 35.5% (p < 0.0001), ADL (Activities in Daily Living) 5.0 ± 1.7 vs. 3.1 ± 2.1 (p < 0.0001)). The 19 operated patients (15.8%) had less comorbidities (cumulative illness rating scale geriatric 10.8 ± 8.2 vs. 15.3 ± 7.1 (p 0.0176)), better functional (ADL 5.9 ± 0.4 vs. 4.9 ± 1.8 (p 0.0171) and nutritional (mini nutritional assessment 20.4 ± 5.0 vs. 17.3 ± 6.2 (p 0.0501)) statuses than non-operated patients. Among all infectious, cardiac and geriatric parameters, body mass index (HR 0.9, range 0.8-1, p 0.05) and ADL at the time of the first evaluation (HR 0.7, range 0.6-0.9, p 0.002) were the sole independent predictors of the 3-month (32.5%) and 1-year mortality (42.5%). Three months later, the 57 assessed patients only partially recovered their ADL (3.7 ± 1.9 vs. 5.3 ± 1.4 2 months prior hospitalization and 4.6 ± 1.9 at the first CGA; p < 0.0001). CONCLUSION: Functional and nutritional abilities are crucial components that can be accurately explored through a CGA when managing IE in oldest patients.


Assuntos
Endocardite/mortalidade , Endocardite/patologia , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Endocardite/cirurgia , Feminino , França , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estado Nutricional , Estudos Prospectivos , Análise de Sobrevida
3.
Presse Med ; 48(5): 513-521, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31056234

RESUMO

The annual incidence of infective endocarditis is estimated around 30 cases per million inhabitants in population-based studies performed in western countries. The incidence of infective endocarditis is markedly increased in patients with prosthetic heart valves and, particularly, in patients with prior infective endocarditis. The epidemiology of infective endocarditis has changed ; it occurs now in older patients and Staphylococcus has become the most frequent responsible microorganism. The pathophysiology of infective endocarditis results of complex interactions between circulating microorganisms, diseased valvular endothelium, and host defences. The main lesions of IE are vegetations which cause emboli and destruction of valvular and/or perivalvular tissues leasing to acute valvular regurgitations.


Assuntos
Endocardite , Endocardite/epidemiologia , Endocardite/patologia , Endocardite/fisiopatologia , Humanos
4.
Mayo Clin Proc ; 94(6): 1024-1032, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30922693

RESUMO

OBJECTIVE: To determine how brain magnetic resonance imaging (MRI) findings impact clinical outcomes in patients with infective endocarditis (IE) and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). PATIENTS AND METHODS: Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS) score. Good outcome was defined as an mRS score of 2 or less. RESULTS: A total of 361 patients with IE were identified, including 127 patients (35%) who had MRI. One hundred twenty-six of 361 patients (35%) had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%) had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001) and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02) and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. CONCLUSION: Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.


Assuntos
Endocardite/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Imagem por Ressonância Magnética , Encéfalo/patologia , Endocardite/patologia , Feminino , Humanos , Hemorragias Intracranianas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Nat Commun ; 10(1): 1149, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30850614

RESUMO

Treatment failure in biofilm-associated bacterial infections is an important healthcare issue. In vitro studies and mouse models suggest that bacteria enter a slow-growing/non-growing state that results in transient tolerance to antibiotics in the absence of a specific resistance mechanism. However, little clinical confirmation of antibiotic tolerant bacteria in patients exists. In this study we investigate a Staphylococcus epidermidis pacemaker-associated endocarditis, in a patient who developed a break-through bacteremia despite taking antibiotics to which the S. epidermidis isolate is fully susceptible in vitro. Characterization of the clinical S. epidermidis isolates reveals in-host evolution over the 16-week infection period, resulting in increased antibiotic tolerance of the entire population due to a prolonged lag time until growth resumption and a reduced growth rate. Furthermore, we observe adaptation towards an increased biofilm formation capacity and genetic diversification of the S. epidermidis isolates within the patient.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Resistência a Múltiplos Medicamentos/genética , Endocardite/microbiologia , Interações Hospedeiro-Patógeno/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/genética , Adulto , Bacteriemia/tratamento farmacológico , Bacteriemia/patologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Tolerância a Medicamentos/genética , Endocardite/tratamento farmacológico , Endocardite/patologia , Evolução Molecular , Fluoroquinolonas/farmacologia , Glicopeptídeos/farmacologia , Humanos , Mutação INDEL , Masculino , Testes de Sensibilidade Microbiana , Marca-Passo Artificial/microbiologia , Peptídeos Cíclicos/farmacologia , Filogenia , Polimorfismo de Nucleotídeo Único , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/crescimento & desenvolvimento , Staphylococcus epidermidis/isolamento & purificação , beta-Lactamas/farmacologia
6.
BMJ Case Rep ; 12(3)2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30852499

RESUMO

Tricuspid valve(TV) destruction with a remote history of endocarditis without known risk factors (ie, HIV, intravenous drug use, neoplasm, trauma) is rare. We describe the case of a TVs destruction in a 12-year-old non-HIV boy, with a 4-year history of endocarditis without known risk factors nor evidence regarding previous appropriately management.


Assuntos
Endocardite/complicações , Insuficiência da Valva Tricúspide/etiologia , Criança , Endocardite/patologia , Humanos , Masculino , Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/patologia
7.
Int Heart J ; 60(1): 204-207, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30464120

RESUMO

A 65-year-old Japanese man complaining of general malaise and presenting with high fever was admitted to our hospital. He had untreated diabetes and hepatocellular carcinoma with liver cirrhosis. Overall findings of the patient indicated sepsis. Two blood cultures were positive for Streptococcus dysgalactiae, a group C or G Streptococcus. Transthoracic and transesophageal echocardiography revealed vegetations on the aortic and mitral valves. Although antimicrobial therapy with aminobenzyl penicillin was effective for controlling infection, multiple cerebral embolisms occurred in the clinical course of the disease. Primary care doctors should consider invasive Streptococcus dysgalactiae infections when treating elderly patients with underlying diseases, and Streptococcus dysgalactiae should be included in the list of microorganisms considered to cause endocarditis in such patients.


Assuntos
Valva Aórtica/diagnóstico por imagem , Encéfalo/patologia , Embolia/patologia , Endocardite/diagnóstico por imagem , Sepse/diagnóstico , Idoso , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Valva Aórtica/microbiologia , Valva Aórtica/patologia , Encéfalo/diagnóstico por imagem , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Embolia/microbiologia , Endocardite/complicações , Endocardite/tratamento farmacológico , Endocardite/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Sepse/tratamento farmacológico , Sepse/microbiologia , Streptococcus/efeitos dos fármacos , Streptococcus/isolamento & purificação , Resultado do Tratamento
8.
Diagn Microbiol Infect Dis ; 94(1): 60-65, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30583882

RESUMO

OBJECTIVES: Austrian syndrome comprises the triad of pneumonia, meningitis, and endocarditis secondary to Streptococcus pneumonia. We present what we believe to be the first reported case of Austrian syndrome with quadruple heart valve involvement and review the literature detailing cases of quadruple valve infective endocarditis. CASE PRESENTATION AND RESULTS: A case is presented of a patient with radiographic evidence of a left lower lobe pneumonia. Sequential transthoracic followed by transesophageal echocardiogram done to evaluate the presence of a cardiac murmur revealed the presence of quadruple valve vegetations. Multiple blood cultures were persistently negative. The patient went on to develop seizures secondary to proven meningitis. Microbiological diagnosis was eventually established through positive Streptococcus pneumoniae antigen (Alere BinaxNOW®) from cerebrospinal fluid, establishing a presumptive clinical diagnosis of Austrian syndrome. A computerized PubMed search for reports of quadruple valve infective endocarditis and their references was collated. A total of 22 patients were found, including our patient. The median age of presentation was 47.5 years. Five patients had a history of intravenous drug abuse, another 5 had underlying congenital heart disease, and 1 had both. Two patients (9.1%) had 2 microorganisms isolated. Staphylococcus aureus and Streptococcus viridans (3 cases, 13.6% each) were the most commonly implicated microorganism. Heart failure was the commonest complication, afflicting 11 patients (50.0%). Ten patients (45.5%) underwent surgery. Overall case fatality rate was 50.0%. Cardiac surgery was of statistical significance in predicting survival (P = 0.009). CONCLUSION: Quadruple valve endocarditis is associated with a high mortality rate, and cardiac surgery may be protective.


Assuntos
Endocardite/diagnóstico , Endocardite/patologia , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/patologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/patologia , Streptococcus pneumoniae/isolamento & purificação , Ecocardiografia , Endocardite/complicações , Valvas Cardíacas/patologia , Humanos , Masculino , Meningite Pneumocócica/complicações , Pessoa de Meia-Idade , Pneumonia Pneumocócica/complicações
9.
Medicine (Baltimore) ; 97(50): e13658, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558065

RESUMO

RATIONALE: Lactococcus lactis and Pediococcus pentosaceus are rare pathogens which rarely caused infections in humans. Several cases with L. lactis endocarditis have been reported in the literature, among them few were caused by L. lactis subsp. Lactis. Opportunistic P. pentosaceus infections were rarely reported. PATIENT CONCERNS: A 66-year-old man presented to our hospital due to persistent fever for 15 days. A physical checking revealed a grade II holosystolic murmur at the heart apex. A chest computed tomography (CT) scan suggested bronchitis. L. lactis subsp. lactis was identified in blood cultures. Transthoracic and transesophageal echocardiography revealed the presence of a large hyperechogenic mass in the left atrium, and a large floating vegetation on the mitral valve with a severe mitral regurgitation. DIAGNOSIS: Infectious endocarditis caused by L. lactis subsp. Lactis was diagnosed. INTERVENTIONS: Levofloxacin (0.5 g/day) was used for 20 days; however, L. lactis subsp. lactis remained to be isolated from blood culture. Therefore, vancomycin (2 g/day) was used to replace levofloxacin. Six days after the treatment with vancomycin, the blood culture revealed no L. lactis subspecies lactis, but yielded a growth of gram-positive and non-spore forming cocci; and P. pentosaceus was identified. Antimicrobial susceptibility test revealed P. pentosaceus was sensitive to penicillin and levofloxacin. Vancomycin was discontinued, and levofloxacin (0.5 g/day) was restarted and treated for another 7 days. The patient recovered with negative blood culture results, and discharged from the hospital. OUTCOMES: The patient recovered with negative blood culture results, and discharged from the hospital. LESSONS: Our patient had a long-period of antibiotic treatment with strategy alterations. Standard interpretation criteria of Clinical and Laboratory Standards Institute (CLSI) for L. lactis should be established, and molecular tests will increase the identification rate of L. lactis infections.


Assuntos
Endocardite Bacteriana/microbiologia , Endocardite/microbiologia , Lactococcus lactis/isolamento & purificação , Valva Mitral/microbiologia , Pediococcus pentosaceus/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite/patologia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/patologia , Humanos , Lactococcus lactis/efeitos dos fármacos , Levofloxacino/administração & dosagem , Levofloxacino/uso terapêutico , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Pediococcus pentosaceus/efeitos dos fármacos , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico
10.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567113

RESUMO

We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Valva Aórtica/patologia , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/microbiologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Corynebacterium/isolamento & purificação , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Endocardite/patologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/patologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Resultado do Tratamento
11.
J Zoo Wildl Med ; 49(3): 820-823, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30212351

RESUMO

Reports of neoplastic diseases in the Siberian chipmunk ( Eutamias sibiricus) are limited. The authors describe herein two necropsy cases of Siberian chipmunks with squamous cell carcinoma; both of which showed self-biting behaviors on presentation to the clinician. In both cases, the neoplasms comprised trabeculae and islands of polyhedral cells, supported by moderate amounts of fibrous stroma. Anisocytosis and anisokaryosis were moderate to prominent. Neoplastic cells were occasionally keratinized, with a keratin pearl formation. In one case, valvular endocardiosis of the left and right atrioventricular valves with secondary pulmonary and hepatic lesions was incidentally diagnosed. This report provides the first documentation of squamous cell carcinoma and endocardiosis in the Siberian chipmunk.


Assuntos
Carcinoma de Células Escamosas/patologia , Endocardite/veterinária , Neoplasias Pulmonares/veterinária , Sciuridae , Neoplasias Cutâneas/veterinária , Animais , Endocardite/patologia , Evolução Fatal , Neoplasias Pulmonares/secundário , Masculino , Neoplasias Cutâneas/patologia
12.
Nuklearmedizin ; 57(4): 146-152, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30041259

RESUMO

The joint position paper of the working community "Cardiovascular Nuclear Medicine" of the German Society of Nuclear Medicine (DGN) and the working group "Nuclear Cardiology Diagnostics" of the German Cardiac Society (DKG) updates the former 2009 paper. It is the purpose of this paper to provide an overview about the application fields, the state-of-the-art and the current value of nuclear cardiology imaging. The topics covered are chronic coronary artery disease, including viability imaging, furthermore cardiomyopathies, infective endocarditis, cardiac sarcoidosis and amyloidosis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiologia , Medicina Nuclear , Cintilografia/métodos , Amiloidose/diagnóstico por imagem , Amiloidose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Endocardite/diagnóstico por imagem , Endocardite/patologia , Política de Saúde , Humanos , Guias de Prática Clínica como Assunto , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia
13.
Cardiovasc Pathol ; 36: 30-34, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30005395

RESUMO

Candida parapsilosis is a rare cause of endocarditis, which is seen to affect the native valves in patients who are known intravenous drug abusers or following contamination during surgery for prosthetic valves. We discuss a unique constellation of autopsy findings in a 35-year-old chronic opium abuser who presented with left-sided weakness followed by low-grade fever. He was diagnosed to have C. parapsilosis native valve endocarditis with septic emboli involving the myocardial vessels, left middle cerebral artery, spleen, and common iliac artery. In addition, autopsy highlighted a right basal ganglia infarct, focal segmental glomerulonephritis, and talc granulomatosis in the lungs and liver.


Assuntos
Valva Aórtica/microbiologia , Candida parapsilosis/isolamento & purificação , Candidíase/microbiologia , Endocardite/microbiologia , Dependência de Ópio/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Valva Aórtica/patologia , Autopsia , Doença Cerebrovascular dos Gânglios da Base/microbiologia , Doença Cerebrovascular dos Gânglios da Base/patologia , Candidíase/diagnóstico , Endocardite/patologia , Evolução Fatal , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/patologia , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/patologia , Humanos , Infarto da Artéria Cerebral Média/microbiologia , Infarto da Artéria Cerebral Média/patologia , Masculino , Sepse/microbiologia , Sepse/patologia , Talco/efeitos adversos
14.
Am J Emerg Med ; 36(9): 1686-1692, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30001813

RESUMO

INTRODUCTION: Infectious endocarditis (IE) is a potentially deadly disease without therapy and can cause a wide number of findings and symptoms, often resembling a flu-like illness, which makes diagnosis difficult. OBJECTIVE: This narrative review evaluates the presentation, evaluation, and management of infective endocarditis in the emergency department, based on the most current literature. DISCUSSION: IE is due to infection of the endocardial surface, most commonly cardiac valves. Major risk factors include prior endocarditis (the most common risk factor), structural heart damage, IV drug use (IVDU), poor immune function (vasculitis, HIV, diabetes, malignancy), nosocomial (surgical hardware placement, poor surgical technique, hematoma development), and poor oral hygiene, and a wide variety of organisms can cause IE. Patients typically present with flu-like illness. Though fever and murmur occur in the majority of cases, they may not be present at the time of initial presentation. Other findings such as Roth spots, Janeway lesions, Osler nodes, etc. are not common. An important component is consideration of risk factors. A patient with IVDU (past or current use) and fever should trigger consideration of IE. Other keys are multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms. If endocarditis is likely based on history and examination, admission for further evaluation is recommended. Blood cultures and echocardiogram are key diagnostic tests. CONCLUSIONS: Emergency physicians should consider IE in the patient with flu-like symptoms and risk factors. Appropriate evaluation and management can significantly reduce disease morbidity and mortality.


Assuntos
Endocardite/diagnóstico , Serviço Hospitalar de Emergência , Endocardite/etiologia , Endocardite/patologia , Endocardite/terapia , Humanos
15.
Curr Cardiol Rev ; 14(3): 217-224, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29788893

RESUMO

BACKGROUND: Despite major advancements since its first description in the 19th century, infective endocarditis remains a significant medical challenge. Although commonly involving a single valve, multiple valve involvement may occur, complicating matters even further. Triplevalve endocarditis is a very rare phenomenon. Poorly studied and described only a handful of times in the literature, little is known about the optimal therapeutic and management options in dealing with this complex entity. CONCLUSION: In this paper we describe the case of a 48-year-old male who was diagnosed with triple-valve endocarditis and provide a review of the literature to delineate what is already known and improve our understanding of this rare phenomenon.


Assuntos
Endocardite/etiologia , Complicações do Diabetes , Endocardite/patologia , Humanos , Masculino , Pessoa de Meia-Idade
16.
Artigo em Inglês | MEDLINE | ID: mdl-29760141

RESUMO

Enterococcus faecium isolates that harbor LiaFSR substitutions but are phenotypically susceptible to daptomycin (DAP) by current breakpoints are problematic, since predisposition to resistance may lead to therapeutic failure. Using a simulated endocardial vegetation (SEV) pharmacokinetic/pharmacodynamic (PK/PD) model, we investigated DAP regimens (6, 8, and 10 mg/kg of body weight/day) as monotherapy and in combination with ampicillin (AMP), ceftaroline (CPT), or ertapenem (ERT) against E. faecium HOU503, a DAP-susceptible strain that harbors common LiaS and LiaR substitutions found in clinical isolates (T120S and W73C, respectively). Of interest, the efficacy of DAP monotherapy, at any dose regimen, was dependent on the size of the inoculum. At an inoculum of ∼109 CFU/g, DAP doses of 6 to 8 mg/kg/day were not effective and led to significant regrowth with emergence of resistant derivatives. In contrast, at an inoculum of ∼107 CFU/g, marked reductions in bacterial counts were observed with DAP at 6 mg/kg/day, with no resistance. The inoculum effect was confirmed in a rat model using humanized DAP exposures. Combinations of DAP with AMP, CPT, or ERT demonstrated enhanced eradication and reduced potential for resistance, allowing de-escalation of the DAP dose. Persistence of the LiaRS substitutions was identified in DAP-resistant isolates recovered from the SEV model and in DAP-resistant derivatives of an initially DAP-susceptible clinical isolate of E. faecium (HOU668) harboring LiaSR substitutions that was recovered from a patient with a recurrent bloodstream infection. Our results provide novel data for the use of DAP monotherapy and combinations for recalcitrant E. faecium infections and pave the way for testing these approaches in humans.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Daptomicina/farmacologia , Endocardite/tratamento farmacológico , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , beta-Lactamas/farmacologia , Animais , Antibacterianos/farmacocinética , Valva Aórtica/efeitos dos fármacos , Valva Aórtica/microbiologia , Valva Aórtica/patologia , Área Sob a Curva , Carga Bacteriana , Daptomicina/farmacocinética , Modelos Animais de Doenças , Esquema de Medicação , Combinação de Medicamentos , Farmacorresistência Bacteriana/genética , Sinergismo Farmacológico , Endocardite/microbiologia , Endocardite/patologia , Endocárdio/efeitos dos fármacos , Endocárdio/microbiologia , Endocárdio/patologia , Enterococcus faecium/genética , Enterococcus faecium/crescimento & desenvolvimento , Enterococcus faecium/isolamento & purificação , Expressão Gênica , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Ratos , Ratos Sprague-Dawley , Sequenciamento Completo do Genoma , beta-Lactamas/farmacocinética
18.
J Forensic Leg Med ; 58: 41-43, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29704724

RESUMO

Involvement of both right and left heart chambers with infective endocarditis is extremely rare. In this case report, we aimed to present a rare case of Infective endocarditis (IE) in an intravenous & inhalational drug misuse involving both cardiac chambers with incidental pneumoconiosis.


Assuntos
Usuários de Drogas , Endocardite/patologia , Dependência de Heroína/complicações , Pneumoconiose/patologia , Valvas Cardíacas/patologia , Humanos , Pulmão/patologia , Masculino , Miocárdio/patologia , Adulto Jovem
19.
Forensic Sci Med Pathol ; 14(2): 229-235, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29556967

RESUMO

"Krokodil" is a home-made opioid drug obtained by synthesizing desomorphine from codeine and combining it with other low-cost additives. Initially introduced in the former Soviet countries, it was then imported to Western Europe as a heroin substitute. To our knowledge, this is the first report of an Italian case of lethal krokodil abuse, that occurred in a 39-year-old man, who died suddenly after transportation to the Emergency Department (ED) for hyperthermia associated with sweating, dyspnoea and tachycardia. Post-mortem examination revealed extensive necrotic ulcerative lesions on the forearms, and autopsy showed a hypertrophic heart with ample endocardial vegetation on the aortic valve and patency of the foramen ovale. Histopathological examination of the heart showed ulcero-vegetative lesions of the aortic valve with an abscess on the annulus and extension to the periaortic adipose tissue, as well as diffuse myocardial interstitial inflammatory neutrophilic infiltrates. Toxicological analysis demonstrated a desomorphine metabolite in urine. On the basis of all these findings the cause of death was ruled to be congestive heart failure caused by endocarditis and myocarditis, correlated with chronic abuse of krokodil.


Assuntos
Analgésicos Opioides/efeitos adversos , Valva Aórtica/patologia , Codeína/análogos & derivados , Endocardite/induzido quimicamente , Miocardite/induzido quimicamente , Adulto , Cardiomiopatia Hipertrófica/induzido quimicamente , Cardiomiopatia Hipertrófica/patologia , Codeína/efeitos adversos , Morte Súbita/etiologia , Endocardite/patologia , Insuficiência Cardíaca/induzido quimicamente , Humanos , Masculino , Miocardite/patologia , Transtornos Relacionados ao Uso de Opioides/complicações , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/patologia
20.
J Laryngol Otol ; 132(4): 368-371, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29463328

RESUMO

BACKGROUND: Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. CASE REPORT: This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss. CONCLUSION: Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.


Assuntos
Endocardite/complicações , Perda Auditiva Bilateral/complicações , Perda Auditiva Neurossensorial/complicações , Perda Auditiva Súbita/complicações , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite/patologia , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/etiologia , Perda Auditiva Bilateral/microbiologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/microbiologia , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/etiologia , Perda Auditiva Súbita/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade
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