Complication Of Bacterial Endocarditis Research Articles

Invasive Candida Infection in Patients With Bacterial Infective Endocarditis.

Over 21 months, 12 patients with invasive Candida infections detected during the course of treatment of bacterial endocarditis, including 11 with candidemia, were identified. Invasive Candida infections can occur as a complication of bacterial endocarditis and may occur more frequently in patients with injection drug use and broad-spectrum antibiotic exposure.

CEREBRAL ABSCESS AND MYCOTIC ANEURYSM AS A CONSEQUENCE OF INFECTIVE ENDOCARDITIS: A CASE REPORT

Background: Neurological complications of infective endocarditis are common and can cause significant morbidity and mortality. A broad spectrum of neurological manifestations may be observed. This case is used to show an approach towards the management of neurological complication of bacterial endocarditis based on a review of the published work. Case Presentation: A 26-year-old male patient was admitted to our department with sudden onset of left side weakness associated with aphasia and an intense headache. Clinical assessment showed an infective endocarditis with two mobile vegetations attached to the mitral valve complicated by an intracranial mycotic aneurysm and a brain abscess. The patient was managed only with antibiotic therapy on the decision of a multidisciplinary team, with an excellent clinical outcome. Conclusions: The management of neurologic complications of infective endocarditis remains challenging given the lack of prospective, controlled studies. Therefore, the decision process requires the participating of a multidisciplinary team.

Haemolytic anaemia resulting from complications of bacterial endocarditis.

Haemolytic anaemia resulting from complications of bacterial endocarditis.

Septic Embolization from Aortic Valve Endocarditis Presenting as Acute Stemi

Embolic events are a well-documented complication of bacterial endocarditis. Coronary artery septic emboli are a much less common manifestation of endocarditis, and can very rarely present as a myocardial infarction (MI) [1]. Though no consensus exists on the best management for these patients, conventional reperfusion strategies often prevail in light of the time constraints surrounding an acute MI [2]. Here we present the case of a septic coronary embolism in a patient with undiagnosed endocarditis who presented with an acute ST-segment elevation myocardial infarction (STEMI) and the subsequent management.

A Giant Pseudoaneurysm of the Forearm as Unusual Complication of Bacterial Endocarditis

A 59-year-old man with fever was diagnosed with endocarditis due to Streptococcus bovis. Two weeks after antibiotic therapy was started, he presented with red and painful swelling of the forearm without any sign of systemic inflammation. A giant hematoma connected to the radial artery was detected with ultrasound. Surgical intervention with the removal of multiple, sterile clots from the hematoma was performed, and the multiple lacerations of the artery detected were corrected. This is the first case reporting rupture of the radial artery as a complication of infective endocarditis.

Sudden Death as a Complication of Bacterial Endocarditis

Three cases are reported to demonstrate the range of possible lesions and wide variation in lethal mechanisms that may be found in cases of unexpected death subsequently shown to be due to bacterial endocarditis. Case 1: A 36-year-old man was found dead on his bedroom floor surrounded by drug paraphernalia. At autopsy, acute myocardial ischemia was present caused by coronary artery ostial occlusion complicating acute bacterial endocarditis of the aortic valve. Case 2: A 54-year-old man with chronic renal failure was found dead in bed at home. At autopsy, a left middle cerebral artery territory cerebral infarct was present due to septic embolization from bacterial endocarditis involving the aortic valve. Case 3: A 23-year-old man was found collapsed in a pool of blood. At autopsy, upper airway hemorrhage from an arteriobronchial fistula was present caused by septic pulmonary infarction from previous endocarditis of a congenital ventricular septal defect. This report demonstrates that bacterial endocarditis may still be a cause of sudden and unexpected death presenting to forensic mortuaries and that the underlying mechanisms may involve complex sequences of pathological changes that compromise vascular function.

George W. Crile: A visionary mind in resuscitation

George Washington Crile was a successful surgeon who lived at the end of the 19th century. He was born on 11 November 1864 on a farm near Chili, Ohio. He became interested in the study of shock after a close friend died from hemorrhage. Crile dedicated his research years to the study of shock, cardiac arrest, and the use of adrenaline. His research on shock and cardiac arrest led to treatment guidelines that are still used today. He also participated in the Spanish-American War and in World War I as a Navy Surgeon and saved the lives of many soldiers with his principles of blood transfusion and sanitation. He is also known in the surgical world as the grandfather of radical neck dissection and received the Gold Lannelongue Medal and prize. Having written over 400 papers and 24 books, George W. Crile died from complications of bacterial endocarditis on 7th January 1943. Although they were published a long time ago, his contributions to medicine remain fundamental to clinical practice in today's operating rooms and critical care units.

Infectious intracranial aneurysms caused by Granulicatella adiacens

Infectious intracranial aneurysms (IIAs) are uncommon but severe complications of bacterial endocarditis. We report a case of IIA due to a rare nutritionally variant streptococcus, Granulicatella adiacens. The 31-year-old young patient, without any known risk for infective endocarditis had a silent clinical course until rupture of IIAs occurred. Despite antibiotic treatment and surgical clipping of IIAs, a second episode of more severe intracerebral hemorrhage occurred four months later. Mitral valvuloplasty was undertaken and there were no more brain insults in the following four years. Awareness of the possibility of hemorrhagic stroke as the initial presentation of Granulicatella adiacens endocarditis, and the possibility of high recurrence and bacteriological failure rate of Granulicatella adiacens infection may be helpful in early diagnosis and surgical decision, thus limiting future fatal complications.

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: Case report and review of the literature

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.

Renal artery mycotic pseudoaneurysm: diagnosis with multi-detector computed tomographic angiography

Renal artery mycotic pseudoaneurysms are uncommon complications of bacterial endocarditis and bacteremia. Complications include hemorrhage and refractory bacteremia, and prompt diagnosis can lead to appropriate treatment. Reported is a case where multidetector computed tomography angiography led to the correct diagnosis.

Increased cytokine levels in a cerebral mycotic aneurysm in a child with Down's syndrome

Cerebral mycotic aneurysms are one of the most serious complications of bacterial endocarditis but the mechanism underlying cerebral aneurysms is unclear. We reported the cytokine levels in a cerebral mycotic aneurysm in a child with Down's syndrome. The patient was a 12-year-old female. She was diagnosed as having Down's syndrome and congenital heart disease consisting of an endocardial cushion defect at birth. She underwent a radical operation at 9 years but mitral valve regurgitation remained. She was hospitalized with high fever, vomiting, loss of activity and gait disturbance. Neurological examination revealed facial palsy and hemiparesis on the left side. Cytokines such as IL-6, TNF-α, sTNFR1 and sE-selectin were elevated in blood, and IL-6, TNF-α and sTNFR1 in cerebrospinal fluid. T2-weighted MRI disclosed a low intensity area in the right Sylvian sulcus. MR angiography showed an aneurysm of the right middle cerebral artery. We think that cytokines and the formation abnormality of collagen fibers are related to the production of aneurysms.

Mycotic Aneurysm of the External Carotid Artery as a Complication of Bacterial Endocarditis: Endovascular Exclusion with an Uncovered Stent

Wepresent a case of a mycotic aneurysm of the leftexternal carotid artery treated endovascularly with anuncovered stent.Case ReportA 37-year-old man with a long history of drug abusewas admitted to hospital with fever, headache andarthralgiaof5weeksduration.Thepatientwasknownto be sero-positive for hepatitis B and C. Investigationof the fever, due to septicemia, revealed endocarditisand severe mitral valve regurgitation. The patientdeveloped a bulky pulsatile enlarging mass in the leftcervicalregion.Digitalsubtractionangiography(DSA)performed on the same day revealed a saccularaneurysm (18.6£ 13.2 mm) arising from the leftexternal carotid artery (Fig. 1).Due to the co-morbidity of the patient it wasdecided to perform a percuteanous endovascularintervention rather than open surgical repair. Using atransfemoral approach a 7-French guiding catheterwas placed in the proximal external carotid artery anda stent (Aku-Link, Guidant) was deployed underbiplanar road map control. The self-expanding stent(5 mm in diameter £ 20 mm long) covering the largeneck (13 mm) of the saccular aneurysm was dilatedwith a balloon catheter (UltraSoft, Boston Scientific) toensure good wall apposition (Fig. 2(a)). No additionalcoil was applied and no complications occurred.Angiography following stent placement revealed thatthe flow in the aneurysm was considerably reducedwith no compromise to the flow in the external carotidartery (Fig. 2(b)). Colour-coded Doppler sonography 2days later showed total occlusion of the aneurysm,which was confirmed by MRA 1 week later. The initialantibiotic treatment with penicillin and gentamicinwas continued for 6 weeks. The severe mitral valveregurgitation required valve replacement 5 monthslater. The CT-scan at 6 month after stenting showed norecurrence of the aneurysm with normal contrastenhancement in the left external carotid artery.DiscussionThe pathogenesis of mycotic aneurysm varies;approximately 45% result from general infectionwith septicemia.

Fistule artério-veineuse des vaisseaux rénaux par embolie septique au cours d’une endocardite bactérienne

A 27 year-old woman developed acute pain of the right flank during the course of an infectious endocarditis. A septic arteriovenous fistula of the renal vessels of a solitary functioning kidney was demonstrated. The cardiac valvular lesions required a prosthetic aortic and mitral replacement valves. An attempt to occlude the fistula by embolization with several coils was unsuccessful and led to surgery: extracorporeal repair enabled complete closure of the fistula. During the long-term follow-up, the aortic prosthetic valve had to be changed. Renal function was satisfactory and remained stable over time. Renal arteriovenous fistula is an exceptional complication of bacterial endocarditis despite the frequency of septic emboli during the course of the disease.

Valve replacement for bacterial endocarditis.

During the 10-year period 1970-79, 88 patients underwent valve replacement for complications of bacterial endocarditis. The mean age of the patients was 42 (15-60) years. There were 64 men and 22 women. Thirty-three patients had a history of rheumatic fever. In 11 cases the murmur was heard already in childhood. In 44 cases (50%) no heart disease was diagnosed before the onset of symptoms of bacterial endocarditis. Strepto- and staphylococci were the most common organisms found in culture. In 12 cases a dental and in 12 a respiratory tract infection preceded the endocarditis. In 51 cases, however, the origin of the infection remained unestablished. Intractable heart failure and embolizations were most common indications for operation. Only 9 patients underwent operation in the acute phase. Aortic valve replacement (AVR) was performed in 58 cases, mitral valve replacement (MVR) in 19, both AVR and MVR in 6, AVR and aneurysm of sinus Valsalva repair in 3 cases, AVR and repair of VSD in one and AVR combined with myocardial revascularization and replacement of the ascending aorta for aneurysm in one case. The early mortality was 9 patients (10%) and late mortality 9 patients. During follow-up times of up to 10 years, 7 patients experienced embolic complications. They recovered uneventfully. One valve prosthesis was replaced because of thrombosis and another due to paraprosthetic leak. Two patients had a late recurrent bacterial endocarditis 5 and 8 years postoperatively. They were treated conservatively and recovered. It was concluded that after valve replacement for bacterial endocarditis, the risk of recurrent infection is relatively low and that results approaching those for elective valve replacement can be achieved.

Computerized Tomography of the Head in Bacterial Endocarditis

To the Editor.— The signs, symptoms, and possible complications of bacterial endocarditis are well known. Intracranial abnormalities that may develop include areas of infarction from septic emboli, mycotic aneurysms, and areas of hemorrhage. The computerized tomographic (CT) head scan findings of the intracerebral complications are not widely recognized. The following is a report of such a case. Report of a Case.— A 62-year-old woman was admitted to the hospital in a semicomatose state. She was apparently up and about the day before admission. Physical examination showed cyanotic discoloration under the nails and on the feet, compatible with embolic phenomena. A CT scan performed at the time of admission showed multiple areas of hemorrhage bilaterally within the brain (Fig 1). Blood cultures grew Staphylococcus aureus and a group D enterococcus. Her CSF also grew S aureus . Her clinical course was downhill, and she died three days after admission. A postmortem examination

Surgery for Mitral Valve Endocarditis

The records of 20 patients who underwent mitral valve replacement for complications of bacterial endocarditis were reviewed. Although the indications for surgery were the same as those for patients with aortic endocarditis, major emboli (cerebral, coronary or retinal) prompted surgery in 8 of 20 patients, a much higher incidence than reported for surgery in aortic valve endocarditis. Eighteen of the patients had mitral regurgitation; 14 of these had severe congestive heart failure, but the development of congestive failure tended to be more insidious than in patients with aortic endocarditis. Continued septicemia despite appropriate antibiotics was the least common indication for surgery. Sixteen of the 20 patients were salvaged by surgery, although some had major residual deficits, related mainly to preoperative emboli. These results are a marked improvement in the expected 90-100 percent mortality rate for patients with these complications of endocarditis. The main reason for a poor result following surgery was temporization leading to continued deterioration of vital functions preoperatively. Reinfection of the prosthesis did not occur, and we do not consider duration of preoperative antibiotic therapy an important factor in the decision to perform surgery.

Rupture of the papillary muscle of the triscupid valve: A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency

Rupture of a papillary muscle is a rare occurrence. Two patients are described in whom rupture of a papillary muscle of the tricuspid valve developed after external cardiac massage during cardiopulmonary resuscitation. One of these patients survived briefly with clinical evidence of triscupid regurgitation immediately after resuscitation. Although tricuspid valve papillary muscle rupture has been described as a complication of bacterial endocarditis, chest trauma and myocardial infarction, it is a generally unrecognized complication of external cardiac massage. Findings in the two patients reported here suggest that patients with a dilated right ventricle may be more susceptible to this rare complication of cardiopulmonary resuscitation.

Mycotic aneurysm of the hepatic artery causing obstructive jaundice

Mycotic aneurysm of the hepatic artery is a known complication of bacterial endocarditis. However, obstructive jaundice due to this lesion is rare [1]. We describe a case in which a mycotic aneurysm of the hepatic artery ruptured, forming a pseudoaneurysm of the right anteroinfenior branch which caused obstructive jaundice. Case Report A 17-year-old nonaddicted black male was admitted to Cook County Hospital because of muscular tenderness, fever, and progressive lethargy. There had been blunt trauma to his right calf 3 weeks earlier followed by swelling and tenderness. On physical examination a low-grade systolic murmur was heard at the apex in the left fifth intercostal space. Numerous hemorrhagic spots were found in the skin, the conjunctivas, and the fundus of the right eye. Cenebrospinal fluid, urine, and blood cultures grew coagulasepositive Staphylococcus aureus, and therapy was started with oxacillin. Echocandiognaphy and cardioangiography revealed mitral insufficiency, aontic valve vegetations, and an aneurysm of the left ventricle. The patient did not respond well to treatment, and during the seventh week of hospitalization abdominal pain and progressive jaundice developed. Total and direct serum bilirubin levels were 8.2/100 ml and 5.1/100 ml, respectively; alkaline phosphatase was 1,606 lU. Rose bengal scan showed findings compatible with obstructive jaundice, and technetium liver scan disclosed prominent ponta hepatis and an area of decreased uptake in the night lobe. Hepatic and splenic angiography demonstrated aneurysmal dilatation of the right and left hepatic arteries, with a large pseudoaneurysm of the right antenoinfenion branch (fig. 1) causing compression and upward displacement of the portal vein. A small aneurysm was seen at the hilus of the spleen.

Bacterial endocarditis with ruptured sinus of valsalva and aorticocardiac fistula

A case is presented of bacterial endocarditis with a ruptured sinus of Valsalva and formation of an aorticocardiac fistula from the right coronary sinus into the right atrium and right ventricle. The pathologic, clinical and surgical aspects of bacterial endocarditis complicated by a ruptured sinus of Valsalva and an aorticocardiac fistula are analyzed. This complication of bacterial endocarditis is still uncommon, but alertness to its diagnosis makes possible early and successful surgical treatment.

Left Ventricular-Right Atrial Shunt Due to Bacterial Endocarditis

Two patients are reported who developed perforation of the ventricular septum resulting in a left ventricular-right atrial shunt, as a complication of bacterial endocarditis. One of these patients presented with catastrophic cardiac deterioration, shock and biventricular failure, while in the other the defect was small and of little hemodynamic significance. With regard to differential diagnosis, note is made of the pansystolic murmur, the prominent venous pressure elevation and the absence of radiographic findings of marked pulmonary edema. Two patients are reported who developed perforation of the ventricular septum resulting in a left ventricular-right atrial shunt, as a complication of bacterial endocarditis. One of these patients presented with catastrophic cardiac deterioration, shock and biventricular failure, while in the other the defect was small and of little hemodynamic significance. With regard to differential diagnosis, note is made of the pansystolic murmur, the prominent venous pressure elevation and the absence of radiographic findings of marked pulmonary edema.