Symptoms Of Infective Endocarditis Research Articles

Cardiac myxoma misdiagnose as infective endocarditis in a patient with acute limb ischemia and cardioembolic cerebral stroke: a case report

Introduction: Fever, systemic embolism, and intra-cardiac masses are all symptoms of Infective Endocarditis (IE) and Cardiac Myxoma (CM)1. As a result, despite proper imaging studies, these diseases are frequently misdiagnosed one for the other.2 Case description: A 23-years-old female patient was admitted to emergency department of Zainoel Abidin General Hospital with acute onset right lower extremity pain for the last few hours and presented roth spots of the retina. The next day after admission, she presented fever. The patient denied having chronic disease, drug abuse, and thrombotic history. Tooth decay were found. Transthoracic Echocardiography (TTE) were obtained due to concern of infective endocarditis. Head CT-scan revealed cardioembolic cerebral stroke. TTE showed ejection fraction 56%, severe mitral regurgitation, and a mobile mass size 3.1x2.4 cm in mitral valve, attached to anterior mitral leaflet. The patient underwent thrombectomy, stroke therapy, dental tooth decay treatment, and lower limb rehabilitation at that moment, before having Mitral Valve Replacement (MVR) surgery. Six months afterward MVR surgery was done, rather than vegetation, we found a 50cc cardiac myxoma in anterior mitral valve leaflet. A 27mm bioprosthetic valve was installed. The patient was recovered quickly and she was able to discharge from hospital in the next 7 days after procedure without any further issue. Conclusion: In order to effectively manage the patients, it is crucial to distinguish between IE and cardiac myxoma. The mainstay of treatment for cardiac myxoma cases is surgery, which has an excellent prognosis. To evaluate for recurrence, long-term follow-up is frequently required.

Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant: A case report

BACKGROUNDSurgical therapy of infective endocarditis (IE) involving aortic valves and mitral valves is widespread. However, there are few reports concerning patients with culture-negative endocarditis complicated by the appearance of comorbid valvular perforation and abscess. Therefore, real-time surveillance of changes in cardiac structure and function is critical for timely surgical management, especially in patients who do not respond to medical therapy.CASE SUMMARYHere, we report an atypical case in a 9-mo-old infant without congenital heart disease but with symptoms of intermittent fever and macular rashes. Physical examination, laboratory tests, and electrocardiograms suggested a diagnosis of IE, although the result of blood cultures was exactly negative. After treatment with antibiotic drugs, the patient got a transient recovery. On the 9th day, we proceeded with continuous echocardiogram due to fever again and the results revealed aortic valve abscess with perforation, regurgitation, vegetation, and pericardial effusion. Intraoperative monitoring revealed aortic valve perforation, presence of apothegmatic cystic spaces below the left coronary cusp of the aortic valve, and severe aortic valve regurgitation. Aortic valve repair was performed by autologous pericardial patch plasty. The patient was discharged after 4 wk of treatment and no complications occurred after surgery.CONCLUSIONOur case demonstrated the necessity of serial echocardiography monitoring for possible adverse symptoms of IE in pediatric patients.

Focused Cardiac Ultrasound Examination as a Tool for Diagnosis of Infective Endocarditis and Myocarditis in Dogs and Cats.

Simple SummaryInfective endocarditis and myocarditis are rarely diagnosed conditions with high mortality rates in dogs and cats. As their clinical signs are highly nonspecific, and advanced cardiological diagnostics are not always available in small animal clinics, both diseases seem to be underdiagnosed. Infective endocarditis affects mainly the mitral and aortic valves. In myocarditis, thickening of the left ventricle walls is usually observed; however, in some cases dilatation of the left ventricle lumen with thinning of the walls can be visible. In human medicine, basic cardiac ultrasound examination enables a quick initial diagnosis of these two conditions. Using this technique, we tentatively diagnosed 7 cases of myocarditis and/or infective endocarditis in dogs and cats, and these diagnoses were later confirmed by other methods. Because the initial diagnoses were made by a general practitioner after relatively short training, not by a cardiology specialist, we conclude that common use of this technique in small animal practices equipped with ultrasound device could increase the rate of diagnosis of these conditions, leading to earlier treatment initiation.Symptoms of infective endocarditis (IE) and myocarditis are usually nonspecific and include fever, apathy, and loss of appetite. This condition can lead to severe heart failure with ascites or/and fluid in the thoracic cavity or/and in the pericardial sac. We describe infective endocarditis and myocarditis in 3 dogs and 4 cats. In all animals, the initial diagnosis was performed on the basis of a focused cardiac ultrasound examination performed by a general practitioner after a training in this technique. The initial findings were confirmed by a board-certified specialist in veterinary cardiology. Post mortem positive microbiological results from valves were obtained in 4 of 7 patients. Methicillin-resistant Staphylococcus aureus was confirmed in 2 cases and Staphylococcus epidermidis was confirmed in 2 cases, one of which included Enterococcus sp. coinfection. Histopathological examination confirmed initial diagnosis in 5 of 7 animals. In the remaining 2 patients, the time elapsed from the onset of clinical symptoms to death was about 1 month and no active inflammation but massive fibrosis was found microscopically. This is, to our best knowledge, the first report of IE and myocarditis diagnosed in small animals using focused cardiac ultrasound examination. Therefore, we conclude that common usage of this technique by trained general veterinarians may increase the rate of diagnosed patients with these conditions.

Infective Endocarditis: A Case with Prolonged Fever

Infective endocarditis (IE) is associated with a high rate of mortality and morbidity in patients with anomalies of heart valves. We present a case of a 23-year-old male known to have severe mitral regurgitation (MR) with a history of prolonged fever for 5 months. According to The Modified Duke Criteria, clinical sign and symptoms fulfilled one major criterion (echocardiography finding of vegetation on mitral valve) and three minor (fever of at least 380 Celsius, valvular heart disease as a predisposing heart condition, and positive blood culture for Lactococcus sp. and Pediococcus sp.) considered as definite IE. Fever is one of the most common symptoms of IE (>90% of cases). Patient with prolonged fever and structural abnormality of heart valve should be considered for acute or subacute of IE. Establishing an diagnosis of IE and appropriate antibiotic therapy will improve the patient's clinical condition, and reduce morbidity and mortality.

P1798Assessing attitudes and knowledge of infective endocarditis in adult survivors of congenital heart disease

Abstract Background Adults with congenital heart disease (ACHD) have an increased risk of infective endocarditis (IE), which is associated with significant morbidity and mortality. This risk is further compounded by patient-related factors such as education and awareness of IE. The onus of patient education falls on both patient and physician, and is paramount to successful outcomes. Our study sought to evaluate patients' understanding of the risks, preventative measures and symptoms of IE, and to identify high-risk ACHD patients who would benefit from targeted education. Methods A cross-sectional study was conducted using a pre-tested questionnaire to assess knowledge of and attitudes towards IE. Patients attending the outpatient department of a tertiary referral centre completed the questionnaires independently. Baseline demographics and clinical data were collected from electronic patient records. Results 132 questionnaires were completed (median age 38 years, 50% male). 106 patients (80%) had previous surgical or percutaneous interventions and 7 patients (5%) had suffered with infective endocarditis in the past. 37% were able to accurately define IE. Out of a range of symptoms, most patients chose temperature (47%) and tiredness (39%) as classical symptoms of IE, however none correctly identified all listed symptoms as potential signs of IE. The majority of patients knew tooth abscess (58%) and body piercings (50%) were risk factors for IE. A fifth of patients (20%) were failing to have annual dental check-ups. 22% thought that IE would only require a few days stay as an inpatient and only 20% of patients were aware of the requirement for prolonged antibiotic treatment and the majority (63%) were unaware of the potential need for open heart surgery. 1 in 4 patients could recall having received information regarding IE. A third of patients reported that they would have made lifestyle changes had they known that IE required prolonged intravenous antibiotic treatment and could result in open heart surgery and death. Discussion Our study highlights key issues in the management of ACHD. Moving forward with the continuously growing population of patients we need to focus on the multi-disciplinary approach including specialist clinical nurses and increasing awareness online and through meetings and patient days as well as the importance of transition services as paediatric patients move across to adult specialists. General physcians will also encounter ACHD, therefore it is important to ensure awareness is widespread in the form online platforms and leaflets. We must also acknowledge the impact of guidelines and ensure there is still a significant focus on IE within them. To conclude, despite the significant morbidity and mortality associated with IE in ACHD, patient awareness of symptoms, risk factors and consequences is limited. Promotion of IE awareness is a cost-effective intervention, which can reduce the incidence and complications of IE.

Heart Osteosarcoma Presenting as Infective Endocarditis: A Case Report of a Patient With a Cardiac Pacemaker and Triple Malignancies

Primary and metastatic cardiac sarcomas represent rare neoplasms with a variable clinical course. We present a rare case of an 84-year-old man with a cardiac pacemaker and heart osteosarcoma, hepatocellular and prostatic carcinoma, who was admitted with suspected symptoms of infective endocarditis. Findings of cardiac osteosarcoma in a patient with a pacemaker and three malignancies have not been reported before in the literature. J Med Cases. 2019;10(8):234-240 doi: https://doi.org/10.14740/jmc3333

Bacterial DNA detected on pathologically changed heart valves using 16S rRNA gene amplification.

Nowadays, dental diseases are one of the most common illnesses in the world. Some of them can lead to translocation of oral bacteria to the bloodstream causing intermittent bacteraemia. Therefore, a potential association between oral infection and cardiovascular diseases has been discussed in recent years as a result of adhesion of oral microbes to the heart valves. The aim of this study was to detect oral bacteria on pathologically changed heart valves not caused by infective endocarditis. In the study, patients with pathologically changed heart valves were involved. Samples of heart valves removed during heart valve replacement surgery were cut into two parts. One aliquot was cultivated aerobically and anaerobically. Bacterial DNA was extracted using Ultra-Deep Microbiome Prep (Molzym GmbH, Bremen, Germany) followed by a 16S rRNA gene PCR amplification using Mastermix 16S Complete kit (Molzym GmbH, Bremen, Germany). Positive PCR products were sequenced and the sequences were analyzed using BLAST database ( http://www.ncbi.nlm.nih/BLAST ). During the study period, 41 samples were processed. Bacterial DNA of the following bacteria was detected in 21 samples: Cutibacterium acnes (formerly Propionibacterium acnes) (n = 11; 52.38% of patients with positive bacterial DNA detection), Staphylococcus sp. (n = 9; 42.86%), Streptococcus sp. (n = 1; 4.76%), Streptococcus sanguinis (n = 4; 19.05%), Streptococcus oralis (n = 1; 4.76%), Carnobacterium sp. (n = 1; 4.76%), Bacillus sp. (n = 2; 9.52%), and Bergeyella sp. (n = 1; 4.76%). In nine samples, multiple bacteria were found. Our results showed significant appearance of bacteria on pathologically changed heart valves in patients with no symptoms of infective endocarditis.

Deri lezyonlu enfektif endokardit olgusu

Infective endocarditis is the microbial infection of the endothelial surface of the heart. It is a rare but serious disease and carries a high risk of mortality and morbidity. The clinical findings and symptoms of infective endocarditis are various. High body temperature, sudden and variable cardiac murmur, splenomegaly, Osler nodules by immunocomplex vasculitis, Janeway lesions, Roth spots at funduscopy may be seen. Antibiotic therapy should be initiated quickly, and should be followed closely in terms of need for surgery. In this case report a female patient who had applied to our clinic with skin lesions, high body temperature and aortic valve vegetation diagnosed as infective endocarditis and later healed by successfull aortic valve replacement is presented. Key Words: Infective endocarditis, aortic valve replacement, skin lesion

Nosocomial infective endocarditis in a renal transplant patient: culprit central venous line

Nosocomial infective endocarditis (IE) is a relatively uncommon but, a serious complication affecting critically ill hospitalized patients who are frequently exposed to life-saving invasive procedures. Immunosuppressive treatment in solid organ transplant recipients predisposes to infections, nevertheless, nonspecific symptoms of IE, such as fever, lassitude, weight loss, and signs of inflammation may often be misinterpreted as acute rejection episode or a common urinary tract infection. The case reported here was a recent renal transplant with methicillin-resistant Staphylococcus aureus IE. We believe the diagnoses of IE in her were missed at her first presentation due to her non-specific symptoms and lack of echocardiography and blood culture results. Septic procedure at insertion of central venous catheter (CVC) in the Intensive Care Unit with trauma to tricuspid valve (TV) at the time of CVC insertion was a possible source of infection for IE. The patient was managed effectively with intravenous antibiotics in spite of having hanging pedunculated vegetation on TV.

Echocardiographic screening of Danish injection drug users

Purpose: Injection drug users (IDUs) account for a disproportionally large number of the hospitalisations for infective endocarditis (IE). However the frequency of previous and cardiac abnormalities in a community-based cohort of active IDUs is unknown. The aim of the present study was to assess cardiac abnormalities with echocardiography in a community-based cohort of active IDUs focusing on signs of previous IE. Methods: A community-based cohort of non-hospitalised, active IDUs was screened with transthoracic echocardiography at five different supervised injection facilities in Copenhagen, Denmark. Participation was anonymous and data on substance abuse and heart disease were self-reported. Valves were described as normal, with regurgitation, thickening of leaflets and/or with vegetations. Echocardiographic findings were summarized as previous IE if two out of three criteria (moderate to severe regurgitation/thickening of leaflets/vegetations) were present for at least one valve. Results: A total of 207 IDUs (mean age 42.7±9.3, 23% female) with a median injection drug abuse of 18 (interquartile range 10-26) years were included. Fourteen IDUs (7%) reported a previous history of IE. Two (1%) IDUs had previously had surgery for with aortic valve replacement. Echocardiographic signs consistent with probable previous were found in 29 (14%) IDUs. The incidence density rate of was 7.7/1000 years of injection drug abuse. The tricuspid valve was affected in 18 (62%), the aortic valve in three (10%) and the mitral valve in eight (28%) IDUs with signs of IE. Vegetations were noted in 16 (8%) IDUs, including in one subject with a prosthetic aortic valve. No medical history of was reported in 21 (72%) of IDUs with findings consistent with previous IE. The presence of echocardiographic signs of was not associated with sex, age or duration of injection drug abuse. In two (2%) IDUs reduced ejection fractions of 45 and 30% was observed. Moderate or severe left atrial dilatation was seen in 24 (12%) IDUs. Conclusion: Echocardiographic signs consistent with previous were frequent in a community-based cohort of active, non-hospitalised IDUs. A majority of those with signs of previous did not have a medical history of IE. The high frequency of previous emphasizes the importance of considering as a differential diagnosis when assessing IDUs with fever. As another point of view the high prevalence of echocardiographic signs consistent with in IDUs calls for caution when interpreting echocardiographic findings in IDUs without symptoms of IE.

Infective endocarditis of presumed dental origin and the new NICE guidelines: a case report

AbstractIntroduction: Antimicrobial prophylaxis against infective endocarditis (IE) in patients undergoing interventional procedures is no longer recommended. We present a case of IE following dental treatment for which NICE guidelines were followed.Case report: A 59‐year‐old gentleman presented with a 1 week history of general malaise, nausea, loss of appetite and lethargy after minimal exertion. Known mitral valve prolapse was reported, and an initial differential diagnosis included subacute bacterial endocarditis. An echocardiogram and Streptococcus mitis growth in the blood cultures supported the likely diagnosis. He was referred to the Oral and Maxillofacial Surgery Department where his previous dental history revealed dental treatment 1 month before admission. In line with the current National Institute for Health and Clinical Excellence (NICE) guidelines, the patient did not receive antibiotics preoperatively.Discussion: Dental professionals should be able to recognise the signs and symptoms of IE. It is important to remain informed about such a pathological entity and be aware of its diagnosis and management. Patients with certain cardiac conditions who are at increased risk of developing IE still remain at risk, despite the recent change in the NICE guidelines. The promotion of preventive dentistry and medicine is crucial to reduce the overall risk of IE.

Use of a Simple Criteria Set for Guiding Echocardiography in Nosocomial Staphylococcus aureus Bacteremia

Infective endocarditis (IE) is a severe complication in patients with nosocomial Staphylococcus aureus bacteremia (SAB). We sought to develop and validate criteria to identify patients at low risk for the development of IE in whom transesophageal echocardiography (TEE) might be dispensable. Consecutive patients with nosocomial SAB from independent cohorts in Europe (Invasive S. aureus Infection Cohort [INSTINCT]) and North America (S. aureus Bacteremia Group [SABG]) were evaluated for the presence of clinical criteria predicting an increased risk for the development of IE (ie, prolonged bacteremia of >4 days' duration, presence of a permanent intracardiac device, hemodialysis dependency, spinal infection, and nonvertebral osteomyelitis). Patients were observed closely for clinical signs and symptoms of IE during hospitalization and a 3-month follow-up period. IE was present in 13 (4.3%) of 304 patients in the INSTINCT cohort and in 40 (9.3%) of 432 patients in the SABG cohort. Within 14 days after the first positive blood culture result, echocardiography was performed in 39.8% and 57.4% of patients in the INSTINCT and SABG cohorts, respectively. In patients with IE, the most common clinical prediction criteria present were prolonged bacteremia (69.2% vs 90% for INSTINCT vs SABG, respectively) and presence of a permanent intracardiac device (53.8% vs 32.5%). In total, 13 of 13 patients in the INSTINCT cohort and 39 of 40 patients in the SABG cohort with documented IE fulfilled at least 1 criterion (sensitivity, 100% vs. 97.5%; negative predictive value, 100% vs 99.2%). A simple criteria set for patients with nosocomial SAB can identify patients at low risk of IE. Patients who meet these criteria may not routinely require TEE.

Infective Endocarditis in Adults with Congenital Heart Disease.

Although modern medicine has improved survival in congenital heart disease dramatically, the long-term course carries a risk of late complications. The incidence of infective endocarditis in adults with congenital heart disease is more than 10 times higher than that of the normal population. Identification of the high-risk groups, a high diagnostic alert, and no random prescription of antibiotics to these patients are important issues to health care providers. There is also a need for a structured education of patients on preventive measures and symptoms of infective endocarditis.

Endocarditis Due to Actinomyces viscosus

We report a case of endocarditis caused by Actinomyces viscosus in a previously healthy young adult with no known identifiable portal of entry. Infective endocarditis caused by A viscosus is uncommon; two cases of endocarditis caused by this species have been previously reported. Primary actinomycotic endocarditis has been previously reviewed in 1993; we provide a review of additional cases since that report. In comparing our case with the other reported cases, we found that actinomycotic endocarditis (1) occurs in a wide spectrum of age, (2) affects primarily males, (3) has a high propensity for systemic embolization, and (4) has involved only native heart valves. The disease is manifested by the typical signs and symptoms of infective endocarditis and is curable with long-term penicillin therapy. The use of echocardiography in the diagnosis of endocarditis, techniques for improving the microbiologic diagnosis of endocarditis, and current indications for surgical intervention are discussed.

Endocarditis Due to Actinomyces viscosus

We report a case of endocarditis caused by Actinomyces viscosus in a previously healthy young adult with no known identifiable portal of entry. Infective endocarditis caused by A viscosus is uncommon; two cases of endocarditis caused by this species have been previously reported. Primary actinomycotic endocarditis has been previously reviewed in 1993; we provide a review of additional cases since that report. In comparing our case with the other reported cases, we found that actinomycotic endocarditis (1) occurs in a wide spectrum of age, (2) affects primarily males, (3) has a high propensity for systemic embolization, and (4) has involved only native heart valves. The disease is manifested by the typical signs and symptoms of infective endocarditis and is curable with long-term penicillin therapy. The use of echocardiography in the diagnosis of endocarditis, techniques for improving the microbiologic diagnosis of endocarditis, and current indications for surgical intervention are discussed.

Autoreactive mechanisms in infective endocarditis.

Infective endocarditis is not a simple interaction between a microbial agent and a cardiac valve. For the infection of a non-bacterial thrombotic vegetation, predisposition is required which is at least partially operative by a decreased suppressor T cell activity. During infection, peripheral blood natural killer cell activity is decreased, but normalizes under anti-microbial therapy. Non-major histocompatibility complex-restricted lymphocytotoxicity to isolated heart cells can be present in one third of patients. Circulating immune complexes normalize during therapy. They may be the cause of many clinical symptoms of infective endocarditis. Anti-bacterial and also anti-sarcolemmal antibodies which are cross-reactive to the bacterium are secreted in a polyclonal immune response. Anti-sarcolemmal antibodies which are cytolytic in vitro in the presence of complement may partly explain the myocardial factor of heart failure in patients with only marginal valve incompetence due to the endocarditic vegetation.

Short-term Therapy for Streptococcal Infective Endocarditis

In a prospective study, 91 patients with penicillin-sensitive infective endocarditis (IE) were treated for two weeks with intramuscular (IM) penicillin G procaine, 1.2 million units every six hours, plus streptomycin sulfate, 500 mg IM every 12 hours. Viridans streptococci were isolated from 70 patients (77%); 21 patients (23%) had Streptococcus bovis infections. Eighteen patients (20%) had had symptoms of IE for three months or longer. Follow-up ranged from two months to 6.6 years. There were no relapses; mild vestibular toxic reactions occurred in two patients (2%). Two patients (2%) died--one of sudden-onset severe heart failure and one of cardiac arrest after aortic valve replacement. Twenty-six patients (19%) required cardiac valve replacement after completion of antimicrobial therapy. This therapy seems as efficacious as four weeks of parenteral antimicrobial therapy and is more cost-effective.