Enfektif Endokarditin Nadir Bir Komplikasyonu (original) (raw)
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Atrioventricular block: An unusual presentation of infective endocarditis
Clinical Intensive Care, 2006
Atrioventricular conduction disturbances are uncommon as the first presentation of infective endocarditis (IE) and are often related to the extension of the valve infection around the annulus and a perivalvular abscess. The electrocardiogram can be useful in the diagnosis of IE. New onset atrioventricular conduction disturbances in a patient with a prosthetic valve, make the diagnosis of IE likely. We present a patient, with an aortic prosthesis, without any sign of sepsis, in whom a type I seconddegree atrioventricular block was the first clinical finding of IE. The patient was admitted for pacemaker implantation because of symptomatic atrioventricular block. Two days after admission, fever was present and Streptococcus viridans grew in blood cultures. An echocardiogram showed a vegetation on the prosthetic valve. In prosthetic valve carriers, echocardiography could be encouraged to preclude IE before pacemaker implant, even when signs or symptoms of sepsis are absent, avoiding electrode infection.
Clujul Med., 2015
Background and aims. In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult.Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients. The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis. Methods. We performed a prospective observational study between January 2008-June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute. We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE. Results. The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible. Conclusion. Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations-bacteremia, fever and peripheral stigmata-makes the diagnosis of IE a challenge.
Clinical, echocardiographic, and operative findings in active infective endocarditis
Heart, 1982
Clinical and echocardiographic findings were compared with those found at operation in 18 consecutive patients with active endocarditis undergoing valve replacement for continuing left ventricular failure. A close correlation was shown between vegetations detected by echocardiography and those found at operation. In 10 of 11 patients with clinically suspected severe aortic regurgitation and vegetations only on the aortic valve and in two of three patients with severe mitral regurgitation echocardiography provided confirmation of the clinical diagnosis. In the three patients with clinically suspected aortic and mitral regurgitation, however, cardiac catheterisation was necessary to confirm the severity ofthe valvular regurgitation. In a further three patients cardiac catheterisation was carried out as the severity of the single valve lesion was difficult to assess or there were associated problems, that is chest pain with myocardial infarction and a sinus of Valsalva aneurysm. Four patients had either an abscess, annular infection, a sinus, or a ventricular septal defect at the time of operation, which were not detected by echocardiography. Nevertheless, because of their size it would be doubtful if these would have been identified by cardiac catheterisation. Echocardiography allowed repeated assessment of the patient so that the optimal time for operation could be determined without the risks ofleft heart catheterisation. Fourteen ofthe 18 patients (78%) survived to leave hospital. The follow-up extended to 44 months. During this time reinfection, prosthetic dehiscence, or paravalvular leaks did not occur. Thus, in the majority of patients with left sided active infective endocarditis and continuing left ventricular failure resulting from severe valvular disease the clinical findings together with echocardiography provide a satisfactory preoperative assessment.
An atypical presentation of infective endocarditis
Revista Portuguesa de Cardiologia, 2012
Infective endocarditis is a well-known clinical entity. However, despite improved diagnostic techniques and advances in treatment options, left-sided native valve infective endocarditis remains a serious disease with high morbidity and mortality, especially in cases caused by Staphylococcus aureus. The clinical heterogeneity of infective endocarditis sometimes prevents rapid recognition, correct diagnosis and timely treatment, which are essential to reduce the morbidity and mortality associated with this disease. We report the case of a 62-year-old man, admitted for atrial fibrillation with complete atrioventricular block, which was found to be the result of methicillin-resistant S. aureus mitral valve endocarditis, complicated by local extension of the infection, heart failure, systemic embolism and multiple organ failure.