Endocarditis infecciosa en canino con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna: reporte de caso / Infectious Endocarditis in Dogs with a Previous Diagnosis of Peripheral Vestibular Syndrome Secondary to Probable Otitis Media-Interna: A Case Report

Resumen La endocarditis infecciosa es un proceso patológico de baja incidencia en la clínica diaria; su principal etiología son los agentes bacterianos, los cuales colonizan con mayor prevalencia de válvula mitral y aortica. En este artículo se presenta el estudio de un perro con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna. Se presenta con un soplo de aparición súbita, claudicaciones intermitentes, inapetencia, depresión y fiebre, por lo cual se hace la valoración ecocardiográfica, donde se evidencia engrosamiento valvular mitral, acompañado de estructuras hiperecoicas en el borde libre que corresponden a lesiones vegetativas. Por medio de los criterios de Duke modificados se obtiene un diagnóstico definitivo de endocarditis infecciosa, para lo cual se realiza manejo médico intrahospitalario, sin evolución favorable. Los hallazgos clínicos y paraclínicos coinciden con lo reportado en la literatura. Los criterios de Duke modificados permiten orientar el diagnóstico y evidenciar signos clínicos de alarma. El manejo médico antimicrobiano deberá realizarse con base en hemocultivos y pruebas de sensibilidad, siempre teniendo en cuenta la prevalencia de patógenos y el origen primario de la infección. Se debe considerar como una patología con un pronóstico malo y un porcentaje de fatalidad alto. Finalmente, se concluye que la principal limitación del caso es la falta de confirmación histopatológica.

Abstract Infectious endocarditis is a pathological process with low incidence in the daily clinical practice. The main etiology are the bacterial agents that colonize with higher prevalence the mitral and aortic valves. This paper reports the case of a dog with a previous diagnosis of peripheral vestibular syndrome secondary to probable otitis media-interna. The dog has a sudden heart murmur, intermittent claudications, lack of appetite, depression and temperatures. It is performed an echocardiographic assessment that shows mitral valve thickening with hyperecoic structures in the free border that indicates vegetations. Using the Modified Duke Criteria, a definitive diagnosis of infectious endocarditis is concluded. The dog is provided a medical treatment at the clinic without success. The clinical and paraclinical findings match the background found in the literature. Modified Duke Criteria allow guiding the diagnosis process and uncovering the alarm clinical signs. Antimicrobial clinical treatment must be administered based on blood cultures and sensitivity tests and considering both the pathogen prevalence and infection primary origin. Doctors must deem this condition as a bad prognosis pathology with a high mortality percentage. Finally, it is concluded that the main limitation in this case is a lack of histopathological confirmation.

Endocarditis infecciosa en hospital clínico Herminda Martín de Chillán: experiencia de los últimos cinco años / Infective endocarditis at Herminda Martin clinical hospital of Chillan: last five years experience

Introducción: la endocarditis infecciosa es una afección con elevada morbilidad y mortalidad, con una incidencia en Chile de 2-3 casos por 100.000 habitantes al año, con una edad de presentación en ascenso y una clínica diversa e inespecífica que requiere un manejo multidisciplinario para el manejo de estos pacientes. Materiales y métodos: estudio observacional descriptivo, se consideró el número total de fichas clínicas del hospital clínico Herminda Martín de Chillán durante los años 2015 al 2019, con diagnóstico confirmado de endocarditis infecciosa. Los datos se registraron en la hoja de recolección de datos elaborada, realizándose los análisis estadísticos pertinentes. Resultados:la muestra (n=17) que pudo ser analizada tenía una edad promedio de 53,5 años; 70,5% (DE 14,50) fueron hombres y el agente más común identificado fue Staphylococcus aureus sensible a meticilina. En promedio los pacientes recibieron 28,8 días de antibióticos y la válvula más afectada fue la aórtica. Conclusiones: la endocarditis infecciosa es una patología con una gran morbimortalidad, que presenta un cuadro clínico inespecífico capaz de simular cualquier enfermedad. Se requieren aún de más estudios que reflejen la realidad nacional.

Introduction: Infective endocarditis is a condition with high morbidity and mortality, with an incidence in Chile of 2-3 cases per 100,000 inhabitants per year, with increasing age of presentation and a diverse and nonspecific clinic that requires multidisciplinary management for treatment of these patients. Materials and methods: Descriptive observational study, the total number of clinical records of the Herminda Martín de Chillán clinical hospital during the years 2015 to 2019, with a confirmed diagnosis of infective endocarditis, was considered. The data were recorded in the data collection sheet prepared, performing the relevant statistical analyses. Results: The sample (n = 17) that could be analysed had an average age of 53.5 years (DS 14.50), 70.5% were men, and the most common agent identified was methicillin-sensitive Staphylococcus aureus. On average, patients received 28.8 days of antibiotics, and the most affected valve was the aortic valve. Conclusions: Infective endocarditis is a pathology with high morbidity and mortality, which presents a nonspecific clinical spectrum, capable of simulating any disease. Still, more studies are required that reflect the national reality

Aorto-cavitary fistula: a complication of infective endocarditis / La fístula aorto-cavitaria: una complicación de la endocarditis infecciosa

Aorto-cavitary fistulae are rare complications of infective endocarditis. The diagnosis, in the absence of concomitant aortic valve disease, replacement of aortic valve with homograft or prosthetic valve, periannular abscess and negative blood culture, requires a high index of suspicion and has important prognostic and management significance. The sensitivity of the Modified Duke Criteria is challenged in this case report with a documented right sinus of valsalva fistula to the right ventricle seen on transthoracic echocardiography.

Los fístulas aorto-cavitarias son complicaciones raras de la endocarditis infecciosa. El diagnóstico - en ausencia de la enfermedad concomitante de la válvula aórtica, el reemplazo de válvula aórtica con homoinjertos o válvulas protésicas, absceso perianular, y cultivo de sangre negativo - requiere un alto índice de sospecha, y reviste gran importancia para la prognosis y el tratamiento. En este reporte de caso, se cuestiona la sensibilidad de los Criterios de Duke Modificados, con la documentación de una fístula del seno de valsalva derecho hacia el ventrículo derecho, observada en una ecocardiografía transtorácica.

Infective Endocarditis in Children : Review of 35 Cases over 11 Years (1987-1997)

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.

Recent trends and clinical outcomes of infective endocarditis / 대한내과학회지

BACKGROUND: We sought to analyze the recent trends and clinical outcomes of infective endocarditis in Korea using newly proposed diagnostic criteria, Duke criteria, for this potentially life-threatening disease. METHODS: Retrospective analysis of medical records including echocardiographic data, blood culture and operation records was done for 156 patients (male 103) with clinical diagnosis of infective endocarditis at Asan Medical Center from 1989 to January 1998. RESULTS: One hundred eighteen patients (75%) fulfilled the criteria for definite group (Group I) in Duke criteria, whereas 38 patients (25%) for possible group (Group II). Mean age was 48+/-16 years. Although valvular heart disease was the most common underlying heart disease (49/156, 31%), in more than half (84/156, 54%) infective endocarditis was the first clinical presentation without previous medical history of any cardiac disease. Surgical intervention was required in 69 patients (44%), and the frequency of surgery during hospital course did not show any difference in Group I versus Group II (44% vs. 45%). Overall mortality was 17%, and did not show any difference in Group I versus Group II. Surgical mortality was 12% (8/69), which was not significantly different form mortality with medical treatment (21%, 18/87). Among 98 survivors in Group I, 84 patients (86%) were followed for average 34+/-24 months (0.5-98 months). Five-year survival and event-free survival rate were 85+/-7 % and 57+/-8 % respectively. CONCLUSION: Recently the mean age of patients with infective endocarditis increased dramatically, and infective endocarditis could be an initial clinical presentation without any previous medical history of cardiac disease in many patients. Surgical intervention was needed in considerable numbers of patients and infective endocarditis still shows relatively high mortality. There were no significant different clinical features in Group I and II.