Caries Experience and Knowledge About Oral Health Importance Among Children with Congenital Heart Diseases in Kosovo

Abstract Objective: To determine the dental health of children with Congenital Heart Diseases (CHD) and to evaluate the parents' knowledge of the importance of oral health and the risk of Bacterial Endocarditis. Material and Methods: This research included 140 children divided into the study group (80 children with CHD) and the control group (60 healthy children). The children were from different parts of Kosova, aged between 3-15. The parents were asked to complete a questionnaire containing demographic data (age and gender), general and special medical history (CHD types), knowledge about oral health importance and risk of bacterial endocarditis, and data about the daily oral hygiene child. The caries experience was reported using the DMFT/dmft index. Results: The average value of the dmft index was 6.7 for the study group and 5.62 for the control group, while the average value of DMFT index for the study group was 4.1, and for the control group was 3.47 (p>0.05). About 68.7% of parents of children with CHD were informed about their risk during dental interventions. However, knowledge was insufficient about the importance of oral health and dental prophylactic measures once only 32.7% of them were aware of those measures. Conclusion: No difference was observed between healthy and CHD children in caries experience and frequency of daily tooth brushing. Our findings provide evidence of a lack of knowledge about the importance of oral health and dental prophylactic measures among parents with CHD children (AU).

Post-mortem findings in Staphylococcus aureus acute infective endocarditis

Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-year-old male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism.

Endocardite aórtica e tricúspide em pacientes de hemodiálise com embolia sistêmica e pulmonar / Aortic and tricuspid endocarditis in hemodialysis patient with systemic and pulmonary embolism

RESUMO Este artigo relata o caso de um homem caucasiano de 43 anos de idade com nefropatia terminal em tratamento com hemodiálise e apresentando endocardite infecciosa das válvulas aórtica e tricúspide. O quadro clínico foi dominado pelo comprometimento neurológico, devido à embolia cerebral e a componentes hemorrágicos. Uma tomografia computadorizada tóraco-abdominal revelou um êmbolo séptico pulmonar. O paciente foi submetido à antibioticoterapia empírica utilizando ceftriaxona, gentamicina e vancomicina, sendo o tratamento modificado para flucloxacilina e gentamicina após o isolamento de S. aureus nas hemoculturas. A equipe multidisciplinar determinou que o paciente deveria ser submetido à substituição de válvulas após estabilização da hemorragia intracraniana; contudo, no oitavo dia após a hospitalização, o paciente entrou em parada cardíaca causada por embolia séptica pulmonar maciça, vindo a falecer. Apesar do risco de agravamento da lesão hemorrágica cerebral, em pacientes de alto risco deveria ser considerado realizar precocemente uma intervenção cirúrgica.

ABSTRACT This is a case report of a 43-year-old Caucasian male with end-stage renal disease being treated with hemodialysis and infective endocarditis in the aortic and tricuspid valves. The clinical presentation was dominated by neurologic impairment with cerebral embolism and hemorrhagic components. A thoracoabdominal computerized tomography scan revealed septic pulmonary embolus. The patient underwent empirical antibiotherapy with ceftriaxone, gentamicin and vancomycin, and the therapy was changed to flucloxacilin and gentamicin after the isolation of S. aureus in blood cultures. The multidisciplinary team determined that the patient should undergo valve replacement after the stabilization of the intracranial hemorrhage; however, on the 8th day of hospitalization, the patient entered cardiac arrest due to a massive septic pulmonary embolism and died. Despite the risk of aggravation of the hemorrhagic cerebral lesion, early surgical intervention should be considered in high-risk patients.

Infectious endocarditis caused by Nocardia sp.: histological morphology as a guide for the specific diagnosis

Nocardia is a rare opportunistic agent, which may affect immunocompromised individuals causing lung infections and exceptionally infective endocarditis (IE). There are few reports of IE caused by Nocardia sp., usually involving biological prostheses but rarely in natural valves. Its accurate microbiological identification may be hampered by the similarity with Rhodococcus equi and Corynebacterium spp. Here we report a case of native mitral valve IE caused by this agent in which the clinical absence of response to vancomycin and the suggestion of Nocardia sp. by histology pointed to the misdiagnosis of Corynebacterium spp. in blood cultures. The histological morphology can advise on the need for expansion of cultivation time and use of extra microbiological procedures that lead to the differential diagnosis with Corynebacterium spp. and other agents, which is essential to establish timely specific treatment, especially in immunocompromised patients.

Endocardite por Coxiella burnetii (febre Q): doença rara ou pouco diagnosticada? Relato de caso / Endocarditis due to Coxiella burnetii (Q fever): a rare or little diagnosed disease? Case report

A febre Q é uma zoonose de distribuição mundial causada por Coxiella burnetii, sendo raros os registros da doença no Brasil. Estudos soroepidemiológicos mostraram uma freqüência relativamente elevada de anticorpos contra Coxiella burnetii em populações com exposição ocupacional. Em humanos, pode se manifestar clinicamente como doença aguda ou crônica, sendo que a endocardite é a forma crônica mais freqüente da febre Q e de maior morbi-mortalidade. Relatamos um caso grave de endocardite por Coxiella burnetii adquirida no Brasil com desfecho fatal, apesar de antibioticoterapia adequada e tratamento cirúrgico valvar.

Q fever is a zoonosis of worldwide distribution that is caused by Coxiella burnetii. However, reports of this disease in Brazil are rare. Seroepidemiological studies have shown relatively high frequencies of antibodies against Coxiella burnetii in populations with occupational exposure. In humans, it can be manifested clinically as acute or chronic disease. Endocarditis is the most frequent chronic form of Q fever and the form with the greatest morbidity and mortality. We report a severe case of endocarditis due to Coxiella burnetii acquired in Brazil that had a fatal outcome, despite specific antibiotic therapy and valve surgery treatment.

Endocarditis infecciosa actinomicótica de la válvula mitral: caso de autopsia y revisión de la literatura / Actinomycotic infective endocarditis of the mitral valve: anatomoclinical case and review of literature

La infección actinomicótica del corazón es una enfermedad poco común, especialmente cuando el compromiso endocárdico valvular es primario. Sólo unos pocos casos han sido publicados. Comunicamos un caso de endocarditis primaria por Actinomyces sp de la válvula mitral, diagnosticada en la necropsia de un hombre de 34 años con antecedentes de valvulopatía reumática crónica, que falleció con una endocarditis infecciosa.

Actinomycotic infections of the heart is an uncommon disease, especially if the infection affects the valvular endocardium as primary focus. Just a few cases have been reported previously. We report a case of primary endocarditis of the mitral valve caused by Actinomyces sp diagnosed at necropsy in a 34 year-old man with history of chronic rheumatic disease presenting as a usual case of infective endocarditis.

Definición, clasificación, aspectos históricos, epidemiología y factores de riesgo / Definition, classification, historical aspects, epidemiology and risk factors

El perfil clínico y epidemiológico de la EI ha variado en las últimas décadas en forma importante, lo que debe considerarse al momento de tomar decisiones en relación al diagnóstico, tratamiento y, posiblemente, en la profilaxis. De ser una afección predominante en pacientes con alteraciones anatómicas valvulares, principalmente secuelas de enfermedad reumática y bacteremias por gérmenes clásicamente extrahospitalarios (60-80 por ciento de los gérmenes aislados correspondían a especies de estreptococos), sus características epidemiológicas han variado sustancialmente en los últimos 20 años. El envejecimiento poblacional, el mayor uso de métodos diagnósticos y terapéuticos de tipo invasivo, la mayor difusión de implantes de dispositivos intracardíacos y las mayores tasas de bacteremias nosocomiales, son algunas de las razones que explican que actualmente la EI se presente en pacientes sin valvulopatías o con una etiología diferente a la reumática y que el germen más frecuentemente aislado en las series comunicadas en el último tiempo sea el estafilococo aureus, incluido el estudio prospectivo nacional ya mencionado.

Infectious endocarditis in pacemaker endocardial leads: Report of three cases / Endocarditis infecciosa en marcapaso endocárdico. Reporte de 3 casos

Se presentan tres casos de endocarditis en cables de marcapasos definitivos y se hace una revisión de la literatura. La ecocardiografía transesofágica permitió diagnosticar las vegetaciones. La infección de los cables del marcapaso es menos común que la infección en el sitio del generador de pulso y tiene mayor morbilidad y mortalidad. Generalmente requiere extirpación quirúrgica de ambos electrodos y de la fuente de poder. Los gérmenes más frecuentemente encontrados son las variedades de Staphylococcus

Endocarditis infecciosa mitral y/o aórtica. Correlación entre ecocardiografía transesofágica, cirugía y anotomía patológica / Mitral and/or aoertic infective endocarditis

El objetivo de este estudio fue correlacionar los hallazgos obtenidos por ecocardiografía transesofágica con los obtenidos durante la cirugía y el estudio de anatomía patológica en pacientes con endocarditis infecciosa (EI) en válvula mitral y/o aórtica. Se estudiaron 28 pacientes a quienes se les realizó historia clínica, estudio bacteriológico y ecocardiograma transesofágico (ETE). En el estudio bacteriológico se encontraron hemocultivos positivos en 15 casos, en 13 los hemocultivos fueron negativos. El ETE demostró vegetaciones infecciosas en válvula mitral en 11 casos y en 5 enfermos en ambas válvulas. Complicaciones relacionadas con el proceso infecciosos se encontraron en el 53 por ciento de los casos. La incidencia de eventos embólicos fue del 25 por ciento. La concordancia entre el ETE y la anatomía patológica, en relación a la presencia de vegetaciones, fue del 92.8 por ciento y entre el ETE y la cirugía, en relación a la presencia de vegetaciones y complicaciones, fue del 89.2 por ciento. El ETE es un método de gran utilidad no sólo para el diagnóstico, sino también para el pronóstico de la EI, por su alta concordancia con los estudios de anatomía patológica y cirugía

Confronto anátomo-propedêutico: sopro de Austin Flint em um caso de endocardite bacteriana / Anatomopropaedeutical confrontation: Austin Flint's murmur in a case of bacterial endocarditis

Trata da correlaçäo anátomo-clínica e ecocardiográfica de um trombo séptico em valva aórtica, que na ausculta cardíaca revelou sopro diastólico com reforço pré-sistólico em foco mitral (sopro de Austin Flint) e, cujo ecocardiograma näo demonstrou a vegetaçäo. Foi discutido a correlaçäo anátomo-radiológica das embolias pulmonares decorrentes da endocardite bacteriana da valva tricúspide.

Endocardite infecciosa: parte 1 / Infective endocarditis: part 1

A endocardite infecciosa (EI) é discutida em seus aspectos etiopatogênicos, patológicos, clínicos, diagnósticos e terapêuticos, sendo também expostas as modernas táticas sobre sua profilaxia. A despeito da introduçao da terapêutica antimicrobiana, que reduziu extraordinariamente a mortalidade por infecçao, os enfermos de EI continuaram a morrer, em conseqüência de insuficiência cardíaca, lesoes neurológicas e embolias arteriais sistêmicas. Embora os procedimentos cirúrgicos com o intuito de baixar essas persistentes causas de morte tenham trazido enorme progresso para o tratamento da EI, permanece elevada a morbidade dessa infecçao e sua mortalidade fica, ainda hoje, em torno de 30 por cento dos casos, devendo-se atribuir aos diagnósticos tardios grande responsabilidade por tais fatos. Mesmo assim, constitui-se essa entidade no presente um dos mais vivos exemplos da trajetória progressista da arte e da tecnologia médicas. Sua atual abordagem correta comprova uma das grandes conquistas do homem.

Endocardite infecciosa: análise de 20 casos de óbito na Santa Casa de Säo Paulo / Infectious endocarditis: analysis of 20 death cases in Santa Casa de Säo Paulo

PURPOSE--To analyze the clinical, laboratory and pathological aspects of 20 cases of infectious endocarditis (IE) who died. The authors compared patients with diagnosis before death of IE and those with diagnosis was made after autopsy. METHODS--Twenty patients who died with IE between April 1982 and November 1991 were studied. We looked for the clinical aspects (fever, cardiac murmurs, anemia, splenomegaly, embolic events and skin manifestation), laboratory aspects (hemocultures), echocardiographic and anatomopathologic features (valvar vegetations events and embolic accidents founded at autopsy). The sample was divided in two sub-groups: A--with clinical diagnosis of IE before and B--without diagnosis before death. RESULTS--Group A--9 patients aged 8-58 years, 3 men, all them with cardiac murmurs, fever and anemia, 5 with splenomegaly. Hemocultures were done in 7 patients and positive in 1. Echocardiogram with valvar vegetation were found in 4 out of 5 patients (80 per cent positive). At autopsy mitral valve vegetation were present in 7, aortic 3, tricuspid 3. One patient showed the exposure of three valves and two of 2 valves. Embolic events were found in 4. Group B--11 patients most of them older then 50 years (54.5 per cent) (p < 0.05) 5 men, all them presented fever and anemia. Cardiac murmurs in 6 (54 per cent) and none with splenomegaly. In one case hemoculture and echocardiogram, were done and were negative. Anatopathologic study showed compromise of mitral valve in 5, aortic 4, tricuspid 2, pulmonary 1. Two patients had 2 valves compromised. In one case a mural vegetation (right atrium) was found. Embolic events were present in 2 cases. CONCLUSION--In group B a significant number of patients (p < 0.05) were older than 50 years and presented his symptoms as an acute illness. We concluded that older patients with compromised general state and fever with or without embolic events IE must be remember