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1.
Rev. bras. cir. cardiovasc ; 36(1): 130-132, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155797

ABSTRACT

Abstract Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.


Subject(s)
Humans , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/diagnostic imaging , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency
2.
Rev. bras. oftalmol ; 79(5): 333-335, set.-out. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137995

ABSTRACT

Abstract This report presents a rare case of endogenous endophthalmitis due to Kingella kingae infectious endocarditis. Endogenous endophthalmitis is a rare condition that has a systemic underlying cause, with hematogenic dissemination of a pathogen that will eventually reach and infect the eye. In this article, we present a case of a 54-year-old woman with fever, chills and decreased visual acuity and pain in the right eye. The slit-lamp exam showed conjunctival injection, anterior chamber reaction with a great amount of fibrinous material obscuring her visual axis. Ultrasound echography revealed profuse exudates and scarce membranous formation in the posterior segment. Blood culture was positive for Kingella kingae, and the patient was treated with intravenous ceftriaxone, along with topic dexamethasone and mydriatic. After 15 days of intravenous antibiotic therapy, the patient exhibited best visual acuity of 20/60. Endogenous endophthalmitis is an ocular emergency that demands quick diagnosis and aggressive intervention in order to preserve vision. Therefore, it is important to recognize its signs and symptoms with no retard.


Resumo O presente relato apresenta um raro caso de endoftalmite endógena por endocardite devido à Kingella kingae. Endoftalmite endógena é uma doença pouco comum com uma causa sistêmica subjacente. A disseminação hematogênica de um microrganismo infeccioso leva à infecção ocular. Nesse artigo, apresentamos o caso de uma mulher com 54 anos, febre, calafrios, baixa da acuidade visual e dor em olho direito. Ao exame na lâmpada de fenda apresentava injeção conjuntival, reação de câmara anterior e acúmulo de fibrina no eixo visual. Ultrassonografia revelou exsudatos profusos e escassa formação membranosa em segmento posterior.A hemocultura foi positiva para Kingella kingae e a paciente foi tratada com ceftriaxone venoso conjuntamente com dexametasona e midriático tópicos. Após 15 dias de terapia antibiótica endovenosa, a paciente apresentou acuidade visual corrigida de 20/60. Endoftalmite endógena é uma emergência ocular que demanda rápido diagnóstico e intervenção agressiva para preservar a visão. Portanto, é importante o reconhecimento precoce dos sinais e sintomas.


Subject(s)
Humans , Female , Middle Aged , Ceftriaxone/therapeutic use , Eye Infections, Bacterial/drug therapy , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Kingella kingae , Endocarditis, Bacterial/complications , Injections, Intravenous
3.
Medicina (B.Aires) ; 80(2): 177-180, abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125062

ABSTRACT

La endocarditis bacteriana con hemocultivo negativo constituye un dilema diagnóstico. Tanto Bartonella como Coxiella pueden causarla, con presentaciones clínicas similares que pueden simular una vasculitis sistémica no infecciosa. Sin embargo, difieren en el tipo y la duración del tratamiento, por lo que es fundamental identificar el agente etiológico. Presentamos un caso de endocarditis por Bartonella henselae asociada a glomerulonefritis y neurorretinitis, con hemocultivo negativo, anticuerpos anticitoplasma de neutrófilos y antiproteinasa 3 positivos, y serología positiva para Bartonella con reacción cruzada para Coxiella burnetti. El diagnóstico etiológico fue confirmado a posteriori mediante amplificación y secuenciación parcial del gen ribC a partir de tejido de la válvula cardíaca. El paciente recibió tratamiento antibiótico e inmunosupresor seguido de recambio valvular aórtico y presentó evolución favorable.


Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with cross-reactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.


Subject(s)
Humans , Male , Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Endocarditis, Bacterial/microbiology , Glomerulonephritis/microbiology , Retinitis/complications , Endocarditis, Bacterial/complications , Glomerulonephritis/complications
4.
Rev. bras. cir. cardiovasc ; 34(5): 615-617, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042032

ABSTRACT

Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.


Subject(s)
Humans , Female , Middle Aged , Gram-Negative Bacterial Infections/surgery , Heart Valve Prosthesis Implantation/methods , Stenotrophomonas maltophilia , Endocarditis, Bacterial/surgery , Heart Valve Diseases/surgery , Mitral Valve/surgery , Shock, Septic/etiology , Gram-Negative Bacterial Infections/complications , Fatal Outcome , Heart Valve Prosthesis Implantation/adverse effects , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Heart Valve Diseases/complications , Heart Valve Diseases/microbiology
6.
Rev. chil. pediatr ; 89(5): 644-649, oct. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978137

ABSTRACT

Resumen: Introducción: La endocarditis es una enfermedad poco frecuente en niños, especialmente en los sin patología cardiaca previa, y de manera extraordinaria se identifica a Kingella Kingae (KK) como la causa. La oxigenación por membrana extracorpórea (ECMO) es una forma de soporte tanto para fa lla cardiaca como respiratoria. Objetivo: Reportar el primer caso de endocarditis infecciosa (EI) por KK que requiere soporte con ECMO por shock cardiogénico refractario. Caso clínico: Lactante de 19 meses, previamente sana, que consultó por cuadro de 2 días de fiebre, diagnosticándose síndrome pie mano boca. Evolucionó con shock, falla multiorgánica, síndrome de distress respiratorio agudo y compromiso hemodinámico profundo, por lo que se le dio soporte con ECMO veno arterial. La ecoscopía mostró imagen compatible con vegetación en válvula mitral, confirmando EI con ecocardiografía transtorácica. El hemocultivo fue positivo a KK. Presentó accidente cerebrovascular isquémico. Requirió dos cardiocirugías -la primera para resección de la masa y la segunda para la reparación de la válvula mitral, que había quedado con un pseudoaneurisma del anillo- velo posterior. La paciente tuvo una evolución favorable, siendo dada de alta a los 73 días desde el ingreso. Al año de seguimien to se encontraba asintomática cardiaca, pero persistía una hemiparesia braquiocrural derecha leve. Conclusión: Este es el primer caso reportado de EI por KK que requirió soporte vital extracorpóreo. La EI por KK es una patología infrecuente, que puede provocar falla orgánica múltiple, la que puede ser soportada exitosamente con ECMO.


Abstract: Introduction: Endocarditis is a rare disease in children, especially in those without previous heart disease, and Kingella Kingae (KK) is rarely identified as the cause. Extracorporeal membrane oxyge nation (ECMO) is a support for both heart and respiratory failure. Objective: To report the first case of infectious endocarditis (IE) due to KK which required ECMO support secondary to refractory cardiogenic shock. Clinical case: 19-months-old previously healthy female patient, with a 2-day his tory of fever, and diagnosed with hand-foot-and-mouth disease. The patient developed refractory cardiogenic shock, multiorgan failure, acute respiratory distress syndrome, and deep hemodynamic compromise that required veno-arterial ECMO support. The echography showed an image compa tible with mitral valve vegetation, confirming IE with transthoracic echocardiography. Blood culture was positive for KK. She had an ischemic stroke and required two heart surgeries, the first one for the mass resection and the second one for mitral valve repair, which had a posterior ring pseudoa neurysm. The patient had a favorable evolution and was discharged 73 days after admission. At one year of follow-up, she had no cardiological symptoms, but a mild right brachial-crural hemiparesis persisted. Conclusion: This is the first reported case of IE due to KK that required extracorporeal life support. KK endocarditis is an uncommon pathology that can cause multiorgan failure, which can be successfully supported with ECMO.


Subject(s)
Humans , Female , Infant , Shock, Cardiogenic/therapy , Extracorporeal Membrane Oxygenation , Neisseriaceae Infections/complications , Kingella kingae , Endocarditis, Bacterial/complications , Shock, Cardiogenic/microbiology
7.
J. vasc. bras ; 17(4): 318-321, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969131

ABSTRACT

Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz


ibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment


Subject(s)
Humans , Male , Aged , Aneurysm, False/complications , Aneurysm, False/physiopathology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/etiology , Endovascular Procedures/methods , Magnetic Resonance Imaging/methods , Stents , Treatment Outcome , Tibial Arteries , Lower Extremity , Infections/diagnostic imaging
8.
Rev. chil. cardiol ; 37(2): 104-109, ago. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959347

ABSTRACT

Resumen Paciente de sexo femenino de 65 años, con antecedentes de hipertensión arterial crónica, resistencia a la insulina, histerectomía total y fractura tibioperonea antigua, es hospitalizada por cuadro febril, sin foco, de 2 meses de evolución, con sospecha de endocarditis por parámetros inflamatorios elevados y soplo diastólico en foco aórtico 2/6. Se estudia con ecocardiograma, transtorácico (ETT) y transesofágico (ETE), que muestra vegetación en velo aórtico coronario izquierdo de 9 mm por 7 mm e insuficiencia aórtica leve, motivo por el cual se toma hemocultivo resultando positivo para Rothia aeria. La paciente evoluciona con embolia de riñón derecho y bazo, y posteriormente, con hemorragia subaracnoidea. Inicia tratamiento antibiótico con ampicilina, vancomicina y gentamicina, con lo cual presenta una evolución satisfactoria y es dada de alta luego de 28 días de hospitalización. Al revisar la literatura, se puede llegar a la conclusión de que la endocarditis por Rothia es extremadamente infrecuente y que, en cuanto al cuadro clínico, tiene tendencia a una forma de presentación subaguda, con presencia de vegetaciones grandes mayores a 10mm y un alto grado de complicaciones neurológicas.


Abstract A 65-year-old female patient, with a history of chronic hypertension, insulin resistance, total histerectomy, and tibioperoneal fracture, is hospitalized for fever of unknown etiology. Basterial endocarditis was suspected due to elevated inflammatory parameters and a 2/6 diastolic murmur present in the aortic focus. Transthoracic and transesophageal echocardiography, showed a 9 mm by 7 mm vegetation in the left coronary aortic leaflet of and mild aortic insufficiency, Blood cultures were positive for Rothia aeria. She developed embolism of the right kidney and spleen, and subsequently, a subarachnoid hemorrhage. Antibiotic therapy was initiated with ampicillin, vancomycin and gentamicin, with a satisfactory evolution being discharged after 28 days of hospitalization. When reviewing the literature, it can be concluded that Rothia endocarditis is extremely rare and that, tends to have a subacute presentation with large vegetations, larger than 10 mm, and a high incidence of neurological complications.


Subject(s)
Humans , Female , Aged , Actinomycetales Infections/complications , Actinomycetales Infections/microbiology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Subarachnoid Hemorrhage/etiology , Actinomycetales Infections/drug therapy , Actinomycetales Infections/diagnostic imaging , Echocardiography , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/diagnostic imaging , Ampicillin/therapeutic use , Micrococcaceae , Anti-Bacterial Agents/therapeutic use
9.
Medicina (B.Aires) ; 77(5): 373-381, oct. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-894503

ABSTRACT

La insuficiencia aórtica aguda (IAOA) por endocarditis infecciosa (EI) es grave y generalmente requiere tratamiento quirúrgico. Se compararon los pacientes con IAOA grave por EI e insuficiencia cardíaca (IC) en clase funcional I-II NYHA (G1) con los pacientes en clase funcional III-IV (G2) en relación a características clínicas, ecocardiográficas, microbiológicas y evolución hospitalaria y se evaluaron los predictores de mortalidad, en un centro de alta complejidad. Desde 06/92 a 07/16, de 439 pacientes con EI, 86 presentaron IAOA: (G1, 39: 45.4% y G2, 47: 54.7%). El G1 presentó mayor EI protésica (43.6% vs. 17.0%; p < 0.01). Los 47 casos G2 presentaban disnea vs. 12 (30.8%) G1 (p < 0.0001). No hubo diferencias en cuanto a las características clínicas, ecocardiográficas y microbiológicas. El tratamiento quirúrgico fue principalmente por extensión de la infección y/disfunción valvular en el G1 y por IC en el G2. La mortalidad hospitalaria fue del 15.4% vs. 27.7% (G1 y G2 respectivamente, p NS). Fueron predictores en el análisis multivariado: la infección intrahospitalaria (p 0.001), los hemocultivos negativos (p 0.004) y la presencia de IC clase funcional III-IV (p 0.039).Una quinta parte de los pacientes con EI presentaron IAOA. Aquellos con IC grave requirieron tratamiento quirúrgico de emergencia y con IC con clase funcional I-II requirieron cirugía por extensión de la infección y/o disfunción valvular. La mortalidad quirúrgica y hospitalaria continúan siendo elevadas en ambos grupos y fueron predictores de mortalidad hospitalaria: la infección intrahospitalaria, los hemocultivos negativos y la IC avanzada.


Acute aortic regurgitation (AAR) due to infective endocarditis (IE) is a serious disease and usually requires surgical treatment. Our study aims to compare the clinical, echocardiographic, and microbiological characteristics as well as in-hospital outcome of patients with AAR according to the severity of heart failure (HF) and to evaluate predictors of in-hospital mortality in a tertiary centre. In a prospective analysis, we compared patients with NYHA functional class I-II HF (G1) vs. functional class III-IV HF (G2). From 06/92 to 07/16, 439 patients with IE were hospitalized; 86 presented AAR: (G1, 39: 45.4% y G2, 47: 54.7%). The G1 had higher prosthetic IE (43.6% vs. 17%, p 0.01). All G2 patients had dyspnoea vs. 30.8% of the G1 (p < 0.0001). There were no differences in clinical, echocardiographic and microbiological characteristics. Surgical treatment was indicated mainly due to infection extension or valvular dysfunction in G1 and HF in G2. In-hospital mortality was 15.4% vs. 27.7% (G1 and G2 respectively p NS). In multivariate analysis, health care-associated acquisition (p 0.001), negative blood cultures (p 0.004), and functional class III-IV HF (p 0.039) were in-hospital mortality predictors. One-fifth of the patients with EI had AAR. Half of them had severe HF which needed emergency surgery and the remaining needed surgery for extension of the infection and / or valvular dysfunction. Both groups remain to have high surgical and in-hospital mortality. Health care-associated acquisition, negative blood cultures and advanced HF were predictors of in-hospital mortality.


Subject(s)
Humans , Male , Female , Middle Aged , Aortic Valve Insufficiency/etiology , Endocarditis, Bacterial/complications , Aortic Valve Insufficiency/mortality , Echocardiography , Acute Disease , Prospective Studies , Hospital Mortality , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality
10.
Arch. pediatr. Urug ; 88(4): 216-221, ago. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-887786

ABSTRACT

Resumen: La endocarditis infecciosa es una enfermedad poco frecuente en pediatría pero con importante morbimortalidad. Si bien existen grupos de riesgo bien definidos puede presentarse en niños sin cardiopatía subyacente e inmunocompetentes, en quienes la etiología estafilocócica es la más frecuente y el diagnóstico continúa siendo un desafío. Presentamos el caso de un niño de 2 años, previamente sano, con una endocarditis a Staphylococcus aureus meticilino sensible de presentación no usual.


Summary: Infective endocarditis is rather an unusual condition in pediatrics, although it is associated with significant morbility and mortality. In spite of there being well defined risk groups the disease may present in children with no underlying heart disease who are immunocompetent, Staphylococcus aureus being the most frequent etiology. In those cases, diagnosis still constitutes a challenge. The study presents the case of a 2 year-old patient, with a healthy history, who presented methicillin-sensitive Staphylococcus aureus infective endocarditis, with rather an unusual presentation.


Subject(s)
Humans , Male , Staphylococcal Infections/complications , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Putaminal Hemorrhage/etiology , Putaminal Hemorrhage/therapy , Intracranial Embolism/etiology , Endocarditis, Bacterial , Endocarditis, Bacterial/etiology
11.
Braz. j. infect. dis ; 21(3): 240-247, May-June 2017. tab
Article in English | LILACS | ID: biblio-839230

ABSTRACT

ABSTRACT Background: Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain. Objectives: To determine the frequency of emboli due to IE and to identify events associated with embolism. Methods: Retrospective analysis of an endocarditis database, prospectively implemented, with a post hoc study driven by analysis of data on embolic events. Data was obtained from the International Collaboration Endocarditis case report forms and additional information on embolic events and imaging reports were obtained from the medical records. Variables associated with embolism were analyzed by the statistical software R version 3.1.0. Results: In the study period, 2006-2011, 136 episodes of definite infective endocarditis were included. The most common complication was heart failure (55.1%), followed by embolism (50%). Among the 100 medical records analyzed for emboli in left-sided infective endocarditis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p < 0.01, OR 4.7, 95% CI 2.04-11). Factors associated with embolism to the spleen were positive blood cultures (p = 0.05, OR 8.9, 95% CI 1.45-177) and splenomegaly (p < 0.01, OR 9.28, 95% CI 3.32-29); those associated to the central nervous system were infective endocarditis of the mitral valve (p < 0.05, OR 3.5, 95% CI 1.23-10) and male gender (p < 0.05, OR 3.2, 95% CI 1.04-10). Splenectomy and cardiac surgery did not impact on in-hospital mortality. Conclusions: Asymptomatic embolism to the central nervous system and to the spleen were frequent. Splenomegaly was consistently associated with embolic events.


Subject(s)
Humans , Male , Female , Middle Aged , Embolism/etiology , Endocarditis, Bacterial/complications , Asymptomatic Diseases/mortality , Severity of Illness Index , Retrospective Studies , Risk Factors , Embolism/mortality , Endocarditis, Bacterial/mortality
12.
Medicina (B.Aires) ; 77(2): 89-94, Apr. 2017. tab
Article in Spanish | LILACS | ID: biblio-894438

ABSTRACT

De acuerdo a la literatura, en un 20 a 40% de las endocarditis infecciosas se producen complicaciones neurológicas. Nuestro objetivo fue determinar la frecuencia de compromiso neurológico en pacientes con endocarditis infecciosa de válvulas izquierdas, considerando la presentación clínica, tipo de lesión en las imágenes y su influencia en la evolución. Se incluyeron en forma prospectiva 98 pacientes con endocarditis infecciosa de válvulas izquierdas. El 47% (46 casos) presentó compromiso neurológico. En 28 casos (61%) el síntoma fue el déficit focal, en 9 (20%) la alteración de estado de conciencia; el 17% (8) fue asintomático y 2% (1 caso) presentó convulsiones. En las imágenes, la isquemia cerebral (76%) fue la lesión más frecuente. El tamaño de la vegetación mayor a 1 cm se asoció a compromiso neurológico (57% vs. 31%, p = 0.01). Aquellos pacientes con compromiso neurológico tuvieron mayor frecuencia de reemplazo valvular (70% vs. 44%, p = 0.01) y la mortalidad hospitalaria también fue mayor (20% vs. 15%, p = 0.5). El tiempo total de internación fue significativamente más prolongado en sujetos con compromiso neurológico (32 ± 27 vs. 21 ± 15 días, p = 0.01) y la discapacidad fue mayor en los que tenían manifestaciones neurológicas (74% vs. 36% p = 0.0001). En nuestra serie, el síntoma más frecuente fue el déficit focal, y en las imágenes la isquemia cerebral fue el patrón más común. Los casos con lesión neurológica presentaron mayor tiempo de internación y grado de discapacidad al alta, pero no mayor mortalidad hospitalaria.


Neurologic complications of infective endocarditis have been observed in 20-40% of cases. Our aim was to determine the frequency of neurologic involvement, clinical manifestations, lesional patterns and evolution in patients with infective endocarditis. This was a prospective cohort study. We included 98 patients with left-sided infective endocarditis. Forty seven percent presented neurologic involvement at some time of the disease. The frequency of symptoms was: focal deficit 61%, sensory disturbance 17% and seizures 2%, while 20% remain asymptomatic. The most prevailing lesion was cerebral ischemia (76%). Vegetations larger than 1 cm were associated to neurologic involvement (57% vs. 31%, p = 0.01). Valvular replacement was more common among patients with neurologic involvement (70% vs. 44%, p = 0.01). Hospital mortality was 20% in patients with neurologic manifestation versus 15% of those without it (p = 0.5). The length of stay was significantly prolonged in patients with neurologic affection (32 ± 27 vs. 21 ± 15 days, p = 0.01) and a favorable Rankin assessment at the discharge was less likely in patients with neurologic involvement (36% vs. 74%, p = 0.0001). In this cohort, the most frequent clinical manifestation was focal deficit and the most prevalent pattern of lesion was cerebral ischemia. Those with neurologic involvement presented an increased length of stay and more disability at the discharge but not statistical significant difference in hospital mortality.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Brain Diseases/etiology , Endocarditis, Bacterial/complications , Prognosis , Brain Diseases/mortality , Brain Diseases/diagnostic imaging , Magnetic Resonance Imaging , Prospective Studies , Risk Factors , Hospital Mortality , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/diagnostic imaging
13.
Rev. méd. hered ; 28(1): 37-41, ene. 2017. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-991391

ABSTRACT

Entre las bacterias poco comunes que causan Endocarditis infecciosa (EI), se encuentran el Streptococcus gordonii, conocido por su habilidad de colonizar y dañar las válvulas cardiacas. Asimismo, se conoce que el hallazgo de aneurisma complicado con fístula intracardiaca es infrecuente en EI, sólo se presenta en el 1,6% de pacientes. Se reporta el caso de un varón de 58 años con EI por Streptococcus gordonii complicada con aneurisma y fístula en la válvula mitral. (AU)


Streptococcus gordonii is a rare cause of infective endocarditis (IE) known for its ability to colonize and damage cardiac valves. Moreover, it is known that complicated aneurism with intracardiac fistula is an infrequent finding in IE, reported in1.6% of patients. We report the case of a 58 year old male patient with IE infected with Streptococcus gordonii and complicated with an aneurism and mitral valve fistula. (AU)


Subject(s)
Humans , Male , Middle Aged , Aneurysm, Infected , Endocarditis, Bacterial , Endocarditis, Bacterial/complications , Streptococcus gordonii , Fistula , Mitral Valve
14.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.250-266.
Monography in Portuguese | LILACS | ID: biblio-848466
16.
An. bras. dermatol ; 91(5,supl.1): 92-94, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-837965

ABSTRACT

Abstract Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler’s nodes and Janeway lesions. Osler’s nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes. Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. We report a case of infective endocarditis and highlight the importance of skin examination as a very important element in the presumptive diagnosis of infective endocarditis.


Subject(s)
Humans , Male , Adult , Skin/microbiology , Skin/pathology , Skin Diseases, Bacterial/microbiology , Skin Diseases, Bacterial/pathology , Endocarditis, Bacterial/complications , Staphylococcus aureus , Telangiectasia, Hereditary Hemorrhagic/microbiology , Telangiectasia, Hereditary Hemorrhagic/pathology , Biopsy , Fatal Outcome
18.
Rev. chil. cardiol ; 35(2): 163-168, 2016. ilus
Article in Spanish | LILACS | ID: lil-796804

ABSTRACT

Resumen Reportamos un caso de reparación de perforación valvular mitral en un joven de 18 años que consulta por disnea de esfuerzos y con el antecedente remoto de una artritis séptica de rodilla tratada. En el examen físico se encontró un soplo holosistólico 4/6 en el foco mitral. Se realizó un ecocardiograma transtorácico (ETT) que objetivó una insuficiencia mitral severa, con un jet de recorrido muy excéntrico originado desde anterior, sospechando una perforación del velo anterior, sin lograr caracterizarla por dicha técnica. Se complementó el estudio con un ecocardiograma transesofágico (ETE) en una plataforma EPIQ 7 cv (PHILIPS), que identificó en el cuerpo del segmento 2 del velo anterior mitral (A2) una posible perforación. El análisis de la válvula mediante ETE tridimensional (3D), confirmó una perforación circular de bordes netos, de dimensiones máximas 6x6 mm, localizada en el cuerpo de A2. El análisis 3D aportó valiosa información para programar la reparación valvular, la cual se efectuó mediante un parche de pericardio autólo-go fresco (sin fijación en glutaraldehido) y una anu-loplastía con un anillo rígido, con óptimo resultado y sin complicaciones.


An 18 year-old man presented with shortness of breath and a remote history of a septic arthritis of the knee. Physical examination revealed a holosystolic mitral valve murmur. Transthoracic echocardiography showed a severe mitral regurgitation originating from de anterior mitral valve leaflet, but the exact mechanism was unclear. Transesophageal echocardiography (EPIQ 7v, Philips) suggested a perforation of the medial scallop of the anterior mitral valve leaflet (A2). 3-D trans esophageal echocardiography confirmed a 6x6 mm perforation at the A2 sector of the anterior leaflet. 3-D echo was also very helpful in guiding the surgical repair of this lesion, using a pericardial patch and rigid mitral valve ring.


Subject(s)
Humans , Male , Adolescent , Echocardiography, Three-Dimensional , Endocarditis, Bacterial/complications , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Echocardiography, Transesophageal , Spontaneous Perforation , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/etiology
19.
Int. j. cardiovasc. sci. (Impr.) ; 28(6): 496-503, nov.-dez. 2015.
Article in Portuguese | LILACS | ID: lil-788768

ABSTRACT

A evolução temporal do conhecimento da doença possibilita avanços nas técnicas que favorecem o diagnóstico precoce que, por consequência, é importante para a sobrevida do paciente com endocardite infecciosa (EI). Objetivo: Descrever a evolução hospitalar de pacientes acometidos por endocardite infecciosa em hospital da rede pública em Belém, Pará, Brasil. Métodos: Estudo observacional, descritivo, prospectivo de série de casos. Realizada análise de prontuário de 18 pacientes com EI no Hospital de Clínicas Gaspar Vianna (HCGV), que faziam parte da demanda espontânea do hospital e que satisfizeram aos critérios de inclusão adotados. Analisados dados sociodemográficos e evolução clínica. Resultados: Dos 18 pacientes estudados, observou-se predomínio do sexo masculino (72,2%), faixa etária entre 39-59 anos (50,0%), grau de escolaridade: ensino fundamental incompleto (61,1%) e renda mensal de dois a quatro salários mínimos (55,5%). O fator de risco mais prevalente foi a presença de prótese valvar biológica (36,0%), 66,5% das hemoculturas foram negativas, a valva aórtica foi a mais acometida (44,4%). Disfunção valvar foi a complicação mais encontrada (26,5%), o tratamento clínico-cirúrgico foi o mais utilizado (55,5%), o critério para cirurgia foi a disfunção grave (33,3%). O tempo para diagnóstico foi 27,7 dias, o tempo para tratamento após o diagnóstico foi 2,4 dias e o desfecho mais encontrado foi o óbito (50,0%). Conclusão: A metade dos pacientes evoluiu para óbito, com um percentual bem acima do que é encontrado na literatura.


The time course of disease knowledge enables advances in techniques that promote early diagnosis which, consequently, is important for the survival of patients with infective endocarditis (IE). OBJECTIVE: To describe the hospital evolution of patients with infective endocarditis in a public hospital in Belém, Pará, Brazil.METHODS: Observational, descriptive, prospective case series study. The study included a review of the medical records of 18 patients with IE from Hospital de Clínicas Gaspar Vianna (HCGV), who were part of the hospital's spontaneous demand and who met the inclusion criteria adopted. Social and demographic data and clinical evolution were analyzed.RESULTS: Of the 18 patients studied, there was predominance of males (72.2%), aged between 39-59 years (50.0%), level of education: incomplete primary education (61.1%) and monthly income two to four minimum wages (55.5%). The most prevalent risk factor was the presence of biological valve prosthesis (36.0%), 66.5% of blood cultures were negative, the aortic valve was the most affected (44.4%). Valve dysfunction was the most frequent complication (26.5%), the medical and surgical treatment was the most used (55.5%), criterion for surgery was severe impairment (33.3%). The time to diagnosis was 27.7 days, time to treatment after diagnosis was 2.4 days and the outcome most found was death (50.0%).CONCLUSION: Half of the patients died with a percentage well above what is found in the literature.


Subject(s)
Humans , Male , Adult , Middle Aged , Comorbidity , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/rehabilitation , Clinical Evolution , Echocardiography , Observational Study
20.
Braz. j. infect. dis ; 19(1): 85-89, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-741235

ABSTRACT

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly causing infective endocarditis over the past decade. Here we report a healthy man who developed a severe acute infective endocarditis with systemic embolism caused by CA- MRSA. The strain was recovered from repeated blood cultures and was characterized using molecular detection and genotyping. The S. aureus isolate was typed as ST630 SCCmecV with spa-type t4549, agrI/IV and was PVL-negative. This is the only case report, to our knowledge, of CA-MRSA infective endocarditis in China. This case highlights the emergence and geographical spread of life-threatening CA-MRSA infection within China.


Subject(s)
Adult , Humans , Male , Embolism, Paradoxical/etiology , Endocarditis, Bacterial/microbiology , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/microbiology , Community-Acquired Infections , Endocarditis, Bacterial/complications , Severity of Illness Index , Staphylococcal Infections/complications
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