[The neurological complications of infectious endocarditis]. / Complicaciones neurológicas de la endocarditis infecciosa.

We review the neurologic complications of 131 episodes of infective endocarditis, and the influences of some factors that are considered risk factors at its presentation, like the presence of vegetations detected by echocardiography, type and location of involved valve, or bacterial culture. Neurologic complications occurred in 28 patients (21.4%), 4 of them were excluded because of the absence of neuroimaging studies. In 21 patients the underlying cardiac pathology was valve disease and in the remaining 3 patients was congenital heart disease. 11 patients had native valve endocarditis and 10 prosthetic valve endocarditis. The cultured bacteria were Streptococcus viridans in 8 cases and Staphylococcus aureus in 7. The most frequent complication was cerebrovascular with incidence of cerebral embolism, and intracerebral hemorrhage of 62.5% and 8.3% respectively. Echocardiographic evidence of vegetation was seen in 18 patients, and cerebral embolism were noted in 12. Death occurred in 29% of patients with neurologic complications and 27% without. Two of nine patients who underwent open-heat surgery died. We conclude that there is no difference in the incidence of neurologic complications between mitral and aortic valve groups, neither when comparing native and prosthetic valve groups. Open-heart surgery does not increase mortality in this group of patients.

[Coxiella burnetii endocarditis. A report of the first case diagnosed in Mexico]. / Endocarditis por Coxiella burnetii. Informe del primer caso diagnosticado en México.

The first case of Q fever endocarditis that has been diagnosed in Mexico is presented. A 10-year-old girl with discrete subaortic stenosis (SAS) and patent ductus arteriosus (PDA) was seen in December of 1996 with fever, hepatomegaly and splenomegaly. She presented also anemia, leukopenia, hypergammaglobulinemia, positive rheumatoid factor, cryoglobulinemia, antinuclear and anticytoplasmic antibodies (anti-RNA-proteins and anti-DNA). An aortic valve vegetation was seen by echocardiogram. Blood-cultures were negative. Antibody test for Coxiella burnetii was positive. Treatment with doxicyclin was initiated as soon the diagnosis was done. PDA was closed, SAS was liberated and two aortic vegetations were resected. Endocarditis in Q fever occurs when there is predisposing heart disease and/or immunodeficiency. Effective therapy has not yet been established. The diagnosis of Q fever endocarditis is difficult; it should be considered, in case of clinical suspicion of endocarditis with negative blood-cultures.

[Infectious endocarditis at the National Institute of Cardiology "Ignacio Chavez". Five year's experience (1990-1994)]. / Endocarditis infecciosa en el Instituto Nacional de Cardiología "Ignacio Chávez". Experiencia de cinco años (1990-1994).

BACKGROUND: Infective endocarditis (IE) is one of the most life threatening infections in both medical and surgical practices. In the last few years, changes in its epidemiology, diagnostic methods and therapeutical trends have appeared. We analysed our experience in the diagnosis and treatment of IE. METHODS: The clinical records of patients admitted to our hospital with definitive (Group I) and highly probable (Group II) diagnosis of IE, during a period of five years (1990-1994), were retrospectively reviewed. Age, sex, clinical features, risk, factors, echocardiographic abnormalities, microbiologic and surgical findings, as well as mortality were recorded. In addition, an evaluation was made of the accuracy of the diagnostic criteria proposed by Von Reyn versus those brought forward by Duke University. RESULTS: One hundred thirty one patients were included, 99 in Group I and 32 in Group II. The mean age was 35 years. Native valve endocarditis was present in 88 patients and prosthetic valve endocarditis in 43 patients. Streptococcus sp. (48%) was the most frequently causative german and 16.7% of cases were culture negative. The sensitivity of transesophageal echocardiography was higher than transthoracic echocardiography in the diagnosis of both vegetations (76% vs 55%) and abscesses (30% vs 16.5%), (p < 0.05). Vegetations (95%) were the most frequent surgical finding followed by abscesses (23%). Inpatient mortality was 22% in Group I and 45% in Group II (p < 0.05). The sensitivity of Von Reyn's diagnostic criteria and that of Duke's University group was 49% and 85.8% (p < 0.05). Mean follow up was 531 days. Two patients had a new event of IE and no outpatient deaths were recorded. CONCLUSION: IE is a medical and surgical emergency. Because of the high mortality rate, in the medically treated group, surgery should be considered in all cases as early as possible in the course of the disease.