1/262. A case of Austrian's syndrome with ocular involvement.A man with a history of alcohol abuse was admitted to hospital with pneumonia and meningitis due to streptococcus pneumoniae. Because of the worsening of respiratory function and the persistence of fever, an echocardiographic examination was made, which showed endocarditis with destruction of the aortic valve. The patient underwent surgical valve replacement. In addition, he showed a choroiditis in the left eye which improved after antibiotic therapy. The interest of this case lies in the rarity of the triad described as Austrian's syndrome and in the coexistent fourth septic localization, namely in the left eye.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
2/262. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
3/262. Recurrent endocarditis in silver-coated heart valve prosthesis.BACKGROUND AND AIM OF THE STUDY: In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection. methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being implanted, the endocarditis recurred. During a third operation an aortic homograft was implanted, and after six months a fourth operation was performed for a pseudoaneurysm at the base of the homograft, in proximity to the anterior mitral valve leaflet. RESULTS: The diagnosis of PVE was confirmed by the presence of continuous fever, transesophageal echocardiography and growth of penicillin-resistant staphylococcus epidermidis from the valve prosthesis. CONCLUSION: The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advantages of silver-coated prostheses in the treatment of this condition have yet to be assessed in clinical trials.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
4/262. Post-parturition infectious endocarditis in a patient with a normal mitral valve.A 29-year-old woman with no history of heart disease was admitted for the treatment of congestive heart failure. Six months earlier, she had given birth, then 20 days later developed a fever and cardiac failure ensued. An echocardiogram demonstrated severe mitral valve regurgitation. Her blood cultures were positive, and we made a diagnosis of mitral valve regurgitation due to infectious endocarditis. Despite treatment for congestive heart failure and antibiotic therapy, resulting in negative blood cultures, her congestive heart failure did not improve, and vegetation on the mitral valve was observed by echocardiography. We successfully removed the infected tissue with mitral valve plasty.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
5/262. myxoma of mitral valve associated with infective endocarditis.A 20-year-old man was hospitalized for persistent fever, embolism, and syncopal attack. echocardiography demonstrated a tumor on the mitral posterior leaflet. It was removed under extracorporeal circulation following extirpation of thrombus in the right common like artery. The tumor consisted of myxoma and vegetation with bacterial colony. myxoma and/or vegetation had destroyed the mitral posterior leaflet. Accordingly, it was necessary to perform mitral valve replacement. The postoperative course was uneventful. This is the 14th surgical case of mitral valve myxoma, and the first case of that associated with infective endocarditis.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
6/262. wegener granulomatosis simulating bacterial endocarditis.Cardiac involvement in wegener granulomatosis is uncommon. We report a case of wegener granulomatosis that presented as culture-negative endocarditis with aortic valvular vegetation. The clinical manifestations included gingival hyperplasia, gangrenous digital infarcts, mononeuritis multiplex, high fever, inflammatory arthritis, pansinusitis, splenic infarct, and aortic valvular vegetation, which underscore the difficulty of distinguishing systemic vasculitis from bacterial endocarditis. Contrary to the common notion that valvular vegetation is invariably associated with bacterial endocarditis, this case proves that such findings can occur in wegener granulomatosis as well. Clinicians are guided toward early treatment with corticosteroids and cyclophosphamide to prevent fatal complications.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
7/262. Chronic sternal wound infection and endocarditis with coxiella burnetii.Chronic q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which q fever endocarditis was subsequently diagnosed. polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii dna, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.- - - - - - - - - - ranking = 3keywords = fever (Clic here for more details about this article) |
8/262. brucella-mediated prosthetic valve endocarditis with brachial artery mycotic aneurysm.A 39-year-old female with a Hall-Kaster mitral prosthesis developed fever, general malaise and arthralgia 15 years after valve replacement for rheumatic mitral valve disease. Prosthetic valve endocarditis was identified after serial laboratory, clinical and echocardiographic examinations. penicillin g (40 x 106 units/day, i.v.) gentamicin (240 mg/day, i.v.) was started as initial therapy. The patient showed no signs of recovery, and penicillin g was replaced with vancomycin (1,000 mg/day, i.v.). There was a gradual reduction in spiking fever, and prominent reductions in erythrocyte sedimentation rate and white cell count. Meanwhile, a tender and pulsatile mass developed in the anterior surface of the left arm; peripheral angiography yielded a diagnosis of brachial artery aneurysm. A successful aneurysmectomy with saphenous vein interposition was performed. Histopathology of the lesion revealed mycotic aneurysm. An initial control SAT for brucella of 1/80( ) was found to increase. A detailed history showed the patient to have consumed unpasteurized dairy products. Doxycyline (200 mg/day, oral) co-trimoxazole (2,700 mg/day, oral) rifampicin (600 mg/day, oral) was administered to treat brucellosis. Later, doxycyline caused intolerable gastrointestinal side effects and was replaced by ciprofloxacin (1,000 mg/day, oral). Subsequently, the patient made an uneventful recovery within one week. Antibiotic treatment was continued for 12 months, with complete resolution of vegetation and paravalvular leakage. During a four-year follow up, the patient showed no signs of relapse.- - - - - - - - - - ranking = 6.751632568656keywords = brucellosis, fever (Clic here for more details about this article) |
9/262. Atypical infective endocarditis.BACKGROUND: Although infective endocarditis has changed in the recent past as a result of microbiologic and risk factors, it continues to be clinically challenging. The disease is characterized by the formation of septic masses of platelets on the surfaces of heart valves. Several mechanisms can cause or contribute to the development of endocarditis. Although risk factors for infective endocarditis are well known, patients with atypical signs and symptoms continue to challenge us. methods: We describe a case report of a patient admitted to our inpatient service with back pain and presumed pyelonephritis. A medline literature search was conducted, using the key words "endocarditis," "back pain," and "bacterial," for the years 1986 to the present. RESULTS AND CONCLUSIONS: A 42-year-old woman with a history of intravenous drug abuse was admitted to the family practice service with back pain and pyelonephritis. She developed hypoxia and a new heart murmur and had continued fevers. blood cultures drawn in the emergency department grew methicillin-resistant staphylococcus aureus. A bone scan and magnetic resonance imaging led to the diagnosis of epidural abscess. What appeared to be a simple case of pyelonephritis with back pain became a case of infective endocarditis complicated by an epidural abscess.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
10/262. livedo reticularis revealing a latent infective endocarditis due to Coxiella burnetti.We report the first case of livedo reticularis revealing a latent infective endocarditis due to Coxiella burnetti. The patient, a 54-year-old woman, also had chronic thrombocytopenia and mixed cryoglobulinemia. Chronic q fever was confirmed by serodiagnosis and livedo regressed totally with doxycycline and hydroxychloroquine.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
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