1/56. Bacterial endocarditis in a patient with Marfan's syndrome.A patient with Marfan's syndrome and subacute bacterial endocarditis is presented. Echocardiographic studies demonstrated dilatation of the aortic root, prolapse of the posterior leaflet of the mitral valve, and the appearance of shaggy echoes on the anterior miltral leaflet, of the kind previously described as representing bacterial vegetations.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
2/56. Compiling the identifying features of bacterial endocarditis. Vague clues may point to this dangerous infection.Bacterial endocarditis is a life-threatening disease. Before the advent of antibiotics, its mortality rate was nearly 100%, but with today's diagnostic and therapeutic advances, it can be successfully managed in most cases. In this article, Drs Harris and Steimle explain the changes that occur when someone, who usually has an underlying cardiac defect, contracts bacteremia with an organism likely to adhere to heart valve surfaces. They describe risk factors, clinical presentations, identification of causative organisms, and empirical and specific therapy. A case report illustrates the many possible manifestations of the disease.- - - - - - - - - - ranking = 20.435139149035keywords = heart valve, valve, heart (Clic here for more details about this article) |
3/56. Right ventricular and septal anomalies complicated by subacute bacterial endocarditis.We report the case of a 31-year-old woman with no history of heart disease. She came to the hospital with fever, dyspnea, palpitation, and edema of the lower extremities. She was found to have aortic, mitral, and pulmonary valve insufficiency, and the initial diagnosis was subacute bacterial endocarditis. At surgery, we replaced the aortic and mitral valves with mechanical prostheses and the pulmonary valve with a bioprosthesis. The prostheses were soaked intraoperatively with fluconazole and the heart chambers were irrigated with povidone-iodine to prevent infection by bacteria and fungi. We also found 2 previously unsuspected anomalies: 1 was a muscular bundle that divided the right ventricle into 2 chambers, and the other was a ventricular septal defect, 1.0 cm in diameter. We resected the muscular bundle and patched the septal defect. The patient had an uneventful postoperative course and was in new york Heart association functional class I at the 15-month follow-up visit. We speculate that this patient's congenital anomalies made the heart more susceptible to damage from the endocarditis. Therefore, any patient who has infective endocarditis should also be examined closely for congenital defects.- - - - - - - - - - ranking = 5.6682084402821keywords = heart disease, valve, heart (Clic here for more details about this article) |
4/56. Diffuse crescentic glomerulonephritis in bacterial endocarditis.Renal involvement is common in patients with bacterial endocarditis. The most common bacteria are staphylococci and streptococci, and the commonest renal histopathological lesion is a diffuse proliferative and exudative type of glomerulonephritis. Very rarely, patients may present with an extensive glomerular epithelial crescent formation with a rapid deterioration in the renal function. This study reviews the published literature on diffuse crescentic glomerulonephritis in bacterial endocarditis and reports a 24-year-old male patient with endocarditis due to Capnocytophagia species, a gramnegative facultative anaerobic bacillus, which normally inhabits the oral cavity. Appropriate antibiotic therapy is essential to eradicate the infection. A brief course of corticosteroid therapy may be helpful in those with deteriorating renal function. plasmapheresis may be useful in those with persistent hypocomplementemia, increased circulating immune complexes, and a progressive deterioration in the renal function. Removal of vegetation or valve replacement may be necessary. prognosis is generally good.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
5/56. Nodular regenerative hyperplasia of the liver.Nodular regenerative hyperplasia of the liver, an uncommonly reported and poorly defined clinicopathological entity, obscured clinical diagnosis and was misdiagnosed on hepatic biopsy in a recent case. Approximately 19 cases are recorded in the English literature. Six patients had Felty's syndrome, about 12 patients had congestive heart failure, and the patient under discussion had subacute bacterial endocarditis. light- and electron-microscopic examination was utilized to define nodular regenerative hyperplasia pathologically. Features common to all reported cases are discussed but elucidation of the pathogenesis of nodular regenerative hyperplasia must await further investigation.- - - - - - - - - - ranking = 0.3166179789571keywords = heart (Clic here for more details about this article) |
6/56. Henoch-Schonlein purpura secondary to subacute bacterial endocarditis.Henoch-Schonlein purpura (HSP), a systemic, small-vessel vasculitic syndrome, is characterized by a nonthrombocytopenic purpuric rash, arthralgia, abdominal pain, and nephritis. These signs and symptoms may occur in any order, and not all are necessary for the diagnosis. Although most common in 4- to 7-year-olds, HSP is well documented in adults and is often preceded by a history of mucosal-based infections, especially of the upper respiratory tract. We report a case of HSP that occurred coincident with the onset of subacute bacterial endocarditis (SBE) in an otherwise healtny 41-year-old white woman. The patient presented with a purpuric rash and arthralgia and was found to have left-sided streptococcal SBE. She subsequently developed abdominal pain and immune complex glomerulonephritis. The bacterial endocarditis was treated with antibiotics and mitral valve replacement, followed by a spontaneous resolution of the associated signs and symptoms of HSP.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
7/56. Infected left atrial mass within anatomically normal heart.A case is presented with some features of subacute bacterial endocarditis and of left atrial myxoma. Operative removal of a 5x3 cm tumour lying above and attached to an anatomically normal mitral valve reversed a rapidly deteriorating clinical situation. Histologically the entire tumour appeared to be old thrombus, and gram-positive cocci in its superficial strata corresponded with streptococcus viridans previously isolated from blood cultures. Many features, including an eight-year history of intermittent neurological disturbances and recent increasing hypergammaglobulinaemia, accord with the diagnosis of atrial myxoma. However, the valvular attachment site, absence of any cardiac structural abnormality, and tumour histopathology with bacterial colonization of the tumour present a unique situation which is explored in the discussion.- - - - - - - - - - ranking = 2.2664719158284keywords = valve, heart (Clic here for more details about this article) |
8/56. Streptococcal viridans subacute bacterial endocarditis associated with antineutrophil cytoplasmic autoantibodies (ANCA).We report an illustrative case of a 60-year-old man with streptococcus viridans subacute bacterial endocarditis (SBE) and positive antineutrophil cytoplasmic autoantibodies (c-ANCA). C-ANCA positivity has been associated with a variety of rheumatic and infectious disease areas, but has been rarely associated with SBE. The patient had mitral valve prolapse with mitral regurgitation, and S viridans SBE developed after a dental procedure. Laboratory abnormalities included anemia, elevated erythrocyte sedimentation rate, positive rheumatoid factor, positive anticardiolipin antibody, positive lupus anticoagulant, and highly elevated c-ANCA level. We believe this is only the ninth reported case of S viridans SBE with a positive c-ANCA, and the third with mitral valve prolapse and vegetations.- - - - - - - - - - ranking = 2keywords = valve (Clic here for more details about this article) |
9/56. vancomycin-induced thrombocytopenia: a case proven with rechallenge.In a rare case of vancomycin-induced thrombocytopenia, a 50-year-old man with culture-negative subacute bacterial endocarditis underwent mitral valve replacement surgery and was treated with vancomycin. His platelet count dropped from 346 x 10(3)/mm3 to 13 x 10(3)/mm3 on postoperative day 4, and a differential diagnosis of heparin- versus drug-induced thrombocytopenia was considered. Antiheparin antibodies were detected in the patient's serum on day 5. He showed no signs of bleeding. His platelet count remained below 5 x 10(3)/mm3 despite two platelet transfusions on day 5. A hemorrhagic pericardial effusion with tamponade developed, requiring drainage. A trial with intravenous immunoglobulin led to fever and chills, and the infusion was not completed. vancomycin was changed to clindamycin on day 9, and methylprednisolone therapy was started on day 11. On day 12, the patient's clinical condition improved, and his platelet count increased from 3 x 10(3)/mm3 to 32 x 10(3)/mm3 with no bleeding. On day 18, his platelet count was 424 x 10(3)/mm3, and he was scheduled for discharge with vancomycin therapy for a total of 6 weeks. He received a single dose of intravenous vancomycin 1 g at the hospital; his platelet count dropped to 160 x 10(3)/mm3 1 hour after the infusion and to 58 x 10(3)/mm3 12 hours later. vancomycin was discontinued and clindamycin and prednisone were restarted. On day 20, the patient's platelet count increased to 105 x 10(3)/mm3 and he was discharged with warfarin, prednisone, and clindamycin therapy. We suspect that our patient's thrombocytopenia was due to vancomycin.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
10/56. Vascular disease in infective endocarditis. Report of immune-mediated events in skin and brain.A patient with subacute bacterial endocarditis, who had a prosthetic mitral valve, exhibited hypocomplementemia, mixed (IgG, IgM) cryoglobulinemia, and widespread dermal vasculitis with IgM deposited at the dermoepidermal junction. Postmortem findings included immune-complex glomerulonephritis and deposits of IgG in the choroid plexus. These findings are consistent with a generalized vasculitis, which may be mediated by circulating immune complexes; basement membrane localization of immune complexes to the skin and choroid plexus appears not to be specific for systemic lupus erythematosus, as has been previously thought, but may represent the general phenomenon of immune-mediated pathogenesis.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
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