Cases reported "Endocarditis, Bacterial"

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1/36. Infective endocarditis on an occluder closing an atrial septal defect.

    Closure of atrial septal defects be means of intravenous catheterisation has been undertaken using a variety of devices as an alternative to surgical closure. We describe the first case, to the best of our knowledge, of infective endocarditis complicating a successful transcatheter closure. This highlights the potential risk of this procedure, and emphasises the need for appropriate antibiotic prophylaxis until complete endothelialization of the device has occurred.
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2/36. aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.

    A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.
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3/36. Treatment of bacterial endocarditis with vancomycin.

    Five patients with bacterial endocarditis who were allergic to penicillin were treated successfully with vancomycin. The causative microorganisms were streptococcus bovis, S faecalis, S agalactiae, S intermedius, and Staphylococcus aureus. Except for the strain of S faecalis, vancomycin was bactericidal against these organisms at easily achievable serum concentrations. To insure a bactericidal serum titer of 1:8 or greater, streptomycin was added in the therapy of the case caused by S faecalis. There was no toxicity from vancomycin therapy in our patients except for mild phlebitis at the infusion site. vancomycin appears to be an effective alternative to penicillin in individuals with endocarditis due to susceptible organisms. vancomycin in combination with an aminoglycoside may be appropriate therapy for enterococcal endocarditis.
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4/36. Pulmonic valve endocarditis after orthotopic liver transplantation.

    Infective endocarditis is a rare complication affecting solid-organ transplant recipients. Isolated pulmonic valve endocarditis is also rare. A case of persistent bacteremia secondary to an isolated pulmonic valve vegetation occurred in a woman 10 days after liver transplantation. A pulmonary vegetectomy was performed as an alternative to valve replacement in addition to long-term antibiotic therapy.
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5/36. Treatment of staphylococcus aureus endocarditis using moxifloxacin.

    The conventional treatment of staphylococcal endocarditis requires in-patient administration, is inconvenient, and is potentially toxic. Increasing experience with well-absorbed, well-tolerated and highly active agents such as the new quinolones has prompted interest in their use as therapeutic alternatives for the treatment of such infections. We describe a case of staphylococcal endocarditis which failed to respond to conventional therapy, but where the addition of moxifloxacin, an 8-methoxyquinolone, was curative.
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6/36. Thrombolytics in infectious endocarditis associated myocardial infarction.

    The use of thrombolytics in the management of acute myocardial infarction in eligible patients is the accepted standard of practice. We present the case of an embolic myocardial infarction in the setting of acute infectious endocarditis, treated with thrombolytics, resulting in a massive intracerebral hemorrhage and the patient's death. Historical and current literature has shown a consistent and significant incidence of concurrent intracerebral mycotic aneurysms in the setting of infectious endocarditis. Despite this, a literature review of contraindications to the use of thrombolytics rarely recognizes endocarditis as a contraindication. It is imperative that the etiology for myocardial infarction be identified; if contraindications to thrombolytic treatment exist, alternative therapeutic interventions must be pursued. This case highlights the importance of the correct etiologic diagnosis of myocardial ischemia, and increases the awareness of the significant risks of intracerebral hemorrhage associated with the use of thrombolytics in the setting of endocarditis.
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7/36. Pacemaker related endocarditis: analysis of seven cases.

    Vegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative.
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8/36. The role of antibiotic treatment alone for the management of brucella endocarditis in adults: a case report and literature review.

    endocarditis is a rare complication of brucellosis but it is the main cause of the mortality in this disease. The accepted treatment for brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most of the authors as it is considered ineffective and increase the risk of fatality. In our literature search, we found 14 adult patients with BE treated only with antibiotics with a favorable outcome. In this report, we described a patient treated with antibiotics alone and reviewed the literature. Depending on the data from the growing literature and our patient we suggest that in selected patients with BE who do not have congestive heart failure, valvular destruction, abscess formation, or a prosthetic valve, conservative antibiotic treatment may be a valid alternative to surgery.
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9/36. Successful use of oral linezolid as a single active agent in endocarditis unresponsive to conventional antibiotic therapy.

    Treatment of resistant gram-positive endocarditis is difficult. We report a case of resistant staphylococcus epidermidis endocarditis that failed to respond to conventional antibiotic therapy but was treated successfully with an oral regimen of a new antibiotic, linezolid as a single active agent. This case report demonstrates the use of linezolid as an effective alternative to conventional antibiotics in such cases.
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10/36. Prosthetic valve endocarditis with extensive aortic root abscess: full aortic root reconstruction with stentless bioprosthesis, xenopericardium and mitral valve replacement.

    Prosthetic valve endocarditis with an extensive aortic root abscess usually has high mortality and morbidity. A 71-year-old male with an extended aortic root abscess following aortic valve replacement survived after full aortic root reconstruction with glutaraldehyde bovine pericardium, mitral valve replacement and full root replacement using stentless bioprosthesis. The patient is well without recurrence of infection, 18 months postoperatively. This procedure might be an alternative treatment for prosthetic valve endocarditis with an extended aortic root abscess.
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