RESUMEN
Clinical, biochemical, bacteriological, x-ray, electrocardiographic, ultrasonic and morphological examinations for pulmonary pathology were made in 230 patients with infectious endocarditis (IEC) treated in 1982-2001. Pulmonary involvement was found in 30% of the examinees. Pulmonary onset of IEC caused misdiagnosis in 11% cases. Its appearance can be recognized by fever (100% cases), chest pain (73%), cough (50%) and dyspnea (46%). Pulmonary affection and pulmonary onset of IEC were associated with disorders of the mitral (26 and 27%, respectively), aortic (17 and 8%, respectively), tricuspis (5 and 8%, respectively) valves or compound valvular heart disease (43 and 50%, respectively). Bacterial vegetations of the heart valves were detected in 60% patients with pulmonary lesions and 62% patients with pulmonary onset of IEC in transthoracic ultrasonography. Pulmonary lesions and pulmonary onset of IEC were caused primarily by staphylococci (73 and 67%, respectively).
Asunto(s)
Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/patología , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/patología , Infecciones Estafilocócicas , Adulto , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Pulmón/patología , MasculinoRESUMEN
Myocardial infarction (MI) developed in 9% of 230 patients with active infectious endocarditis. Development of MI was associated with worsened clinical course and poorer prognosis of infectious endocarditis. MI manifested with pain in 43 and was painless in 57% of these cases. In 29% of patients initial manifestations of MI were disturbances of cardiac rhythm and conduction, and acute left ventricular failure. This precluded timely electrocardiographical diagnosis. However repetitive ECG recordings allowed to confirm MI in all patients. Elevation of enzymes helped to diagnose MI in 81% of cases. Possible causes of MI were shutting of coronary artery ostium by vegetation from an aortic valve cusp (in 47%) and/or lowering of perfusion pressure in coronary arteries because of severe aortic insufficiency (in 62% of patients). Disturbances of hemostasis with activation of its vascular and platelet elements and hypercoagulation found in all patients with infectious endocarditis also facilitated development of MI. The data obtained explain under investigated sides of pathogenesis of MI in infectious endocarditis and allow to find ways for improvement of its diagnosis and therapy.
Asunto(s)
Endocarditis Bacteriana/epidemiología , Infarto del Miocardio/epidemiología , Adulto , Anciano , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , UltrasonografíaRESUMEN
The paper presents clinical manifestations of infectious endocarditis (IE), its new clinical classification, diagnostic criteria, potentialities and limitations of echocardiography. General principles of management of patients with IE are considered. The management algorithm is given, which involves the initial assessment of these patients, empirical therapy, etiotropic chemotherapy (CT) regimens in streptococcal, staphylococcal, gram-negative, fungal endocarditis, and IE of unknown etiology. Possible complications due to IE (refractory heart failure, infection dissemination, thrombohemorrhagic syndrome, immune diseases, persistent fever) are described, which need supplementary treatment, particularly schemes for correction of hemostatic and immune disorders. Clinical and microbiological criteria are proposed for evaluating the efficiency of treatment for IE. The conditions showing a higher risk for the types of IE that require antibiotic prophylaxis and the criteria for choosing its regimen are given. New trends in the treatment of IE, such as shorter courses of antibacterial CT, stepwise antibacterial therapy (ABT), and parenteral ABT at home, are outlined.
Asunto(s)
Endocarditis Bacteriana , Algoritmos , Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Árboles de Decisión , Ecocardiografía , Endocarditis Bacteriana/clasificación , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , HumanosRESUMEN
182 patients with infectious endocarditis (IE) were examined for correlations between valvular bacterial vegetations and IE activity, course, results of bacteriological and morphological findings. 81 of the patients had primary IE, 71 patients had secondary IE which had developed in uncorrected valvular heart disease, in 30 patients secondary IE had developed after surgical correction of rheumatic heart disease. It is shown that echocardiographic detection of bacterial vegetations does not determine IE severity, course and outcome.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
Clinical course of infectious endocarditis (IE) was analysed for 43 intravenous drug abusers. 42 of them had primary IE, one patient--secondary. Acute course and high activity of the disease were registered in 86% of the patients. IE was provoked by Staphylococcus aureus (50%), Staphylococcus epidermidis 920%), Staphylococcus haemolyticus (11%), E. coli (8%), Pseudomonas aeruginosa (2%), Candida albicans (2%), mixed microflora (7%). Vegetations were detected on the tricuspid, mitral and aortic valves (52, 23 and 19%, respectively), on more than one valve (6%). Pneumonia, pleuricy, hydrothorax, enlargement of the liver, spleen, nephritis and anemia were found in 76, 44, 9, 100, 75, 70 and 88% of the patients, respectively. Cardiac failure aggravated the disease in half of the patients, lethality was 18%. Thus, IE in intravenous drug abusers is characterized by a primary form, acute active course, prevalent damage to the tricuspid valve, polyorganic involvement, high lethality. IE cure in such patients is feasible only in adequate antibacterial therapy, timely surgical correction and giving up drug abuse.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Trastornos Relacionados con Opioides/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Masculino , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiologíaRESUMEN
Efficacy and safety of ceftriaxone (Oframax, Ranbaxy, India) in the treatment of 25 patients with Staphylococcus endocarditis (SE) were studied. The drug was administered intravenously in a dose of 2-4 g a day for 4 weeks and simultaneously gentamicin was used intramuscularly in a dose of 2-3 mg/kg body weight a day every 8 hours for 2 weeks. The treatment was followed by observation of the patients for up to 2 years under the hospital or dyspensary conditions. The disease was due to S. epidermidis (17 patients) or S.aureus (8 patients). The efficacy was controlled in the dynamics. The criteria of the therapy efficacy were disappearance of the disease clinical signs, normalization of the blood count and urinalysis and the pathogen eradication by the results of the control bacteriological blood analysis. The cure without any surgical correction was observed in 68 per cent of the patients and that with the valve replacement was stated in 24 per cent of the patients. The lethal outcome due to bacteriotoxic shock was recorded in 8 per cent of the patients. The SE relapsing was stated in 28 per cent of the patients 3 or more months after the ceftriaxone therapy completion. 10 patients (40 per cent) with evident clinicolaboratory improvement were discharged from the hospital 2 (4 patients) and 3 (6 patients) weeks after the therapy start for the treatment with ceftriaxone as outpatients. In 2 patients nausea as the adverse reaction was observed. Therefore, the complex clinicolaboratory investigation showed that the combined use of ceftriaxone and gentamicin was efficient and safe in the treatment of SE. Ceftriaxone may be considered as a basic drug for the therapy of SE. In some patients with SE the treatment with ceftriaxone may be completed under outpatient conditions.
Asunto(s)
Ceftriaxona/uso terapéutico , Cefalosporinas/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Gentamicinas/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Adolescente , Adulto , Ceftriaxona/administración & dosificación , Ceftriaxona/efectos adversos , Cefalosporinas/administración & dosificación , Cefalosporinas/efectos adversos , Recuento de Colonia Microbiana , Quimioterapia Combinada/administración & dosificación , Quimioterapia Combinada/efectos adversos , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/prevención & control , Femenino , Gentamicinas/administración & dosificación , Gentamicinas/efectos adversos , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Recurrencia , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus/crecimiento & desarrollo , Resultado del TratamientoRESUMEN
The authors studied efficacy and safety of ceftriaxone given intravenously for 3-4 weeks in a dose 2-4 g/day to patients with streptococcal endocarditis (SE). Of them, 8, 8 and 1 patients were infected with Streptococcus viridans, Streptococcus pyogenes, Pneumococcus, respectively. Hospital trial and follow-up lasted up to 2 years. Cure without surgical correction occurred in 7 patients, valvular replacement was needed in 4 patients, 1 patient died, 4 patients developed recurrences 3 and more months after therapy with ceftriaxone. The drug was safe and well tolerated. 33% of the patients were discharged from hospital with obvious improvement after 2-3 week treatment to continue it outpatiently for 1-2 weeks.
Asunto(s)
Ceftriaxona/uso terapéutico , Cefalosporinas/uso terapéutico , Endocarditis Bacteriana Subaguda/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Adulto , Ceftriaxona/administración & dosificación , Cefalosporinas/administración & dosificación , Endocarditis Bacteriana Subaguda/microbiología , Femenino , Humanos , Infusiones Intravenosas , Masculino , Recurrencia , Seguridad , Infecciones Estreptocócicas/microbiología , Streptococcus/aislamiento & purificación , Resultado del TratamientoAsunto(s)
Trastornos de las Plaquetas Sanguíneas/etiología , Endocarditis Bacteriana/complicaciones , Tromboembolia/etiología , Adolescente , Adulto , Anciano , Factores de Coagulación Sanguínea/análisis , Trastornos de las Plaquetas Sanguíneas/sangre , Trastornos de las Plaquetas Sanguíneas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agregación Plaquetaria , Tromboembolia/sangre , Tromboembolia/diagnóstico , Factor de von Willebrand/análisisRESUMEN
Ciprofloxacin was used in treatment of 5 patients with infectious endocarditis and bacterial vegetations on the values by the findings of the echocardiography. The hemocultures produced the growth of Staphylococcus epidermidis and S. aureus in 3 and 2 patients respectively. The degree of endocarditis was high in 3 patients and intermediate in 2 patients. The drug was administered intravenously in a dose of 200 mg 2 times a day for 4 weeks. The efficacy of the treatment was estimated by following-up the disease time course: the patients were examined prior to the treatment, every week during the treatment and after the treatment completion. The complex clinico-laboratory investigations showed that ciprofloxacin (Ciprinol, KRKA, Slavonia) is a highly efficient chemotherapeutic drug of the group of fluoroquinolones for the treatment of infectious (staphylococcal) endocarditis due to the sensitive microbes. The intravenous drug is useful in treatment of severe forms of infectious endocarditis. The drug is not toxic and well tolerated by the patients after its intravenous administration.
Asunto(s)
Ciprofloxacina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Adulto , Ciprofloxacina/efectos adversos , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana EdadRESUMEN
The diagnosis of bacterial endocarditis (BE) is analyzed in 255 patients. After examination, the diagnosis of BE was verified but in 92 patients (36.1%). Of these, BE was overdiagnosed in 163 patients (63.9%). The main causes of the overdiagnosis were body temperature rise in 134 patients (52.6%), heart murmur in 163 patients (63.9%), and positive hemoculture in 57 patients (22.3%). Three cases of BE overdiagnosis are provided. Exaggeration of the specificity of body temperature rise in patients with heart murmur often leads to BE overdiagnosis. Mitral valve prolapse is one of the predisposing BE factors. At the same time it is a cause of overdiagnosis of BE in patients with fever, BE overdiagnosis often results in unbased long-term antibacterial therapy, while other causes of the symptoms are not considered. Ineffectiveness of antibacterial treatment (no clinical improvement, continuous or recurrent fever) points to the necessity of further diagnostic search.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Adolescente , Adulto , Dermatomiositis/diagnóstico , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Fiebre/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/diagnóstico , Arteritis de Takayasu/diagnósticoRESUMEN
As many as 113 patients suffering from infectious endocarditis (IE) were placed under observation. Renal damage was discovered in 28 patients (24.7%). Hematuria was the common laboratory sign of renal damage. 15% of patients showed microhematuria, 9.7 had macrohematuria. In 15% of patients with IE, hematuria was due to diffuse glomerulonephritis, in 5.3% to renal infarction, and in 4.4% to focal glomerulonephritis. In 3.5% of patients, the nephrotic syndrome developed at the disease onset, it was attended by hematuria and was thus a cause of erroneous diagnoses. The appearance of hematuria at the IE onset, attesting to involvement of the kidneys into the pathological process, complicates the diagnosis and early treatment institution. Detection of the hematuric syndrome in patients with a verified diagnosis of IE requires specification of the character of renal damage. The latter one contributes to a graver and prognostically unfavourable course of IE. In 2 out of 8 patients with associated IE and renal damage, the death was caused by progressive chronic renal failure. Postmortem examination confirmed mesangioproliferative glomerulonephritis in all the subjects; in 4, it was coupled with renal infarction. 14.1% of the patients manifested complete and 3.5% partial disappearance of hematuria under the influence of adequate antibacterial therapy of IE.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Hematuria/etiología , Enfermedades Renales/etiología , Adulto , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/patología , Femenino , Glomerulonefritis Membranoproliferativa/diagnóstico , Glomerulonefritis Membranoproliferativa/etiología , Glomerulonefritis Membranoproliferativa/patología , Hematuria/diagnóstico , Hematuria/patología , Humanos , Riñón/patología , Enfermedades Renales/diagnóstico , Enfermedades Renales/patología , Masculino , Persona de Mediana Edad , EsclerosisAsunto(s)
Endocarditis Bacteriana/etiología , Enfermedades de las Válvulas Cardíacas/complicaciones , Infecciones Estafilocócicas/etiología , Válvula Aórtica , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/complicaciones , Prolapso , Válvula Pulmonar , Staphylococcus epidermidis , Válvula TricúspideRESUMEN
Investigations have shown that the etiology of bacterial endocarditis (BE) has notably changed, with the prevalence of highly virulent agents which alter a course of disease and often determine a lethal prognosis. A positive NBT-test permits more rapid and accurate detection of systemic bacterial infection than investigations of hemoculture, indicates a high phagocytic activity of neutrophils at the active stage of BE irrespective of a course of disease and permits earlier use of antibacterial therapy. A high activity of antibodies to teichoic acids indicated much earlier and more accurately Staphylococcus aureus as an etiological agent than investigations of hemoculture. It permits early etiotropic chemotherapy when it is more effective. Investigations of antibodies to teichoic acids over time makes it possible to assess the effectiveness of therapy of BE as at the inactive stage of disease the test becomes negative. Enzyme immunoassay of antibodies to native and denatured DNA reveals an active autoimmune process in BE patients, ongoing alterative processes--all of them can be used for characterization of a course and prognosis of disease. Etiotropic therapy alters the nature of a BE course, increasing the number of patients with a chronic course of disease in whom remissions are alternated by recurrences.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Anticuerpos Antibacterianos/análisis , ADN Bacteriano/inmunología , Diagnóstico Diferencial , Errores Diagnósticos , Endocarditis Bacteriana/etiología , Bacterias Grampositivas/inmunología , Humanos , Técnicas para Inmunoenzimas , Neutrófilos/inmunología , Nitroazul de Tetrazolio , Desnaturalización de Ácido Nucleico , Fagocitosis , Ácidos Teicoicos/inmunologíaRESUMEN
Incubation of polymorphonuclear (PMN) cells from patients with systemic lupus erythematosus (SLE) with levamisole increased the ability of those cells to reduce nitroblue tetrazolium (NBT). PMN cells from SLE patients treated with levamisole had an increased ability to reduce NBT compared with PMN cells taken before treatment.