Infective Endocarditis

Background Cerebral embolic events (CEEs) are common complications of infective endocarditis (IE), and their presence can modify diagnosis and therapeutic plans. The aim of the present study was to assess the role of cerebral imaging (Cer-Im) on diagnosis and management of patients with suspected IE. Methods This study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. CEEs and IE were defined according to modified Duke criteria of the European Society of Cardiology (ESC) guidelines. Results Among 573 patients with IE suspicion and Cer-Im, 239 (42%) patients had neurological symptoms. At least 1 CEE was found in 254 (44%) episodes. Based on Cer-Im findings, episodes were reclassified from rejected to possible or from possible to definite IE in 3 (1%) and 25 (4%) patients, respectively (0% and 2% in asymptomatic patients, respectively). Among the 330 patients with possible or definite IE, at least 1 CEE was found in 187 (57%) epi...

We describe the case of a 41-year-old man with congenital heart disease and infective endocarditis (IE), who presented multiple vegetations attached to the pulmonary, mitral, and aortic valves. Three valve replacements were performed, but the patient developed an abscess at the mitral-aortic intervalvular fibrosa and died due to sepsis. We briefly discuss the indications for surgery in IE, emphasizing its role in the treatment of uncontrolled infection.

In spite of the great advances made in diagnosis and treatment, infective endocarditis (IE) remains a life-threatening condition with a high mortality rate. However, its epidemiological characteristics have changed significantly over the past decades. In developed countries, the epidemiological features of IE are changing as a result of increasing longevity, new predisposing factors, and the higher frequency of nosocomial cases. Information on the profile of IE in developing countries is relatively scarce, 8 but differences have been reported. 9,10 This fact emphasizes the necessity of carrying out regional studies in order to describe the local characteristics of this disease, which may help the prevention, diagnosis, and management of this complex condition. Therefore, we undertook the present study with the aim of describing the clinical manifestations, echocardiographic and laboratory findings, microbiological profile, management strategies, and in-hospital outcome of patients with IE who were admitted to a tertiary care hospital in Brazil over a seven-year period. From June 2001 to July 2008, 62 consecutive adult patients with definite (n = 49) or possible (n = 13) IE according to the modified Duke's criteria, 11 who were admitted to the University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil, were included in the study. There were no exclusion criteria. Written informed consent was obtained from all patients, as required by the institutional ethics committee. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed within the first 72 h of admission. For the participants

Background This study examined the characteristics and outcomes of surgical aortic valve replacement (SAVR) both isolated and in combination with other cardiac surgery in Malaysia from 2015 to 2021. Methods This was a retrospective study of 1346 patients analyzed on the basis of medical records, echocardiograms and surgical reports. The overall sample was both considered as a whole and divided into aortic stenosis (AS)/aortic regurgitation (AR)-predominant and similar-severity subgroups. The most common diagnosis was severe AS (34.6%), with the 3 most common etiologies being bicuspid valve degeneration (45.3%), trileaflet valve degeneration (36.3%) and rheumatic valve disease (12.2%). The second most common diagnosis was severe AR (25.5%), with the most common etiologies being root dilatation (21.0%), infective endocarditis (IE) (16.6%) and fused prolapse (12.2%). Rheumatic valve disease was the most common mixed disease. A total of 54.5% had AS-predominant pathology (3 most common etiologies: bicuspid valve degeneration valve, degenerative trileaflet valve and rheumatic valve disease), 36.9% had AR-predominant pathology (top etiologies: root dilatation, rheumatic valve disease and IE), and 8.6% had similar severity of AS and AR. Overall, 62.9% of patients had trileaflet valve morphology, 33.3% bicuspid, 0.6% unicuspid and 0.3% quadricuspid. For AS, the majority were high-gradient severe AS (49.9%), followed by normal-flow low-gradient (LG) severe AS (10.0%), paradoxical low-flow (LF)-LG severe AS (6.4%) and classical LF-LG severe AS (6.1%). The overall in-hospital and total 1-year mortality rates were 6.4% and 14.8%, respectively. Pure severe AS had the highest mortality. For AS-predominant pathology, the etiology with the highest mortality was trileaflet valve degeneration; for AR-predominant pathology, it was dissection. The overall survival probability at 5 years was 79.5% in all patients, 75.7% in the AS-predominant subgroup, 83.3% in the AR-predominant subgroup, and 87.3% in the similar-severity subgroup. The 3 most common causes of AS-predominant patients undergoing SAVR is bicuspid valve degeneration, degenerative trileaflet valve and rheumatic and for AR-predominant is root dilatation, rheumatic and IE. Rheumatic valve disease is an important etiology in our SAVR patients especially in mixed aortic valve disease. Study registration IJNREC/562/2022.

The present study was under taken to determine the spectrum, clinical profile and outcome of patients with congenital heart disease (CHD) admitted to a tertiary care hospital. This is a retrospective, observational hospital based study conducted during January 2006 to December 2006. Out of 14461 admissions, 84 were cases of CHD. Only patients with echocardiographic proof of CHD were included in the study. Detailed clinical and laboratory findings and outcome of all cases were noted in pre-structured formats. Data were entered in MS-excel. Data was analyzed by software SPSS version 10. The incidence of CHD was 5.8 per 1000 hospitalized patients. Out of 84 CHD cases, 51 were males and 33 females; with a male to female ratio of 1.5:1. CHD presented more frequently during infancy (46 %). Acyanotic heart disease was detected in 58 (69 %) cases while cyanotic heart disease was detected in 26 (31%) cases. Among acyanotic heart disease, ventricular septal defect (VSD) was found in 49 (58.3%...

Hypertrophic cardiomyopathy (HCM) is an uncommon disease with significant consequences. Since the 1950s, major strides in understanding its etiology and pathogenesis have led to improved management and patient survival. Hypertrophic cardiomyopathy is associated with various mutations in several cardiac sarcomeric genes. Due to the complications of HCM, such as left ventricular outflow tract obstruction, diastolic dysfunction, arrhythmias, increased risk of stroke, infective endocarditis, and, most importantly, sudden cardiac death, appropriate and timely diagnosis is critical. This review summarizes current knowledge about HCM and the most appropriate investigations for persons suspected of having HCM. Treatment strategies for the disease and its complications are presented briefly.

Hypertrophic cardiomyopathy (HCM) is an uncommon disease with significant consequences. Since the 1950s, major strides in understanding its etiology and pathogenesis have led to improved management and patient survival. Hypertrophic cardiomyopathy is associated with various mutations in several cardiac sarcomeric genes. Due to the complications of HCM, such as left ventricular outflow tract obstruction, diastolic dysfunction, arrhythmias, increased risk of stroke, infective endocarditis, and, most importantly, sudden cardiac death, appropriate and timely diagnosis is critical. This review summarizes current knowledge about HCM and the most appropriate investigations for persons suspected of having HCM. Treatment strategies for the disease and its complications are presented briefly.

In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when inter...

Background: Gram negative infective endocarditis (IE) accounts for < 5% of cases of IE. Acinetobacter baumannii is a pleomorphic, emerging, opportunistic and multi-resistant organism. It is associated with delay in diagnosis and treatment failure. Objectives: We present a case of Acinetobacter baumannii IE in a child with Patent ductus arteriosus (PDA) and features of Downs syndrome. Case Report: A one-year-old boy presented with high grade fever for six (6) weeks. No cough convulsions, genitourinary or gastrointestinal symptoms. He had fast breathing, suck-rest-suck cycle and forehead sweating since six (6) weeks of age. He was acutely ill looking, febrile with axillary temperature of 39.3oC, in respiratory distress, with dysmorphic features and a systolic murmur at the upper left sternal border. He received intramuscular & oral antibiotics, antimalarials on outpatient basis as parents initially declined admission. Results: Initial results were negative urine, throat, blood cultures. Echocardiogram showed reduced flow with turbulence across the PDA and pulmonary regurgitation. He was commenced on intra venous (I.V) Cefotaxime, I.V Gentimicin which was changed to I.V Ciprofloxacin, and later I.V Cefepime on account of lack of response. The diagnosis of Acinetobacter baumannii I.E was made after six (6) weeks on admission with BACTEC. He responded to I.V Amoxicillin and Ciprofloxacin based on susceptibility pattern. Conclusion: This case highlights the rare occurrence of Acinetobacter baumannii infective endocarditis in children, particularly those with Down syndrome, a population already predisposed to infections due to immunodeficiency and unique oral microbiome characteristics.

Candida spp is a common pathogen of nosocomial infections that has increased in recent decades, with mortality rates close to 40% in cases of systemic candidiasis. One type of presentation is infective endocarditis, which, by its prolonged need for treatment, represents a constant challenge for clinicians. We describe a 36-year-old woman, recently diagnosed with ovarian cancer, who developed aortic valve infective endocarditis caused by Candida parapsilosis and who was treated with oral antifungal medication, with no surgical intervention required.

Intravenous drug-addiction is one of the susceptible factors for the development of infectious endocarditis and cocaine, especially when administered intravenously, can produce damage at the level of the valvular endothelium. We have studied a group of cocaine addicts to evaluate the possible existence of valvular alterations. Ninety-eight patients, addicts to intravenous injection and/or nasal insufflation, have been studied with Doppler and echocardiography and they were compared with a non-addict group of fifty persons. Valvular lesions were defined as valvular enlarging and &quot;beaded appearance&quot; lesions. The average age of drug-addicts was 29.1 years (SD 8.31) with a maximum of 66 year and a minimum of 14 years. Ninety-three of them were males and forty-five of them admitted to be intravenous addicts. Twenty cases showed positive serology for HIV. All of them, except one, recognized having used the intravenous route. The control group was 27.78 years old (SD 3.49) and 96...

Background: Gemella haemolysans is a gram-positive coccus that colonizes the genitourinary system, gastrointestinal system, and upper respiratory tract as an opportunistic pathogen. Berge et al. found that the frequency of Gemella species bacteremia was 4.5 and infective endocarditis was 0.31 per 1,000,000 inhabitants yearly. We report the first case of G. haemolysans bacteremia presenting as new-onset atrial fibrillation with rapid ventricular response (RVR) and acute respiratory failure and present a case series on G. haemolysans bacteremia and infective endocarditis.
Case Presentation: A 58-year-old male with a past medical history including aortic valve bioprosthetic replacement, type 2 diabetes, hypertension, and coronary artery stenting and bypass surgery presented with shortness of breath and confusion. Examination and testing revealed a 40.4°C fever, acute respiratory failure, atrial fibrillation with RVR, congestive heart failure, lactic acidosis, and acute renal failure, with no drug use, dental wounds, or pneumonia. Diltiazem, metoprolol, aspirin, atorvastatin, insulin, heparin, and ceftriaxone were started. TTE and TEE revealed no clear vegetations. Blood cultures revealed Gemella haemolysans. He became stable after 4 days, was electrically cardioverted to sinus rhythm with first-degree AV block, progressed to complete heart block, then had a temporary pacer placed. A repeat TEE demonstrated an aortic root abscess. He underwent redo sternotomy and homograft placement with no complications and was discharged with instructions to complete a six-week course of ceftriaxone.
Discussion: Our patient presented with multiple comorbidities at a younger age compared to the mean (66) and median (70) age of the 4 bacteremia cases in our 8-case series. Preemptive antibiotic treatment may be warranted for prosthetic heart valve patients, with the possibility of urgent valve replacement surgery. Several antibiotics were previously reported in case studies with varying results. The shortest course was 16 days, with most courses lasting 4 to 7 weeks. With no standard treatment, this case series suggests G. haemolysans tends to be susceptible to beta-lactam agents.
Conclusion: Our case highlights the importance of a multidisciplinary approach in the diagnosis and management of Gemella haemolysans bacteremia, particularly in patients with complex medical histories and prosthetic heart valves.

Infective endocarditis (IE) associated with permanent cardiovascular implantable electronic devices (CIEDs) is a complication of low frequency, but high mortality without adequate treatment. Progress on the knowledge of this disease and the development of therapeutic strategies such as early diagnosis, antibiotic management and better extraction techniques, among others, have improved the prognosis of these patients. The objectives of this study were to evaluate the in-hospital and out-of-hospital morbidity, and analyze some factors that explain the differences among the published mortality data. Patients diagnosed with IE associated with CIEDs were studied, retrospectively, between March/2002 and March/2011. We analyzed baseline, diagnostic and therapeutic characteristics, and in-hospital and out-of-hospital courses of the disease. We included 26 cases treated in our hospital, 23 of whom were referred from other centers for diagnosis and treatment. The average age of the patients w...

Cilj: Opisati karakteristike bolesnika, tijek bolesti, terapiju te ishod i komplikacije kod kritično oboljelih s COVID-19 liječenih u jedinici intenzivnog liječenja (JIL) Klinike za infektivne bolesti "Dr. Fran Mihaljević" (KZIB) u Zagrebu. Materijali i metode: Opservacijska retrospektivna studija 38 odraslih bolesnika liječenih u JIL KZIB s dokazanim COVID-19 u razdoblju od 11. ožujka do 6. lipnja 2020. godine. Rezultati: Od ukupno 167 bolesnika s COVID-19 liječenih u KZIB, u JIL-u je liječeno 38 bolesnika (22,8%). Medijan dobi JIL bolesnika bio je 69.5 godina (33-85), umrlih 70 (43-85), a preživjelih 66 godina (33-80). Većina je bolesnika bila muškog spola (26 bolesnika ili 68%). Od komorbiditeta najčešći su bili arterijska hipertenzija (20-53%), šećerna bolest (9-24%) te ishemijska bolest srca (8-21%). Svi su bolesnici primljeni zbog hipoksemijskog respiratornog zatajenja. Osim respiratornog zatajenja s primjenom mehaničke ventilacije u 30 (79%) bolesnika, česti su bili šok (25-66%) te akutno bubrežno zatajenje (21-55% bolesnika). Metode kontinuiranog nadomještanja bubrežne funkcije primjenjene su kod 13 (34%) bolesnika. Medijan trajanja hospitalizacije u JIL-u bio je 18 (3-68) dana, a mehaničke ventilacije 17 (5-43) dana. Ukupni je mortalitet bio 50%, a kod bolesnika koji su zahtijevali mehaničku ventilaciju 63%. Smrtnost je bila najveća u dobnoj skupini iznad 65. godine. Zaključak: Bolesnici s COVID-19, liječeni u JIL-u, često su i dugotrajno mehanički ventilirani, a tijekom boravka imaju brojne komplikacije bolesti i intenzivnog liječenja te visoku smrtnost. Najveća je smrtnost kod muškaraca starijih od 65 godina s arterijskom hipertenzijom, šećernom bolesti i ishemijskom bolesti srca.

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to mana...

Introduction: Infective endocarditis is defined as infection of a native or prosthetic heart valve, endocardial surface, or cardiac device. The causes and epidemiology, as well as the microbiology of the disease have evolved over the last few decades with the doubling of the average age of patients and an increased prevalence in patients with indwelling cardiac devices. Patients and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at ERRAZI Hospital-Mohammed VI University Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: Over the study period, 46 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. Endocarditis on ao...

Introduction: Infective Endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic localization is characterized by its progression to myocardial failure and the high number of complications motivating early recourse to surgery. The diagnosis of AR is based on microbiological and imaging studies. Echocardiography is the recommended imaging modality to make the diagnosis, assess the impact and guide surgery. Materials and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at the ERRAZI-CHU Mohammed VI Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: During the study period, 26 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The m...

Aorto-right ventricular fistulas are defects of the aortic wall in the area above the right coronary cusp, where it separates aorta and right ventricular outflow tract. This entity is rare and exceptional. Often, these defects are due to trauma or infective endocarditis. We report an occasional finding of such a fistula with dramatic issue, in young patient without past medical history which admitted for rupture of cerebral mycotic aneurysm secondary to infective endocarditis with double localization (aortic and pulmonary valve).

Austrian syndrome occurs in 1.2% of all patients with pneumococcal infective endocarditis. It presents with the triad of meningitis, pneumonia, and endocarditis. It is commonly seen in elderly males with a history of alcohol abuse, an immunocompromised state, or recent valve surgery. We present a case of Austrian syndrome presenting with paravalvular complications in the form of aortic root fistula. In this report, we describe the second patient with the community-acquired, pneumococcal, native, aortic valve, endocarditis with Austrian syndrome complicated by the development of an aortic fistula.

Nowadays, infective endocarditis remains a major cause of morbidity and mortality worldwide and there are concerns related to the increased number of infections associated with virulent agents and medical procedures. We present a case of a homeless man with unknown medical history, admitted for lumbar pain who became confused, hypotensive and tachycardic, evolving to severe sepsis. His initial investigation was also suggestive of acute myocardial infarction but the transthoracic echocardiogram revealed massive aortic valve vegetation with perivalvular abscess leading to severe aortic regurgitation. The patient died with the final diagnosis of infective endocarditis. Later on the blood cultures was identified Aggregatibacter aphrophilus, an HACEK group agent. This case confirms that, albeit the general favorable outcomes, there are cases of serious infections, especially if the diagnosis and treatment were late.

Infective endocarditis can be associated with complex clinical presentations, sometimes with a diffi cult multi-disciplinary management. Actinobacillus actinomycetemcomitans belongs to the Haemophilus species, Actinomycetemcomitans , Cardiobacterium hominis , Eikenella corrodens and Kingella species group, responsible for 5% to 10% of infective endocarditis in native heart valves. These organisms have slow fastidious growth pattern, often associated with negative cultures, and cause systemic embolism with abscess formation. The authors present the case of a 59-year-old man, admitted due to fever of unknown origin, with a personal history of obstructive hypertrophic cardiomyopathy and recent dental manipulation. The diagnosis of mitral valve's endocarditis was established after a transoesophageal ecocardiography, with a late isolation of A actinomycetemcomitans in blood culture. Despite the institution of antibiotic therapy, the patient suffered from multiple episodes of septic embolism: skin, mucosae, cerebral abscesses, spondylodiscitis and uveitis. He was submitted to heart surgery with miectomy and replacement of the native mitral valve by a mechanical prosthesis, while on antibiotics.

Aim: The purpose of this study is to describe abdominal aortic aneurysm in a 27-year-old hypertensive woman. Case Presentation: The patient is a 27-year-old female, hypertensive housewife, since 1 year and seen for palpitations, epigastric pain, headache, buzzing ears. Evolution: 1 month. Cardiovascular risk factor: hypertension. Cardiac Auscultation, BDC regular at 100 bpm with a B2 flush at the aortic focus. 170/100 mmHg blood pressure with both arms. Soft abdomen with a moving painful moving mass sitting at the epigastrium whose auscultation finds a systolic diastolic murmur. The rest of the exam is peculiar. Conclusion: Aneurysm of the abdominal aorta is a pathology rarely diagnosed in our environment and yet frequently associated with atheroma risk factors. It must be suspected in front of a pulsatile abdominal mass to be confirmed by abdominal ultrasound. Thus, the ideal treatment remains surgical.

Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when accompanied byfever of unknown origin, is more severe since interferes with proper diagnosis and endocarditis treatment. The Rio de Janeiro Infective Endocarditis Study Group reports a case of infectious endocarditis (IE) with negative blood cultures in a 45-year-old white female resident in Rio de Janeiro, Brazil, previously submitted to kidney transplantation. After diagnosis and intervention, the valve culture revealed . The clinical aspects and overview of endocarditis caused by spp. demonstrated that have been isolated from the last IE cases from kidney transplanted patients. Though most of the patients (in literature) recovered well from endocarditis caused by spp., physicians must be aware for diagnosis of fungemia and fungal treatment in kidney transplanted patients suffering of fever of unknown origin in the modern immunosuppressive treatment.

Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines. PRESENTATION OF CASE: We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit. DISCUSSION: Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes. CONCLUSION: Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.

Background. Lead-dependent infective endocarditis (LDIE) is a life-threatening complication of permanent transvenous cardiac pacing. According to the 2015 European Society of Cardiology (ECS) guidelines, the diagnosis of LDIE is based on the modified Duke criteria (MDC), while single-photon emission computed tomography with conventional computed tomography (SPECT-CT) with radioisotope-labeled leukocytes serves as an additional tool in difficult cases. The major challenge is to differentiate between true vegetation and a thrombus. Objectives. The aim of the study was to evaluate the usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing LDIE in patients with intracardiac masses (ICMs). The prospective registry included 40 consecutive patients admitted with an ICM on the lead and suspicion of LDIE. The confirmation or rejection of the LDIE diagnosis was made according to an algorithm based on the MDC. The cohort was divided into 2 groups: patients with definite and possible LDIE diagnoses based on the MDC (the LDIE-positive group), and patients with negative LDIE diagnoses according to the MDC (the LDIE-negative group). All patients underwent SPECT-CT with radioisotope-labeled leukocytes. The diagnostic ability of SPECT-CT was compared to the gold standard MDC. Results. The LDIE-positive group with diagnosis based on the MDC consisted of 19 patients (LDIE definite -11; LDIE possible -8). The LDIE diagnosis was rejected on the basis of the MDC in 21 patients. The SPECT-CT results were compared with the MDC results and showed 73.7% sensitivity, 81.0% specificity, 77.5% accuracy, 77.8% positive predictive value (PPV), 77.3% negative predictive value (NPV), likelihood ratio positive (LR+) 3.868, likelihood ratio negative (LR-) 0.325, and moderate agreement (κ = 0.548, p < 0.001). After the exclusion of 5 patients treated with antibiotics at the time of the SPECT-CT, LR+ and LR-improved to 5.250 and 0, respectively, and inter-test agreement amounted to almost perfect concordance (κ = 0.773, p < 0.001). Conclusions. Single-photon emission computed tomography with conventional CT with radioisotopelabeled leukocytes is a useful, efficient, single-step test for diagnosing LDIE.

Infective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime-labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015-2016. All patients underwent clinical evaluation, TTE and 99mTc-HMPAO-SPECT/CT for the assessment of lesions typical for IE. Scans were evaluated for the presence and location of increased radioactivity foci, corresponding to the accumulation of radiolabeled leukocytes in inflammatory lesions. After 6 months, the patients were re-evaluated clinically and with TTE. Final IE diagnosis was established in 14 (35%) patients. Lesions typical for IE were shown in 28 (70%) TTEs and 16 (40%) 99mTc-HMPAO-SPECT/ CTs. The latter tests were characterized by 90% accuracy, 93% sensitivity, 88% specificity, 96% negative predictive value (NPV), 81% positive predictive value (PPV). TTE demonstrated 60% accuracy, 93% sensitivity, 42% specificity, 92% NPV, and 46% PPV. 99mTc-HMPAO-SPECT/CT was characterized by a lower number of false-positive results compared to TTE (3 vs. 15). In patients with suspected IE, 99mTc-HMPAO-SPECT/CT yields a smaller number of false-positive results, significantly higher diagnostic accuracy, specificity and PPV than TTE. It helps to differentiate IE infectious and sterile echocardiographic lesions and reduces by 27% the number of misdiagnosed IE classified in the 'possible IE' category by modified Duke Criteria.

Background: Several CMR techniques have emerged that permit to directly assess myocardial deformation, which has been demonstrated to be more closely related to myocyte metabolism and contractility than LVEF. Among these techniques, CMR feature-tracking has gained prominence as a fast and accurate modality for the assessment of LV strain. However, it is still unknown whether CMR assessment of myocardial strain provides independent and incremental prognostic information in patients with STEMI. The aim of the present study was to investigate the prognostic utility of feature-tracking derived global circumferential strain (GCS) in patients admitted with a first STEMI. Methods: 180 consecutive patients admitted because of a first STEMI and referred to CMR with LGE imaging were included. All patients underwent immediate coronary angiography and primary PCI. CMR studies were performed using a 1.5T scanner after a median of 8 days following the index event. Cine-CMR and LGE images were analysed offline to assess LV volumes, EF, infarct size (IS) and microvascular obstruction (MVO). The endocardial LV contours from cine-CMR basal, mid and apical short-axis images were analysed offline to derive GCS using 2D Cardiac Performance Analysis Software. Patients were followed-up for a median duration of 95 months. The outcome event was a composite endpoint, which included 1) cardiovascular death; 2) aborted sudden cardiac death, defined as a nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate ICD therapy; and 3) hospitalization for heart failure. The mean age of the study population was 60±12 years and 72% were male. Mean LVEDV index was 83±20 ml/m 2 and mean LVEF was 50±13%; median infarct size was 13% (interquartile range, 5 to 30%) and 31% had MVO. Mean GCS was -16±5%. During follow-up, 40 (22%) patients experienced at least 1 event. At Kaplan-Meier analysis, the risk of outcome event increased significantly with worsening tertiles of GCS (log-rank p<0.001), increasing tertiles of IS (logrank p<0.001) and with the presence of MVO (log-rank p<0.001). After adjustment for clinical and CMR imaging characteristics having univariate association with the outcome event at p≤0.05, GCS remained significantly and independently associated with the outcome event (HR 1.17 per %; 95% CI 1.03-1.33; p=0.013). Of note, a significant increase of global X2 was observed when adding GCS to a model including clinical and non-contrast CMR variables (X2 change = 15.3; p<0.001) and to a model including clinical, non-contrast and LGE variables (X2 change = 5.7; p=0.017). Conclusion: LV GCS assessed by CMR feature-tracking can predict a worse long-term prognosis in patients admitted with a first STEMI and treated with PCI. More importantly, the predictive ability of GCS was incremental to other clinical and especially CMR variables, including IS and MVO.

Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications. Developing molecular imaging modalities may provide additional insights into ongoing infection and support an accurate diagnosis. We present the current evidence for the diagnostic performance and indications for utilization in current guidelines of the hybrid modalities: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime–labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) along with positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). The role of molecular imaging in IE diagnostic work-up has been constantly growing due to technical improvements and the increasing evidence supporting its added diagnostic and prognostic value. The various underlying molecular processes of 99mTc...

1) Background: Treatment of cardiac arrhythmias and conduction disorders with the implantation of a cardiac implantable electronic device (CIED) may lead to complications. Cardiac device-related infective endocarditis (CDRIE) stands out as being one of the most challenging in terms of its diagnosis and management. Developing molecular imaging modalities may provide additional insights into CDRIE diagnosis. (2) Methods: We performed a systematic literature review to critically appraise the evidence for the diagnostic performance of the following hybrid techniques: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime-labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) and positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). An analysis was performed in accordance with PRISMA and GRADE criteria and included articles from PubMed, Embase and Cochrane databases. (3) Results: Initially, there were 2131 records identified which had been published between 1971-2021. Finally, 18 studies were included presenting original data on the diagnostic value of 99mTc-HMPAO-SPECT/CT or 18F-FDG PET/CT in CDRIE. Analysis showed that these molecular imaging modalities provide high diagnostic accuracy and their inclusion in diagnostic criteria improves CDRIE work-up. (4) Conclusions: 99mTc-HMPAO-SPECT/CT and 18F-FDG PET/CT provide high diagnostic value in the identification of patients at risk of CDRIE and should be considered for inclusion in the CDRIE diagnostic process.

We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM). Methods: We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only. Results: Among the 1030 included patients, we identified 42 patients with IE-BM (4.1%). Baseline characteristics of patients with IE-BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE Bruno Hoen and Xavier Duval contributed equally. The members of the AEPEI and the COMBAT study groups are listed in the Acknowledgements section. G. Be ´raud (&)

Objectives: Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei.

To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. Prospective cohort study, conducted from 1984-2013 in 26 Spanish hospitals. A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p &lt; 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23 - 1.85; p&lt; 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately...

Background: The World Health Organization (WHO) and national disease control agencies emphasized the importance of hand hygiene to reduce the spread of the virus during COVID-19 pandemic to curb the spread of the virus coupled with vaccination. Alcohol-based hand sanitizer (ABHS) formulation is effective to reduce or eliminate bacterial or viral load, and commonly applied in the form of hand rub rinses, gel and foam, but it may impair skin barrier integrity and function, increasing the risk of hand dermatitis resulting local and/or systemic infections. Case Description: A 75-year-old woman used ABHS excessively without skin moisturizer resulted in bilateral dry skin-crack hands. Two weeks prior to hospital admission, she experienced progressive generalized fatigue, shortness of breath with moderate exertion, bilateral lower leg edema, orthopnea and paroxysmal nocturnal dyspnea associated with fever and chills. She was diagnosed with Staphylococcus lugdunensis (S. lugdunensis) aortic and mitral valve endocarditis. Intravenous (IV) antibiotics coupled with urgent cardiac surgery to replace the aortic valve, debridement and reconstruction of the left ventricular outflow track followed by a complex mitral valve repair. Her post-operative course complicated by requiring intra-aortic balloon pump (IABP), veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous venous-venous hemodialysis (CVVHD). Despite decannulation of all three mechanical supports, the patient continued to have multiple intensive care unit (ICU) related medical and surgical complications, resulted in her mortality. Conclusions: Excessive use of ABHS without moisturizer can induce dry hands and skin damage, resulting in irritant or allergic contact dermatitis. The injured skin is a potential host for local and systemic infections such as the described case of S. lugdunensis endocarditis.

Prosthetic valve endocarditis (PVE) is a complication of valve replacement associated with high morbidity and mortality. Escherichia coli (E. coli) is rarely associated with infective endocarditis (IE), accounting for less than 1% of the cases reported. The low frequency is attributed to the organism's low affinity to adhere to the endocardial endothelium. Risk factors that may play a role in developing IE by E. coli include age above 70, diabetes mellitus, a genitourinary source of infection, female sex, healthcare contact, implanted endovascular devices, and immunosuppression. We present a 70-year-old Hispanic woman who arrived with constitutional symptoms and persistent urinary complaints. She had diabetes mellitus, recurrent urinary tract infections, and native mitral valve IE treated with antibiotic therapy and tissue valve replacement. The valve was replaced with a mechanical valve a second time due to malfunctioning. The patient was found to have E. coli bacteremia and ultimately diagnosed with PVE. She was treated solely with ceftriaxone and gentamicin combination therapy resulting in complete resolution of valve vegetations. Our case represents the 11th report of this uncommon disease and illustrates its epidemiology and associated risk factors. We summarize the previous 10 cases reported and highlight the lack of prospective trial data to define optimal therapy for managing PVE caused by E. coli.

Q fever is a worldwide zoonotic disease caused by Coxiella burnetii. In humans, it can manifest clinically as an acute or chronic disease and endocarditis, the most frequent complication of chronic Q fever is associated with the greatest morbidity and mortality. We report a severe case of endocarditis in a 55-year-old man with a history of aortic valve replacement affected by monoclonal gammopathy of undetermined significance (MGUS), and living in a non-endemic area for C. burnetii. After two episodes of fever of unknown origin (FUO), occurring 2 years apart and characterized by negative blood cultures, a serological diagnosis of Q fever endocarditis was performed even though the patient did not refer to possible past exposure to C. burnetii. Since people with preexisting valvular heart disease, when infected with C. burnetii, have reported a 40% risk of Q fever endocarditis, clinicians should maintain a high index of suspicion for infective endocarditis in all patients with FUO eve...

La endocarditis infecciosa sobre válvula tricúspide en niños con corazón normal y sin antecedentes patológicos constituye una enfermedad rara, cuyo diagnóstico es difícil, pero con una incidencia que ha aumentado en las últimas décadas. Presentamos el caso clínico de un niño de 11 años, sin factores predisponentes para endocarditis, en quien se realizó diagnóstico de endocarditis infecciosa de válvula tricúspide a Staphylococcus aureus complicada con embolia séptica pulmonar. Recibió tratamiento quirúrgico conservador en la etapa activa de la enfermedad por haber presentado reiteración de embolia pulmonar clínicamente evidente y características ecocardiográficas de la vegetación que sugerían alta probabilidad de nuevos eventos embólicos y falla en la respuesta al tratamiento antibiótico adecuado.

Amaç: Đnfektif endokardit, ekokardiografi kullanımının yaygınlaşması ile tanı oranı ve buna bağlı olarakta, bu tür hastaların tedavisinde sınırlı endikasyonlarda tercih edilen cerrahi tedavi uygulamaları artmıştır. Bununla beraber cerrahi tedavi endikasyonları ve sonuçları hala sorgulanmaktadır. Bu nedenle, biz, kliniğimizde infektif endokardit nedeni ile opere edilen hastalarımızdaki sonuçlarımızı değerlendirmeyi hedefledik. Materyal ve Metod: Ankara Üniveritesi Tıp Fakültesi Kalp ve Damar Cerrahisi kliniğinde ocak 1990 ile temmuz 2001 tarihlerinde infektif kapak endokarditi nedeni ile opere edilen hastalar değerlendirildi. Bu dönem içinde 18 hastanın infektif kapak endokarditi nedeni ile opere olduğu saptandı. Đnfektif kapak endokarditi nedeni ile opere olan hastaların , bu dönemde opere olan hastalara oranı ise % 0.231'di. Hastaların 8'i kadın (%44.4), 10'u erkekti (%55.5). Hastaların yaş ortalaması 45.3±5.1'di. Hastaların 4'ünde stafilokok (% 22.2) , 4'ünde streptokok (%22.2), 2 hastada ise brucella (%11.1) infektif kapak endokarditin nedeni olarak saptandı. Ancak 8 hastada (%44.4) mikroorganizma tespit edilemedi. Hastaların hepsi operasyon öncesinde mikroorganizmaya uygun antibiotik tedavisi aldı. Mikroorganizma tesbit edilemeyen hastalar ise ampirik tedavi gördüler. Hastalar preoperatif olarak transtorasik ve transözafajiyal ekokardiografi ile değerlendirildi.Hastaların 10'unda mitral (%55.5), 4'ünde aort (%22.2), 4'ünde ise hem aort hem de mitral kapak disfonksiyonu (%22.2)mevcuttu. Tekrarlanan kan kültürlerinin negatif olması ve infeksiyon kriterlerinin ortadan kalkması ile hastalar operasyona verildi. Operasyon esnasında kapaklar kültüre gönderildi. Postoperatif olarak hastalar hemodinamik , metabolik yönden değerlendirildi. Uzun dönem takiplerinde ise hastalar ekokardiografi ile değerlendirilmelerinin yanı sıra yeniden bir kapak endokarditi açısından da değerlendirildiler. Sonuçlarımız: Hastalarımızdan redo AVR yapılan bir hasta perioperatif olarak ciddi kardiak yetmezlik nedeni ile exitus oldu. Brucella endokarditi saptadığımız bir hasta ise postoperatif 5. günde intrakranial kanama nedeni ile exitus oldu. Mortalite oranımız %11.1 olarak saptandı. Mitral kapak replasmanı yaptığımız bir hastamızda A-V tam blok gelişmesi üzerine hastaya kalıcı pace maker konuldu. Diğer hastalarımız yoğun bakım ve serviste herhangi bir sorun yaşamadan taburcu edilmişlerdir. Hastalar ilk yıl içinde dört kez ve ikinci yıldan itibaren yılda iki kez ekokardiografik olarak değerlendirildiler. 2 yıl ve daha uzun dönem sonuçlarında ise bu hastalarda hemodinamik ve kapak ile ilgili bir soruna rastlanmadı. Yorum: Đnfektif kapak endokarditi geçirildikten sonra hastada ciddi kardiak hasarlar oluşabilmektedir. Bu nedenle infektif endokardit profilaksisi temel yaklaşım olmalıdır. Ancak infektif endokardit vakalarında cerrahi yaklaşım unutulmamalı ve hastanın uzun dönem yaşam kalitesinin arttırılmasında önemli bir yol olduğu gözden kaçmamalıdır.

Only about 40 cases of septic arthritis of the facet joints have been reported to date. We report 6 new cases including 2 at the cervical spine, which is rarely involved. Mean age was 61.5 years; there were 5 men and 1 woman. Spinal pain and stiffness, fever, and asthenia were the presenting manifestations. Laboratory tests consistently showed inflammation. Among classical risk factors for infection, only noninsulindependent diabetes was noted, in a single patient. Mean time to the diagnosis was 42 days. Discitis, a far more common condition, was considered initially, and early radiographs were of limited diagnostic assistance. Radionuclide bone scans identified the site of the infection and served to look for other foci. Magnetic resonance imaging was effective in confirming the diagnosis at an early stage and in looking for local spread (muscles, epidural space, and disk). L3eL4 was involved in 3 patients, C4eC5 in 2, and L4eL5 in 1. Direct inoculation during mesotherapy sessions was the cause in 1 patient. Cultures of blood and needle biopsy samples were positive in all 6 cases; Staphylococcus aureus was the causative agent in 3 patients. The risk of local and systemic complications governs the prognosis of facet joint infection. Of our 6 patients, 4 experienced complications: there was 1 case each of discitis, epidural infection, endocarditis, and septic arthritis of the acromioclavicular joint. Fatal multiple organ dysfunction occurred in 1 patient. In the other 5 patients, antimicrobial therapy and protection from weight-bearing for 3 months ensured a favorable outcome.

We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998. Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%). Surgical valve replacement was performed for 12 patients (40%). Fourteen patients (47%) died. Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively ( ). The mortality rate for native valve P p .01 endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; ). Additionally, 115 cases in the literature from 1962-1998 were reviewed. During 1980-1998, the P ! .05 percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% ( ) and the mortality rate decreased from 45% to 34% ( ). S. agalactiae is an uncommon P p .05 P p NS cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery. The incidence of invasive infection caused by Streptococcus agalactiae has increased during recent years in nonpregnant adult patients, elderly patients, and patients with chronic immunosuppressive diseases, such as alcoholism, diabetes mellitus, neoplasias, and HIV infection [1]. Infective endocarditis (IE) is an uncommon manifestation of S. agalactiae invasive disease [1].

BACKGROUND The study objective was to evaluate the role of transesophageal echocardiography in identifying the origin of anomalous coronary arteries and confirming their course in relation to the great vessels. The diagnosis of coronary anomalies is made by angiography. The anomalous left main artery with a course between the pulmonary artery and the aorta has been associated with myocardial infarction and sudden death. The course of these anomalous coronary arteries is difficult to demonstrate by angiography alone. METHODS AND RESULTS Nine patients with angiographically confirmed anomalous coronary arteries were studied by transesophageal echocardiography with color flow Doppler. The abnormal origin of the anomalous coronary arteries was confirmed by transesophageal echocardiography in all nine patients. In four patients, the left main coronary artery originated from the right sinus of Valsalva. In all of these patients, transesophageal echocardiography demonstrated the course of t...

In the Institute of Cardiology and Cardiovascular Surgery of Havana city, in the understood period of January of 1992 to December of the 2006 was carried out a descriptive study, traverse to describe the results of the surgical treatment in 45 operated patients of Infective Endocarditis associated to heart devices. The 60 year-old patients and more was those most affected and the masculine sex prevailed. The EIDC was presented with more incidence in relation to the EIVN and the EIVP. The predominant germ in the hemocultivos was the golden estafilococo. Proceeding surgical consisted on the extraction of the generating system and wires of Pacemaker or DCI, and more than the half was carried out without extracorporeal circulation. The cardiac insufficiency, the postoperative bleeding and the infection of the surgical wound were the most frequent complications. The hospital mortality in the EIDC was of 8.9%.