Tag Archives: infective endocarditis

Introduction Infective endocarditis (IE) is a potentially fatal infection of the endothelial lining of cardiac structures, with an estimated incidence between 42 and 67 cases per million in England.1 Mortality without treatment approaches 100%.2 The 1994 Duke diagnostic criteria for IE merge clinical, echocardiographic, and microbiological information, and the European Society of Cardiology (ESC) recommend use of the Duke criteria in conjunction with multi-disciplinary team (MDT) opinions of cardiologists and microbiologists.3,4 Initial investigations include three sets of blood cultures and transthoracic echocardiography (TTE), which remains

Table 1. Clinical features and complications First author Symptoms / complications Pur Jn Spl SCH Os Valve Culprit pathogen Cecarelli1 Meningitis, SMA, SE Y N N N N Mitral Staph. aureus Deonarine2 Cirrhosis, CHF, spondylitis Y N N N N Quadrivalve Strep. mutans El Chami3 CHF, respiratory failure Y N N N N Aortic Enterococcus faecalis Yokota4 Mesenteric abscess Y N N N N Mitral MSSA Miridjanian5 Fever, myalgia, headache Y N Y Y N Aortic Moraxella kingae Mahmoud6 Cirrhosis, CHF, ICE Y N N N N Mitral Pasteurella multocida Tiliakes7 Polyarthralgia, ANCA+ve, splenomegaly Y N N N N Aortic Strep. viridans Messiaen8 CHF, Gln, ANC

Introduction Infective endocarditis (IE) is a devastating syndrome with a high in-hospital and one-year mortality.1,2 Frequently, valve replacement is required, and inpatient stays are prolonged. Moreover, the incidence of IE is increasing in the UK and across Europe.3,4 There is likely no one cause for this increase, and it probably represents the convergence of multiple factors. These include an ageing population, increasing rates of diabetes mellitus, rising rates of medical intervention, and, possibly, a reduction in the provision of antibiotic prophylaxis in the setting of invasive procedures. Links between dentistry and the development

Introduction Table 1. Summary of general dermatological signs Dermatological sign Cardiac disorder Xanthomata Hyperlipidaemia Acanthosis nigricans Obesity, diabetes, hyperinsulinaemia, metabolic syndrome Male-pattern baldness Coronary heart disease Premature hair greying Coronary heart disease, hyperlipidaemia Earlobe crease Coronary heart disease Livedo reticularis Cholesterol embolisation syndrome, anti-phospholipid syndrome/systemic lupus erythematosus, endocarditis, rheumatic fever, diabetes Cyanosis Congenital heart disease, heart failure Clubbing Congenital heart disease, endocarditis, cardiac myxoma Cardiac cond

Introduction A major contributor to the cost of a patient’s care is the number of days occupying hospital beds. In a cardiology department, there are some patients that require long-term antibiotics, such as those with infective endocarditis or infected prosthetic devices. While most of these high-risk patients require some duration of monitoring for complications and deterioration as inpatients, there are patients who may, after a period of observation, be stable enough to be discharged home with outpatient intravenous therapy. In this report, we describe our experience with intravenous antibiotic therapy for patients with cardiology diagn

Introduction Infective endocarditis (IE) is a relatively rare disease; however, it is becoming increasingly common and is associated with significant morbidity and mortality.1 A recent meta-analysis has revealed that the epidemiology of IE has evolved over the last five decades,2 with significant global variation. Several large epidemiological studies show that the incidence of IE is increasing, particularly in male and elderly patients.3-5 There have also been changes in the microbiology of IE with staphylococci overtaking streptococci as the most frequent causative organism.6 There are few recent studies describing the incidence or epidemio

This change followed approaches to Sir Andrew Dillon by the widow of a patient with a replacement aortic valve who died from infective endocarditis (IE) developing after unprotected dental scaling. Her case included: evidence that antibiotic prophylaxis is effective in people at high risk of IE having high-risk dental procedures;3 the observation that the incidence of IE in the UK has accelerated above the global background rise since the original 2008 NICE guidance;4 a change in the law on consent.5-7  It is now necessary for dentists to appraise their patient of the differences between NICE and other guidelines, if it is likely that they

Introduction Figure 1. Chest X-ray (antero-posterior projection) demonstrating a septic lesion (thick arrow) Despite the significant improvements in both diagnostic and therapeutic procedures in recent years, infective endocarditis (IE) remains a medical challenge due to poor prognosis and high mortality. IE varies according to the initial clinical manifestations, underlying cardiac disease, micro-organisms involved and the associated complications. Echocardiographically, the majority of patients demonstrate vegetations on a single valve, while demonstration of involvement of two valves occurs much less frequently; triple-valve involvement is

Dear Sirs, There has been much debate regarding the prophylactic prescribing of antibiotics in patients deemed at risk of developing infective endocarditis (IE) as a result of certain dental procedures.1 The National Institute for Health and Care Excellence (NICE), the British Society for Antimicrobial Chemotherapy (BSAC) and the American Heart Association (AHA) have produced differing guidelines for dental practitioners, who may decide to accept one particular code entirely, or a modified version based on discussion with local cardiology departments. This culture of debate amongst cardiologists, dentists and patients regarding best interest,

The case study in this issue (see pages 46–7) demonstrates a potential use of CT scanning in the diagnosis of a patient with endocarditis. Electrocardiogram (ECG)-gated multi-detector cardiac computed tomography (MDCT) scanning has been proposed by many to have potential in the evaluation of endocarditis by demonstration of vegetations, complications (coronary artery occlusion, fistulae) and peripheral embolism.3 The major limitations of the technique include availability, spatial resolution, failure to demonstrate leaflet perforations and lack of haemodynamic information (table 1). Further, CT findings have not been correlated with clinica