Presentation
We present a case of a 35-year-old male with a history of hypercoagulability and St. [ncbi.nlm.nih.gov]
Entire Body System
- Fever
Case 2 was a 79-year-old woman presenting with fever 40 days after aortic valve replacement with a bioprosthesis. [ncbi.nlm.nih.gov]
The fever decreased but persisted at a level of 37.8°C. [bmcinfectdis.biomedcentral.com]
- Sepsis
The procedure itself was uneventful, but the patient died several days postoperative due to persisting sepsis. [ncbi.nlm.nih.gov]
Postoperatively, the patient received liposomal amphotericin B and flucytosine followed by oral fluconazole, and the sepsis cleared. Figure 1 A 77-year-old man presented with a two-month history of fever, chills, and malaise. [nejm.org]
[…] management of coagulopathy during resternotomy for prosthetic valve endocarditis can reduce associated postoperative morbidity and mortality. 1 While published literature suggests that endocarditis may be associated with overt hypercoagulability, 2 sepsis [anesthesiology.pubs.asahq.org]
By this route they can reach any of the organs, causing sepsis (blood poisoning). If parts of the detached clumps are transported to the brain, then paralysis or other severe loss of function may result. [ismaap.org]
Five months later he was readmitted to our department in a devastating condition with all clinical ( sepsis, multiple emboli) and echocardiographic signs of PVE with a huge vegetation extending into the ascending aorta, and abscess cavities at the non-coronary [omicsonline.org]
- Anemia
Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria. The etiologic microorganism can be isolated in more than 90% of all cases. [ncbi.nlm.nih.gov]
Laboratory tests showed elevated C-reactive protein (CRP), anemia and thrombocytopenia. Blood cultures were negative. [elsevier.pt]
Hemolytic anemia – due to shearing of RBCs across mechanical valves, usually mild, can see schistocytes. Can be severe – especially as a presentation of valve failure. II. [errolozdalga.com]
Case 1 involved a 62-year-old man admitted to the hospital in 2011 with left-flank pain and a 3-year history of anorexia, weight loss, night sweats, and recent diagnosis of anemia. He kept pet cats. [wwwnc.cdc.gov]
[…] extending established guidelines for blood conservation strategy (BCS) in routine cardiac surgeries to aortic valve replacement. [21, 22] The investigators reported that implementing BCS (eg, limits on intraoperative hemodilution, tolerance of perioperative anemia [emedicine.medscape.com]
Respiratoric
- Pneumonia
Keywords Infective endocarditis Prosthetic valve endocarditis Streptococcus pneumoniae Mitral valve replacement Introduction In the pre-antibiotic era up to 15% of all cases of infective endocarditis (IE) were due to S. pneumoniae, but currently 2002 [springerplus.springeropen.com]
Only one case had a native valve, and her endocarditis occurred after pneumonia. All cases were cured. The duration of antibiotic therapy was variable. [ncbi.nlm.nih.gov]
N99.5- ) postgastric surgery syndromes ( K91.1 ) postlaminectomy syndrome NEC ( M96.1 ) postmastectomy lymphedema syndrome ( I97.2 ) postsurgical blind-loop syndrome ( K91.2 ) ventilator associated pneumonia ( J95.851 ) Use Additional code for adverse [icd10data.com]
Cardiovascular
- Heart Disease
[…] of the heart valves Valvulopathy, or heart valve disease, arising in a transplanted heart Rheumatoid vascular disease Congestive heart disease Mitral valve prolapse Age-related degenerative heart disease Heart disease due to underlying connective tissue [dovemed.com]
Disease 502 The Heart and Pregnancy 537 Chapter32 Women and Heart Disease 553 The Elderly and Aging 561 Chapter34 EndofLife Care 587 The Heart and Other Organ Systems 595 Chapter 35B Hematologic Disorders and the Heart 604 Chapter35C The Heart and the [books.google.com]
MD Renu Virmani, MD Review of Normal Anatomy and Histology of the Heart and Blood Vessels Endocarditis, Rheumatic, and Degenerative Valvular Diseases Cardiac Tumors Pathology of the Aorta Elena Ladich, MD Congenital Heart Disease Interpretation and [radiologyebook.vn]
Acute Heart Failure, Interventions and Structural Heart Disease Keywords: Anti-Bacterial Agents, Cardiac Surgical Procedures, Cardiopulmonary Bypass, Edema, Endocarditis, Endocarditis, Bacterial, Heart Failure, Heart Valve Diseases, Pulmonary Edema, [acc.org]
Diseases listed under high risk include: Prior endocarditis Unrepaired cyanotic congenital heart diseases Completely repaired congenital heart disease in their first 6 months Prosthetic heart valves Incompletely repaired congenital heart diseases Cardiac [en.wikipedia.org]
- Heart Murmur
Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria. The etiologic microorganism can be isolated in more than 90% of all cases. [ncbi.nlm.nih.gov]
murmur: It is an abnormal heart sound that can be listened with a stethoscope Electrical abnormalities in the heart (cardiac arrhythmias) Stroke: It is a condition in which blood supply to an area of the brain is disrupted that results in a weakness [dovemed.com]
The most common clinical features are fever, major peripheral emboli, and a changing heart murmur. Less frequently, the patients present focal or generalized neurologic deficits, heart failure or dyspnea. [cureus.com]
Heart murmurs are found in up to 85% and new murmurs have been recently reported in 48% of patients. [patient.info]
Specialty Cardiology, Infectious disease Symptoms Fever, small areas of bleeding into the skin, heart murmur, feeling tired, low red blood cells [1] Complications Valvular insufficiency, heart failure, stroke, kidney failure [2] [1] Causes Bacterial infection [en.wikipedia.org]
- Systolic Murmur
Examination revealed a temperature of 40°C and a systolic murmur in the aortic area. [ncbi.nlm.nih.gov]
Oral temperature was 37.6°C, mechanical heart sounds were heard, as well as a 2/6 apical systolic murmur. The physical examination was otherwise unremarkable. [springerplus.springeropen.com]
Physical examination revealed fever, a splinter hemorrhage, and an ejection systolic murmur. [wwwnc.cdc.gov]
- Diastolic Murmur
On physical examination the patient was pale and presented with bilateral lower limb edema, jugular distension and a grade II/IV diastolic murmur on the left sternal border. [elsevier.pt]
Neurologic
- Meningism
Meningism/meningitis : purulent disease occurs in acute IE and aseptic variety in subacute IE. Criteria for consideration and investigation of possible IE [ 4 ] A febrile illness and a murmur of new valvular regurgitation. [patient.info]
Urogenital
- Hematuria
Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria. The etiologic microorganism can be isolated in more than 90% of all cases. [ncbi.nlm.nih.gov]
Workup
Microbiology
- Blood Culture Positive
positive for infectious organisms Blood cultures that are positive for microorganisms, which are taken 12 hours apart 3 blood cultures positive on separate occasions that are taken at least 1 hour apart Abnormalities in echocardiogram showing either a [dovemed.com]
Microorganisms consistent with IE from 2 persistely positive blood cultures: At least 2 positive blood cultures of blood samples drawn > 12h apart or all of 3 or a majority of ≥ 4 separate cultures of blood with first & last sample drawn at least 1h apart [wikiecho.org]
- Chlamydia
Some examples include pathogens like Aspergillus species, Brucella species, Coxiella burnetii, Chlamydia species, and HACEK bacteria. [en.wikipedia.org]
Laboratory
- Leukocytosis
Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria. The etiologic microorganism can be isolated in more than 90% of all cases. [ncbi.nlm.nih.gov]
Investigations [ 4 ] Nonspecific signs of infection - eg, elevated CRP or ESR, leukocytosis, anaemia and microscopic haematuria. CXR: as part of the initial assessment. ECG is useful to detect the 10% of patients who will develop conduction defects. [patient.info]
Treatment
Data concerning clinical characteristics, treatment, and outcome were registered. [ncbi.nlm.nih.gov]
Prognosis
Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. [ncbi.nlm.nih.gov]
It has a bad prognosis and high morbidity and mortality due to cardiac or extracardiac complications. 1-3 It is often managed by heart surgery 2,4,5 and numerous studies indicate that the prognosis of patients with PVE is better using a combined medical-surgical [revespcardiol.org]
What is the Prognosis of Prosthetic Valve Endocarditis? (Outcomes/Resolutions) Prosthetic Valve Endocarditis, if left untreated is almost always fatal. [dovemed.com]
Etiology
A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings. [ncbi.nlm.nih.gov]
The predominant etiologic agents are bacteria followed by fungi. Fungal endocarditis (FE) is an uncommon occurrence and the most severe form of IE. [omicsonline.org]
Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. [elsevier.pt]
Epidemiology
In addition, a 5-year outlook offers consolidated knowledge on epidemiological trends of both culprit organisms and population subgroups suffering (and projected to suffer) from PVE. [ncbi.nlm.nih.gov]
CRC Press, ١٣/٠٣/٢٠٠٧ - 388 من الصفحات The first up-to-date source on the subject in more than a decade, this authoritative and all-encompassing guide summarizes the latest findings on the epidemiology, pathogenesis, pathophysiology, clinical manifestations [books.google.com]
Pathophysiology
CRC Press, ١٣/٠٣/٢٠٠٧ - 388 من الصفحات The first up-to-date source on the subject in more than a decade, this authoritative and all-encompassing guide summarizes the latest findings on the epidemiology, pathogenesis, pathophysiology, clinical manifestations [books.google.com]
Early infection ( Microbiology: Staph aureus (40%) Coag neg staph (20%) Cx neg (20%) Fungal (10% Late infection: pathophysiology more similar to native valve endocarditis (adherence to platelet-fibrin thrombi on valve), as foreign material has become [errolozdalga.com]
Prevention
This case demonstrates that carefully weighing the risks and benefits of continuing anticoagulation is essential in preventing poor outcomes. [ncbi.nlm.nih.gov]
Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. [books.google.com]