1
|
Bacci M, Patel K, Cabrera G, Kalivoda EJ. Bedside Echocardiography Diagnosis of Tricuspid Valve Infective Endocarditis in the Emergency Department. Cureus 2022; 14:e29541. [DOI: 10.7759/cureus.29541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
|
2
|
Szaluś-Jordanow O, Stabińska-Smolarz M, Czopowicz M, Moroz A, Mickiewicz M, Łobaczewski A, Chrobak-Chmiel D, Kizerwetter-Świda M, Rzewuska M, Sapierzyński R, Grzegorczyk M, Świerk A, Frymus T. Focused Cardiac Ultrasound Examination as a Tool for Diagnosis of Infective Endocarditis and Myocarditis in Dogs and Cats. Animals (Basel) 2021; 11:ani11113162. [PMID: 34827894 PMCID: PMC8614417 DOI: 10.3390/ani11113162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/22/2022] Open
Abstract
Symptoms of infective endocarditis (IE) and myocarditis are usually nonspecific and include fever, apathy, and loss of appetite. This condition can lead to severe heart failure with ascites or/and fluid in the thoracic cavity or/and in the pericardial sac. We describe infective endocarditis and myocarditis in 3 dogs and 4 cats. In all animals, the initial diagnosis was performed on the basis of a focused cardiac ultrasound examination performed by a general practitioner after a training in this technique. The initial findings were confirmed by a board-certified specialist in veterinary cardiology. Post mortem positive microbiological results from valves were obtained in 4 of 7 patients. Methicillin-resistant Staphylococcus aureus was confirmed in 2 cases and Staphylococcus epidermidis was confirmed in 2 cases, one of which included Enterococcus sp. coinfection. Histopathological examination confirmed initial diagnosis in 5 of 7 animals. In the remaining 2 patients, the time elapsed from the onset of clinical symptoms to death was about 1 month and no active inflammation but massive fibrosis was found microscopically. This is, to our best knowledge, the first report of IE and myocarditis diagnosed in small animals using focused cardiac ultrasound examination. Therefore, we conclude that common usage of this technique by trained general veterinarians may increase the rate of diagnosed patients with these conditions.
Collapse
Affiliation(s)
- Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
- Correspondence:
| | | | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Andrzej Łobaczewski
- Round-the-Clock Veterinary Clinic Auxilium, Królewska Street 64, 05-822 Milanówek, Poland;
| | - Dorota Chrobak-Chmiel
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Magdalena Kizerwetter-Świda
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Magdalena Rzewuska
- Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland; (D.C.-C.); (M.K.-Ś.); (M.R.)
| | - Rafał Sapierzyński
- Department of Pathology and Veterinary Diagnostic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
| | - Michał Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chałbińskiego 5 Street, 02-004 Warsaw, Poland;
| | - Anna Świerk
- Round-the-Clock Veterinary Clinic LEGWET, Jagiellońska 20, 05-120 Legionowo, Poland;
| | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 Street, 02-776 Warsaw, Poland;
| |
Collapse
|
3
|
Jingushi N, Iwata M, Terasawa T. Clinical features of patients with infective endocarditis presenting to the emergency department: a retrospective case series. NAGOYA JOURNAL OF MEDICAL SCIENCE 2017; 79:467-476. [PMID: 29238103 PMCID: PMC5719206 DOI: 10.18999/nagjms.79.4.467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infective endocarditis (IE) is an uncommon clinical problem with diverse, nonspecific presentations. Therefore, information on the clinical features of IE patients presenting to emergency departments (EDs) is scarce. To descriptively analyze the pertinent data, we performed a retrospective chart review. We reviewed 15 consecutive IE patients admitted directly from ED in a university hospital in Japan between 2013 and 2015. We compared their clinical features with those of 14 IE patients admitted during the same period without ED presentations. Patients admitted directly from ED were older than those without ED presentations (median, 78 vs. 52 years; adjusted p = 0.036) and were more likely to have come without referrals (referral rate, 21% vs. 86%; adjusted p = 0.012). These patients were less likely to have been treated with antibiotics before admission (antibiotic-exposure rate, 7% vs. 64%; adjusted p = 0.013) and had earlier blood-culture positivity (median, 2 vs. 5 days; adjusted p = 0.012), resulting in earlier diagnosis (median duration of symptoms before diagnosis, 5 vs. 30 days; adjusted p = 0.012). Other clinical features, including causative pathogens and IE-related comorbidities, were similar between the groups, consistent with previous a nationwide Japanese study. In conclusion, most IE patients admitted to the hospital from ED were elderly, were antibiotic-naïve, and had presented without a referral. Relatively few patients had classical presentations of IE. Given the limited data, more research is needed to confirm that IE patients presenting to EDs constitute a unique group of elderly patients with specific clinical features.
Collapse
Affiliation(s)
- Naruhiro Jingushi
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Teruhiko Terasawa
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
4
|
Platt MA, Shah S, Allinder M. Endocarditis With Fistulization and Rupture of Aortic Root Abscess to the Left Atrium. J Emerg Med 2016; 50:e19-e22. [PMID: 26433425 DOI: 10.1016/j.jemermed.2015.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/06/2015] [Accepted: 07/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a difficult emergency department (ED) diagnosis to make. Symptoms are nonspecific and diverse and the classic triad of fever, anemia, and murmur is rare. Severe IE causes considerable morbidity and mortality and should be diagnosed early. However, echocardiogram is essential but not readily available in the ED and can cause diagnostic delay. CASE REPORT This case describes severe IE and its unique presentation, diagnostic challenges, and the use of bedside cardiac ultrasonography. A 28-year-old previously healthy male presented with intermittent fevers, arthralgias, and myalgias for 2 weeks. He had twice been evaluated and diagnosed with lumbar back pain. Physical examination revealed moderate respiratory distress, pale skin with a cyanotic right lower extremity, and unequal extremity pulses. He became hypotensive and rapidly deteriorated. Chest x-ray study showed bilateral pulmonary infiltrates with subsequent imaging demonstrating worsening septic emboli. Bedside ultrasound revealed mitral and aortic valve vegetations and a presumed diagnosis of IE with septic embolization was made. Formal echocardiography (ECHO) confirmed IE with an aortic root abscess with rupture and fistulization into the left atrium. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinical criteria for IE include blood cultures and ECHO, however, these are often not available to an emergency physician, making IE a diagnostic challenge even in severe cases. The role of bedside ultrasound for IE continues to evolve and its utility in the diagnosis of severe IE is distinctly demonstrated in this case.
Collapse
Affiliation(s)
- Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Shirali Shah
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Matthew Allinder
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
5
|
Henriquez-Camacho C, Garcia-Casasola G, Guillén-Astete C, Losa J. Ultrasound for the diagnosis of infectious diseases: Approach to the patient at point of care and at secondary level. J Infect 2015; 71:1-8. [PMID: 25797569 DOI: 10.1016/j.jinf.2015.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/25/2015] [Accepted: 03/13/2015] [Indexed: 12/27/2022]
Abstract
Bedside ultrasound evaluation for infection can be performed promptly at the bedside, using simple equipment and without irradiation. Visualization of the foci often enables prompt antimicrobial therapy and even early ultrasound-guided procedure, facilitating earlier confirmation. These procedures are made safer using the real-time visual control that ultrasound provides. Future challenges for an infectious diseases specialist include gaining experience about the appropriate use of point-of-care ultrasound (POCUS). Ultrasonography training is required to ensure competent use of this technology.
Collapse
Affiliation(s)
| | | | | | - Juan Losa
- Infectious Diseases Department, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| |
Collapse
|