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Greer ME, Ghuman N, Johnson PT, Zimmerman SL, Fishman EK, Facciola J, Azadi JR. Tip of the iceberg: extracardiac CT findings in infective endocarditis. Emerg Radiol 2024:10.1007/s10140-024-02257-7. [PMID: 38941027 DOI: 10.1007/s10140-024-02257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.
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Affiliation(s)
- M E Greer
- School of Medicine, Georgetown University, Washington, DC, USA
| | - N Ghuman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - P T Johnson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - S L Zimmerman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - E K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - J Facciola
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA
| | - Javad R Azadi
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed 4030, Baltimore, MD, USA.
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2
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Huang JB, Lu CC, Wen ZK, Yang JR, Li JJ. Surgical treatment of left-sided infective endocarditis with symptomatic neurological complications before surgery in China. Front Cardiovasc Med 2023; 10:1217148. [PMID: 37736022 PMCID: PMC10510404 DOI: 10.3389/fcvm.2023.1217148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction We aimed to investigate surgical treatment of left-sided infective endocarditis with symptomatic neurological complications before surgery. Methods This was a retrospective study of patients with left-sided infective endocarditis and symptomatic neurological complications before surgery undergoing cardiac surgery between January 2006 and November 2022 at our hospital. Results Eight hundred thirty-two patients were divided into group with symptomatic neurological complications before surgery (n = 112) and without symptomatic neurological complications before surgery (n = 720). There were 48 operative deaths (5.4%). Univariate and multivariate analyses showed that symptomatic neurological complications before surgery is statistically significantly associated with in-hospital mortality following cardiac surgery and prolonged intubation time. Conclusions Our study showed that symptomatic neurological complications before surgery are associated with increased in-hospital mortality following cardiac surgery and prolonged intubation time.
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Affiliation(s)
- Jing-bin Huang
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
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Sasaki H, Numata Y, Saito J, Kamiya S, Asano M. Posterior Mitral Leaflet Prolapse and Subsequent Mitral Valve Endocarditis Complicated With Anterior Leaflet Perforation. Cureus 2023; 15:e36315. [PMID: 37077597 PMCID: PMC10109018 DOI: 10.7759/cureus.36315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/20/2023] Open
Abstract
A 68-year-old male presented with a two-week history of fever, and further investigations revealed mitral valve endocarditis caused by Staphylococcus epidermidis, with associated severe mitral regurgitation (MR). The patient was referred for mitral valve surgery but developed new neurological symptoms two days before the operation, which were diagnosed as symptomatic epilepsy. During surgery, kissing lesions were found on the posterior mitral leaflet (PML), which were not detected on preoperative transesophageal echocardiography (TEE). Mitral valve repair was completed using autologous pericardium. The current case highlights the importance of careful examination of leaflets during surgery and not relying solely on preoperative imaging to detect all lesions. It is essential to promptly diagnose and treat infective endocarditis to prevent further complications and ensure successful outcomes.
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Park YJ, Kang GU, Jeong M, Singh V, Kim J, Lee K, Choi EJ, Kim HJ, Lee S, Lee SY, Oem JK, Shin JH. Bacterial Profiles of Brain in Downer Cattle with Unknown Etiology. Microorganisms 2022; 11:microorganisms11010098. [PMID: 36677388 PMCID: PMC9862898 DOI: 10.3390/microorganisms11010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Downer cow can be caused by muscular paralysis, neurological damage, metabolic disorder, and/or the complication of microbial infection. However, downer cow with unknown etiology is issued because of the non-detection of its bacterial etiological agent. In this study, differences in the bacterial community in brain tissues between downer cattle with unknown etiology and healthy slaughtered cattle are investigated. Bacterial diversity and representative genera between downer and normal cattle were significantly different (p < 0.05). There are significant differences in representative genera of downer and normal cattle, especially the significance, fold change, and area under the receiver operating characteristic curve score (p < 0.05). Furthermore, the prediction of functional genes in brain microbiota between the downer and normal cattle revealed differences in the cluster of orthologous gene categories, such as lipid transport and metabolism, secondary metabolite biosynthesis, and signal transduction (p < 0.05). This study revealed a significant difference in microbiota between the downer and normal cattle. Thus, we demonstrate that representative genera from downer cattle through 16S rRNA gene amplicon sequencing and microbiota analysis have the potential as candidates for bacterial etiological agents for downer cow.
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Affiliation(s)
- Yeong-Jun Park
- Department of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Gi-Ung Kang
- Department of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Minsoo Jeong
- Department of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Vineet Singh
- Department of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Jongho Kim
- Animal and Plant Quarantine Agency, Kimcheon-si 39660, Republic of Korea
- College of Veterinary Medicine, Jeonbuk National University, Iksan-si 54596, Republic of Korea
| | - Kyunghyun Lee
- Animal and Plant Quarantine Agency, Kimcheon-si 39660, Republic of Korea
| | - Eun-Jin Choi
- Animal and Plant Quarantine Agency, Kimcheon-si 39660, Republic of Korea
| | - Heui-Jin Kim
- Animal and Plant Quarantine Agency, Kimcheon-si 39660, Republic of Korea
| | - Seungjun Lee
- Department of Food Science and Nutrition, Pukyong National University, Busan 48513, Republic of Korea
| | - Sook-Young Lee
- College of Veterinary Medicine, Jeonbuk National University, Iksan-si 54596, Republic of Korea
| | - Jae-Ku Oem
- College of Veterinary Medicine, Jeonbuk National University, Iksan-si 54596, Republic of Korea
- Correspondence: (J.-K.O.); (J.-H.S.)
| | - Jae-Ho Shin
- Department of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea
- Correspondence: (J.-K.O.); (J.-H.S.)
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Neurological complications and clinical outcomes of infective endocarditis. J Stroke Cerebrovasc Dis 2022; 31:106626. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 12/13/2022] Open
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Das AS, Jordan SA, McKeown M, Li K, Dmytriw AA, Regenhardt RW, Feske SK. Screening neuroimaging in neurologically asymptomatic patients with infective endocarditis. J Neuroimaging 2022; 32:1001-1008. [PMID: 35726501 DOI: 10.1111/jon.13020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurological complications from infective endocarditis (IE) are common and often present with minimal clinical symptoms. In this study, we examine whether screening neuroimaging in asymptomatic patients results in increased detection of neurological complications and leads to improved patient outcomes. METHODS Using a database of consecutive adults with IE admitted to a single health system from 2015 to 2019, we selected patients who presented without any neurological symptoms and determined whether these patients underwent screening neuroimaging. The presence of septic emboli, territorial infarcts, intracranial hemorrhage, and mycotic aneurysms was recorded. Variables with significant differences in univariable analyses (p < .1) between those with and without screening neuroimaging were entered into regression models with age and sex to determine predictors of neurological complications and favorable discharge outcomes (modified Rankin score ≤2). RESULTS A total of 214 patients were included in the study, of which 154 (72%) received screening neuroimaging. Septic emboli were more common in patients who underwent screening imaging (31% vs. 15%, p = 0.02). In the first multivariate analysis, screening neuroimaging was associated with septic emboli (adjusted odds ratio [aOR] = 2.44, 95% confidence interval [CI]: [1.03-5.75], p = 0.04). In the second multivariate analysis, territorial infarcts (aOR = 0.28, 95% CI: [0.11-0.73], p = .01), but not septic emboli (aOR = 0.71, 95% CI: [0.36-1.43], p = 0.34), were associated with a favorable discharge outcome. CONCLUSIONS Screening neuroimaging leads to the detection of more septic emboli in IE, but only territorial infarcts (in contrast to septic emboli) correlate with an unfavorable discharge outcome.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie A Jordan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan McKeown
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Li
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven K Feske
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Musleh R, Schlattmann P, Caldonazo T, Kirov H, Witte OW, Doenst T, Günther A, Diab M. Surgical Timing in Patients With Infective Endocarditis and With Intracranial Hemorrhage: A Systematic Review and Meta‐Analysis. J Am Heart Assoc 2022; 11:e024401. [PMID: 35574955 PMCID: PMC9238556 DOI: 10.1161/jaha.121.024401] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Intracranial hemorrhage (ICH) is one of the main causes for lack of surgery in patients with infective endocarditis (IE), despite the presence of surgical indications. We aimed to evaluate the impact of early surgery in patients with IE and with ICH on postoperative neurological deterioration and all‐cause mortality and to elucidate the risk of 30‐day mortality in patients who were denied surgery. Methods and Results Three libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The primary outcome was all‐cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed. We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early versus late) and were included in the meta‐analysis. Only one study examined the fate of patients with IE and with ICH who were treated conservatively despite having an indication for cardiac surgery, showing higher mortality rates than those who underwent surgery (11.8% versus 2.5%). We found no significant association between early surgery, regardless of its definition, and a higher mortality (odds ratio [OR], 1.69; 95% CI, 0.95–3.02). Early surgery was associated with higher risk for neurological deterioration (OR, 2.00; 95% CI, 1.10–3.65). Conclusions Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with an increased rate of neurological deterioration. The 30‐day mortality in patients with IE and with ICH who were denied surgery has not yet been sufficiently investigated. This patient group should be analyzed in future studies in more detail.
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Affiliation(s)
- Rita Musleh
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Peter Schlattmann
- Department of Medical StatisticsComputer Science and Data ScienceJena University HospitalFriedrich‐Schiller University JenaJenaGermany
| | - Túlio Caldonazo
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Hristo Kirov
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Otto W. Witte
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Torsten Doenst
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Albrecht Günther
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Mahmoud Diab
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
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Maheshwari R, Cordato DJ, Wardman D, Thomas P, Bhaskar SMM. Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review. J Cent Nerv Syst Dis 2022; 14:11795735221081597. [PMID: 35282315 PMCID: PMC8905057 DOI: 10.1177/11795735221081597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/02/2022] [Indexed: 01/08/2023] Open
Abstract
Background Acute ischemic stroke (AIS) is a common and fatal complication of infective endocarditis (IE); however, there is a lack of understanding regarding treatment efficacy. This systematic review aimed to evaluate the safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in IE patients experiencing AIS. Objectives The aim of this study was to perform a systematic review investigating the outcomes of AIS in IE patients receiving IVT and/or EVT as a treatment method and to evaluate the safety and efficacy of these methods of reperfusion therapy. Design A systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Data Sources and Methods The EMBASE, Cochrane, and PubMed databases were searched for literature published between 2005 and 2021 investigating outcomes of reperfusion therapy post-AIS in IE and non-IE patients. Descriptive statistics were used to describe the overall frequency of clinical outcomes, and groupwise comparisons were performed using Fisher’s exact test to assess the significance of groupwise differences. Results Three studies were finally included in the systematic review. A total of 13.5% of IE patients compared to 37% of non-IE patients achieved a good functional outcome (modified Rankin Scale score≤ 2) (P < .001). Furthermore, a larger percentage of the IE cohort achieved good functional outcomes after EVT (22.0%) compared to IVT (10.4%) (P = .013). The IE cohort also had a higher 3-month postreperfusion mortality rate (48.8%) compared to the non-IE cohort (24.9%) (P < .001). The rate of intracranial hemorrhage (ICH) postreperfusion was also significantly higher in the IE cohort (23.5%) than in the non-IE cohort (6.5%) (P < .001). Conclusion AIS patients with IE, treated with IVT, EVT, or a combination of the two, experience worse clinical and safety outcomes than non-IE patients. EVT yielded better functional outcomes, albeit with higher postreperfusion ICH rates, than IVT.
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Affiliation(s)
- Rohan Maheshwari
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Dennis J. Cordato
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Daniel Wardman
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Mishra AK, Sahu KK, Abraham BM, Sargent J, Kranis MJ, George SV, Abraham G. Predictors, patterns and outcomes following Infective endocarditis and stroke. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022203. [PMID: 35546041 PMCID: PMC9171864 DOI: 10.23750/abm.v93i2.10185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Patients with infective endocarditis can have multiple neurological manifestations. Cerebrovascular events (CVE) in patients with IE can be hemorrhagic or embolic. Multiple factors are known to predispose to CVE and increased mortality in patients with IE. In this study, we aimed to describe various outcomes among patients with IE and CVE. We retrospectively analyzed 160 patients with definite IE. Among these, patients with radiological evidence of CVE were included. Clinical, radiological, echocardiographic details were obtained. Outcome studied were the requirement of intensive care unit care, the requirement of mechanical ventilation, prolonged course of antibiotics, prolonged duration of hospital stay, the requirement of surgical intervention, and mortality. In this study, 16 [10%] of patients with IE were identified to have a CVE. The mean age of the patients was 55, and 87.5% of them were male. 25% of patients had prior IE. IE involving left-sided valves were predominant, with the involvement of mitral valve reported in 62.5% of patients. More than half of the patient's had details of magnetic resonance imaging (MRI) of the brain. CVE were mostly ischemic, anterior circulation predominant, multiple, and bilateral. In patients with IE and CVE morbidity including the requirement of ICU care, prolonged antibiotics course, and the requirement of surgical intervention contributed to increased duration of hospital stay. In conclusion, CVE in patients with IE tends to present as multiple infarcts predominantly located over anterior circulation. IE patients with CVE tend to have higher morbidity and mortality.
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Affiliation(s)
- Ajay Kumar Mishra
- Resident, Department of Internal Medicine, St Vincent Hospital, Worcester, United States
| | - Kamal Kant Sahu
- Resident, Department of Internal Medicine, St Vincent Hospital, Worcester, United States
| | - Benson Mathew Abraham
- Resident, Department of Internal Medicine, St Vincent Hospital, Worcester, United States
| | - Jennifer Sargent
- Department of Internal Medicine, St Vincent Hospital, Worcester, United States
| | - Mark J Kranis
- Division of Cardiovascular Medicine, St Vincent Hospital, Worcester, United States
| | - Susan V George
- Department of Internal Medicine, St Vincent Hospital, Worcester, United States
| | - George Abraham
- Division of Infectious Disease, Department of Internal Medicine, St Vincent Hospital, Worcester, United States
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10
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Acute Ischaemic Stroke in Infective Endocarditis: Pathophysiology and Clinical Outcomes in Patients Treated with Reperfusion Therapy. IMMUNO 2021. [DOI: 10.3390/immuno1040023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infective endocarditis in the setting of acute stroke poses a clinical challenge given the high mortality and morbidity associated with the condition. The pathophysiological mechanisms including clinical and imaging biomarkers that can provide insights into clinical trajectories of such patients are of immense interest. The current paper aims to provide a comprehensive overview of acute stroke with infective endocarditis and provide insights into various clinical factors mediating outcomes and therapeutic strategies, specifically in the setting of reperfusion therapy. Prognostic and therapeutic pathways to potentially improve functional outcomes in these patients are also discussed.
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AlBassri T, Sheikho M, Chaikhouni F, Al Habshan F, Kabbani MS. Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year single-center experience. Int J Pediatr Adolesc Med 2021; 8:198-202. [PMID: 34350336 PMCID: PMC8319676 DOI: 10.1016/j.ijpam.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/26/2020] [Accepted: 02/14/2021] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite improvement in medical management, infective endocarditis (IE) remains a serious disease that may affect children with and without preexisting cardiac conditions with significant morbidity and mortality. Neurological complications of IE represent the worst with guarded prognosis. The aim of this study is to describe the incidence, etiology, characteristics, risk factors, and outcome of children with neurological complications associated with IE. MATERIAL AND METHODS A retrospective cohort study was conducted from 2009 to 2019 where all pediatric patients who fulfilled the modified Duke criteria for IE were included. We divided the cases into 2 groups: IE with neurological complications and IE without neurological complications control group. We compared the two groups statistically and analyzed the results. RESULTS We identified 31 (17 male, 14 female) patients with IE. Neurological complications occurred in 7/31 (23%) patients, mainly in the form of a stroke. Gram-positive microbes were the main causative agents for IE (52%) followed by gram-negative (14%), then fungal organisms (3%). Univariate analysis identified the following risk factors for neurological complications: lower body weight, higher C- reactive protein (CRP) level, and left-sided valvular lesions with P values of (0.0003, 0.0001, and 0.04), respectively.Although mortality was higher in the neurological complications group, it was 43% in comparison to 21% in the control group and it did not reach statistical significance (P = .49). Large vegetation size (more than 10 mm) was seen in 57% of patients with neurological complications as compared to 16% in the control group (P = .052). CONCLUSION Neurological complications occurred in almost a quarter of children with IE. Possible risk factors include lower body weight, left-sided valvular lesion, and higher levels of inflammatory markers (CRP). Stroke was the most common neurological complication encountered with possible increased risk of mortality.
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Affiliation(s)
- Tala AlBassri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha Sheikho
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah Chaikhouni
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Al Habshan
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Cardiac Intensive Care, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Corresponding author. Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, P.O. BOX 22490, Riyadh, 11426, Saudi Arabia.
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Kee TP, Venkatanarasimha N, Mohideen SMH, Chan LL, Gogna A, Schaefer PW, Chia GS, Choi YS, Chen RC. A Tale of Two Organ Systems: Imaging review of diseases affecting the thoracic and neurological systems. Part 1. Curr Probl Diagn Radiol 2021; 51:589-598. [PMID: 34304949 DOI: 10.1067/j.cpradiol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis. This tenet holds true for diseases affecting both the thoracic and neurological systems; in isolation, the radiologic appearance of disease in one organ system may be nonspecific, but viewing the pathophysiologic process in both organ systems may markedly narrow the differential considerations, and potentially lead to a definitive diagnosis. In this article, we discuss a variety of disease entities known to affect both the thoracic and neurological systems, either manifesting simultaneously or at different periods of time. Some of these conditions may show neither thoracic nor neurological manifestations. These diseases have been systematically classified into infectious, immune-mediated / inflammatory, vascular, syndromic / hereditary and neoplastic disorders. The underlying pathophysiological mechanisms linking both regions and radiologic appearances in both organ systems are discussed. When appropriate, brief clinical and diagnostic information is provided. Ultimately, accurate diagnosis will lead to expedited triage and prompt institution of potentially life-saving treatment for these groups of complex disorders.
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Affiliation(s)
- Tze Phei Kee
- Singapore General Hospital, Singapore 169608; National Neuroscience Institute, Singapore 308433.
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Feil K, Küpper C, Tiedt S, Dimitriadis K, Herzberg M, Dorn F, Liebig T, Dieterich M, Kellert L. Safety and efficacy of mechanical thrombectomy in infective endocarditis: A matched case-control analysis from the German Stroke Registry-Endovascular Treatment. Eur J Neurol 2021; 28:861-867. [PMID: 33327038 DOI: 10.1111/ene.14686] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Up to 30% of infective endocarditis (IE) patients have ischemic stroke as a complication. Standard treatment with mechanical thrombectomy (MT) with or without intravenous thrombolysis for large vessel occlusion (LVO) has not been evaluated formally in these patients. METHODS Patients enrolled in the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019 were analyzed. Patients with stroke due to IE and patients with cardioembolic stroke and atrial fibrillation (AF) were compared using propensity score matching. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score = 2b-3. Modified Rankin Scale (mRS) = 0-2 at 3 months indicated good outcome. RESULTS Of 6635 patients, 55 patients (age = 69.0 ± 13.3 years, 43.6% female, median premorbid mRS (pmRS) = 1, interquartile range [IQR] = 0-1, National Institutes of Health Stroke Scale [NIHSS] = 15, IQR = 10-21) presented with septic embolic stroke due to IE and were compared to 104 patients (age = 66.5 ± 13.4 years, 39.4% female, pmRS = 0, IQR = 0-2, NIHSS = 16, IQR = 10-20) with cardioembolic stroke due to AF. Successful recanalization was achieved in 74.5% of endocarditis patients compared to 87.5% of controls (p = 0.039). Intracranial hemorrhage rates were comparable (30.9% vs. 21.6%, p = 0.175). Good functional outcome was 20.0% in patients with IE compared to 43.3% in matched patients (p = 0.006), with a significantly higher mortality (60.0% vs. 28.8%, p < 0.001). IE was strongly associated with poor outcome (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.87, p = 0.03 for good outcome) and mortality (OR = 4.49, 95% CI = 1.80-10.68, p = 0.001). CONCLUSIONS Although MT results in high successful recanalization rates with acceptable safety profile, patients with LVO stroke due to IE have poor outcome.
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Affiliation(s)
- Katharina Feil
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Neurology and Stroke, Eberhard Karls University Tübingen/Universitätsklinikum Tübingen, Tübingen, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Konstantinos Dimitriadis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Moriz Herzberg
- Department of Radiology, University Hospital, Würzburg, Germany.,Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany.,Department of Neuroradiology, University of Bonn, Bonn, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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14
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Diab M, Musleh R, Lehmann T, Sponholz C, Pletz MW, Franz M, Schulze PC, Witte OW, Kirchhof K, Doenst T, Günther A. Risk of postoperative neurological exacerbation in patients with infective endocarditis and intracranial haemorrhage. Eur J Cardiothorac Surg 2020; 59:ezaa347. [PMID: 33036027 DOI: 10.1093/ejcts/ezaa347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cardiac surgery in patients with infective endocarditis (IE) and preoperative intracranial haemorrhage (pre-ICH) is a highly debatable issue, and guidelines are still not well defined. The goal of this study was to investigate the effect of cardiac surgery and its timing on the clinical outcomes of patients with IE and pre-ICH. METHODS We did a single-centre retrospective analysis of data from patients with preoperative brain imaging who had surgery for left-sided IE between January 2007 and May 2018. RESULTS Among the 363 patients included in the study, 34 had pre-ICH. Hospital mortality was similar between the patients with and without pre-ICH (29% vs 27%, respectively; P = 0.84). Unadjusted, postoperative neurological deterioration appeared higher in patients with pre-ICH (24% vs 17%; P = 0.35). In multivariable analysis, pre-ICH did not qualify as an independent predictor for either postoperative neurological deterioration [odds ratio 1.10, 95% confidence interval (CI) 0.44-2.73; P = 0.84] or hospital mortality (odds ratio 1.02, 95% CI 0.43-2.40; P = 0.96). Postoperative partial thromboplastin time was significantly elevated in 4 patients with relevant post-ICH compared with those patients without relevant post-ICH (65.5 vs 37.6, respectively; P = 0.004). CONCLUSIONS Pre-ICH was not an independent predictor for postoperative neurological deterioration or hospital mortality in patients with IE. Postoperative coagulation management seems to be crucial in patients with IE with ICH. Although this is to date the largest monocentric study addressing surgical decision and timing, the number of patients with pre-ICH was low. Therefore, these conclusions should be regarded with caution; randomized clinical trials are needed.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Rita Musleh
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Marcus Franz
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Klaus Kirchhof
- Division of Neuroradiology, Department of Radiology, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
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15
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Acute Ischemic Stroke Treatment in Infective Endocarditis: Systematic Review. J Stroke Cerebrovasc Dis 2020; 29:104598. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104598] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023] Open
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16
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Bajaj T, Karapetians A, Karapetians N, Duong H, Heidari A. Methicillin resistant Staphylococcus aureus infective endocarditis presenting as neutrophilic meningoencephalitis. AME Case Rep 2020; 4:4. [PMID: 32206750 DOI: 10.21037/acr.2019.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/21/2019] [Indexed: 11/06/2022]
Abstract
Infective endocarditis (IE) with Staphylococcus aureus is associated with intravenous drug abuse or infected cardiac devices and commonly presents with non-specific constitutional symptoms. A 53-year-old female presented to the hospital with back pain, altered mental status, fever, and tachycardia. Due to patient's lethargy and decline in respiratory effort, she was intubated and lumbar puncture was performed that revealed neutrophil-predominant leukocytosis of the cerebrospinal fluid. The patient was empirically started on ceftriaxone and vancomycin, and blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA). A chest X-ray demonstrated pulmonary congestion and an implanted pacemaker; furthermore, a transesophageal echocardiogram (TEE) revealed a vegetation on the atrial lead of the pacemaker. As the patient's condition improved after a few days, she was extubated and was able to provide a clear history. The source of her infection was a pus pocket around her pacemaker which was placed two months prior to her admission. As expected, the infection resolved with proper source control and antibiotic therapy.
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Affiliation(s)
- Tushar Bajaj
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
| | - Anthony Karapetians
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
| | - Natalie Karapetians
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA.,Department of Medicine, American University of the Caribbean School of Medicine, Pembroke Pines, FL, USA
| | - Hanh Duong
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA.,Department of Medicine, Ross University School of Medicine, Miramar, FL, USA
| | - Arash Heidari
- Department of Medicine, UCLA - Kern Medical, Kern Medical Center, Bakersfield, CA, USA
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17
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Walker M, Levitt MR, Gibbons EF, Horne DJ, Corcorran MA. Clot Analysis in Acute Ischemic Stroke. Stroke 2020; 50:e106-e109. [PMID: 30869564 DOI: 10.1161/strokeaha.118.023700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melanie Walker
- From the Departments of Neurological Surgery (M.W., M.L.), University of Washington, Seattle.,Stroke and Applied Neuroscience Center (M.W., M.R.L.), University of Washington, Seattle
| | - Michael R Levitt
- From the Departments of Neurological Surgery (M.W., M.L.), University of Washington, Seattle.,Radiology (M.R.L.), University of Washington, Seattle.,Mechanical Engineering (M.R.L.), University of Washington, Seattle.,Stroke and Applied Neuroscience Center (M.W., M.R.L.), University of Washington, Seattle
| | - Edward F Gibbons
- Division of Cardiology (E.F.G.), Department of Medicine, University of Washington School of Medicine, Seattle
| | - David J Horne
- Division of Pulmonary, Critical Care, and Sleep Medicine (D.J.H.), Department of Medicine, University of Washington School of Medicine, Seattle
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases (M.A.C.), Department of Medicine, University of Washington School of Medicine, Seattle
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18
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Biesiada G, Krycińska R, Czepiel J, Stażyk K, Kędzierska J, Garlicki A. Meningoencephalitis caused by Lactobacillus plantarum - case report. Int J Neurosci 2019; 129:715-718. [PMID: 29813007 DOI: 10.1080/00207454.2018.1482293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Specific strains of Lactobacillus spp. are widely used as probiotic agents but it has been repeatedly reported that may have a pathogenic potential. We present the report on a case of meningoencephalitis caused by Lactobacillus plantarum in a 63-year-old man with newly diagnosed metastatic planoepitheliale lung cancer. The patient was hospitalised due to newly diagnosed cancer and during the course of hospitalisation developed symptoms of neuroinfection. On the basis of the symptoms and results of the conducted tests the patient was diagnosed with bacterial meningoencephalitis. In microbiological tests of the blood and cerebrospinal fluid L. plantarum was cultured. During the course of antibiotic therapy the patient's condition improved. Lactobacilli are now recognised as a causative agent of infection, most notably bacteraemia. To our knowledge, this is the fourth documented case of Lactobacillus-associated neuroinfection, and only the second in an adult. Lactobacilli cause mostly opportunistic infections in immunocompromised individuals.
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Affiliation(s)
- Grażyna Biesiada
- a Department of Infectious and Tropical Diseases , Jagiellonian University Medical College , Krakow , Poland
| | - Róża Krycińska
- b Students' Scientific Society , Jagiellonian University Medical College , Krakow , Poland
| | - Jacek Czepiel
- a Department of Infectious and Tropical Diseases , Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Stażyk
- a Department of Infectious and Tropical Diseases , Jagiellonian University Medical College , Krakow , Poland
| | | | - Aleksander Garlicki
- a Department of Infectious and Tropical Diseases , Jagiellonian University Medical College , Krakow , Poland
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19
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Pairan MS, Mohammad N, Abdul Halim S, Wan Ghazali WS. Intracranial bleeding (ICB) as a catastrophic complication of Streptococcus gordonii infective endocarditis (IE) in an immunocompetent patient. BMJ Case Rep 2018; 2018:bcr-2018-225265. [PMID: 30206067 PMCID: PMC6144261 DOI: 10.1136/bcr-2018-225265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/03/2022] Open
Abstract
We present an interesting case of late-onset intracranial bleeding (ICB) as a complication of Streptococcus gordonii causing infective endocarditis. A previously healthy young woman was diagnosed with infective endocarditis. While she was already on treatment for 2 weeks, she had developed seizures with a localising neurological sign. An urgent non-contrasted CT brain showed massive left frontoparietal intraparenchymal bleeding. Although CT angiogram showed no evidence of active bleeding or contrast blush, massive ICB secondary to vascular complication of infective endocarditis was very likely. An urgent decompressive craniectomy with clot evacuation was done immediately to release the mass effect. She completed total 6 weeks of antibiotics and had postoperative uneventful hospital stay despite having a permanent global aphasia as a sequel of the ICB.
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Affiliation(s)
- Mohd Shakirin Pairan
- Department of Internal Medicine, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nurashikin Mohammad
- Department of Internal Medicine, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Department of Internal Medicine, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Wan Syamimee Wan Ghazali
- Department of Internal Medicine, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
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20
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Aithoussa M, Atmani N, Mounir R, Moutakiallah Y, Bamous M, Abdou A, Nya F, Seghrouchni A, Bellouize S, Drissi M, Elouennass M, Elbekkali Y, Boulahya A. Early results for active infective endocarditis. Pan Afr Med J 2018; 28:245. [PMID: 29881490 PMCID: PMC5989182 DOI: 10.11604/pamj.2017.28.245.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. Methods We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). Results in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. Conclusion Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.
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Affiliation(s)
- Mahdi Aithoussa
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Noureddine Atmani
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Reda Mounir
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Younes Moutakiallah
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mehdi Bamous
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdessamad Abdou
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Fouad Nya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Anis Seghrouchni
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Siham Bellouize
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mohamed Drissi
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Intensive Care of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Mostafa Elouennass
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Department of Bacteriology, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Youssef Elbekkali
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdelatif Boulahya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
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21
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Carmelli G, Surles T, Brown A. Endophthalmitis and Mycotic Aneurysm: The Only Clues to Underlying Endocarditis. Clin Pract Cases Emerg Med 2018; 2:16-20. [PMID: 29849250 PMCID: PMC5965132 DOI: 10.5811/cpcem.2017.8.34723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 01/16/2023] Open
Abstract
Infective endocarditis is a deadly disease that can present as a myriad of symptoms and thus its diagnosis can be missed. We present a case of infective endocarditis presenting as endogenous endophthalmitis and a ruptured mycotic aneurysm. This case illustrates both the complexity of infective endocarditis as a disease process and the more subtle diagnostic criteria as outlined by the Modified Duke Criteria.
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Affiliation(s)
- Guy Carmelli
- King's County Hospital Center, Department of Emergency Medicine, Brooklyn, New York.,SUNY Downstate University Hospital of Brooklyn, Department of Emergency Medicine, Brooklyn, New York
| | - Taylor Surles
- King's County Hospital Center, Department of Emergency Medicine, Brooklyn, New York.,SUNY Downstate University Hospital of Brooklyn, Department of Emergency Medicine, Brooklyn, New York
| | - Alisha Brown
- University of Washington, Department of Emergency Medicine, Seattle, Washington
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22
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Septic Embolic Stroke Followed by Hemorrhage and Brain Abscess in a Patient with Systemic Infections: A Case Report and Literature Review. Case Rep Radiol 2018; 2018:4602352. [PMID: 29854535 PMCID: PMC5960533 DOI: 10.1155/2018/4602352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/25/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
Abstract
We report a case of 50-year-old man with a severe acute ischemic stroke followed by intracerebral hemorrhage and brain abscess due to systemic infection. His initial intracranial radiographic findings were normal but three days later MRI scan of the brain revealed well-defined rounded cystic lesion on the T2-weighted and T1-weighted images in the right basal ganglia; the lesion presented an area of diffusion restriction on DWI; lately the lesion was confirmed to be an early stage of cerebral abscess. A week later the patient was noted to have worsening neurological status and left extremity weakness, and emergency brain CT scan revealed massive intracerebral hemorrhage in the right occipital lobe; he underwent intracranial hematoma evacuation surgery. The hematoma was removed successfully, and the systemic infections were treated with antibiotics.
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23
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Mohananey D, Mohadjer A, Pettersson G, Navia J, Gordon S, Shrestha N, Grimm RA, Rodriguez LL, Griffin BP, Desai MY. Association of Vegetation Size With Embolic Risk in Patients With Infective Endocarditis: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:502-510. [PMID: 29459947 PMCID: PMC5876809 DOI: 10.1001/jamainternmed.2017.8653] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Infective endocarditis is a life-threating condition with annual mortality of as much as 40% and is associated with embolic events in as many as 80% of cases. These embolic events have notable prognostic implications and have been linked to increased length of stay in intensive care units and mortality. A vegetation size greater than 10 mm has often been suggested as an optimal cutoff to estimate the risk of embolism, but the evidence is based largely on small observational studies. OBJECTIVE To study the association of vegetation size greater than 10 mm with embolic events using meta-analytic techniques. DATA SOURCES A computerized literature search of all publications in the PubMed and EMBASE databases from inception to May 1, 2017, was performed with search terms including varying combinations of infective endocarditis, emboli, vegetation size, pulmonary infarct, stroke, splenic emboli, renal emboli, retinal emboli, and mesenteric emboli. This search was last assessed as being up to date on May 1, 2017. STUDY SELECTION Observational studies or randomized clinical trials that evaluated the association of vegetation size greater than 10 mm with embolic events in adult patients with infective endocarditis were included. Conference abstracts and non-English language literature were excluded. The search was conducted by 2 independent reviewers blinded to the other's work. DATA EXTRACTION AND SYNTHESIS Following PRISMA guidelines, the 2 reviewers independently extracted data; disputes were resolved with consensus or by a third investigator. Categorical dichotomous data were summarized across treatment arms using Mantel-Haenszel odds ratios (ORs) with 95% CIs. Heterogeneity of effects was evaluated using the Higgins I2 statistic. RESULTS The search yielded 21 unique studies published from 1983 to 2016 with a total of 6646 unique patients with infective endocarditis and 5116 vegetations with available dimensions. Patients with a vegetation size greater than 10 mm had increased odds of embolic events (OR, 2.28; 95% CI, 1.71-3.05; P < .001) and mortality (OR, 1.63; 95% CI, 1.13-2.35; P = .009) compared with those with a vegetation size less than 10 mm. CONCLUSIONS AND RELEVANCE In this meta-analysis of 21 studies, patients with vegetation size greater than 10 mm had significantly increased odds of embolism and mortality. Understanding the risk of embolization will allow clinicians to adequately risk stratify patients and will also help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm.
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Affiliation(s)
| | - Ashley Mohadjer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jose Navia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Nabin Shrestha
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Richard A Grimm
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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24
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Ariane M, Leroux G, Bertrand A, Jaureguiberry S, Saadoun D, Mazier D, Caumes E, Cacoub P. Des lésions cérébrales. Rev Med Interne 2018; 39:68-70. [DOI: 10.1016/j.revmed.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
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25
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Soundhar A, Udesh R, Mehta A, Schindler J, Jeevanantham V, Gleason T, Thirumala PD. Delirium Following Transcatheter Aortic Valve Replacement: National Inpatient Sample Analysis. J Cardiothorac Vasc Anesth 2017; 31:1977-1984. [DOI: 10.1053/j.jvca.2017.03.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 12/14/2022]
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26
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Chakraborty T, Scharf E, Rabinstein AA, DeSimone D, El Rafei A, Brinjikji W, Baddour LM, Wijdicks E, Wilson W, Steckelberg JM, Fugate JE. Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis. J Stroke Cerebrovasc Dis 2017; 26:2527-2535. [PMID: 28673812 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Brain magnetic resonance imaging (MRI) is frequently obtained in patients with infective endocarditis, yet its utility in predicting outcomes for valve replacement surgery in patients is unknown. The objective of this study was to determine how brain MRI findings impact clinical management and outcomes. METHODS Demographic and clinical data from electronic medical records at Mayo Clinic were retrospectively reviewed for patients hospitalized with definite or possible infective endocarditis according to the modified Duke criteria between January 1, 2007 and December 31, 2014. There were 364 patients included in the study. RESULTS Cardiac valve replacement surgery was performed in 195 of 364 (53.6%) patients, and 95 (48.7%) of the surgical patients underwent preoperative MRI, which was associated with preoperative neurologic symptoms in 56 of 95 (58.9%) patients (odds ratio = 12.92; 95% confidence interval, 5.98-27.93; P <.001). Postoperative neurologic complications occurred in 24 of 195 (12.3%) patients, including new ischemic stroke in 4 of 195 (2.1%) and new intracerebral hemorrhage in 3 of 195 (1.5%). No patients with microhemorrhages developed postoperative hemorrhage. No significant differences existed in rates of postoperative complications between patients with and those without preoperative MRI. There were no substantial associations between preoperative MRI findings and postoperative neurologic complications, functional outcomes as described by the modified Rankin Scale score, or 6-month mortality. CONCLUSIONS In patients undergoing valve replacement surgery, preoperative MRI findings were not associated with differences in postoperative outcomes, irrespective of finding or timing of valve replacement surgery.
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Affiliation(s)
- Tia Chakraborty
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, Minnesota.
| | - Eugene Scharf
- University of Rochester Medical Center Department of Neurology, Rochester, New York
| | | | - Daniel DeSimone
- Mayo Clinic Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Abdelghani El Rafei
- Mayo Clinic Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Waleed Brinjikji
- Mayo Clinic Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Larry M Baddour
- Mayo Clinic Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eelco Wijdicks
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Walter Wilson
- Mayo Clinic Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - James M Steckelberg
- Mayo Clinic Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jennifer E Fugate
- Mayo Clinic Department of Neurology, Mayo Clinic, Rochester, Minnesota.
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Champey J, Pavese P, Bouvaist H, Maillet M, Kastler A, Boussat B, Francois P. Is brain angio-MRI useful in infective endocarditis management? Eur J Clin Microbiol Infect Dis 2016; 35:2053-2058. [PMID: 27599711 DOI: 10.1007/s10096-016-2764-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
In infective endocarditis (IE), brain magnetic resonance imaging (MRI) is helpful to diagnose clinically silent neurological events. We assessed the usefulness of systematic early brain MRI in IE diagnosis and medico-surgical management. Over a period of 1 year, all patients admitted in one of the three hospitals participating in and fulfilling the Duke criteria for definite or possible IE underwent cerebral MRI within 7 days of IE suspicion. Eight panels of experts analyzed the records a posteriori. For each case, one record with and one record without the MRI results were randomly assigned to two panels, which determined the theoretical diagnosis and treatment. Paired comparisons were performed using a symmetry test. Thirty-seven brain MRIs were performed within a median of 5 days after inclusion. MRI was pathological in 26 patients (70 %), showing 62 % microischemia and 58 % microbleeds. The expert advice did not differ significantly between the two evaluations (with or without the MRI results). The therapeutic strategies determined diverged in five cases (13.5 %). Diagnosis differed in two cases (5.4 %), with an upgrading of diagnosis from possible to definite IE using MRI results. Early brain MRI did not significantly affect the IE diagnosis and medico-surgical treatment plan. These results suggest that systematic use of early brain MRI is irrelevant in IE. Further studies are necessary to define whether MRI is mandatory in IE management within a multidisciplinary approach, with particular attention paid to better timing and the subset of patients in whom this imaging examination could be beneficial.
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Affiliation(s)
- J Champey
- Intensive Care Medicine, CHU de Grenoble, BP 218, 38043, Grenoble Cedex 9, France.
| | - P Pavese
- Infectious Disease Department, CHU Grenoble, Grenoble, France
| | - H Bouvaist
- Cardiology Department, CHU Grenoble, Grenoble, France
| | - M Maillet
- Infectious Disease Department, CHU Grenoble, Grenoble, France
| | - A Kastler
- Neuroradiology Department, CHU Grenoble, Grenoble, France
| | - B Boussat
- Public Health Department, CHU Grenoble, Grenoble, France
| | - P Francois
- Public Health Department, CHU Grenoble, Grenoble, France
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Morotti A, Gamba M, Costa P, Poli L, Gilberti N, Delrio I, Mardighian D, Gasparotti R, Padovani A, Pezzini A. Infective Endocarditis Presenting with Intracranial Bleeding. J Emerg Med 2016; 51:50-4. [PMID: 27236244 DOI: 10.1016/j.jemermed.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/24/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infective endocarditis (IE) can be complicated by intracranial bleeding (ICB) caused by different pathologic mechanisms. The occurrence of ICB in patients with IE significantly influences therapeutic decisions and has a negative impact on outcome. CASE REPORT We describe the clinical courses of 3 patients with aortic prosthetic valve IE presenting with ICB. Patients 1 and 2 experienced subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), respectively, caused by rupture of an intracranial infectious aneurysm (IIA). Both underwent endovascular treatment of IIA with good outcome. In patient 3, ICB was the hemorrhagic conversion of an acute ischemic lesion from septic brain embolization. In the subacute phase of the disease, aortic valve replacement was performed, with excellent outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ICB is a relevant complication and sometimes the first clinical feature of IE. Imaging of brain vessels should be performed to investigate the pathologic mechanism underlying ICB. The prevalence of IIA is probably underestimated and may influence the therapeutic strategy. Cerebrovascular imaging may therefore also be considered in asymptomatic subjects with left-sided IE. Withdrawal of anticoagulant treatment and delay of cardiac surgery are recommended in all cases of IE complicated by ICB. Because of the impact of ICB on IE management and outcome, a high level of clinical suspicion and prompt recognition and treatment of this complication are necessary.
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Affiliation(s)
- Andrea Morotti
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Massimo Gamba
- Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Costa
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Loris Poli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Nicola Gilberti
- Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy
| | - Ilenia Delrio
- Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy
| | - Dikran Mardighian
- Dipartimento di Diagnostica per Immagini, Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy
| | - Roberto Gasparotti
- Dipartimento di Diagnostica per Immagini, Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
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Champey J, Pavese P, Bouvaist H, Vittoz JP, Tahon F, Eker OF, Goutier S, Recule C, Francois P. Cerebral imaging in infectious endocarditis: A clinical study. Infect Dis (Lond) 2015; 48:235-40. [PMID: 26567595 DOI: 10.3109/23744235.2015.1109704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because neurological failure is the most frequent extra-cardiac complication in Infectious Endocarditis (IE), a brain computerised tomography (CT) scan is usually performed. The benefits of magnetic resonance imaging (MRI) have not been clearly established. This study aims to clarify the prevalence and type of cerebral lesions in IE detected using MRI and to compare them with those detected using CT scans. METHODS In the Grenoble University Hospital, patients diagnosed with definite or possible endocarditis according to Duke's criteria were screened from 2010-2012. Brain CT and MRI were performed as soon as possible after diagnosis. RESULTS Of the 62 patients with IE who underwent at least one cerebral imaging within 3 weeks of diagnosis, Streptococcus (29) and Staphylococcus (14) were the main micro-organisms present. Twenty-eight (45%) patients underwent cardiac surgery. Eight (13%) died before discharge. Twenty (32%) had neurological symptoms. A brain CT-scan was performed on 53 (85%) patients and a MRI was performed on 43 (69%) patients. CT was pathological in 26 (49%) patients, whereas 32 (74%) MRI demonstrated abnormalities. The MRI lesions were classified as follows: ischaemia (48%), microbleeds (34%), haemorrhages (16%), abscesses (9%) and microbial aneurysms (4%). Of the 37 patients who underwent both MRI and CT examinations, ischaemia (48% vs 35%) and microbleeds (34%) demonstrated the difference between the two imaging methods. CONCLUSION Through the early diagnosis of cerebral damage, even in asymptomatic cases, MRI may have a role in the IE management, influence any surgical decision and assist in prognosis assessment.
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Affiliation(s)
| | | | | | | | | | - Omer F Eker
- f Neuroradiology Department , CHU Montpellier , France
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31
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Bashiri FA. Mycoplasma pneumoniae Infection: Risk Factor for Childhood Stroke. Glob Pediatr Health 2015; 2:2333794X15592764. [PMID: 27335969 PMCID: PMC4784591 DOI: 10.1177/2333794x15592764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Fahad A Bashiri
- Division of Neurology,Department of Pediatrics,College of Medicine & King Khalid University Hospital,King Saud University, Riyadh, Saudi Arabia
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32
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Ng CS, Mohamad S, Maskon O. Medical therapy of a left-sided native valve endocarditis with neurologic sequela. Saudi Med J 2015; 36:743-6. [PMID: 25987119 PMCID: PMC4454911 DOI: 10.15537/smj.2015.6.11420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Infective endocarditis could present with a plethora of signs and symptoms. Among the rarity of its presentation is acute confusion associated with neurological deficits, mimicking stroke especially in the young population. We report a case of a 33-year-old young man with acute right-sided hemiparesis and confusion 2 weeks after tooth extraction. The brain CT and MRI was consistent with new infarction on the left middle and anterior cerebral arteries’ territory. Echocardiography unveiled the existence of posterior mitral valve leaflet vegetation. Blood culture grew Group B beta-haemolytic Streptococcus, sensitive to penicillin. Two weeks of intravenous gentamicin with 6 weeks of intravenous benzylpenicillin were administered. In this case report, we highlight the importance of recognition of infective endocarditis in a young patient presenting with cerebrovascular accident following tooth extraction.
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Affiliation(s)
- Choon S Ng
- Department of Medicine, National University of Malaysia Medical Center, Kuala Lumpur, Malaysia. E-mail.
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Methicillin-Resistant Staphylococcus aureus Meningitis and Endocarditis After a Shrimp Skin Lesion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grecu N, Tiu C, Terecoasa E, Bajenaru O. Endocarditis and stroke. MAEDICA 2014; 9:375-381. [PMID: 25705308 PMCID: PMC4316883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/05/2014] [Indexed: 06/04/2023]
Abstract
Endocarditis is an important, although less common, cause of cerebral embolism. All forms of endocarditis share an initial common pathophysiologic pathway, best illustrated by the non-bacterial thrombotic form, but also a final potential for embolization. Stroke associated with endocarditis has signifficant mortality and morbidity rates, especially due to the frequent concomitant multiple sites of brain embolization. In this article we aim to briefly review endocarditis with a focus on stroke as a complication, while also presenting case correlates from our department.
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Affiliation(s)
- Nicolae Grecu
- Department of Neurology, Emergency University Hospital, Bucharest, Romania
| | - Cristina Tiu
- Department of Neurology, Emergency University Hospital, Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Terecoasa
- Department of Neurology, Emergency University Hospital, Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bajenaru
- Department of Neurology, Emergency University Hospital, Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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35
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Prediction of early postoperative cerebral hemorrhage in infective endocarditis patients using magnetic resonance imaging. Gen Thorac Cardiovasc Surg 2014; 62:608-13. [DOI: 10.1007/s11748-014-0416-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/28/2014] [Indexed: 02/04/2023]
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36
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Hussain K, Abubaker J, Al Deesi ZO, Ahmed R. Unreported neurological complications of Gemella bergeriae infective endocarditis. BMJ Case Rep 2014; 2014:bcr-2014-204405. [PMID: 24899013 DOI: 10.1136/bcr-2014-204405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery. This case highlights the dire, unreported neurological complications of infective endocarditis due to a rare causative organism-G. bergeriae.
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Affiliation(s)
- Kosar Hussain
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jawed Abubaker
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Zulfa Omar Al Deesi
- Department of Pathology Unit, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Raees Ahmed
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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37
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Hui FK, Bain M, Obuchowski NA, Gordon S, Spiotta AM, Moskowitz S, Toth G, Hussain S. Mycotic aneurysm detection rates with cerebral angiography in patients with infective endocarditis. J Neurointerv Surg 2014; 7:449-52. [PMID: 24778139 DOI: 10.1136/neurintsurg-2014-011124] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cerebral angiography remains the gold standard for the detection of mycotic aneurysms, and it has been estimated that ruptured mycotic aneurysms result in 5% of the neurological complications of patients with infective endocarditis (IE). OBJECTIVE To determine the diagnostic yield of cerebral angiography in the above patient population and to assess patient factors that might suggest greater or lesser utility. METHODS We retrospectively reviewed 168 patients who underwent cerebral angiography with a diagnosis of IE or infected left ventricular assist device at the Cleveland Clinic between January 2003 and March 2010 in accordance with institutional review board guidelines. Chart and imaging review was performed. RESULTS 15/168 patients (8.9%) had mycotic aneurysms; 93.3% (14/15) of the patients with mycotic aneurysms presented with CNS hemorrhage and 66.7% (10/15) had acute ischemic findings. Of the 15 patients with mycotic aneurysms on angiography, seven underwent CT angiography and six underwent MR angiography, which showed mycotic aneurysms in three (42.9%) and two cases (one of which was questionable; 33.3%), respectively. CONCLUSIONS Patients with IE or similar sources of central bacterial emboli are prone to neurovascular complications. Approximately 9% of patients with IE at our institution who undergo cerebral angiography have mycotic aneurysms. Presentation with hemorrhage appears to be more predictive of aneurysm, as approximately 22% of patients with IE and hemorrhage were found to have an aneurysm compared with only 1% when hemorrhage was absent. Thus, patients with IE presenting with intracranial hemorrhage should undergo vascular imaging, preferably with cerebral angiography.
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Affiliation(s)
- Ferdinand K Hui
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Bain
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Steven Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shazam Hussain
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
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38
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Rizzi M, Ravasio V, Carobbio A, Mattucci I, Crapis M, Stellini R, Pasticci MB, Chinello P, Falcone M, Grossi P, Barbaro F, Pan A, Viale P, Durante-Mangoni E. Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI). BMC Infect Dis 2014; 14:230. [PMID: 24779617 PMCID: PMC4101861 DOI: 10.1186/1471-2334-14-230] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/24/2014] [Indexed: 12/28/2022] Open
Abstract
Background Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. Methods We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). Results There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Conclusions Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery.
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Affiliation(s)
- Marco Rizzi
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, piazza OMS 1, Bergamo, BG 24127, Italia.
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Lee SJ, Oh SS, Lim DS, Na CY, Kim JH. Clinical significance of cerebrovascular complications in patients with acute infective endocarditis: a retrospective analysis of a 12-year single-center experience. BMC Neurol 2014; 14:30. [PMID: 24528538 PMCID: PMC3928916 DOI: 10.1186/1471-2377-14-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebrovascular complications (CVCs) frequently occur in patients with acute infective endocarditis (IE). The aim of this study is to describe the clinical findings of CVCs and to evaluate the impact of CVCs on long-term mortality in patients with IE. METHODS We retrospectively analyzed 144 patients who fulfilled the modified Duke's criteria for definite left-sided IE. CVCs were classified into minor (silent cerebral embolism, TIA and stroke with an initial modified Rankin scale ≤ 2) or major (an initial modified Rankin scale ≥ 3) CVCs. Cox proportional hazards model was used for mortality analysis. Hazard ratio (HR) and 95% confidence interval (CI) were obtained. RESULTS The mean age of the 144 patients (96 males and 48 females) was 49.1 years (range 6-85 years). A CVC was found in 37 (25.7%) patients. Of these, 25 were treated with surgical therapy. The patients who underwent early surgery within 2 weeks after stroke had a statistical trend toward a higher risk of postoperative brain hemorrhage (50% versus 4.8%, P = 0.057 by Fisher exact test). The minor CVC group had a similar risk of death as the no-CVC group (P = 0.803; HR 0.856; CI 0.253-2.894), whereas the major CVC group had a higher mortality (P = 0.013; HR 2.865; CI 1.254-6.548) than the no-CVC group. In the multivariate analysis, major CVC (P = 0.002; HR 3.893; CI 1.649-9.194) was a significant predictor of mortality in IE patients, together with advanced age (P = 0.005; HR 3.138; CI 1.421-6.930) and prosthetic valve IE (P = 0.008; HR 2.819; CI 1.315-6.044). CONCLUSIONS IE can give rise to various forms of CVC, most frequently, acute ischemic brain lesions. In our study, major CVC was associated with high risk of mortality although total CVC was not significantly related to the risk of death in patients with IE.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, Sejong General Hospital, Bucheon, South Korea.
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40
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Novy E, Sonneville R, Mazighi M, Klein IF, Mariotte E, Mourvillier B, Bouadma L, Wolff M. Neurological complications of infective endocarditis: new breakthroughs in diagnosis and management. Med Mal Infect 2013; 43:443-50. [PMID: 24215865 DOI: 10.1016/j.medmal.2013.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/05/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022]
Abstract
Neurological complications are frequent in infective endocarditis (IE) and increase morbidity and mortality rates. A wide spectrum of neurological disorders may be observed, including stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Ischemic lesions account for 40% to 50% of IE central nervous system complications. Systematic brain MRI may reveal cerebral abnormalities in up to 80% of patients, including cerebral embolism in 50%, mostly asymptomatic. Neurological complications affect both medical and surgical treatment and should be managed by an experimented multidisciplinary team including cardiologists, neurologists, intensive care specialists, and cardiac surgeons. Oral anticoagulant therapy given to patients presenting with cerebral ischemic lesions should be replaced by unfractionated heparin for at least 2 weeks, with a close monitoring of coagulation tests. Recently published data suggest that after an ischemic stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Surgery should be postponed for 2 to 3 weeks for patients with intracranial hemorrhage. Endovascular treatment is recommended for cerebral mycotic aneurysms, if there is no severe mass effect. Recent data suggests that neurological failure, which is associated with the location and extension of brain injury, is a major determinant for short-term prognosis.
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Affiliation(s)
- E Novy
- Service de réanimation médicale et des maladies infectieuses, université Paris-Diderot, Sorbonne Paris-Cité, hôpital Bichat-Claude-Bernard, Assistance Publique-hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Ekici F, Kocabaş A, Aktaş D, Çetin İ, Eminoğlu S. Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa. Echocardiography 2013; 31:E60-3. [DOI: 10.1111/echo.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Filiz Ekici
- Department of Pediatric Cardiology; Ankara Children's Hematology and Oncology Research and Training Hospital; Ankara Turkey
| | - Abdullah Kocabaş
- Department of Pediatric Cardiology; Ankara Children's Hematology and Oncology Research and Training Hospital; Ankara Turkey
| | - Doğukan Aktaş
- Department of Pediatric Cardiology; Ankara Children's Hematology and Oncology Research and Training Hospital; Ankara Turkey
| | - İlker Çetin
- Department of Pediatric Cardiology; Ankara Children's Hematology and Oncology Research and Training Hospital; Ankara Turkey
| | - Sancar Eminoğlu
- Department of Pediatric Cardiology; Ankara Children's Hematology and Oncology Research and Training Hospital; Ankara Turkey
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Stawicki SP, Firstenberg MS, Lyaker MR, Russell SB, Evans DC, Bergese SD, Papadimos TJ. Septic embolism in the intensive care unit. Int J Crit Illn Inj Sci 2013; 3:58-63. [PMID: 23724387 PMCID: PMC3665121 DOI: 10.4103/2229-5151.109423] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Septic embolism encompasses a wide range of presentations and clinical considerations. From asymptomatic, incidental finding on advanced imaging to devastating cardiovascular or cerebral events, this important clinico-pathologic entity continues to affect critically ill patients. Septic emboli are challenging because they represent two insults—the early embolic/ischemic insult due to vascular occlusion and the infectious insult from a deep-seated nidus of infection frequently not amenable to adequate source control. Mycotic aneurysms and intravascular or end-organ abscesses can occur. The diagnosis of septic embolism should be considered in any patient with certain risk factors including bacterial endocarditis or infected intravascular devices. Treatment consists of long-term antibiotics and source control when possible. This manuscript provides a much-needed synopsis of the different forms and clinical presentations of septic embolism, basic diagnostic considerations, general clinical approaches, and an overview of potential complications.
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Affiliation(s)
- Stanislaw P Stawicki
- Department of Surgery, Division of Trauma, Critical Care and Burns, The Ohio State University College of Medicine, Columbus, Ohio, USA
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[Central nervous system embolism in the course of infective endocarditis]. Neurol Neurochir Pol 2013; 47:53-62. [PMID: 23487295 DOI: 10.5114/ninp.2013.32939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the progress made in diagnosis and treatment of heart valve diseases, the incidence of infective endocarditis (IE) remains constant. It is still associated with high mortality and high rate of embolic complications, including most dangerous one, i.e. stroke. It has a significant impact on further treatment and qualifications for cardiac surgery. In this paper, the authors discuss the epidemiology, mechanisms of stroke and its impact on the qualifications for cardiac surgery. The authors discuss the problem of clinically silent central nervous system embolism in the course of IE and the usefulness of neuroimaging and markers of central nervous system damage in diagnosis of cerebral embolism.
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Kin H, Yoshioka K, Kawazoe K, Mukaida M, Kamada T, Mitsunaga Y, Ikai A, Okabayashi H. Management of infectious endocarditis with mycotic aneurysm evaluated by brain magnetic resonance imaging†. Eur J Cardiothorac Surg 2013; 44:924-30. [DOI: 10.1093/ejcts/ezt101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koeda C, Tashiro A, Itoh T, Okabayashi H, Nakamura M. Mild renal dysfunction on admission is an important prognostic predictor in patients with infective endocarditis: a retrospective single-center study. Intern Med 2013; 52:1013-8. [PMID: 23676584 DOI: 10.2169/internalmedicine.52.9305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Infective endocarditis (IE) continues to be associated with high mortality. The aim of the present study was to identify prognostic predictors for short-term mortality in patients with IE. METHODS We conducted a retrospective study of 119 consecutive patients with IE (mean age 58±17). Prognostic predictors for mortality at the early phase of admission were determined using a multivariate regression analysis, and a receiver operating characteristic (ROC) analysis was carried out to evaluate the predictive ability. RESULTS Eleven of 119 patients died during hospital admission. In this non-survivor group, the clinical parameters at the time of admission, including serum creatinine (Cr), the estimated glomerular filtration rate (eGFR), the red blood cell count, the white blood cell count, the serum CRP level and heart rate, differed significantly from those observed in the survivors (all; p<0.05). According to a logistic regression analysis, an increase in log-serum Cr per one standard deviation (odds ratio=2.18, 95%CI=1.08-4.41) and a decrease in log-eGFR per one standard deviation (odds ratio=0.51, 95%CI=0.26-0.98) were significantly associated with in-hospital death. The area under the ROC curve for serum Cr to predict the outcome was 0.80, the sensitivity was 64% and the specificity was 85% at a cut-off value of 1.16 mg/dL. For eGFR, the area under the ROC curve was 0.77, the sensitivity was 64% and the specificity was 86% at a cut-off value of 47.5 mL/min./1.73 m(2). CONCLUSION Mild renal dysfunction at the time of admission is an important predictor of early phase mortality in patients with IE.
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Affiliation(s)
- Chikahiko Koeda
- Department of Internal Medicine, Iwate Medical University, Japan.
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Ghosh PS, Friedman NR, Ghosh D. Fever, lethargy, and leg weakness in a 9-month-old boy. Clin Pediatr (Phila) 2012; 51:808-11. [PMID: 22511192 DOI: 10.1177/0009922812441677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Partha S Ghosh
- Pediatric Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.
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Accident vasculaire cérébral hémorragique révélant une endocardite infectieuse. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Prise en charge précoce des insuffisances aortique et mitrale aiguës en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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