جستجوی مقالات مرتبط با کلیدواژه « Endocarditis » در نشریات گروه « پزشکی »

 Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI).

 The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website.

 Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five.

 This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.

Q fever is a contagious zoonotic disease which is caused by a gram-negative and intracellular Cocco-bacillus known as Coxiella burnetii ticks play a role in its transmission. Endocarditis is the most common consequence of chronic Q fever.

Here we report a case of endocarditis caused by Q fever. The patient is a 67-year-old, and she had coronary artery bypass graft (CABG) and aortic valve replacement surgery.

The result of echocardiography showed a suspicious mass (Vegetation) on the implanted valve. Based on la-boratory and clinical assessments, endocarditis caused by C. burnetii was the final diagnosis.

Q fever is a tick-transmitted pathogen that has been known as an important cause of culture-negative en-docarditis in Iran, and more attention needs to be paid to this disease in Iran by the healthcare system and physicians.

Endocarditis of cardiac implanted electronic devices is a complex and serious disease. Commensal bacteria of the skin are commonly considered as contamination of blood culture. Herein, the authors report the case of a pacemaker endocarditis with cultures positive for Cutibacterium acnes. These were already found 3 and 6 years ago but not observed during hospitalisation. The PET-scan was of great help in guiding the diagnosis. The management was particularly difficult with 9 leads to extract. A sequential approach in the operating room from endovascular procedure to surgery under cardio-pulmonary bypass was used. A second procedure was necessary to extract a small forgotten foreign body already visible on the preoperative chest X-ray. This experience shows the importance of having a high level of suspicion in case of culture positive for Cutibacterium with intracardiac devices, and of looking for foreign bodies on the preoperative chest X-ray in case of a history of multiple rhythmological procedures.

 In light of the high incidence of cardiovascular diseases within the population and recognizing them as one of the most frequently encountered conditions in dental practice, the significance of effectively managing these medically compromised patients in dental settings has become increasingly crucial. Thus, this study aimed to assess the knowledge of senior dental students concerning patients afflicted with prevalent cardiovascular disorders.

 In this analytical cross-sectional study with a total population sampling method, there were 64 senior dental students selected from Gilan University of Medical Sciences during 2021-2022. They completed a questionnaire with demographic information and 14 four-choice questions assessing knowledge towards Hypertension, Ischemic Heart Diseases, and Infective Endocarditis. Knowledge levels were categorized as poor, average, and good based on the statistical thirds. The significance level was set at P<0.05.

 The participants achieved an average score of 48.21 ± 16.88 (out of 100). There were statistically significant differences (P<0.001) in knowledge scores across disease categories, with the lowest average score for Ischemic Heart Diseases and the highest for Infective Endocarditis. Furthermore, the statistical analysis found no significant difference in knowledge scores based on gender and no statistically significant correlation between Grade Point Average (GPA) and knowledge scores (P>0.05).

 The dental education curriculum could be modified to emphasize teaching common systemic diseases in clinical care, and improving the quantity and quality of education to create a positive outlook on the significance of acquiring knowledge in the field of cardiovascular disorders.

Infective endocarditis (IE) is associated with several morbidities and high rate of mortality. Predicting these morbidities can be helpful in managing patients and can prevent possible complications, result from IE. In this study, we aimed to evaluate the association between C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (BNP), monocyte to high density lipoprotein (HDL) ratio Charlson comorbidity index, and European System for Cardiac Operative Risk Evaluation (Euro SCORE) in complicated cases of IE.

This prospective study was conducted on a referral center from January 2017 to December 2020. Patients with definite or possible diagnosis of IE based on the modified Duke criteria were included in this study. Demographic information and serum levels of N-terminal pro BNP, D-Dimer, CRP were evaluated in patients. In addition, we used Charlson comorbidity index and The Euro SCORE for subjective assessment.

One hundred and four patients(64 males, median age: 58) included in the final analysis. Intracardiac involvement, central nervous system (CNS) complications and systemic complications were observed in nine patients(9.7%), 16 patients(15.4%), and eight patients (7.7%) respectively. The mortality rate was 14.4%. D-dimer (P = 0.008), pro-BNP (P = 0.008), and Charlson criteria (P = 0.012) were higher in patients with systematic complications. In addition, NT pro‑BNP was significantly associated with CNS complications (P = 0.04) and D‑Dimer level was significantly associated with in‑hospital mortality (P = 0.008).

Serum biomarkers such as pro‑BNP and D‑dimer, and comorbidity indices can be used for risk stratification of patients with IE. The level of pro‑BNP is significantly associated with CNS complications and the level of D‑dimer is significantly with mortality in patients with IE.

Infectious endocarditis is a rare infectious disease of the cardiac endothelium, but blood culture-negative endocarditis (BCNE) should be considered.

This study aims to determine the prevalence of possible infectious agents of BCNE.

Real-time PCR and PCR sequencing were used to identify Coxiella burnetii, Tropheryma whipplei, Brucella spp., Legionella spp., and Bartonella spp. 16srRNA sequencing was used for the samples with negative results of PCR sequencing and real-time PCR.

Among the 59 positive results, the rates of Bartonella spp., Legionella spp., and Brucella spp. were 8.5%, 5.1%, and 3.4%, respectively. C. burnetii and T. whipplei were not detected. 16srRNA sequencing revealed 1 Stenotrophomonas maltophilia, 1 Aeribacillus spp. and 1 uncultured bacterium.

The rate of some bacteria that are difficult to detect with routine laboratory tests was high in our study, and it seems that hospitals should use dedicated technology to detect BCNE pathogens.

Bacteria, especially staphylococcal groups, cause aortic graft infection. Infection stems from synthetic materials that repair aneurysms or artery blockages. Aortic stent infection and vegetation formation are rare, and heterogeneous presentations and ambiguous findings in routine diagnostic modalities render the diagnosis challenging. A 25-year-old man with a history of catheter-based aortic stenting for hypertension associated with severe aortic coarctation was referred to our tertiary care hospital. Five months before the presentation, the patient had been infected with COVID-19, but he recovered after mild symptoms. Nevertheless, 3 months later, he developed erythematous lesions, progressive anorexia, epigastric pain, fever, and weakness. The results of blood tests, blood cultures, transthoracic echocardiography, plain chest radiography, computed tomography angiography, and electrocardiography were unremarkable. We found severe infectious aortitis, crescent thickness surrounding the aorta, pseudoaneurysm development, and a mass with dimensions of 17 mm×8 mm within the aortic stent on transesophageal echocardiography (TEE). Broad-spectrum antibiotic therapy was initiated, and the patient was transferred to the operating room, where the infected stent and adhesive vegetation were removed. The patient recovered remarkably after the surgery and was discharged. At 6 months’ follow-up, he was in good condition. Our findings highlight the significance of maintaining vigilance and a high level of clinical suspicion for the possibility of vegetation formation and aortitis as the possible sequelae of COVID-19, particularly in patients with an implanted stent. Furthermore, we strongly suggest TEE in patients with implanted stents to detect vegetation and aortitis.

Herein, we present a case with clinical and laboratory manifestations of infectious endocarditis but in echocardiography, the ventricular septal defect and bicuspid aortic valve were detected without any vegetation. However, an aortic root pseudoaneurysm was first suspected in transesophageal echocardiography and then confirmed in computed tomography angiography of the aorta that points to importance of searching infectious endocarditis complications even in absence of vegetation.

Several microorganisms are associated with infective endocarditis (IE), but the most common IE causes are staphylococci and streptococci. Among streptococci, the viridans group streptococci are responsible for a considerable percentage of all IE cases.

Since 2006, the Iranian Registry of Infective Endocarditis has recorded information regarding all adult patients with a definite or possible IE diagnosis according to the modified Duke criteria. Patients with viridans streptococcal endocarditis were detected through three blood culture sets. The patients’ demographic characteristics, predisposing factors, clinical presentations, and echocardiographic findings were recorded.

Of 731 patients diagnosed with endocarditis, viridans streptococci were found in 46 (6.3%) patients, consisting of 28 (60.9%) men and 18 (39.1%) women at a mean age of 42.56 ± 15.46 years, who were subsequently included in the study. Among the 46 patients with viridans streptococcal endocarditis, 26 had a subacute course, whereas 20 had an acute course. Vegetation was detected in 35 patients. All the patients were treated with the standard antibiotic regimen for viridans streptococcal endocarditis, and cardiac surgery was performed on 16 patients.

Clinicians should pay sufficient heed to the following points in all cases of viridans streptococcal endocarditis: firstly, an appropriate antibiotic regimen must be based on a precise minimal inhibitory concentration determination for the usual antibiotics. Secondly, since prolonged antibiotic therapy is crucial to the eradication of microorganisms within vegetation, all patients with viridans streptococcal endocarditis must receive an adequate therapy course.

The COVID-19 pandemic, together with its complications and management, has been a significant issue worldwide since March 2020. Concomitant infections in vulnerable patients with preexisting cardiovascular diseases are not uncommon. Sharing information about the diagnostic management and treatment of these comorbidities has a prominent role in unveiling some of this pandemic’s challenges. We herein describe a young adult with a history of implantable cardioverter-defibrillator implantation diagnosed with COVID-19 infection and infective endocarditis. (Iranian Heart Journal 2022; 23(4): 102-108)

Infective Endocarditis (IE) is a life-threatening disease. Regardless of improved healthcare, the incidence of IE has increased over time. A variety of microorganisms have been found to be associated with IE.

This study aimed to determine the incidence of various microorganisms in patients admitted with IE and to assess their relationships with in-hospital complications.

This prospective cross-sectional study was conducted on patients with definite or possible IE based on the Duke criteria at a tertiary referral center between 2016 and 2021. Blood cultures were performed for all the patients to document the positive or negative blood cultures as well as the types of microorganism. Statistical analyses were performed using the SPSS 18 software.

The study population consisted of 286 patients (181 males (63.3%) and 105 females (36.7%)) with the mean age of 49.67 ± 17.11 years. The most common cardiac predisposing factor was the prosthetic valve (n = 110, 38.5%) followed by a history of congenital heart disease (n = 68, 23.8%), while the most frequent non-cardiac predisposing factors were a history of chronic kidney disease (n = 75, 26.2%) and diabetes mellitus (n = 53, 18.5%). The most frequent causative microorganisms were coagulase-negative Staphylococcus (n = 37, 12.9%), Staphylococcus aureus (n = 31, 10.4%), Enterococcus (n = 29, 10.1%), and Streptococcus viridans (n = 14, 4.9%). The most common complications were acute renal failure (26.6%), heart failure (17.5%), and pulmonary involvement (8.4%).

The frequencies of microorganisms related to IE, especially culturenegative IE, vary in different countries, precluding the practical use of a specific guideline around the world. Further research is, therefore, required to determine the epidemiology and microbiology of IE in different countries with a view to eventually devising an individualized guideline appropriate to the epidemiology and microbiology of IE in every country.

Hemodialysis catheter-related infections are associated with increased morbidity and mortality in end-stage renal disease patients. Here we present a case of an end-stage renal disease patient who presented with fever and weakness. During workup, we found a deeply inserted jugular vein double lumen catheter into the inferior vena cava that was complicated by infection.

An accessory mitral valve (AMV) is a rare anomaly of the mitral valve (MV) that often causes left ventricular outflow tract (LVOT) obstruction. We describe a young woman presenting with infrequent palpitations to our outpatient clinic. She was evaluated for mid-systolic murmur at the left sternal border. At the initial transthoracic echocardiography, vegetation on the MV was suspected. The patient was referred to our advanced echocardiography lab, where transesophageal echocardiography revealed an AMV with mild LVOT obstruction. The findings, along with extensive laboratory tests, ruled out vegetation. Additionally, she had a bicuspid aortic valve. At follow-up after 1 year, the patient was asymptomatic regarding the AMV with LVOT obstruction, and the repeat echocardiography depicted no changes compared with the previous echocardiography. Distinguishing AMVs from other MV masses, including vegetation, sometimes poses a challenge and can lead to unnecessary diagnostic and therapeutic measures. This rare MV anomaly is associated with bicuspid aortic valves.

Coronavirus Disease 2019 (COVID-19) is an ongoing pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Patients with infective endocarditis (IE) and COVID-19 can present similar signs and symptoms; thus, it may be difficult for clinicians to diagnose such infections. This report presented a patient diagnosed with IE and co-infected with COVID-19. This case highlights that every physician should consider COVID-19 infection when evaluating patients with IE.

Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.

Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.

Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (<6 wk) was reported in 38 patients (63.3%). Fever (n=58, 95%) and loss of appetite (n=17, 28.3%) were the most frequent symptoms. The most frequent location of involvement was the aortic valve (n=22, 36.7%), followed by the mitral valve (n=20,33.3%). Vegetation was detected in 53 patients (88.3%), abscess formation in 8 (13%). Fifteen patients (25%) had heart failure, and 11 (18%) had central nervoussystem complications. The mortality rate was 20%.

Given the serious complications and the high mortality rate in the patients with IE of enterococcal origin, which may be due to these organisms’ intrinsic resistance to many antibiotics, we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

Infective endocarditis is rare in children but can cause significant morbidity and mortality. Streptococcus and Staphylococcus species are the leading causes of this disease. Staphylococcus is more common in people with underlying heart disease, and Streptococcus viridans is more common in people who have had a dental procedure. In general, any fever of unknown origin in children with an underlying heart problem should be carefully evaluated for endocarditis, and empiric therapy should be performed. The main symptoms of the disease include fever, new murmur, deterioration of the previous murmur, hematuria, embolic events, splenomegaly, bleeding splinter, Osler's nodes, Janeway lesion, and Roth spots. One of the important complications of infective endocarditis is cerebrovascular event and stroke. Herein, we describe a 6-year-old girl presented with fever and skin lesions and no history of underlying heart problem or dental procedure. The patient expired after three days of mitral valve infection with S. aureus.

Use of miniscrews has become very common in orthodontic treatment of patients. Following tissue manipulation during miniscrew placement, bacteremia may occur, which is important in patients susceptible to infective endocarditis. This study aimed to investigate the possibility of bacteremia following orthodontic miniscrew placement.

The present quasi-experimental study was conducted on 30 orthodontic patients, including 11 males (36.7%) and 19 females (63.3%) with a mean age of 23.67±4.87 years, who required miniscrew placement in their treatment plan. Two blood samples were taken from the patients for aerobic and anaerobic cultures right before and 30-60 seconds after miniscrew placement. To investigate the presence of bacteremia, the blood samples were incubated in an automated blood culture machine for five days. The standard biological methods were used for the positive sample(s) to identify the type of bacteria. Data analysis was performed using the McNemar test.

The blood samples of 29 patients were negative for the bacteria before and after miniscrew placement. Blood sample of one patient was positive for aerobic and anaerobic bacteria after miniscrew placement. However, bacteremia was negative in the initial (preplacement) blood samples for both aerobes and anaerobes.

Miniscrew placement in orthodontic patients was not associated with bacteremia.

Infective endocarditis is a rare disease of the heart valves and endocardium, which can be developed after invasive dental procedures. To prevent this event, antibiotic prophylaxis is recommended for patients with predisposing cardiac conditions. The purpose of this study was to assess the knowledge of general dentists working in Guilan province regarding antibiotic prophylaxis for the prevention of infective endocarditis.

This descriptive cross-sectional study was conducted on 264 general dentists in Guilan province using a validated questionnaire. There were 157 males and 107 females. The questionnaire included 25 questions. The total score ranges from 0 to 25 with this classification: [0-12: low level, 13-17: moderate level and 18-25: high level]. Age, gender, clinical experience, place of work and participation in retraining programs of participants were also recorded. Data analysis was performed using T-test and Pearson’s Correlation Coefficient with the SPSS version 24.

The mean knowledge score of the dentists was 14.43 and 53.2% of participants had moderate level of knowledge. 28.1% and 18.7% of dentists had a low and high level of knowledge, respectively. No significant differences were noted in the knowledge scores between the two genders and regarding age, clinical experience and participation in retraining programs (p-value >0.05).

The knowledge level of general dentists working in Guilan province was at  a moderate level. Therefore, it is better to take actions to improve the dentist’s knowledge regarding this topic.