Document Detail


Latent infective endocarditis: epidemiology and clinical characteristics of patients with unsuspected endocarditis detected after elective valve replacement.
MedLine Citation:
PMID:  15511445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The diagnosis of infective endocarditis is usually made on the basis of clinical and laboratory criteria and may be confirmed by histologic examination or culture of excised valves. We tried to determine the incidence and significance of inflammatory changes in valves excised during operations for reasons other than infective endocarditis. METHODS: The charts and histopathology of all patients undergoing valve replacement during a 10-year period (1993-2002) were reviewed. A total of 868 patients underwent a total of 970 valve replacements during this period, of whom 11 patients (1.3%) were for endocarditis, with the remaining 857 (98.7%) for other indications. All excised valves were cultured and examined histologically for the presence of inflammatory infiltrates, vegetations, and microorganisms. RESULTS: In 8 of 857 patients (0.9%), the histologic examination unexpectedly demonstrated an infiltrate suggestive of endocarditis. Blood and valve cultures, and serologic tests for Mycoplasma, Chlamydia, Legionella, Q fever, Brucella, Rickettsiae, VDRL, and Bartonella were negative in all but 1 patient, who was found to have Q fever. All received a prolonged course of antibiotics. Six patients had an uneventful recovery; 1 had intramyocardial abscesses and expired during cardiac reoperation; and 1 had recurrent fever and dehiscence of the aortic and mitral valve prostheses and after two cardiac reoperations remains in severe heart failure. CONCLUSIONS: The presence of an unexpected inflammatory infiltrate in heart valves excised for reasons other than endocarditis may occur in 0.9% of such operations; these infiltrates could indicate presence of endocarditis. A microbial origin should be sought, and patients should receive empiric antibiotic treatment for endocarditis.
Authors:
Nadiv Shapira; Ofer Merin; Eliezer Rosenmann; Ilia Dzigivker; Dan Bitran; Amos M Yinnon; Shuli Silberman
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-29     Completed Date:  2005-02-04     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1623-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Combined Modality Therapy
Drug Therapy, Combination / therapeutic use
Endocarditis, Bacterial / diagnosis,  drug therapy,  epidemiology*,  surgery
Female
Heart Valve Diseases / complications,  surgery
Heart Valve Prosthesis Implantation*
Humans
Incidental Findings*
Israel / epidemiology
Male
Middle Aged
Pneumococcal Infections / complications,  diagnosis,  drug therapy
Q Fever / complications,  diagnosis,  drug therapy
Retrospective Studies
Surgical Procedures, Elective
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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