Early Diagnosis and Treatment in Infective Endocarditis: Challenges for a Better
            Prognosis

Sobreiro, Daniely Iadocico; Sampaio, Roney Orismar; Siciliano, Rinaldo Focaccia; Brazil, Calila Vieira Andrade; Branco, Carlos Eduardo de Barros; Lopes, Antonio Sérgio de Santis Andrade; Tarasoutchi, Flávio; Strabelli, Tânia Mara Varejão

doi:10.5935/abc.20180270

Cited by 8 publications

(14 citation statements)

References 10 publications

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“…The percentage of positive blood culture and TTE pictures suggestive for IE, according to the Duke modified criteria, observed in our study is due to an earlier alert of an infectious disease consultant closely involved with the hospital team for the management of IE patients. In fact, in our patients, both blood culture and TTE were performed within the first days from admission to the emergency unit, confirming the utility of an early TTE [26,[28][29]. Fever was the main symptom of IE, highlighting that this symptom is vital for the suspicion of IE.…”

Section: Discussionsupporting

confidence: 72%

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

Serra¹,

Colomba²,

Carlo³

et al. 2020

Cureus

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Background Infective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management. We aimed to define diagnosis parameters and delineate in-hospital management in patients with IE admitted in a tertiary hospital of Southern Italian. Materials and methods Fifty-six consecutive patients (42 males, 14 females; age range: 34-85 years) admitted for IE in the Infectious Diseases, Cardiac Surgery, and Cardiology units, between January 2011 and August 2017, were enrolled. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, and antimicrobial therapy were collected and analyzed. Any comments at the multidisciplinary team meetings were recorded in minutes of and approved. Results We found 83.9% of patients with positive blood cultures. The four most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA: 21.3%), methicillin-sensitive Staphylococcus aureus (MSSA: 17%), Streptococci (14.9%), and Enterococci (14.9%). Both in the univariate and multivariate analysis, we observed a significant positive correlation between surgery and complications. Particularly in the univariate analysis only, surgery was positively correlated to males and C-reactive protein (CPR) at baseline. Also, considering the most common bacteria, it resulted in a positive correlation between surgery and MRSA and Streptococci spp. and between complications and MSSA. Finally, the male gender was positively correlated to MSSA and heart complications, major arterial embolism, septic pulmonary emboli, splenic infarction, and cerebral embolism. Conclusions A blood culture test remains a critical factor for the diagnosis of IE and the antibiotic treatment 1 2 2,

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Section: Discussionsupporting

confidence: 72%

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

Serra¹,

Colomba²,

Carlo³

et al. 2020

Cureus

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“…Os principais fatores de riscos para EI, descritos nos estudos, são idade avançada, presença de comorbidades, como diabetes mellitus, insuficiência renal crônica e anemia 12,15 , próteses valvares, cateteres venosos, uso de drogas intravenosas, hemodiálise, imunossupressão 3,15 , presença de mais de 2 eletrodos e número de manipulações do dispositivo cardíaco10. Com o avanço da cardiologia nos últimos anos, os DCEI (marcapasso, cardiodesfibriladores e ressincronizadores) e a substituição de válvula aórtica transcateter foram incluídos como fatores de risco 3,15,16 . O paciente desse caso apresenta como fatores de risco: idade avançada e tubo valvado em válvula aórtica; apesar de ser hipertenso, não é portador de lesões de órgão alvo e nem das comorbidades citadas.…”

Section: Discussionunclassified

“…Em 2000, os critérios de Duke modificados foram recomendados para realização do diagnóstico dessa condição, considerando as manifestações clínicas e os achados ecocardiográficos e/ou microbiológicos 13,16,17 . No entanto, esses critérios possuem baixa acurácia para o diagnóstico de EI em fases iniciais, principalmente, em pacientes portadores de próteses valvares e DCEI, como marcapasso e cardiodesfibrilador implantável 13,15 .…”

Section: Discussionunclassified

Endocardite infecciosa em cabo de marcapasso por Enterobacter cloacae: relato de caso

Vieira

Macedo

et al. 2020

R. Saúde

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A endocardite infecciosa (EI) é um desafio diagnóstico para a prática médica devido aos seus sinais e sintomas inespecíficos, principalmente, se for endocardite infecciosa sobre dispositivos cardíacos (EIDC) que corresponde a 10% dos casos de EI. Os microrganismos mais prevalentes, na EIDC, são Staphylococcus aureus e estafilococos coagulase-negativa (CoNS). A presença de bactérias Gram-negativas, como Enterobacteriaceae, representa 1,8% dos casos de EI, e está relacionada à infecção hospitalar e pior prognóstico. O diagnóstico e o tratamento precoce estão relacionados à melhor prognóstico. O tratamento da EIDC é cirúrgico associado à antibioticoterapia, assim como no caso da EI por bactérias Gram-negativas. O objetivo desse estudo foi descrever o caso de EI no cabo do marcapasso, um dispositivo cardíaco, por uma bactéria Gram-negativa, sem história recente de internação hospitalar ou cirurgias. Paciente do sexo masculino, 66 anos, portador de tubo valvado aórtico e marcapasso definitivo, deu entrada no hospital com queixa de febre alta persistente associada à tosse seca com duração de um mês, em uso de antibiótico. Foi realizada a ecocardiografia transesofágica, que sugeriu o diagnóstico de EIDC. O paciente foi internado, foi realizada a antibioticoterapia por um longo período e, posteriormente, foi necessária a extração do dispositivo cardíaco. A suspeita clínica de EI em pacientes com sintomas inespecíficos associados a fatores de riscos, como uso de dispositivos cardíacos, é essencial para o diagnóstico. A terapêutica adequada precoce está relacionada à melhor prognóstico.

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“…Infective endocarditis is a dangerous condition where early recognition and treatment are crucial. With accurate diagnosis and treatment in a timely manner, approximately two-thirds of patients will survive [1]. Early diagnosis is the key to improving outcomes in infective endocarditis.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosed and treated, approximately two-thirds of patients with infective endocarditis can be saved. The key to improving the outcomes of infective endocarditis is early diagnosis [1]. The key to early diagnosis of infective endocarditis is history and physical examination, as it is for most diseases [2].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis Masked by Narrow Focus Thinking, Inadequate Physical Examination and Analgesic Medication

Nichols

Hernández

Henderson

2019

Cureus

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It is important not to miss a diagnosis of infective endocarditis. It is fatal if untreated and most often successfully treatable if recognized. We report a classic case of subacute bacterial endocarditis with Osler nodes and Janeway lesions due to viridans streptococci from an oral source of poor dentition, infecting a presumably abnormal mitral valve. The diagnosis was missed repeatedly by multiple different clinicians over the course of seven months. Detailed analysis of this case suggests some of the pitfalls that led to the delay in diagnosis. The infective endocarditis was masked by analgesic medication, inadequate physical examination, and narrow focus thinking. The images of this case can serve as a reminder of the features of infective endocarditis. The detailed history and discussion can provide potential lessons in how to not miss the diagnosis of infective endocarditis.

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Early Diagnosis and Treatment in Infective Endocarditis: Challenges for a Better Prognosis

Cited by 8 publications

References 10 publications

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population

Endocardite infecciosa em cabo de marcapasso por Enterobacter cloacae: relato de caso

Infective Endocarditis Masked by Narrow Focus Thinking, Inadequate Physical Examination and Analgesic Medication

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