Streptococcus mitis
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward in Case Studies in Infectious Disease, 2010
Persons at greatest risk for subacute bacterial endocarditis are those who have had previous infective endocarditis or rheumatic heart disease, those with prosthetic heart valves, congenital heart disease, other malformations of the heart, and those who use intravenous drugs. Persons with periodontal disease and poor oral hygiene are also at higher risk. The signs and symptoms of bacterial endocarditis resemble a nonspecific flu-like illness. Almost all patients are febrile and may have chills, sweats, anorexia, malaise, cough, headache, myalgia and/or arthralgia, and confusion. Fever is usually low-grade, rarely exceeding 39°C, remittent, and usually not associated with rigors. In about one-third of patients there may be neurologic abnormalities that include stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Peripheral symptoms include petechiae on the conjunctiva, buccal or palatal mucosa, and the extremities. There may be splinter and subungual hemorrhages in the nail beds of the fingers and toes and Osler nodes in the pulp of the digits. In China S. mitis has been reported to cause a scarlet fever-like pharyngitis and about half the cases developed a streptococcal toxic shock-like syndrome. This finding indicates that some S. mitis strains must express superantigenic activity.
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
The most difficult cases to diagnose are those presenting with fever, anemia, and weight loss, without abdominal pain and diarrhea. Lee and Davies55 reported two such cases. One patient presented with fever, joint pains, mild anemia, and an elevated ESR. Rheumatic fever was suspected and the patient was treated accordingly. After 3 months in which the patient failed to respond to therapy, he developed severe, colicky, lower abdominal pain. The patient underwent operation; histologic examination of the resected gut revealed Crohn’s disease. A second patient presented with fever, a systolic murmur, and splenomegaly. The presumptive diagnosis was bacterial endocarditis. Again there was no response to treatment. Subsequently a tender, mobile, sausage-shaped mass was palpated in the right iliac fossa. The diagnosis of regional enteritis was confirmed by histologic examination of resected intestine. Wolff et al.56 report several patients with recurrent, spiking fevers, sometimes without gastrointestinal symptoms, who were shown to have regional enteritis.
Endocarditis
Andrew R. Houghton in MAKING SENSE of Echocardiography, 2013
Perform a full echo study and note any structural abnormalities that predispose to infective endocarditis. According to the National Institute for Health and Clinical Excellence (2008), patients at risk of developing infective endocarditis include those with: acquired valvular disease, including stenosis or regurgitationvalve replacementstructural congenital heart disease, including surgically corrected or palliated conditions (except isolated atrial septal defect and fully repaired VSD or PDA, and endothelialized closure devices)hypertrophic cardiomyopathyprevious infective endocarditis.
Infective endocarditis initially manifesting as pseudogout
Published in Baylor University Medical Center Proceedings, 2021
Tim Brotherton, Chad S. Miller
Infective endocarditis (IE) is a bacterial infection of the endocardium that often affects the heart valves. Risk factors for IE include preexisting valvular disease, a recent dental procedure, and intravenous drug use. The most commonly isolated bacteria is Staphylococcus aureus. In 2009, there were over 40,000 hospital admissions for IE, with admissions increasing in each of the five prior decades.1 Prompt diagnosis and treatment are paramount due to the mortality rate; estimated in-hospital mortality alone was 19.7% in the 2000s.2 Common symptoms include fever, chills, fatigue, arthralgias, myalgias, cardiac manifestations, and extracardiac manifestations that are attributed to embolic disease and immune complexes. Our case describes what appears to be an extremely rare occurrence of IE manifesting initially with pseudogout of the ankle. IE commonly manifests with musculoskeletal symptoms and can mimic other diseases. However, an association between IE and pseudogout has not been illustrated.
Investigation of bacteremia after debonding procedures
Published in Acta Odontologica Scandinavica, 2018
Yasin Akbulut, Merve Goymen, Yasemin Zer, Ayse Buyuktas Manay
Poor oral hygiene has been shown to be the most significant cause of infective endocarditis [4]. Investigators have shown that a significant proportion of bacterial endocarditis cases arise as a result of dental procedures [5,6]. In a study, the incidence of bacteremia was found to be 51% for single tooth extraction, 68–100% for multiple tooth extraction, 0–31% for root canal therapies where the canal instruments do not exceed the root apex, 0–54% for root canal therapies where the canal instruments exceed the root apex, 36–88% for periodontal flap lifting procedures, 83% for gingivectomy, 8–88% for scaling and root planing procedures, 0–40% for periodontal prophylaxis, 0–26% for toothbrushing, 20–58% for use of dental floss, 20–40% for interproximal toothbrushing, 7–50% for dentogingival irrigation and 17–51% for chewing [7]. Besides, for orthodontic stripping, mini-screw insertion and removal procedures, fixed treatments were reported to produce the bacteremia [8,9]. However, bacteremia was detected even after dental procedures such as the application of a rubber dam and matrix band that are not associated with bleeding [10,11] and it has been suggested that bleeding is not absolutely necessary for bacteremia to occur [12].
Infection of cardiac prosthetic valves and implantable electronic devices: early diagnosis and treatment
Published in Acta Cardiologica, 2021
Lampros Lakkas, Burcu Dirlik Serim, Andreas Fotopoulos, Ioannis Iakovou, Argyrios Doumas, Ulku Korkmaz, Lampros K. Michalis, Chrissa Sioka
The modified Duke criteria offer a reliable approach to diagnose endocarditis due to prosthetic valve and CIED infection [5]. In this regard, echocardiography still remains the cornerstone for the diagnosis of endocarditis. The three major echocardiographic findings which are regarded as major diagnostic criteria are: oscillating intracardiac mass (vegetation), abscess formation and valve dehiscence in prosthetic valves. There are also other echocardiographic features concerning the diagnosis of infective endocarditis (aneurysms, intracardiac fistulae, small perforations and other non-specific findings). Overall, echocardiography represents a rather fast, inexpensive and accurate imaging modality [17]. However, one of its limitations there is its low diagnostic efficacy in cases with prosthetic materials, such as valves and pacemaker or defibrillator leads. Recently, advances in other imaging modalities, apart from echocardiography, have resulted in further diagnostic improvement. Thus, the European Society of Cardiology published in 2015 a modified diagnostic algorithm for the diagnosis of infective endocarditis in prosthetic valves that include the use of FDG PET/CT as an additional imaging modality [18].
Related Knowledge Centers
- Anemia
- Endocardium
- Fever
- Heart Murmur
- Petechia
- Infection
- Heart Valve
- Signs & Symptoms
- Regurgitation
- Heart Failure