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.
Neurological Manifestations of Medical Disorders
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Patient groups at particular risk of endocarditis include those with immunosuppression, intravenous drug use, prosthetic heart valves or structural heart valve disease. Emboli may cause infection or vasculitis of vessels where they impact, with or without the development of mycotic aneurysms (typically in distal branches of the middle cerebral artery). Anticoagulation is not recommended in native valve endocarditis because of the high risk of haemorrhagic complications, but in the case of prosthetic valve endocarditis anticoagulants may need to be continued (although it is probably safe to discontinue them for 1–2 weeks acutely). Early cerebral angiography is generally advised in the case of areas of symptomatic haemorrhage to exclude mycotic aneurysm, which can be treated by endovascular methods. Conversely, angiography is probably not necessary in cases of asymptomatic unruptured mycotic aneurysms.
The heart
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Pharmacotherapy of valvular disease often includes diuretics to reduce congestion and anticoagulants to prevent the formation of an embolism. Vasodilators can be of value in reducing afterload in mitral valve disease. Anti-arrhythmic drugs may be employed if arrhythmias are present. Positive inotropic agents like digitalis glycosides can increase the force of contraction if heart failure occurs. Antibiotics may be given prophylactically to prevent endocarditis. A number of techniques have evolved in recent years for surgically treating or correcting valvular defects. Mitral valvotomy involves opening of the mitral valve either surgically or with a balloon catheter. Valvuloplasty may be performed to surgically repair damaged valves or, if the disease is too advanced, affected valves may be completely replaced with graft valves (porcine, bovine or human) or with mechanical valves.
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.
Effect of promethazine on biofilms of gram-positive cocci associated with infectious endocarditis
Published in Biofouling, 2023
Gláucia Morgana de Melo Guedes, Carliane Melo Alves Melgarejo, Alyne Soares Freitas, Bruno Rocha Amando, Cecília Leite Costa, Crister José Ocadaque, Francisco Ivanilsom Firmiano Gomes, Silviane Praciano Bandeira, Rossana de Aguiar Cordeiro, Marcos Fábio Gadelha Rocha, José Júlio Costa Sidrim, Débora de Souza Collares Maia Castelo-Branco
The American Heart Association (AHA) estimates that about 100,000 to 200,000 new cases of infective endocarditis are diagnosed in the United States of America (USA) each year, and recent data showing an increase in incidence in USA and UK (Yang et al. 2015; Hubers et al. 2020). Endocarditis is usually caused by an infection, where an endothelial cardiovascular presents an inflammatory structure of platelets and fibrin commonly observed with growth of vegetations composed of microorganisms, which can be considered a pathognomonic sign of the disease (Cahill and Prendergast 2016; Pecoraro and Doubell 2020). The main etiological agents are Gram-positive cocci, with emphasis on the genera Staphylococcus spp. and Streptococcus spp. (Htwe and Khardori 2012). To treat the infection, several drug regimens can be used, most of which include oxacillin or vancomycin against Staphylococcus spp. and ceftriaxone or vancomycin against Streptococcus spp., with vancomycin as the last drug resource (Gould et al. 2012; Habib et al. 2015).
The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives
Published in Expert Review of Anti-infective Therapy, 2021
Massimo Andreoni, Matteo Bassetti, Salvatore Corrao, Francesco Giuseppe De Rosa, Vincenzo Esposito, Marco Falcone, Paolo Grossi, Federico Pea, Nicola Petrosillo, Carlo Tascini, Mario Venditti, Pierluigi Viale
Infective endocarditis (IE) is an infectious process involving the endocardial surface of intracardial structures, such as heart valves, both native or prosthetic, or intracardial implantable medical devices. Based on the clinical manifestations of the disease, IE can be further classified in acute or subacute. While acute endocarditis generally present with a sudden onset of fever or systemic complications, subacute endocardial infections are often misdiagnosed because of unspecific symptoms lasting over weeks or months such as fatigue, dyspnea or weight loss. The most commonly isolated pathogen in blood cultures of patients with IE is Staphylococcus aureus, followed by Viridians group streptococci and by enterococci which are typical for the elderly. Coagulase negative Staphylococci are a leading cause of infective endocarditis involving prosthetic valves or intracardiac devices. Due to frequent antibiotic resistance and difficult medication penetration into bacterial endocardial vegetations, IE often require a combined and prolonged intravenous antimicrobial therapy and debridement and valve replacement surgery [31,32]. Dalbavancin is not currently approved for the treatment of IE; nevertheless, because of its activity spectrum and pharmacokinetic properties, it may be a promising alternative in this clinical setting, reducing hospitalization duration and assistance costs.
Related Knowledge Centers
- Endocardium
- Fibrin
- Inflammation
- Interventricular Septum
- Platelet
- Chordae Tendineae
- Heart
- Heart Valve
- Vegetation
- Acute