Cardiomyopathy, Hypertrophic/diagnostic imaging* ; Endocarditis/diagnosis* ; Endocarditis, Bacterial/drug therapy* ; Humans

Candida prosthetic valve endocarditis (PVE) is a rare entity. However, its incidence is expected to increase along with increasing incidence of nosocomial candida infection. A valve replacement combined with antifungal chemotherapy has been the standard treatment. However, successful treatment with the long-term administration of oral fluconazole has been reported. Herein, a case of bioprosthetic valve endocarditis due to candida parapsilosis, which recurred after a re-do operation, and treated with long-term antifungal chemotherapy, is reported.
Candida* ; Drug Therapy ; Endocarditis* ; Fluconazole ; Heart Valve Prosthesis ; Incidence

Erysipelothrix rhusiopathiae endocarditis in man is a very rare disease. The bacteria can be easily misiden- tified as nonpathogenic gram-positive bacilli or streptococci. This organism was isolated from blood samples taken from a 39-year-old male farmer with subacute bacterial endocarditis. The patient had cirrhosis of the liver; diabetes, and tuberculosis. The isolate showed typical cultural and biochemical characteristics such as facultative growth, formation of small greenish colonies on blood agar, positive hydrogen sulfide, negative catalase, and nonmotility. The isolate was susceptible to penicillin G and the cephalosporins.
Adult ; Endocarditis, Subacute Bacterial/diagnosis* ; Endocarditis, Subacute Bacterial/drug therapy ; Erysipeloid/diagnosis* ; Erysipeloid/drug therapy ; Human ; Male

BACKGROUND: Clinical significance of viridans streptococcal bacteremia may be variable from insignificant colonization to serious invasive diseases such as endocarditis. However, there have been no data on the clinical implications of viridans streptococcal bacteremia in Korea to date. MATERIALS AND METHODS: We have analyzed 95 cases of viridans streptococcal bacteremia diagnosed at the Samsung Medical Center from 1997 to 2003. All available clinical and microbiological data were analyzed. RESULTS: Of the total 95 cases, 76 (80%) had clinically significant infections, while 20% of cases were not associated with clinical diseases. Primary bacteremia was the most common disease (48%) followed by intra-abdominal infections (15%), and infective endocarditis (8%). Primary bacteremia was mostly observed in patients with neutropenia after anti-cancer chemotherapy. Infective endocarditis was unlikely if patients did not have underlying heart diseases. S. mitis, S. oralis, and S. intermedius were the most common etiologic agent in infective endocarditis, primary bacteremia, and intra-abdominal infection, respectively. Thirty-eight percent of isolates were not susceptible to penicillin. CONCLUSION: Viridans streptococcal bacteremia is likely to be associated with invasive clinical diseases, especially in patients with neutropenia, intra-abdominal diseases or underlying heart diseases. However, the presence of viridans streptococci in the blood cultures does not necessarily mean the possibility of infective endocarditis.
Bacteremia* ; Colon ; Drug Therapy ; Endocarditis ; Heart Diseases ; Humans ; Intraabdominal Infections ; Korea ; Neutropenia ; Penicillins ; Viridans Streptococci*

BACKGROUND: Clinical significance of viridans streptococcal bacteremia may be variable from insignificant colonization to serious invasive diseases such as endocarditis. However, there have been no data on the clinical implications of viridans streptococcal bacteremia in Korea to date. MATERIALS AND METHODS: We have analyzed 95 cases of viridans streptococcal bacteremia diagnosed at the Samsung Medical Center from 1997 to 2003. All available clinical and microbiological data were analyzed. RESULTS: Of the total 95 cases, 76 (80%) had clinically significant infections, while 20% of cases were not associated with clinical diseases. Primary bacteremia was the most common disease (48%) followed by intra-abdominal infections (15%), and infective endocarditis (8%). Primary bacteremia was mostly observed in patients with neutropenia after anti-cancer chemotherapy. Infective endocarditis was unlikely if patients did not have underlying heart diseases. S. mitis, S. oralis, and S. intermedius were the most common etiologic agent in infective endocarditis, primary bacteremia, and intra-abdominal infection, respectively. Thirty-eight percent of isolates were not susceptible to penicillin. CONCLUSION: Viridans streptococcal bacteremia is likely to be associated with invasive clinical diseases, especially in patients with neutropenia, intra-abdominal diseases or underlying heart diseases. However, the presence of viridans streptococci in the blood cultures does not necessarily mean the possibility of infective endocarditis.
Bacteremia* ; Colon ; Drug Therapy ; Endocarditis ; Heart Diseases ; Humans ; Intraabdominal Infections ; Korea ; Neutropenia ; Penicillins ; Viridans Streptococci*

Pacemaker lead infections are rare. There are only about 0.4%-1.1% of the patients who have been implanted permanent pacemakers suffering from serious infections which lead to endocarditis. Generally, removal of the infected pacemaker wire and lead, long-term anti-infection therapy, and implantation of a new pacemaker to another anatomic site are accepted approaches for these patients.
Device Removal ; Endocarditis ; drug therapy ; Humans ; Male ; Middle Aged ; Mycoses ; drug therapy ; Pacemaker, Artificial ; adverse effects ; Scopulariopsis

American Heart Association ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Cardiac Surgical Procedures ; Child ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Endocarditis ; drug therapy ; surgery ; Endocarditis, Bacterial ; drug therapy ; surgery ; Humans ; Practice Guidelines as Topic ; United States

Infective endocarditis in pregnancy is extremely rare in clinical practice. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. Due to increased blood volume and hemodynamic changes in late pregnancy, endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism, respiratory, cardiac arrest and sudden death may occur in pregnant women, the fetus can suffer from intrauterine distress and stillbirth at any time, leading to adverse outcomes for pregnant women and fetuses. The disease is dangerous and difficult to treat, which seriously threatens the lives of mothers and babies. Early diagnosis and reasonable treatment can effectively improve the prognosis of patients. The most important method for the treatment of infective endocarditis requires early, adequate, long-term and combined antibiotic therapy. Moreover, surgical controversies regarding indication and timing of treatment exist, especially in pregnancy. In terms of the timing of termination of pregnancy, the timing of cardiac surgery, and the method of surgery, individualized programs must be adopted. A pregnant woman with 30⁺⁵ weeks of gestation is reported. She was admitted to hospital due to intermittent chest tightness, suffocation and fever, with grade Ⅲ cardiac insufficiency. Imaging revealed large mitral valve vegetation, 22.0 mm×4.1 mm and 22.0 mm×5.1 mm, respectively, and severe valve regurgitation. Mitral valve perforation was more likely, blood culture suggested Staphylococcus epidermidis infection, after antibiotic conservative treatment, the effect was poor. After the joint consultation including cardiology, neonatology, interventional vascular surgery, anesthesiology, and obstetrics, the combined operation of obstetrics and cardiac surgery was performed in time. The heart was blocked for 60 minutes, the bleeding was 1 200 mL, the newborn was mildly asphyxiated after birth, and the birth weight was 1 890 g. Nine days after the operation, the patient was discharged from the hospital, and the newborn was discharged with the weight of 2 020 g. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child. An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication, informed consent of the patient, and concerted action among the specialists involved.
Anti-Bacterial Agents/therapeutic use* ; Cardiac Surgical Procedures ; Endocarditis/drug therapy* ; Endocarditis, Bacterial/therapy* ; Female ; Heart Valve Diseases/drug therapy* ; Humans ; Infant, Newborn ; Mitral Valve/surgery* ; Pregnancy ; Staphylococcal Infections

In this study, two school-aged children had an acute onset in spring and had the manifestations of fever, headache, vomiting, disturbance of consciousness, purpura and ecchymosis, and positive meningeal irritation sign. There were increases in peripheral white blood cells and neutrophils, but reductions in the hemoglobin level and platelet count in the two children. They had a significant increase in C-reactive protein. There were hundreds or thousands of white blood cells in the cerebrospinal fluid, mainly neutrophils. Increased protein contents but normal levels of glucose and chloride in the cerebrospinal fluid were found. Head CT scan showed multiple hematomas in the right cerebellum and both hemispheres in one child. Bone marrow cytology indicated infection in the bone marrow, and both blood culture and bone marrow culture showed methicillin-resistant Staphylococcus aureus (MRSA). Both patients had cardiac murmurs and progressive reductions in the hemoglobin level and platelet count during treatment, and echocardiography showed the formation of vegetation in the aortic valve. Therefore, the patients were diagnosed with infectious endocarditis (IE). Vancomycin was used as the anti-infective therapy based on the results of drug sensitivity test. One child was cured after 6 weeks, and the other child was withdrawn from the treatment and then died. Dynamic monitoring of cardiac murmurs should be performed for children with unexplained fever, and echocardiography should be performed in time to exclude IE. IE should also be considered for children with purulent meningitis and skin and mucosal bleeding which cannot be explained by the reduction in platelet count.
Adolescent ; Child, Preschool ; Endocarditis, Bacterial ; diagnosis ; drug therapy ; etiology ; Female ; Fever ; etiology ; Headache ; etiology ; Humans ; Male ; Purpura ; etiology

Ampicillin ; pharmacology ; therapeutic use ; Cellulitis ; drug therapy ; prevention & control ; Comorbidity ; Endocarditis ; drug therapy ; prevention & control ; Female ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Recurrence ; Sepsis ; drug therapy ; prevention & control ; Streptococcal Infections ; drug therapy ; physiopathology ; Streptococcus agalactiae ; pathogenicity