Ziel der Studie war es zu analysieren, inwiefern eine Operation bei Patienten mit einer infektiösen Endokarditis der linksseitigen Nativklappen und keiner weiteren Operationsindikation als einer Vegetationsgröße ≥10mm, das Auftreten von systemischen Embolien, erneuten Endokarditiden und das Langzeitüberleben beeinflussen. Dafür wurden alle Patienten, die zwischen Januar 2000 und Juni 2012 in der Klinik für Kardiologie des Herzzentrums Leipzig mit einer Linksherzendokarditis der Nativklappen und einer Vegetationsgröße ≥10mm behandelt wurden, in ein Register aufgenommen. Alle Patienten mit anderen Operationsindikationen als ihrer Vegetationsgröße wurden ausgeschlossen. Es wurde eine Langzeitkontrolle hinsichtlich definierter klinischer Ereignisse durchgeführt. 71 Patienten wurden in die Studie eingeschlossen. Die mittlere Vegetationsgrößebetrug 17±5mm. 59 Patienten wurden nach einer mittleren Zeit von 5±6 Tagen nach Beginn der Antibiotikatherapie operiert. Die übrigen 12 wurden rein konservativ behandelt. Das mittlere Follow-up erfolgte nach 6,0±2,9 Jahren. Eine chirurgische Behandlungsstrategie war im Vergleich zu rein medikamentöser Therapie mit einer signifikanten Erhöhung der Langzeitmortalität verbunden (p=0,03, Log-rank-Test; unadjustierte Analyse). In einem multivariaten Cox-Regressionsmodell zeigten chirurgische Behandlung, Beteiligung der Mitralklappe, Staphylokokkus aureus-positive Blutkulturen und steigendes Alter einen Trend als unabhängige Beeinflussungsfaktoren der Langzeitmortalität. Ein signifikanter Unterschied zwischen den beiden Gruppen hinsichtlich symptomatischer systemischer Embolien nach Therapiebeginn und Zahl erneuter Endokarditiden bestand nicht. Daher scheint eine operative Behandlung von Patienten mit einer infektiösen Linksherzendokarditis der Nativklappen und großen Vegetationen ohne weitere Operationsindikationen, wie sie aktuell von europäischen und amerikanischen Leitlinien empfohlen wird, möglicherweise mit einer höheren Mortalität verbunden zu sein. Eine kontrollierte randomisierte Studie zur Gegenüberstellung von operativer und konservativer Behandlung dieser Subgruppe von Endokarditispatienten ist deshalb erstrebenswert.

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There are two previous reports of Candida dubliniensis endophthalmitis in North America. Here, we report a third case of C. dubliniensis endogenous endophthalmitis in a 31-year-old male patient who complained of left-sided decreased visual acuity. He had an associated mitral and tricuspid valve endocarditis, in the setting of intravenous drug use. Blood and sputum cultures were positive for C. dubliniensis. Fundoscopic examination was consistent with a fungal endophthalmitis. He was treated with fluconazole followed by intravenous liposomal amphotericin B for 6 weeks. C. dubliniensis is an important but rare cause of endophthalmitis in intravenous drug abusers.

Background: Infective endocarditis is a rare but severe condition associated with a high mortality rate in small animal patients. This condition is caused by a microbial (most often bacterial) infection of the valvular portion of the endocardium, from which proliferative and/or erosive lesions on the cardiac valves or immediately adjacent structures develop. The two most commonly affected cardiac valves are the aortic and mitral valves. Case presentation: We report the clinical case of a 4-year old male neutered Bull terrier, 27.6 kg, body condition score 4/9, that presented with a 3-months history of pyrexia and general weakness. The patient history also revealed a transient left hind limb lameness (grade 2/4), which coincided with the onset of clinical signs about 3 months before presentation. On physical examination, a left-sided systolic heart murmur (grade 3/6) with the same intensity at the left heart base and apex, and an irregularly irregular heart rhythm were noted. Electrocardiography showed ventricular premature complexes, and echocardiography revealed lesions consistent with endocarditis involving the aortic and mitral valve. Bacterial culture of blood yielded a positive result, and the organism isolated was identified as Erysipelothrix rhusiopathiae. The extended patient history revealed that the dog lived close to a farm housing pigs and other livestock. Conclusion: We report a rare case of the premortal diagnosis of infective bacterial endocarditis in a dog due to E. rhusiopathiae infection. Most reports about this condition are from necropsy series. This clinical case report emphasizes that E. rhusiopathiae infection and bacteremia should be considered as a differential diagnosis in dogs with suspected infective endocarditis, especially in dogs living in rural areas with access to livestock and particularly farm pigs. Also, particular emphasis should be placed on the zoonotic potential of this infectious disease.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 6 uppsatser.

UA Open Access Publishing Fund / Molecular diagnostics offers quick access to information but fails to operate at a speed required for clinical decision-making. Our novel methodology, droplet-on-thermocouple silhouette real-time polymerase chain reaction (DOTS qPCR), uses interfacial effects for droplet actuation, inhibition relief, and amplification sensing. DOTS qPCR has sample-to-answer times as short as 3 min 30 s. In infective endocarditis diagnosis, DOTS qPCR demonstrates reproducibility, differentiation of antibiotic susceptibility, subpicogram limit of detection, and thermocycling speeds of up to 28 s/cycle in the presence of tissue contaminants. Langmuir and Gibbs adsorption isotherms are used to describe the decreasing interfacial tension upon amplification. Moreover, a log-linear relationship with low threshold cycles is presented for real-time quantification by imaging the droplet-on-thermocouple silhouette with a smartphone. DOTS qPCR resolves several limitations of commercially available real-time PCR systems, which rely on fluorescence detection, have substantially higher threshold cycles, and require expensive optical components and extensive sample preparation. Due to the advantages of low threshold cycle detection, we anticipate extending this technology to biological research applications such as single cell, single nucleus, and single DNA molecule analyses. Our work is the first demonstrated use of interfacial effects for sensing reaction progress, and it will enable point-of-care molecular diagnosis of infections.