published_or_final_version / Medicine / Master / Master of Medical Sciences

Thesis (M.Med.Sc.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 81-91).

Purpose: The aim was to determine the echocardiographic features of patients with infective endocarditis, and to compare the findings in HIV positive versus HIV negative patients. Methods: This was a prospective study, conducted over three years using the modified Duke criteria in diagnoses. A control group of age-matched patients with clinical and echocardiographic evidence of valvular regurgitation, who did not satisfy the criteria and who underwent surgery was used in comparison. Results: During this period 91 patients were screened for infective endocarditis. 77 satisfied the criteria for a definite diagnosis of IE. Blood cultures were positive in 46% cases. The commonest organism was S. aureus. Most patients had advanced valve disruption with heart failure and a high peri-operative mortality. The clinical features in the two groups of patients was similar. The incidence of echocardiographic complications was 50.6% in the whole group. Except for leaflet aneurysms in four HIV positive cases, complications were not more frequent in this group. Conclusion: There was a high rate of culture negative cases in this study, probably related to prior antibiotic usage; in this setting the modified Duke criteria have diagnostic limitations. There was no difference in the clinical presentation of infective endocarditis between HIV positive and HIV negative patients. Leaflet aneurysms were more common in the HIV positive patients. / Thesis (M.Med.)-University of KwaZulu-Natal, 2008.

Thesis (Ph. D.)--University of Sydney, 2005. / Title from title screen (viewed 21 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Oral Biology, Faculty of Dentistry. Includes bibliographical references. Also available in print form.

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on June 08, 2010). Includes bibliographical references (p. 39-42).

Orientadores: Francisco Carlos Groppo, Pedro Luiz Rosalen / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-06T15:10:53Z (GMT). No. of bitstreams: 1 Baglie_RobertaCristianeCatelli_D.pdf: 1140633 bytes, checksum: 4a8bfaf4ec7f401180e020ef256fbba7 (MD5) Previous issue date: 2006 / Resumo: A endocardite infecciosa (EI) é uma infecção grave das válvulas cardíacas, do endocárdio mural e de septos defeituosos, provocada principalmente pelos Staphylococcus aureus e pelos estreptococos grupo viridans. O objetivo deste trabalho foi verificar a resistência aos antimicrobianos de cepas de Staphylococcus aureus e estreptococos grupo viridans provindas de 100 voluntários, sendo 60 adultos (16 a 75 anos) que foram divididos em três grupos: saudáveis (grupo 1), cardiopatas de baixo risco (grupo 2) e cardiopatas de alto risco (grupo 3) para EI e 40 crianças (6 a 14 anos) que foram divididas em dois grupos: saudáveis (grupo 1) e cardiopatas de alto risco (grupo 2) para EI. Além disso, os voluntários dos grupos 2 e 3 e os responsáveis pelas crianças do grupo 2 responderam a um formulário sobre os riscos da EI e sua profilaxia. Amostras de saliva (diluídas 1: 1000) foram inoculadas em Mitis Salivarius agar e incubadas em microaerofilia durante 48 h. Amostras de pele (swab) foram inoculadas em Sal Manitol agar e incubadas em aerobiose durante 24 h. Após testes bioquímicos, os estreptococos grupo viridans e os Staphylococcus aureus foram identificados e submetidos a testes de susceptibilidade microbiológica empregando-se agentes antimicrobianos. Dos voluntários adultos, foram isoladas 186 cepas, 58 do grupo 1, 62 do grupo 2 e 66 do grupo 3. Dentre os estreptococos a espécie S. mitis foi a mais cQmum. A cepa mais resistente contra as penicilinas (amoxicilina, ampicilina, meticilina e oxaci li na) foi a do S. aureus isolada dos grupos 2 (57,90/0) e 3 (800/0). Considerando os grupos 2 e 3: 21 voluntários (52,5%) tinham conhecimento sobre sua doença, entretanto, somente 12,5% sabiam o significado de EI. Dezessete voluntários (42,5%) sabiam sobre a antibioticoprofilaxia antes de algum procedimento dental e 10 voluntários nomearam a amoxicilina como o principal antibiótico para a profilaxia. Trinta e cinco voluntários não receberam informações dos médicos ou dentistas sobre a importância da saúde oral para prevenir a EI. A maior parte (60%) disse ter visitado.o dentista pela última vez há mais de 1 ano. Trinta e cinco porcento afirmou apresentar algum tipo de doença oral (gengivite, cárie, etc.). Dos voluntários pediátricos, foram isoladas 98 colônias, 51 do grupo 1 e 47 do grupo 2. A espécie mais isolada foi Streptococcus pneumoniae: 23,4% e 25,5% nos grupos 1 e 2, respectivamente. S. aureus corresponderam a 36,2% e 31,9% nos grupos 1e 2, respectivamente. Quatorze responsáveis (700/0) tinham conhecimento sobre a doença de suas crianças; entretanto, somente 15% sabia o significado de "endocardite infecciosa". Onze responsáveis (55%) sabiam sobre a antibioticoprofilaxia antes de algum procedimento dental, e 10 responsávies nomearam a amoxicilina como o principal antibiótico para a profilaxia. Dezesseis responsáveis (80%) não receberam informações dos médicos ou dentistas sobre a importância da saúde oral para prevenir a EI. A maioria (40%) disse que a criança visitou o dentista pela última vez há 6 meses. Concluímos que, de acordo com o perfil de resistência das cepas de estregtococos orais, a amoxicilina é o agente antimicrobiano de primeira escolha para a profilaxia da EI. É clara a necessidade ~ de oferecer informações sobre a EI para os pacientes afetados por doenças cardíacas ou para seus responsáveis / Abstract: The aim of this study was to verify the antimicrobial resistance of Staphy/ococcus aureus and viridans streptococci from 100 volunteers, 60 adults (16 to 75 yearsold), which were divided into three groups: healthy (Group 1), low risk (Group 2) and high risk (Group 3) for infective endocarditis (IE) and 40 children (6 to 14 years-old) which were divided into two groups: healthy (Group 1) and high risk (Group 2) for IE. In addition, volunteers were submitted to a structured formulary about IE risks and prophylaxis. Saliva samples were inoculated on Mitis Salivarius agar and incubated in microaerophilia during 48h. Skin samples were inoculated on Mannito/-Sa/t agar and incubated in aerobiosis during 24h. After biochemical tes~ viridans streptococci and S. aureus were identified and submitted to antimicrobial susceptibility tests agc;linst antimicrobial agents. Considering adults, Streptococcus mitis was the most common strain isolated among streptococci. 186 strains were isolated, being 58 from group 1, 62 from group 2 and 66 from group 3. The most resistant strain against penicillins (amoxicillin, ampicillin, methicillin and oxacillin) a was S. aureusisolated from groups 2 (57.9%) and 3 (80%). Consideringgroups 2 and 3: twenty-one volunteers (52.5%) were aware about their disease however, only 12.5% were aware of the meaning of "infective endocarditis". Seventeen volunteers (42.5%) knew about antibiotic prophylaxis before some dental procedures, and 10 volunteers named amoxicillin as the main antibiotic for prophylaxis. Thirty-five volunteers did not receive information from physicians or a , dentists about importance of ora'l health to prevent IE. The majori~ (60%) reported the last visit to the dentist more than 1 year ago. Thirty-five percent reported some kind of oral disease (gingivitis, caries, etc.). Considering children, 98 strains were isolated, being 51 from group 1 and 47 from group 2. . a Streptococcus pneumoniae was the most common streptococci isolated: 23.4% and 25.5% in groups 1 and 2, respectively. S. aureus corresponded to 36.2% and 31.9% in groups 1 and 2, respectively.' Fourteen guardians (70%) were aware about their child's disease; however, only 15% were aware of the meaning of ~ "'infective endocarditis". Eleven guardians (55%) knew about antibiotic prophylaxis before some dental procedures, and 10 volunteers named amoxicillin as the main antibiotic for prophylaxis. Sixteen guardians (80%) did not received information from physicians or dentists about importance of oral health to prevent IE. The most part (40%) reported the last visit to the dentist at least six months ago. We concluded that the resistant profile of the oral streptococci strains supports amoxicillin as the first choice antimicrobial agent for IE prophylaxis. There was a .: clear need for more information regarding IE among patients affected by cardiac disease or their guardians / Doutorado / Farmacologia, Anestesiologia e Terapeutica / Doutor em Odontologia

Infective endocarditis due to Bartonella bacilliformis is rare. A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias. A systolic murmur was heard on the tricuspid area upon examination, and an echocardiogram showed endocardial lesions in the right atrium. Bartonella bacilliformis was isolated in blood cultures, defining the diagnosis of infective endocarditis using Duke’s criteria. Subsequently, the patient developed clinical and laboratory features compatible with antineutrophil cytoplasmic antibody-associated vasculitis. This case presents an uncommon complication of B. bacilliformis infection associated with the development of systemic vasculitis.

Introduction: Advances in modern medicine have enabled early detection of infective diagnosis through blood cultures and echocardiography, which have been standardized by the widely accepted Modified Duke Criteria and have enabled rapid administration of antibiotics. As a consequence, the well-discussed and often variable clinical findings have become less common and have relegated to minor criteria in diagnosis. Fever is the single most common presenting symptom, whereas more specific signs such as petechiae may be seen in only 20-40% of patients. Even more rare are the pathognomonic Janeway lesions, Roth spots, and Osler nodes. Here we present a case in which early diagnosis was established through minor criteria manifest upon physical exam, and we highlight the timely insight provided from physical exam. Case: A 29-year-old man was admitted to the hospital for altered mental status, fever, vomiting, diarrhea, and vertigo. His past medical history included IV drug abuse, thrombotic thrombocytopenia, Hepatitis C, and seizures. Upon admission, his encephalopathy progressed rapidly, and he was mechanically ventilated and started on hemodialysis. Blood cultures grew Methicillin sensitive Staphylococcus aureus and Elizabethkingia meningosepticum and susceptibilities were attained. Echocardiography showed 3.1 cm vegetation on the aortic valve. By the Modified Duke Criteria, the diagnosis of infective endocarditis was confirmed. Discussion: The increasing incidence of complex infective endocarditis—including polymicrobial infection as well as the increasing resistance to antibiotic therapy—poses challenges to the rapid assessment and treatment necessary to mitigate the multi-organ involvement and the devastating consequences of septic emboli. Developments in medical technology have expedited both the diagnosis and treatment of infective endocarditis, which has subsequently decreased the extent and frequency of classical signs. Nonetheless, this case illustrates the unavoidable vitality of the physical exam, because this patient’s quick and clear presentation enabled diagnosis solely through physical exam. Empiric antibiotic treatment was started promptly and subsequently adjusted based on culture and susceptibilities.

El siguiente estudio fue de tipo descriptivo, transversal, se realizó con el objetivo de determinar el Nivel de conocimiento sobre Profilaxis Antibiótica de Endocarditis Infecciosa previa a procedimientos odontológicos en internos de odontología. La muestra fue estratificada, constituida de 117 internos de tres universidades de Lima que se encontraban finalizando su internado hospitalario correspondiente en el año 2013. Para determinar el nivel de conocimiento se realizó una revisión bibliográfica y se elaboró una encuesta/cuestionario que constaba de 20 preguntas cerradas que fue validado mediante juicio de expertos. El instrumento evaluó el nivel de conocimiento de cuatro secciones: Epidemiologia, etiopatogenia, indicación y farmacología de profilaxis antibiótica para prevenir EI en pacientes de riesgo previa a procedimientos odontológicos y los califico como bajo regular y alto, según la escala establecida. El 53,85% de los estudiantes participantes de la investigación tenían un nivel bajo de conocimientos sobre profilaxis antibiótica de endocarditis infecciosa previo a procedimientos odontológicos. En el nivel de conocimientos, regular, se distribuyó el 32.48% de la población y en el nivel de conocimientos, bueno, se encontró el 13,68% de la población. Las secciones donde los internos obtuvieron los mayores puntajes fueron epidemiologia de Endocarditis Infecciosa y farmacología de la profilaxis antibiótica de EI. En cambio las secciones de etiopatogenia de EI e indicación de profilaxis antibiótica fueron donde se obtuvieron los menores puntajes. Con el estudio se concluye que existe un déficit en el conocimiento sobre profilaxis antibiótica para prevenir EI en pacientes de riesgo previo a procedimientos odontológicos y que se deben de tomar medidas educativas para mejorar los aspectos que muestran necesidades de aprendizaje, debido a la importancia del rol que cumplen los odontólogos en la prevención de esta potencialmente mortal infección, en beneficio de la población que podrán serán atendido por los futuros odontólogos. / *** The following study was descriptive, cross-sectional, was conducted to determine the level of knowledge of Infective Endocarditis Antibiotic prophylaxis prior to dental procedures in dentistry inmates. The sample was stratified, consisting of 117 inmates from three universities in Lima who were ending their corresponding hospital internship in 2013. To determine the level of knowledge was conducted a literature review and a survey /questionnaire consisted of 20 closed questions was developed and was validated by expert judgment. The instrument assessed the level of knowledge of four sections: Epidemiology, pathogenesis, pharmacology and indications for antibiotic prophylaxis to prevent IE in patients at risk prior to dental procedures and qualify as under regular and high, according to the scale set. 53.85% of students research participants had a under level of knowledge on antibiotic prophylaxis of infective endocarditis prior dental procedures. At the level of knowledge, regular, was circulated on 32.48% of the population and the level of knowledge, high, found 13.68% of the population. The sections where the inmates obtained the highest scores were Infective Endocarditis epidemiology and pharmacology of antibiotic prophylaxis of IE. Instead sections pathogenesis of EI and indication for antibiotic prophylaxis were where lower scores were obtained. With the study concludes that there is a deficit in knowledge about antibiotic prophylaxis to prevent IE in patients at risk prior to dental procedures and should be taking steps to improve educational aspects that show learning needs, because of the importance of the role that dentists in preventing this potentially fatal infection, the benefit of the population that will be served by future dentists / Tesis

Embolic events from infective endocarditis can cause acute coronary syndrome. Mortality rate is high and optimal management might be different from those chosen in setting of classic atherosclerotic coronary artery disease. We present a case of 56-year-old male who had received 5 weeks of antibiotics for aortic valve endocarditis and developed acute ST segment elevation myocardial infarction in hospital settings. Interestingly, patient had recent left heart catheterization that was normal. This was recognized as embolic event from sterile vegetation. Patient was managed with balloon angioplasty and placement of intracoronary stent. Following re-vascularization, patient chest pain and electrocardiogram normalized and he improved in short term. However due to multiple comorbidities he had to be intubated and placed on dialysis.