Perioperative Management of Recurrent Fungal Tricuspid Endocarditis in a Young Patient Abusing Intravenous Drugs.
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ABSTRACT:
SUBMITTER: Mercier Laporte C
PROVIDER: S-EPMC6833124 | biostudies-literature | 2019 Oct
REPOSITORIES: biostudies-literature
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Perioperative Management of Recurrent Fungal Tricuspid Endocarditis in a Young Patient Abusing Intravenous Drugs.
Mercier Laporte Chantal C Schulte Thomas E TE Markin Nicholas W NW
CASE (Philadelphia, Pa.) 20190810 5
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Project description:Right-sided infective endocarditis in patients with intravenous drug abuse portends a worse prognosis. Data on optimal management strategy in this situation are scarce. We describe outcomes of 2 different treatment strategies, including a patient treated conservatively with favorable intermediate-term results and another who was treated surgically and developed recurrent endocarditis. (Level of Difficulty: Intermediate.).
| S-EPMC10039380 | biostudies-literature
Project description:BackgroundInfective endocarditis (IE) is increasing among persons who inject drugs (PWID) and has high morbidity and mortality. Recurrent IE in PWID is not well described.MethodsThis was a retrospective cohort study conducted between February 2007 and March 2016. It included adult inpatients (≥18) at any of 3 tertiary care centers in London, Ontario, with definite IE based on the Modified Duke's Criteria. The objectives were to characterize recurrent IE in PWID, identify risk factors for recurrent IE, identify the frequency of fungal endocarditis, and establish whether fungal infection was associated with higher mortality.ResultsThree hundred ninety patients had endocarditis, with 212/390 in PWID. Sixty-eight of 212 (32%) PWID had a second episode, with 28/212 (12%) having additional recurrences. Second-episode IE was more common in PWID (11/178 [6.2%] vs 68/212 [32.1%]; P < .001). Peripherally inserted central catheter (PICC) line abuse was associated with increased risk of recurrent endocarditis (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01-3.87; P = .04). In PWID, fungal IE was more common in second episodes than first episodes (1/212 [0.5%] vs 5/68 [7.4%]; P = .004). Additionally, fungal infections were associated with mortality in second-episode IE in PWID with an adjusted OR of 16.49 (95% CI, 1.12-243.17; P = .041). Despite recurrent infection, likely due to continued drug use, there was a low rate of referral to addiction treatment (14/68 [20.6%]).ConclusionsPWID have a high risk of recurrent endocarditis, particularly in patients who abuse PICC lines. Fungal endocarditis is more common in second-episode endocarditis and is associated with increased mortality. Consideration of empiric antifungal therapy in PWID with IE history and suspected IE should be considered.
| S-EPMC6796994 | biostudies-literature
Project description:Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU) with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD(4) count are associated with increased risk of death. This report presents a case of isolated tricuspid valve endocarditis with advanced HIV infection who was also an IVDU.
| S-EPMC3215441 | biostudies-other
Project description:BackgroundCandida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example.Case presentationWe report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge.ConclusionsFungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.
| S-EPMC7603709 | biostudies-literature
Project description:Fungal infective endocarditis (IE) is uncommon in postoperative cardiac surgical patients. The fungal IE accounts for 1.3'-6.8' of all IE cases and is considered the most severe form with a mortality rate as high as 45'-50'. There are various predisposing factors for fungal IE which include congenital heart defects, cardiac interventions like pacemaker insertion, degenerative valvular heart diseases, long-term use of broad-spectrum antimicrobial therapy, and long-term use of central venous. Mortality can reach up to 100' without specific treatment. Definitive therapy necessitates surgical debridement of vegetations/mass/abscess followed by long-term treatment with antifungal agents in patients who have symptoms of heart failure despite optimum medical management. We, hereby, report a case of fungal IE which occurred after the closure of a ventricular septal defect and was treated successfully with liposomal amphotericin B.
| S-EPMC8081123 | biostudies-literature
Project description:Fungal endocarditis (FE) accounts for ~50% of the mortality rate associated with predisposing host conditions. Despite optimal therapeutic strategies, the survival rate remains low. FE is mostly caused by Candida albicans and Aspergillus fumigatus. Previous valvular surgery is the most essential risk factor for Aspergillus endocarditis, which observed in 40-50% of cases. However, native valve FE caused by Aspergillus is uncommon, with only a few reported cases. We hereby report a case of native valve FE caused by A. fumigatus with complications following Wegener's disease and prostate cancer. The patient survived after successful management with the combination of surgical and medical therapy. Aspergillus endocarditis is a rare and fatal fungal infection. Despite difficulties in diagnosis and treatment, medical intervention with antifungal therapy and immediate surgical intervention are essential to achieve desirable outcomes.
| S-EPMC7104203 | biostudies-literature
Project description:Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure. In general, a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of >65 mm Hg are recommended. This article discusses the causes of increased blood pressure and the treatment methods for perioperative hypertension during the preoperative, intraoperative, and postoperative periods, in order to find ways to maintain normal blood pressure in patients during surgery. Further, in this paper, we review the causes of perioperative hypertension, such as anxiety, epinephrine, pain, and postoperative nausea and vomiting. The treatment methods for perioperative hypertension are analyzed according to the following 3 operative periods, with a review of the characteristics and interactions of each drug: preoperative antihypertensive medicine (atenolol, clonidine, and nifedipine), intraoperative intravenous (IV) hypnotics (propofol, midazolam, ketamine, and dexmedetomidine), and postoperative antiemetic medicine (metoclopramide and ondansetron). This article focuses on the knowledge necessary to safely apply local anesthesia with IV hypnotics during facelift surgery without the assistance of an anesthesiologist.
| S-EPMC5533066 | biostudies-other
Project description: Not available
| S-EPMC11544262 | biostudies-literature
Project description:Infective endocarditis is an infection of the heart valves or endocardium caused by bacterial, viral, or fungal microorganisms. Blood cultures are used to detect the bacteria causing infective endocarditis, and echocardiography is performed to find the damaged heart valves. In blood culture-negative endocarditis, no endocarditis-causing organisms can be found in blood cultures, and blood cultures using usual laboratory methods remain sterile after inoculation of at least three independent blood samples.Case presentationA 24-year-old male with a history of polysubstance abuse presented with complaints of fever, cough, and shortness of breath. He had a past history of pulmonary tuberculosis 4 years ago, for which he was treated with antitubercular therapy. High-resolution computed tomography of the chest revealed multiple cavitary lesions and consolidative areas in the bilateral lungs. Based on these findings, a provisional diagnosis of reactivation of pulmonary tuberculosis was considered, and antitubercular therapy was started. Due to his deteriorating condition, he was readmitted and evaluated. Bronchoalveolar lavage was done and sent for culture and sensitivity testing, which showed the presence of Staphylococcus aureus, and treatment was started accordingly. Despite continuing intravenous antibiotics for 5 days, the patient was not improving. Three sets of samples were withdrawn for blood culture and sensitivity testing, which came out to be negative. Transthoracic echocardiography was done, which revealed vegetation in the tricuspid valve. The patient was diagnosed with culture-negative tricuspid valve endocarditis based on the clinical criteria.DiscussionBlood culture-negative endocarditis is difficult to diagnose and presents challenges. When faced with a diagnosis like culture-negative endocarditis in the context of a condition that can appear very similar, like tuberculosis, a broad differential diagnostic approach is important.ConclusionIntravenous drug use is the main cause of right-sided valvular infective endocarditis. Endocarditis should be considered in intravenous drug users even in the absence of positive blood cultures. An appropriate antibiotic regimen and long-term follow-up with a multidisciplinary team are necessary for a good outcome.
| S-EPMC10010812 | biostudies-literature
Project description:Pediatric endocarditis, a rare entity in developed countries, remains a challenging diagnosis to make in children. We present an uncommon etiology of shortness of breath on exertion (SOBOE) in a 7-year-old male presenting with two weeks of nocturnal fever, malaise and fatigue following a viral prodrome. Point of care ultrasound (POCUS) led to suspicion for a ventricular septal defect (VSD) with tricuspid valve (TV) endocarditis, which was ultimately confirmed by formal echocardiography. This ultrasound diagnosis allowed emergency clinicians to order blood cultures under the suspicion of endocarditis as well as expedited antibiotic treatment.
| S-EPMC9979955 | biostudies-literature