Bartonella henselae bacilli in cardiac valve of a patient with blood culture-negative endocarditis. The bacilli appear as black granulations.
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Infective endocarditis

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves. more...

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Endocarditis can be classified by etiology as either infective or non-infective, depending on whether a foreign micro-organism is causing the problem.

Infective endocarditis

As the valves of the heart do not actually receive any blood supply of their own, which may be surprising given their location, defense mechanisms (such as white blood cells) cannot enter. So if an organism (such as bacteria) establish hold on the valves, the body cannot get rid of them.

Normally, blood flows pretty smoothly through these valves. If they have been damaged (for instance in rheumatic fever) bacteria have a chance to take hold.

Read more at Wikipedia.org


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Pulmonary Manifestations Of Infective Endocarditis - Abstract
From CHEST, 10/1/00 by Alex A Demin

Alex A Demin, Prof(*) and Vera P Drobysheva, MD. Internal Medicine, Medical Academy, Novosibirsk, Russia.

PURPOSE: Pulmonary manifestations (PM) and pulmonary oncet (PO) of infective endocarditis (IE) may resemble variety of diseases and result from systemic effects of infection, metastatic foci and emboli. The aim of the study was to determine the incidence of PM and PO in the clinical course of IE and their significance for diagnostics of disease.

METHODS: The analysis of the clinical course of 230 patients (pts) with IE was made. Diagnosis of IE was based on Duke criteria and pts were followed up at Novosibirsk IE-centre (1979-99).

RESULTS: PM was revealed in 18%, PO - in 11% of IE pts. The pulmonary symptoms included chest pain (52%), dyspnea (32%), cough (22%), hemoptysis (9%). PO of IE leaded to diagnostic mistakes in 11% of pts. Early clinical symptoms in PO of IE were fever (100%), chest pain (73%), cough (50%), dyspnoe (46%). High percentage of PM (43%) and PO (50%) of IE were revealed in patients with combined congenital heart disease. Pulmonary involvement and PO of the disease were associated with isolated tricuspid valve endocarditis in 5% and 8%, and with left-side endocarditis in 43% and 34%, acc.; in case of mitral valve affection - in 26% and 26%; and in case of aortic valve affection - in 17% and 8%, acc. Echo valvular vegetations, 10-20 mm, were revealed by transesophageal echocardiography in 59,5% of pts with PM and in 61,5% of pts with PO of the disease. The leading causative organism of IE with PM and PO were staphylococci in 73,4% and 66,6%, acc. Pulmonary emboli or pneumonia were common in intravenous drug abusers.

CONCLUSION: The incidence of PM in the clinical course of IE was rather high especially in patients with combined congenital heart disease.

CLINICAL IMPLICATIONS: The knowledge PO of disease is of important for timely diagnostics and treatment of modern IE.

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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