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Infective endocarditis in intravenous drug users

Karen Magsino, Rohan Sanjanwala, Brett Hiebert, Janet Rothney, Rizwan Manji, Rakesh Arora, Pallav Shah
BACKGROUND:  The increasing prevalence of intravenous drug users (IVDU) has resulted in higher incidence of right-sided infective endocarditis (RSIE). However, treatment guidelines for RSIE in IVDU are not well defined. The aim is to evaluate efficacy of different treatment strategies in reducing mortality and to describe treatment outcomes. METHODS:  We systematically reviewed the literature using PubMed, Cochrane, CENTRAL, OvidEMBASE, Web of Science, and Medline databases to include prospective studies that compare mortality rates among IVDU with RSIE receiving isolated medical treatment versus those receiving medical-surgical treatment...
January 19, 2018: Thoracic and Cardiovascular Surgeon
Hilmir Asgeirsson, Anders Thalme, Ola Weiland
PURPOSE: To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome.  Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS: The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures...
March 2018: Infectious Diseases
Naomi Hauser, Elizabeth Tanner, Michael Keuroghlian, Lalitha Koduri
Non-HACEK Gram-negative bacilli account for only a small percentage of infective endocarditis cases globally. Among those, Klebsiella species account for only about 10% of cases and are most often health-care acquired. We present a rare case of Klebsiella oxytoca endocarditis in a young intravenous drug user.
2017: IDCases
Aaron T Fleischauer, Laura Ruhl, Sarah Rhea, Erin Barnes
Opioid dependence and overdose have increased to epidemic levels in the United States. The 2014 National Survey on Drug Use and Health estimated that 4.3 million persons were nonmedical users of prescription pain relievers (1). These users are 40 times more likely than the general population to use heroin or other injection drugs (2). Furthermore, CDC estimated a near quadrupling of heroin-related overdose deaths during 2002-2014 (3). Although overdose contributes most to drug-associated mortality, infectious complications of intravenous drug use constitute a major cause of morbidity leading to hospitalization (4)...
June 9, 2017: MMWR. Morbidity and Mortality Weekly Report
Teresa Backes
INTRODUCTION: Intravenous drug users have a substantially increased risk of infective endocarditis, especially in the setting of implanted cardiac devices. Purulent pericarditis is a rare occurrence that can occur iatrogenically or through direct or hematogenous spread. CASE DESCRIPTION: A 75 year old man with a past medical history significant for hepatitis C, IV drug abuse, and sick sinus syndrome status post pacemaker was brought in by EMS with a chief complaint of diaphoresis and chest pain...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
S Soudet, C Becquart, F Dezoteux, K Faure, D Staumont-Salle, E Delaporte
BACKGROUND: Bacillus cereus is a ubiquitous telluric organism. B. cereus endocarditis is a rare condition seen mostly in prosthetic heart valves and among intravenous drug users. We report a new case of a patient without risk factors and with a good clinical outcome not requiring valve replacement. CASE REPORT: In October 2014, a 50-year-old woman was referred to the dermatology department of Lille University Hospital for lower-limb wounds developing 6 months earlier...
January 2017: Annales de Dermatologie et de Vénéréologie
Waldemar Elikowski, Małgorzata Małek-Elikowska, Monika Lisiceka, Dariusz Wróblewski, Natalia Fertała
Infective endocarditis of the tricuspid valve (TVE) occurs predominantly in selected groups of patients including intravenous drug users (IVDUs). The most often cultured pathogen in IVDUs is Staphylococcus aureus. Eikenella corrodens, normally existing as a commensal in the mouth and the upper respiratory tract, is identified as an etiologic pathogen of endocarditis very rarely. The authors describe a case of a 27-year-old male with a past history of staphylococcal TVE readmitted to hospital after 5 months due to progression of right-sided heart failure...
February 20, 2017: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Claudia R Libertin, Ulas M Camsari, Walter C Hellinger, Terry D Schneekloth, Teresa A Rummans
We report a case of an intravenous drug user (IVDU) patient who had 4 episodes of endocarditis within a 2-year time period in rural Georgia. The institutional cost was approximately $380,000. The lack of an established transitional care plan for IVDUs to outpatient care is a common phenomenon at institutions. Guidelines are essential to optimize the quality of care rendered to IVDUs with such infections, to assist providers in utilizing limited resources, and to limit the cost to the institutions.
2017: IDCases
Hilmir Asgeirsson, Anders Thalme, Ola Weiland
Staphylococcus aureus is a leading cause of infective endocarditis in people who inject drugs (PWID). The management of S aureus endocarditis (SAE) in PWID can be problematic. The objective of this retrospective observational study was to assess the epidemiology, clinical characteristics, and mortality of S aureus endocarditis (SAE) in PWID in Stockholm, Sweden.The Department of Infectious Diseases at the Karolinska University Hospital serves as a regional referral center for drug users with severe infections...
December 2016: Medicine (Baltimore)
Varun K Phadke, Jesse T Jacob
A 46-year-old man with HIV infection and active intravenous drug use presented with approximately two weeks of fevers and body aches. On physical examination he was somnolent, had a new systolic murmur, bilateral conjunctival hemorrhages, diffuse petechiae, and left-sided arm weakness. Echocardiography revealed a large mitral valve vegetation and brain imaging demonstrated numerous embolic infarctions. Blood cultures grew Serratia marcescens. Despite aggressive treatment with meropenem the patient died due to intracranial hemorrhage complicated by herniation...
May 2016: Infectious Diseases in Clinical Practice: IDCP
Eleanor A Powell, Sanam Razeghi, Stephen Zucker, Jason T Blackard
INTRODUCTION: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV...
February 2016: Hepatitis Monthly
Joon Bum Kim, Julius I Ejiofor, Maroun Yammine, Masahiko Ando, Janice M Camuso, Ilan Youngster, Sandra B Nelson, Arthur Y Kim, Serguei I Melnitchouk, James D Rawn, Thomas E MacGillivray, Lawrence H Cohn, John G Byrne, Thoralf M Sundt
BACKGROUND: With increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals. METHODS: We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Leila Abid, Salma Charfeddine, Samir Kammoun
Group B streptococcal (GBS) tricuspid infective endocarditis is a very rare clinical entity. It affects intravenous drug users, pregnant, postpartum women, and the elderly. We report the case of a 68-year-old patient without known predisposing factors who presented a GBS tricuspid endocarditis treated by penicillin and aminoglycosides with no response. The patient was operated with a good evolution. Our case is the 25th reported in the literature. GBS disease is increasing in the elderly and is mainly associated to comorbid conditions...
April 2016: Journal of the Saudi Heart Association
Ashref Mohamed, Connor Hall, Michael Hatch, Mohamed Ayan, Richard Winn
Infective endocarditis caused by Klebsiella species is rare, with most isolates being K. pneumoniae. We report the case of a 24-year-old intravenous drug user with newly diagnosed seminoma who developed K. oxytoca endocarditis. In addition to having K. oxytoca isolated from blood culture, cultures of that species were obtained from a retroperitoneal metastasis found on original presentation.
April 2016: Proceedings of the Baylor University Medical Center
Ohide Otome, Stephen Guy, Adrian Tramontana, Garry Lane, Harin Karunajeewa
BACKGROUND: Previously described prognostic markers in right-sided infective endocarditis (RSIE) include vegetation size ≥1cm, fever for more than three weeks, cardiac failure and severe sepsis. This study aimed to evaluate effectiveness of medical therapy for vegetations ≥1cm and explore determinants of outcome in a representative population of intravenous drug users (IDUs) at a metropolitan Australian health service. METHODS: Retrospective review of consecutive IDUs presenting to our institution with native-valve RSIE (by modified Duke criteria) over seven years (2005-2011)...
May 2016: Heart, Lung & Circulation
E Seminari, A De Silvestri, V Ravasio, S Ludovisi, R Utili, N Petrosillo, F Castelli, M Bassetti, F Barbaro, P Grossi, N Barzaghi, M Rizzi, L Minoli
Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17...
February 2016: European Journal of Clinical Microbiology & Infectious Diseases
Nabha Shetty, Dave Nagpal, Sharon Koivu, Marko Mrkobrada
BACKGROUND: Tricuspid valve (TV) infective endocarditis (IE) is a known complication of intravenous drug use (IVDU). This study assessed long-term outcomes of surgically and medically treated cases of TV IE. METHODS: This was a retrospective cohort study of all cases of native TV IE treated in London, Ontario between 2008 and 2011. Outcomes for medically and surgically managed cases were assessed at two years. Outcomes related to the timing of surgery were also assessed...
February 2016: Journal of Cardiac Surgery
Rohan Goel, Baskar Sekar, Mark N Payne
Infective endocarditis (IE) is a life-threatening condition with adverse consequences and increased mortality, despite improvements in treatment options. Diagnosed patients usually require a prolonged course of antibiotics, with up to 40-50% requiring surgery during initial hospital admission. We report a case of a 42-year-old intravenous drug user who presented feeling generally unwell, with lethargy, rigours, confusion and a painful swollen right leg. He was subsequently diagnosed with Proteus mirabilis endocarditis (fulfilling modified Duke criteria for possible IE) and deep vein thrombosis (DVT)...
November 26, 2015: BMJ Case Reports
Antonio Davide Scardigno, Giovanni Deluca, Domenico Riccardo Rosario Chieppa, Veronica Carbonara
We report a case of isolated pulmonary valve endocarditis evaluated with real-time three-dimensional echocardiography in a previous intravenous drug user. Although right-sided infective endocarditis is common in this population, the involvement of the pulmonary valve without infection of the tricuspid valve is a rare condition.
November 2015: Giornale Italiano di Cardiologia
Karolina Mėlinytė, Jurgita Savickaitė, Daiva Emilija Rekienė, Albinas Naudžiūnas, Aušra Burkauskienė, Laima Jankauskienė
Infective endocarditis is a common complication among injecting drug users. Disease risk among these patients is increased by the spread of HIV infection. In the following article, we discuss the exceptional clinical presentation of a 28-year-old patient who used intravenous drugs (heroin) for 10 years, had been infected with HIV for seven years and as a complication had developed Staphylococcus aureus infective endocarditis. The patient came to the hospital in serious condition, complaining of bodily pain, swelling of the legs and general weakness...
October 2015: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
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