Limitations Of This Study
The limitations of the study include, first, its retrospective nature. All patient information was obtained by reviewing the medical records and the quality of the data was not high. Second, the renal insufficiency group comprised only 56 patients and patients in both groups may have had important differences that are not comparable. Third, we did not have any long-term follow-up data on the patients. The long-term prognosis of the patients with renal dysfunction was unclear. Fourth, the positive rate of our microbial culture was low because some diagnosed patients had a history of antibiotic use at admission. The diagnosis of patients whose microbial culture was negative was made according to the modified Duke criteria when combinations of clinical criteria were met. Despite these limitations, this multicenter large-scale study, for the first time, illustrated the relationship between IE and renal dysfunction and its etiology in China.
Ie In Hd Patients In Western Mexico
Our group works at a reference center, in the Mexican Institute of Social Security and takes care of all cardiothoracic surgical patients in the west of Mexico that are affiliated to IMSS. This means that more than 10 states represent more than 8.5 million affiliated people and possible patients. There are other hospitals in western Mexico that deal with endocarditis patients, but a patient who has surgical indication or who is seriously ill is sent to our center.
We retrospectively analyzed the last 5 year cases of IE in our center. There were 173 cases of which 77 were surgically treated. In these 77 patients, 33 patient where in HD. We used the IE in general population guidelines for the decision of medical or surgical treatment in all our patients.
Figure 1.
Affected valves in HD patients .
Differences Between Case Series Of Ie In Esrd Patients
The following tables summarizes some of the most representative contemporary case series of IE in ESRD patients published in the last decade. The percentage of HD patients with IE who are undergoing cardiac surgery ranges from 7.8 to 53% in different regions of the world and also the associated pathologies are listed in Table 1. S. aureus is the microorganism most frequently involved in all series . The valves involve with IE in previous studies involved most frequently the left side valves . There are significant differences in the percentage of ESRD patients with AVFs in different regions, the highest being in Europe . And morbidity and mortality also differ between regions .
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Our Team At University Of Utah Health
University of Utah Health has a full-service team thats here for you from diagnosis to treatment. Our endocarditis health care experts include representatives from internal medicine, infectious disease, cardiovascular medicine, cardiothoracic surgery, behavioral health and addiction medicine, nursing and care management.;
What Are The Kidney Failure Stages Of Death
Our kidneys work day and night to filter our blood and get rid of all the toxic waste products in the form of urine. A lot of our body functions depend upon normal functioning of kidneys and the entire renal system.
Kidney failure is a serious clinical condition in which the kidneys fail to excrete metabolic end-products from the body. In this condition, the kidneys also fail to maintain fluid, electrolyte and pH balance of the blood.
Whenever a person is diagnosed with renal failure, the first question that comes into his/ her mind is that is it curable? And secondly, what are the stages of kidney failure causing death?
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Can Mrsa Affect Your Kidney
Yes, definitely MRSA can affect your kidney. For affecting any organ the infection has to be present in the blood. Similarly, when an organism is present in the bloodstream and it can easily invade any organ. Consequently, the kidneys can be easily involved in MRSA. Kidneys are usually affected by two mechanisms-
- Deposition of antigen-antibody complex which leads to an immunological mechanism. Preformed antigen and antibody complex within the bloodstream gets deposited on the endothelium lining of glomerulus which initiates an immunological reaction. Thus, damage to endothelium takes place. The patient usually presents with proteinuria and in severe cases hematuria.
- Another mechanism by which renal damage takes place is through the direct invasion of the organism. Organism invades the endothelium and acts as an antigen against which an immune response is generated.
The best way of diagnosing antigen-antibody complex on endothelium is by immune fluorescence through electron microscopy.
At times methicillin-resistant Staphylococcus aureus infection can cause multisystem dysfunction ranging from infective endocarditis affecting heart valves to chronic kidney disease which eventually leads to renal failure.
Diagnosis Of Infective Endocarditis
Sometimes bacteria cannot be cultured from blood samples. Special techniques may be needed to grow the particular bacteria, or the person may have taken antibiotics that did not cure the infection but did reduce the number of bacteria enough to be undetectable. Another possible explanation is that the person does not have endocarditis but has a disorder, such as a heart tumor Overview of Heart Tumors A tumor is any type of abnormal growth, whether cancerous or noncancerous . Tumors in the heart may be Primary Metastatic Primary… read more , that causes symptoms very similar to those of endocarditis.
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Study Design And Data Analysis
The preoperative endogenous creatinine clearance rate of the included cases was calculated based on the Cockcroft-Gault equation . A total of 401 IE patients were divided into two groups: a renal insufficiency group and a normal renal function group . The demographic data, results of laboratory tests at admission , preoperative complications and medications, and results of pathogen detection were analyzed and compared between the two groups. Outcome indexes including surgical data and prognosis were propensity score-matched and compared to adjust for baseline differences between the two groups. One patient underwent renal biopsy and pathological examination.
What Are The Renal Symptoms Of Infective Endocarditis
The deposition of circulating immune complexes in the kidney may produce interstitial nephritis or proliferative glomerulonephritis, with renal failure progressing to the point of uremia at the time of the patients presentation. Similarly, various musculoskeletal symptoms arise from immunologically mediated synovitis.
Osler nodes and Roth spots arise from immune-mediated vasculitis. Patients may experience palpitations, ie, the symptoms of an immune-mediated myocarditis.
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References And Recommended Reading
Lowance M: Subacute bacterial endocarditis, Streptococcus viridans, with mesenteric thrombosis and recovery. Ann Intern Med 1946, 24:485487.
Dawson M: The treatment of subacute bacterial endocarditis with penicillin; second report. Ann Intern Med 1946, 46:170185.
Cataldo R: Acute bacterial endocarditis; a case report with recovery after treatment with penicillin. Ann Intern Med 1946, 24:479484.
Cabell CH, Jollis JG, Peterson GE, et al.: Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002, 162:9094. Excellent demonstration of the changing type of patients and organisms currently causing endocarditis in a large medical center.
Maraj S, Jacobs LE, Shiang-Cheng K, et al.: Epidemiology and outcome of infective endocarditis in hemodialysis patients. Am J Med Sci 2002, 324:254260. Very recent review of endocarditis in hemodialysis patients in the modern era.
McCarthy JT, Steckelberg JM: Infective endocarditis in patients receiving long-term hemodialysis. Mayo Clin Proc 2000, 75:10081014.
Robinson DL, Fowler VG, Sexton DJ, et al.: Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis 1997, 30:521524.
Herzog CA, Ma JZ, Collins AJ: Long-term survival of dialysis patients in the United States with bacterial endocarditis. . J Am Soc Nephrol 2002, 13:439A.
Role Of Surgery In The Prognosis Of Infective Endocarditis
Infective endocarditis is one of the deadly diseases associated with an in-hospital mortality rate of 1030%. Among them, 50% required cardiac surgery in their acute phase. The two main objectives of heart surgery in such patients mainly involve complete removal of the infected tissue and renewal of cardiac morphology, including repair or replacement of the affected valves. During the operation, different types of valves such as a biological valve, mechanical valve, autograft and homograft may be used as required.
According to The 2014 American College of Cardiology/American Heart Association guidelines, a biological valve is recommended in patients of 65 years age or older, while a mechanical valve is appropriate for patients under 65 years of age, but there are no specific guidelines or recommendations for surgery of infective endocarditis.
It has been suggested that mechanical valves provide a considerably better prognosis in infective endocarditis patients. Moreover, there were considerable differences in the clinical features of patients with biological valve compared to patients receiving a mechanical valve. A study suggested that any mortality risk of the biological valve group patients was significantly higher than that of the mechanical valve group patients.
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What Is Bacterial Endocarditis
Infective endocarditis occurs when germs enter the blood stream and attach to and attack the lining of the heart valves. Infective endocarditis causes growths on the valves, produces toxins and enzymes which kill and break down the tissue to cause holes on the valve, and spreads outside the heart and the blood vessels. The resulting complications are embolism of material from the vegetations, leaky valve, heart block and abscesses around the valve. Without treatment, endocarditis is a fatal disease.
Normally, bacteria can be found in the mouth, on the skin, in the intestines, respiratory system, and in the urinary tract. Some of these bacteria may be able to get into the bloodstream when eating, during teeth brushing and when passing stools and cause endocarditis. Normal heart valves are very resistant to infection, but diseased valves have defects on the surface where bacteria may attach. Valve prosthesis are more prone to infection than normal valves. The bacteria rapidly form colonies, grow vegetations and produce enzymes, destroying the surrounding tissue and opening the path for invasion.
Dental procedures and endoscopic examinations are associated with bacteria in the blood, so prophylactic antibiotics are advised for some patients with valve disease and all patients with valve replacements. Intravenous drug abusers are at high risk for developing IE.
Infectious Endocarditis And Kidney Damage
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In the pathogenesis of infective endocarditis, an important role is played by 3 factors: the state of the organism, the circumstances leading to transient bacteremia, and the features of the pathogen .
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What Are The Complications Developed Because Of Endocarditis
Complications could develop because of damage caused by the infection. These could be clinically manifested as abnormal heart rhythm, development of jaundice due to high levels of bilirubin in the blood, or formation of blood clots that may spread to other parts of the body through the blood stream to cause obstruction. The original bacteria can also travel to other internal organs such as your brain, lungs, or kidneys to cause injury. This could lead to seizures, kidney damage, paralysis etc. In severe cases, endocarditis can lead to a stroke and eventual heart failure.
Central Nervous System Complications
These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli , break away and lodge in the brain.
There, they can cause local infections or a more widespread brain infection .
Emboli also can cause a stroke or seizures. This happens if they block blood vessels or affect the brain’s electrical signals. These complications can cause long-lasting damage to the brain and may even be fatal.
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Causes Of Infective Endocarditis
Bacteria that are introduced into the bloodstream can sometimes lodge on heart valves and infect the endocardium. Abnormal, damaged, or replacement valves are more susceptible to infection than normal valves. The bacteria that cause subacute bacterial endocarditis nearly always infect abnormal, damaged, or replacement valves. However, normal valves can be infected by some aggressive bacteria, especially if many bacteria are present.
, a severe blood infection, introduces a large number of bacteria into the bloodstream. When the number of bacteria in the bloodstream is large enough, endocarditis can develop, even in people who have normal heart valves.
If the cause of infective endocarditis is injection of illicit drugs or prolonged use of intravenous lines , the tricuspid valve is most often infected. In most other cases of endocarditis, the mitral valve or the aortic valve is infected.
Prognosis Of Infective Endocarditis
If untreated, infective endocarditis is always fatal. When treatment is given, the risk of death depends on factors such as the person’s age, duration of the infection, the presence of a replacement heart valve, the type of infecting organism, and the amount of damage done to the heart valves. Nonetheless, with aggressive antibiotic treatment, most people survive.
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Can Valvular Surgery Decrease Mortality Rates In Endocarditis Patients
According to an investigation published in the November 23/30 issue of JAMA, it has been suggested that approximately two-thirds of patients with heart failure and infective endocarditis require valvular surgery, which has been associated with a substantial reduction in the risk of mortality in hospital and one year after the surgery.
Some prior studies have suggested that the risk of mortality due to infective endocarditis and heart failure can be decreased with the help of valvular surgery. The procedure has been strongly recommended by the American College of Cardiology/American Heart Association and European Society of Cardiology.
Researchers have found that patients who have undergone a valvular surgery had a very low mortality rate as compared to patients who had received medical treatment only. Mortality rate of patients with valvular surgery was found to be 20.6 percent and mortality rate was found to be 44.8 percent in patients who were on medical treatment only. Furthermore, the researchers observed that valvular surgery patients had a one-year mortality rate of 29.1% compared to 58.4% in patients with only medical therapy.
Currently, Saima Andrabi is working at Maxinov Solutions Private LTD as a research associate and is associated with DiseaseFix as a medical content writer.
How Is Bacterial Endocarditis Treated
Once endocarditis occurs, quick treatment is necessary to prevent damage to the heart valves and more serious complications, such as death. As soon as the blood cultures have been secured the patient is started on intravenous antibiotic therapy , covering as many as possible of suspected bacterial species. The antibiotics are adjusted to the sensitivity of the organism that grows from the blood culture as soon as that is available. IV antibiotics is usually given for as long as 6 weeks to cure of the infection. Symptoms are monitored throughout therapy and blood cultures are repeated to determine the effectiveness of treatment.
If heart valve and heart damage has occurred, surgery may be required to fix the heart valve and improve heart function.
After treatment is completed, the patient should be worked up for sources of bacteremia and these should be treated. In the future, the patient should take antibiotics prophylactically according to guidelines .
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Cleveland Clinic Heart Vascular & Thoracic Institute Cardiologists And Surgeons
The Endocarditis Center provides comprehensive care to treat acute episodes of endocarditis; manage endocarditis non-responsive to medical therapies; and long term care to prevent endocarditis from occurring in the future. The Endocarditis Center is a specialized center involving a multi-disciplinary group of specialists including cardiologists, cardiac surgeons, infectious disease specialists, neurologists and behavior health specialists, with expertise in treating endocarditis.
Call Cardiology Appointments at toll-free 800.223.2273, extension 4-6697 or request an appointment online.
What Are The Common Causes Of Endocarditis
This condition usually develops because of bacterial, viral or fungal infection. Bacterial endocarditis is the most common form of the condition.
Typically, these disease-causing pathogens enter the body through our orifices like nose, mouth or ear and latch on to the damaged sections of the heart.
In most cases, the immune system should be able to kill these pathogens. However, there are conditions where the immune system becomes compromised and so these pathogens enter the heart through the blood stream and cause infection/inflammation in the heart valves.
In addition, the heart valves are not directly supplied with blood. Therefore, white blood cells cannot reach the valves via the bloodstream. Hence, when an infection develops in the heart valves, it is difficult for both our immune system and external medications who delivery depends on bloodstream to fight off the infection. The most common clinical symptoms seen are high fever with chills, an increased heart rate, muscle pain, swelling in the legs and a persistent cough.
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What Are The Symptoms Of Endocarditis
The symptoms of endocarditis arent always severe, and they may develop slowly over time. In the early stages of endocarditis, the symptoms are similar to many other illnesses. This is why many cases go undiagnosed.
Many of the symptoms are similar to cases of the flu or other infections, such as pneumonia. However, some people experience severe symptoms that appear suddenly. These symptoms may be due to inflammation or the associated damage it causes.
Common symptoms of endocarditis include:
- heart murmur, which is an abnormal heart sound of turbulent blood flow through the heart
- pale skin
- an enlarged spleen, which may be tender to touch
Changes in the skin may also occur, including:
- tender red or purple spots below the skin of fingers or toes
- tiny red or purple spots from blood cells that leaked out of ruptured capillary vessels, which usually appear on the whites of the eyes, inside the cheeks, on the roof of the mouth, or on the chest
The signs and symptoms of infectious endocarditis vary greatly from person to person. They can change over time, and they depend on the cause of your infection, heart health, and how long the infection has been present. If you have a history of heart problems, heart surgery, or prior endocarditis, you should contact your doctor immediately if you have any of these symptoms. Its especially important to contact your doctor if you have a constant fever that will not break or youre unusually tired and dont know why.