Search

Bartonellae are vector-borne gram-negative, aerobic, intracellular bacteria with a tropism for erythrocytes and endothelial cells (1). These bacteria, many of which are zoonotic, infect a wide range of domestic and [...]

Streptococcus suis, an emerging zoonotic pathogen, causes invasive infections in persons who are in close contact with infected pigs or contaminated pork-derived products (1). On the basis of capsular polysaccharides, [...]

The immune mechanisms that provoke concomitant inflammation of synovial joints and cardiac valves in disorders such as rheumatic fever and systemic lupus erythematosus remain poorly defined. Here, we report the discovery of spontaneous endocarditis--in addition to their well-studied autoimmune arthritis--in K/BxN T cell receptor (TCR) transgenic mice. The same adaptive immune system elements were required for initiation of arthritis and endocarditis, and both diseases were dependent on autoantibodies. In contrast, the participation of key innate immune system molecules and perhaps T cells as effectors of inflammation differed between the 2 target tissues. Arthritis in K/BxN TCR transgenic mice depended primarily on complement C5 and not FcR[gamma]-using receptors; conversely, endocarditis depended essentially on FcR[gamma] receptors and not C5. Elucidating how a single systemic autoimmune disease engages distinct immune effector pathways to damage different target tissues is essential for optimizing the treatment of such disorders. autoimmunity | complement | Fc receptor | rheumatic | lupus

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.02.009 Byline: Pilar Martin-Davila (a), Enrique Navas (a), Jesus Fortun (a), Jose Luis Moya (b), Javier Cobo (a), Vicente Pintado (a), Carmen Quereda (a), Manuel Jimenez-Mena (b), Santiago Moreno (a) Abstract: Native valve endocarditis in drug-user patients had a microbiology, a frequency of involvement of different cardiac valves, and a prognosis that differ from those in non-drug users. A retrospective study of native valve endocarditis cases in intravenous drug users diagnosed from 1985 to 1999 in our institution was performed to analyze the inhospital mortality of drug users with native valve endocarditis and to identify factors predictive of mortality. Author Affiliation: (a) Department of Infectious Diseases, Hospital Ramon y Cajal, Madrid, Spain (b) Department of Cardiology, Hospital Ramon y Cajal, Madrid, Spain Article History: Received 23 June 2004; Accepted 7 February 2005

We tested hypotheses that social living arrangement and drug use in one's network are independently associated with entry into opiate agonist treatment modalities. Injection drug users (IDUs) attending the Baltimore Needle Exchange Program who received a referral for drug abuse treatment were studied. Baseline interviews, HIV testing, and the Addiction Severity Index (ASI) were administered. Agency records were used to confirm entry into a treatment program offering opiate agonist maintenance therapy within 30 days of the baseline interview. Logistic regression was used to identify predictors of treatment entry. To date, of 245 IDUs, 39% entered such a program. Multivariate logistic regression models controlling for age and intervention status revealed that compared to individuals who lived alone, in a controlled, or nonstable environment (e.g., streets, abandoned house, transitional housing program, or boarding house), individuals who lived with a sexual partner were 3 times more likely to enter treatment (adjusted Odds Ratio [aOR]=3.04: p=0.013) and those who lived with family or friends were almost 3 times more likely to enter treatment (aOR=2.72; p=0.016). In the bivariate analyses, a marginal association was observed between being responsible for children or others and entry into treatment (p=0.066); however, this association was not significant in the multivariate model. Findings from this study suggest that supportive living environments may facilitate entry into treatment and may be helpful in devising appropriate and targeted interventions to encourage drug treatment entry. Keywords: Social network, living arrangement, treatment, injection drug users, INTRODUCTION Injection drug users (IDUs) represent the second largest risk group for HIV infection in the United States, accounting for approximately one-third of AIDS cases in the U.S. (1, 2). [...]

Enterococcus faecalis, a common cause of endocarditis and known for its capacity to transfer antibiotic resistance to other pathogens, has recently emerged as an important, multidrug-resistant nosocomial pathogen. However, knowledge of its lineages and the potential of particular clones of this species to disseminate and cause disease is limited. Using a nine-gene multilocus sequence typing (MLST) scheme, we identified an evolving and widespread clonal complex of E. faecalis that has caused outbreaks and life-threatening infections. Moreover, this unusual clonal complex was found to contain isolates of unexpected relatedness, including the first known U.S. vancomycin-resistant enterococcus (E. faecalis strain V583), the first known penicillinase-producing ([Bla.sup.+]) E. faecalis isolate, and the previously described widespread clone of penicillinase producers, a trait found in

Regional variation in patients with Staphylococcus aureus infective endocarditis (IE) is evaluated and the characteristics of IE caused by Staphylococcus aureus are documented. The findings suggest the need to reduce the number of health care associated infections through improved compliance with infection control procedures and the need for new interventions and preventive strategies.

Byline: D. J. Anderson (2), D. R. Murdoch (3), D. J. Sexton (1), L. B. Reller (1,3), J. E. Stout (1), C. H. Cabell (4), G. R. Corey (1) Abstract: Abstract. Background: Based on previous studies, enterococcal infective endocarditis (IE) is considered a unimicrobial, community-acquired disease of older Caucasian men. Patients and Methods: We evaluated the relationship between enterococcal bacteremia and IE by comparing clinical and demographic characteristics of all cases of enterococcal IE within an 8-year period (n = 41) with controls randomly chosen from patients with enterococcal bacteremia without IE. Results: By univariate and multivariable analyses, the presence of a prosthetic valve (PV) and infection with Enterococcus faecalis were significantly associated with IE, while age, gender, race, polymicrobial infection and community-acquired infection were not. Almost an equal number of women and men had enterococcal IE. Cases of enterococcal IE were commonly nosocomial (39%) and polymicrobial (17%). Conclusions: Enterococcal endocarditis can no longer be considered exclusively a unimicrobial, community-acquired disease of Caucasian men. Instead, our data suggest that the presence of a PV and infection by E. faecalis are associated with an increased risk for IE. Author Affiliation: (1) Division of Infectious Diseases, Dept. of Medicine, Duke University Medical Center, 3605, Durham, NC, 27710, USA (2) Dept. of Medicine, Duke University Medical Center, Durham, North Carolina, USA (3) Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina, USA (4) Division of Cardiology, Dept. of Medicine, Duke University Medical Center, Durham, North Carolina, USA Article History: Registration Date: 01/01/2004 Received Date: 11/11/2002 Accepted Date: 20/11/2003

Byline: M. Maeder (1), P.R. Vogt (1), G. Schaer (2), A. von Graevenitz (2), H.F. Gunthard (3) Abstract: Serious infections caused by Rhodotorula spp. are rare and usually occur in immunocompromised people, especially in patients with tumors and long-time use of indwelling central venous catheters. We report a case of Rhodotorula mucilaginosa homograft endocarditis in an otherwise healthy man, which was successfully treated by surgery in combination with amphotericin B and subsequently intraconazole. Author Affiliation: (1) Dept. of Surgery, Clinic of Cardiovascular Surgery,University Hospital Zurich, Zurich, Switzerland, CH (2) Dept. of Medical Microbiology, University of Zurich, Zurich, Switzerland, CH (3) Dept. of Medicine, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Ramistr. 100, CH-8091 Zurich, Switzerland. huldrych.guenthard@usz.ch, CH Article note: Received: September 9, 2002 * Revision accepted: November 9 2002 H.F. Gunthard (corresponding author)

Byline: I. Simon-Vermot (1), M. Altwegg (3), W. Zimmerli (2), U. Fluckiger (2) Abstract: Bartonella spp. were recently recognized as causative agents of culture-negative endocarditis. Molecular techniques, such as broad-range PCR, are now available to detect fastidious or slow-growing microorganisms, or those which cannot be cultured. Such microorganisms may be responsible for culture-negative endocarditis. Alcoholism and homelessness are known risk factors for Bartonella quintana endocarditis, even in patients without previous valvular disease. We report a case of B. quintana endocarditis diagnosed by PCR amplification on the excised heart valve, in a young non-alcoholic and immunocompetent patient with few clinical signs of infection who did not fulfill the Duke criteria. Author Affiliation: (1) Department of Internal Medicine, University Hospitals Basel, Petersgraben 4, CH-4031 Basel, Switzerland, CH (2) Division of Infectious Diseases, University Hospitals Basel, Petersgraben 4, CH-4031 Basel, Switzerland, CH (3) Department of Medical Microbiology, University of Zurich, Switzerland, CH Article note: Received: March 4, 1999 * Revision accepted: May 27, 1999

Byline: Ville V. Valtonen Abstract: A growing amount of epidemiologic, experimental, and clinical evidence has linked infection as a risk factor to variousatherosclerotic diseases including acute myocardial infarction and cerebral infarction. Bacteremic infections with and without endocarditis carry a high risk for both stroke and acute myocardial infarction. During the last decade, chronic bacterial infections such as Chlamydia pneumoniae and dental infections have been associated as risk factors for various atherosclerotic diseases. These chronic bacterial infections are risk factors for acute cardiovascular events, but they may also have some role in the etiopathogenesis of atherosclerotic process itself. There are many known mechanisms that might explain the observed association of infection and atherosclerotic diseases, but it is probable that these mechanisms are complex and multifactorial and probably differ from infection to infection and from patient to patient. Infection theory is by no means against classic risk factor theory in the etiopathogenesis of atherosclerosis. Infection may also act as a synergistic risk factor together with classic risk factors in the development of various atherosclerotic diseases. (Am Heart J 1999;138:S431-S433.) Author Affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital. Helsinki, Finland Article Note: (footnote) [star] Reprint requests: Ville Valtonen, MD, Department of Medicine, Helsinki University Central Hospital, PL 340, 00029 HYKS, Helsinki, Finland., [star][star] 0002-8703/99/$8.00 + 0 4/0/101702

To the Editor: In Rosario, Argentina, during June 2005, a 15-year-old boy was hospitalized because of a 2-month history of fever. The patient had no history of cardiac disease or [...]

Byline: K. Claes (1), F. De Man (2), F. Van de Werf (2), W.E. Peetermans (1) Keywords: Key words Endocarditis; Streptococcus pneumoniae; Heart valve prosthesis Abstract: Infective endocarditis (IE) caused by Streptococcus pneumoniae is a rare disease. Only eight cases of pneumococcal prosthetic valve endocarditis have been described in the literature. In this report we describe the first case of pneumococcal endocarditis involving two prosthetic heart valves. The patient had pneumonia as the probable portal of entry but no predisposing conditions for invasive pneumococcal disease. Our case also illustrates the importance of transesophageal echocardiography (TEE) for the early diagnosis of IE and a timely decision for cardiac surgery. Author Affiliation: (1) Dept. of Internal Medicine, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium Phone: +32-16-344275, Fax: +32-16-344230, e-mail: willy.peetermans@uz.kuleuven.ac.be, BE (2) Dept. of Cardiology, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium, BE Article note: Received: August 20, 1999 * Revision accepted: November 17, 1999

The heart's mitral valve, a structure between the left atrium and left ventricle, functions to direct blood flow from the atrium to the ventricle during contraction of the heart. Mitral valve prolapse, MVP, is a condition in which the mitral valve bulges into the left atrium resulting in impaired blood flow, abnormal heart sounds, and other signs and symptoms including chest pain, fatigue and palpitations. Individuals with MVP are often prescribed antibiotics when they undergo certain procedures to prevent infection (prophylactic therapy) because they are considered to be at risk for endocarditis, inflammation of the membranes lining the heart valve. For example, a person with MVP takes penicillin or another antibiotic prior to and following dental examinations to prevent bacteria in the mouth from causing infectious endocarditis (IE). In this case, the antibiotic is considered to be endocarditis prophylaxis. Previous research suggests that individuals with MVP are five times more likely to develop IE. This study examined the factors that were associated with the use of endocarditis prophylaxis in 127 individuals with MVP who resided in Olmsted County, Minnesota. Prophylactic therapy was recommended three to four times more often in patients under 40 years compared to those more than 60 years. For every ten year increase in age, there was a 30 percent reduction in the recommendation for endocarditis prophylaxis. Results of echocardiography, the use of sound waves to visualize the heart, and physical examination were criteria supporting physicians' recommendations for treatment. However, the actual appearance of the prolapsed mitral valve did not influence the decision to use endocarditis prophylaxis. Further investigation is required to determine the risk factors for infectious endocarditis in individuals with MVP., ABSTRACT: We conducted a population-based study to examine the association between clinical and Doppler echocardiographic characteristics and physicians' recommendation for endocarditis prophylaxis. Of 127 consecutive Olmsted County, Minnesota, residents with newly documented isolated mitral valve prolapse, endocarditis prophylaxis was recommended three to four times more often in patients under 40 years compared with those more than 60 years of age. Using multiple logistic regression, for every 10-year increment in age, there was a 30% independent reduction in recommendations for endocarditis prophylaxis. Doppler evidence of mitral regurgitation was also independently associated with recommendations for endocarditis prophylaxis. Observations from physical examination, including systolic murmur and systolic click, were weakly associated with endocarditis prophylaxis recommendations. Mitral valve appearance (thickened vs not) was not associated with endocarditis prophylaxis. Although current recommendations for endocarditis prophylaxis and mitral valve prolapse do not address age and Doppler-detected mitral regurgitation, these variables are strongly associated with clinical decisions. Prospective, longitudinal, population-based studies are needed to define endocarditis risk further in subgroups with mitral valve prolapse to provide a more scientific basis for clinical decision making.