感染性心内膜炎75例临床分析

目的：分析感染性心内膜炎（IE）患者临床特点,以便早期诊断与治疗。方法：回顾性：分析1995年1月～2012年5月我院确诊的75例IE患者的临床资料,分析其心脏基础疾病情况、病原菌、临床表现和超声心动图检查结果。结果：75例IE中65例患有各种心脏病,其中风湿性心脏病占首位（41．5％）,其次为先天性心脏病（24．6％）,老年退行性瓣膜病（13．8％）;血培养阳性率为46．7％,病原菌以链球菌（48．6％）和葡萄球菌（28．6％）多见;超声心动图检查阳性率高（96％）;35．4％患者在抗感染治疗后接受心外科手术治疗,痊愈62例（82．7％,62／75）,死亡13例（17．3％）。结论：正确应用超声心动图和血培养检查,有助于早期诊断和治疗。     

感染性心内膜炎103例临床分析

目的：通过分析103例感染性心内膜炎患者的临床资料,总结其临床特点。方法回顾性分析103例感染性心内膜炎患者的临床资料。结果103例患者中,仅10例无基础心脏病,93例伴有各种不同的心脏病,主要为风湿性心脏病和先天性心脏病。临床表现为发热34例,贫血31例,栓塞56例。血培养检查阳性61例,阴性42例;致病菌检出率最高为草绿色链球菌。超声心动图检查发现部分患者有赘生物,赘生物多见于心内膜炎患者,发生于左心者84例（81．5％）,且单瓣病变多,二尖瓣单瓣病变者38例,主动脉瓣单瓣病变者26例;发生于右心者12例（11．6％）,以三尖瓣单瓣为主。97例患者经过治疗后痊愈,随访6个月,死亡6例,死亡原因为心力衰竭3例,肺栓塞1例,脑出血1例,严重感染1例。结论感染性心内膜炎的临床特点发生了变化,及时了解其变化,早期治疗可以提高其治愈率。     

感染性心内膜炎120例临床分析

目的 探讨感染性心内膜炎(IE)的基础病因、致病微牛物和临床特征,提高IE的诊治水平.方法 回顾件分析北京协和医院1997年10月-2007年9月确诊的120例IE患者的临床资料.结果 120例IE患者中,108例(90.0%)为自然瓣膜心内膜炎(NVE),12例(10.0%)为人工瓣膜心内膜炎(PVE);29例(24.2%)无基础心脏病变,79例(73.1%)NVE患者存在各种基础心脏病,其中先天性心血管畸形30例(38.0%),其次为特发性二尖瓣脱垂(23例,29.1%)和风湿性心脏病(11例,13.9%).临床主要表现为发热(100.0%)、贫血(65例,54.2%)和栓塞(58例,48.3%).有83例(69.2%)细菌培养阳性,其中43例(51.8%)致病菌为链球菌.结论 IE最常见的基础心脏病前3位是先天性心血管畸形、二尖瓣脱垂和风湿性心脏病.不明原因长期发热患者应想到心内膜炎?鬃 的町能,血培养和超声心动图检查有助于IE的诊断.     

静脉吸毒所致的感染性心内膜炎的临床分析

目的探讨静脉使用毒品所致感染性心内膜炎的临床特点和诊疗要点。方法对18例静脉使用毒品引起的感染性心内膜炎进行回顾性分析。结果均有肺部感染和感染性心内膜炎的临床表现，UCG示均有心内膜下赘生物，经6-8周抗炎治疗后16例痊愈。结论吸毒极易继发多脏器多病原菌感染，经及时、足量应用敏感抗生素治疗，一般预后良好。     

HIV抗体阳性静脉药瘾者右心感染性心内膜炎临床分析

目的探讨静脉药瘾者有心感染性心内膜炎（right—sided infective endocarditis,RIE）并人类免疫缺陷病毒（human immunodeficiency virus,HIV）抗体阳性的临床特点。方法回顾性分析21例HIV抗体阳性的RIE患者临床资料,着重分析患者的检查结果和治疗情况。结果①无业男青年居多,无基础心脏病,静脉吸毒时间0．5年～5年不等;②均有发热、浅表静脉炎性反应及肺损害等;③心脏损害以三尖瓣受损为主,部分有肺动脉瓣受损,少数并发二尖瓣受累;④实验室检查多有贫血,白细胞升高及低蛋白血症,血培养阳性率达61．9％,以金黄色葡萄球菌居多;⑤超声心动图检出三尖瓣赘生物达100％,符合右心感染性心内膜的特点;⑥预后较差。结论静脉药瘾是RIE与HIV感染的致病原因,RIE与HIV感染共患,相互影响,增加RIE的严重性及治难性,临床症状重,预后较差。     

感染性心内膜炎97例临床分析

目的 了解近年来感染性心内膜炎(IE)的临床特点变化.方法 回顾性分析华山医院近10年收治的97例IE患者的临床资料,包括发病年龄、易感因素、临床表现、血培养及超声心动图检查.计量数值如患者发病年龄等以算术平均数±标准差表示,病例阳性数以百分比表示,对比分析采用Fisher确切概率法.结果 97例IE患者平均年龄(49±17)岁,有基础心脏病73例,占75.3％;前三位是风湿性心脏病27例(27.8％)、先天性心脏病23例(23.7％)、特发性二尖瓣脱垂18例(18.6％).临床表现为发热96例(99.0％)、心脏杂音93例(95.9％)、贫血82例(84.5％).血液细菌培养阳性66例(68.0％),其中草绿色链球菌28株(42.4％),仍为主要致病菌,且全部发生于自然瓣膜心内膜炎患者中;葡萄球菌18株(27.3％),金黄色葡萄球菌10株(15.2％),有3株为耐甲氧西林金黄色葡萄球菌(MRSA),凝固酶阴性葡萄球菌8株(12.1％),有2株为耐甲氧西林凝固酶阴性葡萄球菌(MRCNS);鲍曼不动杆菌、嗜麦芽窄食单胞菌等耐药性强的病原菌各1株.超声心动图赘生物检出79例,占81.4％,其中右心赘生物9例,病原主要为葡萄球菌.结论 IE患者临床表现、易感因素、致病菌发生了变化,多次血培养及超声心动图检查有助于诊断.     

静脉药瘾感染性心内膜炎29例诊治体会

目的:探讨静脉药瘾感染性心内膜炎患者的临床特征及治疗方法.方法:回顾性分析2001-01至2011-10我院确诊的29例静脉药瘾感染性心内膜炎患者临床资料.结果:29例患者中21例外科手术治愈,5例内科抗生素治疗后治愈,3例人类免疫缺陷病毒(HIV)抗体阳性,转相应医院治疗.结论:静脉药瘾感染性心内膜炎可通过正规的抗生素治疗,外科手术是治疗本病的较为有效的方法.     

右心感染性心内膜炎的临床特点

我院１９８６～１９９３年收治１２例右心感染性心内膜炎，其中２例同时累及左心瓣膜。肺部急性炎症浸润或多发性肺脓肿是本病的主要临床特征。本组血培养阳性者１０例，其中金黄色葡萄球菌７例，草绿色链球菌２例，白色念珠菌１例。１２例均进行二维或彩色多普勒血流仪检查，在右心瓣膜或心室壁上均有赘生物存在，最大者３５ｍｍ×１２ｍｍ，最小者７ｍｍ×５ｍｍ。多普勒超声检查对本病的诊断具有重要价值，但早期可显示阴性，因此，对可疑病例应行动态观察。     

Complementary role of MRI in infectious endocarditis

The usefulness of magnetic resonance for imaging of cardiac structures is well established. In this study, we evaluated the role of this technique in the diagnosis of perivalvular extension of infectious endocarditis. Our initial experience and the few case reports in the literature show that magnetic resonance imaging can complement echocardiography in the assessment of periannular extension of infectious endocarditis.     

左冠状动脉右房瘘合并感染性心内膜炎1例

1病历资料患者女,14岁,因"反复发热5个月"于2011-05-22入院。主要症状:5个月反复发热、咳嗽、咳痰,发热无规律,最高体温40℃,伴有寒战、心率加快、乏力、夜间盗汗,偶有关节疼痛,无胸痛、胸闷、呼吸困难等症状。在各级医院诊断"肺部感染",治疗后病情控制不佳。入院时心、肺、腹查体未见异常。送检血培养提示草绿色链球菌生长。第一次超声心     

Infective endocarditis caused by Granulicatella adiacens

Granulicatella adiacens, a recently nomenclatured bacterium, was considered as one of the nutritionally variant streptococci (NVS) and is a mouth commensal. It is redesignated as a streptococcus like bacterium since it differs from streptococci. We report a case of infective endocarditis (IE) caused by this fastidious and unusual bacteria in a 63-year-old man with rheumatic valvular heart disease. G. adiacens was isolated from four of his blood culture samples, which was sensitive to beta lactams, moderately sensitive to gentamicin and resistant to erythromycin and co-trimoxazole. Patient recovered completely on treatment with high dose of ampicillin and gentamicin for 28 days.     

感染性心内膜炎特点分析(附119例报告)

目的探讨感染性心内膜炎(IE)的基础病因、致病微生物、临床特征及治疗结果等因素,提高IE的诊治水平。方法对119例IE患者的基础病因、临床特征、致病微生物、治疗效果等临床资料进行回顾性分析。结果①基础病因中先天性心脏病比例最高(48例,40.3%),其次为风湿性心脏瓣膜病(36例,30.3%),无基础心脏病变有所增加(22例,18.5%)。②发热仍是IE最常见的临床表现(106例,89.1%)和首发症状(95例,79.8%),28例(23.5%)患者以心功能不全为主要症状。③98例患者做血培养,阳性率为63.1%(62例),其中链球菌27例(43.5%),葡萄球菌26例(41.9%)。④28例经胸超声心动图检查未发现赘生物的患者中11例(39.3%),手术发现赘生物,术后行病理检查均符合IE的病理诊断标准。结论基础病因中无基础心脏病变比例明显增加;葡萄球菌感染呈增多趋势。     

Acute aortic regurgitation caused by non-bacterial thrombotic endocarditis

A case of non-bacterial thrombotic endocarditis, which causedacute aortic regurgitation in a middle-aged, otherwise healthywoman, is presented. The diagnosis was confirmed with echocardiographyand documented by a histopathological study of the excised aorticvalve after operation for valve replacement.     

血液透析患者合并感染性心内膜炎6例临床分析

目的总结血液透析（hemodialysis,HD）患者合并感染性心内膜炎（infective endocarditis,IE）的临床特点及转归。方法回顾性分析1985年3月至2012年8月在广东省人民医院住院的6例HD合并IE患者的临床资料及随访结果。6例患者均符合IE改良的Duke诊断标准。结果入选患者6例,男1例,女5例,年龄52.8（42～68）岁;血液透析血管通路：5例自体动静脉内瘘、1例临时颈内静脉透析导管。主要临床表现及并发症：发热5例,心力衰竭恶化3例,脑栓塞3例。血培养阳性3例：2例粪肠球菌,1例光滑球拟酵母菌。超声心动图发现瓣膜赘生物5例,瓣膜穿孔1例,其中累及二尖瓣4例。3例病情恶化自动出院后1周内死亡,1例出院后4个月猝死,1例出院后17个月猝死,1例出院后4年至今仍存活。结论 IE合并HD患者在广东省人民医院尚属少见,患者易出现心力衰竭及栓塞等并发症,预后较差。     

A case report of PR-3-ANCA-positive glomerulonephritis with histological features of GPA associated with infectious endocarditis

Rationale:Several renal diseases are associated with infectious endocarditis. However, there are few reports on patients with granulomatosis with polyangiitis (GPA) associated with infectious endocarditis, and there is no consensus for appropriate treatment.Patients concerns:A 35 -years-old man with congenital ventricular septal defect presented severe anemia, hematuria and proteinuria. The blood and urine examinations showed elevated white blood cells (12,900 cells/μL), C-reactive protein level (13.1 mg/dL) and proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (11.0 IU/mL), severe anemia (hemoglobin: 6.1 g/dL) and renal dysfunction [estimated glomerular filtration rate (eGFR): 12.7 ml/min.1.78 m² with hematuria and proteinuria].Diagnoses:The patient was diagnosed with crescentic glomerulonephritis with histological features of GPA associated with infectious endocarditis by renal biopsy and transthoracic echocardiography.Interventions:Antibacterial drugs (ampicillin-sulbactam) were administrated. No immunomodulating agents were used because immunosuppressive drugs may worsen infectious endocarditis. Subsequently, renal function and urinary findings improved. However, infectious endocarditis was not improved. Therefore, valve replacements and ventricular septal closure surgery were conducted.Outcomes:Thereafter, his postoperative course was uneventful, renal function improved (eGFR: 64.3 ml/min.1.78 m²), and PR3-ANCA level normalized.Lessons:We reported a case report of PR3-ANCA positive glomerulonephritis with histological features of GPA associated with infectious endocarditis. Physicians might note this renal complication when they manage infectious endocarditis.     

Mural endocarditis caused by Salmonella virchow: survival with conservative treatment

We describe a case of endocarditis caused by Salmonella enterica serotype virchow, which was treated conservatively with antibiotics alone. It is the only reported case of survival from salmonella endocarditis with conservative treatment, and the first reported case of endocarditis caused by Salmonella virchow. The changing prevalence, virulence patterns and importance of salmonella species in endocarditis are discussed.