Fever of unknown origin and splenomegaly: A case report of blood culture negative endocarditis

Rationale: Fever of unknown origin (FUO) can be determined by different conditions among which infectious diseases represent the main cause. Patient concerns: A young woman, with a history of aortic stenosis, was admitted to our unit for a month of intermittent fever associated with a new diastolic heart murmur and splenomegaly. Laboratory tests were negative for infectious screening. The total body computed tomography (CT) scan excluded abscesses, occulted neoplasia, or lymphadenopathy. Diagnoses: The transthoracic and transesophageal echocardiogram showed an aortic valve vegetation. Three sets of blood cultures were negative for all microorganisms tested. According to these findings, Bartonella endocarditis was suspected and the serology tests performed were positive. Finally, real-time polymerase chain reaction (RT-PCR) detected Bartonella henselae DNA on tissue valve. Interventions: The patient underwent heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral Doxycycline was prescribed for 16 days and, successively, with Doxycycline and Ceftriaxone for 6 weeks. Outcomes: After surgery and antibiotic therapy, patient continued to do well. Lessons: Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment. ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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CONCLUSIONS: The Mosaic bioprosthesis has shown excellent durability over two decades of clinical use, with a negligible incidence of valve degeneration and need for reoperation. Thus, it may be considered a valid option for AVR, especially in elderly patients. PMID: 30560605 [PubMed - in process]
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
Though heart is known primarily as a pump, it is the four cardiac valves that ensures the critical , non-stop unidirectional flow that sustain the circulation . It is to be recalled these valves originate in the very early days of cardiac development when the primitive heart tube loops , even as the chambers expand from primitive ventricle. Mesenchymal differentiation controlled by various genes that cleaves the valve from myocardial tissue. While heart by itself is the supreme vascular organ ,  its surprising  few structures inside the heart , like the valves are quiet avascular ( or is it really so ?)...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: cardiac embryology Embryology : Heart valve development Infective endocarditis : Pathology valvular heart disease blood supply to heart valves hematogenous spread of infective endocarditis how bacteria reach mitral valve in infective endocardi Source Type: blogs
Authors: Eltchaninoff H, Durand E, Barbanti M, Abdel-Wahab M Abstract Aortic bioprostheses are increasingly used both for surgery, as an alternative to mechanical valves, and for transcatheter implantation in patients with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) has been widely adopted for the treatment of severe symptomatic aortic stenosis in elderly (>75 years) patients who are at risk for surgery and who have favourable transfemoral access. It is already under evaluation in low-risk patients. The aim of this review is to present an update on definitions and to assess the various...
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
Authors: Lamba H, Deo S, Altarabsheh S, Elgudin Y, Markowitz A, Park S Abstract Hypereosinophilic syndrome (HES) is a rare hematological disorder, which may present with cardiac involvement. The case is presented of a 61-year-old male patient with isolated aortic stenosis secondary to non-bacterial thrombotic endocarditis and HES. The patient underwent successful aortic valve replacement with a bioprosthesis and remained recurrence-free at the 18-month follow up. A review of the current literature is also presented and cardiac manifestations, clinical presentation and surgical issues in the care of patients with th...
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
CONCLUSIONS: At long-term follow up the Sorin Freedom SOLO bioprosthesis was associated with favourable hemodynamic results and survival. Freedom from SVD was not superior to that occurring with stented bioprostheses. PMID: 28290166 [PubMed - in process]
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
The post below first appeared on HuffPost Healthy Living on April 20. Jen Hyde, a 30-year-old poet and artist living in Brooklyn, has a congenital heart defect. By the age of 25, Hyde had two open-heart surgeries, including a heart valve replacement. “I know that heart disease is the number one killer of women in America,” Hyde said. “I’m currently in great shape, but part of staying this way means building a strong relationship with my cardiologist so that the care I receive is preventative, not reactive.” Hyde is not alone in suffering from heart health issues — in the U.S., cardiova...
Source: Disruptive Women in Health Care - Category: Consumer Health News Authors: Tags: Chronic Conditions Source Type: blogs
We present the case of a 67-year-old man with recurrent hemolytic anemia and HC, without infective endocarditis. Attempts at iron repletion and augmentation of beta-blocker therapy proved his anemia to be refractory to medical management. Ventricular septal myectomy led to the resolution of hemolysis, anemia, and its coexisting symptoms. PMID: 26424952 [PubMed]
Source: Baylor University Medical Center Proceedings - Category: Universities & Medical Training Authors: Tags: Proc (Bayl Univ Med Cent) Source Type: research
CONCLUSION: The durations of CPB and aortic cross-clamping may not affect maternal outcome, but shorter CPB and aortic cross-clamp times led to better fetal outcomes. Increasing the perioperative dosage of inotropes may lead to a reduced fetal survival. PMID: 26204695 [PubMed - in process]
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
Transcatheter Aortic Valve-In-Valve Implantation for Severe Bioprosthetic Stenosis after Bentall Operation Using a Homograft in a Patient with Behçet's Disease. J Heart Valve Dis. 2015 Mar;24(2):217-9 Authors: Joo HJ, Hong SJ, Yu CW Abstract A 43-year-old man presented with severe aortic stenosis. Eight years previously, he had undergone primary surgical aortic valve replacement (AVR) for severe aortic regurgitation, but one year later developed cardiac arrest and complete atrioventricular block as a result of non-bacterial thrombotic endocarditis with severe valvular dehiscence. Following the d...
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
Authors: Cimmino G, Ciccarelli G, Golino M, D'Amico C, Golino P Abstract During the past few years, a new and attractive approach--transcatheter aortic valve implantation (TAVI)--has been developed for patients who are symptomatic of aortic stenosis and, due to the high expected operative risk, would not be otherwise treated. Unfortunately, TAVI can result in endocarditis of the percutaneously implanted valve that may present atypically and cause delays in diagnosis and treatment. Herein, the case is described of a 79-year-old female affected by endocarditis on aortic valve percutaneously implanted caused by Entero...
Source: Journal of Heart Valve Disease - Category: Cardiology Tags: J Heart Valve Dis Source Type: research
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