Enterococcal Endocarditis

Abstract

Enterococci, most often Enterococcus faecalis, cause 5%-20% of cases of infective endocarditis (IE). Enterococcal IE is usually a disease of older men, and the most frequent source of infection is the genitourinary tract. In cases of enterococcal IE, both normal and previously damaged valves can be involved. The disease most commonly presents in a subacute fashion; clinical and laboratory features are similar to those observed with IE caused by other pathogens. Diagnosis is based on the presence of clinical criteria of IE in association with positive blood cultures. Optimal therapy entails the parenteral use of a cell wall-active agent (penicillin G, ampicillin, or vancomycin) in combination with streptomycin or gentamicin in cases caused by enterococcal strains with high-level resistance to streptomycin. A 4-week treatment course may be adequate in many cases. In patients with streptomycin-resistant strains, mitral valve disease, illness of greater than 3 months' duration, and/or relapse after previous therapy, a 6-week treatment course should probably be administered. With standard treatment and the appropriate use of valve replacement, a cure rate of approximately 85% can be expected.

Genetic modifications to temperate Enterococcus faecalis phage ϕEf11 that abolish the establishment of lysogeny and sensitivity to repressor, and increase host range and productivity of lytic infection

“…The wEf11 host species, E. faecalis, and closely related species, such as Enterococcus faecium, have emerged as significant human pathogens, being major aetiological agents of infectious endocarditis, nosocomial infections, burn infections, urinary tract infections, meningitis and surgical wound infections (Lewis & Zervos, 1990;Moellering, 1992;Megran, 1992;Emori & Gaynes, 1993;Jett et al, 1994;Edgeworth et al, 1999;Richards et al, 2000;National Nosocomial Infections Surveillance System, 2004;Biedenbach et al, 2004;Linden, 2007). In terms of oral disease, E. faecalis is the most commonly isolated species from infected root canals of teeth that fail to heal following root canal therapy (Sundqvist et al, 1998;Peciuliene et al, 2000;Pinheiro et al, 2003 Complicating management of these infections is the development of resistance among many enterococcal strains against many of the available, previously effective antibiotics, including vancomycin (Havard et al, 1959;Murray & Mederski-Samaroj, 1983;Uttley et al, 1988;Grayson et al, 1991;Bonten et al, 2001;Tenover & McDonald, 2005).…”

Mycobacterium celatum as a cause of disseminated infection in an AIDS patient

“…haemophilum have emerged as potential pathogens in AIDS patients. M. celatum is a recently discovered microorganism causing disseminated infection in immunocompromised patients and could be misidentified [2]. We report a case of M .…”

“…celatum, further differentiated into two genotypes 1 and 2 with a 10-nucleotide difference 141. Disseminated infection in AIDS patients was first reported in Italy, and more recently a retrospective study with seven cases has been published by Tortoli et al, including the first two isolates [2,5,6]. O n the basis of 16s rRNA sequencing, all these strains were assigned to the genotype 1.…”

Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II)

“…Предшествующая сердечная патология отмечается примерно у 50% больных. Данной форме в большей степени свойственно подострое течение с пре-имущественным вовлечением в процесс левых отделов сердца (в том числе у больных наркоманией) и достаточ-но низкой (10%) частотой развития эмболий [3].Пневмококковый ИЭ в основном встречается у больных, страдающих алкоголизмом, хроническими заболеваниями бронхолегочной системы, а также у пожилых лиц. Протекает, как правило, остро (воз-можно и подострое развитие болезни), с быстро раз-вивающейся деструкцией клапанов (чаще аортально-го), формированием обширных вегетаций, абсцессов и системных эмболий.…”

“…Предшествующая сердечная патология отмечается примерно у 50% больных. Данной форме в большей степени свойственно подострое течение с пре-имущественным вовлечением в процесс левых отделов сердца (в том числе у больных наркоманией) и достаточ-но низкой (10%) частотой развития эмболий [3].…”