Infective Endocarditis in Adults

Mylonakis, Eleftherios; Calderwood, Stephen B.

doi:10.1056/nejmra010082

Cited by 1,136 publications

(890 citation statements)

References 93 publications

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“…The most frequent neurological complications include cerebral infarction, bacterial meningitis, intracerebral hemorrhage and mycotic aneurysms [5,6]. Neurological complications after infective endocarditis in children have been less well characterized.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Venkatesan

Wainwright

2008

Pediatric Neurology

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The approach to the acute management of stroke in children with infective endocarditis is limited by the paucity of published data on their clinical course and outcome. We conducted a retrospective study at an urban tertiary care academic center to characterize the clinical course of seven pediatric patients with endocarditis and subsequent cerebral infarct. Among 115 patients with endocarditis, a stroke occurred in seven. Four patients had congenital heart disease. In 6 patients, the stroke was in the distribution of the middle cerebral artery and there was no preference for left or right hemisphere. The most common presenting symptom was focal weakness. Three patients had mycotic aneurysms, all of which were successfully repaired. Two patients were placed on aspirin therapy with no adverse effects. All patients survived but neurological recovery was variable. The two youngest patients (3 and 14 weeks of age) had the longest periods of hospitalization and had the most severe neurologic impairment. These findings suggest that children may have better outcome than adults after stroke secondary to bacterial endocarditis. Routine surveillance for mycotic aneurysms in patients with new neurological deficits and the use of aspirin should be considered in the medical management.

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Section: Introductionmentioning

confidence: 99%

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Venkatesan

Wainwright

2008

Pediatric Neurology

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“…TEE is particularly useful in patients with prosthetic valves and for evaluating myocardial invasion. Negative TEE has a negative predictive value of over 92% for IE (Mylonakis & Calderwood, 2001). …”

Section: Transesophageal Echocardiographymentioning

confidence: 99%

Native and Prosthetic Aortic Valve Endocarditis

Ţilea¹,

Ţilea²,

Tătar³

et al. 2011

Aortic Valve

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“…In addition, growth and fortification of the vegetation by SC-induced fibrin deposition protects the bacteria in the vegetation from clearance by leukocytes and macrophages [12]. Coagulase-positive S. aureus causes 40-50% of neonatal endocarditis and 30-40% of endocarditis in adults between the ages of 16-60 years, with a mortality rate of 25-47%, even with antibiotic therapy [8,13].…”

Section: Acute Bacterial Endocarditismentioning

confidence: 99%

The staphylocoagulase family of zymogen activator and adhesion proteins

Panizzi

Friedrich

Fuentes‐Prior

et al. 2004

CMLS, Cell. Mol. Life Sci.

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Staphylocoagulase (SC) secreted by Staphylococcus aureus is a potent non-proteolytic activator of the blood coagulation zymogen prothrombin and the prototype of a newly established zymogen activator and adhesion protein (ZAAP) family. The conformationally activated SC•prothrombin complex specifically cleaves fibrinogen to fibrin, which propagates the growth of bacteria-fibrinplatelet vegetations in acute bacterial endocarditis. Our recent 2.2 Å X-ray crystal structures of an active SC fragment [SC(1-325)] bound to the prothrombin zymogen catalytic domain, prethrombin 2, demonstrated that SC(1-325) represents a new type of non-proteolytic activator with a unique fold. The observed insertion of the SC(1-325) N-terminus into the 'Ile 16' cleft of prethrombin 2, which triggers the activating conformational change, provided the first unambiguous structural evidence for the 'molecular sexuality' mechanism of non-proteolytic zymogen activation. Based on the SC(1-325) fold, a new family of bifunctional zymogen activator and adhesion proteins was identified that possess N-terminal domains homologous to SC(1-325) and C-terminal domains that mediate adhesion to plasma or extracellular matrix proteins. Further investigation of the ZAAP family may lead to new insights into the mechanisms of bacterial factors that hijack zymogens of the human blood coagulation and fibrinolytic systems to promote and disseminate endocarditis and other infectious diseases.

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Infective Endocarditis in Adults

Cited by 1,136 publications

References 93 publications

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Native and Prosthetic Aortic Valve Endocarditis

The staphylocoagulase family of zymogen activator and adhesion proteins

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