Disseminated Endocarditis

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

Disseminated histoplasmosis Acute (Infantile) Subacute Progressive histoplasmosis (immunocompetent patients and immunosuppressed patients without AIDS) 0.02-0.05 Disseminated histoplasmosis Untreated mortality 83% to 93% relapse 5% to 23% in non-AIDS patients therapy is recommended tor all patients Nonimmunosuppressedpatients Ketoconazole 400 mj day orally x 6-12 months or amphotericin B 35 mg/kg IV Immunosuppressed patients (non-AIDS) or endocarditis or CNS disease Amphotericin B >35 mg/kg x 3 months followed by fluconazole or itraconazole 200 mg orally twice daily x 12 months Life-threatening disease Amphotericin B 0.7-1 mg/kg/day IV for a total dosage of 35 mj kg over 2-4 months once the patient is afebrile, able to take oral medications, and no longer requires blood pressure or ventilatory support therapy can be changed to itraconazole 200 mg orally twice daily for 6-18 months Non-life-threatening disease Itraconazole 200-400 mg orally daily for 6-18 months fluconazole therapy 400-800 mg daily should be reserved for patients intolerant to itraconazole, and the development of resistance can lead to relapses... 

Disseminated gonococcal infections (eg, meningitis, endocarditis, arthritis)... 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

HOST FACTORS A critical determinant of antibiotic efficacy is the status of the host humoral and cellular defense mechanisms. In the immunocompetent host, merely halting the multiplication of the microorganism with a bacteriostatic agent frequently is sufficient to cure the infection. If host defenses are impaired, bacteriostatic activity may be inadequate and a bactericidal agent is required for cure. Examples where this applies include bacterial endocarditis, bacterial meningitis, and disseminated bacterial infections in nentropenic patients. Patients with HIV-1 infection and acquired immunodeficiency syndrome have impaired cellular immune responses. Therapy for opportunistic infection therefore often is snppressive bnt not cnrative disseminated infections with Salmonella or atypical mycobacteria typically require prolonged antibiotic therapy to prevent relapse. 

Atrial fibrillation with mitral valve disease has long been considered a stroke risk factor. Recurrent embolism occurs in 30-65% of patients with rheumatic mitral valve disease who have a history of a previous embolic event. Most of these recurrences (around 60%) develop within the first year. Mechanical prosthetic valves are a prime site for thrombus formation and patients with these valves require anticoagulation [7, 38]. Bacterial endocarditis can cause stroke as well as intracerebral mycotic aneurysms. Because mycotic aneurysms are inflammatory defects in the vessel wall, treatment with systemic thrombolysis or anticoagulation can lead to rupture with subsequent lobar hemorrhage. Nonbacterial, or marantic, endocarditis is also associated with multiple embolic strokes. This condition is most common in patients with mucinous carcinoma and may be associated with a low-grade disseminated intravascular coagulation. A nonbacterial endocarditis, called Libman-Sacks endocarditis, occurs in patients with systemic lupus erythematosus (SLE) [42],... 

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