C. Glenn Cobbs

Indications for cardiac surgery in patients with active infective endocarditis

Currently, absolute indications for valve replacement during active infective endocarditis include severe heart failure, the presence of an infecting microorganism that is not susceptible to available antimicrobial agents, and, in patients with an infected prosthetic valve, an unstable device. Relative indications include an etiologic microorganism other than a susceptible Streptococcus, relapse after presumed effective therapy, evidence of intracardiac extension of the infection, two or more systemic emboli, vegetations large enough to be demonstrated by echocardiography, and, in patients with an infected prosthetic device, early disease and periprosthetic leak. With use of data from the medical literature, a study generated by the cardiovascular surgical group at the University of Alabama School of Medicine, and a brief cost analysis, a point system was constructed to assist in decision-making concerning surgery in patients with active infective endocarditis. The usefulness of this system will depend on experience generated from its utilization in a larger number of patients as well as new data relative to a more complete understanding of the risks and benefits of surgery in this condition.

Endocarditis at the Millennium

The members of the Interplanetary Society (Pus Club) have made significant contributions to the understanding of the pathogenesis of infective endocarditis (IE). Although the incidence of IE has essentially remained unchanged, the spectrum and characteristics of patients potentially affected by this disorder are expanding. Moreover, in addition to the typical microorganisms implicated in IE, there are increasing reports of new or atypical pathogens causing IE, including those that are resistant to standard antibiotic therapy. The infectious diseases community is challenged to continue to provide effective antimicrobial regimens for IE and to further develop diagnostic and surgical strategies to identify and treat patients with this disorder. New information is available regarding the demographics, diagnostic methods, and therapeutic options for the management of IE.

Case Report: Q Fever Endocarditis

Q fever endocarditis, which is seen most often in Great Britain and Australia, has been rarely observed in the United States. A patient with an eight month febrile illness who had signs and symptoms of endocarditis and serologic studies diagnostic of Q fever endocarditis is reported. A history of extensive travel makes it unclear where he originally contracted the disease. Q fever endocarditis is probably underdiagnosed and should be looked for in any case of culture negative endocarditis or chronic fever of unknown origin.

Infections from Body Piercing and Tattoos.

The infectious complications of body piercing and tattooing are reviewed.