Archive for October 22, 2015

Infective Endocarditis in Adults

Circulation. 2015 Oct 13 V.132 N.15 P.1435-86.

Diagnosis, Antimicrobial Therapy, and Management of Complications

A Scientific Statement for Healthcare Professionals From the American Heart Association.

Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council.



Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.


This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations.


Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.




October 22, 2015 at 2:06 pm

2015 ESC Guidelines for the management of infective endocarditis

Eur Heart J. 2015 Aug 29.

The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).

Authors/Task Force Members, Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL.

Collaborators (32)

Erol Ç, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, De Backer J, De Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM.




October 22, 2015 at 2:04 pm

A Cluster of Ocular Syphilis Cases – Seattle, Washington, and San Francisco, California, 2014-2015.

MMWR Morb Mortal Wkly Rep. 2015 Oct 16 V.64 N.40 P.1150-1.

Woolston S, Cohen SE, Fanfair RN, Lewis SC, Marra CM, Golden MR.

1Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington; 2San Francisco Department of Public Health; 3Division of Infectious Diseases, University of California, San Francisco; 4Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 5Department of Neurology, University of Washington; 6HIV/STD Control Program, Public Health – Seattle & King County.

Corresponding author: Robyn Neblett Fanfair, 404-639-6044,

From December 1, 2014, to January 30, 2015, in King County, Washington, four cases of ocular syphilis, defined as clinical signs or symptoms consistent with ocular disease (e.g., uveitis or vision loss) in a person with laboratory-confirmed syphilis of any stage, were reported.

All four cases occurred in men who have sex with men (MSM), two of whom were sex partners. Median age of the four patients was 39 years (range = 29–52 years).

Three of the patients were infected with human immunodeficiency virus (HIV). Among the three HIV-infected patients, the median CD4 count was 111 cells/ml, and the median HIV-RNA was 34,740 copies/ml.

All four patients had visual symptoms, including vision loss, flashing lights, and blurry vision.

Ophthalmologic examinations were performed and all four were diagnosed with uveitis. All four patients had positive serum from rapid plasma reagin (RPR) testing (titer range = 1:256–1:4096).

Based on history, one patient had late latent syphilis, and the remaining three received diagnoses of early latent syphilis. The three patients with early latent syphilis had cerebrospinal fluid (CSF) analysis performed; two had positive CSF in venereal disease research laboratory (VDRL) testing.

Three patients received treatment with aqueous crystalline penicillin G for 14 days, and one was treated with 10 days of procaine penicillin and probenecid. All four patients had initial improvement in ocular symptoms after treatment.

However, one patient still had a blind spot in one eye 1 month after treatment, and two patients were considered legally blind after 5 months; the fourth patient was lost to follow-up.


PDF (see p.1150-1)


October 22, 2015 at 2:01 pm


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