Infective endocarditis is a devastating, progressive and frequently fatal heart disease usually caused by bacterial pathogens. It was first identified in the nineteenth century and has changed beyond all recognition due to evolution of the disease itself and developments in modern healthcare such as open-heart surgery, antibiotics and new medical imaging techniques.
"In spite of these medical advances, infective endocarditis is still evolving and we are seeing new patterns of the disease and its complications. Despite all our improvements in health care, the death rate has been virtually unchanged for the last 20 years, and now seems to be rising again," said cardiologist Dr Bernard Prendergast from the John Radcliffe Hospital in Oxford, UK.
"In the nineteenth century rheumatism affecting the heart valves was the most common form of heart disease and the usual target for infective endocarditis. Now that people live so long, degenerative heart valve disease is a more common problem. We're also seeing complications in patients who have received replacement heart valves and infections as a result of intravenous drug use," said Dr Prendergast. "On top of that, aggressive Staphylococcus infections are now common, and conventional antibiotic treatments are becoming less effective because of drug-resistant bacteria".
Early surgery to treat valve infection would probably save many lives. However, the operations needed are often tricky and high risk because patients are extremely sick at the time of surgery. For this reason, the timing of the operation can be difficult and expert care is essential.
A second controversy is whether patients with valve disease can be protected from the risk of infection at the time of routine procedures such as dental work by using preventative antibiotic treatment. While this has been traditional practice, recent assessment by the government watchdog NICE, has suggested that this practice is obsolete, although this recommendation is in conflict with the position in the USA and Europe.
"It's an impossible and continuing debate, fuelled by fundamental differences in international guidelines," said Dr Prendergast. "We just don't have the results from properly conducted and randomised clinical trials to know whether routine prophylactic antibiotics are helpful or not. Greater awareness of the dangers of infective endocarditis amongst both doctors and patients is certainly essential and improved dental health and skin hygiene are probably at least as important as blanket antibiotic treatment. As the disease evolves even further this debate could run on for years with heart physicians, microbiologists and surgeons all having different opinions. This is very unhelpful and confusing for patients."
Lucy Goodchild | alfa
Inhaling air pollution-like irritant alters defensive heart-lung reflex for hypertension
19.06.2019 | University of South Florida (USF Innovation)
Nitric oxide-scavenging hydrogel developed for rheumatoid arthritis treatment
06.06.2019 | Pohang University of Science & Technology (POSTECH)
The quality of additively manufactured components depends not only on the manufacturing process, but also on the inline process control. The process control ensures a reliable coating process because it detects deviations from the target geometry immediately. At LASER World of PHOTONICS 2019, the Fraunhofer Institute for Laser Technology ILT will be demonstrating how well bi-directional sensor technology can already be used for Laser Material Deposition (LMD) in combination with commercial optics at booth A2.431.
Fraunhofer ILT has been developing optical sensor technology specifically for production measurement technology for around 10 years. In particular, its »bd-1«...
The well-known representation of chemical elements is just one example of how objects can be arranged and classified
The periodic table of elements that most chemistry books depict is only one special case. This tabular overview of the chemical elements, which goes back to...
Light can be used not only to measure materials’ properties, but also to change them. Especially interesting are those cases in which the function of a material can be modified, such as its ability to conduct electricity or to store information in its magnetic state. A team led by Andrea Cavalleri from the Max Planck Institute for the Structure and Dynamics of Matter in Hamburg used terahertz frequency light pulses to transform a non-ferroelectric material into a ferroelectric one.
Ferroelectricity is a state in which the constituent lattice “looks” in one specific direction, forming a macroscopic electrical polarisation. The ability to...
Researchers at TU Graz calculate the most accurate gravity field determination of the Earth using 1.16 billion satellite measurements. This yields valuable knowledge for climate research.
The Earth’s gravity fluctuates from place to place. Geodesists use this phenomenon to observe geodynamic and climatological processes. Using...
Discovery by Brazilian and US researchers could change the classification of two species, which appear more akin to jellyfish than was thought.
The tube anemone Isarachnanthus nocturnus is only 15 cm long but has the largest mitochondrial genome of any animal sequenced to date, with 80,923 base pairs....
29.04.2019 | Event News
17.04.2019 | Event News
15.04.2019 | Event News
19.06.2019 | Physics and Astronomy
19.06.2019 | Information Technology
19.06.2019 | Materials Sciences