warfarin and Streptococcal-Infections

Acute ischemic stroke (AIS) is highly prevalent in patients with infective endocarditis (IE) and associated with high rates of death and disability. IE presenting as an acute ischemic stroke, especially recurrent concurrence of acute anterior and posterior circulation infarct, has rarely been reported. Herein, we report a case study of a 60-year-old man with a history of aortic valve replacement and was under warfarin, presented with recurrent acute ischemic stroke which was found to have no vegetation secondary to infective endocarditis caused by Streptococcus constellatus as the embolic source. This is the first case report of recurrent ischemic stroke secondary to IE without vegetation caused by Streptococcus constellatus involving concurrence of acute anterior and posterior circulation. We also then systematically analyze the cases with IE initially presenting as AIS reported in the literature to establish possible demographic, clinical, laboratory patterns, and prognostic features of these cases.

Topics: Aortic Valve; Brain; Brain Ischemia; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Recurrence; Streptococcal Infections; Streptococcus constellatus; Stroke; Warfarin

Topics: Anti-Bacterial Agents; Anticoagulants; Cavernous Sinus Thrombosis; Child; Heparin, Low-Molecular-Weight; Humans; Magnetic Resonance Imaging; Male; Sinusitis; Streptococcal Infections; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Crescenteric glomerulonephritis preceded by a streptococcal infection with creatinine clearance CCr of less than 30 ml/minute/1.73 m2 was treated by supportive care plus three months of quintuple therapy (prednisone, azathioprine, cyclophosphamide, dipyridamole, and heparin followed by warfarin) in five children (Group A) or by supportive care alone in five others (Group B). Of the glomeruli examined, 69.8 +/- 11.7% (mean +/- SE) in Group A and 64.4 +/- 10.6% in Group B had crescents which involved 54.0 +/- 10.8% and 60.0 +/- 10.5% of glomerular circumference, respectively. Clinical and histologic findings supported a recent streptococcal infection in every patient. Two patients from Group A had mild proteinuria and normal CCr at 12 months; one died abruptly of pulmonary hemorrhage after maintaining a normal CCr for 25 months. Following a second episode of poststreptococcal acute glomerulonephritis seven months after the first, one patient from Group B had persistent mild proteinuria for 41 months and hypertension through 56 months of follow-up. Nine surviving patients have maintained normal CCr for eight to 60 months (mean 29.5 months). The findings of this study suggest that this quintuple therapy offers no advantage over supportive care in the clinical management and outcome of children with severe crescenteric glomerulonephritis when an antecedent streptococcal infection is confirmed by serologic and histopathologic criteria.

Topics: Adolescent; Azathioprine; Child; Child, Preschool; Cyclophosphamide; Dipyridamole; Drug Therapy, Combination; Female; Follow-Up Studies; Glomerulonephritis; Heparin; Humans; Kidney Glomerulus; Male; Prednisone; Streptococcal Infections; Warfarin

The role of blood monocytes in the attachment of streptococci to endocardial vegetations was investigated in an experimental Streptococcus sanguis endocarditis by depletion of blood monocytes with the cytostatic drug VP 16-213 alone and combined with anticoagulant treatment with warfarin sodium. The numbers of streptococci in the vegetations of control, monocytopenic, and monocytopenic/anticoagulated rabbits were comparable. In the vegetations streptococci were found mainly in areas free of phagocytic cells. It is concluded that streptococci do not have to be phagocytosed by monocytes in the circulation before being deposited on the surface of endocardial vegetations. Even the vegetations of intensively anticoagulated/monocytopenic rabbits showed colonies of streptococci embedded in polymerized fibrin and cellular material, this matrix possibly being held together by streptococcal dextran.

Topics: Animals; Endocarditis, Bacterial; Endocardium; Etoposide; Granulocytes; Leukocyte Count; Male; Microscopy, Electron; Monocytes; Podophyllotoxin; Rabbits; Streptococcal Infections; Streptococcus sanguis; Warfarin

Topics: Acute Disease; Adolescent; Adult; Aged; Aneurysm; Child; Chronic Disease; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Female; Fetal Death; Fibrinolysis; Hemangioma; Heparin; Humans; Iliac Artery; Infusions, Parenteral; Lung Neoplasms; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Pregnancy; Sepsis; Streptococcal Infections; Syndrome; Thrombophlebitis; Thumb; Warfarin