posted
Anyone ever had a problem with serratia? A recent mucous sample showed Serratia liquefaciens and now doctor is getting scared [I think]. Alex has been fighting pseudomonas, although after a gentamycin trial, that helped. Today, serratia was found and doctor is now getting antsy.
We still haven't found or decided on a consulting doctor. Dr. S. and Dr. K. would be my dream team... but they're on opposite coasts. I made several attempts at contacting them both, but never got any responses.
posted
Have you tried contacting Doc J in CT? He's the best pediatric LLMD and if anyone knows, he would!!
Posts: 9020 | From Illinois | Registered: May 2006
| IP: Logged |
posted
I don't know if this is helpful.... A while ago there was a recall of Heparin flushes from certain companies and specific lot numbers---They were found to be contaminated with Serratia marcescens. I am NOT sure it's the same thing you're talking about, but, it might be a different strain of it or something.
Have you used Heparin to flush a Port, PICC, or IV line in the recent months?
Contents of this page: Illustrations Alternative Names Definition Causes Symptoms Exams and Tests Treatment Outlook (Prognosis) Possible Complications When to Contact a Medical Professional Prevention
Illustrations
Heart, section through the middle
Heart, front view
Infective endocarditis
Janeway lesion on the finger
Alternative Names Return to top
Endocarditis - infectious Definition Return to top
Infectious endocarditis is an infection of the lining of the heart chambers and heart valves, caused by bacteria, fungi, or other infectious agents.
Causes Return to top
Infectious endocarditis is an inflammation of the heart valves. Endocarditis is distinguished from infections of heart muscle (myocarditis) or the lining of the heart (pericarditis). Most people who develop infectious endocarditis have underlying heart disease.
Endocarditis is usually a result of bacteremia (bacteria in the blood), which is common during dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures. The bacteria in the bloodstream can settle on damaged heart valves, and grow to create a ``vegetation'' or clump of live bacteria. These growths may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen.
Many bacteria can cause endocarditis in patients with underlying valve problems, but an organism commonly found in the mouth, Streptococcus viridans, is responsible for approximately half of all bacterial endocarditis. Other common organisms include Staphylococcus aureus and enterococcus. Less common organisms include pseudomonas, serratia, and candida. Staphylococcus aureus can infect normal heart valves, and is the most common cause of infectious endocarditis in intravenous drug users.
Symptoms of endocarditis may develop slowly (subacute) or suddenly (acute). Fever is a hallmark of both. In the slower form, fever may be present on a daily basis for months before other symptoms appear. Other symptoms are nonspecific, such as fatigue, malaise (general discomfort), headache, and night sweats. As the illness progresses, small dark lines, called splinter hemorrhages, may appear under the fingernails.
The health care provider may hear changing murmurs in the heart and detect an enlarged spleen and mild anemia. Murmurs result from changes in blood flow across valves when clumps of bacteria, fibrin and cellular debris, called vegetations, collect on the heart valves. The mitral valve is most commonly affected, followed by the aortic valve.
Preexisting conditions that increase the likelihood of developing endocarditis include:
Congenital (present at birth) heart disease (atrial septal defect, patent ductus arteriosus, and others) Prior rheumatic heart disease Cardiac valve anomalies (such as mitral insufficiency) Artificial heart valves Since Streptococcus viridans is often found in the mouth, dental procedures are the most common cause of bacterial endocarditis. This can put children with congenital heart conditions at risk. As a result, it is common practice for children with some forms of congenital heart disease, and adults with certain heart-valve conditions to start on antibiotics prior to any dental work.
Symptoms Return to top
Fatigue Weakness Fever Chills Night sweats (may be severe) Weight loss Muscle aches and pains Heart murmur Shortness of breath with activity Swelling of feet, legs, abdomen Blood in the urine Excessive sweating Red, painless skin spots on the palms and soles (Janeway lesions) Paleness Nail abnormalities (splinter hemorrhages under the nails) Joint pain Abnormal urine color Red, painful nodes (Osler's nodes) in the pads of the fingers and toes Exams and Tests Return to top
A history of congenital heart disease raises the level of suspicion. A physical examination may show an enlarged spleen. The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages. Eye examination may show retinal hemorrhages with a central area of clearing, called Roth's spots.
The following tests may be performed:
Repeated blood culture and sensitivity (#1 test for detection) ESR (erythrocyte sedimentation rate) CBC (complete blood count) may show low grade, microcytic (small red blood cells) anemia Echocardiogram Transesophageal echocardiogram Chest x-ray CT scan of the chest Treatment Return to top
Hospitalization is required initially to administer intravenous antibiotics. Long-term, high-dose antibiotic trearment is required to eradicate the bacteria from the vegetations on the valves. Treatment is usually administered for 4-6 weeks, depending on the organism. The chosen antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivities tests.
If heart failure develops as a result of damaged heart valves, surgery to replace the affected heart valve may be needed.
Outlook (Prognosis) Return to top
Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be damaged if diagnosis and treatment are delayed.
Possible Complications Return to top
Congestive heart failure if treatment is delayed Blood clots or emboli that travel to brain, kidneys, lungs, or abdomen, causing severe damage Arrhythmias (rapid or irregular heartbeat), such as atrial fibrillation Glomerulonephritis Severe valve damage Stroke Brain abscess Neurologic changes Jaundice When to Contact a Medical Professional Return to top
Call your health care provider if you note the following symptoms during or after treatment:
Weight loss without change in diet Blood in urine Chest pain Weakness Numbness or weakness of muscles Fever Prevention Return to top
Preventive antibiotics are often given to people at risk for infectious endocarditis before dental procedures or surgeries involving the respiratory, urinary, or intestinal tract. Continued medical follow-up is recommended for people with a previous history of infectious endocarditis.
Intravenous drug users are also at risk for this condition, because unsterile injecting practices increase the exposure of the bloodstream to infectious agents. Treatment for addiction should be sought. If this is not possible, use of a new needle for each injection, avoiding sharing any injection-related paraphernalia, and use of alcohol pads to sterilize the injection site can reduce risk.
Update Date: 5/26/2006
Updated by: Monica Gandhi MD, MPH, Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
Hospital-Acquired and Institutional-Acquired Pneumonia
Buy the Book
Print This Topic
Email This Topic
Pronunciations
coccal
empyema
Klebsiella
pneumococcal
pneumonia
Pseudomonas
Serratia
staphylococcal
vancomycin
Pneumonia that is acquired in the hospital or another type of institution tends to be far more severe than pneumonia acquired in the community. The organisms in these institutions tend to be more aggressive and harder to treat. Additionally, people in hospitals and nursing homes tend to be sicker even without pneumonia than those living in the community and therefore are not as able to fight the infection.
Staphylococcal Pneumonia: Staphylococcus aureus causes only 2% of community-acquired pneumonias, but it causes 10 to 15% of hospital-acquired pneumonias. This type of pneumonia is most likely to occur while people are hospitalized for another disorder, and it tends to develop in the very young, the very old, and people who are already debilitated by other illnesses. It also tends to occur in alcoholics. Although uncommon, it is serious--the death rate is about 15 to 40%--in part because those who develop staphylococcal pneumonia are usually already seriously ill.
Staphylococcus causes typical pneumonia symptoms, but the chills and fever are more persistent in staphylococcal pneumonia than in pneumococcal pneumonia. Sometimes the symptoms worsen rapidly, with severe and potentially fatal deterioration in lung function. Staphylococcus may occasionally cause collections of pus (abscesses) in the lungs and, in children, may produce lung cysts that contain air (pneumatoceles). Bacteria may be carried from the lung by the bloodstream and produce pus elsewhere. Collections of pus in the pleural space (empyema) are relatively common (see Pleural Disorders: Types of Fluid). These collections are drained using a needle or a chest tube.
Staphylococcal Pneumonia
Antibiotics that are active against Staphylococcus, usually a type of penicillin called oxacillinSome Trade Names PROSTAPHLIN or nafcillinSome Trade Names UNIPEN or the equivalent, are started as soon as possible. However, more and more strains of Staphylococcus are becoming resistant to these penicillins, requiring the use of other antibiotics, such as vancomycinSome Trade Names VANCOCIN .
Gram-negative Bacterial Pneumonia: Gram-negative bacteria, such as Klebsiella (Friedl�nder's pneumonia), Pseudomonas, Enterobacter, Proteus, Serratia, and Acinetobacter, cause pneumonia that tends to be serious.
Gram-negative bacterial pneumonias almost always occur only in people who are hospitalized or who live in nursing homes; they rarely infect the lungs of healthy adults. Gram-negative bacteria are particularly common causes of pneumonia in people who are on ventilators (breathing machines used in intensive care units). Other people at risk are infants, older people, alcoholics, and people with chronic diseases, especially immune system disorders.
The symptoms of gram-negative bacterial pneumonia are the same as for gram-positive pneumonia, except that people tend to be sicker and worsen quickly. Gram-negative bacteria may rapidly destroy lung tissue, so gram-negative pneumonia tends to become serious quickly. Fever, coughing, and shortness of breath are common. The coughed-up sputum may be thick and red--the color and consistency of currant jelly.
Because of the seriousness of the infection, the person is treated intensively in the hospital with antibiotics, supplemental oxygen, and intravenous fluids. Sometimes the person must be put on a ventilator. Despite receiving excellent treatment, about 25 to 50% of people with gram-negative pneumonia die.
Last full review/revision February 2003
IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic