Clinical Characteristics and Outcome of Patients with Infective Endocarditis Diagnosed in a Department of Internal Medicine.

Louis Kreitmann,Hélène Maillard,David Launay,Vincent Sobanski,David Montaigne,Eric Hachulla,Sandrine Morell-Dubois,Marc Lambert

doi:10.3390/jcm9030864

Abstract

Clinical manifestations of infective endocarditis (IE) can be highly non-specific. Our objective was to describe the clinical characteristics of patients initially referred to a department of internal medicine for a diagnostic work-up, and eventually diagnosed with IE. We retrospectively retrieved adult patients admitted to the department of internal medicine at Lille University Hospital between 2004 and 2015 who fulfilled Duke Classification criteria for definite IE. Thirty-five patients were included. The most frequently involved bacteria were non-hemolytic streptococci. Most patients presented with various systemic, cardiac, embolic, rheumatic, and immunological findings, with no sign or symptom displaying high sensitivity. The first transthoracic echocardiogram was negative in 42% of patients. Furthermore, definite diagnosis required performing at least 2 transesophageal examinations in 24% of patients. We observed a trend towards decreased survival in the subgroup of patients in whom the delay between onset of symptoms and diagnosis was >30 days. In conclusion, patients who are initially referred to internal medicine for a diagnosis work-up and who are ultimately diagnosed with IE have non-specific symptoms and a high percentage of initial normal echocardiography. Those patients require prolonged echocardiographic monitoring as a prolonged delay in diagnosis is associated with poorer outcomes such as death.

Highlights

Infective endocarditis (IE) is defined by infection of the endocardial surface of the heart, usually the valves [1,2], affecting about 5–15 per 100,000 people per year [3]
While several reports have described the extra-cardiac manifestations of infective endocarditis (IE), there have been few studies, to our knowledge, focusing on patients first referred to an internal medicine department for a diagnostic work-up, in whom clinical investigations led to the diagnosis of IE
Seventy-six patients were diagnosed with IE during their hospital stay in the internal medicine department between 2004 and 2015

Summary

Introduction

Infective endocarditis (IE) is defined by infection of the endocardial surface of the heart, usually the valves [1,2], affecting about 5–15 per 100,000 people per year [3]. Despite prominent cardiac and septic manifestations, various signs and symptoms can be found [8,9], which are related to the immunological and embolic complications of IE, affecting the brain [10,11], skin [12,13,14], bones and joints [15,16], kidneys [17,18], and/or eyes This clinical variability can cause a significant delay in the diagnosis of IE and can negatively affect patients’ prognosis [19,20].

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