Pulmonary complications of infective endocarditis in intravenous drug users

Abstract

Pulmonary manifestations of infective endocarditis (IE) in intravenous drug users may resemble variety of diseases and result from systemic effects of infection, metastatic foci and emboli. The objective of the study was to analyze the pulmonary complications of IE and evaluate their role in the clinical course of disease in intravenous drug users. 100 intravenous drug users with IE (86 male, 14 female) at the age from 16 to 54 years (average age 28 years) were observed. There were used clinical, bacteriologic and instrumental methods. Diagnosis of IE fulfilled the modified Duke criteria.(2000). Pulmonary complications of IE were revealed in 74% patients. The onset of IE in most patients was acute. High activity of IE was in 76% patients. Primary diagnosis of pneumonia was in 45% intravenous drug users with IE. The pulmonary symptoms included cough (43%), dyspnoe (70%), hemophtysis (20%), chest pain (23%). Pulmonary complications of IE in intravenous drug users included pneumonia in 74%, pleurisy in 21%, hydrothorax in 12%, lung abscess in 4% patients. Bilateral location of infiltrates was noted 74% patients with pulmonary complications. Respiratory insufficiency was in 57% patients. Destructive pneumonias developed in 25% patients and in the most cases were caused by S. aureus. Pleuro-pulmonary manifestations were noted more frequently when right sides of the heart were affected. Thus, pneumonia was in 81% patients with right-sided IE, and in 60% patients with left-sided IE (p=0.04), pleurisy in 27% and 8% (p=0.04), hydrothorax in 17% and 3%, lung abscess in 6% and 4% patients respectively. Pulmonary emboli or pneumonia are common complications of IE in intravenous drug users. The knowledge of PM of IE in intravenous drug users is important for early diagnostics and treatment.