Pulmonary onset and complications of intravenous drug users infective endocarditis

Abstract

Introduction: Pulmonary onset and complications (PC) in intravenous drug users (IDU) infective endocarditis (IE) may resemble variety of diseases and result from systemic effects of infection, metastatic foci and emboli. Purpose: To analyze the pulmonary onset and PC in IDU with IE. Methods: The study consisted of 300 IDU (heroin, hydromorphone, desomorphine, acetylfentanil) with IE (2012-17). All the cases included fulfilled the Duke criteria, mean age of pts - 26 years, women - 26%. Results: Among IDU with IE PC were revealed in 72%. All patients had primary form and high IE-activity. Etiology: high incidence of staphylococci (70%), gram-negative bacteria (10%), fungi (5%) and mixed virulent organisms (10%). Pulmonary onset included cough (52%), dyspnoe (34%), hemophtysis (27%), chest pain (43%), fever (90%) and leaded to diagnostic mistakes in 30% pts. PC included pneumonia in 72%, pleuritis in 33%, hydrothorax in 19%, lung abscess in 15%, pneumothorax in 6% pts. Pulmonary insufficiency was in 67% pts. Destructive pneumonias developed in 52% pts and in the most cases were caused by S. aureus. Mortality at discharge was 25%, at 6 months 35%. On morphological examination there were revealed inflammatory foci with microabscess formation and hemorrhagic infarcts in the lung tissue. Conclusions: The existence of pulmonary embolism simulating pneumonia was the first clue to diagnosis of IE in IDU. Echo detected the vegetations on tricuspid valve and confirmed the diagnosis. The pulmonary onset and PC knowledge of IDU IE is important for early diagnostics in any clinical department of a modern hospital.