Diagnosis Of Infective Endocarditis Research Articles

The role of imaging in infective endocarditis.

Infective endocarditis (IE) poses a large diagnostic and therapeutical challenge. An early diagnosis is necessary for a positive outcome. Echocardiography is initial diagnostic method when there is a possibility of IE presence. TTE and TEE are useful in detection, accurate localisation and estimation of vegetation size, and also in detection of paravalvular spreading of infection. In certain situations, there is a need for usage of complementary methods like CCT and nuclear techniques. This article will outline advantages and limitations of certain diagnostic methods in diagnosis of IE.

Infective Endocarditis in Hypertrophic Obstructive Cardiomyopathy After Etonogestrel Implant Removal

The modified Duke criterion "predisposing heart condition" is poorly defined, and is based on outdated studies of the epidemiology of infective endocarditis (IE).Hypertrophic obstructive cardiomyopathy (HOCM) is not classified as a modified Duke criterion for the diagnosis of IE but is associated with a higher incidence of IE nonetheless. The presence of a cardiovascular implantable electronic device (CIED) is independently associated with an increased risk of IE. Patients with HOCM may be candidates for the implantation of an automated internal cardiac defibrillator (AICD) for the prevention of sudden cardiac death. Previous studies of the risk of IE in patients with HOCM did not make a distinctionfor patients with CIEDs. We present a case of a 25-year-old female with HOCM and an AICD for primary prevention, who presented with sudden right-sided hemiplegia, aphasia, dysarthria, and a low-grade fever. CT angiography demonstrated large vessel occlusion of the terminal left internal carotid artery and proximal middle cerebral artery (MCA), prompting emergent treatment with mechanical thrombectomy, which achieved full recanalization and full reperfusion. Cardioembolic stroke was suspected. She had no arrhythmias, a transthoracic echocardiogram showed new mitral valve vegetation. The etiology of the stroke was determined to be septic emboli from mitral valve subacute bacterial endocarditis and two blood cultures grew staph epidermidis. Ten days prior to presentation, she had undergone removal of an etonogestrel implant in her arm, and this was the suspected source of initial bacteremia and valvular seeding. She was treated with a six-week course of vancomycin with improvement and maintained on daily minocycline as long as the AICD were to remain in place. Our patient started developing symptoms of endocarditis after the removal of her etonogestrel implant, had no other recent procedures, and had good dentition. Hence, we maintainthat this was the likely source of her initial bacteremia that led to valvular seeding and resultant IE. This is the first reported case of etonogestrel implant removal-related endocarditis. Further studies of the association between etonogestrel implant removal, transient bacteremia, and valvular seeding leading to IE are warranted. Clinicians should be reminded of the increased risk of IE in patients with HOCM. Identifying HOCM patients at higher risk for IE, i.e. dilated left atrium and/or CIEDs is easier to accomplish with current cardiac imaging techniques.

New criteria for the diagnosis of infective endocarditis using 18F-FDG PET/CT imaging

The purpose of this study was to examine a qualitative scoring system and a semi-quantitative method of FDG-PET/CT imaging in the diagnosis of infective endocarditis (IE). We retrospectively included 108 patients who underwent 18F-FDG-PET/CT for suspected IE. PET/CT scans were interpreted using a 4-point score (0 = no uptake; 1 = cardiac uptake < blood-pool activity; 2 = blood-pool < uptake < liver activity; 3 = uptake > liver) and semi-quantitatively using SUVmax and SUVmean of the suspected valve lesion, liver, spleen, and of the bone marrow (BM). BM and spleen SUVmean were normalized to the liver, and hypermetabolism (HSBM) was defined as a BM or spleen-to-liver ratio > 1. Comparing the score criteria results with the clinical final diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of qualitative criteria were 93%, 81%, 84%, 91%, and 87%, respectively. A definite IE was documented in 83% of patients showing HSBM and abnormal cardiac uptake, 44% with abnormal cardiac uptake, 28% with HSBM, and 10% with neither one. The qualitative scoring system is helpful in the diagnosis of IE. The HSBM is an additional, reliable indirect sign of IE.

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

Objective: Pregnancy and postpartum infective endocarditis (PPIE), although uncommon, is a very serious condition. To describe cases of infectious endocarditis (IE) in in a cohort of adults with IE in a Brazilian center and to review data from the recent literature on the subject. Methods: Cases of definite IE by the modified Duke criteria in adults were retrieved in a contemporary cohort of adults with IE from January 2006 to December 2020. Literature review on the topic was carried out and case reports on PPIE from 2014 to 2020 were compiled. Results: Two cases of PPIE were found in 401 adult patients with IE, with a prevalence of 0.5% in the cohort, of 2/139 (1.4%) among women and 2/83 (2.4%) of women of reproductive age (18 -49 years) in this same cohort. The search for published case reports from 2014 to 2020 resulted in 61 episodes of PPIE; in these, 7 pregnant women (11.4%), 10 fetuses (16.4%) and 1 premature newborn (1.6%) died. There was a previous valve predisposition in 12 (19.7%) cases and intravenous drug use in 14(23%). Left-sided valves were the most frequently affected in 41 (67.2%) of the cases. The most common isolated infectious agent was methicillin sensitive Staphylococcus aureus in 18/61 (29.5%) patients, although as a group, oral viridans streptococci accounted for 16/61 (26.2%). Valve surgery was done for 70% of patients. Conclusions: Intravenous drug use remained to be the main risk factor for IE. Mortality remained high for mothers and their children, despite the fact surgery was done more frequently in the recent cases. In the case of fever without an obvious focus in pregnant or post-partum women, the diagnosis of IE must be readily considered, especially in those with prosthesis and/or intravenous drug use.

Infective endocarditis and COVID-19: the impact of SARS-CoV-2 infection on diagnostics, course, and prognosis

Aim. To study the impact of coronavirus disease 2019 (COVID-19) pandemic on hospitalization rates, diagnosis, and outcomes of infective endocarditis (IE) with a subanalysis of IE course in combination with COVID-19.Material and methods. This prospective cohort study included 168 patients with definite or probable IE (DUKE 2015) hospitalized in the V.V. Vinogradov City Clinical Hospital from July 2017 to July 2022. All patients underwent a conventional examination in accordance with current clinical guidelines. We studied clinical, paraclinical and etiological parameters, as well as outcomes.Two clinical observations of the combination of IE and COVID-19 are presented.Results. When assessing the local registry of patients with IE, a trend towards an increase in hospitalizations rate of IE in 2021-2022 was shown, with a decrease during the period of long-term lockdowns in Moscow and a subsequent surge after their cancellation. Patients with IE during the COVID-19 pandemic had a more favorable clinical profile, a 2-fold increase in IE diagnosis (due to late hospitalization), frequent detection of Staphylococcus aureus MSSA (32,6%), and frequent surgical treatment (up to 87,6% with a combination of IE and COVID-19), as well as high in-hospital mortality, but without a tendency to increase (30,4%). Clinical observations of IE and COVID-19 combination are presented, which demonstrates the contribution of COVID-19 as the only risk factor for native tricuspid valve IE in a patient without predisposing causes, as well as a factor in the unfavorable prognosis for native aortic valve IE after the addition of COVID-19, which led to lethal outcome.Conclusion. The present study demonstrates the profile of patients with IE and COVID-19 depending on the epidemiological situation of COVID-19 and the association with SARS-CoV-2 infection. The data obtained make it possible to discuss the potential relationship between COVID-19 and IE. The "endocarditis team" determines the timely implementation of surgery and the absence of an increase in inhospital mortality, regardless of the epidemiological situation.

Feasibility of Low-Seated Composite Aortic Conduit for Surgical Treatment of Prosthetic Valve Endocarditis: A Case Report

Background: A 49-year-old male presented with a delayed diagnosis of infective endocarditis leading to extensive intracardiac destruction. Such cases present technical challenges to operative debridement as crucial anchoring points for replacement conduits are compromised. Case Presentation: Our patient presented at age 49 with nausea, lethargy, and diarrhea 2 weeks after recent travel. His prior history included bioprosthetic valve replacement for a bicuspid aortic valve. The patient was first given a trial of antimicrobials for a suspected UTI. Subsequently, he was admitted briefly to an outside hospital for a “cardiac work-up,” which returned negative. The patient sought care for the third time, during which he developed unstable supraventricular tachycardia, prompting echocardiography 16 days following the onset of symptoms. Echocardiography demonstrated a 6 cm abscess cavity invading the interventricular septum with a fistula into the left ventricular outflow tract, multiple ventricular septal defects (VSD), and suspected fistulae into the right ventricular outflow tract. The patient was treated with valve explant and extensive debridement. A valved-conduit for the aorta could not be sewn to the aortic annulus in the usual fashion due to destruction and debridement of the annulus, so a neo-annulus was created using the anterior leaflet of the mitral valve and the left ventricular outflow tract of the heart below the level of the VSDs. A mechanical-valved conduit was implanted onto the neo-annulus. A pacemaker was subsequently implanted. Conclusion: In patients with extensive intracardiac destruction with the compromise of the aortic annulus due to infective endocarditis, a low-seated, mechanical-valved conduit implanted directly to the aorto-mitral curtain and left ventricular outflow tract should be considered a novel, durable reconstructive option that allows complete debridement of infected tissues.

Imaging of Septic Pulmonary Embolism in Right-Side Infective Endocarditis

Early and correct diagnosis of infective endocarditis (ie) of the right heart does not lose its importance due to the persistence of the problem of intravenous drug use and an increase in the number of surgical interventions on the heart. Septic pulmonary embolism (spe) is a typical sign of right-side ie, and, with a number of nonspecific respiratory symptoms in patients with fever, its detection by radiology allows to start a diagnostic search for ie and locate the primary embolic source in the right parts of the heart. The review examines the current state of the problem of right-side ie, morphology and clinical evidence, main ct signs and differential diagnostics of spe, including the context of the covid-19 pandemic.

Impact of Opioid Epidemic on Infective Endocarditis Outcomes in the United States: From the National Readmission Database

Infective endocarditis (IE) is associated with marked morbidity and mortality in the United States and parallels the opioid pandemic. Few studies explore this interaction and its effect on clinical outcomes. We analyzed contemporary patients admitted with IE to determine predictors of readmission in the United States. The 2017 National Readmission Database was used to identify index admissions in adults with the diagnosis of IE, based on the International Classification of Disease, 10th Revision codes. The primary outcome of interest was 30-day readmission. Secondary outcomes were mortality, hospital charges, and predictors of hospitalization readmission. Of 40,413 index admissions for IE, 5,558 patients (13.8%) were readmitted within 30 days. Patients who were readmitted were younger (55 ± 20 vs 61 ± 19 years, p <0.001) and more likely to have end-stage renal disease (12.2% vs 10.5%, p <0.001), hepatitis C virus (19.4% vs 12.6%, p <0.001), HIV (1.8% vs 1.2%, p=0.001), opioid abuse (23.9% vs 15%, p <0.001), cocaine use (7.3% vs 4.4%, p <0.001), and other substance abuse (8.5 vs 5.6, p <0.001). Patients readmitted were less likely to have diabetes mellitus (27.8% vs 29.4%, p=0.01), hypertension (56.9% vs 64%, p <0.001), heart failure (37.7% vs 40%, p <0.001), chronic kidney disease (31.2% vs 32%, p <0.001), and peripheral vascular disease (3.6% vs 4.6%, p=0.001). The median cost of index admission for the total cohort was $84,325 (39,922 to 190,492). After adjusting for age, diabetes mellitus, heart failure, hypertension, and end-stage renal disease, opioid abuse (odds ratio [OR] 1.34; 95% confidence interval [CI] 1.23 to 1.46; p <0.001), cocaine use (OR 1.32; 95% CI 1.17 to 1.48; p <0.001), other substance abuse (OR 1.16; 95% CI 1.04 to 1.30; p=0.008), and hepatitis C virus (OR 1.32; 95% CI 1.21 to 1.43; p <0.001) correlated with higher odds of 30-day readmission. These factors may present targets for future intervention.

Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement.

Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases may vary according to sex. This multicentre study aimed to determine the sex differences in clinical characteristics, management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579 patients (217 women, 37.5%) who had the diagnosis of definite IE following TAVR were included retrospectively from the Infectious Endocarditis After TAVR International Registry. Women were older (80 ± 8 vs 78 ± 8 years; P= 0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological profiles were similar between men and women, but culture-negative IE was more frequent in women (9.9% vs 4.3%; P= 0.009). A high proportion of patients had a clinical indication for surgery (54.4% in both groups; P= 0.99), but a surgical intervention was performed in a minority of patients (women 15.2%, men 20.3%; P= 0.13). The mortality rate at index IE hospitalisation was similar in both groups (women 35.4%, men 31.7%; P= 0.37), but women exhibited a higher mortality rate at 2-year follow-up (63% vs 52.1%; P= 0.021). Female sex remained an independent risk factor for cumulative mortality in the multivariable analysis (adjusted HR 1.28, 95% CI 1.02-1.62; P= 0.035). After adjustment for in-hospital events, surgery was not associated with better outcomes in women. There were no significant sex-related differences in the clinical characteristics and management of IE after TAVR. However, female sex was associated with increased 2-year mortality risk.

Pathogen Detection in Infective Endocarditis Using Targeted Metagenomics on Whole Blood and Plasma: a Prospective Pilot Study.

Initial microbiologic diagnosis of infective endocarditis (IE) relies on blood cultures and Bartonella and Coxiella burnetii serology. Small case series and one prospective study have preliminarily reported application of metagenomic sequencing on blood or plasma for IE diagnosis. Here, results of a prospective pilot study evaluating targeted metagenomic sequencing (tMGS) for blood-based early pathogen detection and identification in IE are reported. Subjects diagnosed with possible or definite IE at a single institution were prospectively enrolled with informed consent from October 2020 to July 2021. Blood was drawn and separated into whole blood and plasma. Both specimen types were subjected to nucleic acid extraction and PCR targeting the V1-V3 region of the 16S ribosomal RNA gene, followed by next-generation sequencing on an Illumina MiSeqTM platform. 35 subjects, 28 (80%) with definite and 7 (20%) with possible IE were enrolled, including 6 (17%) with blood culture-negative endocarditis (BCNE). Overall, 20 whole blood (59%) and 16 plasma (47%) samples tested positive (P = 0.47). When results of whole blood and plasma testing were combined, a positive tMGS result was found in 23 subjects (66%). tMGS identified a potential pathogen in 5 of 6 culture-negative IE cases. Although further study is needed, the results of this pilot study suggest that blood-based tMGS may provide pathogen identification in subjects with IE, including in culture-negative cases.

Infective Endocarditis in Pregnancy: A Contemporary Cohort.

Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort. We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria. Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry. These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center. · Intravenous drug use was the most common risk factor for IE in pregnancy.. · IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation.. · A multidisciplinary team approach can assure the best possible maternal and fetal outcomes..

Infective endocarditis in pregnant women without intravenous drug use: a multicentre retrospective case series.

To describe the clinical features and outcomes of infective endocarditis (IE) in pregnant women who do not inject drugs. A multinational retrospective study was performed at 14 hospitals. All definite IE episodes between January 2000 and April 2021 were included. The main outcomes were maternal mortality and pregnancy-related complications. Twenty-five episodes of IE were included. Median age at IE diagnosis was 33.2 years (IQR 28.3-36.6) and median gestational age was 30 weeks (IQR 16-32). Thirteen (52%) patients had no previously known heart disease. Sixteen (64%) were native IE, 7 (28%) prosthetic and 2 (8%) cardiac implantable electronic device IE. The most common aetiologies were streptococci (n = 10, 40%), staphylococci (n = 5, 20%), HACEK group (n = 3, 12%) and Enterococcus faecalis (n = 3, 12%). Twenty (80%) patients presented at least one IE complication; the most common were heart failure (n = 13, 52%) and symptomatic embolism other than stroke (n = 4, 16%). Twenty-one (84%) patients had surgery indication and surgery was performed when indicated in 19 (90%). There was one maternal death and 16 (64%) patients presented pregnancy-related complications (11 patients ≥1 complication): 3 pregnancy losses, 9 urgent Caesarean sections, 2 emergency Caesarean sections, 1 fetal death, and 11 preterm births. Two patients presented a relapse during a median follow-up of 3.1 years (IQR 0.6-7.4). Strict medical surveillance of pregnant women with IE is required and must involve a multidisciplinary team including obstetricians and neonatologists. Furthermore, the potential risk of IE during pregnancy should never be underestimated in women with previously known underlying heart disease.

Multivalvular Endocarditis: A Rare Condition with Poor Prognosis.

Background. Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE). Methods. We used a retrospective analysis of the Spanish IE Registry (2008–2020). Results. From 4064 definite cases of valvular IE, 577 (14.2%) had MIE. In patients with MIE, the most common locations were mitral (552, 95.7%) and aortic (550, 95.3%), with mitral-aortic involvement present in 507 patients (87.9%). The most common etiologies were S. viridans (192, 33.3%) and S. aureus (113, 19.6%). MIE involved only native valves in 450 patients (78.0%). Compared with patients with SIE, patients with MIE had a similar age (69 vs. 67 years, respectively, p = 0.27) and similar baseline characteristics, but were more frequently men (67.1% vs. 72.9%, p = 0.005) and had a higher incidence of intracardiac complications (36.2% vs. 50.4%, p < 0.001), heart failure (42.7% vs. 52.9%, p < 0.001), surgical indication (67.7 vs. 85.1%, p < 0.001), surgery (46.3% vs. 56.3%), and in-hospital mortality (26.9% vs. 34.3%, p < 0.001). MIE was an independent predictor of in-hospital mortality (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1–1.7, p = 0.004) but did not have an independent association with 1-year mortality (OR 1.1, 95% CI 0.9–1.4, p = 0.43). Conclusions. About one-seventh of the valvular IE patients had MIE, mainly due to mitral-aortic involvement. MIE is associated with a poor in-hospital prognosis. An early diagnosis and treatment of IE might avoid its spread to a second valve.

A Review on Updated Species List of Viridans Streptococci causing Infective Endocarditis

Viridans streptococci are important causative organism of infective endocarditis, which is a disease having long-lasting effects among the patients who live with the disease as well as those who are cured. Infective endocarditis due to viridans streptococci generally usually affects persons with structural heart disease and is also associated with intravascular prosthetic devices. After the onset of bacteremia with the pathogenic viridans streptococci, vegetation is formed in one or more heart valves. The diagnosis of infective endocarditis due to viridans streptococci is difficult to establish in patients with underlying risk factors and it involves the correlation of microbiological (in-vitro growth of viridans streptococci), clinical, and echocardiography results (modified Duke criteria). The common microorganisms are Staphylococcus spp., Enterococcus spp followed by viridans streptococci. The details of viridans streptococci causing infective endocarditis were reviewed in detail. Viridans streptococci possess a challenge in identification up to its species level and which helps in the identification of the source of infection as well as treating the infection.

LATE DIAGNOSIS OF INFECTIVE ENDOCARDITIS: CLINICAL CASE REPORT

Infective endocarditis is a rare but clinically variable and difficult to diagnose disease. Delayed diagnosis of infective endocarditis can lead to total valve damage, which can require surgical treatment. We present a case report of a 36-year-old patient admitted to the hospital because of swelling and pain in the left shin and febrile fever. Two-dimensional transthoracic echocardiography was performed and infective endocarditis was suspec­ted. ¹⁸F-FDG PET-CT did not confirm the diagnosis of infective endocarditis and the patient was discharged as an outpatient with antibiotic therapy. The patient was readmitted with persistent inflammatory markers. Tran­sesophageal echocardiography showed a ruptured mitral valve with severe regurgitation. When the inflammatory parameters were reduced by antibiotic therapy, the patient underwent mechanical mitral valve replacement surgery. The patient had an uncomplicated postoperative period.

Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications.

BackgroundCritical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs.Patients and methodsData for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes.ResultsThe mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004.ConclusionSeptic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis.How to cite this articleAyad RD, Andraos AW, Taema KAE, Attia IM, Yehia M. Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications. Indian J Crit Care Med 2022;26(8):930–934.

The clinical pattern differentiates ANCA-positive infective endocarditis patients from ANCA-associated vasculitis patients: a 23years' retrospective cohort study in China and follow-ups.

ObjectivesPatients with infective endocarditis (IE) may present rheumatic manifestations concurrent with various autoantibodies and thus mimic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aims to characterize the specific features in a long-term cohort of ANCA-positive IE patients and to perform comparative analysis with primary AAV patients.MethodsWe performed a retrospective thorough review of 475 consecutive IE patients over 23 years, identifying 22 patients positive for proteinase 3 and/or myeloperoxidase and 36 treatment-naïve AAV patients. The clinical, laboratory, and follow-up data were collected to perform comparative analysis.ResultsOur study illustrated that ANCA-positive IE patients were younger and had a shorter duration than AAV patients. Pulmonary lesions, ENT signs, peripheral neuropath, and proteinuria were more commonly seen in AAV patients, while heart valve involvement, spleen enlargement, and cerebral hemorrhage were more typical for IE patients (all p < 0.05). Besides, ANCA-positive IE patients presented a higher level of PR3-ANCA but lower C3 (both p < 0.05). Hyperleukocytosis and thrombocytopenia were more frequently found in AAV patients (both p < 0.05). No significant difference was noticed in the survival rate.ConclusionsOur study urges the early differential diagnosis of IE in ANCA-positive patients. It supports the claim that ANCA-positive IE patients and AAV patients do not share the same clinical spectrum. Echocardiography, serological profiles, and evaluation of multi-organ involvement might be required to improve diagnostic accuracy.Key Points•Early differential diagnosis of ANCA-positive IE from AAV is challenging even for expert rheumatologists.•Our study is so far one of the largest to include 22 ANCA-positive IE patients in one single center and spanning over 23 years. It is also the first study to include both ANCA-positive IE patients and AAV patients in one center.•Our study aides to identify a clinical picture to differentiate ANCA-Positive IE Patients from AAV Patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06313-w.

Diagnostic accuracy of splinter haemorrhages in patients referred for suspected infective endocarditis

ObjectiveSplinter haemorrhages are an examination finding that has classically been associated with infective endocarditis (IE), but are not included in current diagnostic algorithms. Splinter haemorrhages have not been evaluated as...

Infective Endocarditis in People Who Inject Drugs: Report from the Italian Registry of Infective Endocarditis.

Intravenous drug use is a predisposing condition for infective endocarditis (IE). We report the clinical features of IE, taken from the Italian Registry of IE, in people who inject drugs (PWIDs). The registry prospectively collected epidemiological, clinical, in-hospital, and follow-up data on patients with IE from 17 Italian centers. A total of 677 patients were enrolled, and 61 (9%) were intravenous drug users (IDUs). Most PWIDs were male (78.6%), and aged between 41 and 50 years old (50%). The most frequent comorbidities were HIV (34.4%) and chronic liver disease (32%). Predisposing factors for IE were present in 6.5% of the patients, and 10% had minor valvular abnormalities. IE had occurred previously in 16.4% of the patients, and 50% of them had undergone heart surgery. Overall mortality was 9.8% in IDUs and 20% in patients with recurrent IE. IE in PWIDs mostly affected the native valves (90%). The echocardiographic diagnosis of IE was based on the detection of vegetation in 91.82% of cases. Staphylococcus aureus was the main microorganism isolated (70%) from blood cultures. Thirty patients (49%) underwent heart surgery: thirteen had aortic valves, eleven had mitral valves, and six had tricuspid valve interventions. IE in PWIDs was relatively common, and patients with native valve right-sided IE had a better prognosis, with a low rate of surgical interventions.

Infectious endocarditis in HIV-infected intensive care unit patients

Infective endocarditis (IE) is one of the most common cardiac complications in HIV patients who are intravenous drug addicts. The presence of IE and secondary diseases in immunocompromised individuals usually requires specific diagnostic and therapeutic approach.Aim: Optimizing the diagnosis of IE in patients with advanced HIV/AIDS.Materials and methods We reviewed 429 case records of HIV/AIDS ICU patients using the modified duke criteria for diagnosis of infective endocarditis. Statistical significance (p &lt;0.05) of data was assessed using the χ2 test.Results. 25 patients were diagnosed with IE. The male gender dominated – 68%. Mean age was 38. 60% had stage 4B HIV infection. 68% were ART naive. The medium viral load was 294560 copies / ml, while the medium CD4 count was 218 cells / μl. Fever of &gt;38°C was a key symptom found in all patients. Blood cultures were positive in 60% cases. 80% had a high C reactive protein (CRP), and 44% had CRP levels above 100 mg/l. Procalcitonin (PCT) levels were increased in 52%. Echocardiogram revealed IE in 92%. Pneumonia was diagnosed in 92%. Fatal outcome occurred in 76%. Anemia was a predictor of severe outcome (p&lt;0.002), while patients with leukocytosis had good prognosis (p&lt;0.05).Conclusion. Infective endocarditis is a common complication among HIV IDUs. The most common diagnostic criteria are fever &gt;38°C, pneumonia, anemia, leukocytosis, thrombocytopenia and echocardiographic findings. The levels of the hemoglobin and WBCs could evaluate prognosis of the disease outcome.