Form Of Infective Endocarditis Research Articles

Clinical and morphological features of infective endocarditis of native and prosthetic heart valves

Aim. To evaluate clinical and morphological data of infective endocarditis (IE) of native and prosthetic heart valves.Material and methods. This retrospective cohort study included 354 patients that had signs of IE according to pathological study of surgical material from native valves and prosthetic heart valves. The patients were divided into two groups: the first group included patients with native valve IE (n=328), while the second group — with prosthetic valve IE (n=26).Results. Among patients with native valve IE, aortic (AV) and mitral valve (MV) IE was recorded in 67,6% and 20,7%, respectively. In the group of patients with prosthetic IE, AV IE also predominated — 57,7% vs 26,9% in MV IE. In the majority of patients in the first group, secondary IE was detected (68,9%). The development of IE in the presence of bicuspid AV (BAV), degenerative AV disease, and rheumatic valve disease was revealed in 40,7%, 31,4% and 6,7%, respectively. In the group of patients with native valve IE, subactive IE was most often detected — in 38,4%, while in 7,1% — signs of process remission were detected. In the group of patients with prosthetic valve IE, IE with moderate activity was detected more often than in the group of patients with native valve IE (42,3% vs 26,8%, p=0,042). In the group of patients with prosthetic valve IE, the presence of colonies of microorganisms and neutrophilic infiltration in the histological material was somewhat more common, while in patients with native valve IE there was a tendency towards a higher percentage of necrosis in the studied material (42,4% vs 38,5%, p>0,05).Conclusion. This work confirms changes in the epidemiological characteristics of patients with IE. A high frequency of subactive forms of IE was noted according in patients with native valve IE, which requires individual approach to antibacterial therapy depending on the pathomorphological IE activity.

Indication and Timing of Surgery in Patients with Endocarditis of the Tricuspid Valve

Endocarditis of the right heart is a particular form of infective endocarditis, it often affects intra venous (IV) drug addicts, it can be severe, its diagnosis is based on Duke's criteria, it can be complicated by pulmonary or paradoxical emboli which can sometimes worsen the clinical situation, in addition to antibiotics surgical treatment is sometimes necessary for recovery, the indication for which depends on several clinical, anatomical, and biological criteria. The aim of this review is to illustrate the indications and place of the different surgical methods in the management of tricuspid endocarditis, as well as the best time for the operation.

Perceived Stress in Relation to Demographics and Clinical Forms among Patients with Infective Endocarditis: A Cross-Sectional Study.

(1) Background: Infective endocarditis (IE) is a disease of the endocardial surface of the heart, caused by infection of the native or prosthetic valve or an indwelling cardiac device. Apart from IE predisposing risk factors that include heart conditions and medical procedures, the novel trajectories from demographic factors to perceived stress conditions have been under investigation in recent years. The aim of the present study was to evaluate the associations between perceived stress and demographic characteristics as well as clinical forms of IE among survivors of IE in Kaunas, Lithuania. (2) Methods: A cross-sectional study among IE cases (n = 135) at the Lithuanian University of Health Sciences Kaunas Clinics Cardiology department during the period 2014-2017 was performed. Data about IE clinical features, sociodemographic characteristics and perceived stress level (Perceived Stress Scale (PSS-10)) upon diagnosis were collected. Package "SPSS 25.0" was used in the statistical analysis. Logistic regression analysis was performed including gender, previous occupation, place of residence and clinical forms of IE in the analysis of perceived stress among survivors of IE. The STROBE checklist for cross-sectional studies was used in this study. (3) Results: Perceived stress was experienced by 54.8 percent of the respondents. In the final model, the OR (odds ratio) of perceived stress for females was 2.07 as compared to men; for rural residents, the OR was 2.25 as compared to urban residents. These results were statistically significant. A tendency for increased OR of perceived stress for low-skilled workers as compared to high-skilled ones and classical IE clinical form as compared to non-classical form was observed, but these results were not statistically significant. (4) Conclusions: The present study is an attempt to focus the attention of IE researchers on the effects of psychological state in the disease development. Differences in perceived stress and some demographic characteristics, as well as tendencies of IE clinical forms, were observed among survivors of IE in Kaunas, Lithuania.

Clinical Characteristics of a Zoonotic Occupational Disease—Brucella endocarditis with Review of Literature

Abstract Background Brucellosis is a zoonotic bacterial infection caused by a gram-negative aerobic coccobacillus. It can have varied presentation. Most severe complications include neurological and cardiovascular involvement (most commonly in the form of infective endocarditis). Aortic valve is most commonly involved (75%). Blood culture is highly specific, while serologic tests are more sensitive for diagnosing brucellosis. Transthoracic and transesophageal echocardiography plays a major role in diagnosing infective endocarditis. Treatment of Brucella endocarditis includes combination of antibiotic therapy and surgical valve replacement. We are presenting here a case series of seven cases of B. endocarditis with different presentations and varied underlying cardiac conditions. Materials and Methods Total seven cases of B. endocarditis were reported. The age group ranges from 22 to 45 years. Majority of them were from agriculture and dairy industry. All have presented with fever and three patients had severe breathlessness. Three cases were rheumatic valve diseases, one was bicuspid aortic valve, and one was congenital heart disease with prosthetic valve. Six patients had native valve endocarditis (four had predisposing cardiac condition with diseased valves, two had normal valves), whereas one had prosthetic valve endocarditis. Four had aortic valve involvement and three had mitral involvement. All cases were diagnosed using blood culture, serology, and echocardiography. Conclusion All were treated initially with antibiotics and valve replacement was done in five cases. Mortality was the outcome in two cases on conservative treatment and before surgery. Other five patients recovered after surgery.

A RARE CASE OF NATIVE TRIPLE-VALVE INFECTIVE ENDOCARDITIS

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Infective endocarditis (IE) is a life-threatening infection. Despite medical advances, mortality from IE remains high. Enterococcal IE is becoming more prevalent in elderly patients with degenerative valvular disease and bloodstream infections from gastrointestinal (GI) or genitourinary (GU) tracts. We present a rare case of native triple-valve infective endocarditis. CASE PRESENTATION: A 58-year-old man with a history of squamous cell carcinoma of tongue post hemiglossectomy with chemoradiation therapy and small bowel obstruction post open laparotomy a month earlier presented for altered mental status. Initial vitals showed tachycardia and was otherwise normal. Positive examination findings were cachexia, a healed partial tongue resection, decreased air entry over lung bases and left upper abdominal tenderness without peritonitis. The rest of the physical exam was unremarkable. Initial lab results were significant for leukocytosis, mild anemia, elevated BUN and creatinine. Computed tomography (CT) of chest and abdomen showed a large left lower lobe consolidation, right lower lobe patchy parenchymal disease and gastric wall thickening. He was started empirically on Zosyn, vancomycin and fluconazole. Blood cultures grew Enterococcus faecalis and transthoracic echocardiogram (echo) showed an acute-on-subacute endocarditis with vegetations on the tricuspid, mitral and aortic valves with ejection fraction 65-70%. Bronchoscopy with bronchoalveolar lavage (BAL) culture was positive for Candida Glabrata 3 days after his death. He later developed septic shock with multiorgan failure and was considered ineligible for surgery. Despite optimal medical therapy and no worsening of echo findings, he ultimately died. DISCUSSION: Multivalvular IE increases the likelihood of complications from congestive heart failure, acute renal failure, embolic events, disseminated intravascular anticoagulation and death (1). Enterococcus faecalis is an opportunistic pathogen in oral cavity, the GI and GU tracts. Manipulation of the GI and GU tracts, cancer and previous treatment with antibiotics increase the risk of enterococcal bacteremia. Our patient’s overall immunocompromised state and recent surgical intervention placed him at higher risk of Enterococcus faecalis infection. Enterococcus faecalis bacteremia is a common cause of IE that has had no survival improvement in the past decade (2). Ultimately, his BAL culture was positive for Candida glabrata, which if resulted in fungemia, could be complicated by a rare but aggressive form of IE with a mortality rate of 80% requiring both medical and early surgical intervention (3). CONCLUSIONS: Triple valve endocarditis is rare with few studies in literature to guide the best management. Further research is necessary to identify patients at increased risk of multivalve IE, in regards to optimal screening methods to facilitate early detection and therapy. Reference #1: Kim, N., Lazar, J., Cunha, B., Liao, W., & Minnaganti, V. (2000). Multi-valvular endocarditis. Clinical Microbiology and Infection, 6(4), 207–212. doi: 10.1046/j.1469- 0691.2000.00065.x Reference #2: Dahl, A., Rasmussen, R. V., Bundgaard, H., et al. (2013). Enterococcus faecalis Infective Endocarditis. Circulation, 127(17), 1810–1817. doi: 10.1161/circulationaha.112.001170 Reference #3: Baddley, J. W., Benjamin, D. K., et al. (2008). Candida infective endocarditis. European Journal of Clinical Microbiology & Infectious Diseases, 27(7), 519–529. doi: 10.1007/s10096-008-0466-x DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Lamiaa Rougui, source=Web Response

Spondylodiscitis complicating infective endocarditis

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with...

Spondylitis: A frequent and severe complication of infective endocarditis

Spondyslodiscitis (SP) is a rare but severe complication of infective endocarditis (IE). The indicence, clinical features and prognosis of SP in IE are unknown. The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques. In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 ( n = 1755), 150 (8.5%) presented with SP. Patients were divided in two groups for the analysis: patients with ( n = 150) and without ( n = 1605) SP. Patients with SP were older (mean age 69 ± 18 vs. 66 ± 14, P = 0.004), had more arterial hypertension (48% vs. 33%, P < 0.001) and autoimmune disease (5% vs. 2%, P = 0.003) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci and Gallolyticus streptococci were more frequent (24% vs. 12% and 24% vs. 11%, P < 0.001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, incliding similar in-hospital mortality (16% vs. 14%, P = 0.38). We describe the largest ever reported series of patients with SP complicating IE. SP is a more frequent complication of IE than previously reported but has similar prognosis than other forms of IE. Multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this IE complication.

P238 Chemotherapy venous access port endocarditis in a patient with breast cancer

Abstract Funding Acknowledgements No funding Background/Introduction Right sided infective endocarditis (IE) accounts for less than 10% of all IE cases. Predisposing factors include portal of entry, implanted foreign material and unrepaired congenital heart disease with conduit. Fungal endocarditis (FE) constitutes the most severe form of IE and is etiologically connected predominantly to Candida and Aspergillus species. Among these two agents, Candida species is a common nosocomial infection with increasing prevalence and mortality rates up to 40% in cases of systemic candidiasis. Individuals with different forms of solid or hematological malignancies, under chemotherapy regimens or bone marrow transplantation comprise a particularly susceptible patient population. Case presentation A 58 year old woman with personal history of triple negative breast adenocarcinoma stage IV under palliative chemotherapy, administered for metastatic mass riknosis in the gastrointestinal tract, was admitted to the Emergency Department of our Hospital due to persistent fever, malaise and dyspnea on effort. Chemotherapy was infused via an implantable venous access port (intraport catheter). Methods/Results: Her heart auscultation revealed a holosystolic ejection type murmur of 3/6 located in the third intercostal space of changing quality. Candida tropicalis was isolated in three separate blood cultures. Transthoracic echocardiography demonstrated a good overall left ventricular systolic function. The right cavities were moderately dilated with moderate tricuspid regurgitation and a pulmonary pressure estimated at 45 mmHg. A large vegetation (approximately 2 cm maximal diameter) at the atrial surface of the posterior and diaphragmatic leaflets of the tricuspid valve with parts of the vegetation periodically apparent in the right ventricle was observed. Transesophageal echocardiography confirmed the findings of the transthoracic study and elucidated in the bicaval view the connection of the vegetation in the tricuspid valve with the edge of the intraport catheter. Moreover computed tomography scan revealed multiple pulmonary emboli in the segmental branches of the bronchial tree and a circumscribed peripheral pulmonary infarct of the left inferior lobe. A multidisciplinary team concluded that the best treatment strategy would require aggressive intravenous combined antifungal therapy until eradication followed by removal of the implantable venous access port, which was uncomplicated. Conclusions The majority of fungal endocarditis episodes represented healthcare-associated infections in vulnerable subsets of patients. Treatment of Candida endocarditis can prove challenging because of the formation of biofilms on prosthetic devices often requiring combination therapy. Septic pulmonary embolism with multiple loci is a frequent complication in right sided infective endocarditis. Removal of the prosthetic device if feasible in addition to antifungal treatment is linked to a more favorable prognosis. Abstract P238 Figure. Chemotherapy intraport endocarditis

P1459 Flu-like syndrome complicated in a rare form of infective endocarditis

Abstract Background The HACEK group of organisms are one of the infrequent causes of infective endocarditis (IE)(5% of cases in adults).Cultures require long incubation time and clinical presentation may be insidious,delaying final diagnosis.We report a case of subacute atypical presentation of native mitral valve Haemophilus parainfluenzae IE A 33 yo female with no history of cardiac disease was presented in our hospital with malaise,weakness &amp;high fever till 39oC for at about two weeks.The patient was treated with levofloxacin and discharged. The 1st blood culture was negative.After 25 days the patient was presented with prolonged fever,neurological signs of TIA(motor aphasia and septic embolic episode of 2nd level on the right hand&amp;foot).Physical exam normal,no cardiac murmurs. ECG:normal. Echo:TTE-mitral valve with thickened leaflet, presence of structures suggestive for vegetations (15x19 mm) at the posterior leaflet, perforation of the posterior leaflet causing an IM mild-moderate.TEE-mitral valve with small posterior leaflet, big anterior leaflet with mobile vegetations of coral-forms with diameter maximum 20x10 mm,located at A3 scallop of mitral valve at posteromedial commissural,with a perforation at this level causing moderate IM.No other pathological findings.Cranial CT scan-no data of any acute intracranial abnormality.Body CT scan-a low uptake area of the renal parenchyma related to acute pyelonephritis/infarction.Blood tests-elevated CRP &amp; thrombocytopenia.Blood culture(2nd one): Haemophilus parainfluenzae.Treatment-The patient went on ceftriaxone and underwent a surgical mitral valve repair with mitral annuloplasty and patch placement because of the size of the vegetation and the embolic risk.We also respect the desire of the patient to be pregnant.The patient improved, no fever. Follow-up:CRP normal.TTE echo showed no evidence of the previously detected vegetation with a residual mild MR.The patient was discharged home followed up after 6 weeks with full recovery. Discussion We present the case of a young healthy woman without any diseases,admitted with the symptoms of a simple flu-like syndrome with a negative blood culture, but complicated later in one of the rarest forms of IE with Haemophilus parainfluenzae. HACEK organisms are most often associated with IE, although rare, can be extremely serious because of the tendency of big size vegetation and embolic episodes,but outcomes generally are successful if the organism is identified early and treated appropriately.The treatment of a HACEK infection is based on the location of the infection,clinical severity and available susceptibility data.According to the ESC recommendations Ceftriaxone or ampicillin/sulbactam is the therapy of choice for patients with HACEK endocarditis in both native and prosthetic-valve endocarditis.Fluoroquinolones may be considered as alternative therapy.Regardless of the agent chosen,treatment should last 4– 6 weeks,depending upon the type of valve involved Abstract P1459 Figure.

P3666Spondylitis: a frequent and severe complication of infective endocarditis

Abstract Background Spondylodiscitis (SP) is a rare, but severe complication of infective endocarditis (IE). The incidence, clinical features and prognosis of SP in IE are unknown. Purpose The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis, and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques. Methods In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n=1755), 150 (8.5%) presented with SP. Clinical, epidemiological, microbiological, and prognostic variables were prospectively recorded and compared between patients with (n=150) and without (n=1605) SP. Results Patients with SP were older (mean age 69.7±18 vs 66.2±14; p=0.004), had more arterial hypertension (48% vs 34,5%; p&lt;0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci et Gallolyticus streptococci were more frequent (24% vs 12% and 24% vs 11%; p&lt;0,001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, including similar in-hospital mortality (16% vs 13,5%, p=0.38). Conclusions We describe the largest ever reported series of patients with spondylodiscitis complicating IE. Spondylodiscitis is a more frequent complication of IE than previously reported (8.5% of IE), is observed in older hypertensive patients with Enterococcal or Streptococcus gallolyticus IE and has a similar prognosis than other forms of IE. Since SP is associated with prolonged antibiotic therapy and may need specific surgical therapy, multimodality imaging including MRI, CT, and PET/CT should be used for early diagnosis of this IE complication.

Endocardites infectieuses : formes particulières (coeur droit, prothèse valvulaire, dispositif électronique intracardiaque)

Right-sided infective endocarditis (IE) represents 5-10% of IE. It may occur in patients with electronic intracardiac device, central venous catheter or congenital heart disease, but the most frequent situation is intravenous drug use. Prosthetic valve IE is the most severe form of IE. The diagnosis is more challenging than that of native valve IE, as is treatment, both antibiotic treatment and surgical indications. The infection of an electronic intracardiac device is a severe disease. Both diagnostic and therapeutic strategies are difficult.

Сравнение предоперационных иммунологических показателей у пациентов, оперированных по поводу различных форм инфекционного эндокардита

Сравнение предоперационных иммунологических показателей у пациентов, оперированных по поводу различных форм инфекционного эндокардита

Инфекционный эндокардит: проблемы диагностики и лечения

Results of the clinical study involving 458 patients (from 12 to 75 years, mean age 49 +/- 9.3 years) with various forms of infective endocarditis (IE) have been summarized. Integrated echocardiography was the principal non-invasive method of presurgical diagnosis of the disease. Sensitivity of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were 96% and 97.9% in patients with primary IE, 59% and 92% in patients with secondary IE and 2.7% and 90% in patients with prosthetic endocarditis, respectively. Results of echocardiography were confirmed during intrasurgical revision and histological study of removed valves. However, we have not found correlation between size, location, shape, mobility of vegetations, and risk of embolic events. Integrated echocardiography contributed to the correct diagnosis and also provided the possibility to determine the necessity of surgery and to schedule it in time. The main goals of surgery in IE heart valves are complete removal/sanitation of infected tissue and restoration or replacement of damaged heart valves. Overall hospital mortality was 8.1%. Mortality among patients operated in the active stage of IE and during remission was 10.5 and 7.1%, respectively. Surgical treatment in the active phase of IE is indicated in patients with factors of high risk, when the possibility of cure with antibiotics is unlikely, as well as in patients with high chances of recovery according to the state of organs and systems.

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis.

To determine the prevalence of antineutrophil cytoplasmic antibodies (ANCA) in patients with infective endocarditis (IE) in internal medicine; and to compare clinical and biochemical features and outcome between patients exhibiting IE with and without ANCA.Fifty consecutive patients with IE underwent ANCA testing. The medical records of these patients were reviewed.Of the 50 patients with IE, 12 exhibited ANCA (24%). ANCA-positive patients with IE exhibited: longer duration between the onset of first symptoms and IE diagnosis (P = 0.02); and more frequently: weight loss (P = 0.017) and renal impairment (P = 0.08), lower levels of C-reactive protein (P = 0.0009) and serum albumin (P = 0.0032), involvement of both aortic and mitral valves (P = 0.009), and longer hospital stay (P = 0.016). Under multivariate analysis, significant factors for ANCA-associated IE were: longer hospital stay (P = 0.004), lower level of serum albumin (P = 0.02), and multiple valve involvement (P = 0.04). Mortality rate was 25% in ANCA patients; death was because of IE complications in all these patients.Our study identifies a high prevalence of ANCA in unselected patients with IE in internal medicine (24%). Our findings further underscore that ANCA may be associated with a subacute form of IE leading to multiple valve involvement and more frequent renal impairment. Because death was due to IE complications in all patients, our data suggest that aggressive therapy may be required to improve such patients’ outcome.

Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative staphylococcus infective endocarditis

Staphylococcus lugdunensis is a coagulase-negative organism that causes a rare but destructive form of infective endocarditis (IE). We sought to evaluate the clinical and echocardiographic profile of S. lugdunensis IE at our institution and compare it to that of Staphylococcus aureus IE. Utilizing microbiology isolates, we retrospectively reviewed cases of S. lugdunensis bacteraemia admitted to our institution between 2002 and 2011 and included cases that met the modified Duke's criteria and those with device infection. We used univariate analysis to compare the clinical and echocardiographic features and outcomes of these patients with 76 cases of S. aureus IE. We identified 15 cases of S. lugdunensis IE (10 native, two prosthetic, three device only), amongst whom five cases had underlying structural valvular heart disease. Echocardiography revealed bulky vegetations in 12, abscesses in three, perforation in four, and valve dehiscence in one case. Overall, 7/12 (58%) of valvular IE involved left-sided valves; six of these underwent successful surgical intervention. S. lugdunensis IE resulted in marked valvular destruction similar to S. aureus IE but was more likely to affect patients with prior structural valvular heart disease (42 vs. 7%, p=0.004). Unlike other coagulase-negative staphylococci, S. lugdunensis causes a rare but destructive form of IE that can involve structurally normal native valves. Echocardiographic imaging is characterized by bulky vegetations and profound valvular destruction similar to that seen with S. aureus IE, thus isolation of this organism in the blood should not be disregarded as a contaminant. Confirmation of left-sided valvular endocarditis warrants surgical intervention.

Infective endocarditis in congenital heart disease

Congenital heart disease (CHD) has become the leading risk factor for pediatric infective endocarditis (IE) in developed countries after the decline of rheumatic heart disease. Advances in catheter- and surgery-based cardiac interventions have rendered almost all types of CHD amenable to complete correction or at least palliation. Patient survival has increased, and a new patient population, referred to as adult CHD (ACHD) patients, has emerged. Implanted prosthetic material paves the way for cardiovascular device-related infections, but studies on the management of CHD-associated IE in the era of cardiovascular devices are scarce. The types of heart malformation (unrepaired, repaired, palliated) substantially differ in their lifetime risks for IE. Streptococci and staphylococci are the predominant pathogens. Right-sided IE is more frequently seen in patients with CHD. Relevant comorbidity caused by cardiac and extracardiac episode-related complications is high. Transesophageal echocardiography is recommended for more precise visualization of vegetations, especially in complex type of CHD in ACHD patients. Antimicrobial therapy and surgical management of IE remain challenging, but outcome of CHD-associated IE from the neonate to the adult is better than in other forms of IE. Primary prevention of IE is vital and includes good dental health and skin hygiene; antibiotic prophylaxis is indicated only in high-risk patients undergoing oral mucosal procedures.

Gemella Morbillorum Prosthetic Valve Endocarditis

The authors describe a case of prosthetic valve infective endocarditis (IE) caused by Gemella morbillorum (GM), a gram-positive coccus that grows slowly in culture and occasionally causes a subacute to chronic form of IE. To the author's knowledge, this is the third case of GM prosthetic valve IE to be reported. Subacute to chronic IE caused by slow-growing organisms can be subtle in presentation and should be suspected in patients who have prosthetic valves presenting with worsening heart failure.

Multivalvular Infective Endocarditis in a Tetralogy of Fallot

Infective endocarditis (IE) is still a problem in patients with adult congenital heart disease. Tetralogy of Fallot (TOF) is one of the most important manifestations of congenital heart disease, which carries a high risk for the development of IE. We present an 18-year-old male with TOF complicated by an aggressive form of IE involving all cardiac valves.

ENTEROCOCCAL ENDOCARDITIS PRESENTING WITH SUDDEN RIGHT ARM WEAKNESS IN A 73‐YEAR‐OLD MAN

ENTEROCOCCAL ENDOCARDITIS PRESENTING WITH SUDDEN RIGHT ARM WEAKNESS IN A 73‐YEAR‐OLD MAN

Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis.

To characterize the incidence and clinical features of patients with infective endocarditis (IE) and stroke. The authors reviewed the records of 707 patients diagnosed with definite or possible IE between January 1984 and November 1999. Stroke was confirmed by application of strict definitions and classified by type, pathophysiology, vascular territory, and severity. The authors determined mortality rates for the initial hospitalization and 12 months after admission. Strokes occurred in 68 (9.6%) of 707 patients with IE, 38 (17%) of 218 patients with mitral valve endocarditis (MVE), 14 (9%) of 149 patients with aortic valve endocarditis (AVE), and 16 (5%) of 340 patients with other forms of IE (OR for MVE vs AVE = 2.0, 95% CI 1.1 to 3.9). Among the patients with MVE or AVE and stroke, there were no significant relationships between site of vegetation and length of hospitalization, stroke severity, mortality during the initial hospitalization, or 12-month mortality. Fifty-two percent of patients with stroke and IE died within 1 year of admission. The overall incidence of stroke in patients with IE (9.6%) is lower than previous reports (21 to 39%). Patients with MVE had a greater risk of stroke than patients with AVE. Fifty-two percent of patients died within 1 year of admission for IE.