Presentation Of Infective Endocarditis Research Articles

A rare presentation of infective endocarditis: Phase 4 block of the left bundle branch as key for the diagnosis. A case report

Definitive diagnosis of infective endocarditis (IE) is mainly based on microbiological and imaging criteria. In a minority of cases, particularly when perivalvular area is involved, cardiac conduction disorders (CCD) may appear, which implies worse prognosis. In this scenario, different degrees of auriculoventricular block can occur, but development of bundle branch block is rare. Herein, we present a case of IE with negative initial imaging tests, where the occurrence of phase 4 bundle branch block after a sequence of type I second degree AV block was crucial to establish a definitive diagnosis and an optimal therapeutic approach.

A Case Report of Subacute Infective Endocarditis Presenting With Extreme Weight Loss, Aortic Regurgitation, and Splenic Infarct

A Case Report of Subacute Infective Endocarditis Presenting With Extreme Weight Loss, Aortic Regurgitation, and Splenic Infarct

Infective Endocarditis Presenting as Endogenous Endophthalmitis and Multiple Cerebral Infarcts

A 60-year-old housewife as admitted with fever, pain and redness in her right eye for 2 days. She had right eye redness with haziness of the cornea, white fibrinous material in the anterior chamber, and vitreous in the posterior segment. She was evaluated and found to have Endogenous Endophthalmitis (EE) with multiple cerebral infarcts due to methicillin-sensitive coagulase-negative Staphylococcus endocarditis. The patient received intravitreal injections of vancomycin and ceftazidime. She received cefazolin 2 g thrice daily intravenously. The plan of vitrectomy was suggested as per the advice from the ophthalmologist but the relatives opted for conservative management. The patient went into multiorgan failure with disseminated intravascular coagulation and despite all efforts, she succumbed to her illness. Our patient had two extracardiac manifestations of IE together. The presence of any of these manifestations should raise suspicion of infective endocarditis (IE). We report a case of native mitral valve methicillin-sensitive coagulase-negative Staphylococcus endocarditis presenting with extracardiac manifestations. Our case reminds readers to be aware of endocarditis when evaluating patients with extracardiac manifestations like EE.

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Clinical presentation, etiology and outcome of infective endocarditis in a tertiary hospital in Malaysia

Enterococcal Prosthetic Valve Infective Endocarditis Presenting as Complete Heart Block with Intramyocardial Abscess Causing Asystolic Cardiac Arrest

The extension of an intracardiac abscess causing complete heart block is a rare complication of infective endocarditis that is associated with a high mortality. Early identification of conduction abnormalities and a low threshold for suspecting infective endocarditis is crucial to provide prompt management to prevent intracardial extension of infection. We report a case of a patient presenting with complete heart block in the setting of profound hyperkalemia, and was then found to have enterococcal prosthetic valve endocarditis, which was complicated by an intracardiac aortic root abscess which led to asystolic cardiac arrest. The development of heart block in endocarditis serves as a marker for poor prognosis and can signify progression of infection. Management therefore requires immediate pacing, antibiotic delivery to lessen infectious burden, and evaluation for consideration of surgical options such as valve replacement. It is therefore recommended for patients with endocarditis complicated by conduction abnormalities or intracardial abscesses to be treated by a multi-disciplinary team consisting of cardiologists, cardiothoracic surgeons, and infectious disease specialists.

Infective endocarditis presenting as meningitis: a case report.

Here, the authors present a case of a 53-year-old male who presented with bacterial meningitis secondary to IE. His blood culture was positive for methicillin-sensitive staphylococcal aureus. Echocardiography findings were suggestive of endocarditis. Despite aggressive intensive care management, our patient did not survive. The isolation of Staphylococcus aureus in culture should raise a suspicion of foci being elsewhere outside the central nervous system. Treatment of complications like meningitis may require intrathecal antibiotics. The vegetation and neurological complications are often difficult to treat and require the participation of a multidisciplinary team. The diagnosis of IE in patients presenting with neurologic deficits and fever should be considered. A physician should raise a suspicion of infective foci being elsewhere outside the central nervous system if the organism isolated in culture is Staphylococcus aureus.

Early Infective Endocarditis Associated with an Amplatzer Atrial Septal Occluder Device in a 14-Year-Old Male.

Infective endocarditis (IE) associated with an ASD device, particularly in the early post-procedure period, is extremely rare. We report a case of infective endocarditis presenting with embolic complications and vegetations on the device that were only seen on transesophageal echocardiography, necessitating device removal.

A Case of Blood Culture-Negative Infective Endocarditis Presenting as Recurrent Ischemic Stroke (P8-10.007)

<h3>Objective:</h3> We present a unique case of recurrent ischemic stroke in a patient with blood culture-negative bacterial endocarditis. <h3>Background:</h3> The incidence of infective endocarditis (IE) has steadily increased in the past decade. About 2–7% of IE cases have negative blood cultures, making it difficult to diagnose with worse resulting prognoses. The risk of neurological complications in culture-negative IE, such as stroke, are high and linked to poor clinical outcomes. However, there are limited data on the incidence of stroke as an isolated presenting symptom or on the rate of stroke recurrence in this population. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 57-year-old woman with a history of diabetes mellitus, hypertension, and coronary artery disease presented with recurrent multi-territorial ischemic strokes. Her initial work-up showed unclear etiology. A transesophageal echocardiogram was obtained and demonstrated a 0.5×1 cm mobile echodensity on the mitral valve, concerning for either thrombus or vegetation. Thrombophilic laboratory results displayed an indeterminate lupus anticoagulant cascade. As the patient lacked infectious symptoms with an extensive negative infectious workup, she was started on anticoagulation due to possible thrombotic source in the setting of thrombophilia. However, the patient suffered another ischemic stroke while fully anticoagulated. With this being her third stroke in a seven-month period, the patient underwent surgical resection of the lesion. At the time of surgery, the mass was noted to appear as an infectious vegetation, and she was treated with broad-spectrum antibiotics for presumed culture-negative endocarditis. The valve culture later grew <i>Staphylococcus epidermidis</i>. Daptomycin was continued and she has had no additional strokes to date. <h3>Conclusions:</h3> It is well-established that stroke is a common complication of IE. However, little has been documented about stroke as the presenting symptom in blood culture-negative IE. Therefore, it is important to maintain a high degree of suspicion for indolent infection to pursue additional work-up and prevent any delays in treatment. <b>Disclosure:</b> Ms. Chatfield has nothing to disclose. Ms. Braddick has nothing to disclose. Dr. Sobhani has nothing to disclose.

Disseminated Infective Endocarditis Presenting as Hypotension

Disseminated Infective Endocarditis Presenting as Hypotension

Endocarditis: a case series with review on atypical presentations of infective endocarditis

Infective endocarditis is a well-known clinical entity. However, despite improved diagnostic techniques and advances in treatment options, clinical heterogeneity of infective endocarditis sometimes prevents rapid recognition, correct diagnosis and timely treatment which are very essential to reduce morbidity and mortality associated with this disease. We herein present a case series of seven patients who presented to Government Medical College, Kozhikode during the period 2018-2022 with atypical presentations of infective endocarditis.

Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review

Infective endocarditis (IE) is a bacterial infection with high morbidity and mortality rates, particularly among the elderly. This systematic review was conducted to determine the clinical characteristics of IE in older adults and the risk factors that could lead to adverse outcomes. The research employed three databases (PubMed, Wiley, and Web of Science), with a primary search for studies that have described cases of IE in patients older than 65 years. From a total of 555 articles, 10 were selected for inclusion in the current study, comprising a total of 2222 patients with a confirmed diagnosis of IE. The primary findings were an increased incidence of staphylococcal and streptococcal infections (33.4% and32.0%, respectively), an increased prevalence of comorbidities, namely, cardiovascular disease, diabetes, and cancer, and a significantly greater mortality risk than the younger group. Regarding mortality risks, the pooled odds ratio for cardiac disorders was OR = 3.81, septic shock OR = 8.22, renal complications OR = 3.75, and advancing age OR = 3.54 were most frequently mentioned. Taking into consideration the fact that the majority of the elderly population suffers from significant complications and is unable to undergo surgery due to an increased risk of complications after the procedure, it is imperative that effective treatment methods should be investigated.

Abstract 14509: A Rare Case of Cardiac Tamponade as an Initial Presentation of Native Aortic Valve Infective Endocarditis

Background: Pericardial involvement is a rare presentation of infectious endocarditis (IE). We present a case of septic cardiac tamponade, paravalvular abscess and fibrinous pericarditis secondary to native aortic valve (AV) IE. Presentation: A 50-year-old gentleman with a history of IV drug use presented with fever, dyspnea and pleuritic chest pain for one week. He was febrile, tachycardic and hypotensive on presentation. Examination revealed a new onset early diastolic murmur. Workup: EKG showed mild diffuse ST segment elevations and PR segment depressions suggestive of pericarditis. Blood cultures grew Serratia marcescens in 6 out of 6 bottles and IV cefepime was initiated. TTE revealed large effusion with right atrium and right ventricle diastolic collapse consistent with tamponade physiology (fig. A, B). A vegetation was seen on the right coronary cusp of AV along with aortic insufficiency and aortic root abscess. TEE confirmed the above findings (fig. C-F) Management: An emergency cardiac surgery was performed for acute aortic regurgitation and cardiac tamponade. Intraoperative findings revealed 600mL of purulent effusion. A large vegetative mass near left-to-right commissure covering an abscess cavity that extended into the aortic wall that destroyed the annulus and extended into the ventricular muscle. AV replacement with 21mm Inspiris pericardial AV and pericardial patching was done. Epicardial tissue as well as AV leaflet cultures revealed moderate to heavy growth of S. marcescens . He was discharged on cefepime for a total duration of 6 weeks. Follow up TTE revealed normal peak and mean transaortic gradients. Conclusion: Cardiac tamponade is a rare but life-threatening complication of IE. Pericardial involvement should prompt us further work up to exclude intra-cardiac abscess which carries poor prognosis due to high complication rates. Hence, early multidisciplinary team response is of paramount importance to reduce in-hospital mortality.

Atypical Presentation of Infective Endocarditis in a Young Man without Risk Factors: A Case Report

Infective endocarditis is a disease caused by the adherence of infectious agents to the endocardial surface, resulting in inflammation and damage, especially to the heart valves. Endocarditis may be diagnosed in up to 5% of patients with prolonged febrile syndrome. The incidence of endocarditis affecting the right heart chambers ranges from 5% to 10% with predominant involvement of the tricuspid valve. Pulmonary valve involvement is rare and usually associated with immunosuppressive conditions or structurally abnormal hearts. Pulmonary valve endocarditis may present atypically with recurrent respiratory symptoms, so that echocardiography should be considered to assess the presence of right heart lesions, which may be a challenge for suspicion and diagnosis, especially in patients without risk factors. In this study, the authors report a case of isolated infective endocarditis in the pulmonary valve due to Staphylococcus aureus in a young man with recurrent pneumonia episodes and without traditional risk factors. Although technological advances contribute to the diagnosis of complex cases, the clinical approach was the best way to determine the appropriate tests and examinations, and for choosing or developing interventions. Despite the availability of resources and diagnostic tools, many diseases associated with high morbidity and mortality may be misdiagnosed and mistreated, including infective endocarditis. A comprehensive patient assessment is essential for the correct diagnosis, as many signs and symptoms are common to different diseases.

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry.

Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry. The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53-75) years; group 2, 57 (41-68) years; group 3, 33 (26-43) years; P < 0.001] with a higher frequency of smokers, intravenous drug use, and human immunodeficiency virus infection (all P < 0.001) and presented later [median (IQR) days since symptom onset: group 1, 12 (3-35); group 2, 19 (6-54); group 3, 31 (12-62); P < 0.001] with a higher likelihood of developing congestive heart failure (13.6%, 11.1%, and 22.6%, respectively; P < 0.001) and persistent fever (9.8%, 14.2%, and 27.9%, respectively; P < 0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in group 3 patients (75.5%, 76.8%, and 51.3%, respectively; P < 0.001), who also demonstrated the highest mortality (15.0%, 23.0%, and 23.7%, respectively; P < 0.001). Socioeconomic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.

Anesthesia Considerations in Infective Endocarditis

The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

A Case of Infantile Infective Endocarditis Presenting Acute Mitral Regurgitation due to Valvular Destruction without Fever

A Case of Infantile Infective Endocarditis Presenting Acute Mitral Regurgitation due to Valvular Destruction without Fever

RIGHT SIDED INFECTIVE ENDOCARDITIS MASQUERADING AS PULMONARY TUBERCULOSIS: A CASE REPORT

Right-sided infective endocarditis is not as common as left-sided infective endocarditis. The clinical signs and symptoms of right-sided infective endocarditis are subtle, making clinical detection more complex and easily leads to misdiagnosis. We present a case of mild haemoptysis as a presentation of right-sided infective endocarditis but was initially misdiagnosed as pulmonary tuberculosis, which led to a delay in treatment. The patient had multiple visits to the health facilities (private clinic, government’s health clinic and hospital) and one admission to the hospital for recurrent cough, fever, and haemoptysis without any improvement. Later, he was diagnosed with right-sided infective endocarditis and was well after treatment. Delays in treatment can lead to an increased risk of permanent morbidity to the patient.This case report highlights the importance of a high index of suspicion and exploring other differential diagnoses of haemoptysis apart from pulmonary tuberculosis.

Sudden Cardiac Death Caused by a Septic Coronary Artery Embolism as the First Clinical Presentation of Infective Endocarditis

This report describes an uncommon and fatal case of myocardial infarction due to coronary embolus arising from vegetation in the aortic valve with a background of infective endocarditis (IE). There are various causes of fatal IE. Myocardial infarction due to septic emboli is rare. We report a case of sudden death in a 69-year-old woman with hyperlipidemia and no known cardiac disease. She had severe general weakness and was hospitalized for colonoscopy. The patient unexpectedly presented with cardiac arrest and died. The autopsy showed total occlusion of the left anterior descending artery by an embolus, which originated from the septic vegetation of the aortic valve. Myocardial infarction from septic emboli associated with IE can be fatal and manifested as the first presentation. In autopsy practice of deceased patients with IE, careful examination of the coronary arteries is required.

Socio-economic variations in the clinical presentation, etiology and outcome of infective endocarditis in the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry: a prospective cohort study

Abstract Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-centre registry. Methods The ESC-EORPEURO-ENDO registry comprises a prospective cohort of 3116 adult patients admitted to 156 hospitals in 40 countries with IE between January 2016 and March 2018. We analysed the complete dataset to assess potentially important determinants of variation according to World Bank economic stratification (high income (Group 1) [73.8%]; upper-middle income (Group 2) [17.1%]; lower-middle income (Group 3)[9.1%]). Results Patients in Group 3 were younger (median age [IQR]: Group 1 - 66 [54–75] years; Group 2 - 57 [40–68] years; Group 3 - 33 [26–43] years; p&amp;lt;0.001) with a higher prevalence of smoking, intravenous drug use and human immunodeficiency virus (HIV) infection (all p&amp;lt;0.001). Group 3 patients with IE presented later (median [IQR) days since symptom onset: Group 1 - 12 [3–35]; Group 2 - 20 [6–51]; Group 3 - 31 [12–62]; p&amp;lt;0.001) and were more likely to develop congestive heart failure (13.6%; 11.3%; and 22.6%, respectively; p&amp;lt;0.001), septic shock (8.3%; 11.1%; 13.4%; p=0.007), and persistent fever for greater than 7 days (9.6%; 14.4%; 27.9%; p&amp;lt;0.001) following hospital admission. Surgery was performed less frequently in Group 3 (75.4%, 76.8% and 51.3% in Groups 1, 2 and 3, respectively; p&amp;lt;0.001) and mortality was highest in the poorest countries (14.6%; 23.6% and 23.7%, respectively; p&amp;lt;0.001). Conclusion Socio-economic factors influence the clinical profile of patients presenting with IE across the world. Despite being younger, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and less frequent use of surgery. Funding Acknowledgement Type of funding sources: None.