Presentation Of Infective Endocarditis Research Articles

Demographic Characteristics, Clinical Presentation, Underlying Conditions, and Outcome of Infective Endocarditis

Background: The understanding of the epidemiology and demographic patterns of diseases can accelerate diagnosis and treatment, as well as decrease morbidity and mortality. Objectives: This study was performed to determine the epidemiological pattern of infective endocarditis in the city of Ahvaz, Iran. Methods: In this cross-sectional study, 79 patients with infective endocarditis were studied between 2004 and 2013 in Razi Teaching Hospital affiliated to the Ahvaz Jundishapur University of Medical Sciences. The diagnosis was made based on the Duke criteria. The data were recorded in a checklist for epidemiologic data including age, gender, time to defervescence, etc. Data analysis was performed using SPSS version 18 software. Results: Among the sample of 79 patients, the frequency was highest in men (n = 65, 82.3%) and in the age group of 26 - 35 years (38%). The fever was resolved in 49 (49.4%) patients after four days whereas 19 (24.1%) patients had no fever. The most common predisposing factor was being an intravenous drug user, which was true for 44 (55.7%) patients. The most common affected valve was the tricuspid valve, as seen in 43 (54.4%) patients. The most common peripheral manifestation was musculoskeletal manifestations seen in 13 (16.5%) patients. Blood cultures were positive in 12 (15.2%) patients. Fifteen (19%) patients expired during the study period and 64 patients were improved, of whom 23.4% required surgical intervention. Conclusions: Appropriate diagnosis is necessary for decreasing mortality.

Quadruple valve infective endocarditis presenting with suspected Austrian syndrome: a case report and a case series of quadruple valve infective endocarditis

ObjectivesAustrian syndrome comprises the triad of pneumonia, meningitis, and endocarditis secondary to Streptococcus pneumonia. We present what we believe to be the first reported case of Austrian syndrome with quadruple heart valve involvement and review the literature detailing cases of quadruple valve infective endocarditis. Case presentation and resultsA case is presented of a patient with radiographic evidence of a left lower lobe pneumonia. Sequential transthoracic followed by transesophageal echocardiogram done to evaluate the presence of a cardiac murmur revealed the presence of quadruple valve vegetations. Multiple blood cultures were persistently negative. The patient went on to develop seizures secondary to proven meningitis. Microbiological diagnosis was eventually established through positive Streptococcus pneumoniae antigen (Alere BinaxNOW®) from cerebrospinal fluid, establishing a presumptive clinical diagnosis of Austrian syndrome. A computerized PubMed search for reports of quadruple valve infective endocarditis and their references was collated.A total of 22 patients were found, including our patient. The median age of presentation was 47.5 years. Five patients had a history of intravenous drug abuse, another 5 had underlying congenital heart disease, and 1 had both. Two patients (9.1%) had 2 microorganisms isolated. Staphylococcus aureus and Streptococcus viridans (3 cases, 13.6% each) were the most commonly implicated microorganism. Heart failure was the commonest complication, afflicting 11 patients (50.0%). Ten patients (45.5%) underwent surgery. Overall case fatality rate was 50.0%. Cardiac surgery was of statistical significance in predicting survival (P = 0.009). ConclusionQuadruple valve endocarditis is associated with a high mortality rate, and cardiac surgery may be protective.

Fulminant Staphylococcal Infections.

Fulminant staphylococcal infection indicates an explosive, intense, and severe infection occurring in a patient whose previous condition and antecedent would never have caused any anticipation of life-threatening development. This includes necrotizing pneumonia, necrotizing fasciitis, and to some extent toxic shock syndrome and infective endocarditis. In the three former diseases, toxin production plays a major role whereas in the latter (fulminant presentation of infective endocarditis), association with any particular toxinic profile has never been demonstrated. This article reviews the clinical, pathophysiological, and therapeutic aspects of these diseases.

Infective Endocarditis Presenting as Spontaneous Subarachnoid Haemorrhage

Infective Endocarditis Presenting as Spontaneous Subarachnoid Haemorrhage

Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock

Sepsis and septic shock are common presentations of infective endocarditis (IE), but little is known about clinical characteristics in this group of patients, use of surgical treatment, and their associations with outcome. We sought to determine the influence of cardiac surgery (CS) on the outcome of patients with IE in different stages of sepsis severity. Two hundred ninety four patients with definite IE native or prosthetic valve IE admitted between 2000 and 2011. Prospective evaluation using multivariable logistic regression to evaluate clinical characteristics and outcomes (in-hospital and 1-year mortality) in surgically and medically treated patients stratified by severity of sepsis and using new Sepsis-3 definitions. The presence of sepsis or septic shock during IE showed a statistical relationship with increased in-hospital mortality (odds ratio [OR] 8.915, P < 0.001 and OR 35.969, P < 0.001, respectively) after adjusting for other risk factors of poor outcomes (neurological complications, congestive heart failure, and Staphylococcus aureus IE). Surgical treatment had a positive influence on in-hospital mortality in patients with sepsis or septic shock and IE (OR 5.157, P < 0.001) as well as on 1-year survival (hazard ratio 3.092, P < 0.001). The presence of sepsis or septic shock as defined in Sepsis-3 definitions is associated with unfavorable outcomes in patients with IE. Surgical treatment has a positive effect on outcomes (in-hospital mortality and 1-year survival) in patients with IE and sepsis or septic shock.

Ruptured distal middle cerebral artery mycotic aneurysm: A rare, first presentation of infective endocarditis

Mycotic cerebral aneurysms are rare inflammatory aneurysms associated with high mortality and morbidity reaching up to 80% after rupture. We report a case of incidentally diagnosed infective endocarditis presenting with rupture of distal middle cerebral artery mycotic aneurysm and intracerebral hematoma. Aneurysmectomy with clip ligation of the terminal cortical branch and hematoma evacuation was done with good surgical outcome.

Infective endocarditis presenting as back pain

A 51-year-old healthy man presented to emergency department with complaints of severe low back pain for 3 days and 2-week history of low-grade fever. Because of persistent back pain with fever up to 38 ℃, we ordered contrast-enhanced abdominal computed tomography (CT) which showed a huge aortic thrombus at the level of aortic bifurcation. Transthoracic two-dimensional echocardiography showed a vegetation at anteromedial leaflet of mitral valve, and infective endocarditis (IE) was diagnosed. After long-term broad-spectrum antibiotics and arterial embolectomy with mitral valve replacement, he discharged uneventually. Early diagnosis and treatment of IE at emergency department may be the key to the better result.

Infective endocarditis presenting as an acute ischemic stroke: A case report and analysis of the case series

Background: Acute ischemic stroke (AIS) are highly prevalent in patients with infective endocarditis (IE) and associated with high rates of death and disability. IE presenting as an acute ischemic stroke, especially recurrent concurrence of acute anterior and posterior circulation infarct, has rarely been reported.

A Case Report of Recurrent Rheumatic Fever: Considerations and Comments

Rheumatic fever (RF) is a prevalent healthcare problem in the developing countries. Recurrence of this disorder is often observed in childhood and adolescence. RF can mimic the presentations of infective endocarditis, and clinicians are not really familiar with this issue. Herein, we present a case of recurrent acute rheumatic fever in a patient suspicious of acute bacterial endocarditis due to her previous RF. Finally, she was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotics besides regular follow-up

The implications of HIV infection on the management of valvular heart disease in Southern Africa

There is very limited information on the disease profile and treatment approaches in HIV patients with valvular heart disease (VHD) in developing countries. HIV infection impacts on patients with VHD in three settings: HIV/Aids as a comorbid disease in patients with underlying valve disease, infective endocarditis secondary to immunosuppression, and non-infective valve involvement from myocardial failure or from marantic endocarditis. The clinical presentation of infective endocarditis does not differ between HIV and non-HIV patients, with the exception that intravenous drug abuse is a common cause in specific populations. While peri-operative mortality and morbidity is high in acute infective endocarditis, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of cardiac-related pregnancy complications or that pregnancy may alter the course of HIV infection. Since antiretroviral therapy has been associated with considerable improvement in clinical status prior to surgery, as well as in long term outcomes, all patients with valve disease in whom intervention is likely should undergo HIV testing and staging so that highly active antiretroviral treatment (HAART) may be instituted timeously. Conclusion: The high prevalence of HIV in our population makes consideration of this comorbidity an essential facet in the routine evaluation and management of patients with VHD. There is solid evidence that these patients do no worse than non-HIV patients undergoing medical treatment or percutaneous/surgical intervention – open-heart surgery may be offered safely to patients with HIV if proper precautions are taken.

Infective Endocarditis Presenting as Pauciimmune vasculitis

Infective Endocarditis Presenting as Pauciimmune vasculitis

Right ventricular outflow tract endocarditis caused by brucellosis.

Right-ventricular outflow tract (RVOT) endocarditis is a very rare presentation of right-sided infective endocarditis (RSIE) by brucellosis. RSIE occurs most commonly in immune-suppressed cases and illicit drug abuser. The patients with RSIE and an incompetent immune system usually have a prosthetic foreign body in blood circulation such as catheter, pacemakers, or central venous lines and may be accompanied with tricuspid or pulmonary valve dysfunction. The most common site for RSIE is the tricuspid valve. We describe an exceedingly rare condition of RVOT endocarditis in a patient with brucellosis in which vegetation is attached to a muscle bundle of the RVOT. Despite appropriate antibiotic therapy, the general condition of the patient deteriorated and was finally scheduled for open-heart surgery. The mass was resected and the patient recovered uneventfully and was discharged on the 9th day of surgery with appropriate oral antibiotics.

Infective Endocarditis Presenting as Inferior ST-Elevation Myocardial Infarction

ST elevation myocardial infarction (STEMI) is an uncommon complication of infective endocarditis. We present a case of a 65-year-old male admitted with STEMI who was subsequently found to have a large aortic valve vegetation. The patient presented with angina and inferior STEMI complicated by ventricular fibrillation. Coronary angiography revealed acute distal posterior descending artery occlusion, with no discernible stenosis observed after wiring the vessel during the primary percutaneous intervention. This raised the suspicion of an embolic cause. Transthoracic echocardiography demonstrated a mobile mass attached to a bicuspid aortic valve. There were no symptoms or signs of infective endocarditis other than a 3-week history of fatigue. Transoesophageal echocardiography confirmed a 0.7 cm mobile mass attached to the aortic valve. He underwent emergent aortic valve replacement with a bioprosthesis. Histological examination confirmed a vegetation though tissue and blood culture did not yield an organism. The patient was treated with 6 weeks of intravenous antibiotics and has recovered well.

Clinical Presentation of Infective Endocarditis in the Early 21st Century: A Descriptive Study

Clinical Presentation of Infective Endocarditis in the Early 21st Century: A Descriptive Study

Characteristics of Infective Endocarditis in a Tertiary Hospital in East China.

The epidemiology, clinical presentation, and treatment of infective endocarditis (IE) has significantly changed over the past few years in developed countries. However, relevant data from developing countries are different and remain scarce. The objective of this study was to evaluate the clinical presentations, treatment and outcomes of IE patients in a tertiary hospital in East China over an 8-year period. This was a retrospective observational study of consecutive cases of definite or possible IE as per the modified Duke criteria between January 2008 and December 2015. A total of 135 definite and 39 probable IE cases were identified. The mean age was 47.8 ± 15.7 years, with a male preponderance (1.9: 1). Degenerative valve disease accounted for 30.5% cases of IE, followed by congenital heart disease (29.9%) and rheumatic heart disease (14.9%). Native cardiac valves were present in 93.7% of the IE patients. Echocardiography and blood culture were performed in all patients, of whom 55.2% were found to have large vegetations (≥10 mm) and the positive rate of blood culture was 60.3%. Streptococcus remained the chief causative agent that was identified in 61.9% of culture-positive patients. Glycopeptide antibacterials and cephalosporins were the most frequently used antimicrobial drugs for IE therapy. Seventy-six (43.7%) of the IE patients were surgically treated. The mortality rate during hospital stay was 10.9%. Our data reflected clinical and microbiological profile, and treatment of IE in a tertiary hospital located in the East China.

Unusual presentation of infective endocarditis with cerebral infarction in a neuro-trauma patient

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Acute Embolic Ischemic Stroke as the Sole Presentation of Subacute Enterococcal Endocarditis

Neurological complications are the most frequent extra cardiac complications of infective endocarditis (IE) dominated by the stroke with a high mortality . These manifestations might be the first sign of IE in rare cases. Atrial fibrillation and infective endocarditis (IE) are two of the most common causes of cardio embolic strokes. The patients with infective endocarditis (IE) can present with variable symptoms ranging from vague complaints of fever and chills to any embolic complication. Duke’s criteria is the most common criteria used to diagnose infective endocarditis. We present a case of an acute ischemic stroke in a young patient, which was the sole presentation of subacute infective endocarditis associated with Enterococcus faecalis, thus leading to delayed diagnosis and treatment.

What Imaging for Cerebral Complications of Infective Endocarditis?

Infective endocarditis (IE) is a serious condition with in-hospital mortality rates of 15-20% and one-year mortality approaching 40%. [ [1] Murdoch D.R. et al. Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis-Prospective Cohort Study. Archives of Internal Medicine. 2009; 169.5 (PMC. Web. 23 Aug. 2015): 463-473 Crossref Scopus (1482) Google Scholar ] Early diagnosis and treatment reduces the incidence of septic embolism and mortality. [ [2] Erba P.A. Conti U. Lazzeri E. et al. Added value of 99mTc-HMPAO–labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med. 2012; 53: 1235-1243 Crossref PubMed Scopus (147) Google Scholar ] We reviewed cerebral imaging studies performed for IE and the rate of clinical findings over a 10-year period to determine if there was a significant difference in complications found when using MR over CT. Cerebral imaging requests and reports at our institution from 2003-2013 were searched for IE related complications. Clinical cerebral complications were identified in 62 of the 161 patients scanned (38.5%). Using CT or CTA cerebral complications were found in 42 of 132 patients (31.8%), and 36 of 61 patients (59%) using MRI or MRA. Over a 10-year period, cerebral MR imaging identified significantly more complications of IE than CT (63.5% v 39.6%, p<0.01), with a greater proportion of infarcts being discovered (75% v 46%). Early detection of asymptomatic cerebrovascular complications through the use of systematic cerebral MR in suspected IE cases may be the prompt for more aggressive surgical management.

Infective Endocarditis Presenting with Intracranial Bleeding

BackgroundInfective endocarditis (IE) can be complicated by intracranial bleeding (ICB) caused by different pathologic mechanisms. The occurrence of ICB in patients with IE significantly influences therapeutic decisions and has a negative impact on outcome. Case ReportWe describe the clinical courses of 3 patients with aortic prosthetic valve IE presenting with ICB. Patients 1 and 2 experienced subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), respectively, caused by rupture of an intracranial infectious aneurysm (IIA). Both underwent endovascular treatment of IIA with good outcome. In patient 3, ICB was the hemorrhagic conversion of an acute ischemic lesion from septic brain embolization. In the subacute phase of the disease, aortic valve replacement was performed, with excellent outcome. Why Should an Emergency Physician be Aware of This?ICB is a relevant complication and sometimes the first clinical feature of IE. Imaging of brain vessels should be performed to investigate the pathologic mechanism underlying ICB. The prevalence of IIA is probably underestimated and may influence the therapeutic strategy. Cerebrovascular imaging may therefore also be considered in asymptomatic subjects with left-sided IE. Withdrawal of anticoagulant treatment and delay of cardiac surgery are recommended in all cases of IE complicated by ICB. Because of the impact of ICB on IE management and outcome, a high level of clinical suspicion and prompt recognition and treatment of this complication are necessary.

Infective endocarditis presenting as acute coronary syndrome

We report tow cases of infective endocarditis (IE) presenting as acute coronary syndrome (ACS). Case 1: A 60-year-old man with the diagnosis of mitral IE complicated by an ST segment elevation myocardial infarction. Primary percutaneous coronary intervention with aspiration of the thrombus at the distal leftanteriordescending (LAD) arterywas successfully performed. Case 2: A 72 year old man was admittedfor an aortic root abscess compressing the left coronary artery. The treatment required surgery, including coronary artery bypass procedure. The postoperative course was complicated by multiple organ failure, and the patient died after 48 h.