Acute bacterial endocarditis patients are usually severely ill, with high fever, chills, poor appetite, weight loss and possible signs of embolism, acute heart failure or heart block. These may be patients who have previously been diagnosed with a congenital heart disease, individuals who recently underwent various procedures that can cause bacteremia or in whom bacteremia is the primary source. Fever may be absent in elderly or immunocompromised patients [1].

Clinical examination must be carefully performed and special attention must be paid to new murmurs or to a change in character of preexisting murmurs, suggestive of valvular dysfunction [2]. However, murmurs are absent in about 33% of acute bacterial endocarditis cases. Heart rate evaluation is also important because intramyocardial abscesses, especially those originating from the aortic valve [3], can involve the conduction system and cause heart block [4]. The patient may also exhibit acute heart failure symptoms [5], as well as signs of peripheral embolic phenomena, located in the central nervous system, lungs, kidneys, liver and spleen [6] Anterior mitral leaflet vegetations, especially if large and friable, are most likely to embolize [7], but the risk decreases after antibiotic treatment begins. Pulmonary embolism presents with chest pain, acute dyspnea and cough.

Peripheral signs of acute bacterial endocarditis are represented by Janeway lesions, located on the palms and soles and caused by vasculitis. The patient may also have articular or osseous pain, due to septic arthritis or osteomyelitis (most often vertebral). If consciousness level is decreased, the physician should suspect acute stroke or meningitis, that is usually purulent in acute endocarditis [8]. If an implantable device is present, it requires special attention [9]. Macroscopic hematuria may signify the presence of glomerulonephritis or embolic renal infarction.

• Fever

  Fever is present in all cases, although fever may be present for a febrile period. [remedyland.com]

  Once the fever and the worst of the symptoms have gone away, the patient may be able to continue antibiotic therapy at home. [medical-dictionary.thefreedictionary.com]

  Acute bacterial endocarditis patients are usually severely ill, with high fever, chills, poor appetite, weight loss and possible signs of embolism, acute heart failure or heart block. [symptoma.com]

  Typically the presentation is silent, with persistent fever and positive blood cultures being the only consistent findings. Fibrin-platelet vegetations on the valvular endocardium are thought to be seeded during bacteremic episodes. [ncbi.nlm.nih.gov]

  Fungal, yeast, anaerobic infection or Q fever (needs special culture). Right sided endocarditis. [prepareformedicalexams.blogspot.com]

• Chills

  Patients with right-sided ABE present with symptoms of fever and chills, and symptoms and signs of pulmonary emboli. In the patient presented, the PICC line was removed and high-dose cefazolin therapy, 2 g (IV) every 8 hours, was initiated. [ncbi.nlm.nih.gov]

  Acute bacterial endocarditis patients are usually severely ill, with high fever, chills, poor appetite, weight loss and possible signs of embolism, acute heart failure or heart block. [symptoma.com]

  Patients may experience such general symptoms as fevers, chills, fatigue, weight loss, muscle aches, and sweating. These general, nonspecific, symptoms can make it hard both for the patient and the doctor to recognize endocarditis. [diagnose-me.com]

  On post-procedure day 5, he experienced mental confusion, chills and fever. Upon readmission, he was in severe sepsis with a left central facial palsy and bilateral absence of radial pulses. [link.springer.com]

  Other symptoms that can occur with endocarditis are chills, night sweats, fatigue, joint and muscle aches, and swelling of the legs, abdomen, and feet due to fluid accumulation (edema). [medicinenet.com]

• Weight Loss

  Symptoms can be as non-specific as fever, fatigue, weight loss, new rashes (either painful or painless), headaches, backaches, joint pains and confusion; hence the disease remains a diagnostic and therapeutic challenge. [books.google.de]

  Long-term fever, weight loss, joint pain and muscle pain, fatigue and anemia. Heart murmur, petechiae, emboli phenomena. Blood culture is positive. [remedyland.com]

  Acute bacterial endocarditis patients are usually severely ill, with high fever, chills, poor appetite, weight loss and possible signs of embolism, acute heart failure or heart block. [symptoma.com]

  Patients may experience such general symptoms as fevers, chills, fatigue, weight loss, muscle aches, and sweating. These general, nonspecific, symptoms can make it hard both for the patient and the doctor to recognize endocarditis. [diagnose-me.com]

  Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin, and weight loss. [icdlist.com]

• Malaise

  For example, fever, malaise, weakness, and shortness of breath are common symptoms of endocarditis. [medicinenet.com]

  This form of endocarditis develops rapidly, with fever, malaise, and other signs of systemic infection coupled with abnormal cardiac function and… Read More formation of antigen-antibody complexes In immune system disorder: Type III hypersensitivity … [britannica.com]

  In addition, the patient reported a mild febrile illness with malaise and dysuria during the 3 weeks prior to presentation. Figure 1. [retinalphysician.com]

  […] and platelets Prognosis often presents as fever of unknown origin endocarditis prophylaxis may be required before dental procedures Presentation Symptoms persistent fevers (the most common symptom) shortness of breath systemic symptoms weakness fever malaise [medbullets.com]

  Other common symptoms of subacute infective endocarditis include anorexia, weight loss, malaise, and night sweats. [histopathology-india.net]

• Anemia

  Hemiplegia, persistent heart failure, anemia, bleeding fondness or uremia may be caused by the subacute bacterial endocarditis. [remedyland.com]

  As follows: CBC ; Hb%, TC, DC, ESR (normochromic normocytic anemia, neutrophil leukocytosis, high ESR may be present). Serum CRP (increased. It is more reliable than ESR in monitoring progress). [prepareformedicalexams.blogspot.com]

  The symptoms of chronic IE may be such things as fatigue, mild fever (99°–101°F), a moderately fast heart rate, weight loss, sweating, a low red blood cell count (anemia) and can take place over as much as a period of months. [heart.org]

• Dyspnea

  The sudden dyspnea with acute AR appeared and aortic valve replacement was performed immediately. In case of unknown etiology of fever, an echocardiographic examination is suggested for the diagnosis of IE. [ci.nii.ac.jp]

  Pulmonary embolism presents with chest pain, acute dyspnea and cough. Peripheral signs of acute bacterial endocarditis are represented by Janeway lesions, located on the palms and soles and caused by vasculitis. [symptoma.com]

  There is no history suggestive of orthopnea or paroxysmal nocturnal dyspnea. For the last 2 months, the patient also experiences malaise, generalized weakness, arthralgia, myalgia, anorexia and substantial loss of weight. [prepareformedicalexams.blogspot.com]

  Patient care During the acute phase of treatment, patients are monitored for signs and symptoms of heart failure (e.g., dyspnea, orthopnea, crackles, dependent edema, changes in the heart murmur, and a postsystolic gallop), cerebral emboli (e.g., paralysis [medical-dictionary.thefreedictionary.com]

• Heart Disease

  Other previously reported cases of this functional delay of the left branch were secondary to arteriosclerotic heart disease. [ncbi.nlm.nih.gov]

  The subacute bacterial endocarditis is usually a rheumatic or congenital heart disease. [remedyland.com]

  […] of infection or heart disease People who inject drugs are also more likely to develop endocarditis. [nhs.uk]

  He has been suffering from some valvular heart disease for several years. There is no family history of such illness. He used to take frusemide, propranolol and vitamins prescribed by the local physicians. [prepareformedicalexams.blogspot.com]

  The prevalence of infective endocarditis is between 1.7 and 4 people per 100,000, and is most commonly found in people who have underlying heart disease. [books.google.de]

• Heart Murmur

  Clinical manifestations of infective endocarditis is heart murmurs and signs of congestive heart failure. Much less common is heart blockage and pericarditis. [remedyland.com]

  Both ME and IE may present with fever and a heart murmur with or without embolic phenomenon. Leukocytosis and elevated erythrocyte sedimentation rate suggest the diagnosis of IE. [ncbi.nlm.nih.gov]

  With a stethoscope, a doctor can listen to your chest for the distinct sound of a new heart murmur or a change in the sound of an old heart murmur. Heart murmurs are caused by the sound of faulty heart valves and by certain defects in your heart. [texasheart.org]

  Have a new heart murmur. Endocarditis can cause a new or additional heart murmur, or unusual sound in your heartbeat, or changes to an existing one. See changes in your skin. Tiny bumps or spots may show up on your hands or feet. [webmd.com]

  They will also check for fever, nodules, and other signs and symptoms, such as a heart murmur, or an altered heart murmur if the patient already had one. A series of tests may be used to confirm endocarditis. [medicalnewstoday.com]

• Chest Pain

  Pulmonary embolism presents with chest pain, acute dyspnea and cough. Peripheral signs of acute bacterial endocarditis are represented by Janeway lesions, located on the palms and soles and caused by vasculitis. [symptoma.com]

  Symptoms may include : Symptoms include fever, chest pain, and fatigue. a high temperature, or fever a new or different heart murmur muscle pain bleeding under the fingernails or toenails broken blood vessels in the eyes or skin chest pain coughing headache [medicalnewstoday.com]

  The symptoms may include fever, lethargy, shortness of breath, chest pain or palpitations. These symptoms require prompt assessment and investigation by a physician. [dermnetnz.org]

  He also complains of central chest pain, sharp in nature without any radiation, does not aggravate by cough or movement of the chest. [prepareformedicalexams.blogspot.com]

  pain when you breathe Swelling in your feet, legs or abdomen Endocarditis can also cause symptoms that are more uncommon. [mayoclinic.org]

• Tachycardia

  Heart murmur is present in approximately 80-90% of patients, and in subacute bacterial endocarditis is more frequent up to 95% and it is accompanied by tachycardia and other signs of aggravated heart failure. [remedyland.com]

  ECG Non-specific, but electrocardiographic abnormalities common and may include: prolongation of the PR interval with progressive degrees of AV block sinus tachycardia right atrial enlargement bundle branch blocks left or right ventricular strain pattern [radiopaedia.org]

  There may also be a rapid heartbeat (tachycardia). Individuals with prosthetic valvular endocarditis may develop abscesses on or near the valves. Bacteria may also grow in the heart and obstruct the flow of blood through it. [rarediseases.org]

  Löffler's endocarditis, Löffler's parietal fibroplastic endocarditis endocarditis associated with eosinophilia, marked by fibroplastic thickening of the endocardium, resulting in congestive heart failure, persistent tachycardia, hepatomegaly, splenomegaly [medical-dictionary.thefreedictionary.com]

  Furthermore, 2 patients presented with ventricular tachycardia during ACS. At least 7 patients had elevated enzymatic markers of myocardial necrosis, although the values ranged widely. [revespcardiol.org]

• Diastolic Murmur

  On cardiovascular exam he has no murmur initially then developed early diastolic murmur after 2 days of admission. [omicsonline.org]

• Conjunctival Petechiae

  It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. [merckmanuals.com]

• Sweating

  Call your doctor if you have any of these signs of an infection: Fever over 100°F(38.4°C) Sweats or chills, particularly night sweats Skin rash Pain, tenderness, redness or swelling Wound or cut that won't heal Red, warm or draining sore Sore throat, [my.clevelandclinic.org]

  The symptoms of acute IE usually begin with fever (102°–104°F), chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough or swelling in the feet, legs or abdomen. [heart.org]

  Other symptoms that can occur with endocarditis are chills, night sweats, fatigue, joint and muscle aches, and swelling of the legs, abdomen, and feet due to fluid accumulation (edema). [medicinenet.com]

  Patients may experience such general symptoms as fevers, chills, fatigue, weight loss, muscle aches, and sweating. These general, nonspecific, symptoms can make it hard both for the patient and the doctor to recognize endocarditis. [diagnose-me.com]

  If you have acute endocarditis, meaning the infection has happened recently, you may feel like you have the flu, with a fever, night sweats, muscle aches and pains, and decreased energy. [texasheart.org]

• Janeway Lesion

  What are Osler nodes and Janeway lesions? Osler nodes and Janeway lesions are two rare but well-known skin manifestations of bacterial endocarditis. [dermnetnz.org]

  Peripheral signs of acute bacterial endocarditis are represented by Janeway lesions, located on the palms and soles and caused by vasculitis. [symptoma.com]

  O/e his blood pressure 140/90 mm Hg, Pulse 136/min, temperature 37.5, respiratory rate 22/min, janeway lesion, splinter hemorrhages, clubbing, Osler nodes, conjunctival hemorrhages. [omicsonline.org]

  Physical exam reveals nailbed splinter hemorrhages, Osler nodes on his fingers, and Janeway lesions on his palms and soles. Heart auscultation reveals a new murmur. [medbullets.com]

  […] criteria Predisposition: predisposing heart condition or intravenous drug use Fever: T> 38.0° C (100.4° F) Vascular phenomena : major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway [lifeinthefastlane.com]

• Splinter Hemorrhage

  O/e his blood pressure 140/90 mm Hg, Pulse 136/min, temperature 37.5, respiratory rate 22/min, janeway lesion, splinter hemorrhages, clubbing, Osler nodes, conjunctival hemorrhages. [omicsonline.org]

  hemorrhages Petechiae (embolic or vasculitic) Clubbing: in long standing disease Eyes: Roth spots (boat shaped hemorrhages with pale centers, in retina) and conjunctival splinter hemorrhages Neurological: Confusion, hemiplegia and sensory dysfunction [pathologyoutlines.com]

  Doctors may also look for small, dark lines under your fingernails that look like wood splinters (called splinter hemorrhages) or burst blood vessels in the retina of your eyes (called Roth’s spots). [texasheart.org]

  During a physical examination, the physician will look for the presence of the following: Low-grade fever A new or changing heart murmur Janeway lesions Osler’s nodes Roth’s spots Splinter hemorrhages Conjunctival hemorrhages Weakness/paralysis of a part [dovemed.com]

• Petechiae

  In these cases, the changes are masked and as the first warning sign, suddenly embolism, then petechiae, unexpected heart failure, altered murmur or high temperature can occur. [remedyland.com]

  Petechiae These are small (1-2mm) purple spots, caused by a minute haemorrhage. They can be caused by loads of things. [almostadoctor.co.uk]

  Emboli may also cause petechiae, tiny purple or red spots on the skin, resulting from hemorrhages under the skin's surface. Tiny hemorrhages resembling splinters may also appear under the fingernails or toenails. [medical-dictionary.thefreedictionary.com]

  Most patients with infective endocarditis have a heart murmur (most commonly preexisting), and patients may have petechiae on the skin, conjunctivae, or oral mucosa, as well as splenomegaly and other peripheral manifestations. [histopathology-india.net]

  […] existing murmur (a regurgitant murmur may disappear or worsen) Skin lesions Osler nodes: tender lesions found on finger pulps and thenar / hypothenar eminences Janeway lesions: transient, nontender macular papules on palms or soles Splinter hemorrhages Petechiae [pathologyoutlines.com]

• Skin Rash

  Call your doctor if you have any of these signs of an infection: Fever over 100°F(38.4°C) Sweats or chills, particularly night sweats Skin rash Pain, tenderness, redness or swelling Wound or cut that won't heal Red, warm or draining sore Sore throat, [my.clevelandclinic.org]

  rash Splinter haemorrhages and conjunctival haemorrhages Oslers nodes – tender nodules on pulps of fingers and toes Janeway lesions – non-tender haemorrhagic pulps on fingers and toes Roth spots – retinal hemorrhages with a pale centre Splenomegaly New [lifeinthefastlane.com]

  The diagnosis of acute interstitial nephritis is usually based on the clinical presentation (fever, skin rash, acute arthralgia), and laboratory findings (eosinophilia and abnormal urinalysis findings of eosinophiluria, proteinuria, hematuria, sterile [antimicrobe.org]

While evaluating an acute bacterial endocarditis patient, all efforts should be made to identify the etiological agent. A minimum of three blood cultures should be obtained, preferably while the patient is febrile. Blood workup should also include determination of the inflammatory markers and rheumatoid factor. Leukocytosis is usually present. Baseline workup should also include creatinine, urea, blood urea nitrogen, glycemia, and electrolytes.,

The electrocardiogram is able to highlight rhythm and conduction abnormalities if present. The chest radiography is used to mark out concomitant pulmonary infection or pulmonary embolic pyogenic abscesses.

The definitive diagnosis is established following echocardiography, both transthoracic and transesophageal if needed [5]. Emphysema, obesity and valve prosthesis make transthoracic diagnosis more difficult [10]. A vegetation is described as an oscillating mass, usually attached to a valve, but may also be appended to implanted material or ventricular wall. This method is able to describe the size, motility, and consequences of the pathological process, such as leaflet perforation or pillar rupture, dehiscence of a prosthetic valve [11], abscess [12], aneurysm or fistula formation [13].

Computer tomography and magnetic resonance imaging are adjunct methods for acute bacterial endocarditis diagnosis, not widely used in clinical practice, except for selected cases [14].

Urinalysis may demonstrate the presence of hematuria, indicative for immunologically mediated glomerulonephritis or renal infarction. Proteinuria may also be present.

• Blood Culture Positive

  Diagnosis 5.1 Clinical features 5.2 Laboratory findings 5.3 Imaging techniques 5.3.1 Echocardiography 5.3.2 Multislice computed tomography 5.3.3 Magnetic resonance imaging 5.3.4 Nuclear imaging 5.4 Microbiological diagnosis 5.4.1 Blood culture–positive [escardio.org]

  positive for infectious organisms Blood cultures that are positive for microorganisms, which are taken 12 hours apart 3 blood cultures positive on separate occasions that are taken at least 1 hour apart Abnormalities in echocardiogram showing either a [dovemed.com]

  If CRP and WCC are normal, yet you have a positive blood culture, the positive culture is likely due to contamination. [almostadoctor.co.uk]

  […] with IE Blood cultures persistently positive for one of these organisms, from cultures drawn more than 12 hours apart Three or more separate blood cultures drawn at least 1 hour apart Major echocardiographic criteria include the following: Echocardiogram [emedicine.medscape.com]

Among 82 patients who underwent surgical treatment for acute endocarditis over a 10-year period, 15 (18.2%) had extensive destruction of the anulus necessitating special reconstructive techniques for treatment. [ncbi.nlm.nih.gov]

Delay in treatment is a major cause of mortality in this population and only a high index of suspicion can lead to an early life saving diagnosis and treatment. [pjms.com.pk]

Treatment for Bacterial Endocarditis Treatment for infective endocarditis can be medical and surgical. The basis of medication therapy is antibiotic therapy. [remedyland.com]

Infective endocarditis is a condition that still carries a high morbidity and mortality rate (20-30%) despite modern antibiotics and surgical treatment. [books.google.de]

Aortic insufficiency has the hardest prognosis and requires appropriate surgical intervention. Worst prognosis have embolism which affect the brain. [remedyland.com]

Outcome after discharge: follow-up and long-term prognosis 11.1 Recurrences: relapses and reinfections 11.2 Short-term follow-up 11.3 Long-term prognosis 12. [escardio.org]

The emergence of multi-drug resistant strains make treatment more difficult and prognosis more grim. [symptoma.com]

What is the Prognosis of Bacterial Endocarditis? (Outcomes/Resolutions) Bacterial Endocarditis, if left untreated is almost always fatal. [dovemed.com]

[…] endocarditis; HACEK endocarditis; Bloodstream infection Overview Historical Perspective Classification Pathophysiology Causes Differentiating Endocarditis for other Disorders Risk Factors Epidemiology and Demographics Natural History, Complications, and Prognosis [wikidoc.org]

The most frequent bacterial etiologic agents of acute endocarditis are enterococci. The emergence of multi-drug resistant strains make treatment more difficult and prognosis more grim. [symptoma.com]

The etiology of IE has been changing over successive years, and it also differs in various countries. [journals.plos.org]

In case of unknown etiology of fever, an echocardiographic examination is suggested for the diagnosis of IE. [ci.nii.ac.jp]

[…] and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Significant impact on health outcomes is the etiology of infective endocarditis. Only about 50% of patients feel good five years after a cure of bacterial endocarditis. [remedyland.com]

Prosthetic valve endocarditis; Endocardial infection; Native valve endocarditis; HACEK endocarditis; Bloodstream infection Overview Historical Perspective Classification Pathophysiology Causes Differentiating Endocarditis for other Disorders Risk Factors Epidemiology [wikidoc.org]

Epidemiology of infective endocarditis in a large Belgian non-referral hospital. Acta Clinica Belgica. 2014; 69: 183–190. pmid:24761948 View Article PubMed/NCBI Google Scholar 49. [journals.plos.org]

Introduction Clinical definition inflammation of the heart valve, typically secondary to infection Epidemiology location mitral valve > tricuspid valve tricuspid valve disease is associated with intravenous (IV) drug use Staphylococcus aureus, Pseudomonas [medbullets.com]

Infective endocarditis epidemiology over five decades: a systematic review. PLoS One. 2013. 8 (12):e82665. [Medline]. Mendiratta P, Tilford JM, Prodhan P, Cleves MA, Wei JY. [emedicine.medscape.com]

Management of specific situations 12.1 Prosthetic valve endocarditis 12.1.1 Definition and pathophysiology 12.1.2 Diagnosis 12.1.3 Prognosis and treatment 12.2 Infective endocarditis affecting cardiac implantable electronic devices 12.2.1 Introduction [escardio.org]

Intravenous drug abuse endocarditis; Intravenous drug abuse infective endocarditis; Prosthetic valve endocarditis; Endocardial infection; Native valve endocarditis; HACEK endocarditis; Bloodstream infection Overview Historical Perspective Classification Pathophysiology [wikidoc.org]

Pathoanatomic, pathophysiologic and clinical correlations in endocarditis. New Eng J Med 1974; 291(21): 1122-6. 11. Blumer G. Subacute bacterial endocarditis. Medicine 1923; 2: 105-70. 12. Wilensky ND, Milton M, Moldovan A, Gherardi GJ. [pjms.com.pk]

[…] defibrillator, IVDA (right sided endocarditis), indwelling catheter Congenital heart disease: small ventricular septal defect, bicuspid aortic valve, coarctation of aorta, patent ductus arteriosus Uncommon with large VSD, mitral stenosis, atrial septal defect Pathophysiology [pathologyoutlines.com]

Rifampicin-associated acute renal failure: pathophysiologic, immunologic, and clinical features. Am J Kidney Dis 1998;31:108-15. [PubMed] 1 1. Lomaestro BM. Fluoroquinolone-induced renal failure. Drug Saf 2000;2: 479-85. [PubMed] 12. [antimicrobe.org]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.de]

[…] of systemic embolism 8.3.1 Embolic events in infective endocarditis 8.3.2 Predicting the risk of embolism 8.3.3 Indications and timing of surgery to prevent embolism in infective endocarditis 9. [escardio.org]

Prevention for those at risk usually involves awareness of the risks, and preventative antibiotics prior to certain surgical, dental and medical procedures. [heart.org]

Preventive antibiotics Certain dental and medical procedures may allow bacteria to enter your bloodstream. [mayoclinic.org]

Conclusion: This patient has a very rare presentation of Acute Infective Endocarditis, in this case we exactly do not know the source of Staphylococcus aureus but it could be due to poor dental hygiene, early diagnosis and appropriate treatment can prevent [omicsonline.org]

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