The presentation of bacterial endocarditis is classified as subacute or acute [1]. While both forms share similar features, they differ regarding duration and rate of progression.

Subacute

Patients with this type experience an insidious onset of nonspecific symptoms such as low-grade fever, fatigue, anorexia, weight loss, malaise, night sweats, chills, and arthralgia. These may persist for weeks to months [2].

Acute

The clinical picture of acute bacterial endocarditis consists of a sudden onset of fever [3] along with a rapid and aggressive course [4]. Septic shock may occur in these critically ill individuals. The majority of patients will have a heart murmur.

Complications

Patients with bacterial endocarditis are at risk for congestive heart failure (CHF), stroke, various types of infection [2], myocardial infarction, etc.

Physical exam

Up to half of all patients will exhibit classic physical signs such as 1) petechiae, 2) splinter hemorrhages, 3) Osler's nodes, 4) Janeway lesions and 5) Roth's spots. The latter three are considered minor criteria used for diagnosis of bacterial endocarditis [5].

Notable vital sign findings include fever and tachycardia. The patient overall appears toxic and pale. Also, patients with CHF present with jugular vein distension and peripheral edema. Moreover, focal neurologic deficits occur in up to 40% of affected patients [6]. Delirium and other mental status changes may be evident. Additionally, conjunctival hemorrhage may also be apparent.

The cardiac exam is a crucial component of the physical assessment as auscultation typically reveals the presence of a murmur. This may either be new or an exacerbation of a preexisting murmur. Other abnormal heart and lung sounds may include gallops, rales, pericardial rub, and pleural friction rub.

• Splenomegaly

  Symptoms can include heart murmur, embolic phenomena, splenomegaly, bacteremia, extended fever, and heart failure. [medical-dictionary.thefreedictionary.com]

  RESULTS--Group A--9 patients aged 8-58 years, 3 men, all them with cardiac murmurs, fever and anemia, 5 with splenomegaly. Hemocultures were done in 7 patients and positive in 1. [bases.bireme.br]

  […] murmurs Petechiae or round spots caused by bleeding into the skin Subungual haemorrhages or dark red linear lesions of the nail bed Tender subcutaneous nodules on the finger pads Lesions on the palms and soles Retinal haemorrhages with clear centres Splenomegaly [docdoc.com.sg]

  It has been proposed that the minor criteria be extended to include erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), splenomegaly, microscopic hematuria, and newly diagnosed clubbing. [ncbi.nlm.nih.gov]

  […] splinter hemorrhages Neurological: Confusion, hemiplegia and sensory dysfunction due to emboli Subarachnoid hematoma due to rupture of mycotic aneurysm Renal: Infarction causes loin pain and hematuria Immune complex deposition may cause glomerulonephritis Splenomegaly [pathologyoutlines.com]

• Fever

  Diagnosis Endocarditis is suspected in a patient with a heart murmur and unexplained fever for at least one week, and in an intravenous drug abuser with a fever, even in the absence of hearing a murmur. [healthcentral.com]

  Another major criterion requiring redefinition regards Q-fever serology. In the original Duke criteria, a positive serology for Q fever was considered a minor microbiological criterion. [doi.org]

  Fever (39 degrees C or higher) was noted 23 days after admission. A blood culture revealed Trichosporon asahii (T. asahii), suggesting T. asahii fungemia. [ncbi.nlm.nih.gov]

  The subacute variety is usually caused by lodging of Streptococcus viridans in heart valves damaged by rheumatic fever. [medical-dictionary.thefreedictionary.com]

• Weight Loss

  He consulted our hospital because of weight loss and fever. Computed tomography (CT) revealed renal infarction. Nine days after admission, CT showed hemorrhagic cerebral infarction in the right frontal lobe. [ncbi.nlm.nih.gov]

  Bacterial endocarditis should be considered in horses with clinical signs of weight loss, fever, cardiac murmur and tachycardia. [cbmr.ku.dk]

  The clinical presentation is one of fever, night sweats, weight loss, and weakness, with additional symptoms due to cardiac failure or embolism. Heart murmurs are common. [gpnotebook.co.uk]

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

  Other symptoms may include: poor appetite fatigue rapid breathing joint pain rash weight loss What are the causes of bacterial endocarditis? Bacterial endocarditis can occur when bacteria enter the body and grow on the heart lining. [childrenshospital.org]

• Chills

  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]

  Symptoms fever shaking chills swollen joints lameness spontaneous bleeding blindness behavioral and personality changes unstable gait seizures new or changing heart murmur Treatment Intensive therapy with injectable antibiotics can be effective if diagnosed [bigheartsfund.org]

  Symptoms: Early symptoms: Fatigue and weakness Intermittent fever, chills and excessive sweating, especially at night Weight loss Vague aches and pains Heart murmur Late symptoms: Severe chills and high fever Shortness of breath on exertion Swelling of [maxor.com]

• Fatigue

  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]

  Acute bacterial endocarditis usually begins suddenly with a high fever, fast heart rate, fatigue, and rapid and extensive heart valve damage. [merckmanuals.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]

• Anemia

  In 1939 Middleton and Burke 2 reported anemia, usually of [jamanetwork.com]

  RESULTS--Group A--9 patients aged 8-58 years, 3 men, all them with cardiac murmurs, fever and anemia, 5 with splenomegaly. Hemocultures were done in 7 patients and positive in 1. [bases.bireme.br]

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

  Staphylococcus epidermidis and Staphylococcus aureus "Bacteria FROM JANE" mnenomic Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli A particular organism causes endocarditis in patients with underlying colorectal carcinoma [quizlet.com]

  These tests may reveal leukocytosis, anemia, elevated ESR, and positive RF. Also, urinalysis typically shows microscopic hematuria and may also depict red blood cell (RBC) casts. [symptoma.com]

• Cough

  Cough, shortness of breath, joint pain, diarrhea, and abdominal or flank pain may be present. About 90 percent of patients will have heart murmurs, but murmurs may be absent in patients with right-sided heart infections. [healthcentral.com]

  Other symptoms include a cough, skin changes, and swelling in the arms, legs, or abdomen. Bacterial endocarditis is treated with antibiotics. If significant heart valve damage occurs, heart valve replacement surgery may be needed. [urmc.rochester.edu]

• Dyspnea

  He was well, apart from episodes of dizziness and dyspnea after exercise during the previous 4 months. These episodes had started 1 week after the patient had undergone a dental treatment. Previous extensive investigations had been inconclusive. [nejm.org]

  A 37-year-old man was admitted with fever, hemoptysis, and dyspnea. Admission examinations revealed severe renal failure requiring dialysis therapy. Chest radiograph showed extensive pulmonary reticulonodular infiltrates. [ncbi.nlm.nih.gov]

  […] and enterococci Early onset: S. epidermidis or S. aureus (most common) [1][2] Late-onset: S. epidermidis (most common) [1][2] Constitutional symptoms Fever and chills (∼ 90% of cases), tachycardia General malaise, weakness, night sweats, weight loss Dyspnea [amboss.com]

• Rales

  Other abnormal heart and lung sounds may include gallops, rales, pericardial rub, and pleural friction rub. [symptoma.com]

  Other signs include the following: Stiff neck Delirium Paralysis, hemiparesis, aphasia Conjunctival hemorrhage Pallor Gallops Rales Cardiac arrhythmia Pericardial rub Pleural friction rub Subacute infective endocarditis Approximately 3-15% of patients [emedicine.medscape.com]

  Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields suggest the development of pulmonary edema (fluid in the alveoli). [en.wikipedia.org]

• Hemoptysis

  A 37-year-old man was admitted with fever, hemoptysis, and dyspnea. Admission examinations revealed severe renal failure requiring dialysis therapy. Chest radiograph showed extensive pulmonary reticulonodular infiltrates. [ncbi.nlm.nih.gov]

  Right-sided endocarditis Septic pulmonary emboli may cause cough, pleuritic chest pain, and sometimes hemoptysis. A murmur of tricuspid regurgitation is typical. [merckmanuals.com]

  Septic pulmonary emboli may cause cough, pleuritic chest pain, and sometimes hemoptysis. A murmur of tricuspid regurgitation is typical. [msdmanuals.com]

• Loss of Appetite

  […] of appetite, weight loss, paleness, headache, or weakness Palpitations Fainting Trouble speaking Weakness in any extremity or face Spots on your fingernails, fingertips, whites of the eyes, or other parts of your skin Symptoms of a stroke such as trouble [saintlukeskc.org]

  These may include: Fever Chills Fatigue Weakness Discomfort Unexplained weight loss Poor appetite Muscle aches Joint pain Coughing Shortness of breath Little red dots on the skin, inside the mouth, and/or under the nails Bumps on the fingers and toes [health.cvs.com]

  Symptoms of bacterial endocarditis may include fever, fatigue, loss of appetite, night sweats, chills, headaches, joint discomfort, and tiny pinpoint-sized hemorrhages on the chest and back, fingers, or toes. [healthcentral.com]

  Other constitutional symptoms include chills, sweats, loss of appetite, and malaise [2]. Although a new or changed regurgitant murmur is the most common cardiac finding on physical examination, this may be absent in right-sided endocarditis. [journalofethics.ama-assn.org]

  Some of the general symptoms of endocarditis can include: Fever and chills Lethargy Loss of appetite Generalised aching throughout the body Abnormal heart rhythms such as a slow heart rate or tachycardia (rapid heart rate) Heart murmur Increased breathing [betterhealth.vic.gov.au]

• Heart Disease

  Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device. Antibiotic prophylaxis is not recommended for any other form of congenital heart disease. [ada.org]

  Author information 1 1Department of Congenital Heart Diseases and Pediatric Cardiology,Silesian Center for Heart Diseases,Medical University of Silesia,Zabrze,Poland. 2 2Department of Transplantology and Cardiac Surgery,Silesian Center for Heart Diseases [ncbi.nlm.nih.gov]

  This infection can occur in any person (infant, child or adult) who has heart disease present at birth (congenital heart disease), or can occur in people without heart disease. [cincinnatichildrens.org]

  This bacteria generally don't cause problems but can be life threatening in patients with heart disease or valve conditions. [ucsfhealth.org]

• Heart Murmur

  About 90 percent of patients will have heart murmurs, but murmurs may be absent in patients with right-sided heart infections. A changing murmur is common only in acute endocarditis. [healthcentral.com]

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

  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]

• Chest Pain

  When to call your healthcare provider Call your healthcare provider right away if you have any of the following: Tiredness that persists for 2 to 3 days Decreased exercise tolerance Chest pain or shortness of breath Fever over 100.4 °F ( 38.0 °C) Sweats [saintlukeskc.org]

  Symptoms may include: fever chest pain weakness blood in urine chills sweating red skin rash white spots in mouth or on tongue pain and swelling in joints muscle aches and tenderness abnormal urine color fatigue cough shortness of breath sore throat sinus [healthline.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]

  […] parts of the body Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain When to Contact a Medical Professional Call your provider if you notice the following symptoms during or after treatment: Blood in urine Chest [mountsinai.org]

• Tachycardia

  Bacterial endocarditis should be considered in horses with clinical signs of weight loss, fever, cardiac murmur and tachycardia. [cbmr.ku.dk]

  Notable vital sign findings include fever and tachycardia. The patient overall appears toxic and pale. Also, patients with CHF present with jugular vein distension and peripheral edema. [symptoma.com]

  Neonates with endocarditis may also have feeding problems, respiratory distress, or tachycardia. [emedicine.medscape.com]

  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]

  You should not be at increased risk of infective endocarditis if you: have a pacemaker or defibrillator; have an arrhythmia such as supraventricular tachycardia (SVT); or have acquired heart disease which has not damaged the heart valves, for example, [chfed.org.uk]

• Systolic Murmur

  On physical exam, you appreciate a faint systolic murmur. Before any lab tests or other imaging have been done, you obtain the following echo: Post navigation [web.archive.org]

  Cardiovascular examination revealed an ejection click and a systolic murmur that radiated to the carotids. Neurological examination demonstrated left facial weakness and Medical Research Council (MRC) grade 4/5 power in left upper and lower limbs. [academic.oup.com]

  Patients with mitral valve prolapse should be given antibiotics only when it is associated with a systolic murmur. Antibiotics UK recommedations 1. [aic.cuhk.edu.hk]

  In addition to the general symptoms of infective endocarditis, there may be a heart murmur from blood flowing backward through a defective valve (regurgitative murmur) or a murmur suggestive of blood outflow obstruction (systolic murmur). [rarediseases.org]

• Roth's Spots

  The fundoscopy revealed Roth spots in both eyes that aroused the suspicion of infective endocarditis. [pesquisa.bvsalud.org]

  Little black bags, ophthalmoscopy, and the Roth spot. Tex Heart Inst J 2013 ; 40 : 115 – 6. 2. Litten's sign (Roth's spots) in bacterial endocarditis. Arch Ophthalmol 1994 ; 112 : 683 – 4. 3. [academic.oup.com]

  The presence of white-centered hemorrhages (Roth spots) should prompt the consideration of possible infective endocarditis. A comparison of Panel A and Panel B (3 days apart) shows how quickly such spots can change. [nejm.org]

  - http://en.wikipedia.org/wiki/Osler%27s_node ● Roth spots (retinal hemorrhages) Oval shaped, Roth spots, white centered hemorrhages present on the retina of a patient with infective endocarditis - http://simple-cardio.blogspot.com/2012/06/peripheral-signs-of-infective [pedclerk.bsd.uchicago.edu]

• 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]

• Night Sweats

  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]

  The clinical presentation is one of fever, night sweats, weight loss, and weakness, with additional symptoms due to cardiac failure or embolism. Heart murmurs are common. [gpnotebook.co.uk]

  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

  lesions ( painless hemorrhagic lesions on palms and soles) Nontender, erythematous and nodular Janeway lesions - http://simple-cardio.blogspot.com/2012/06/peripheral-signs-of-infective.... ● Glomerulonephritis ● Osler nodes ( painful lesions on hand [pedclerk.bsd.uchicago.edu]

  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]

  Janeway lesions are seen in people with acute bacterial endocarditis. They appear as flat, painless, red to bluish-red spots on the palms and soles. Janeway lesions are seen in people with acute bacterial endocarditis. [mountsinai.org]

  lesions Immunologic phenomena : glomerulonephritis, Osler's nodes, Roth spots (what's this?) [medcalc.com]

• Petechiae

  Roth spots are petechiae of the retina with a white or pale center that corresponds to a bundle of cotton wool or a multinuclear leukocyte aggregate. [pesquisa.bvsalud.org]

  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]

  Petechiae differ from those due to � platelets in that they tend to occur on palms and soles rather than in dependent areas. Also tend to be larger and have irregular edges. [aic.cuhk.edu.hk]

  Physical exam Up to half of all patients will exhibit classic physical signs such as 1) petechiae, 2) splinter hemorrhages, 3) Osler's nodes, 4) Janeway lesions and 5) Roth's spots. [symptoma.com]

• Splinter Hemorrhage

  He was afebrile but had a pansystolic murmur and a solitary splinter hemorrhage on the right thumb. Echocardiography revealed moderate-to-severe mitral-valve regurgitation, with thickening and signs of vegetations. The ejection fraction was 65%. [nejm.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]

  Physical exam Up to half of all patients will exhibit classic physical signs such as 1) petechiae, 2) splinter hemorrhages, 3) Osler's nodes, 4) Janeway lesions and 5) Roth's spots. [symptoma.com]

  Cutaneous manifestations include petechiae, Osler nodes, Janeway lesions, and splinter hemorrhages. Neurologic syndromes include cerebral embolism, infarction, and intracerebral hemorrhage and stroke. [emedicine.medscape.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]

• Eczema

  Pyoderma form when the organism colonises, and subsequently invades (especially when occlusive dressings are used), exfoliative lesions, venous stasis ulcers or eczema. These have a characteristic moth-eaten appearance and erythematous border. [web.archive.org]

• Arthralgia

  Subacute Patients with this type experience an insidious onset of nonspecific symptoms such as low-grade fever, fatigue, anorexia, weight loss, malaise, night sweats, chills, and arthralgia. These may persist for weeks to months. [symptoma.com]

  Churchill et al reported on 192 patients with a diagnosis of bacterial infective endocarditis, 29 (15%) of whom had only musculoskeletal involvement as the first symptom of IE and their symptoms included: arthralgia (38%), arthritis (31%), lumbar pain [scielo.br]

  SymptomsAcute– High grade fever andchills– SOB– Arthralgias/ myalgias– Abdominal pain– Pleuritic chest pain– Back painSub acute– Low grade fever– Anorexia– Weight loss– Fatigue– Arthralgias/ myalgias– Abdominal pain– N/VThe onset of symptoms is usually [slideshare.net]

  Constitutional symptoms Endocarditis should be considered in patients with vague or generalized constitutional symptoms such as fever, rigors, night sweats, anorexia, weight loss, or arthralgia. [ncbi.nlm.nih.gov]

• Myalgia

  SymptomsAcute– High grade fever andchills– SOB– Arthralgias/ myalgias– Abdominal pain– Pleuritic chest pain– Back painSub acute– Low grade fever– Anorexia– Weight loss– Fatigue– Arthralgias/ myalgias– Abdominal pain– N/VThe onset of symptoms is usually [slideshare.net]

  He was admitted to the hospital due to intense diffuse myalgia, left ankle arthritis, and abdominal pain. He did not have a history of cardiac or general disease and reported no intravenous drug abuse. [doi.org]

  […] aureus (most common) [1][2] Late-onset: S. epidermidis (most common) [1][2] Constitutional symptoms Fever and chills (∼ 90% of cases), tachycardia General malaise, weakness, night sweats, weight loss Dyspnea;, cough, pleuritic chest pain Arthralgias, myalgias [amboss.com]

  It can be associated with chills, night sweats, anorexia, weight loss, loss of appetite, malaise, headache, myalgias, arthralgias, abdominal pain, dyspnea, cough, and pleuritic pain. Cardiac murmurs are observed in about 85% of patients. [ncbi.nlm.nih.gov]

  Complaints of low back pain, pain in the joints (arthralgia) or in one or more muscles (myalgia) are common. These symptoms usually appear early in the disease, occasionally as the only initial symptoms. [rarediseases.org]

• Back Pain

  Back pain, may be severe Heart murmur Weight loss Late stages: Severe chills and high fever Shortness of breath on exertion Swelling of the feet, legs and abdomen Rapid or irregular heartbeat Acute bacterial endocarditis (ABE) has similar symptoms, but [diagnose-me.com]

  It may present as an acute, rapidly progressive infection but also as a subacute or chronic disease, with nonspecific symptoms - eg, fatigue, low-grade fever, flu-like illness, polymyalgia-like symptoms, loss of appetite, back pain, pleuritic pain, abdominal [patient.info]

  Incidence of clinical features in infective endocarditis >75% Fever, heart murmur 50-75% Embolic phenomena, previous heart disease 25-50% Chills, weakness, splenomegaly < 25% Weight loss, anorexia, arthralgia, back pain, glomerulonephritis, clubbing Investigations [aic.cuhk.edu.hk]

  Complaints of low back pain, pain in the joints (arthralgia) or in one or more muscles (myalgia) are common. These symptoms usually appear early in the disease, occasionally as the only initial symptoms. [rarediseases.org]

• Low Back Pain

  Complaints of low back pain, pain in the joints (arthralgia) or in one or more muscles (myalgia) are common. These symptoms usually appear early in the disease, occasionally as the only initial symptoms. [rarediseases.org]

• Hematuria

  […] hemorrhages with pale centers, in retina) and conjunctival splinter hemorrhages Neurological: Confusion, hemiplegia and sensory dysfunction due to emboli Subarachnoid hematoma due to rupture of mycotic aneurysm Renal: Infarction causes loin pain and hematuria [pathologyoutlines.com]

  Microscopic hematuria is seen in about 50% of cases. Gross hematuria indicates the presence of focal or diffuse glomerulonephritis or possible embolic renal infarction. [antimicrobe.org]

  Also, urinalysis typically shows microscopic hematuria and may also depict red blood cell (RBC) casts. [symptoma.com]

  However, renal insufficiency resulting from immune complex–mediated glomerulonephritis occurs in less than 15% of patients with endocarditis and may cause hematuria and, rarely, azotemia. [emedicine.medscape.com]

  Renal Infarction causes loin pain and hematuria. Immune complex deposition may result in glomerulonephritis. [ncbi.nlm.nih.gov]

• Stroke

  In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. [ncbi.nlm.nih.gov]

  […] risk of stroke. [medicalxpress.com]

• Headache

  A sudden, severe headache that is different from past headaches. Call your doctor or nurse call line now or seek immediate medical care if: You have a new or higher fever. [myhealth.alberta.ca]

  Symptoms may include: Flu-like symptoms, such as fever, chills, tiredness, aching muscles and joints, night sweats, and headaches Shortness of breath Cough Pale skin Bumps under the skin on the fingers and toes Spots on the palms of the hands and soles [stlouischildrens.org]

  Tiredness that persists for 2 to 3 days Decreased exercise tolerance Chest pain or shortness of breath Fever over 100.4 °F ( 38.0 °C) Sweats Severe abdominal or flank pain Bloody urine Return of symptoms such as loss of appetite, weight loss, paleness, headache [saintlukeskc.org]

• Confusion

  Endocarditis is generally preventable with simple measures, but the implementation of these measures is often confusing for the parents of thechild, the physician, and the dentist. Hopefully this brief article will decrease some of that confusion. [csun.edu]

  Sudden confusion or trouble understanding simple statements. Sudden problems with walking or balance. A sudden, severe headache that is different from past headaches. [myhealth.alberta.ca]

  It has been acknowledged that the changes in recommendations may be confusing to patients who have been receiving prophylactic antibiotics over their lifetime and are unwilling to change this practice. [saheart.com.au]

  […] nontender macular papules on palms or soles Splinter 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 [pathologyoutlines.com]

  If the infection spreads to the brain, it can cause headaches, confusion, or even stroke. [diagnose-me.com]

• Altered Mental Status

  38 yo female presents with altered mental status. The patient was found down at home, and no further history is known. EMS intubated on scene. [web.archive.org]

The clinical assessment should include a detailed history of the patient and the inquiry about risk factors such as congenital heart defects, history of the rheumatic disease, and the presence of prosthetic valves [7] as well as intravenous drug use (IVDU) [8].

The clinical presentation, history, and physical exam findings should raise suspicion for bacterial endocarditis. Further testing is necessary as described below. Also, the clinician must follow the Duke diagnostic criteria for endocarditis to establish the diagnosis [5].

Laboratory tests

The American Heart Association (AHA) recommends obtaining at least three blood cultures, of which the initial and final sets are drawn at least one hour apart [5]. Furthermore, the samples should be retrieved from 3 different venipuncture sites. Very importantly, initiation of empiric antibiotic treatment should be postponed until after cultures are provided.

The workup further includes a complete blood count (CBC), complete metabolic panel (CMP), erythrocyte sedimentation rate (ESR), complement panel, coagulation studies, and rheumatoid factor (RF). These tests may reveal leukocytosis, anemia, elevated ESR, and positive RF. Also, urinalysis typically shows microscopic hematuria and may also depict red blood cell (RBC) casts.

Imaging

The AHA also recommends the use of echocardiography to investigate the presence of valvular vegetations and annular abscess [5] and to evaluate the valvular and heart function overall. Specifically, transthoracic echocardiography (TTE) is the initial imaging modality performed in most individuals while transesophageal echocardiogram (TEE) is the study of choice for those with a cardiac implantable electronic device (CIED) [9] or prosthetic valves [5].

Note that a patient with manifestations suggestive of cerebral emboli should be evaluated with a head computed tomography (CT) scan [10] or magnetic resonance imaging (MRI) [5].

• Erythrocyte Sedimentation Rate Increased

  Established infections often cause a normocytic-normochromic anemia, elevated white blood cell count, increased erythrocyte sedimentation rate, increased immunoglobulin levels, and the presence of circulating immune complexes and rheumatoid factor, but [msdmanuals.com]

• Blood Culture Positive

  Staphylococcus aureus, or enterococcus), OR 2) there are persistently postiive blood cultures (two positive cultures from samples 12 h apart or three positive cultures drawn 1 h apart) of a microorganism consistent with IE, such as S epidermidis, OR 3 [pedclerk.bsd.uchicago.edu]

  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]

  Analysis of patients with negative blood culture by the Duke criteria shows that these criteria perform poorly in such patients, which is not surprising since blood culture positivity is a major criterion. [doi.org]

  In cases of blood culture-positive endocarditis, results of valve cultures may cause unnecessary confusion if valve cultures generate discrepant (i.e., falsely positive) results. [jcm.asm.org]

• Leukocytosis

  These tests may reveal leukocytosis, anemia, elevated ESR, and positive RF. Also, urinalysis typically shows microscopic hematuria and may also depict red blood cell (RBC) casts. [symptoma.com]

  FROM JANE - Fever, Roth's spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail bed hemorrhage, Emboli References:[16][1][7][18][19][20][21][22][23][24][2] Diagnostics Laboratory studies Best initial test: blood cultures Leukocytosis (with left shift [amboss.com]

  Bacterial Endocarditis Patients with acute or recent infection High temperature with chills, sweating, weakness Sudden changes or appearance of new murmurs The emergence embolism, petechiae and toxic effects General intoxication, an enlarged spleen Anemia, leukocytosis [remedyland.com]

  Investigations[4] Nonspecific signs of infection - eg, elevated CRP or ESR, leukocytosis, anaemia and microscopic haematuria. CXR: as part of the initial assessment. ECG is useful to detect the 10% of patients who will develop conduction defects. [patient.info]

  Nosocomial infective endocarditis NIE commonly manifests with elements of a sepsis syndrome (ie, hypotension, metabolic acidosis fever, leukocytosis, and multiple organ failure). [emedicine.medscape.com]

[…] and after completion of antimicrobial treatment. [ncbi.nlm.nih.gov]

Patients were included if they had to receive antibiotic prophylaxis prior to dental treatment according to the 1997 AHA protocol and did not require antibiotic prophylaxis prior to dental treatment according to the 2007 AHA guidelines. [web.archive.org]

A 40-year-old man, smoker with cavitated lesions in both lungs, and inflammation in the nasal mucosa and vocal cords developed an ischemic stroke in the left middle cerebral artery, with the etiological study showing non-bacterial endocarditis. [ncbi.nlm.nih.gov]

FIG 2 Diagnostic testing for identification of the microbiological etiology of infective endocarditis. [jcm.asm.org]

Endocarditis/complications, Vision Disorders/etiology, Endocarditis/diagnostic imaging, Endocarditis/therapy, Female, Humans, Middle Aged, Vision Disorders/diagnostic imaging, Vision Disorders/therapy, Visual Acuity [pesquisa.bvsalud.org]

Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987-2013). Europace. 2016;18(6):836–41. CrossRef PubMed Google Scholar 44. [doi.org]

Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very scarce. Moreover, prophylaxis guidelines have recently changed and the impact on IE incidence is still unknown. [ncbi.nlm.nih.gov]

Contents: The concept of micro-organisms -- Bacterial structure and physiology -- Bacterial taxonomy -- Bacterial pathogenicity and epidemiology -- Bacterial genetics and molecular biology -- Viruses -- Fungi -- Host defences -- Immunization --Antimicrobial [worldcat.org]

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]

[…] administer 1 hour before procedure) Patients who are unable to take oral medication: IV ampicillin Patients with penicillin allergy: PO clarithromycin or azithromycin References:[15][32] Infective endocarditis Summary Etiology Pathogens Risk factors Pathophysiology [amboss.com]

Methicillin-Resistant Staphylococcus aureus Prosthetic Valve Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin. Microbiol. Rev. 2019 Mar 20;32(2) [PMC free article: PMC6431130] [PubMed: 30760474] 2. [ncbi.nlm.nih.gov]

A quick-reference, easy-to-use format includes these headings for each med-surg disorder: Overview/Pathophysiology Assessment Diagnostic Tests Collaborative Management Nursing Diagnoses and Interventions Patient-Family Teaching and Discharge Planning [play.google.com]

[…] 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]

So, I don’t recommend antibiotic prophylaxis to prevent prosthetic joint infections. [thischangedmypractice.com]

The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. [ncbi.nlm.nih.gov]

It is important to recognize that even if antibiotics effectively prevented infective endocarditis and were used according to current guidelines, only a small percentage of cases could be prevented. [ahajournals.org]

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