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]

  Signs and symptoms include fever, chills, sweating, malaise, weakness, anorexia, weight loss, splenomegaly, flu-like feeling, cardiac murmur, heart failure, petechia (red spots on the skin), Osler's nodes (subcutaneous nodules found on hands and feet) [en.wikipedia.org]

• Fever

  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]

  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]

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

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

• Weight Loss

  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]

  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]

  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

  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]

  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: 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

  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]

  These sometimes can: Be present for days before any other symptoms appear Come and go, or be more noticeable at nighttime You may also have fatigue, weakness, and aches and pains in the muscles or joints. [mountsinai.org]

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

• Anemia

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

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

  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]

  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]

• Cough

  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]

  Coughing up pink, foamy mucus. You passed out. You have symptoms of a stroke. These may include: Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body. Sudden vision changes. [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]

• Dyspnea

  She had signs of infection resistant to antibiotic therapy, secondary cachexia, and dyspnea. [ncbi.nlm.nih.gov]

  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]

  […] 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]

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

• Loss of Appetite

  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]

  […] 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]

  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]

  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]

  Other symptoms are loss of appetite, unexplained weight loss, new rashes (both painful and painless), headache, backache, joint pain, confusion, shortness of breath, or sudden weakness in the face or limbs suggestive of a stroke. [circ.ahajournals.org]

• Heart Disease

  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]

  Bacterial endocarditis is an infection of the lining of the heart. 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. [chw.org]

• 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]

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

  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]

  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]

• Chest Pain

  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]

  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]

  […] 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]

  […] failure Spread of the infection to other parts of the body Stroke, caused by small clots or pieces of the infection breaking off and traveling to the brain Call your provider if you notice the following symptoms during or after treatment: Blood in urine Chest [nlm.nih.gov]

  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]

• Tachycardia

  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]

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

  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]

  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]

• 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]

  On the eighth hospital day, a grade 2 systolic murmur was present in the mitral area. [scielo.br]

• Roth's Spots

  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]

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

  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]

• 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]

  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]

• 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]

  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 ( 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]

• 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]

  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]

  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]

  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]

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

• 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]

  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]

  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]

  Other signs can include: Small areas of bleeding under the nails ( splinter hemorrhages ) Red, painless skin spots on the palms and soles (Janeway lesions) Red, painful nodes in the pads of the fingers and toes (Osler nodes) Shortness of breath with activity [mountsinai.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]

  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]

  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]

• 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]

  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]

  […] 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]

  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]

  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]

  Secondary phenomena could include focal neurologic complaints due to an embolic stroke or back pain associated with vertebral osteomyelitis. As many as 20% of cases present with focal neurologic complaints and stroke syndromes. [emedicine.medscape.com]

• 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

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

  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]

  […] 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]

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

• Stroke

  We report the case of a patient who presented with multifocal left middle cerebral artery stroke in the setting of Enterococcus faecalis endocarditis and was found to have near-occlusive ipsilateral carotid artery stenosis in stroke workup. [ncbi.nlm.nih.gov]

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

  Symptoms include stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Renal embolism and infarction occur in patients with bacterial endocarditis. [emedicine.medscape.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]

• 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]

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

  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]

  Other symptoms are loss of appetite, unexplained weight loss, new rashes (both painful and painless), headache, backache, joint pain, confusion, shortness of breath, or sudden weakness in the face or limbs suggestive of a stroke. [circ.ahajournals.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]

  On the basis of these data, we agree with Fournier et al. that an antiphase I IgG antibody titer ≥1:800 or a single blood culture positive for C. burnetii should be a major criterion in the Duke schema. [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]

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

The cornerstone of treatment is early initiation of antibiotic treatment, which significantly reduces the risk of embolization after 1 week of treatment. [ncbi.nlm.nih.gov]

“Infective endocarditis treatment and management.” Medscape. http://emedicine.medscape.com/article/216650-treatment#d11 Huckell VF. “Infective endocarditis.” [docdoc.com.sg]

[…] setting of a bioprosthetic aortic valve abscess in which there was no complete coronary occlusion visualized and given the patient's recent unremarkable catheterization and findings of diffuse tapering of the proximal left coronary system, the most likely etiology [ncbi.nlm.nih.gov]

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

Streptococcus viridans is the usual etiologic agent of sbe. [icd9data.com]

The etiology is likely due to common pathogens that affect individuals with risk factors. This disease may manifest in a subacute or acute form. The presentation of bacterial endocarditis is classified as subacute or acute. [symptoma.com]

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]

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]

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]

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]

[…] 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]

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]

In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). [ncbi.nlm.nih.gov]

View complete AHA Statement on Prevention of Infective Endocarditis (PDF) . [chp.edu]

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. [circ.ahajournals.org]

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