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Bacterial Endocarditis

Bacterial Endocarditides

Bacterial endocarditis is an infection of the endocardium or the heart valves as a result of bacteremia. The etiology is likely due to common pathogens that affect individuals with risk factors. This disease may manifest in a subacute or acute form.


Presentation

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]
  • There can been present splenomegaly, tachycardia, petechiae on the skin occur in about 10-15% of patients usually appear in groups 2-3 days and fade away and disappear without a trace, mucous membranes, then finding on the fundus, bleeding beneath the[remedyland.com]
  • The clinical examination on admission showed a temperature of 39.7 C and splenomegaly combined with hepatomegaly. Cardiac auscultation found an unknown aortic regurgitation murmur. There were no signs of severe sepsis or congestive heart failure.[doi.org]
  • These minor criteria were splenomegaly (3), haematuria (4), clubbing (2), splinters (2), rash (1), petechiae (2), and purpura (1) (table 5).[doi.org]
  • A British study of 118 pathologically proven cases of IE showed improved diagnostic sensitivity in this highly selected group, with the addition of the following minor criteria: splenomegaly, splinter hemorrhages, petechiae, newly diagnosed clubbing,[doi.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]
  • On the fourth postoperative day, the patient presented with fever and worsening abdominal pain, which was later diagnosed as infectious aortitis.[ncbi.nlm.nih.gov]
  • Abstract A 66-year-old man with a large secundum atrial septal defect (ASD) that had been repaired percutaneously 30 months previously with an Amplatzer ASD occluder (ASO) presented with fevers and Staphylococcus aureus bacteremia.[ncbi.nlm.nih.gov]
  • Here we report a case of 40-year old female who was referred because of generalized body swelling and decrease urine output associated with low grade fever on and off for two to three months.[ncbi.nlm.nih.gov]
  • Abstract A 9-month-old infant presented with fever, dyspnoea, and a murmur. Echocardiography showed a mitral vegetation with significant regurgitation.[ncbi.nlm.nih.gov]
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]
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]
  • 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]
  • 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]
  • Long-term fever, weight loss, joint pain and muscle pain, fatigue and anemia. Heart murmur, petechiae, emboli phenomena. Blood culture is positive.[remedyland.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]
  • 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]
  • 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]
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]
  • 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]
  • 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]
  • 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]
  • Other clinical signs, such as dyspnea, cough, general body pain, lower extremity pain, and finger clubbing were detected in a few cases [1] .[doi.org]
Rales
  • Other abnormal heart and lung sounds may include gallops, rales, pericardial rub, and pleural friction rub.[symptoma.com]
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]
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]
  • 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]
  • Other symptoms may include night sweats, chills, headache and severe loss of appetite resulting in weight loss. Heart murmurs are present in over 85% of individuals with infective endocarditis, and 60% have enlarged spleens.[rarediseases.org]
  • […] 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 Severe abdominal or flank pain Bloody urine Return of symptoms such as loss[saintlukeskc.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]
  • These cases are probably overestimated by the publications, whereas millions of people are tattooed and pierced around the world and congenital heart diseases concern approximately 1% of the general population.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Pediatric Cardiology and Congenital heart Diseases, Cardiovascular Hospital Louis Pradel and Claude Bernard Lyon-1 University, Lyon, France.[ncbi.nlm.nih.gov]
Heart Murmur
  • Heart murmurs can be considered irrelevant when it comes to infections tricuspidalis valves and valvular pulmonary artery. However, with repeated pulmonary infarction due to pneumonia, heart murmurs can be very characteristic signs.[remedyland.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]
  • Heart murmurs are common. Also a focal renal infarction, focal nephritis or diffuse glomerulonephritis is very common, resulting in microscopic haematuria and proteinuria. The onset of the illness may be difficult to date.[gpnotebook.co.uk]
  • 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]
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]
  • 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]
  • 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]
  • An electrocardiogram revealed sinusal tachycardia. Thoracic radiography and abdominal ultrasonography examinations were normal. Lumbar radiography showed a lytic lesion in the L4 vertebral body.[scielo.br]
Chest Pain
  • pain Fatigue Fever that doesn't go away Fever Numbness Weakness Weight loss without change in diet Prevention The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with: Certain[mountsinai.org]
  • 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 : 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]
  • pain Fatigue Fever that doesn't go away in two or three days Fever Numbness Weakness Weight loss without change in diet The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with[nlm.nih.gov]
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]
  • 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]
  • 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]
  • 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]
  • 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]
  • 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]
  • This finding is known as Roth spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.[mountsinai.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]
  • 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]
  • 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]
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]
  • 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]
  • Back pain (15% of patients) may have origin in immune complex deposition in disc spaces. Investigations [ 4 ] Nonspecific signs of infection - eg, elevated CRP or ESR, leukocytosis, anaemia and microscopic haematuria.[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]
Myalgia
  • 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]
  • 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]
  • CASE REPORT A 47-year-old man was admitted to our hospital with a 1-month history of fever, shivering, fatigue, myalgia, headaches, anorexia, and weight loss (6 kg).[doi.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]
Night Sweats
  • 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]
  • 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]
  • 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
  • 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]
  • 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]
  • 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]
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]
  • 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]
  • In addition, the musculoskeletal symptoms preceded the infective endocarditis (IE) by about 1 month, which occurred together with other symptoms, e.g. mycotic aneurysms and petechiae.[scielo.br]
Splinter Hemorrhage
  • 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]
  • 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]
  • 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]
  • Reddish-brown streaks (splinter hemorrhages) may occur under the nails of the fingers and toes, and small painful nodules may appear in the pads of the fingers or toes (Osler’s nodes).[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]
  • Blood or blood cells may be present in the urine (hematuria). Small red or purple spots composed of blood (petechiae) may cover the skin of the upper trunk.[rarediseases.org]
  • […] 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]
Stroke
  • […] complications Stroke/diagnosis* Stroke/diagnostic imaging Tomography, X-Ray Computed[ncbi.nlm.nih.gov]
  • The presence of an ischemic stroke in this disease is very rare.[ncbi.nlm.nih.gov]
  • BE patients (32-77 years) presented multiple (n 3) or single ischemic strokes (n 2) or encephalopathy and headache (n 2).[ncbi.nlm.nih.gov]
  • […] risk of stroke.[medicalxpress.com]
  • Bacterial endocarditis can permanently damage your heart valves, and may cause heart failure, stroke and abnormal heart rhythms (arrhythmias). Bacterial endocarditis can be treated with antibiotics.[medmovie.com]
Headache
  • BE patients (32-77 years) presented multiple (n 3) or single ischemic strokes (n 2) or encephalopathy and headache (n 2).[ncbi.nlm.nih.gov]
  • 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]
  • 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 fever persisted and on the third hospital day, the patient showed acute mental confusion, right hemiparesis, meningeal signs and hypotension (80/40 mmHg).[scielo.br]
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]

Workup

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].

Elevated Sedimentation Rate
  • Blood tests show signs of inflammation such as an elevated sedimentation rate,while anemia and blood cells in the urine are often present. The most important diagnostic test for endocarditis involves a positive blood culture.[csun.edu]
Blood Culture Positive
  • Duke Criteria - Major Criteria Positive blood culture* Positive echocardiogram (vegetation, paravalvular abscess, or valve dehiscence after surgery). While transesophageal echo recommended in adults, transthoracic echo is fine in children.[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 culturepositive[escardio.org]
  • Whipple’s endocarditis: review of the literature and comparisons with Q fever, Bartonella infection, and blood-culture positive endocarditis. Clin Infect Dis 2001 ; 33 : 1309 –16. La Scola B, Raoult D.[doi.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]

Treatment

  • 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]
  • In these cases, additional measures or a modification to our dental treatment need to be taken.[ncbi.nlm.nih.gov]
  • Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.[ncbi.nlm.nih.gov]
  • Ideal treatment strategy is not clearly defined. In addition to antibiotic treatment, plasmapheresis and steroids have been used with variable results.[ncbi.nlm.nih.gov]
  • When the anatomical feature and size of the aneurysm is suitable, endovascular treatment may be the first-line treatment, providing an efficacious and safe alternative to traditional surgical repair.[ncbi.nlm.nih.gov]

Prognosis

Etiology

  • 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]
  • It is a diagnostic quandary because it commonly shows similar clinical, pathologic, and aortographic features independently of the etiology.[ncbi.nlm.nih.gov]
  • […] 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]
  • 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]

Epidemiology

  • 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]
  • This should be useful for more accurate diagnosis and classification of patients with suspected endocarditis and provide better entry criteria for epidemiologic studies and clinical trials.[ncbi.nlm.nih.gov]
  • We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials.[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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • […] 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]
  • Pathophysiology When introduced into healthy tissue, the HACEK group organisms have the potential for abscess formation and invasive disease.[emedicine.com]
  • Further studies are needed to determine if S bovis bacteremia is an independent predictor of malignancy and to determine the pathophysiologic features of this relationship. Accepted for publication December 17, 2003. Correspondence: Ronald R.[doi.org]

Prevention

  • 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]
  • The focused update on infective endocarditis of the American College of Cardiology/American Heart Association 2008 (ACC/AHA guidelines) and guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) of the European[ncbi.nlm.nih.gov]
  • View complete AHA Statement on Prevention of Infective Endocarditis (PDF) .[chp.edu]
  • American Heart Association (AHA) and other national and international organizations have made recommendations for the prevention of IE, although no randomised clinical trial has confirmed its efficacy.[ncbi.nlm.nih.gov]
  • Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis.[ncbi.nlm.nih.gov]

Patient Information

References

Article

  1. Mylonakis E, Calderwood SB. Medical progress: infective endocarditis in adults. N Engl J Med. 2001;345(18):1318-1330.
  2. Giessel BE, Clint J, Koenig CJ, and Blake RL Jr. Management of Bacterial Endocarditis. Am Fam Physician. 2000; 61(6):1725-1732.
  3. Crawford MH, Durack DT. Clinical presentation of infective endocarditis. Cardiol Clin. 2003; 21(2):159-66, v.
  4. McDonald JR. Acute Infective Endocarditis. Infect Dis Clin North Am. 2009;23(3):643-664.
  5. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, AntimicrobialTherapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015; 132(15):1435-86.
  6. Epaulard O, Roch N, Potton L, Pavese P, Brion JP, Stahl JP. Infective endocarditis-related stroke: diagnostic delay and prognostic factors. Scand J Infect Dis. 2009; 41(8):558-62.
  7. Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1997;277(22):1794–801.
  8. Berlin JA, Abrutyn E, Strom BL, et al. Incidence of infective endocarditis in the Delaware Valley, 1988–1990. Am J Cardiol. 1995;76(12):933–6.
  9. Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121(3):458-77.
  10. Roe MT, Abramson MA, Li J, Heinle SK, et al. Clinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the duke criteria. Am Heart J. 2000; 139(6):945-51.

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Last updated: 2018-06-22 00:24