Presentation depends on whether the disease is acute or subacute. An acute infective endocarditis patient usually presents with high fever, chills and rapid onset of heart failure symptoms or peripheral embolic phenomena. Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea. Other findings like right upper quadrant pain or abdominal postprandial distress are not uncommon. The physician must inquire about the existence of known congenital heart defects, about recent dental, surgical or other invasive procedures or intravenous drug use. The history of the disease helps differentiate between an acute and a subacute endocarditis episode: a subacute patient will usually be diagnosed about 6 weeks after the pathological process has started, whereas an individual suffering from acute endocarditis will be obligated to present sooner by dramatic symptoms.

Peripheral embolism may manifest as stroke [1], hemiplegia, hematuria, unilateral blindness, myocardial or pulmonary infarction. If the disease goes undiagnosed for a longer period of time, the physician will notice Janeway lesions, petechiae, splinter hemorrhages, Roth spots and Osler nodes, caused by immune-mediated vasculitis. Right-sided endocarditis sometimes presents in a similar manner to pulmonary empyema. Mycotic aneurysms suggest Pseudomonas aeruginosa etiology.

Internal cardiac defibrillators associated endocarditis patients have a two-fold higher mortality rate than single-chamber pacemaker endocarditis individuals [2]. Their disease is usually caused by coagulase-negative staphylococci [3]. Also, these cases may report accompanying pericarditis and mediastinitis signs, almost always along with fever. Signs of congestive heart failure, such as distended jugular veins or changes in previously known murmurs result from mitral valve involvement, which occurs in in eighty percent of methicillin-resistant Staphylococcus aureus endocarditis cases associated with dialysis catheters [4]. Additional findings may include splenomegaly, gallop or arrhythmia, pericardial or pleural rubs, rales, pallor, acute septic monoarticular arthritis or delirium.

• Fever

  Six-month mortality was higher in the Q fever PCR-positive group than in the Q fever PCR-negative group [38% (3/8) vs 0% (0/12), P   .049). [ncbi.nlm.nih.gov]

  Fever was high-grade intermittent, not associated with rigors and chills and subsided with analgesics. There was a history of miscarriage, but no history of any heart disease, rheumatic fever, and intravenous drug use. [jpma.org.pk]

  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]

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

  Subacute bacterial endocarditis gradually causes such symptoms as fatigue, mild fever, a moderately fast heart rate, weight loss, sweating, and a low red blood cell count. [merckmanuals.com]

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

  […] 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 of appetite, weight [saintlukeskc.org]

• Chills

  Abstract A 72-year-old man with end-stage renal disease and who was on dialysis was admitted with fever and chills. Two years previously, he had been diagnosed with caseous calcification of the mitral annulus (CCMA). [ncbi.nlm.nih.gov]

  Clinical features include constitutional symptoms (fatigue, fever /chills, malaise ) in combination with signs of pathological cardiac changes (e.g., new or changed heart murmur, heart failure signs) and possibly manifestations of subsequent damage to [amboss.com]

  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]

  If you have chronic endocarditis, which may last for months, you may feel feverish and chilled, be very tired, lose weight, and have joint pain, night sweats, or the symptoms of heart failure. [texasheart.org]

• Fatigue

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

  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]

  Abstract A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. [ncbi.nlm.nih.gov]

  Common symptoms are: fever chills weakness fatigue aching joints and muscles night sweats shortness of breath paleness persistent cough swelling in the feet, legs or abdomen Less common symptoms include: unexplained weight loss blood in your urine a new [heartandstroke.ca]

• Anemia

  The patient's laboratory results were low blood albumin and globulin, anemia, and leukopenia. A blood culture revealed Burkholderia cepacia that was resistant to multiple antimicrobial agents. A chest x-ray showed infiltrate on both lung fields. [ncbi.nlm.nih.gov]

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

  A complete blood count (CBC) may also be used to check for anemia. A shortage of red blood cells can occur with infective endocarditis. Your doctor may order an echocardiogram, or an ultrasound of the heart. [healthline.com]

• Splenomegaly

  This score includes clinical, epidemiological (male, fever, splenomegaly, clubbing, vascular disease and stroke) and biological criteria (Leucocytes 10,000/mm3, sedimentation rate (SR)   50/mm or C reactive protein 10 mg/L and hemoglobin [ncbi.nlm.nih.gov]

  Signs and symptoms of IE include petechiae, anorexia, high fever, heart failure, cardiac murmur, Osler's nodes, Janeway lesions, Roth Spots, and splenomegaly. [youtube.com]

  […] to microemboli and microabscesses with neutrophilic capillary infiltration ) Osler nodes : painful nodules on pads of the fingers and toes Roth spots : retinal hemorrhages with pale centers Signs of acute renal injury, including hematuria and anuria Splenomegaly [amboss.com]

  […] 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]

• Cough

  Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture. [ncbi.nlm.nih.gov]

  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]

  Common symptoms are: fever chills weakness fatigue aching joints and muscles night sweats shortness of breath paleness persistent cough swelling in the feet, legs or abdomen Less common symptoms include: unexplained weight loss blood in your urine a new [heartandstroke.ca]

  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]

• 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]

  After 4 weeks of antibiotics, he presented with New York Heart Association class III dyspnea. Repeat TEE demonstrated severe MR. [ncbi.nlm.nih.gov]

  IV drug users ; and concomitant HIV infection ;, immunosuppressed patients, ; and patients with central venous catheters Aortic valve regurgitation early diastolic murmur ; loudest at the left sternal border Signs of progressive heart failure ( e.g., dyspnea [amboss.com]

• Rales

  Additional findings may include splenomegaly, gallop or arrhythmia, pericardial or pleural rubs, rales, pallor, acute septic monoarticular arthritis or delirium. Echocardiography is usually the first imaging method applied. [symptoma.com]

  The oxygen saturation was 96%, with no pulmonary rales, and blood pressure was 85/60 mmHg. We detected a diastolic rumble, a relatively loud first heart sound, a proto diastolic noise suggesting a “tumor plop”, and moderate hepatosplenomegaly. [ncbi.nlm.nih.gov]

  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]

• Hemoptysis

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

  B-cell lymphoma[26] Tetracycline, metronidazole and bismuth salt combination[26] (No vaccine or preventive drug)[26] Klebsiella pneumoniae Mouth, skin, and gut flora.[57] Pneumonia upon aspiration Klebsiella pneumonia, with significant lung necrosis and hemoptysis [en.wikipedia.org]

• Loss of Appetite

  CASE REPORT A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. [ncbi.nlm.nih.gov]

  […] 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]

  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]

  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]

  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]

• Heart Disease

  Rheumatic heart disease was the commonest (30.9%) underlying cardiac lesion followed by mitral valve prolapse with mitral regurgitation (23.7%), degenerative valvular disease (23%), congenital heart disease (15.8%) and prosthetic valves (3.6%). [ncbi.nlm.nih.gov]

  People with underlying heart problems such as congenital heart disease, valvular heart disease, hypertrophic cardiomyopathy, rheumatic heart disease, or previous bouts of endocarditis. [heartandstroke.ca]

  Prophylaxis is no longer recommended for forms of congenital heart disease not mentioned above including mitral valve prolapse. Prophylaxis is no longer recommended for rheumatic heart disease. [infectiousdiseaseadvisor.com]

  disease, congenital heart disease, prosthetic valves, previous IE) can cause damage to the endothelium Damage to endothelium produces a fibin and platelet sterile thrombus. [coreem.net]

  Conditions predisposing to IE were common, notably underlying structural heart disease. [nzma.org.nz]

• Heart Murmur

  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]

  Common symptoms of infective endocarditis include: Fever Chills Sweating at night Heart murmur or change in heart murmur, i.e. an abnormal sound made by the heart between beats Nausea and vomiting Feeling tired Aching muscles and joints Chest and/or back [ada.com]

  If you already have a heart murmur from an existing valve problem, the murmur may change or become more intense. A new or changing murmur is often what alerts a doctor to suspect infective endocarditis. [heartfoundation.org.nz]

  Blood clots can cause serious complications throughout the body: heart damage – heart murmur, heart valve damage, heart failure stroke pulmonary embolism seizure kidney damage enlarged spleen paralysis organ abscesses Recovery It’s normal to feel worried [heartandstroke.ca]

• Mitral Valve Prolapse

  Prophylaxis is no longer recommended for forms of congenital heart disease not mentioned above including mitral valve prolapse. Prophylaxis is no longer recommended for rheumatic heart disease. [infectiousdiseaseadvisor.com]

  Correct answer response for cardiac conditions was 81.3% (highest failure: mitral valve prolapse [MVP] with regurgitation). [ncbi.nlm.nih.gov]

  It is now an infection of older people, and mitral-valve prolapse is the most common predisposing cardiovascular problem in developed countries. In contrast, rheumatic heart disease is an important predisposing problem in developing countries. [nejm.org]

  In different series, the range of IE in those patients with mitral valve prolapse can go from 11 to 23% [106, 107]. In another study, 8.6% of patients with mitral valve prolapse who were monitored prospectively for 9–22 years developed IE [108]. [intechopen.com]

• Chest Pain

  Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture. [ncbi.nlm.nih.gov]

  Three days after admission, the patient complained of worsening chest pain. The electrocardiogram showed significant anterior ST depression, and troponin I level rose to 5.3 ng/ml. [panafrican-med-journal.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]

  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]

• Tachycardia

  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]

  […] glomerulonephritis ;, Osler nodes Therapeutic consequences Lack of valve vascularization requires antibiotic treatment for several weeks References: [14] [15] [6] [16] Clinical features Course of disease Constitutional symptoms Fever and chills ( 90% of cases), tachycardia [amboss.com]

  It can cause lethal effects to the mother by producing tachycardia and cardiac failure. 8 In this case, bicuspid aortic valve remained asymptomatic before the pregnancy, but pregnancy-related physiologic changes aggravated the stress on the bicuspid aortic [jpma.org.pk]

  His ECG shows sinus tachycardia with no significant abnormalities. A broad-spectrum antibiotic is administered, and he's admitted to the medical ICU for suspected sepsis. (See Close-up on abnormal lab values .) That evening, Mr. [nursingcenter.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]

• Roth's Spots

  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]

  Splinter hemorrhages and petechia aren't specific to infective endocarditis, while Osler's nodes, Roth spots, and Janeway lesions are usually indicative of the disease. 8 * Splinter hemorrhages are long striations of blood under the nailbeds. 7 Figure [nursingcenter.com]

  spots – retinal hemorrhages with a pale centre Splenomegaly New neurological signs New murmur, e.g. aortic regurgitation and associated systemic features Left ventricular failure – basal crackles and effusions Emboli — major arteries, pulmonary, spleen [lifeinthefastlane.com]

  Signs and symptoms of IE include petechiae, anorexia, high fever, heart failure, cardiac murmur, Osler's nodes, Janeway lesions, Roth Spots, and splenomegaly. [youtube.com]

  Immunological phenomena: glomerulonephritis, Osler's nodes, Roth's spots and rheumatoid factor. [patient.info]

• Conjunctival Petechiae

  petechiae Janeway lesions Immunologic phenomena: Glomerulonephritis Osler nodes Roth spots Rheumatoid factor Microbiologic evidence of infection consistent with but not meeting major criteria Serologic evidence of infection with organisms consistent [merckmanuals.com]

• Janeway Lesion

  Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. [ncbi.nlm.nih.gov]

  Splinter hemorrhages and petechia aren't specific to infective endocarditis, while Osler's nodes, Roth spots, and Janeway lesions are usually indicative of the disease. 8 * Splinter hemorrhages are long striations of blood under the nailbeds. 7 Figure [nursingcenter.com]

  Diagnosis can be difficult because subacute infective endocarditis can develop gradually over many months, and because, in the modern era, few people present with classical symptoms of fever, heart murmur, bacteremia, Osler nodes or Janeway’s lesions. [ada.com]

  lesions – non-tender haemorrhagic pulps on fingers and toes Roth spots – retinal hemorrhages with a pale centre Splenomegaly New neurological signs New murmur, e.g. aortic regurgitation and associated systemic features Left ventricular failure – basal [lifeinthefastlane.com]

  Signs and symptoms of IE include petechiae, anorexia, high fever, heart failure, cardiac murmur, Osler's nodes, Janeway lesions, Roth Spots, and splenomegaly. [youtube.com]

• Petechiae

  Splinter hemorrhages and petechia aren't specific to infective endocarditis, while Osler's nodes, Roth spots, and Janeway lesions are usually indicative of the disease. 8 * Splinter hemorrhages are long striations of blood under the nailbeds. 7 Figure [nursingcenter.com]

  External links [ edit ] Look up petechia in Wiktionary, the free dictionary. Wikimedia Commons has media related to Petechiae . [en.wikipedia.org]

  Signs and symptoms of IE include petechiae, anorexia, high fever, heart failure, cardiac murmur, Osler's nodes, Janeway lesions, Roth Spots, and splenomegaly. [youtube.com]

  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]

  […] the spleen bleeding under the nails flat, painless spots on the palms of your hands and soles of feet (Janeway lesions) Painful, red bumps on the pads of the fingers and toes (Osler’s nodes) Small red spots on the skin, whites of the eyes or mouth (petechiae [heartandstroke.ca]

• Night Sweats

  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]

  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]

  Common symptoms are: fever chills weakness fatigue aching joints and muscles night sweats shortness of breath paleness persistent cough swelling in the feet, legs or abdomen Less common symptoms include: unexplained weight loss blood in your urine a new [heartandstroke.ca]

  sweats, weight loss Dyspnea ;, cough, pleuritic chest pain Arthralgias, myalgias Cardiac manifestations New heart murmur development or change to a preexisting one Mitral valve regurgitation holosystolic murmur, loudest at the heart 's apex, and radiates [amboss.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]

  Splinter hemorrhages and petechia aren't specific to infective endocarditis, while Osler's nodes, Roth spots, and Janeway lesions are usually indicative of the disease. 8 * Splinter hemorrhages are long striations of blood under the nailbeds. 7 Figure [nursingcenter.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]

  Petechiae ; especially splinter hemorrhages ( hemorrhages underneath fingernails ) Janeway lesions : non-tender, erythematous macules on palms and soles ; ( due to microemboli and microabscesses with neutrophilic capillary infiltration ) Osler nodes : [amboss.com]

• 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

  A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias. [ncbi.nlm.nih.gov]

  […] treatment for several weeks References: [14] [15] [6] [16] Clinical features Course of disease Constitutional symptoms Fever and chills ( 90% of cases), tachycardia General malaise, weakness, night sweats, weight loss Dyspnea ;, cough, pleuritic chest pain Arthralgias [amboss.com]

  […] subacute, chronic Newer classification system is based on causative organism Also classify based on native valve or prosthetic valve endocarditis Clinical features Vague constitutional symptoms such as fever, rigors, night sweats, anorexia, weight loss, arthralgia [pathologyoutlines.com]

  Other symptoms are nonspecific and include malaise, myalgia, arthralgia, anorexia, night sweats and headaches. Splenomegaly can be found in 15-50% of patients with IE. A new or changing murmur indicates valvular involvement. [utmb.edu]

• Myalgia

  A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias. [ncbi.nlm.nih.gov]

  […] several weeks References: [14] [15] [6] [16] Clinical features Course of disease 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]

  Other symptoms are nonspecific and include malaise, myalgia, arthralgia, anorexia, night sweats and headaches. Splenomegaly can be found in 15-50% of patients with IE. A new or changing murmur indicates valvular involvement. [utmb.edu]

  General symptomatology usually is hyperpyretis (febrile in most cases, high fever during septic shock), anorexia, asthenia, myalgia. [f1000research.com]

  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]

• Back Pain

  Common symptoms of infective endocarditis include: Fever Chills Sweating at night Heart murmur or change in heart murmur, i.e. an abnormal sound made by the heart between beats Nausea and vomiting Feeling tired Aching muscles and joints Chest and/or back [ada.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]

  Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea. [symptoma.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]

• 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]

  […] palms and soles ; ( due to microemboli and microabscesses with neutrophilic capillary infiltration ) Osler nodes : painful nodules on pads of the fingers and toes Roth spots : retinal hemorrhages with pale centers Signs of acute renal injury, including hematuria [amboss.com]

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

  Other supporting laboratory evidence includes anemia, leukocytosis with a left shift, positive rheumatoid factor, hematuria and elevated ESR/CRP. The finding of vegetations on echocardiography is confirmatory. [utmb.edu]

  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]

• Stroke

  Copyright 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. KEYWORDS: Acute ischemic stroke; Streptococcus constellatus; aortic valve replacement; infective endocarditis [ncbi.nlm.nih.gov]

• Headache

  PATIENT CONCERN: A 42-year-old woman was admitted to our hospital because of fever, abdominal pain, headache, and right limb weakness. [ncbi.nlm.nih.gov]

  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]

  […] 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 congestion and headache [healthline.com]

• Confusion

  […] 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]

  […] as a result, the Gram stain characteristics are highly variable. 5,7-10 The organism's cell wall chemical composition of peptidoglycan is consistent with Gram-positive organisms. 10 These characteristics have contributed greatly to the classification confusion [journals.lww.com]

  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]

  Among the confusing proliferation of haemopoietic cells in bone marrow, megakaryocytes are easy to recognize by their huge size and large, lobulated nuclei. [mendesmiguel.com.br]

  Members of the S anginosus group ( S intermedius, anginosus, and constellatus ) also have been referred to as the S milleri group, and this has caused some confusion. [doi.org]

• 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]

  Three weeks later, the patient was brought to the emergency department with altered mentals status. [zdoc.site]

Echocardiography is usually the first imaging method applied. Transthoracic and transesophageal can help in diagnosis. They are able to characterize the dimensions of the vegetations and their effect on the underlying structures, such as valvular regurgitation or rupture. Anterior myocardial abscesses are better observed with transthoracic echocardiography, while abscesses in other locations are visualized by transesophageal studies [5]. Embolization can be predicted to some extent, based on vegetation dimensions and echogenicity. Color Doppler echo can diagnose cusp perforation and valvular regurgitation apart and showcase intracardiac fistulas, especially when used in transesophageal views. Advanced harmonic imaging techniques add accuracy to these methods [6].

A thoracic radiograph showing pulmonary pyogenic abscesses suggest tricuspid endocarditis. Atrioventricular blocks and new interventricular conduction delays may be seen on the electrocardiogram and suggest a poor prognosis. Computer tomography is used to ascertain cerebral abscesses [7], but also to characterize vegetations and valvular anatomy [8].

• 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

  Of the 20 patients with blood culture-positive IE, none yielded a positive Q fever PCR result for valve tissue. [ncbi.nlm.nih.gov]

  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]

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2. Özcan C, Raunsø J, Lamberts M, et al. Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study. Europace. 2017;19(6):1007-14.
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