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Infective Endocarditis

Infective endocarditis represents an acquired disease caused by various pathogenic agents, affecting the valvular or mural endocardium or the surface of septal defects, leading to abscess formation, valvular regurgitation or even rupture. The disease causes heart failure and is often lethal if left unaddressed.


Presentation

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.

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]
  • 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]
  • […] 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]
  • Patients with SRL lesions were mainly men (P   .01), had liver disease (P   .001) with natural valve (P   .050) and mitro-aortic valve involvement (P   .042), splenomegaly (P   .001), nonabdominal emboli (P   .001), and a greater number and larger vegetation[ncbi.nlm.nih.gov]
  • […] splinter hemorrhages Neurological: Confusion, hemiplegia and sensory dysfunction due to emboli Subarachnoid hematoma due to rupture of mycotic aneurysm Renal: Infarction causes loin pain and hematuria Immune complex deposition may cause glomerulonephritis Splenomegaly[pathologyoutlines.com]
Fever
  • 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 (39 degrees C or higher) was noted 23 days after admission. A blood culture revealed Trichosporon asahii (T. asahii), suggesting T. asahii fungemia.[ncbi.nlm.nih.gov]
  • 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]
  • […] 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]
  • 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]
  • 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]
Chills
  • RESULTS: On the second day after EVL, the patient developed fever and chills. A week after EVL, the blood cultures were viridans streptococcus positive, and echocardiogram showed a vegetation on the cardiac valve.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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]
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]
  • 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]
Anemia
  • 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.[msdmanuals.com]
  • 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]
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]
  • Along with the general symptoms of infective endocarditis, there may be coughing or pain in the chest, abdomen, fingers and toes. A sensation of pricking, tingling or creeping of the skin (paresthesia) may be present.[rarediseases.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]
  • Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea.[symptoma.com]
  • 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]
  • 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]
  • […] 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]
  • 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]
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]
  • […] focal neurologic deficits: The most common neurologic sign Intracerebral hemorrhage Multiple microabscesses Other signs of IE include the following: Splenomegaly Stiff neck Delirium Paralysis, hemiparesis, aphasia Conjunctival hemorrhage Pallor Gallops Rales[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
  • Septic pulmonary emboli may cause cough, pleuritic chest pain, and sometimes hemoptysis. A murmur of tricuspid regurgitation is typical.[merckmanuals.com]
  • […] 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 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]
  • 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]
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]
  • The epidemiology of heart disease in children has changed over the past 3 to 4 decades.[pediatrics.aappublications.org]
  • 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]
  • Some conditions put you at more risk of developing infective endocarditis, including: Prosthetic heart valves (biological or mechanical) Rheumatic valvular heart disease Previous endocarditis Unrepaired cyanotic congenital heart disease (includes palliative[heartfoundation.org.nz]
Heart Murmur
  • Heart murmurs are present in over 85% of individuals with infective endocarditis, and 60% have enlarged spleens. Blood or blood cells may be present in the urine (hematuria).[rarediseases.org]
  • 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]
  • 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.[msdmanuals.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]
  • 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]
  • 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]
  • 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]
Systolic Murmur
  • A systolic murmur was heard on the tricuspid area upon examination, and an echocardiogram showed endocardial lesions in the right atrium.[ncbi.nlm.nih.gov]
  • In spite of the improvement of her unconscious state, she developed a new-onset systolic murmur on day 13, and echocardiography revealed severe mitral valve regurgitation with vegetation.[ncbi.nlm.nih.gov]
  • 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 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]
Tachycardia
  • 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]
  • 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]
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]
  • There may also be pale, oval spots on the retina of the eye (Roth’s spots) which may hemorrhage.[rarediseases.org]
  • 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.[symptoma.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]
  • 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]
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]
Myalgia
  • A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias.[ncbi.nlm.nih.gov]
  • Complaints of low back pain, pain in the joints (arthralgia) or in one or more muscles (myalgia) are common. These symptoms usually appear early in the disease, occasionally as the only initial symptoms.[rarediseases.org]
  • Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea.[symptoma.com]
  • […] 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]
  • 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]
Arthralgia
  • A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias.[ncbi.nlm.nih.gov]
  • Complaints of low back pain, pain in the joints (arthralgia) or in one or more muscles (myalgia) are common. These symptoms usually appear early in the disease, occasionally as the only initial symptoms.[rarediseases.org]
  • […] 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]
  • Patient and observation 1 st case A 60-year-old man, presented with severe chest pain, persistent fever and arthralgia for one month prior to admission. His coronary risk factors were hypertension and current smoking.[panafrican-med-journal.com]
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]
  • Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea.[symptoma.com]
  • 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]
  • 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]
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]
  • Painless, reddish-blue skin patches (Janeway lesions) may appear on the palms of the hands and the soles of the feet. The course of acute bacterial endocarditis is very rapid.[rarediseases.org]
  • 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.[symptoma.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]
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.[msdmanuals.com]
  • External links [ edit ] Look up petechia in Wiktionary, the free dictionary. Wikimedia Commons has media related to Petechiae .[en.wikipedia.org]
  • Small red or purple spots composed of blood (petechiae) may cover the skin of the upper trunk. There may also be pale, oval spots on the retina of the eye (Roth’s spots) which may hemorrhage.[rarediseases.org]
  • 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.[symptoma.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]
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]
  • 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]
  • 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]
  • Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea.[symptoma.com]
  • 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]
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]
  • 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]
  • 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.[symptoma.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]
  • 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]
Hematuria
  • 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]
  • Peripheral embolism may manifest as stroke, hemiplegia, hematuria, unilateral blindness, myocardial or pulmonary infarction.[symptoma.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]
  • […] 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 emboli may cause flank pain and, rarely, gross hematuria. Splenic emboli may cause left upper quadrant pain. Prolonged infection may cause splenomegaly or clubbing of fingers and toes.[merckmanuals.com]
Stroke
  • […] with and without acute stroke.[ncbi.nlm.nih.gov]
  • 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]
  • In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs.[ncbi.nlm.nih.gov]
  • Here, we describe typical presentations of ischaemic stroke and intracerebral haemorrhage caused by infective endocarditis. We review the diagnostic challenges, the importance of rapid diagnosis, treatment options and controversies.[ncbi.nlm.nih.gov]
  • Complications observed were congestive cardiac failure (31.2%), acute kidney injury (25.9%), stroke (21.6%), septic shock (16.5%), embolic phenomenon non-stroke (8.6%), atrial fibrillation (5%) and ring abscess (2.9%). Mortality rate was 17.3%.[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]
  • 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]
  • Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea.[symptoma.com]
  • […] 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]
  • Compromise of left ventricular forward function may result in symptoms of poor systemic circulation such as dizziness , confusion and cool extremities at rest.[en.wikipedia.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.[ultrasoundoftheweek.com]
  • Three weeks later, the patient was brought to the emergency department with altered mentals status.[zdoc.site]

Workup

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].

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]
  • 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]
  • 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]
  • Moreover, viridians group streptococci remain the leading causative pathogen of IE, reflecting the persistent poor dental health in China, while blood culture positive rate is still low.[journals.plos.org]

Treatment

  • […] and after completion of antimicrobial treatment.[ncbi.nlm.nih.gov]
  • Patients were included if they had to receive antibiotic prophylaxis prior to dental treatment according to the 1997 AHA protocol and did not require antibiotic prophylaxis prior to dental treatment according to the 2007 AHA guidelines.[ncbi.nlm.nih.gov]
  • We aimed to investigate differences in the outcome of EFIE according to the duration (4 versus 6 weeks) of antibiotic treatment (A G or A C).[ncbi.nlm.nih.gov]

Prognosis

  • MVE is a poorly studied entity, and there is little information regarding its main characteristics, prognosis, and the best management approach.[bjcardio.co.uk]
  • Abstract PURPOSE OF REVIEW: In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE).[ncbi.nlm.nih.gov]
  • We evaluated the implications of a positive echocardiography in the prognosis of a cohort of patients with IE. METHODS: Prospective multicentre study in 31 Spanish centres.[ncbi.nlm.nih.gov]
  • We report the present case of IE complicated by T. asahii fungemia, which is rare in patients other than malignant blood disease or tumor patients, showing a poor prognosis in which survival was achieved by surgery.[ncbi.nlm.nih.gov]
  • Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known.[ncbi.nlm.nih.gov]

Etiology

  • Given the lack of clear etiology between septic embolus versus prosthesis associated thromboembolism, we opted for a successful conservative approach. Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • FIG 2 Diagnostic testing for identification of the microbiological etiology of infective endocarditis.[jcm.asm.org]
  • However, after another 5 months the patient died from sepsis and recurrent infective endocarditis of unclarified etiology. CONCLUSIONS: Mycoplasma hominis is a rare causative agent of infective endocarditis.[ncbi.nlm.nih.gov]
  • Staphylococcal etiology was the most common (33.3%). Surgery procedures were necessary in 62.2% of patients.[ncbi.nlm.nih.gov]
  • We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide.[ncbi.nlm.nih.gov]

Epidemiology

  • BACKGROUND: Little information exists regarding population-based epidemiological changes in infective endocarditis (IE) in Europe. OBJECTIVES: This study sought to analyze temporal trends in IE in Spain from 2003 to 2014.[ncbi.nlm.nih.gov]
  • Conclusions and Relevance: The epidemiology and management of infective endocarditis are continually changing.[ncbi.nlm.nih.gov]
  • Conclusions and Relevance The epidemiology and management of infective endocarditis are continually changing.[jamanetwork.com]
  • The epidemiology of heart disease in children has changed over the past 3 to 4 decades.[pediatrics.aappublications.org]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • Slightly higher male predominance (1.5:1 – 2:1) ( Moreillon 2010 ) In-hospital mortality of 14–22% and 1-year mortality of 20-40% ( Gomes 2017 , ( Habib 2006 ) Before antibiotics and surgery it was almost universally fatal ( Aretz 2010 , Osman 2013 ) Pathophysiology[coreem.net]
  • Osler had a particular interest in the pathophysiology of distant complications associated with endocarditis, including those involving the CNS: “The meningeal complications of endocarditis have not received much attention, considering the frequency with[medlink.com]
  • ., UTIs , spondylodiscitis ) References: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] Pathophysiology Pathogenesis : localized infection or contamination bacteremia bacterial colonization and possible formation of thrombi on valve leaflets[amboss.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]
  • Pathoanatomic, pathophysiologic and clinical correlations in endocarditis (first of two parts). N Engl J Med . 1974 Oct 17. 291(16):832-7. [Medline] . Wang CC, Lee CH, Chan CY, Chen HW.[emedicine.medscape.com]

Prevention

  • The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997.[ncbi.nlm.nih.gov]
  • Over 50 years ago the first guidelines recommending antibiotic prophylaxis (AP), with the aim of preventing IE developing after procedures, were proposed. However, there has only ever been circumstantial evidence in humans that AP prevents IE.[ncbi.nlm.nih.gov]
  • The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial.[ncbi.nlm.nih.gov]
  • "Prevention of infective endocarditis. Guidelines from the American Heart Association.[infectiousdiseaseadvisor.com]
  • The following are points to remember about the timing of surgery among patients with IE: The main indications for early surgery in IE are heart failure, uncontrolled infection, and prevention of embolization.[acc.org]

References

Article

  1. Epaulard O, Roch N, Potton L, et al. Infective endocarditis-related stroke: diagnostic delay and prognostic factors. Scand J Infect Dis. 2009;41(8):558-62.
  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.
  3. Ortiz-Bautista C, López J, García-Granja PE, et al. Right-sided infective endocarditis in cardiac device carriers: Clinical profile and prognosis. Med Clin (Barc). 2017 Jun 22. [Epub ahead of print]
  4. Janga KC, Sinha A, Greenberg S, et al. Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis. Case Rep Nephrol. 2017:9460671.
  5. Choussat R, Thomas D, Isnard R et al. Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study. Eur Heart J. 1999;20(3):232-41.
  6. Casella F, Rana B, Casazza G, et al. The potential impact of contemporary transthoracic echocardiography on the management of patients with native valve endocarditis: a comparison with transesophageal echocardiography. Echocardiography. 2009; 26(8):900-6.
  7. Roe MT, Abramson MA, Li J, 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.
  8. Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53(5):436-44.

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Last updated: 2018-06-22 00:22