Embolic events were present in 2 cases. CONCLUSION--In group B a significant number of patients (p < 0.05) were older than 50 years and presented his symptoms as an acute illness. [bases.bireme.br]

Symptoms Most patients present with a fever that lasts several days to 2 weeks. Nonspecific symptoms are common. Cough, shortness of breath, joint pain, diarrhea, and abdominal or flank pain may be present. [healthcentral.com]

Snapshot A 50-year-old man presents to the emergency room for a fever that has persisted for several days. He denies any history of intravenous drug use or any congenital heart disease. [medbullets.com]

[…] satisfied Vascular abnormalities; embolism, aneurysm, infarcts, conjunctival haemorrhage, intracranial haemorrhage etc You can then assess whether infective endocarditis is present or not: IE definitely present: 2 major criteria present OR 1 major criteria [almostadoctor.co.uk]

In less than 4 per cent of cases, 1 usually when the disease occurs in childhood, vegetations may be present only within the right chambers of the heart on such sites as the tricuspid valve, pulmonary valve, interventricular septal defect or patent ductus [annals.org]

• Fever

  Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 1990; 161:381—396. ‏ معلومات المراجع [books.google.com]

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

  […] of unknown origin endocarditis prophylaxis may be required before dental procedures Presentation Symptoms persistent fevers (the most common symptom) shortness of breath systemic symptoms weakness fever malaise Physical exam new murmur on auscultation [medbullets.com]

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

  Once the fever and the worst of the symptoms have gone away, the patient may be able to continue antibiotic therapy at home. [medical-dictionary.thefreedictionary.com]

• Chills

  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]

  Consultant: Volume 47 - Issue 2 - February 2007 For a week, a 39-year-old woman with a history of intravenous heroin use had generalized pain, fever, chills, and a nonproductive cough. [consultant360.com]

  Other symptoms include chills, weakness, cough, trouble breathing, headaches, aching joints, and loss of appetite. Emboli may also cause a variety of symptoms, depending on their location. [medical-dictionary.thefreedictionary.com]

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

  Common signs and symptoms of endocarditis include: Flu-like symptoms, such as fever and chills A new or changed heart murmur, which is the heart sounds made by blood rushing through your heart Fatigue Aching joints and muscles Night sweats Shortness of [mayoclinic.org]

• Surgical Procedure

  However, antibiotics are no longer recommended before all dental or other surgical procedures, or for all people. [mayoclinic.org]

  Anyone who falls into a high-risk category should alert his or her health-care professionals before undergoing any surgical or dental procedures. [medical-dictionary.thefreedictionary.com]

  The prognosis depends on a set of factors that include: The overall health condition of the individual The type of organism causing infection The presence of any heart disease or heart abnormality The presence of any prosthetic heart device Surgical procedures [dovemed.com]

  The presence of an intravascular catheter, recent surgical procedures and staphylococcus bacteriemia should reinforce the suspicion of right-sided endocarditis. The prognosis appears to be more favorable than for left-sided endocarditis. [revespcardiol.org]

  Endocarditis also may result from asymptomatic bacteremia, such as typically occurs during invasive dental, medical, or surgical procedures. [merckmanuals.com]

• Rigor

  Cardiac / renal failure can develop rapidly (50-70%) Haematuria secondary to renal failure present in about 70% of patients Rigors Night sweats Splinter haemorrhages (10-20%) Red lines that run vertically along the nails. [almostadoctor.co.uk]

  […] based on course of untreated disease: acute, 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 [pathologyoutlines.com]

  The patient presented with fever with chills and rigors 2 weeks after the induced abortion. She remained febrile for 1.5 months and did not respond to therapy. After subsequent investigations, she was found to have TV endocarditis. [atmph.org]

  A 33-year-old male, intravenous drug abuser presented with history of fever, rigors, night sweats, cough, pleuritic chest pain, hemoptysis, and worsening dyspnea of two months duration. [heartviews.org]

  […] phenomena: glomerulonephritis which allows for blood and albumin to enter the urine, [7] Osler's nodes (painful subcutaneous lesions in the distal fingers), Roth's spots on the retina, positive serum rheumatoid factor Other signs may include night sweats, rigors [en.wikipedia.org]

• High Fever

  Symptoms Symptoms of acute endocarditis include: High fever Chest pain Shortness of breath Cough Extreme fatigue Symptoms of subacute endocarditis include: Low-grade fever (less than 102.9 degrees Fahrenheit) Chills Night sweats Pain in muscles and joints [drugs.com]

  Case Report A five-years-old boy was admitted to our hospital with high fever(40ºC) for 20 days who was diagnosed as sinusitis, and pneumonia. History revealed no previous cardiac problems. There was a 3/6 pansystolic murmur over the sternum. [ispub.com]

  Symptoms of Endocarditis Include: ”Acute’ IE can comes on extremely quickly with rapid onset of symptoms over 1-2 days: high fever, chest pain, shortness of breath, cough, and small hemorrhages on the palms and soles of the feet, delerium. [blackpoppymag.wordpress.com]

  Acutely infected patients often present with high fevers, prostration, chills and sweats, stiff joints or back pain, symptoms of heart failure (esp. if the infection has completely disrupted a heart valve or its tethers), heart block (if the infection [medical-dictionary.thefreedictionary.com]

• Heart Disease

  Keywords: Endocarditis, daptomycin, MRSA, congenital heart disease DOI: 10.3233/JPI-130391 Journal: Journal of Pediatric Infectious Diseases, vol. 8, no. 3, pp. 139-142, 2013 Received 30 October 2012 | Accepted 6 February 2013 | Published: 2013 [content.iospress.com]

  Candida risk factors rheumatic heart disease IV drug use immunosuppression prosthetic heart valve congenital heart disease Etiology Pathogenesis endothelial damage on the surface of the cardiac valve can cause a thrombus to form factors include turbulent [medbullets.com]

  Conditions predisposing to native valve endocarditis are rheumatic heart disease (where the mitral valve is frequently involved followed by the aortic valve), congenital heart disease (commonly patent ductus arteriosus, ventricular septal defect, and [atmph.org]

  Diseases listed under high risk include: Prior endocarditis Unrepaired cyanotic congenital heart diseases Completely repaired congenital heart disease in their first 6 months Prosthetic heart valves Incompletely repaired congenital heart diseases Cardiac [en.wikipedia.org]

  heart diseases [ 1 ]. [cardiovascularultrasound.biomedcentral.com]

[…] consistent with IE Echocardiogram results consistent with IE but not meeting major echocardiographic criteria A definitive clinical diagnosis can be made based on the following: 2 major criteria 1 major criterion and 3 minor criteria 5 minor criteria See Workup [emedicine.medscape.com]

• Candida

  Pathogens: S. aureus - 60%, Streptococcal species - 20%, P. aeruginosa - 10%, Candida - 5%, S. epidermidis - 2%. Right-sided endocarditis, most common, tricuspid valve involved in 60% of cases. [hopkinsguides.com]

  Introduction Clinical definition inflammation of the heart valve, typically secondary to infection Epidemiology location mitral valve > tricuspid valve tricuspid valve disease is associated with intravenous (IV) drug use Staphylococcus aureus, Pseudomonas, Candida [medbullets.com]

  S. faecalis, S. bovis, S. faecium HACEK organisms: Haemophilus parainfluenza, Haemophilus aphrophilus, Actinobacillus (Haemophilus) actinomycetemcomitans, Cardiobacterium hominis, Eikenella species, and Kingella species Less common organisms: Candida [pathologyoutlines.com]

  The most common organism of both fungal NVE and fungal PVE is Candida albicans. Fungal IVDA IE is usually caused by Candida parapsilosis or Candida tropicalis. Aspergillus species are observed in fungal PVE and NIE. [emedicine.medscape.com]

  HACEK (group of gram-negative bacteria), in rare cases: It is seen in intravenous (IV) drug users who regularly contaminate their needles with saliva Candida albicans is a fungus that is also seen in intravenous drug users. [dovemed.com]

• Chlamydia

  […] clinical criteria, blood cultures may be negative This is due to either subtherapeutic antibiotic therapy or an organism whose growth requirements make in vitro growth difficult Gram negative organisms of the HAECK group, Brucella, Fungi, Coxiella, Chlamydia [pathologyoutlines.com]

  These organisms include; coxiella, bartonella, legionella and chlamydia. Giving antibiotics before taking samples can result in negative samples, despite the presence of a causatory organism Always check the CRP and WCC if you suspect infection. [almostadoctor.co.uk]

  Some examples include pathogens like Aspergillus species, Brucella species, Coxiella burnetii, Chlamydia species, and HACEK bacteria. [en.wikipedia.org]

  If blood cultures after 72 hours were negative, specific serological tests were done for Chlamydia, Brucella, Q fever, Legionella, and Mycoplasma. [revespcardiol.org]

  […] any species of streptococci or staphylococci, and less often by Haemophilus spp. or other HACEK bacteria (e.g., Actinobacillus actinomycetem comitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella kingae ), enteric bacteria, ricksettsiae, chlamydiae [medical-dictionary.thefreedictionary.com]

• Blood Culture Positive

  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]

  positive for infectious organisms Blood cultures that are positive for microorganisms, which are taken 12 hours apart 3 blood cultures positive on separate occasions that are taken at least 1 hour apart Abnormalities in echocardiogram showing either a [dovemed.com]

  The Duke Criteria for the Clinical Diagnosis of Infectious Endocarditis Major criteria Positive blood culture Two separate blood cultures positive for microorganism consistent with infectious endocarditis (viridans Streptococcus, Streptococcus bovis, [aafp.org]

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

  […] with IE Blood cultures persistently positive for one of these organisms, from cultures drawn more than 12 hours apart Three or more separate blood cultures drawn at least 1 hour apart Major echocardiographic criteria include the following: Echocardiogram [emedicine.medscape.com]

• Leukocytosis

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

Postoperative antibiotic treatment A full course of antimicrobial treatment should be completed regardless of the duration of treatment prior to surgery, for at least seven to 15 days postoperatively. [inmo.ie]

In our case, the diagnosis and treatment of right-sided infective endocarditis without any inducement were extremely difficult. [scirp.org]

If a stable patient has suspected IE but is already on antibiotic treatment, consideration should be given to stopping treatment and performing three sets of blood cultures off antibiotics. [patient.info]

Most patients with uncomplicated IE become afebrile in 3 to 5 days with appropriate antibiotic treatment. Surveillance cultures should be obtained 48 to 72 hours after treatment begins to ensure eradication of the organism. [journalofethics.ama-assn.org]

[…] patient also had right heart failure that failed to respond to treatment). [revespcardiol.org]

Outcome after discharge: follow-up and long-term prognosis 11.1 Recurrences: relapses and reinfections 11.2 Short-term follow-up 11.3 Long-term prognosis 12. [escardio.org]

Surgery may be required in some cases Untreated Intravenous Drug Abuse Endocarditis can lead to an extremely poor prognosis and is almost always be fatal. With appropriate early diagnosis and treatment, the outcomes are better. [dovemed.com]

The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis. No Reference information available - sign in for access. [ingentaconnect.com]

An important relationship exists between systemic co-morbid factors and underlying cardiac conditions at high risk for poor prognosis for Infective Endocarditis. [research.unipd.it]

MANAGEMENT AND PROGNOSIS Uncomplicated TVE is successfully treated medically in 80% of patients, with only 20% needing surgical intervention[ 12, 29 ]. [wjgnet.com]

Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. [ingentaconnect.com]

Streptococcus viridans is the usual etiologic agent of SBE. The distinction between "acute" and "subacute" endocarditis has traditionally been made based on the pathogenic organism and clinical presentation. [fpnotebook.com]

[…] valve > tricuspid valve tricuspid valve disease is associated with intravenous (IV) drug use Staphylococcus aureus, Pseudomonas, Candida risk factors rheumatic heart disease IV drug use immunosuppression prosthetic heart valve congenital heart disease Etiology [medbullets.com]

[…] ventricular septal defect (VSD), vegetations can be found on the right ventricular side of the VSD, on the tricuspid valve or where the jet impinges on the right ventricular wall Vegetations found in coarctation usually occur distal to the obstruction Etiology [pathologyoutlines.com]

We report herein a case without any apparent etiologic factor contributing infective endocarditis, with special emphasis on treatment. [ispub.com]

Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. [ingentaconnect.com]

Epidemiological Characteristics IDUs patients were the youngest and patients with cardiac devices the oldest. [journals.lww.com]

References [ 1 ] Yuan, S.M. (2014) Right-Sided Infective Endocarditis: Recent Epidemiologic Changes. [scirp.org]

[…] abscess formation • Mycotic aneurysm: : A term applied to fungal or bacterial infection within the wall of a vessel • Mycotic endocarditis: : Endocarditis caused by fungus Objectives After completing this article, readers should be able to: Discuss the epidemiology [pedsinreview.aappublications.org]

In addition, there is a lack of epidemiological studies documenting the burden of disease in terms of prevalence and related morbidity and mortality due to drug abuse in this region. [wjgnet.com]

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]

[…] 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]

Often the endocarditis is less clinically severe in IV drug users Pathophysiology Endocardial damage leads to the formation of thrombi at the damaged site. The thrombus is made mainly of platelets and fibrin. [almostadoctor.co.uk]

Pathophysiology The development of infectious endocarditis requires the presence of bacteria or fungi in the blood and an intracardiac surface on which these microorganisms can attach. [aafp.org]

We believe the very low infectivity of F. odoratum and its very slow growth in culture media prevented an early diagnosis. [ncbi.nlm.nih.gov]

Prevention Prevention, for IV drug users, comes with hygienic injecting practises. [blackpoppymag.wordpress.com]

[…] of systemic embolism 8.3.1 Embolic events in infective endocarditis 8.3.2 Predicting the risk of embolism 8.3.3 Indications and timing of surgery to prevent embolism in infective endocarditis 9. [escardio.org]

Prevention for those at risk usually involves awareness of the risks, and preventative antibiotics prior to certain surgical, dental and medical procedures. [heart.org]

Preventive antibiotics Certain dental and medical procedures may allow bacteria to enter your bloodstream. [mayoclinic.org]