ABSTRACT
Infective endocarditis (IE) poses a diagnostic challenge due to its diverse clinical presentations, especially among high-risk groups. Diagnosis relies on integrating clinical presentation, blood cultures and imaging findings. Advanced imaging techniques enhance diagnostic accuracy, particularly in complex cases. Treatment involves antimicrobial therapy and surgery in complicated cases, with early intervention crucial for optimal outcomes. Coordinated care by an Endocarditis Team ensures tailored treatment plans, prompt complication management and long-term monitoring after discharge. The authors present a case of subacute IE presenting initially with back pain in a patient with a complex medical history, highlighting diagnostic and management approaches.
Subject(s)
Back Pain , Endocarditis, Subacute Bacterial , Humans , Back Pain/etiology , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/drug therapy , Male , Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Middle Aged , Diagnosis, DifferentialSubject(s)
Aneurysm, Infected/diagnosis , Endocarditis, Subacute Bacterial/diagnosis , Peripheral Vascular Diseases , Streptococcal Infections/diagnosis , Streptococcus salivarius/isolation & purification , Ulnar Artery , Adult , Aortic Valve/abnormalities , Endocarditis, Subacute Bacterial/complications , Humans , Male , Peripheral Vascular Diseases/diagnostic imaging , Streptococcal Infections/complications , Tomography, X-Ray Computed , Ulnar Artery/diagnostic imagingSubject(s)
Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cloxacillin/therapeutic use , Diagnosis, Differential , Endocarditis, Subacute Bacterial/drug therapy , Exanthema/etiology , Fever/etiology , Humans , Male , Middle AgedSubject(s)
Aortic Valve/microbiology , Bartonella Infections/diagnosis , Bartonella quintana/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/microbiology , Adult , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Aortic Valve/pathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/drug therapy , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/microbiology , Arthralgia/microbiology , Bartonella Infections/diagnostic imaging , Bartonella Infections/drug therapy , Bartonella Infections/microbiology , Doxycycline/therapeutic use , Electrocardiography , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Female , Gentamicins/therapeutic use , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/drug therapy , Heart Valve Diseases/microbiology , Humans , Oxacillin/therapeutic use , Socioeconomic Factors , Treatment OutcomeABSTRACT
BACKGROUND/AIM: Fewer of unknown origin (FUO) remains amongst the most difficult diagnostic dilemmas in contemporary medicine. The aim of this study was to determine the causes of FU and to identify the methods of diagnosis in patients with FUO in a tertiary care setting in the Republic of Macedonia. METHODS: Retrospectively histories of 123 immunocompetent patients older than 14 years with classical FUO that had been examined at the University Hospital for Infectious Diseases and Febrile Conditions in the city of Skopje, during the period 2006-2012 were evaluated. FUO was defined as axillary fever of ≥ 37.5 °C on several occasions, fever duration of more than 21 days and failure to reach the diagnosis after the initial diagnostic workup comprised of several defined basic investigations. RESULTS: Infections were the cause of FUO in 51 (41.5%) of the patients, followed by non-infective inflammatory disorders (NIID) in 28 (22.8%), miscellaneous in 12 (9.7%) and neoplasm in 11 (8.9%) of the patients. Twenty one of the patients (17.1%) remained undiagnosed. The most common causes for FUO were visceral leishmaniasis, abscesses, urinary tract infections, subacute endocarditis, polymyalgia rheumatica and adult onset of Still disease. The final diagnosis was reached with histology in 24 (23.5%), imaging and endoscopic procedures in 21 (20.6%), clinical course and empiric therapy response in 20 (19.6%), serology in 18 (17.6%) and cultures in 16 (15.7%) of the cases. CONCLUSION: In the Republic of Macedonia infections are the leading cause of FUO, predominately visceral leishmaniasis. In the future in patients with prolonged fever, physicians should think more often of this disease, as well as of the possibility of atypical presentation of the common classical causes of FUO.
Subject(s)
Abscess/diagnosis , Developing Countries , Endocarditis, Subacute Bacterial/diagnosis , Fever of Unknown Origin/diagnosis , Leishmaniasis, Visceral/diagnosis , Neoplasms/diagnosis , Polymyalgia Rheumatica/diagnosis , Still's Disease, Adult-Onset/diagnosis , Urinary Tract Infections/diagnosis , Abscess/complications , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Endocarditis, Subacute Bacterial/complications , Female , Fever of Unknown Origin/etiology , Humans , Leishmaniasis, Visceral/complications , Male , Middle Aged , Neoplasms/complications , Polymyalgia Rheumatica/complications , Republic of North Macedonia , Retrospective Studies , Still's Disease, Adult-Onset/complications , Urinary Tract Infections/complications , Young AdultSubject(s)
Anti-Bacterial Agents/toxicity , Endocarditis, Subacute Bacterial/drug therapy , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Drug Therapy, Combination , Endocarditis, Subacute Bacterial/diagnosis , Erythema/etiology , Gentamicins/therapeutic use , Humans , Male , Purpura/etiology , Treatment Outcome , Vancomycin/therapeutic use , Young AdultABSTRACT
Univentricular heart is a complex cyanotic congenital heart malformation classically repaired during early childhood. Despite correction, a residual risk of infective endocarditis still persists and may be associated with a severe prognosis. We report the case of a 50 year-old woman with a known partially corrected univentricular heart in whom we diagnosed an infective endocarditis with a favorable evolution under antibiotics.
Subject(s)
Echocardiography , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/drug therapy , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/surgery , Heart Ventricles/abnormalities , Heart Ventricles/surgery , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus sanguis , Combined Modality Therapy , Echocardiography, Transesophageal , Electrocardiography , Female , Gentamicins/therapeutic use , Humans , Middle Aged , Prognosis , Vancomycin/therapeutic useSubject(s)
Aneurysm, Ruptured/microbiology , Basilar Artery , Endocarditis, Subacute Bacterial/complications , Intracranial Aneurysm/microbiology , Subarachnoid Hemorrhage/microbiology , Adolescent , Aneurysm, Ruptured/diagnostic imaging , Endocarditis, Subacute Bacterial/diagnosis , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Radiography , Rupture, Spontaneous/diagnostic imaging , Rupture, Spontaneous/microbiology , Subarachnoid Hemorrhage/diagnostic imagingABSTRACT
A 52 years old patient is hospitalized in June 2007 in the Cardiology Clinic of Cardiovascular Diseases Medical Institute in Iasi with suspected subacute infectious endocarditis. Echocardiography shows mobile vegetation on the pulmonary valve. Acremonium spp is isolated from blood cultures after 2 weeks of incubation. The patient was treated with fluconazole, but died after 3 months due to renal failure.
Subject(s)
Acremonium/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Fungemia/diagnosis , Antifungal Agents/therapeutic use , Endocarditis, Subacute Bacterial/blood , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Fatal Outcome , Fluconazole/therapeutic use , Fungemia/blood , Fungemia/drug therapy , Hospitals, University , Humans , Inpatients , Male , Middle Aged , Renal Insufficiency/etiology , Treatment Failure , UltrasonographyABSTRACT
This is a case report of an adult who presented with apparent culture negative endocarditis (CNE) thought to be marantic endocarditis due to a B-cell lymphoproliferative disorder. This was a most perplexing case and was eventually diagnosed as subacute bacterial endocarditis (SBE) due to a rare slow growing organism. Against the diagnosis of SBE was the lack of fever, hepatomegaly, peripheral manifestations and microscopic hematuria. Also, against a diagnosis of SBE was another explanation for the patient's abnormal findings, e.g., elevated ferritin levels, elevated α1/α2 globulins on SPEP, an elevated alkaline phosphatase, flow cytometry showing B-lymphocytes expressing CD5, and a bone lesion in the right iliac. Findings compatible with both SBE and marantic endocarditis due to a B-cell lymphoproliferative disorder included an elevated ESR, and splenomegaly. Blood cultures eventually became positive during hospitalization. We report a case of native aortic valve (AV) subacute bacterial endocarditis (SBE) due to Aerococcus christensenii mimicking marantic endocarditis due to a B-cell lymphoproliferative disorder. To the best of our knowledge, this is the first reported case of native AV SBE due to A. christensenii presenting as marantic endocarditis.
Subject(s)
Aerococcus , Endocarditis, Subacute Bacterial/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Aortic Valve/microbiology , Diagnosis, Differential , Endocarditis, Non-Infective/diagnosis , Fever , Humans , Male , Middle AgedABSTRACT
Infective endocarditis is a microbial infection of the endocardial surface of the heart. Its symptoms and signs are varied, and include fever, heart murmur, peripheral embolism, and heart failure. The diagnosis of subacute bacterial endocarditis (SBE) is suggested by a history of an indolent process characterized by fever, fatigue, anorexia, and unexplained weight loss. These patients may have had an invasive procedure, such as dental work, or abused intravenous drugs prior to the diagnosis of SBE. Although uncommon, the patients may present with nonspecific symptoms caused by peripheral embolic events. Herein, we report a 25-year-old male diagnosed with SBE, who presented with the unusual symptom of sudden onset of left upper quadrant abdominal pain for 2 days. His clinical history is also discussed.
Subject(s)
Abdominal Pain/diagnosis , Endocarditis, Subacute Bacterial/diagnosis , Adult , Diagnosis, Differential , Humans , MaleSubject(s)
Endocarditis, Subacute Bacterial/diagnosis , Hand Dermatoses/diagnosis , Streptococcal Infections/diagnosis , Tooth Extraction/adverse effects , Viridans Streptococci , Endocarditis, Subacute Bacterial/etiology , Hand Dermatoses/etiology , Humans , Male , Middle Aged , Streptococcal Infections/etiologySubject(s)
Endocarditis, Subacute Bacterial/complications , Myocardial Infarction/etiology , Panophthalmitis/microbiology , Aged , Brain Abscess/diagnosis , Brain Abscess/microbiology , Coronary Occlusion/microbiology , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial/diagnosis , Humans , Magnetic Resonance Imaging , Male , Myocardial Infarction/microbiology , Streptococcal Infections/diagnosisABSTRACT
Acute suppurative thyroiditis is a rare disorder that is mostly found in the left lobe of the thyroid gland of children due to congenital patency of the pyriform sinus fistula. Here, we report a 61-year-old man with acute right-sided suppurative thyroiditis without pyriform sinus fistula. He also showed infectious hip arthritis, spondylitis and Roth's spots. He presented with heart failure and was diagnosed with infectious endocarditis by sequential transesophageal echocardiography. A replacement with a prosthetic valve was performed and cured him. It is important to recognize that infectious endocarditis can be a focus of acute suppurative thyroiditis.
Subject(s)
Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnosis , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/etiology , Heart Failure/therapy , Heart Valve Prosthesis , Humans , Male , Middle Aged , Thyroiditis, Suppurative/microbiology , Thyroiditis, Suppurative/therapySubject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Rupture/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Aortic Aneurysm/surgery , Aortic Rupture/surgery , Aortic Valve/diagnostic imaging , Diagnosis, Differential , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Streptococcus sanguis , UltrasonographyABSTRACT
A 6 yr old domestic longhair cat was evaluated for progressive weight loss, weakness, and dyspnea. Results of a physical examination and electrocardiogram were suggestive of cardiac disease. Thoracic radiographs revealed pleural effusion, which thoracocentesis revealed was consistent with chyle. An echocardiogram was performed, and aortic valve endocarditis with secondary aortic insufficiency was presumptively diagnosed. The cat was treated with broad-spectrum oral antibiotics and palliative cardiac medications. Two days after discharge, the cat's dyspnea returned, and it died suddenly. Histopathology and culture confirmed Pseudomonas bacterial endocarditis of the aortic valve. Bacterial endocarditis in the cat has rarely been reported in the literature. This case described heart failure and chylothorax resulting from bacterial endocarditis.
Subject(s)
Cat Diseases/diagnosis , Chylothorax/veterinary , Endocarditis, Subacute Bacterial/veterinary , Pseudomonas Infections/veterinary , Animals , Cat Diseases/diagnostic imaging , Cat Diseases/pathology , Cats , Chylothorax/complications , Chylothorax/diagnosis , Diagnosis, Differential , Echocardiography/veterinary , Electrocardiography/veterinary , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnosis , Fatal Outcome , Male , Pseudomonas/isolation & purification , Pseudomonas Infections/complications , Pseudomonas Infections/diagnosisABSTRACT
The presentation of endocarditis varies from patient to patient, making it a difficult infection to diagnose correctly. While some patients will develop symptoms acutely over days, it may take weeks or months for symptoms to develop as in the case of subacute bacterial endocarditis.
Subject(s)
Endocarditis, Subacute Bacterial/diagnosis , Nurse Practitioners , Adult , Anti-Bacterial Agents/therapeutic use , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/physiopathology , Humans , MaleSubject(s)
Actinobacillus Infections/diagnosis , Aggregatibacter actinomycetemcomitans/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Fingers/pathology , Hand Dermatoses/etiology , Actinobacillus Infections/complications , Actinobacillus Infections/diagnostic imaging , Actinobacillus Infections/drug therapy , Actinobacillus Infections/microbiology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/microbiology , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Ciprofloxacin/administration & dosage , Ciprofloxacin/therapeutic use , Drug Therapy, Combination , Edema/etiology , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Gentamicins/administration & dosage , Gentamicins/therapeutic use , Hand Dermatoses/pathology , Heart Valve Prosthesis , Hemorrhage/etiology , Humans , Male , Middle Aged , Nail Diseases/etiology , Rheumatic Heart Disease/complications , UltrasonographyABSTRACT
A 19-year-old male patient was diagnosed with S. sanguinis brain abscess of unknown etiopathology as a complication of subclinical endocarditis. While viridans streptococci are implicated in dental seeding to the heart, S. sanguinis brain abscesses are rare. Six previous cases of S. sanguinis brain abscess in the literature reported dental procedures and maxillofacial trauma. In our patient, there was no obvious source of infective endocarditis preceding the development of brain abscess. This demonstrates the importance of prompt diagnosis and initiation of antimicrobial therapy given the potential for long-term sequelae such as focal deficits and seizures.
Subject(s)
Brain Abscess/diagnosis , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnosis , Streptococcal Infections/diagnosis , Streptococcus sanguis , Anti-Bacterial Agents/therapeutic use , Brain Abscess/drug therapy , Combined Modality Therapy , Craniotomy , Drug Therapy, Combination , Early Diagnosis , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial/drug therapy , Humans , Magnetic Resonance Imaging , Male , Mitral Valve Insufficiency/diagnosis , Streptococcal Infections/drug therapy , Tomography, X-Ray Computed , Young AdultABSTRACT
We describe an elderly patient presenting with cardio-embolic stroke who was found to have infective endocarditis (IE) affecting the mitral valve. Penicillin-resistant Facklamia hominis was identified as the causative pathogen. Despite initiation of aggressive antibiotic treatment, the patient suffered a fatal myocardial infarction 2 days post-diagnosis of IE. Facklamia spp. have not been previously reported to be associated with IE. Here, we discuss the link between IE and cardio-embolic stroke along with a discussion of various causative pathogens.