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Brinksman P, Nugent L. What is the incidence of septic arthritis in patients with infective endocarditis? A systematic review. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Brotherton T, Miller CS. Infective endocarditis initially manifesting as pseudogout. Proc AMIA Symp 2021; 34:496-497. [PMID: 34219936 DOI: 10.1080/08998280.2021.1888632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Infective endocarditis is a commonly encountered disease in which diagnosis is often challenging due to the variety of clinical manifestations. Early identification is key due to risk of mortality without treatment. In this case, a 31-year-old man presented with pseudogout of the right ankle and COVID-19 infection. Further workup showed blood cultures growing Staphylococcus aureus, and the diagnosis of infective endocarditis was confirmed by echocardiography. Independently, pseudogout and infective endocarditis result in activation of the innate immune system and can manifest with joint inflammation. Their co-occurrence likely resulted in an augmented inflammatory response due to overlap in their pathophysiologic pathways.
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Affiliation(s)
- Tim Brotherton
- Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Chad S Miller
- Department of Medicine, Saint Louis University, St. Louis, Missouri.,School of Medicine, Saint Louis University, St. Louis, Missouri
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Toda M, Yamaguchi M, Katsuno T, Iwagaitsu S, Nobata H, Kinashi H, Banno S, Ito Y. Streptococcus mutans-Induced Infective Endocarditis Associated With Hypocomplementemia and Positive Anti-Double-stranded DNA Antibody. J Clin Rheumatol 2021; 27:e15-e16. [PMID: 31743271 DOI: 10.1097/rhu.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Masayoshi Toda
- From the Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
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Clinical features of patients with septic arthritis and echocardiographic findings of infective endocarditis. Infection 2019; 47:771-779. [PMID: 31123928 DOI: 10.1007/s15010-019-01302-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Patients with septic arthritis (SA) often undergo echocardiographic evaluation to identify concomitant infective endocarditis (IE). The purpose of this study is to identify distinguishing features of patients with SA and IE by comparing them to patients with SA alone. METHODS We conducted a retrospective study of all patients 18 and older admitted to a single tertiary hospital between 1998 and 2015 with culture-positive SA. Patients were stratified by echocardiogram status and the presence of vegetations: those who had echocardiographic evaluation with no evidence of infective endocarditis (ECHO + IE-) or with a vegetation present (ECHO + IE+) and those who had no echocardiographic evaluation (ECHO-). Demographic data, clinical characteristics, microbiology data, treatment strategies, and patient outcomes were recorded and compared. RESULTS We identified 513 patients with SA. Transthoracic echocardiogram and/or transesophageal echocardiogram were performed in 263 patients (51.2%) and demonstrated evidence for IE in 19 patients (3.7%). While most demographic features, comorbidities, and clinical characteristics did not differ significantly between those with and without IE, those with IE had higher rates of sepsis and septic shock. In addition, patients with SA and IE had higher rates of positive blood cultures and Methicillin-sensitive staphylococcus aureus (MSSA) infection when compared to those with SA without IE. Patients with IE had higher rates of intensive care unit admission and increased 30-day mortality. CONCLUSIONS IE is uncommon among patients with SA. Echocardiography may be overutilized and may be more useful among patients presenting with sepsis, shock, or positive blood cultures, especially when MSSA is isolated.
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Medani S, O'Callaghan P. Rare manifestations of infective endocarditis: the long known, never to be forgotten diagnosis. BMJ Case Rep 2015. [PMID: 26219292 DOI: 10.1136/bcr-2015-211276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening condition often manifesting as a multisystem disease; its heterogeneous features present a diagnostic challenge. We report two cases of IE masquerading as rare extracardiac complications: a splenectomised patient with a periarticular ankle abscess and acute encephalopathy; and a young man with a cutaneous vasculitis following a spontaneous intracerebral haemorrhage. In both cases, the diagnosis was suspected following detection of afebrile bacteraemia and confirmed with echocardiography. Risk factors included a pneumococcal bacteraemia in the asplenic patient and a previously undiagnosed bicuspid aortic valve in the second patient. Both patients recovered well with appropriate antibiotic therapy followed by valve surgery. IE is an important diagnosis to consider in patients with systemic symptoms or organ specific, otherwise unexplained relevant pathology especially in the presence of a cardiac murmur or risk factors for IE including structural heart disease, prosthetic valves or intravascular devices, and in immunosuppressed patients.
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Affiliation(s)
- Samar Medani
- Department of Cardiology, University Hospital Waterford, Waterford, Ireland
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Mahfoudhi M, Hariz A, Turki S, Kheder A. Septic sacroiliitis revealing an infectious endocarditis. BMJ Case Rep 2014; 2014:bcr-2014-204260. [PMID: 25123569 DOI: 10.1136/bcr-2014-204260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 43-year-old man admitted for right hip ache and fever. Physical examination revealed a fever, an ache at the manipulation of the sacroiliac joint and a limitation of abduction and external rotation of the right hip. There was no murmur in cardiac auscultation. No anomaly was found at the conventional radiographs of the sacroiliac joint, while the pelvic MRI confirmed a right sacroiliitis. A sacroiliac puncture with a study of synovial fluid demonstrated the presence of Streptococcus viridans. The blood culture revealed the same germ. Transthoracic and transoesophageal echocardiography confirmed infectious endocarditis with vegetation in the mitral valve. He received penicillin G and gentamicin relayed by pristinamycin because of an allergy to penicillin G with a total duration of treatment of 40 days. His symptoms and the laboratory and radiological tests abnormalities resolved totally with no recurrence.
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Affiliation(s)
- Madiha Mahfoudhi
- Internal Medicine A Department, Charles Nicolle Hospital, EL Manar University, Tunis, Tunisia
| | | | - Sami Turki
- Internal Medicine A Department, Charles Nicolle Hospital, EL Manar University, Tunis, Tunisia
| | - Adel Kheder
- Internal Medicine A Department, Charles Nicolle Hospital, EL Manar University, Tunis, Tunisia
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The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection. Am J Med 2014; 127:669.e9-669.e15. [PMID: 24608019 DOI: 10.1016/j.amjmed.2014.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The clinical significance of vertebral osteomyelitis and infectious endocarditis co-infection is unclear. This study investigates the rate, clinical features, and outcome of vertebral osteomyelitis with and without concomitant infectious endocarditis. METHODS A retrospective study of all cases of osteomyelitis with spinal imaging (n = 176), from January 2007 to April 2013, that were diagnosed as vertebral osteomyelitis. Sixty-two patients with spontaneous vertebral osteomyelitis were identified after excluding postsurgical, decubitus ulcers and spinal metastases. Seventeen (27%) were identified with concomitant infectious endocarditis. RESULTS All patients presented with back pain and 59% were diagnosed with infectious endocarditis subsequent to vertebral osteomyelitis. Distinguishing features among the co-infection group include the increased use of transesophageal echocardiography (94% vs 58%, P = .004), predisposing cardiac conditions (59% vs 16%, P = .001), and Gram-positive bacteremia, of which Streptococcus sp. and Enterococcus sp. were more common (35% vs 11%, P = .026). Adverse neurologic events were increased significantly in the co-infection group (59% vs 22%, P = .006). On transesophageal echocardiography, 88% of co-infection patients had highly mobile vegetations, 9 of which measured 10 mm or more. The overall mortality was 41% and 29% in the co-infection and lone vertebral osteomyelitis groups, respectively (P = .356). One-year mortality was identical for both groups at 24% (P = .999), and higher than previously reported (11.3% for lone vertebral osteomyelitis). CONCLUSIONS Patients with vertebral osteomyelitis, in whom infectious endocarditis is not excluded, are at increased risk for adverse neurologic events and mortality. The prompt diagnosis of infectious endocarditis, and associated high-risk features that may benefit from surgical intervention, require early evaluation by transesophageal echocardiography.
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Ojeda J, López-López L, González A, Vilá LM. Infective endocarditis initially presenting with a dermatomyositis-like syndrome. BMJ Case Rep 2014; 2014:bcr-2013-200865. [PMID: 24414182 DOI: 10.1136/bcr-2013-200865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infective endocarditis (IE) may present with rheumatological manifestations such as myalgias, arthralgias, arthritis and back pain. However, muscle inflammation is rare. We present a case of a 68-year-old Hispanic man who presented with 1-month history of tiredness, weight loss, fever, myalgias, muscle weakness and dysphagia to solid food. On physical examination he had severe weakness in the proximal upper and lower extremities, and erythematous eruption involving the upper eyelids, neck and metacarpophalangeal joints. Creatine kinase levels were markedly elevated at 15 809 U/L. MRI of the right thigh revealed intermuscular and intramuscular oedema. Muscle biopsy showed acute necrotising suppurative perimyositis. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. A transoesophageal echocardiogram revealed vegetations in the pulmonic valve. All clinical manifestations were resolved completely with broad-spectrum antibiotics. This case suggests that IE should be considered in the differential diagnosis of a patient presenting with inflammatory myopathy.
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Affiliation(s)
- Joel Ojeda
- Department of Medicine, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Hypertrophic cardiomyopathy: role of current recommendations by the american heart association for infective endocarditis. Pediatr Cardiol 2013; 34:709-11. [PMID: 22580831 DOI: 10.1007/s00246-012-0324-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
Abstract
In the past decade, there has been evolution in the diagnosis, management, and long-term care of patients with infective endocarditis and its complications. This includes the relatively new but contentious prophylactic antibiotic regimen. However, these cases still continue to pose a challenge in the adult and pediatric populations. We present a case of a teenager with hypertrophic cardiomyopathy that had an atypical presentation of infective endocarditis.
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Tamura K. Clinical characteristics of infective endocarditis with vertebral osteomyelitis. J Infect Chemother 2010; 16:260-5. [PMID: 20217170 DOI: 10.1007/s10156-010-0046-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/03/2010] [Indexed: 11/29/2022]
Abstract
The relationship between infective endocarditis (IE) and vertebral osteomyelitis (VO) is uncertain. This study investigates the incidence of VO in patients with IE and the outcome of IE-associated VO. Among 58 patients with IE at Musashino Red Cross Hospital from January 2002 to July 2009, 11 patients (19.0%) had VO. Back pain was reported in all cases with VO. Because the antibiotics treatment for VO should continue for 6-8 weeks, hospital stay was significantly longer for patients with VO (75.8 +/- 41.0 days) compared to patients without VO (42.6 +/- 30.4 days; P = 0.0035). Although 6 hospital deaths (15.8%) occurred among the patients without VO, there were no hospital deaths among patients with VO. The 30- and 80-month survival was not significantly different between the patients with VO and without VO (30-month: 88.9% vs 81.7%, 80-month: 88.9% vs 74.3%, respectively). When specifically sought, the incidence of VO is high in patients with IE. VO does not appear to worsen the prognosis of IE, although the need for long hospital stays seems to be more frequent.
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Affiliation(s)
- Kiyoshi Tamura
- Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Musashino, Tokyo 180-8610, Japan.
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Lamas C, Bóia M, Eykyn SJ. Osteoarticular infections complicating infective endocarditis: A study of 30 cases between 1969 and 2002 in a tertiary referral centre. ACTA ACUST UNITED AC 2009; 38:433-40. [PMID: 16798689 DOI: 10.1080/00365540500546308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Osteoarticular infections (osteomyelitis and septic arthritis) were studied in 693 episodes of infective endocarditis (IE) presenting to St. Thomas' Hospital (STH) between 1969 and 2002. The incidence of osteoarticular infections (OAI) was 4.3% (30/693). In intravenous drug users (IVDU), the incidence of OAI was 17.6% (9/51). 22 (73%) were clinically definite by the modified Duke criteria and 8 (27%) were probable. The respective figures using the St. Thomas' modified criteria were 83% and 17%. Blood cultures were positive in 93% (27/29). Only Gram-positive organisms were isolated. Infection mainly involved the vertebrae and large joints. Culture of joint fluid or bone was positive in 82% of cases (14/17). Over half the patients who developed OAI had major embolic complications of IE and the overall mortality was 33%. Bivariate analysis of risk factors for OAI in endocarditis showed statistical significance for S. aureus bacteraemia (OR 4.2, 1.9-9.3), IVDU (OR 6.3, 2.5-15.7), tricuspid valve involvement (OR 4.2, 1.8-9.6), pulmonary emboli (OR 3.9, 1.2-11.8) and emboli to the CNS (3.9, 1.5-9.9); on multivariate analysis, however, only S. aureus bacteraemia (OR 3.9, CI 2.5-5.9) and IVDU ( OR 3.2, CI 2.0-5.2) were associated with OAI in IE.
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Affiliation(s)
- Cristiane Lamas
- Departamento de Medicina Tropical, Instituto Oswaldo Cruz, Fiocruz.
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Turnier L, Nausheen S, Cunha BA. Fatal Streptococcus viridans (S. oralis) aortic prosthetic valve endocarditis (PVE) with paravalvular abscesses related to steroids. Heart Lung 2009; 38:167-71. [PMID: 19254635 DOI: 10.1016/j.hrtlng.2007.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 12/19/2007] [Indexed: 10/21/2022]
Affiliation(s)
- Laurence Turnier
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA
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Cone LA, Hirschberg J, Lopez C, Kanna PK, Goldstein EJC, Kazi A, Gade-Andavolu R, Younes B. Infective endocarditis associated with spondylodiscitis and frequent secondary epidural abscess. ACTA ACUST UNITED AC 2007; 69:121-5. [PMID: 17720227 DOI: 10.1016/j.surneu.2007.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 03/08/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although many patients with IE complain of joint, muscle, and back pain, infections at these sights are rare. Indeed, in patients with back pain and endocarditis, less than 4% actually demonstrate spondylodiscitis. CASE DESCRIPTION We recently encountered 4 patients with this complication, one each caused by Staphylococcus aureus, Streptococcus bovis, Streptococcus mitis, and Enterococcus faecalis, and wondered whether the nature of the infecting organism determined the development of spondylodiscitis and epidural abscess. In a literature review, 36 patients with endocarditis and spondylodiscitis were identified. Only 9 (25%) were caused by Streptococcus viridans and the remainder by staphylococci, enterococci, and other streptococci. Usually more than 50% of all cases of IE were caused by Streptococcus viridans, although more recent studies would indicate an incidence of about 40%. CONCLUSION We conclude that spondylodiscitis with epidural abscess is more likely to occur in those patients with endocarditis who are infected by organisms with pyogenic potential.
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Affiliation(s)
- Lawrence A Cone
- Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA.
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Pigrau C, Almirante B, Flores X, Falco V, Rodríguez D, Gasser I, Villanueva C, Pahissa A. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 2005; 118:1287. [PMID: 16271915 DOI: 10.1016/j.amjmed.2005.02.027] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE The relationship between pyogenic vertebral osteomyelitis and infectious endocarditis is uncertain. This study investigates the incidence and risk factors of infectious endocarditis in patients with pyogenic vertebral osteomyelitis, and the outcome of pyogenic vertebral osteomyelitis with and without associated infectious endocarditis. METHODS A retrospective record review was conducted of all cases of vertebral osteomyelitis from January 1986 to June 2002, occurring in a tertiary referral hospital. Patients were followed for at least 6 months with careful attention to detection of infectious endocarditis and relapses. RESULTS Among 606 patients with infectious endocarditis, 28 (4.6%) had pyogenic vertebral osteomyelitis. Among 91 cases of pyogenic vertebral osteomyelitis, 28 (30.8%) had infectious endocarditis. In 6 patients with no clinical signs of infectious endocarditis, the disease was established by routine echocardiography. Infectious endocarditis was more common in patients with predisposing heart conditions and streptococcal pyogenic vertebral osteomyelitis infection. Overall, pyogenic vertebral osteomyelitis in-hospital mortality was 11% (7.1% with infectious endocarditis). Twelve of 25 patients with infectious endocarditis with uncomplicated pyogenic vertebral osteomyelitis were treated for 4 to 6 weeks (endocarditis protocol), with no pyogenic vertebral osteomyelitis relapses. CONCLUSIONS When specifically sought, the incidence of infectious endocarditis is high in patients with pyogenic vertebral osteomyelitis. Oral therapy may be an option for uncomplicated pyogenic vertebral osteomyelitis; nevertheless, in gram-positive infections, this approach should only be considered after excluding infectious endocarditis. Favorable outcome with shorter treatment in uncomplicated pyogenic vertebral osteomyelitis associated with infectious endocarditis suggests that prolonged therapy may not be needed in this subgroup except for those infected by difficult to treat microorganisms, such as methicillin-resistant Staphylococcus aureus or Candida spp.
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Affiliation(s)
- Carlos Pigrau
- Infectious Diseases División, Hospital Universitari Vall d'Hebron, Universitat Autónoma, Barcelona, Spain.
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Llinas L, Harrington T. Musculoskeletal manifestations as the initial presentation of infective endocarditis. South Med J 2005; 98:127-8. [PMID: 15678653 DOI: 10.1097/01.smj.0000149395.99893.b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vlahakis NE, Temesgen Z, Berbari EF, Steckelberg JM. Osteoarticular infection complicating enterococcal endocarditis. Mayo Clin Proc 2003; 78:623-8. [PMID: 12744551 DOI: 10.4065/78.5.623] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite the common occurrence of musculoskeletal complaints in patients with infective endocarditis, infectious osteoarticular complications are diagnosed infrequently. Moreover, although enterococcal infection is the third most common cause of infective endocarditis, infectious osteoarticular complications are rare. We report a case of disk space infection in a patient with enterococcal endocarditis. Blood cultures and an L3-4 aspirate grew Enterococcus faecalis, and transthoracic echocardiography revealed a large vegetation on the posterior mitral valve leaflet. The osteoarticular infection resolved with antimicrobial treatment, but worsening heart failure necessitated valve replacement surgery. The patient had an uneventful recovery with no evidence of recurrence or complications. A review of the medical literature from 1966 through 1998 identified 13 additional cases, only 8 of which provided clinical and treatment data. We present the clinical and laboratory findings reported in these cases, along with data from our patient. This report highlights the rare occurrence of osteoarticular infection in the setting of enterococcal endocarditis and emphasizes early recognition and treatment.
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Affiliation(s)
- Nicholas E Vlahakis
- Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
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Abstract
Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.
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Affiliation(s)
- Mark E Shirtliff
- Center for Biofilm Engineering Montana State University, Bozeman, Montana 59717-3980, USA.
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González-Juanatey C, González-Gay MA, Llorca J, Crespo F, García-Porrúa C, Corredoira J, Vidán J, González-Juanatey JR. Rheumatic manifestations of infective endocarditis in non-addicts. A 12-year study. Medicine (Baltimore) 2001; 80:9-19. [PMID: 11204504 DOI: 10.1097/00005792-200101000-00002] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infective endocarditis (IE) is due to a microbial infection of the heart valves or of the endocardium in close proximity to either congenital or acquired cardiac defects. This infection is associated with a high risk of complications. Rheumatic manifestations are known to be frequent complications of IE. Controversy, however, frequently exists about the actual incidence of these complications. This may be due to the small number of series describing the frequency and type of rheumatic manifestations, the absence of uniform criteria used for the diagnosis of IE, and the fact that some studies on rheumatic manifestations in IE have been described from tertiary referral centers, which implicates associated problems of referral bias and uncertainty of denominator population. To investigate further the incidence, clinical spectrum, and outcome of patients with IE and rheumatic manifestations, we examined the features of patients diagnosed with clinically definite IE according to the Duke classification criteria at the single reference hospital for a defined population in northwestern Spain during a 12-year period. Between 1987 and 1998, 100 consecutive patients had 110 episodes of clinically definite IE. Rheumatic manifestations were observed in 46 of the 110 episodes (41.8%). As in other western countries, they occurred more commonly in men aged in their 50s. The most frequent valve involved was the aortic (43.5%) followed by the mitral valve (30.4%). Myalgia was a frequent symptom. Peripheral arthritis, generally as monoarthritis, was clinically evident in 15 cases (13.6%), and sacroiliitis in 1 patient. Low back pain was described in 14 cases (12.7%). Septic discitis was observed in 2 cases, and biopsy-proved cutaneous leukocytoclastic vasculitis was found in 4 cases. Other conditions such as trochanteric bursitis and polymyalgia were observed in 2 and 1 case, respectively. Apart from a significantly higher frequency of hematuria and a trend to lower serum complement levels in patients with rheumatic complications, no differences in clinical features, laboratory tests, or microbiologic blood culture results were found between cases with IE with or without rheumatic manifestations. Also, although patients with rheumatic manifestations had more embolic complications, the inhospital mortality rate in patients with rheumatic manifestations was not significantly different from that of the rest of the patients. The present study supports the claim that rheumatic complications are frequent in patients with clinically definite IE from southern Europe. The presence of musculoskeletal or vasculitic manifestations may be of some help, as warning signs, for the recognition of patients with severe disease who require rapid diagnosis and therapy.
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Suzuki J, Ando H, Nakajima T, Tamada T, Asada K, Sasaki S. Arthritis and meningitis--the first manifestations of bacterial endocarditis in 2 patients. JAPANESE CIRCULATION JOURNAL 1997; 61:450-4. [PMID: 9192245 DOI: 10.1253/jcj.61.450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have encountered 2 patients in whom the first manifestations of bacterial endocarditis were arthritis (in 1 case septic arthritis and in the other nonseptic arthritis) and bacterial meningitis. These presentations were followed by acute heart failure due to aortic valve destruction, although the patients showed no significant cardiovascular manifestations on admission. Aortic valve replacement was performed in each case and the patients' postoperative course was comfortable. We would like to emphasize the following points. (1) Arthritis and meningitis are uncommon in patients with bacterial endocarditis. However, it is necessary to consider the possibility of bacterial endocarditis when these clinical manifestations present together. Such a combination can cause rapid valve destruction. When more than 2 rare complications of bacterial endocarditis coexist, surgery should be considered as soon as the definite diagnosis of bacterial endocarditis is established, even if congestive heart failure has not yet developed. (2) Arthritis associated with bacterial endocarditis might be truly septic rather than mediated by circulating immune complexes as is commonly believed.
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Affiliation(s)
- J Suzuki
- Department of Internal Medicine, Takatsuki Red Cross Hospital, Japan
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Abstract
Osteomyelitis is thought to occur as a complication of infectious endocarditis in as many as 6% of cases of endocarditis. We describe this association in three patients. Osteomyelitis may be difficult to diagnose in patients with endocarditis because symptoms such as fever, bone pain and stiffness are common to both illnesses, therefore physicians need to have a high index of suspicion to avoid missing this important complication. We recommend that patients with endocarditis and persistent or localized musculoskeletal symptoms should be investigated to exclude osteomyelitis. Plain radiographs can be normal in 50% of cases of osteomyelitis in the early stages or show only minor abnormalities, but bone scans are highly sensitive. We suggest that a bone scan is performed if radiography is unhelpful, since a diagnosis of osteomyelitis can effectively be excluded if the bone scan is normal. We advocate close follow-up of these patients with prolonged antibiotic treatment consisting of at least 6 weeks of intravenous therapy, and 3 months or longer of oral therapy.
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Roberts-Thomson PJ, Rischmueller M, Kwiatek RA, Soden M, Ahern MJ, Hill WR, Geddes RA. Rheumatic manifestations of infective endocarditis. Rheumatol Int 1992; 12:61-3. [PMID: 1411084 DOI: 10.1007/bf00300978] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.
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22
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Abstract
The presentation of a pig farmer with acute arthritis of the shoulder, cardiac murmurs, and Streptococcus suis growing on blood cultures highlights one of the rheumatological presentations of bacterial endocarditis. The need for a thorough general medical examination together with synovial fluid and blood culture in patients with acute monarthritis is emphasised. The suggestion that acute arthritis related to endocarditis is in nature truly septic, rather than mediated by circulating immune complexes, is supported.
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Affiliation(s)
- A Doube
- Royal National Hospital for Rheumatic Diseases, Bath
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23
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Demers C, Tremblay M, Lacourcière Y. Acute vertebral osteomyelitis complicating Streptococcus sanguis endocarditis. Ann Rheum Dis 1988; 47:333-6. [PMID: 3365031 PMCID: PMC1003516 DOI: 10.1136/ard.47.4.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The first well documented case of acute pyogenic vertebral osteomyelitis presenting as the initial manifestation of Streptococcus sanguis endocarditis is reported. The importance of suspecting vertebral osteomyelitis in the presence of disc infection and the diagnostic value of imaging procedures are underlined.
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Affiliation(s)
- C Demers
- Department of Medicine, Le Centre Hospitalier de l'Université Laval, Québec, Canada
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24
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Abstract
A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started.
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Affiliation(s)
- C Watanakunakorn
- Department of Internal Medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio 44501-1790
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25
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Fabre J, Allal J, Abadie J, Becq-Giraudon B. Spondylodiscite et endocardite à streptocoque bovis : une nouvelle observation. Med Mal Infect 1982. [DOI: 10.1016/s0399-077x(82)80022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Allen SL, Salmon JE, Roberts RB. Streptococcus bovis endocarditis presenting as acute vertebral osteomyelitis. ARTHRITIS AND RHEUMATISM 1981; 24:1211-2. [PMID: 7306247 DOI: 10.1002/art.1780240918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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27
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Wofsy D. Culture-negative septic arthritis and bacterial endocarditis. Diagnosis by synovial biopsy. ARTHRITIS AND RHEUMATISM 1980; 23:605-7. [PMID: 6990934 DOI: 10.1002/art.1780230513] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The capacity of bacterial endocarditis to mimic other systemic illnesses is well known. This report describes a patient with blood culture-negative bacterial endocarditis who presented with features suggestive of rheumatoid arthritis. Despite sterile synovial fluid, synovial biopsy culture resulted in identification of the causative organism and led to specific antibiotic therapy and cure. This is the first report of such a case.
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28
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