Infective endocarditis (IE) first diagnosed at autopsy: analysis of 31 cases in Ribeirão Preto, Brazil

Abstract

Thirty one infective endocarditis (IE) fatal cases whose diagnosis was first obtained at autopsy were studied. The clinical data of these patients (Group 1) showed significant differences compared to other 141 IE cases (Group 2). The average age of 53 years in Group 1 patients was 18 years higher than that of Group 2. The Group 1 patients had a low frequency of IE predisposing heart disease. Both patient groups presented fever (about 87%), but a significant low frequency of cardiac murmur (25.8%) was observed in Group 1 patients and echocardiography tests were performed in only 16.1%, suggesting that IE diagnosis was not suspected. Likewise, although most Group 1 patients appeared with severe acute illness, they did not present the classic IE clinical presentation. Blood cultures were performed in only 64.5% of the Group 1 patients. However, bacteria were isolated in 70% of these blood cultures and Staphylococcus aureus was isolated in 71.4%. The bacteria attacked mitral and aortic valves. Complications such as embolizations and cardiac failure occurred in almost half of the cases and they also presented with infections of the lungs, urinary tract, and central nervous system. Medical procedures were performed in practically all fatal cases whose diagnosis was first obtained at autopsy. Sepsis occurred in about half of the patients and it was followed by shock in more than 25%. This form of IE must be suspected in mature and in old febrile hospitalized patients having infection predisposing diseases, embolization, and suffering medical procedures.

Staphylococcus aureus Endocarditis

“…sumed source of bacteremia, confirming previous single-center observations. 13,14,16,[32][33][34] Prosthetic cardiac devices (pacemakers, defibrillators, and prosthetic cardiac valves) were present in almost one quarter of the patients in this investigation. This finding is consistent with a recent report using Medicare claims data to demonstrate increasing numbers of cardiac device infections over the previous decade.…”

Treatment Duration for Uncomplicated Staphylococcus aureus Bacteremia To Prevent Relapse: Analysis of a Prospective Observational Cohort Study

“…However, this did not mean that echocardiography may not be required in these patients. Because clinical criteria alone have a low ability to exclude endocarditis (2,37,38), all patients with S. aureus bacteremia should at least undergo TTE.…”

Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography

“…This finding is of clinical importance, as S. aureus IE is a potentially lethal infection that is often unsuspected on clinical grounds alone. 7,18,21,29,30 Thus, it is vital that patients with S. aureus IE are diagnosed early in the course of the disease in order to optimize clinical outcome. One potential strategy for the early and accurate identification of S. aureus IE is to perform screening echocardiography on all patients with SAB.…”