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A 63-year-old man was admitted to the hospital for nausea, vomiting, and right flank pain. He was found to have septic emboli in multiple organs secondary to aortic valve endocarditis. He was started on broad-spectrum antibiotics and underwent valve replacement. Blood cultures from admission were negative, but a blood polymerase chain reaction (PCR) test for fastidious difficult-to-culture pathogens showed a positive result for Tropheryma whipplei. Valve histopathological evaluation confirmed Tropheryma whipplei endocarditis. He was treated with intravenous penicillin followed by oral trimethoprim-sulfamethoxazole. A high index of suspicion for causes of culture-negative endocarditis needs to be maintained when blood cultures are negative despite clear evidence of endocarditis especially with large vegetation sizes and other complications such as septic emboli. Multiple imaging modalities are available to assist with diagnosis including transthoracic and transesophageal echocardiogram as well as cardiac computed tomography. A blood PCR test can identify the implicated pathogen in a more expeditious manner compared to valve histopathological evaluation. Treatment is complex and usually requires surgical intervention and prolonged antimicrobial therapy., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Background: The CRP/albumin ratio (CAR), a new inflammatory marker, is associated with adverse outcomes in various cardiovascular diseases. We evaluated the effectiveness of CAR in predicting embolic events in patients diagnosed with infective endocarditis (IE). Methods: A total of 145 patients with IE were included in the study and categorized into two groups according to the presence of embolic events. We retrospectively analyzed the patients' clinical, laboratory and echocardiographic data. Results: CRP (94.2 vs 63.3; p < 0.001) and CAR (25.8 vs 15.1; p < 0.001) values were significantly higher in patients who experienced embolic events. Multivariate analysis showed that a high CAR value (odds ratio: 1.030; 95% CI: 1.000-1.060; p = 0.041) was an independent predictor of embolic events in patients with IE. Conclusion: The CAR is a cheap and easily accessible marker that can predict the development of embolic events in patients diagnosed with IE.

Complete heart block, aortic root abscess and aortic valve regurgitation are well-recognized complications of infective endocarditis of the aortic valve. Splenic abscess and aorto-cavitary fistula are rarer phenomena and are indicative of calamitous infection. The authors present the case of an otherwise healthy 61-year-old man presenting with a 2-month history of non-specific symptoms, who developed suppurative endocarditis with a fistulating aortic root abscess, combined with severe sepsis, splenic embolization and complete heart block. Staphylococcus lugdunensis was the causative bacterium identified. The combination of these sequelae in the same patient is sparsely reported, is exceedingly rare and carries a significant risk of mortality.

A 26-year-old male patient presented with left-sided pneumonia, endocarditis of the tricuspid and pulmonary valves and a pulmonary artery embolism. In 2004 a Ross operation was performed because of congenital aortic valve stenosis. There was an elevation of the antibody titer for Coxiella burnetii, the pathogen of Q fever. Under antibiotic treatment with levofloxacin and doxycycline there was an improvement of the symptoms and a normalization of the inflammation parameters. The treatment of the endocarditis was successful., (© 2021. The Author(s).)

The errors in the following list appeared in the article entitled "Systematic Immune-Inflammation Index Predicts Embolic Eventsin Infective Endocarditis" by Wangling Hu, Guanhua Su, Wanyue Zhu, Enqing Zhou, and Xinxin Shuai (Vol. 63, 510-516, 2022).

Embolic myocardial infarction (MI) caused by infective endocarditis (IE) is rare, but it is increasingly recognized as an important complication. This complication typically occurs in patients with aortic valve endocarditis during the acute phase of the infection. It is also known to have a high mortality rate; however, the best practice for its management is unclear owing to scarce available data. In addition, most cases of embolic acute MI (AMI) caused by IE are indirectly diagnosed with a combination of angiographic examination such as coronary angiography or cardiac computed tomography. Herein, we report a case of fatal embolic ST-elevation MI (STEMI) caused by mitral valve IE during the healed phase, which was clearly proven by the pathology findings.

Background: Infective endocarditis (IE) continues to be associated with great challenges. Embolic events (EE) are frequent and life-threatening complications in IE patients. It remains challenging to predict and assess the embolic risk in individual patients with IE accurately., Hypothesis: Accurate prediction of embolization is critical in the early identification and treatment of risky and potentially embolic lesions in patients with IE., Methods: We searched the PubMed, Web of Science, and Google Scholar databases using a range of related search terms, and reviewed the literatures about the pathogenesis and embolic predictors of IE., Results: The development of IE and its complications is widely accepted as the result of complex interactions between microorganisms, valve endothelium, and host immune responses. The predictive value of echocardiographic characteristics is the most powerful for EE. In addition, both easily obtained blood biomarkers such as C-reactive protein, mean platelet volume, neutrophil-to-lymphocyte ratio, anti-β2-glycoprotein I antibodies, D-Dimer, troponin I, matrix metalloproteinases, and several microbiological or clinical characteristics might be promising as potential predictors of EE., Conclusion: Our review provides a synthesis of current knowledge regarding the pathogenesis and predictors of embolism in IE along with a review of potentially emerging biomarkers., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Infective endocarditis is associated with high morbidity and mortality. Hence, early diagnosis and prompt intervention is crucial. Multivalvular endocarditis involving 3 or more valves is rarely reported with little information regarding best management or prognosis, particularly in nonsurgical patients. Conflicting guidelines regarding medical versus surgical treatment in multivalvular endocarditis exist with few studies describing the outcome of medically managed patients. We report the case of a previously healthy male presenting with infective endocarditis involving 3 valves further complicated by multiple septic emboli and deemed a nonsurgical candidate.

Treatment of acute coronary syndromes secondary to septic coronary valvular embolism in endocarditis patients remains unclear. Several revascularization strategies have been described, including thromboaspiration, stent implantation, balloon angioplasty, and surgical intervention. We herein present an illustration of an atypical case of an acute coronary syndrome related to a coronary bifurcation occlusion due to a septic embolism in a patient presenting with infective endocarditis. We also summarized previous similar cases and their management.

Coronary artery septic embolization is a rare, but severe complication of infective endocarditis involving the leftside of the valves. The first case mentioned in the literature was a postmortem finding of a left anterior descending coronary artery occlusion by a vegetation fragment. Since this case, there have been several therapeutic strategies published with this clinical setting including medical treatment, percutaneous coronary angioplasty addressing coronary occlusion, surgical intervention for both the infected valve and coronary embolization, and hybrid procedures with transcatheter septic embolus aspiration followed by surgical valvular interventions. Out of the three interventions mentioned, the latter provided the best results and was in concordance with results observed in a case of mitral valve infected endocarditis complicated with acute occlusion of the left anterior descending coronary artery in patient whose comorbidities included hypertrophic obstructive cardiomyopathy. A transcatheter left anterior descending coronary artery embolus aspiration was performed , followed by a surgical mitral valve replacement and septal myectomy with an uneventful postoperative course. Although rare, this severe complication of infective endocarditis has a specific clinical course and therapeutic strategy, and in our opinion, it could be mentioned as a separate entity among embolic complications of infective endocarditis in future guidelines. Previously published cases suggest that the hybrid intervention might be the therapy of choice for this clinical setting; however, larger studies are necessary for confirmation., Competing Interests: The authors declare no competing interests., (© 2019 Bitay et al. Published by IMR press. All rights reserved.)

Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej , and ser ( sedjr ; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr -encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr . This mecA - sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.

Acute limb ischemia related to Coxiella burnetii endocarditis is rare. We report an original case of a 68-year-old man hospitalized for recurrent acute left limb ischemia in a context of atrial flutter, which revealed C. burnetii endocarditis. This case illustrates that even if embolic events are uncommon, septic embolisms must be systematically searched for in case of C. burnetii endocarditis. Conversely, extensive etiologic explorations must be performed in case of systemic embolism. New molecular techniques represent a major step forward in infective endocarditis diagnosis. Finally, diagnosis must be suspected in case of unexplained fever, inflammatory syndrome, or embolic event, especially in patients at risk. Conversely, in case of chronic Q fever, an immunodeficiency cause must be researched., (Copyright © 2018. Published by Elsevier Inc.)

Q fever is a zoonotic disease with a reservoir in mammals, birds, and ticks. Acute cases in human beings can be asymptomatic, or they can present with a flu-like illness, pneumonia, or hepatitis. Approximately 5% of cases progress to chronic Q fever. Endocarditis, the most typical manifestation of chronic Q fever, is usually associated with small vegetations that occur in patients who have had prior valvular damage or who are immunocompromised. We present what we think is the first reported case of superior mesenteric artery embolism from Q fever endocarditis of the aortic valve, in a 39-year-old woman who needed surgical embolectomy and subsequent aortic valve replacement.

We hypothesised that increased on-admission and follow-up mean platelet volume (MPV) levels would correlate with adverse outcomes in patients with infective endocarditis (IE). A total of 108 consecutive patients were grouped into two according to median MPV level (≤ 8.6 and > 8.6 fL). Patients with MPV level of > 8.6 fL had a significantly higher rate of end-stage renal disease, Staphylococcus aureus infection, higher CRP levels, embolic events and in-hospital mortality compared to patients with MPV levels ≤ 8.6 fL. In multivariable Cox regression analysis, previous history of IE, S. aureus infection, end-stage renal disease, depressed LVEF, early surgical intervention, vegetation size ≥ 10 mm, presence of perivalvular abscess, higher on-admission platelet count, CRP and MPV levels emerged as independent predictors of in-hospital unfavourable outcomes. Patients with embolic events and in-hospital mortality revealed an incremental trend for MPV levels compared to patients without any adverse events. Our study results suggest that both on-admission and follow-up MPV levels may be a simple and available biomarker for risk stratification of IE patients.

Background: Platelet activation appears to play an important role in thromboembolic complications of infective endocarditis (IE). Mean platelet volume (MPV) is a potentially useful marker of platelet activity and a quick and easy determinant of thrombotic risk. Hence the aim of this study was to investigate the baseline platelet volume indices (MPV and platelet distribution width [PDW]) in IE patients who developed embolic events in the follow-up period and who did not., Methods: The study group consisted of 76 consecutive patients (female: 55, male: 21, mean age: 26 years old, ranged: 8-64 years) with definite IE according to Duke Criteria. Thirty four healthy subjects, who were age and gender adjusted, served as the control group. The mean duration of hospital stay was 44 days., Results: Among the IE patients, 13 (13/76, 17.1%) had major embolic events. Significantly larger vegetations were observed in patients with embolic events as compared to non-embolic group (1.4 vs. 1.0 cm, p = 0.03). MPV at hospital admission was higher in patients who had embolic events in the follow-up period compared to both those who did not and the control subjects (10.62 ± 1.13 vs. 9.25 ± 0.97 and 8.93 ± 0.82 fL, p < 0.001, respectively). Similarly, the patients with embolic events had increased PDW compared to the non-embolic ones and the control group (16.31 ± 2.42 vs. 14.35 ± 1.97 and 14.04 ± 1.82%, p < 0.001, respectively)., Conclusions: The present study demonstrated that IE patients with embolic events had increased MPV and PDW values, compared to non-embolics. Future prospective studies with standardized measurements may clarify the clinical role of platelet volume indices in thrombo-embolic complications of IE.

A 28-year-old woman presenting with fever was referred to our hospital and diagnosed as septic pulmonary embolism secondary to tricuspid valve endocarditis. Although antibiotic therapy was initiated, she further showed multiple complications including Janeway lesions and cerebral infarctions, suggestive of septic systemic embolism. Transoesophageal echocardiography detected a right-to-left shunt through a patent foramen ovale (PFO). The patient was successfully treated with surgical tricuspid valvuloplasty and PFO closure. Paradoxical systemic embolism may occur in patients with septic pulmonary embolism through the PFO., (2014 BMJ Publishing Group Ltd.)

Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.

In a patient with staphylococcus lugdunensis prosthetic aortic valve endocarditis and coronary septic embolism accompanied by antero-lateral myocardial infarction, embolic material was successfully aspirated from the bifurcation of the left anterior descending coronary artery and the first diagonal branch. A good angiographic result was documented six months thereafter when the patient presented with a second complication, pulsatile compression of the left main coronary artery by an abscess cavity originating between the aortic and mitral annulus, leading to congestive heart failure. The patient underwent successful surgical replacement of the aortic valve prosthesis with concomitant patch reconstruction of the annulus as well as tricuspid annuloplasty., (Copyright © 2013 Wiley Periodicals, Inc.)

Purpose: Acute infective endocarditis is a potentially life-threatening disease. Its outcome strongly depends on systemic embolization and extracardiac infections. When present, these conditions usually lead to a more aggressive therapeutic approach. However, the diagnosis of peripheral septic embolism is very challenging. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has proven to be accurate for the detection of inflammatory diseases and occult infections. The aim of this study was to assess the added value of (18)F-FDG PET/CT in the detection of extracardiac embolisms in the evaluation of patients with suspected valvular endocarditis (VE)., Methods: Seventy-one patients with suspected infective endocarditis, enrolled between June 2010 and December 2012, underwent (18)F-FDG PET/CT with the standard procedure on a dedicated PET/CT scanner. Extracardiac findings were subsequently evaluated with other imaging procedures., Results: Of the 71 patients with suspicion of infective endocarditis, we found unexpected extracardiac findings in 17 patients (24%) without any clinical suspicion. Extracardiac findings were subsequently evaluated with other imaging procedures., Conclusion: PET/CT detected unexpected extra sites of infection in 24% of cases, leading to changes in therapeutic management in a very relevant percentage of patients. These findings may have important therapeutic implications.

Despite the progress made in diagnosis and treatment of heart valve diseases, the incidence of infective endocarditis (IE) remains constant. It is still associated with high mortality and high rate of embolic complications, including most dangerous one, i.e. stroke. It has a significant impact on further treatment and qualifications for cardiac surgery. In this paper, the authors discuss the epidemiology, mechanisms of stroke and its impact on the qualifications for cardiac surgery. The authors discuss the problem of clinically silent central nervous system embolism in the course of IE and the usefulness of neuroimaging and markers of central nervous system damage in diagnosis of cerebral embolism.

Coronary artery septic embolisation resulting in cardioembolic myocardial infarction (MI) is a rare complication of bacterial infective endocarditis (IE), representing <1% of complications related to IE. Diagnosis requires a combination of high clinical suspicion, coronary angiography, echocardiography and cultures of peripheral blood and/or embolic material. The associated mortality rate remains high despite early diagnosis. Optimal interventional therapy is unknown with published international experience over the past two decades limited to very small case series and individual case reports. We present a case of ST elevation MI resulting from coronary artery septic embolisation with an accompanying comprehensive review of the literature., (Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.)

Infectious endocarditis is a rare disease with high mortality. Epidemiological changes in recent years, the emergence of new risk factors, and the increasing use of intravasal prosthetic materials has led to changes in not only the clinical appearance of this disease but also in its diagnosis and treatment. Early diagnosis of infectious endocarditis is crucial. However, the often unspecific symptoms and the changes in its epidemiologic profile pose a challenge for the treating physician. This is especially true since the incidence of hospital-acquired, "nosocomial" cases of infectious endocarditis is increasing and often affects severely ill patients in intensive care units (ICU). There are diagnostic and therapeutic algorithms to guide the physician from an early diagnosis to an adequate treatment of the disease. In some critically ill patients, only surgery in combination with antimicrobial treatment may lead to complete eradication of the infectious disease. This review aims to subsume the guidelines, paying special attention to aspects that are important for intensive care and emergency doctors.

A 75-year-old woman, who had been treated for rheumatic arthritis, was transferred to our hospital because of acute abdomen and continuous fever for several weeks. She had peritonitis, and abdominal computed tomography detected a thrombus occluding the proximal superior mesenteric artery and infarctions of the kidneys and spleen. Echocardiography showed a large vegetation on the anterior leaflet of the mitral valve. The necrotic small bowel and ascending colon were resected, and mitral valve replacement was performed 5 days later. She suffered from hyperbilirubinemia and pneumonia for several weeks after the operation but recovered successfully thereafter.

Infective endocarditis (IE) is an inflammatory disease of the endocardium, with a high morbidity and mortality, particularly when it progresses with predisposing conditions and complications. Embolic events induced by mural cardiac vegetations are a common and life-threatening complication of IE. Herein, we present a first case with left ventricular IE and a giant vegetation causing multiple emboli.

Infective endocarditis (IE) is a lethal disease if not promptly treated with antibiotics, either in association with surgery or not. The incidence of disease has not decreased over the last decades due to the change of risk conditions. Complications of IE may involve cardiac structures when the infection spreads within the heart, or extra cardiac ones when the cause is usually from embolic origin; they may also be due to medical treatment or to the septic condition itself. A variety of complications may occur in most of patients. The literature reports one complication of IE in 57%, two in 26% and three or more in about 14% of patients examined. The frequency of specific complications depends on variables as the infecting pathogen, duration of disease before therapy and type of treatment. However it is often difficult to assess the true incidence of complications because the published reviews in literature are frequently based on retrospective chart reviews and different diagnostic criteria are used. The decision over either indication or timing of surgery should be individualized and based on a multidisciplinary approach involving at least cardiologists and cardiac surgeons. Congestive heart failure (CHF) is the most important complication of IE, which has the greatest impact on prognosis. Periannular abscesses are a relatively common complication of IE (42% to 85% of cases during surgery or at autopsy respectively), associated with a higher morbidity and mortality. Systemic embolization occurs in 22% to 50% of cases; emboli may involve major arteries, mostly affecting the central nervous system, but also other organs. Splenic abscess is a rare complication of IE, due to direct seeding of spleen by an embolus or bacterial seeding of a bland infarction. Neurological complications develop in 20% to 40% of patients with IE and represent a dangerous subset of complications. Mycotic aneurysms are rare, resulting from diffusion of infection to the vessel wall. Actually the clinical profile, the best treatment (medical or surgical approach) and outcome of complicated IE are not well defined. Changing trends in aetiology of IE with emerging infections from Staphylococci, bacteria of the HACEK group and Fungi have resulted in an increased frequency of culture negative IE. Sepsis or persistent fever despite appropriate antimicrobial therapy, recurrent emboli, heart failure or new pathologic murmurs suggest haemodynamic impairment and/or infection extending beyond the valve leaflet or prosthetic valvular annulus. The course of the disease will consequently get worse with an increasing need of surgery. Patients who develop abscesses are more likely to undergo surgery than those who do not (84-91% vs 36%), and also their in-hospital mortality rate is higher (19% vs 11%). A prompt detection of complications often allows an earlier surgical treatment which represents the best way to improve the outcome. The introduction of molecular methods techniques has increased the ability to identify the causal agents of IE, mostly in cases of culture negative endocarditis. Echocardiography, mainly from transesophageal (TEE) approach, has significantly improved the evaluation of IE allowing to detect the specific signs of the disease as vegetations, abscesses, valve insufficiency, prosthetic valve dehiscence, fistulas. In our 3rd referral Hospital (Lancisi Heart Hospital, Ancona, Italy) we performed a follow-up (mean 8.26 years) of 15 patients with periannular complications associated with IE. The long term follow-up showed low mortality rate, high incidence of reintervention, improved New York Heart Association (NYHA) class in survivors and no changes of the lesions at the echocardiographic examination, suggesting that periannular complications have not significantly influenced the overall survival in our patients at the follow-up.

The authors present the case of a 49-year-old female who presented to the emergency department with a chief complaint of "not eating well." She was found to have a heart murmur, a focal neurological deficit, and large mitral valve vegetation. The patient was later diagnosed with acute Pseudomonal endocarditis with septic emboli to the brain, liver, spleen, and kidneys. A discussion of the patient presentation, diagnostic evaluation, and outcome are reviewed.

Introduction and Objectives: Among the complications of infective endocarditis, systemic embolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms., Material and Method: Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304)., Results: There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolated in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death., Conclusions: Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death.

Objectives: This study examined the effect of aspirin on the risk of embolic events in infective endocarditis (IE)., Background: Embolism is a major complication of IE, and studies in animal models have shown that platelet inhibition with aspirin can lead to more rapid vegetation resolution and a lower rate of embolic events., Methods: We conducted a randomized, double-blinded, placebo-controlled trial of aspirin treatment (325 mg/day) for four weeks in patients with IE to test the hypothesis that the addition of aspirin would reduce the incidence of clinical systemic embolic events. Patients with perivalvular abscess were excluded. Serial cerebral computed tomograms and transesophageal echocardiograms were obtained in a subset of patients., Results: During the four-year study period, 115 patients were enrolled: 60 assigned to aspirin and 55 assigned to placebo. Embolic events occurred in 17 patients (28.3%) on aspirin and 11 patients (20.0%) on placebo, with an odds ratio (OR) of 1.62 (95% confidence interval [CI] 0.68 to 3.86, p = 0.29). There was a trend toward a higher incidence of bleeding in the patients taking aspirin versus placebo (OR 1.92, 95% CI 0.76 to 4.86, p = 0.075). Development of new intracranial lesions was similar in both groups. Aspirin had no effect on vegetation resolution and valvular dysfunction., Conclusions: In endocarditis patients already receiving antibiotic treatment, the addition of aspirin does not appear to reduce the risk of embolic events and is likely associated with an increased risk of bleeding. Aspirin is not indicated in the early management of patients with IE.

The most important complications of endocarditis are congestive heart failure, paravalvular abscess formation, and embolism, especially stroke. In addition, endocarditis may be complicated by septic arthritis, vertebral osteomyelitis, pericarditis, metastatic abscesses and an array of renal problems ranging from immune-complex glomerulonephritis to renal abscesses. Adverse reactions associated with medical treatment of endocarditis can also result in significant complications such as ototoxicity and nephrotoxicity, skin rashes, and serum sickness. This review focuses on the cardiac, embolic, neurologic and renal complications of endocarditis and discusses how these complications influence the clinical management of individual cases in daily practice.

Infective endocarditis (IE) presents with several signs and symptoms that are mainly heart-related and the result of bacteremia. We describe the case of a woman with severe renal hemorrhage due to a septic embolic cortical infarction, who was also receiving anticoagulation therapy because of cardiopathy, whose retroperitoneal hematoma was the first manifestation of IE.

Objectives: This study was designed to assess the risk of systemic embolization in patients with left-sided infective endocarditis, once adequate antibiotic treatment had been initiated, on the basis of prospective clinical follow-up., Background: As one of the complications of infective endocarditis, embolization has a great impact on prognosis. Prediction of an individual patient's risk of embolization is very difficult., Methods: We studied 217 episodes of left-sided endocarditis that were experienced among a cohort of 211 prospectively recruited patients. According to the Duke criteria, 91% of the episodes were definite infective endocarditis. Seventy-two episodes involved infections located on prosthetic valves. All patients were studied by transthoracic and transesophageal echocardiography. Clinical, echocardiographic and microbiologic data were entered in a data base. The mean follow-up interval was 151 days., Results: Twenty-eight episodes (12.9%; group I) of endocarditis had embolic events after the initiation of antibiotic therapy. The remaining 189 episodes did not embolize (group II). Most emboli (52%) affected the central nervous system, and 65% of the embolic events occurred during the first two weeks after initiation of antibiotic therapy. Previous embolism was associated with new embolism (relative risk [RR] 1.73, 95% confidence interval [CI] 1.02 to 2.93; p = 0.05). There was an increase in the risk of embolization with increasing vegetation size (RR 3.77, 95% CI 0.97 to 12.57; p = 0.07). Vegetation size had no impact on the risk of embolization in streptococcal endocarditis or aortic infection. By contrast, large (> or = 10 mm) vegetations had a higher incidence of embolism when the microorganism was staphylococcus (p = 0.04) and the mitral valve was infected (p = 0.03). The increase in vegetation size at follow-up showed a higher risk for embolization (RR 2.64, 95% CI 0.98 to 7.16; p = 0.02)., Conclusions: Embolism before antimicrobial therapy is a risk factor for new emboli. The risk of embolization seems to increase with increasing vegetation size, and this is particularly significant in mitral endocarditis and staphylococcal endocarditis. An increase in vegetation size, despite antimicrobial treatment, may predict later embolism.

Background: Patients with infective endocarditis are at risk for embolic complications. Emboli often occur very early in the course of endocarditis., Vegetations: Pathologic substrate of emboli are vegetations which can be visualized by echocardiography with high sensitivity and accuracy. The question whether echocardiographically derived characteristics of vegetations such as size, mobility, location, and "consistency" poses an increased risk for complications, in particular arterial embolism, remains controversial. An analysis of pooled studies revealed an odds ratio of 2-3 for increased risk of embolization in the presence of a vegetation > 10 mm, particularly in mitral valve endocarditis., Treatment and Prevention: However, because of poorly defined co-variables, lack of standardized methods for measurements, as well as a high overlap in the vegetation size between patients with and without embolic complications, no therapeutic implications can be drawn on the echocardiographic findings alone. It appears that an early diagnosis with initiation of an adequate antibiotic therapy is still the best prevention for embolic complications.

Acute bacterial endocarditis continues to be a significant medical and surgical problem in the United States. The authors describe a complicated case of acute Staphylococcus aureus endocarditis in an 18-year-old man. The patient suffered multiple systemic emboli requiring aggressive medical and surgical intervention.