Abstract

To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization. The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p = 0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p = 0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%, p = 0.017). A Cox regression analysis revealed that creatinine > 2 mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events. Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke.

Abstract

Background: infective endocarditis is a septic condition predominantly of bacterial origin, although there is a fungal etiology of the native valvular endothelium of the heart, it is a disease associated with high mortality and complications, despite advances in its approach, its incidence has not decreased in the last 30 years. Case presentation: 30-year-old black female patient, housewife, with a personal history of intraventricular septal defect. She went to the on-call department for presenting high fever at any time of the day accompanied by chills, with joint pain. She had undergone a curettage due to the presence of a fetal ovum. Three days prior to this, she had a fever of 38 degrees Celsius with no specific time of day, accompanied by chills, which was easily relieved with sodium metamizole. The fever persisted daily, which led to several hospital admissions, after which she was discharged home with no diagnostic cause. She was readmitted due to a chronic febrile syndrome, to which joint pain was added. Medulogram was performed and was not useful, suggesting iliac crest biopsy to rule out anarco-proliferative processes, and antimicrobials were not administered during this time. Conclusions: infective endocarditis on native valves with negative blood cultures remains a challenge, despite medical advances in recent decades, and due to demographic changes of patients and the disease, it remains a complex pathology with high morbidity and mortality.