Bacterial endocarditis masked by COVID‑19: A case report

Abstract

Infective endocarditis represents a rare complication among patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); it is often a nosocomial infection and the symptomatology can be masked by respiratory failure symptoms from SARS-CoV-2 bronchopneumonia. Management of patients with severe forms of SARS-COV-2 infection who also have associated infective endocarditis is very difficult, especially in mono-specialty hospitals (such as infectious diseases hospitals) where access to cardiological investigations is limited. The current study presents the case of a 73-year-old woman with increased cardiovascular risk (high blood pressure, diabetes mellitus and obesity), with uninvestigated ischaemic heart disease, who was admitted to the Department of Infectious Diseases in the Clinical Infectious Diseases Hospital (Constanta, Romania) due to SARS-CoV-2. Although the evolution was initially favorable, the condition of the patient significantly deteriorated on the 14th day of hospitalization due to the development of Enterococcus faecium infective endocarditis. Despite the therapy, the evolution was fulminant. Infection with coronavirus disease 2019 can result in numerous comorbidities, which cause higher mortality rates than in the general population.

Impact of the SARS-CoV-2 Pandemic on the Management and Prognosis of Infective Endocarditis

“…In our study, there was no significant difference in the site of acquisition of infection between community- and healthcare-associated IE. This was consistent with the literature [ 13 ], even though some authors have reported cases of nosocomial IE during long-term hospitalization for SARS-CoV-2 infection [ 15 , 16 ]. In contrast, the proportion of IE related to IV drug use was significantly higher in the pandemic year (Group 2) than in Group 1 (11.8% versus 3.7%) and also higher than that in the literature, which reported a rate of approximately 6.9% [ 2 ].…”

“…The SARS-CoV-2 pandemic had a psychosocial impact and social consequences, which may have promoted the occurrence or decompensation of psychiatric pathologies such as depression, anxiety disorders, and addictions. Moreover, patients who use intravenous drugs may have had more difficulty in accessing sterile equipment during the lockdown period [ 15 , 16 , 17 , 18 , 19 ]. Finally, paradoxically, this population may have had better and priority access to emergency care.…”

A Comprehensive Review on Cardiovascular Complications of COVID-19: Unraveling the Link to Bacterial Endocarditis

“…These individual clinical accounts offer valuable insights and anecdotal evidence that can contribute to our understanding of the complex interplay between these distinct yet potentially interrelated conditions. By meticulously examining these real-world cases, researchers and clinicians can identify patterns, trends, and commonalities that indicate a possible association or shared mechanisms [ 42 , 49 - 51 ].…”

Cardiovascular complications in the context of COVID-19: arrhythmias

“…Описано множество случаев инфекционного эндокардита в контексте COVID-19. Например, в Румынии описан случай с 73-летней женщиной, у которой диагностирован инфекционный эндокардит Enterococcus faecium с молниеносным течением после перенесенного COVID-19 [53]. Также группа исследователей заметила увеличение заболеваемости инфекционным эндокардитом во время пандемии COVID-19.…”