Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century

Abstract

Streptococcus pneumoniae is an infrequent cause of severe infectious endocarditis (IE). The aim of our study was to describe the epidemiology, clinical and microbiological characteristics, and outcome of a series of cases of S. pneumoniae IE diagnosed in Spain and in a series of cases published since 2000 in the medical literature.We prospectively collected all cases of IE diagnosed in a multicenter cohort of patients from 27 Spanish hospitals (n = 2539). We also performed a systematic review of the literature since 2000 and retrieved all cases with complete clinical data using a pre-established protocol. Predictors of mortality were identified using a logistic regression model.We collected 111 cases of pneumococcal IE: 24 patients from the Spanish cohort and 87 cases from the literature review. Median age was 51 years, and 23 patients (20.7%) were under 15 years. Men accounted for 64% of patients, and infection was community-acquired in 96.4% of cases. The most important underlying conditions were liver disease (27.9%) and immunosuppression (10.8%). A predisposing heart condition was present in only 18 patients (16.2%). Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The microbiological diagnosis was obtained from blood cultures in 84.7% of cases. In the Spanish cohort, nonsusceptibility to penicillin was detected in 4.2%. The most common clinical manifestations included fever (71.2%), a new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of patients. The in-hospital mortality rate was 20.7%. The multivariate analysis revealed the independent risk factors for mortality to be meningitis (OR, 4.3; 95% CI, 1.4–12.9; P < 0.01). Valve surgery was protective (OR, 0.1; 95% CI, 0.04–0.4; P < 0.01).Streptococcus pneumoniae IE is a community-acquired disease that mainly affects native aortic valves. Half of the cases in the present study had concomitant pneumonia, and a considerable number developed meningitis. Mortality was high, mainly in patients with central nervous system (CNS) involvement. Surgery was protective.

Severe Austrian Syndrome in an Immunocompromised Adult Patient – A Case Report

“…A review of the literature gives alcoholism as an important risk factor in the development of Austrian syndrome, with a frequency of 10.4-28.1 % [2,6] [14]. In the presented case, the risk factor for the invasive infection with S. pneumoniae was an immunodeficiency caused by splenectomy, a condition which increases the risk of disease with encapsulated bacteria.…”

“…Diagnosis of pneumococcal endocarditis is sometimes delayed due to the low incidence of the agent causing the cardiac pathology, the absence of classical stigmata of infective endocarditis and the delayed occurrence of cardiac auscultation signs [6]. A review of the literature gives alcoholism as an important risk factor in the development of Austrian syndrome, with a frequency of 10.4-28.1 % [2,6] [14].…”

“…The aortic valve is mostly affected, varying from 46.7 % to 77.4 %, leading to life-threatening complications. The mitral valve can be affected in 31.4 % to 56.7 % of cases [5][6].…”

Síndrome de Austrian, reporte de caso

“…Esta patología puede ser mortal si el tratamiento apropiado no se administra temprano [14][15][16] . En una revisión de 111 casos de endocarditis por S. pneumoniae de España publicada recientemente, se registró que el síndrome de Austrian parece ser un factor de mal pronóstico y estuvo presente en 43,5% de los pacientes con endocarditis por S. pneumoniae que murieron en esa serie, se reportó que neumonía fue la primera manifestación clínica del síndrome de Austrian en casi la mitad de los casos 17 . El síndrome de Austrian se caracteriza por afectar principalmente a las cavidades izquierdas del corazón, especialmente la válvula aórtica y por presentar una gran agresividad, la destrucción valvular es casi constante 1,12 .…”

“…El síndrome de Austrian se caracteriza por afectar principalmente a las cavidades izquierdas del corazón, especialmente la válvula aórtica y por presentar una gran agresividad, la destrucción valvular es casi constante 1,12 . La endocarditis por S. pneumoniae afecta principalmente a las válvulas nativas, aunque los datos sobre las válvulas más comúnmente afectadas son contradictorios y varían entre las series 17 . El perfil clínico es de una edad media de presentación de 52 años, con una frecuencia de 75% en hombres.…”