Clinical profile and one-year outcomes of patients with mural infective endocarditis: – A tertiary care centre study based on data from a seven-year registry

BackgroundInfective endocarditis patients present very rarely with vegetations on the mural endocardium. Only very few studies are available comparing Mural infective endocarditis with commoner valvular or device related infective endocarditis.AimTo analyse the clinical features, microbiological profile and clinical course of mural endocarditis in comparison to valvular endocarditis.MethodsThis was a retrospective analysis of data from a registry of infective endocarditis. Patients enrolled between April 2012 and April 2019 were included. Patients who were reported to have vegetations on the mural endocardial surface were taken as a group and compared with rest of the patients. Clinical profile, laboratory parameters including culture and outcomes were compared between the two groups.ResultsOut of 278 patients in the study, 15 (5.38%) had vegetations on the mural endocardium. Of them, only 4 patients had structural heart diseases. All the patients with mural endocarditis were NYHA class II or below at presentation. Ventricles were the commonest sites of vegetations. Inflammatory markers like ESR and CRP were low in mural endocarditis compared to rest. Culture positivity was high in mural endocarditis and Staphylococcus Aureus was the commonest organism. Mural endocarditis patients had similar in hospital mortality to rest of the patients. Cardiac complications were not reported in mural endocarditis, but they had similar incidence of embolic complications including neurological events.ConclusionMural endocarditis is a rare clinical entity with similar morbidity and mortality to that of endocarditis with valvular vegetation.     

非细菌性血栓性心内膜炎与卒中

非细菌性血栓性心内膜炎（nonbacterial thromboendocarditis，NBTE）是一种异质性疾病，以 心脏瓣膜赘生物形成为特征。NBTE与恶性肿瘤及其他原因所致的高凝状态有关，是引起隐匿性卒中 的原因之一。经食道超声心动图和头颅MRI是诊断NBTE相关卒中的重要方法。合并恶性肿瘤的NBTE 患者发生卒中的风险较正常人群高，短期内卒中的复发率高、预后差。因此，早期识别NBTE相关性卒 中，并开展相应的治疗和二级预防是值得临床关注的问题。目前对NBTE的治疗包括原发肿瘤的治疗 和抗凝治疗两部分。     

Acute Ischemic Stroke Therapy in Infective Endocarditis: Case Series and Systematic Review

Objectives: To evaluate the safety of acute ischemic stroke (AIS) therapy in patients with infective endocarditis (IE) with intravenous thrombolysis (IVT) or endovascular therapy (EVT) such as mechanical thrombectomy. Methods: We conducted a retrospective study of patients who underwent AIS therapy with IVT or EVT at a tertiary referral center from 2013 to 2017, that were later diagnosed with acute IE as the causative mechanism. We then performed a systematic review of reports of acute ischemic reperfusion therapy in IE since 1995 for their success rates in terms of neurological outcome, and mortality, and their risk of hemorrhagic complication. Results: In the retrospective portion, 8 participants met criteria, of whom 4 received IVT and 4 received EVT. Through systematic review, 24 publications of 32 participants met criteria. Combined, a total of 40 participants were analyzed: 18 received IVT alone, 1 received combined IVT plus EVT, and 21 received EVT alone. IVT compared to EVT were similar in rates of good neurologic outcomes (58% versus 76%, P= .22) and mortality (21% versus 19%, P= .87), but had higher post-therapy intracranial hemorrhage (63% versus 18% [P= .006]). Conclusion: IV thrombolysis has a higher rate of post-therapy intracranial hemorrhage compared to EVT. EVT should be considered as first-line AIS therapy for patients with known, or suspected, IE who present with a large vessel occlusion.     

Human native endocarditis caused by Streptococcus canis—a case report

We report a very rare case of Streptococcus canis native infective endocarditis in a 73‐year‐old woman living in close contact with her dog. Her echocardiography showed large calcifications in the mitral annulus, massive regurgitation below the posterior leaflet, and adjacent vegetation. Blood culture was positive for Streptococcus Lancefield group G. A coronary artery bypass and mitral valve replacement had to be done. Streptococcus canis was detected in a heart valve using a broad range PCR followed by 16S rRNA and confirmed by tuf gene sequencing, while tissue culture remained negative. The patient was not bitten by her dog nor did she have comorbidities or skin ulcers. She fully recovered.