Query: skin manifestations of infective endocarditis

title: Prognostic value of skin manifestations of infective endocarditis.
abstract: Infective endocarditis (IE) is a rare disease with poor prognosis. When IE is suspected, skin examination is mandatory to look for a portal of entry and classic skin lesions to help diagnose and manage the condition.  To describe the prevalence of and factors associated with dermatological manifestations in patients with definite IE.  Observational, prospective, population based epidemiological study between January 1 and December 31, 2008. Subsequently, collected dermatological data were subjected to post hoc analysis.  Patients (n 497) diagnosed in 7 French regions and hospitalized in France for definite IE satisfying modified Duke criteria.  Patient and disease epidemiological information was collected, focusing on the most classic dermatological manifestations of IE (Osler nodes, Janeway lesions, purpura, and conjunctival hemorrhages) Disease outcome was also recorded.  Among 497 definite IE cases, 487 had known dermatological status. Of 487 cases, 58 (11.9% had skin manifestations, including 39 (8.0% with purpura, 13 (2.7% with Osler nodes, 8 (1.6% with Janeway lesions, and 3 (0.6% with conjunctival hemorrhages (5 patients had 2 skin manifestations) Patients with skin manifestations had a higher rate of IE related extracardiac complications than patients without skin manifestations, particularly cerebral emboli (32.8% vs 18.4% P .01) without increased mortality. Patients with purpura had larger cardiac vegetations (18.1 vs 13.7 mm, P .01) and Janeway lesions were associated with more extracerebral emboli (75.0% vs 31.8% P .02)  Specific skin manifestations of IE are associated with a higher risk of complications and should alert physicians to examine for extracardiac complications, notably with cerebral imaging.

title: Dermatologic manifestations of infective endocarditis*
abstract: Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler's nodes and Janeway lesions. Osler's nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes. Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. We report a case of infective endocarditis and highlight the importance of skin examination as a very important element in the presumptive diagnosis of infective endocarditis.

title: Dermatological manifestations of infective endocarditis
abstract: Infective endocarditis (IE) is a relatively rare infectious disease with considerable morbidity and mortality of around 20%.1 Classic dermatological manifestations suggestive of septicaemia have been described in IE. These findings can often lead to the diagnosis but can be difficult to distinguish from other non specific lesions. A 49 year old woman presented with fever and skin lesions for 10 days and weakness of her left arm

title: Left sided infective endocarditis caused by Streptococcus agalactiae: rare and serious
abstract: A comparative study of the behaviour of left sided infective endocarditis (left sided IE) due to Streptococcus agalactiae (GBS) with left sided IE caused by Staphylococcus aureus (SA) A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left sided IE; 41 (2.3% caused by GBS vs. 344 (19.6% due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare associated acquirement was 10% vs. 43% p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56% Vegetations were detected in 80% and measured 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6% The course was acute in both groups. There were more skin manifestations in SA left sided IE, 7.3% vs. 32% p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45% p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150) p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40 2.73; 1.19 2.39 and 0.99 1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left sided IE caused by GBS is similar in severity to left sided IE caused by SA.

title: Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management
abstract: Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to b lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high quality evidence for many key clinical questions.

title: Infective endocarditis in renal transplant recipients
abstract: Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years) Causative organisms included fungi, Staphylococcus aureus (3 cases each) Corynebacterium sp. (2 cases) Streptococcus viridans, VRE, Brucella sp. Clostridium sp. Nocardia sp. and Erysipelothrix sp. (one case each) Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died) Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

title: Immune complexes in infective endocarditis.
abstract: One of the unresolved issues dealing with the pathogenesis of infective endocarditis is whether some of the extravascular manifestations of this infection such as the glomerulitis, arthritis or ski.

title: Infective Endocarditis by Bartonellaquintana Masquerading as Antineutrophil Cytoplasmic Antibody Associated Small Vessel Vasculitis
abstract: The Bartonella species have been recently recognized as important causative agents of culture negative bacterial endocarditis. Antineutrophil cytoplasmic antibodies (ANCAs) have been associated with the spectrum of idiopathic small vessel vasculitis. However, a variety of infections can result in a false positive ANCA test, and especially subacute bacterial endocarditis (SBE) with the presence of ANCAs occasionally mimics the clinical manifestations of an ANCA associated vasculitis such as skin purpura and glomerulonephritis. In contrast, noninfectious endocardial involvement is known to be part of the spectrum of the manifestations of the ANCA associated vasculitis. Therefore, it is crucial to distinguish an ANCA positive SBE from an ANCA associated vasculitis with endocardial compromise, because the misdiagnosis of an SBE as an ANCA associated vasculitis can lead to an inappropriate immunosuppressive therapy with catastrophic consequences. The differential diagnosis is sometimes difficult, especially in the case of culture negative infective endocarditis with a positive ANCA test. We describe here a case of a culture negative SBE caused by Bartonellaquintana, accompanied with a positive cytoplasmic ANCA test and clinical findings masquerading as ANCA associated vasculitis. Both a serological test for Bartonella and polymerase chain reaction restriction fragment length polymorphism analysis were helpful for a correct diagnosis and appropriate treatment.

title: Neurologic manifestations of disseminated infection with Mycobacterium abscessus
abstract: Mycobacterium abscessus is a ubiquitous, saprophytic organism with low pathogenic potential. The authors describe the previously unreported clinical features of meningitis and native valve endocarditis caused by this rapidly growing atypical mycobacterium. The fatal outcome of this unusual case coincides with the grim prognosis of this disseminated infection and the significant mortality rate associated with neurologic complications of infective endocarditis.

title: Native valve Staphylococcus epidermidis endocarditis: report of seven cases and review of the literature.
abstract: This report describes seven patients from three university hospitals whose native valve infective endocarditis was caused by Staphylococcus epidermidis. The literature on endocarditis caused by S. epidermidis is also reviewed and the clinical features of patients with native valve endocarditis due to this organism are compared with those of patients from a general series of infective endocarditis cases. Compared with infective endocarditis caused by other organisms, S. epidermidis endocarditis tends to occur more frequently in male patients. Patients with S. epidermidis endocarditis exhibit fewer embolic complications and skin manifestations. The frequency of congestive heart failure is lower in this group. The relative indolent course and apparent rarity of native valve S. epidermidis endocarditis necessitate a high index of suspicion for early diagnosis.