Acute endocarditis in intravenous drug users: a case report and literature review PMC

Given the magnitude of the problem of IDUs, the on-going HIV epidemic, and the emergence of multidrug-resistant pathogens (including the specter of vancomycin-resistant S. aureus [76]), more work in this arena is necessary. A possible practical medium for data collection and generation of a large international database of IDU-related endocarditis cases is the World Wide Web. Such a database could accrue a sufficient number of cases to allow more powerful statistical analysis to be applied to further evaluate the pathogenesis of this major clinical entity. Such a database would be helpful in unravelling a lot of the contradicting data that exists in the literature, often based on small case series or isolated clinical observations. A special subset of endocarditis is that affecting prosthetic valves.

Multidisciplinary Care Is Crucial

• The increase was driven most strongly by an increase in DU-IE surgeries, which increased 2.7-fold.
• Very limited patients can be trialed with a short duration course.
• However, any IDU who becomes non-compliant, relapses, and acquires a second episode of IE generally will not be offered further valve surgeries (21).

As we move into the second century of our work, we are advancing health and hope for everyone, everywhere. This article does not contain any studies with human or animal subjects performed by any of the authors. Authors are grateful to ‘Fondazione A.R.Card Onlus’ for its unconditional support.

Medical Information

Risk factors for children and young adults include birth defects of the heart such as malformed valves or a hole in the septum, which allow blood to leak from one part of the heart to another. Infective endocarditis refers to infection in the lining of the heart, but also affects the valves. In contrast with the experience of Rohn et al. [3], we did not find higher mortality even after multiple relapses. Moreover, since we could not identify any predictor of a futile surgery, this reinforces the concept that any patient with a complicated IE deserves surgery without delay, irrespective of its aetiology.

Patient selection

• Here we describe a case of an IVDU patient with atypical presentation of IE who ultimately required multiple revision surgeries for native aortic valve endocarditis.
• Similarly, a study by Mathew et al. [32] showed that streptococcal endocarditis in a group of IDUs localized to left-side valves, whereas S.
• Case managers and social workers also play an essential role in finding rehab facilities to help prevent future IVDU, as well as to help arrange for outpatient facilities to obtain longer term IV antibiotics if necessary.
• Although pre-existing endothelial damage is considered necessary for vegetation formation, the explanation of particle- or drug-induced valvular damage may be too simplistic.

Left-sided lesions may embolize to any tissue, particularly the kidneys, spleen, and central nervous system. Diffuse glomerulonephritis may result from immune complex deposition. If you have symptoms of endocarditis, see your health care provider as soon as possible — especially if you have a congenital heart defect or history of endocarditis. A proper evaluation by a health care provider is needed to make the diagnosis. The proportion of DU-IE among all infective endocarditis operations increased in all regions of the U.S. from 2011 to 2018.

Adhesins, or ligand binding proteins, that bind to extracellular matrix molecules have been termed microbial surface components recognizing adhesive matrix molecules (MSCRAMM). Ligand-matrix interactions are believed to be iv drug use integral to the ability to colonize a host [48]. It can be hypothesized that there is a greater expression of matrix molecules that bind to MSCRAMM on right-side valvular surfaces in IDUs, predisposing these valves to S.

Response to treatment

This is traditionally divided into early onset (within 60 days of surgery) or late onset. Early onset usually results from perioperative valve contamination with staphylococci, whereas the etiology of late prosthetic valve endocarditis resembles native valve infection, usually due to streptococci. Causative microorganisms vary by site of infection, source of bacteremia, and host risk factors (eg, IV illicit drug use), but overall, streptococci and Staphylococcus aureus cause 80 to 90% of cases. Enterococci, gram-negative bacilli, HACEK organisms (Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae), and fungi cause most of the rest. However, the incidence of staphylococcal and enterococcal endocarditis has been increasing, and streptococcal endocarditis has been decreasing.

What are the Signs and Symptoms of Intravenous Drug Abuse Endocarditis?

Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. Diagnosis requires demonstration of microorganisms in blood and usually echocardiography. Treatment consists of prolonged antimicrobial treatment and sometimes surgery.

These bacteria can lodge on heart valves and cause infection of the endocardium. Interprofessional management of the patient with IE is essential to ensure positive outcomes. Physicians are important clinicians in assessing these patients and helping establish the diagnosis of TVIE.

• First, some argue that the cost of these medications does not justify their use.
• Antibiotics should not be initiated before three sets of blood cultures have been taken.
• The sensitivity of blood cultures is over 90% if they are sent before administration of antibiotics.
• Retinal emboli can cause round or oval hemorrhagic retinal lesions with small white centers (Roth spots).
• Although the valvulitis did not localize specifically to the right side of the heart, one may predict that a predisposing endothelial lesion, as might occur on the right side in IDUs, might cause greater right-side immune complex deposition.
• Hospitalizations for infective endocarditis have increased substantially since 2011.

Diagnostic criteria

Several dosing strategies have been proposed that include once and twice weekly dosing with variable loading and maintenance dosages.67,68 Despite anecdotal success, more rigorous evaluation is clearly needed. In the treatment of IE, from any source, fever may still be present 2 weeks after starting the appropriate treatment, even with drug-sensitive organisms. This could be due to the presence of an underlying large vegetation or abscess. If fever persists, the sensitivity of the infecting organism should be checked and drug levels monitored. Repeat echo should be performed to exclude increasing vegetation size or abscess formation.