ABSTRACT
PURPOSE--To analyze the clinical, laboratory and pathological aspects of 20 cases of infectious endocarditis (IE) who died. The authors compared patients with diagnosis before death of IE and those with diagnosis was made after autopsy. METHODS--Twenty patients who died with IE between April 1982 and November 1991 were studied. We looked for the clinical aspects (fever, cardiac murmurs, anemia, splenomegaly, embolic events and skin manifestation), laboratory aspects (hemocultures), echocardiographic and anatomopathologic features (valvar vegetations events and embolic accidents founded at autopsy). The sample was divided in two sub-groups: A--with clinical diagnosis of IE before and B--without diagnosis before death. RESULTS--Group A--9 patients aged 8-58 years, 3 men, all them with cardiac murmurs, fever and anemia, 5 with splenomegaly. Hemocultures were done in 7 patients and positive in 1. Echocardiogram with valvar vegetation were found in 4 out of 5 patients (80 per cent positive). At autopsy mitral valve vegetation were present in 7, aortic 3, tricuspid 3. One patient showed the exposure of three valves and two of 2 valves. Embolic events were found in 4. Group B--11 patients most of them older then 50 years (54.5 per cent) (p < 0.05) 5 men, all them presented fever and anemia. Cardiac murmurs in 6 (54 per cent) and none with splenomegaly. In one case hemoculture and echocardiogram, were done and were negative. Anatopathologic study showed compromise of mitral valve in 5, aortic 4, tricuspid 2, pulmonary 1. Two patients had 2 valves compromised. In one case a mural vegetation (right atrium) was found. Embolic events were present in 2 cases. CONCLUSION--In group B a significant number of patients (p < 0.05) were older than 50 years and presented his symptoms as an acute illness. We concluded that older patients with compromised general state and fever with or without embolic events IE must be remember
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Endocarditis, Bacterial/mortality , Brazil/epidemiology , Retrospective Studies , Cause of Death , Embolism/complications , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/pathology , Fever/complications , Age FactorsABSTRACT
Análise de aspectos clínicos, diagnósticos e terapêuticos de casos de endocardite infecciosa (EI). Oitenta e dois pacientes submetidos a tratamento clínico da EI, no período de janeiro de 1980 a dezembro a dezembro de 1987. Estudaram-se critérios clínicos, laboratoriais e anátomo-patológicos, pexsquisando-se localizaçäo mais frequentes da lesäo endocárdica, porta de entrada do agente microbiano e relaçäo do tempo de antibioticoterapia com a evoluçäo dos pacientes. Trinta e sete (44,6%) pacientes eram homens; febre esteve presente em 75 (90,4%) casos, sopro cardíaco em 76 (91,5%), esplenomegalia em 28 (33,7%) e insuficiência cardíaca graus III/IV em 32 (39,8%). A hemocultura teve 55,5% de positividade, sendo estafilococos identificados em 50% das positivas; anemia ocorreu em 66 (79,5%) pacientes e aumento de mucoproteínas séricas em 58 (92%); o ecocardiograma teve 85,7% de positividade. Houve 33 (39,76%) óbitos, tendo como principal causa a insuficiência cardíaca congestiva; 78,1% dos mesmos ocorreram antes de completos 15 dias de antibioticoterapia. Insuficiência cardíaca congestiva, sepse e embolia sistêmica foram as principais complicaçöes no curso da doença, em geral antes de se completar 15 dias de antibioticoterapia. Nestes casos, é possível que a indicaçäo de cirurgia diminuísse a letalidade da doença