[Neurologic complications of infectious endocarditis]. / Complications neurologiques de l'endocardite infectieuse.

Ten patients with neurological complications (NC) among a retrospective series of 53 consecutive cases of infective endocarditis were studied: 6 males and 4 females, mean age 60 years. NC were present at admission in 6 cases: 2 generalized seizures, 4 strokes, associated with 2 meningeal syndromes. Four cases of NC occurred during hospitalization: 1 stroke with come, 1 transient ischaemic attack, 2 generalized seizures. Blood cultures were positive in 7 cases: 6 group D Streptococci, 1 Gram negative bacillus. Five digestive portal of entry were identified. Cerebrospinal fluid was purulent in 1 patient, aseptic in 1, haemorragic in 2, and normal in 1. Cranial computed tomography revealed: infarct in 4 cases, brain abscess in 1 case, absence of abnormality in 1 case. There was no angiographic documentation. Antimicrobial therapy was maintained 5 to 6 weeks. Two patients underwent cardiac surgery. Two patients died of subarachnoid haemorrage. Comparison of patients with NC, and the 43 without NC, revealed two different point: vegetations were more frequent in the NC (8 cases out of 10) than without NC (19 cases out of 43) (p = 0.04). Streptoccus was often more found in NC (6 cases out of 6) than without NC (6 cases out of 24) (p < 0.01). Compared with the previously reported studies, where Staphylococcus was usually described, our results showed a higher frequency of Streptococcus D bovis, an older age, a higher frequency of stroke and digestive portal of entry. Vegetations were more frequent with NC than without.

[Current aspects of infectious endocarditis. Apropos of 53 cases]. / Aspects actuels de l'endocardite infectieuse. A propos de 53 observations.

Fifty-three cases of infective endocarditis are reported: 10 definite, 33 probable, 10 possible. There were: 35 males, 18 females, mean age: 66 +/- 14 years. Twenty-three patients had a known valve involvement, 21 a recently diagnosed valve involvement, 9 a prosthetic valve. Fifty patients had fever, 43 had a regurgitating murmur, 28 weakness and weight-loss, 13 cutaneous lesions, 11 arthritis, 8 splenomegaly, 3 ocular lesions. The portal of entry was suspected or confirmed in 37 cases: intestinal in 12 cases, dental in 11 cases, cutaneous in 7 cases, urinary tract infection in 6 cases, upper respiratory tract infection in 1 case. The micro-organism was found in 45 cases: 10 oral streptococci, 12 D bovis streptococci, 6 enterococci, 5 aureus staphylococci, 3 coagulase-negative staphylococci, 2 Coxiella burnetii, 7 other bacterias. Blood-cultures were negative in 8 cases. Precordial echocardiography found vegetations in 27 native valves and 9 prosthetic alterations. Ten patients had neurologic complications, 27 cardiac complications, 8 acute renal failure. Nine patients needed cardiac surgery, 6 died. Our results, compared with those in the literature, showed older age, a higher frequency of digestive portal of entry and of D bovis streptococci, frequently associated with a colic tumour.