Síndrome de Austrian: quien no sabe lo que busca, no entiende lo que encuentra / Austrian Syndrome: he who does not know what he is looking for will not understand what he finds

Resumen El síndrome de Austrian es una tríada que engloba neumonía, meningitis y endocarditis causadas por Staphylococcus pneumoniae. Dado el aumento en el uso de antibióticos, cada vez vemos esta enfermedad de forma menos frecuente en la práctica clínica diaria. No obstante, se debe recordar su existencia ya que el conocimiento de esta entidad puede ser crucial en el pronóstico de estos enfermos. Desconocer algunos síndromes por presentar una frecuencia menor en los tiempos actuales no exime de mantener la buena práctica clínica ya que de ello puede depender el devenir del paciente. Se presenta un caso de síndrome de Austrian en un paciente joven, quien tuvo evolución tórpida los primeros días de ingreso; finalmente, tras la realización de varias pruebas, se solicitó un ecocardiograma que fue la clave para el diagnóstico. Se trata de un caso de interés para reflexionar en que, a pesar de poseer nuevas tecnologías a nuestro alcance en la actualidad, es preciso recordar la importancia de una buena exploración física.

Abstract Austrian syndrome is a triad that includes pneumonia, meningitis, and endocarditis caused by Staphylococcus pneumoniae. Given the increase in the use of antibiotics, it is becoming less common to see this disease in daily clinical practice. However, it should be remembered that it exists since knowledge of this condition could be crucial in the prognosis of these patients. To not recognise some syndromes due to currently having a lower frequency does not exempt maintaining good clinical practice, since the outcome of the patient may depend on this. A case of Austrian syndrome is presented in a young patient, who had a slow response in the first days of admission. Finally, after performing several tests, a cardiac ultrasound was requested, which was key for the diagnosis. It is an interesting case to reflect that, despite currently having new technologies within our reach, it is essential to remember the importance of a good physical examination.

Síndrome de Austrian en endocarditis infecciosa: reporte de un caso y manejo médico quirúrgico exitoso / Austrian syndrome in infective endocarditis

Resumen: El Síndrome de Austrian, corresponde al cuadro clínico descrito por Robert Austrian en 1957, definido por la triada de Neumonía, Endocarditis Infecciosa (EI) y Meningitis, causado por Streptococcus pneumoniae. En la mayoría de los casos el vicio valvular presente, es la insuficiencia valvular aórtica, cuyo tratamiento médico y resolución quirúrgica de acuerdo con su gravedad, deben ser realizados precoz y oportunamente. Un paciente de 51 años, sin antecedentes de valvulopatía, con historia de poli consumo de alcohol y cocaína comenzó dos semanas previo a su ingreso hospitalario con síndrome febril, neumonía, y meningitis bacteriana por Streptococcus pneumoniae. Sus hemocultivos fueron negativos. El ecocardiograma transesofágico (ETE) fue compatible con EI valvular aórtica con insuficiencia moderada a severa. Se trató como EI a microorganismo desconocido y se efectuó un reemplazo valvular aórtico electivo con prótesis biológica a la 5° semana después de terminado el tratamiento médico antibiótico, cuyo resultado fue exitoso.

Abstract: A syndrome including Infective endocarditis, pneumonia and Meningitis caused by S pneumoniae was described by Robert Austrian in 1957. The aortic valve is affected in most cases. Medical followed by surgical treatment should be promptly implemented. The clinical case of a 51 year old man with a history of multiple drug consumption developing fever, pneumonia, and meningitis caused by S pneumoniae is presented. Blood cultures were negative and trans esophageal echocardiography showed aortic valve vegetations and moderate regurgitation. After multiple antibiotic treatment the patient underwent aortic valve replacement and recovered satisfactorily. Clinical and epidemiological characteristics of this syndrome are discussed.

Rapidly Progressive and Almost Lethal Pneumonia.

We herein describe the case of a 65-year-old male patient who presented with Osler's triad, which is the combination of endocarditis, pneumonia, and meningitis. This report is even more unusual since the pathogen isolated was the invasive and virulent strain of Streptococcus pneumoniae serotype 3. The clinical entity described is also called Austrian syndrome. Even though rare in this antibiotic era, the syndrome remains one of high morbidity and mortality. This particular case is of paramount importance for the clinician reader. First, it documents the clinical features associated with invasive pneumococcal disease and the Austrian syndrome. Second, and equally important, it highlights why following the Surviving Sepsis Campaign guidelines saves lives. For this case, the following steps were taken: 1. As a surrogate for perfusion, early and aggressive fluid resuscitation therapy (guided by lactic acid levels) was instituted; 2. also early in the treatment, broad spectrum antibiotics were administered; 3. to guide antibiotic therapy, microbiological cultures were obtained. The patient subsequently improved and was transferred to the internal medicine ward to complete 4 weeks of antibiotic therapy.

Síndrome de Austrian: Presentación de dos casos clínicos y revisión de la literatura / Austrian Syndrome: Presentation of two cases and review of literature

RESUMEN: La asociación conocida como triada de Austrian, se refiere a la presencia de meningitis aguda supurada (MEAS), neumonía y endocarditis causada por la infección diseminada del Streptococcus Pneumoniae (S. Pneumoniae). Si bien puede presentarse con un curso subagudo, sobre todo en pacientes añosos, lo más frecuente es la rápida progresión donde las complicaciones son la regla, teniendo una mortalidad global del 65%, que en caso de diagnóstico y cirugía precoz disminuye al 33%. Presentamos dos casos clínicos, de curso agudo, con complicaciones cardíacas y extracardíacas, habiendo fallecido uno de los pacientes asistidos.

Abstract: The association known as Austrian triad refers to the presence of acute suppurative meningitis, pneumonia and endocarditis caused by the disseminated infection of Streptococcus Pneumoniae. While it may be presented with a subacute course, especially in elderly patients more often rapid progression where complications are the rule, with an overall mortality of 65%, that in case of early diagnosis and surgery decreases to 33%. We present two cases of acute course, with cardiac and extracardiac complications, having passed one of the assisted patients.

Austrian syndrome in the context of a fulminant pneumococcal native valve endocarditis

This is the case of a young male suffering from Austrian syndrome, which is the triad of endocarditis, meningitis, and pneumonia due to invasive S. pneumoniae infection. He reported recurrent fever for six months without any antibiotic treatment, which may have determined the further course of the syndrome. Echocardiography revealed massive native valve endocarditis, and the patient was considered for ultima-ratio cardiac surgery. Intraoperative aspect presented extensive affection of the aortic root with full destruction of aortic valve, mitral valve, and aortomitral continuity. The myocardium showed a phlegmonlike infiltration. Microbiologic testing of intraoperatively collected specimens identified penicillin-sensitive Streptococcus pneumoniae. S. pneumoniae is a very uncommon cause for infective infiltrative endocarditis and is associated with severe clinical courses. Austrian syndrome is even more rare, with only a few reported cases worldwide. In those patients, only early diagnosis, immediate antibiotic treatment, and emergent cardiac surgery can save lives.