Beta-haemolytic streptococcal endocarditis: Clinical presentation, management and outcomes

Abdelghani El Rafei, Daniel C. DeSimone, Christopher V. DeSimone, Brian D. Lahr, James M. Steckelberg, Muhammad R. Sohail, Walter R. Wilson, Larry M. Baddour

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Beta-haemolytic streptococcal (BHS) endocarditis is rare, but well-recognised for its high morbidity and mortality. This study sought to further characterise clinical features, management and outcomes of BHS endocarditis. Methods Retrospective review of all adultpatients (≥18 years old) with BHS endocarditis treated at the Mayo Clinic from 1 January 2000 to 31 December 2014. Results Forty-nine cases of BHS endocarditis were identified with a mean (± SD) age of 64 (±14.9) years and 65% were males. The infection was community acquired in 92% of the cases, with a median (IQR) time to diagnosis from symptom onset of 6 days (5-10). Associated conditions included the presence of a prosthetic valve (41%), malignancy (33%) and diabetes mellitus (DM) (31%). Median (IQR) vegetation size was 12mm (9-17 mm). In a univariate analysis patients with DM had larger vegetations, median (IQR)=17mm (10.5-26 mm) compared to non-diabetic patients, median (IQR)=11mm (8-15 mm) (p=0.01). Septic brain emboli occurred in 43% of cases. Eighteen patients (37%) underwent early (within 30 days) surgery. All-cause 1 month and 6 month mortality rates were 25% and 31%, respectively. Conclusion BHS endocarditis has an acute onset and is complicated by relatively large vegetations with a high rate of systemic embolisation. DM was the second most common associated medical condition and patients with DM had larger vegetations. Despite medical and surgical advances, mortality due to BHS endocarditis remains high, particularly within 30 days of diagnosis.

Original languageEnglish (US)
Pages (from-to)373-378
Number of pages6
JournalInfectious Diseases
Volume48
Issue number5
DOIs
StatePublished - 2016

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Endocarditis
Diabetes Mellitus
Mortality
Community-Acquired Infections
Intracranial Embolism
Ambulatory Surgical Procedures
Morbidity
Neoplasms

Keywords

  • Beta-haemolyticstreptococci
  • Diabetes mellitus
  • Infective endocarditis
  • Mortality
  • Surgery

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Microbiology(all)
  • Microbiology (medical)

Cite this

El Rafei, A., DeSimone, D. C., DeSimone, C. V., Lahr, B. D., Steckelberg, J. M., Sohail, M. R., ... Baddour, L. M. (2016). Beta-haemolytic streptococcal endocarditis: Clinical presentation, management and outcomes. Infectious Diseases, 48(5), 373-378. https://doi.org/10.3109/23744235.2015.1129672

Beta-haemolytic streptococcal endocarditis : Clinical presentation, management and outcomes. / El Rafei, Abdelghani; DeSimone, Daniel C.; DeSimone, Christopher V.; Lahr, Brian D.; Steckelberg, James M.; Sohail, Muhammad R.; Wilson, Walter R.; Baddour, Larry M.

In: Infectious Diseases, Vol. 48, No. 5, 2016, p. 373-378.

Research output: Contribution to journalArticle

El Rafei, A, DeSimone, DC, DeSimone, CV, Lahr, BD, Steckelberg, JM, Sohail, MR, Wilson, WR & Baddour, LM 2016, 'Beta-haemolytic streptococcal endocarditis: Clinical presentation, management and outcomes', Infectious Diseases, vol. 48, no. 5, pp. 373-378. https://doi.org/10.3109/23744235.2015.1129672
El Rafei A, DeSimone DC, DeSimone CV, Lahr BD, Steckelberg JM, Sohail MR et al. Beta-haemolytic streptococcal endocarditis: Clinical presentation, management and outcomes. Infectious Diseases. 2016;48(5):373-378. https://doi.org/10.3109/23744235.2015.1129672
El Rafei, Abdelghani ; DeSimone, Daniel C. ; DeSimone, Christopher V. ; Lahr, Brian D. ; Steckelberg, James M. ; Sohail, Muhammad R. ; Wilson, Walter R. ; Baddour, Larry M. / Beta-haemolytic streptococcal endocarditis : Clinical presentation, management and outcomes. In: Infectious Diseases. 2016 ; Vol. 48, No. 5. pp. 373-378.
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abstract = "Background Beta-haemolytic streptococcal (BHS) endocarditis is rare, but well-recognised for its high morbidity and mortality. This study sought to further characterise clinical features, management and outcomes of BHS endocarditis. Methods Retrospective review of all adultpatients (≥18 years old) with BHS endocarditis treated at the Mayo Clinic from 1 January 2000 to 31 December 2014. Results Forty-nine cases of BHS endocarditis were identified with a mean (± SD) age of 64 (±14.9) years and 65{\%} were males. The infection was community acquired in 92{\%} of the cases, with a median (IQR) time to diagnosis from symptom onset of 6 days (5-10). Associated conditions included the presence of a prosthetic valve (41{\%}), malignancy (33{\%}) and diabetes mellitus (DM) (31{\%}). Median (IQR) vegetation size was 12mm (9-17 mm). In a univariate analysis patients with DM had larger vegetations, median (IQR)=17mm (10.5-26 mm) compared to non-diabetic patients, median (IQR)=11mm (8-15 mm) (p=0.01). Septic brain emboli occurred in 43{\%} of cases. Eighteen patients (37{\%}) underwent early (within 30 days) surgery. All-cause 1 month and 6 month mortality rates were 25{\%} and 31{\%}, respectively. Conclusion BHS endocarditis has an acute onset and is complicated by relatively large vegetations with a high rate of systemic embolisation. DM was the second most common associated medical condition and patients with DM had larger vegetations. Despite medical and surgical advances, mortality due to BHS endocarditis remains high, particularly within 30 days of diagnosis.",
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T2 - Clinical presentation, management and outcomes

AU - El Rafei, Abdelghani

AU - DeSimone, Daniel C.

AU - DeSimone, Christopher V.

AU - Lahr, Brian D.

AU - Steckelberg, James M.

AU - Sohail, Muhammad R.

AU - Wilson, Walter R.

AU - Baddour, Larry M.

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N2 - Background Beta-haemolytic streptococcal (BHS) endocarditis is rare, but well-recognised for its high morbidity and mortality. This study sought to further characterise clinical features, management and outcomes of BHS endocarditis. Methods Retrospective review of all adultpatients (≥18 years old) with BHS endocarditis treated at the Mayo Clinic from 1 January 2000 to 31 December 2014. Results Forty-nine cases of BHS endocarditis were identified with a mean (± SD) age of 64 (±14.9) years and 65% were males. The infection was community acquired in 92% of the cases, with a median (IQR) time to diagnosis from symptom onset of 6 days (5-10). Associated conditions included the presence of a prosthetic valve (41%), malignancy (33%) and diabetes mellitus (DM) (31%). Median (IQR) vegetation size was 12mm (9-17 mm). In a univariate analysis patients with DM had larger vegetations, median (IQR)=17mm (10.5-26 mm) compared to non-diabetic patients, median (IQR)=11mm (8-15 mm) (p=0.01). Septic brain emboli occurred in 43% of cases. Eighteen patients (37%) underwent early (within 30 days) surgery. All-cause 1 month and 6 month mortality rates were 25% and 31%, respectively. Conclusion BHS endocarditis has an acute onset and is complicated by relatively large vegetations with a high rate of systemic embolisation. DM was the second most common associated medical condition and patients with DM had larger vegetations. Despite medical and surgical advances, mortality due to BHS endocarditis remains high, particularly within 30 days of diagnosis.

AB - Background Beta-haemolytic streptococcal (BHS) endocarditis is rare, but well-recognised for its high morbidity and mortality. This study sought to further characterise clinical features, management and outcomes of BHS endocarditis. Methods Retrospective review of all adultpatients (≥18 years old) with BHS endocarditis treated at the Mayo Clinic from 1 January 2000 to 31 December 2014. Results Forty-nine cases of BHS endocarditis were identified with a mean (± SD) age of 64 (±14.9) years and 65% were males. The infection was community acquired in 92% of the cases, with a median (IQR) time to diagnosis from symptom onset of 6 days (5-10). Associated conditions included the presence of a prosthetic valve (41%), malignancy (33%) and diabetes mellitus (DM) (31%). Median (IQR) vegetation size was 12mm (9-17 mm). In a univariate analysis patients with DM had larger vegetations, median (IQR)=17mm (10.5-26 mm) compared to non-diabetic patients, median (IQR)=11mm (8-15 mm) (p=0.01). Septic brain emboli occurred in 43% of cases. Eighteen patients (37%) underwent early (within 30 days) surgery. All-cause 1 month and 6 month mortality rates were 25% and 31%, respectively. Conclusion BHS endocarditis has an acute onset and is complicated by relatively large vegetations with a high rate of systemic embolisation. DM was the second most common associated medical condition and patients with DM had larger vegetations. Despite medical and surgical advances, mortality due to BHS endocarditis remains high, particularly within 30 days of diagnosis.

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KW - Diabetes mellitus

KW - Infective endocarditis

KW - Mortality

KW - Surgery

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