Department of Infectious Diseases, NRITLD, Shaheed Beheshti University of Medical Sciences and Health Services, TEHRAN-IRAN.
Background: Despite the decreased incidence of rheumatic fever and use of prophylactic antibiotic the incidence rate of
infective endocarditis has not declined. In this research, we have studied the clinical feature and therapeutic response of
patients with infective endocarditis presenting with pulmonary manifestations to a pulmonary referral center.
Materials and Methods: All patients with diagnosis of endocarditis that had pulmonary manifestations (based on Duke
Criteria) as their primary clinical presentation were entered in this study. Data in regard to individual information, clinical
features, laboratory finding and therapeutic responses were noted. All data were analysed using SPSS software (version
Results: A total number of twenty patients here entered the study. Mean age was 34.8±11.6 yr. The commonest clinical
features included: fever (95%), cough (65%) and dyspnea (65%). Also the commonest signs were cardiac murmurs (65%),
hepatomegaly (35%) and splenomegaly (35%). Clubbing was seen in 10%. Sixty percent of the cases were intravenous drug
users and 25% were infected with HIV. Also 50% of the patients did not have any background of valvular diseases. However,
there was vegetations on one valve in 75% and multiple valves were involved in 25%. The commonest valves affected were
trocuspid (50%), mitral (30%) and pulmonic valve (10%). Staphylococcus aureus (47.3%) and Streptococcus viridans
(27.3%) were the commonest microorganisms detected. Pericardial effusion was present in 30% which was higher in IV drug
users (p. value=0.042). Total mortality rate in hospital was 5%.
Conclusion: Infective endocarditis should be considered in the list of differential diagnosis in patients suffering from
pulmonary symptoms especially in IV drug users. (Tanaffos 2005; 4(16): 41-45)