Heart 1998;80:276-280 ( September )

Clinical and morphological characteristics in Streptococcus bovis endocarditis: a comparison with other causative microorganisms in 177 cases

I Kupferwasser,^a H Darius,^a A M Müller,^b S Mohr-Kahaly,^a T Westermeier,^c H Oelert,^d R Erbel,^e J Meyer^a

^a Department of Medicine II, Mainz University, Mainz, Germany, ^b Department of Pathology, Mainz University, ^c Department of Biostatistics, Mainz University, ^d Department of Cardiothoracic and Vascular Surgery, Mainz University, ^e Division of Cardiology, University of Essen, Essen, Germany

Correspondence to: Dr I Kupferwasser, Adult Infectious Diseases, Harbor-UCLA Medical Center, Bldg RB-2; Second Floor, 1000 West Carson Street, Torrance, CA 90509, USA. email: kupferwasser{at}humc.edu

Accepted for publication 24 April 1998

AimTo compare the clinical and morphological characteristics of patients with Streptococcus bovis endocarditis with those of patients with endocarditis caused by other microorganisms.
Methods177 consecutive patients (Streptococcus bovis, 22; other streptococci, 94; staphylococci, 44; other, 17) with definite infective endocarditis according to the Duke criteria were included. All patients underwent transthoracic and transoesophageal echocardiography. In 88 patients, findings from surgery/necropsy were obtained.
ResultsS bovis endocarditis was associated with older patients, with a higher mortality (p = 0.04), and with a higher rate of cardiac surgery (p < 0.001) than other microorganisms, although embolic events were observed less often (p = 0.02). Pathological gastrointestinal lesions were detected in 45% of the patients. Multiple valves were affected in 68% of the patients with S bovis endocarditis and in 20% of those with other organisms (p < 0.001). Moderate or severe regurgitation occurred more often in S bovis endocarditis than with other microorganisms (p = 0.05). When surgery or necropsy was performed, infectious myocardial infiltration of the left ventricle was confirmed histopathologically in 36% of the patients with S bovis endocarditis and in 10% of those with other organisms (p = 0.002).
ConclusionsS bovis endocarditis is a severe illness because of the more common involvement of multiple valves, and of the frequent occurrence of haemodynamically relevant valvar regurgitation and infectious myocardial infiltration.

Keywords: infective endocarditis;  Streptococcus bovis;  transoesophageal echocardiography;  valvar disease

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© 1998 by Heart
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