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Clinical and morphological characteristics inStreptococcus bovis endocarditis: a comparison with other causative microorganisms in 177 cases
  1. I Kupferwassera,
  2. H Dariusa,
  3. A M Müllerb,
  4. S Mohr-Kahalya,
  5. T Westermeierc,
  6. H Oelertd,
  7. R Erbele,
  8. J Meyera
  1. aDepartment of Medicine II, Mainz University, Mainz, Germany, bDepartment of Pathology, Mainz University, cDepartment of Biostatistics, Mainz University, dDepartment of Cardiothoracic and Vascular Surgery, Mainz University, eDivision of Cardiology, University of Essen, Essen, Germany
  1. 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}


Aim To compare the clinical and morphological characteristics of patients withStreptococcus bovis endocarditis with those of patients with endocarditis caused by other microorganisms.

Methods 177 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.

Results S 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 withS 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 withS bovis endocarditis and in 10% of those with other organisms (p = 0.002).

Conclusions S 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.

  • infective endocarditis
  • Streptococcus bovis
  • transoesophageal echocardiography
  • valvar disease

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