Related Experiment Videos
Gonococcal endocarditis: twenty-five year experience
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9034.
Abstract:
Gonococcal endocarditis is a devastating albeit rare complication of disseminated gonorrhea. It virtually disappeared as a disease entity with the advent of antibiotic therapy. Recently, it has reappeared with surprisingly high frequency for unclear reasons. Since 1983, the authors have observed six episodes of this disease in five patients, the largest series reported to date. It is predominantly a disease of young people without underlying valvular heart disease. Characteristic clinical features include a high frequency of congestive heart failure and nephritis and a proclivity for aortic valve involvement, commonly with associated ring abscess, and large vegetations. Genitourinary symptoms, arthralgias, and rash are uncommon. Previously undescribed features include involvement of all four valves simultaneously, recurrence on an aortic valve prosthesis, and a high frequency of terminal complement deficiencies. Precipitous hemodynamic deterioration despite appropriate therapy is not uncommon, and overall mortality rate remains an alarming 19%.
Insights
Gonococcal endocarditis, a rare complication of gonorrhea, is re-emerging. This study details its characteristics in young patients, highlighting frequent heart failure and aortic valve issues, with a concerning 19% mortality rate.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Gonococcal endocarditis (GE) was historically rare and nearly eradicated by antibiotics.
- Recent observations suggest a resurgence of GE, necessitating updated understanding.
Observation:
- The authors report six episodes of GE in five patients, a significant series since 1983.
- The disease predominantly affects young individuals lacking pre-existing valvular heart disease.
- Clinical presentation often includes congestive heart failure, nephritis, and aortic valve involvement with ring abscesses and large vegetations.
Findings:
- Uncommon presentations include simultaneous involvement of all four heart valves and recurrence on prosthetic valves.
- A high incidence of terminal complement deficiencies was noted in affected patients.
- Despite appropriate treatment, rapid hemodynamic decline is frequent, contributing to a 19% mortality rate.
Implications:
- The re-emergence of GE underscores the need for vigilance and potentially revised treatment strategies.
- Understanding risk factors, such as complement deficiencies, may aid in early diagnosis and prevention.
- This study highlights the severe morbidity and mortality associated with contemporary GE, even with antibiotic therapy.