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

Area of Science:

• Infectious Diseases
• Cardiology
• Internal Medicine

Background:

• Beta-haemolytic streptococcal (BHS) endocarditis is a rare condition with significant morbidity and mortality.
• Characterizing its clinical features, management, and outcomes is crucial for improving patient care.

Purpose of the Study:

• To further characterize the clinical features of BHS endocarditis.
• To analyze management strategies and patient outcomes.
• To identify risk factors associated with BHS endocarditis.

Main Methods:

• Retrospective review of adult patients (≥ 18 years) diagnosed with BHS endocarditis.
• Data collected from January 1, 2000, to December 31, 2014, at the Mayo Clinic.
• Analysis of clinical presentation, comorbidities, vegetation size, complications, treatment, and mortality.

Main Results:

• Forty-nine cases of BHS endocarditis were identified, with a mean age of 64 years and 65% males.
• Community-acquired infection in 92%, with a median diagnosis time of 6 days.
• Common comorbidities included prosthetic valves (41%), malignancy (33%), and diabetes mellitus (DM) (31%).
• Median vegetation size was 12 mm; patients with DM had significantly larger vegetations (17 mm vs. 11 mm, p=0.01).
• Systemic septic brain emboli occurred in 43% of cases.
• 37% underwent early surgery (within 30 days).
• All-cause mortality rates were 25% at 1 month and 31% at 6 months.

Conclusions:

• BHS endocarditis presents acutely with large vegetations and a high risk of systemic embolization.
• Diabetes mellitus is a significant comorbidity associated with larger vegetations.
• Despite advances, BHS endocarditis continues to have high mortality, especially within 30 days of diagnosis.