Endocarditis in intravenous drug abusers with staphylococcal septicaemia

The case reports of 186 intravenous drug abusers admitted over a three year period were studied. Nineteen had proven staphylococcal septicaemia. Echocardiography showed tricuspid vegetations in seven and aortic vegetations in two. Eighteen out of 19 had systolic murmurs, but only the two patients with aortic vegetations had diastolic murmurs. The chest x ray showed opacities in 10 patients (all those with tricuspid vegetations plus three with normal echocardiograms). Four patients died during follow up, including both those with aortic vegetations; both mitral and tricuspid vegetations were found at necropsy in the other two. All remaining patients were alive at one year. The presence of tricuspid vegetations in intravenous drug abusers is associated with opacities on chest x ray, but carries a good short term prognosis. But these results suggest a poor outcome when left sided endocarditis is present in intravenous drug abusers.