Splenic abscess and infective endocarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Radiology

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves.
• Splenic abscesses (SAs) are rare but significant complications of IE.
• Understanding SA characteristics in IE is vital for diagnosis and management.

Purpose of the Study:

• To investigate the background, bacteriology, clinical, and radiological features of splenic abscesses in patients with infective endocarditis.
• To identify associated lesions, treatment strategies, and outcomes for SA in IE.

Main Methods:

• Retrospective study of 474 patients with definite IE from 2005-2021.
• Diagnosis of SA in 36 patients (7.6%) confirmed via abdominal CT scans.
• Analysis of patient demographics, pre-existing conditions, causative organisms, and complications.

Main Results:

• Common pathogens included Streptococcus spp., Enterococcus faecalis, and Staphylococcus spp.
• Prevalent comorbidities were diabetes, prosthetic valves, and previous IE.
• Frequent presentations involved abdominal pain and pleural effusion; common complications included emboli and osteoarticular infections.

Conclusions:

• Splenic abscesses in IE patients showed higher rates of large vegetations, Enterococcus faecalis, rare pathogens, diabetes, osteoarticular involvement, and cancer compared to non-SA IE patients.
• Splenic abscesses can arise from splenic infarcts; IE patients with splenic emboli require evaluation for abcedation.
• Combined cardiac surgery and splenectomy, with cardiac surgery preceding, proved safe.