Clinical profile of Streptococcus agalactiae native valve endocarditis.
BACKGROUND
Streptococcus agalactiae is an unusual pathogen in adults who are not pregnant. S agalactiae endocarditis is a poorly defined entity because it is uncommon; in contrast to other streptococcal endocarditis, it bears a high mortality rate. The aim of this study was to define its clinical, prognostic, and therapeutic profile on the basis of a series of 9 consecutive patients.


METHODS
We conducted a prospective and multicenter study of patients with infectious endocarditis in which 310 episodes were included.


RESULTS
S agalactiae grew in 9 patients (3%) who had no valve prosthesis. All patients except 1 had underlying diseases, and all patients had serious complications; the most common complications were major emboli, heart failure, and shock. The valve affected was the mitral valve in 4 patients, the aortic valve in 2 patients, both the mitral and aortic valves in 2 patients, and the tricuspid valve in 1 patient. All episodes were on native valves. Vegetations tended to be large (maximal diameter >10 mm in all patients), very mobile, and pedunculated. An abscess was found in 2 patients, and a perforation of the valve developed in 3 patients. Five patients died (mortality rate, 56%), 3 of whom had received antibiotic therapy alone. The 4 patients who survived underwent combined medical-surgical therapy.


CONCLUSIONS
S agalactiae native valve endocarditis is very aggressive, and early surgery should be considered to prevent the destruction of valves and development of serious complications.
Rollán
María Jesús
MJ
Department of Cardiology, Hospital Universitario del Río Hortega, Valladolid, Spain. asanroman@secardiologia.es
San Román
José Alberto
JA
Vilacosta
Isidre
I
Sarriá
Cristina
C
López
Javier
J
Acuña
María
M
Bratos
José Luis
JL
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000382:microbiology; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000382:microbiology*; D013292:Streptococcus agalactiae; D014463:Ultrasonography