title: Infective endocarditis associated with spondylodiscitis and frequent secondary epidural abscess.
abstract: BACKGROUND
  Although many patients with IE complain of joint, muscle, and back pain, infections at these sights are rare. Indeed, in patients with back pain and endocarditis, less than 4% actually demonstrate spondylodiscitis.
  
  
  METHODS
  We recently encountered 4 patients with this complication, one each caused by Staphylococcus aureus, Streptococcus bovis, Streptococcus mitis, and Enterococcus faecalis, and wondered whether the nature of the infecting organism determined the development of spondylodiscitis and epidural abscess. In a literature review, 36 patients with endocarditis and spondylodiscitis were identified. Only 9 (25%) were caused by Streptococcus viridans and the remainder by staphylococci, enterococci, and other streptococci. Usually more than 50% of all cases of IE were caused by Streptococcus viridans, although more recent studies would indicate an incidence of about 40%.
  
  
  CONCLUSIONS
  We conclude that spondylodiscitis with epidural abscess is more likely to occur in those patients with endocarditis who are infected by organisms with pyogenic potential.
authors.affiliation: Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA. laconemedico@aol.com
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Cone
authors.forename: Joel
authors.initials: J
authors.lastname: Hirschberg
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopez
authors.forename: Puneet K
authors.initials: PK
authors.lastname: Kanna
authors.forename: Ellie J C
authors.initials: EJ
authors.lastname: Goldstein
authors.forename: Asma
authors.initials: A
authors.lastname: Kazi
authors.forename: Radhika
authors.initials: R
authors.lastname: Gade-Andavolu
authors.forename: Bachir
authors.initials: B
authors.lastname: Younes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D004696:Endocarditis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013293:Enterococcus faecalis; D020802:Epidural Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D013211:Staphylococcus aureus; D016985:Streptococcus bovis; D034361:Streptococcus mitis