title: Isolated right-sided valvular endocarditis in non-intravenous drug users.
abstract: OBJECTIVE
  Characteristics of isolated right-sided endocarditis in patients without a pacemaker and who are not intravenous drug users (IVDU) are poorly understood. The aim of this study was to investigate the current frequency of this entity and describe its clinical, microbiological, echocardiographic and prognostic profile.
  
  
  METHODS
  We have prospectively analyzed 17 consecutive cases of isolated right-sided endocarditis in non-IVDU who did not have a pacemaker, out of a total of 583 consecutive episodes of endocarditis (2.9%).
  
  
  RESULTS
  Mean age was 38+/-15 years; 11 of the 17 patients were men. Almost half of the patients had at least one predisposing disease. An intravascular catheter was the most frequent port of entry (35%). The most common signs and symptoms on admission were fever, dyspnea, septic pulmonary embolisms, pleural effusion and right-sided heart failure. The most frequent microorganism was Staphylococcus aureus (41%). In most cases (82%) the infection was located in the tricuspid valve. Recurrent pulmonary embolisms were the most frequent complication and the main cause for surgery, which was needed in 5 patients (29%). Two patients died during hospitalization (12%), both from septic shock. During follow-up one patient died of unknown causes 1 month after discharge, and other relapsed 3 months after discharge.
  
  
  CONCLUSIONS
  Isolated right-sided endocarditis should be included in the differential diagnosis of patients with febrile syndrome, respiratory symptoms and predisposing disease, even when they do not have a pacemaker and are not IVDU. The presence of intravascular catheters and Staphylococcus bacteriemia should heighten suspicion of endocarditis.
authors.affiliation: Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. arevillaorodea@gmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villacorta
authors.forename: Itziar
authors.initials: I
authors.lastname: Gómez
authors.forename: Teresa
authors.initials: T
authors.lastname: Sevilla
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: del Pozo
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
authors.forename: María del Carmen
authors.initials: Mdel C
authors.lastname: Manzano
authors.forename: Pedro
authors.initials: P
authors.lastname: Mota
authors.forename: Santiago
authors.initials: S
authors.lastname: Flórez
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: Mariano
authors.initials: M
authors.lastname: Sánchez
authors.forename: José Alberto
authors.initials: JA
authors.lastname: San Román
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult