title: Endocarditis in adults with bacterial meningitis.
abstract: BACKGROUND
  Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown.
  
  
  RESULTS
  We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of bacterial meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants, and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurological (54%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died.
  
  
  CONCLUSIONS
  Endocarditis is an uncommon coexisting condition in bacterial meningitis but is associated with a high rate of unfavorable outcome.
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam, Department of Neurology.
authors.forename: Marjolein J
authors.initials: MJ
authors.lastname: Lucas
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004696:Endocarditis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
keywords: cerebrovascular disorders; complications; echocardiography; endocarditis; meningitis