title: Prosthetic valve endocarditis due to Streptococcus pneumoniae.
abstract: BACKGROUND
  In the pre-antibiotic era up 10% of cases of infective endocarditis were due to Streptococcus pneumoniae, but this association is currently exceedingly rare.
  
  
  METHODS
  Since 1997 we have diagnosed three patients, all aged >70, with endocarditis due to S. pneumoniae. One of these three cases involved a prosthetic valve, another a prosthetic ring. All three patients completely recovered with antibiotic treatment only.
  
  
  RESULTS
  During the same period there were 1694 cases of pneumococcal bacteremia, of whom 395 (23%) after age 70. Therefore, after age 70 the prevalence of endocarditis out of all cases of pneumococcal bacteremia was 0.7%. A literature review detected another 16 cases of pneumococcal PVE. The mean age of these 17 patients was 64±14; 10 were female and 7 male. In most instances, symptom duration was short, < 6 days. Valve surgery was performed in 5 cases (29%) and 13 patients (76%) survived.
  
  
  CONCLUSIONS
  Endocarditis due to S. pneumoniae is rare in the antibiotic era; even in patients with prosthetic valves its course is evidently not more virulent than with other low-virulent organisms.
authors.affiliation: Department of Medicine B, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Ayman
authors.initials: A
authors.lastname: Natsheh
authors.affiliation: Department of Medicine A, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Vidberg
authors.affiliation: Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Reuven
authors.initials: R
authors.lastname: Friedmann
authors.affiliation: Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel ; Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with The Hebrew University-Hadassah Medical School, P.O. Box 3235, Jerusalem, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Ben-Chetrit
authors.affiliation: Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel ; Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with The Hebrew University-Hadassah Medical School, P.O. Box 3235, Jerusalem, Israel.
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
authors.affiliation: Department of Medicine B, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Zevin
keywords: Infective endocarditis; Mitral valve replacement; Prosthetic valve endocarditis; Streptococcus pneumoniae