INFECTIVE ENDOCARDITIS COMPLICATING WITH SEVERE MITRAL VALVE

REGURGITATION AND EVENTUAL CONGESTIVE HEART FAILURE – A CASE

REPORT
Irmarisyani Sudirman, Yosua Kumambong, Nurul Fajrina, Ratu Intania, Widya Inarah, Ria
Christin
La Temmamala Hospital, Watansoppeng, South Sulawesi, Indonesia

Background:
Infective endocarditis (IE) is an acute or subacute endocardial infection caused by bacterial, viral
or fungal microorganisms. It is associated with high rate of mortality and morbidity especially in
patients with heart valves anomalies. The most common pathogens are Streptococcus viridans,
which generally leads to subacute endocarditis, while Staphylococcus aureus causes acute
endocarditis.

Case Description:
A 45-years old male patient was admitted to La Temmamala Hospital, Watansoppeng, due to
shortness of breath and fever since 3 weeks ago. On physical examination, we found an obvious
systolic murmur best heard at apex cordis. Blood examination showed that there is leucocytosis;
echocardiography examination showed vegetation and severe mitral regurgitation. Patient then
hospitalized with diagnosis of infective endocarditis and severe mitral regurgitation plus
congestive heart failure. The primary treatment was antibiotics: ceftriaxone and gentamycin.
After being hospitalized in several days, the symptoms slowly began to subside.

Discussion:
The clinical endocarditis syndrome is highly variable and spans a continuum between acute and
subacute presentations. The causative microorganisms primarily responsible for endocarditis are
β-Hemolytic streptococci, S. aureus, and pneumococci, with a range of specific bacterias called
the HACEK group. The diagnosis of IE is based on a combination of fever, presence of
vegetation in echocardiography and positive blood cultures. Modified Duke Criteria were
developed using clinical and microbiological findings as well as findings in echocardiography.
Documentation of two major criteria, of one major criterion and three minor criteria, or five
minor criteria allows a clinical diagnosis of definite infective endocarditis. Primary treatment is
intravenous wide spectrum antibiotics with addition of supportive treatment.

Conclusion:
Infective endocarditis is a hideous yet fatal disease that can lead to congestive heart failure due to
valve function failure. A thorough and precise examination will lead to early detection and
treatments, thus decrease the mortality and morbidity level and concurrent improvement of the
quality of life.

Keywords: Infective endocarditis, mitral regurgitation, congestive heart failure

References
1. Kasper, D., Fauci, A., et al. Harrison’s Principle of Internal Medicine, 19th edition.
2017. UK: McGraw Hill Education
2. Zipes, D., Libby, P., et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular
Medicine, 11th edition. 2018. UK: Elsevier