REVIEW OF PNEUMOCOCCAL ENDOCARDITIS IN ADULTS IN THE PENICILLIN ERA

Streptococcus pneumoniae is an infrequent cause of infectious endocard itis in adults. In the past 2 years, however, we have encountered seve ral cases at our institution, and additional cases have been reported in the literature. This infection typically follows pneumonia in the s etting of chronic alcoholism and may additionally be complicated by me ningitis. Less commonly, pneumococcal endocarditis occurs in other hos ts ol follows primary infection at other extrapulmonary sites. In such cases, the diagnosis may be initially missed, with a resultant delay in institution of appropriate therapy. Moreover, there are controversi es regarding the optimal therapy for infections of this nature in the era of penicillin resistance. Since a comprehensive review of this top ic has not been published since 1990, we reviewed cases of pneumococca l endocarditis in the penicillin era, with particular attention to dis ease recognition, the role of echocardiography, and the dilemmas surro unding medical and surgical therapeutic interventions.