CLINICAL AND MORPHOLOGICAL-CHARACTERISTICS IN STREPTOCOCCUS-BOVIS ENDOCARDITIS - A COMPARISON WITH OTHER CAUSATIVE MICROORGANISMS IN 177 CASES

Aim-To compare the clinical and morphological characteristics of patie nts with Streptococcus bovis endocarditis with those of patients with endocarditis caused by other microorganisms. Methods-177 consecutive p atients (Streptococcus bovis, 22; other streptococci, 94; staphylococc i, 44; other, 17) with definite infective endocarditis according to th e Duke criteria were included. All patients underwent transthoracic an d transoesophageal echocardiography. In 88 patients, findings from sur gery/necropsy were obtained. Results-S bovis endocarditis was associat ed with older patients, with a higher mortality (p = 0.03), and with a higher rate of cardiac surgery (p < 0.001) than other microorganisms, although embolic events were observed less often (p = 0.02). Patholog ical gastrointestinal lesions were detected in 45% of the patients. Mu ltiple valves were affected in 68% of the patients with Streptococcus bovis endocarditis and in 20% of those with other organisms (p < 0.001 ). Moderate or severe regurgitation occurred more often in S bovis end ocarditis than with other microorganisms (p = 0.05). When surgery or n ecropsy was performed, infectious myocardial infiltration of the left ventricle was confirmed histopathologically in 36% of the patients wit h S bovis endocarditis and in 10% of those with other organisms (p = 0 .002). Conclusions-S bovis endocarditis is a severe illness because of the more common involvement of multiple valves, and of the frequent o ccurrence of haemodynamically relevant valvar regurgitation and infect ious myocardial infiltration.