Valencia Ortega M E, Guinea Esquerdo J, Enríquez Crego A, Moreno Celda V, Laguna Cuesta F, González Lahoz J
Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid.
An Med Interna. 1999 Apr;16(4):171-4.
Left-sided endocarditis in HIV-infected patients has an special clinical, epidemiological and microbiological characteristics and its relationship with drug addicts subjects is unknown.
Since 1986 up to 1996 we have been diagnosed 214 episodes of infective endocarditis in 190 HIV-infected patients. In 34 cases (15%) there was left-sided endocarditis. These patients are described.
Mean age was 30 years and 28 were male (82%). Thirty patients had been intravenous drug addicts (IVDA) but only 18 were active-IVDA. In three cases the endocarditis was nosocomial. Mean CD4+ lymphocyte count was 176 per mm3 and 59% were AIDS-patients. Tuberculosis was the most frequent opportunistic infection (14 cases). The presentation was subacute in 70% and the most important symptom was fever. Only 3 (9%) had septic emboli in chest X-ray. The affected valve was mitral in 31 patients (91%). The blood culture was negative in 21 episodes (62%) and only in 6, Staphylococcus aureus was isolated. The mortality was 18% and 68% were outcome without any problem.
Left-sided endocarditis in patients with HIV infection is a very serious problem. It seems to affect to patients with severe immunosuppression and the culture blood may be negative. Its diagnosis is difficult and the mortality is elevated.
HIV 感染患者的左侧心内膜炎具有特殊的临床、流行病学和微生物学特征，其与吸毒者的关系尚不清楚。
自 1986 年至 1996 年，我们诊断出 190 例 HIV 感染患者发生了 214 次感染性心内膜炎发作。其中 34 例（15%）为左侧心内膜炎。对这些患者进行了描述。
平均年龄为 30 岁，男性 28 例（82%）。30 例患者曾是静脉吸毒者（IVDA），但只有 18 例是活跃的 IVDA。3 例心内膜炎为医院获得性。平均 CD4 + 淋巴细胞计数为每立方毫米 176 个，59% 为艾滋病患者。结核病是最常见的机会性感染（14 例）。70% 的表现为亚急性，最重要的症状是发热。胸部 X 光检查中只有 3 例（9%）有脓毒性栓子。31 例患者（91%）受累瓣膜为二尖瓣。21 次发作（62%）血培养阴性，仅 6 次分离出金黄色葡萄球菌。死亡率为 18%，68% 的患者预后无任何问题。
HIV 感染患者的左侧心内膜炎是一个非常严重问题。它似乎影响严重免疫抑制的患者，血培养可能为阴性。其诊断困难，死亡率高。
