Cicalini S, Forcina G, De Rosa F G
Department of Infectious and Tropical Diseases, University La Sapienza of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
J Infect. 2001 May;42(4):267-71. doi: 10.1053/jinf.2001.0812.
To determine the clinical features, sites of involvement, bacteriological findings, and outcome of infective endocarditis (IE) in patients with HIV infection.
All patients with diagnosis of IE admitted to 54 infectious disease centres in Italy over a 15-year period (1984-1999) were reviewed, and 895 cases fulfilled the Duke criteria for definite diagnosis of IE. Data were collected with regard to the clinical, laboratory, and demographic characteristics of patients, as well as results of blood cultures and data on clinical outcome.
There were 108 episodes of IE in 105 HIV-infected patients. The mean age of patients was 30.1 years, and the commonest predisposing condition was intravenous drug use (94.3%). Staphylococci were the predominant organisms (60.2%), and the tricuspid valve was the most frequently involved site of infection (51.9%). Left-sided heart involvement (45.4%) and multivalvular involvement (17.6%) were also frequently observed. The greater frequency of S. aureus affecting the tricuspid valve vs. other valves was statistically significant (P<0.001). Six patients (5.9%) underwent surgery, and one (16.7%) of them died. Ninety-five (94.1%) patients were treated medically, and 17 (17.9%) of them died. Overall mortality rate was 17.8%. Any left-sided heart involvement was predictive of an increased risk of death if compared with any right-sided heart involvement (P< 0.004). The mortality rate among HIV-infected patients was higher in those with CD4 cell counts below 200/mm(3).
IE in HIV-infected patients, for the most part intravenous drug users, is more commonly localized to the right side of the heart; however, mixed or left-side valvular infections are frequent. Severe immunosuppression and left-side valvular involvement are associated with a greater risk for mortality.
确定HIV感染患者感染性心内膜炎（IE）的临床特征、受累部位、细菌学检查结果及预后。
回顾了意大利54个传染病中心在15年期间（1984 - 1999年）收治的所有诊断为IE的患者，895例符合IE确诊的杜克标准。收集了患者的临床、实验室和人口统计学特征数据，以及血培养结果和临床结局数据。
105例HIV感染患者发生了108次IE发作。患者的平均年龄为30.1岁，最常见的易感因素是静脉吸毒（94.3%）。葡萄球菌是主要病原体（60.2%），三尖瓣是最常受累的感染部位（51.9%）。左侧心脏受累（45.4%）和多瓣膜受累（17.6%）也很常见。金黄色葡萄球菌累及三尖瓣的频率高于其他瓣膜，差异有统计学意义（P<0.001）。6例患者（5.9%）接受了手术，其中1例（16.7%）死亡。95例（94.1%）患者接受了药物治疗，其中17例（17.9%）死亡。总死亡率为17.8%。与右侧心脏受累相比，任何左侧心脏受累均提示死亡风险增加（P<0.004）。CD4细胞计数低于200/mm³的HIV感染患者死亡率更高。
HIV感染患者（大多为静脉吸毒者）的IE大多局限于心脏右侧；然而，混合性或左侧瓣膜感染也很常见。严重免疫抑制和左侧瓣膜受累与更高的死亡风险相关。
