Chambers H F, Korzeniowski O M, Sande M A
Medicine (Baltimore). 1983 May;62(3):170-7.
Data collected from a prospective multicenter study of endocarditis caused by S. aureus were analyzed to contrast the clinical presentation of the disease between a group of 46 intravenous drug addicts and a group of 35 nonaddicts. Two-thirds of the patients in each group were men. The duration of illness before diagnosis was similar (mean, 9.3 days). Intravenous-drug addicts were younger and had less underlying disease (30% versus 80%) than the non-addicts. When first seen, the drug addicts had signs and symptoms of sepsis and pulmonary embolism, but only 40% had pathologic murmurs. Seventy-six percent had evidence of tricuspid valve infection only. Congestive heart failure and neurologic manifestations were uncommon in addicts. Nonaddicts had infection involving predominantly the left side of the heart (14 mitral valves, 8 aortic valves, 4 both aortic and mitral valves) and 80% had underlying medical diseases. Only half of these patients had pathologic murmurs when first examined, but another 30% developed them later. Congestive heart failure, involvement of the central nervous system, and peripheral embolic or septic complications each occurred in over half of the nonaddicts. Eighty percent of these patients had peripheral stigmas of endocarditis. One intravenous drug addict (2%) and seven nonaddicts (20%) died. Six patients required cardiac valve replacement either during or after a course of antibiotics. Outcome was not related to the titer of peak serum bactericidal tests. Endocarditis caused by S. aureus presents as two distinct clinical syndromes depending on the patient population (intravenous drug user or nonaddict) and the location of infection (right-sided or left-sided). The disease is distinguished from endocarditis due to other causes by its acute onset and its fulminant course manifested by a multitude of septic and embolic complications and its ability to cause heart failure. Medical management alone is often successful but in certain subsets of patients, notably those with infection of aortic or multiple valves, early operation may be necessary.
对一项关于金黄色葡萄球菌引起的心内膜炎的前瞻性多中心研究收集的数据进行分析，以对比46名静脉注射吸毒者和35名非吸毒者这两组人群中该疾病的临床表现。每组三分之二的患者为男性。诊断前的病程相似（平均9.3天）。静脉注射吸毒者比非吸毒者更年轻，且基础疾病更少（分别为30%和80%）。初次就诊时，吸毒者有败血症和肺栓塞的体征及症状，但只有40%有病理杂音。76%仅有三尖瓣感染的证据。充血性心力衰竭和神经系统表现在吸毒者中不常见。非吸毒者的感染主要累及心脏左侧（14个二尖瓣、8个主动脉瓣、4个主动脉瓣和二尖瓣均受累），80%有基础疾病。这些患者初次检查时只有一半有病理杂音，但另有30%后来出现了病理杂音。充血性心力衰竭、中枢神经系统受累以及外周栓塞或败血症并发症在超过一半的非吸毒者中均有发生。这些患者中有80%有感染性心内膜炎的外周体征。1名静脉注射吸毒者（2%）和7名非吸毒者（20%）死亡。6名患者在抗生素疗程期间或之后需要进行心脏瓣膜置换。结果与血清杀菌试验峰值滴度无关。金黄色葡萄球菌引起的心内膜炎根据患者群体（静脉注射吸毒者或非吸毒者）以及感染部位（右侧或左侧）呈现出两种不同的临床综合征。该疾病因其急性起病、由多种败血症和栓塞并发症表现出的暴发性病程以及导致心力衰竭的能力，与其他原因引起的心内膜炎相区别。仅药物治疗通常是成功的，但在某些特定患者亚组中，尤其是那些主动脉瓣或多个瓣膜感染的患者，可能需要早期手术。
