Røder B L, Wandall D A, Espersen F, Frimodt-Møller N, Skinhøj P, Rosdahl V T
Division of Microbiology, Statens Seruminstitut, Copenhagen, Denmark.
Am J Med. 1997 Apr;102(4):379-86. doi: 10.1016/s0002-9343(97)00090-9.
To investigate the neurologic manifestations of infective endocarditis caused by Staphylococcus aureus in a population of nondrug addicts with special emphasis on the clinical presentation, epidemiology, and mortality.
During the period from 1982 to 1991 a total of 8,514 cases of bacteremia with S aureus were reported to the Staphylococcus Laboratory, Copenhagen, Denmark. The medical records of cases of suspected infective endocarditis were retrospectively reviewed and classified according to the new diagnostic criteria for endocarditis proposed by Durack.
A total of 260 cases from 63 hospitals fulfilled the diagnostic criteria. Overall, 91 patients (35%) experienced neurologic manifestations. Sixty-one presented with neurologic symptoms, whereas 30 patients developed neurologic complications at various intervals (median: 10 days) after the debut of the disease. The most frequent neurologic manifestation was unilateral hemiparesis, which occurred in 41 patients (45%). Forty-two percent of the females had neurologic manifestations compared to only 30% of the males (P = 0.06). Cases with native mitral valve infection had a significantly higher frequency of neurologic manifestations compared with all other valvular involvement (44% versus 29%, P = 0.02) but the frequency of neurologic complications was only nonsignificantly higher in those patients with native mitral valve infection than in those patients with native aortic valve infection (44% versus 31%, P = 0.10). Only two of the patients with tricuspid valve infection and none of those with congenital heart disorder experienced neurologic manifestations. A neurologic manifestation occurred in 22 (35%) of the 63 episodes in which vegetations were detected on the echocardiograms, compared with 17 (26%) of the 65 episodes without vegetations (P = 0.38). The mortality was 74% in patients with major neurologic manifestations and 56% in patients without neurologic manifestations (P = 0.008). In patients with neurologic complications the mortality was significantly higher among those treated with antibiotics alone as compared with those treated surgically (65 of 81, 80% versus 2 of 10, 20%; P = 0.0003).
In a population of nondrug addicts with infective endocarditis caused by S aureus the following main conclusions can be drawn: neurologic manifestations occur with a higher frequency in patients with native mitral valve infection. The presence of vegetations on echocardiograms is not a risk factor for developing neurologic complications but this conclusion is based on the results of transthoracic echocardiograms performed in only one half of the patients. The majority of the neurologic manifestations occur on presentation or shortly thereafter and the risk of recurrent embolism is low. Mortality is increased in patients with neurologic manifestations. A neurologic event per se may constitute an indication for surgical treatment.
研究在非吸毒人群中，由金黄色葡萄球菌引起的感染性心内膜炎的神经学表现，特别关注临床表现、流行病学及死亡率。
1982年至1991年期间，丹麦哥本哈根葡萄球菌实验室共报告了8514例金黄色葡萄球菌菌血症病例。对疑似感染性心内膜炎病例的病历进行回顾性审查，并根据杜拉克提出的新的心内膜炎诊断标准进行分类。
63家医院的260例病例符合诊断标准。总体而言，91例患者（35%）出现神经学表现。61例表现为神经症状，而30例患者在疾病初发后的不同时间间隔（中位数：10天）出现神经并发症。最常见的神经学表现是单侧偏瘫，41例患者（45%）出现此症状。42%的女性有神经学表现，而男性仅为30%（P = 0.06）。与所有其他瓣膜受累情况相比，原发性二尖瓣感染病例的神经学表现频率显著更高（44%对29%，P = 0.02），但原发性二尖瓣感染患者的神经并发症频率仅比原发性主动脉瓣感染患者略高，无显著差异（44%对31%，P = 0.10）。三尖瓣感染患者中只有2例出现神经学表现，先天性心脏病患者均未出现。63例经超声心动图检测到赘生物的病例中，22例（35%）出现神经学表现，而65例未检测到赘生物的病例中有17例（26%）出现神经学表现（P = 0.38）。有严重神经学表现的患者死亡率为74%，无神经学表现的患者死亡率为56%（P = 0.008）。在有神经并发症的患者中，单纯接受抗生素治疗的患者死亡率显著高于接受手术治疗的患者（81例中的65例，80%对10例中的2例，20%；P = 0.0003）。
在由金黄色葡萄球菌引起感染性心内膜炎的非吸毒人群中，可得出以下主要结论：原发性二尖瓣感染患者神经学表现的发生率更高。超声心动图上赘生物的存在不是发生神经并发症的危险因素，但这一结论仅基于一半患者经胸超声心动图的结果。大多数神经学表现在就诊时或之后不久出现，复发栓塞的风险较低。有神经学表现的患者死亡率增加。神经事件本身可能构成手术治疗的指征。
