Inflammatory causes of stroke are frequent and often pose diagnostic and therapeutic challenges due to the scarcity of randomized trials and the absence of clear guideline recommendations for many scenarios. Following the publication of the recommendations of the European Stroke Organization on primary angiitis of the central nervous system (PACNS) last year, the German Neurological Society (DGN) has issued very clear guidelines this year on the diagnostics and treatment of PACNS and updated the recommendations for systemic vasculitides; however, stroke often occurs not only as a result of primary vascular inflammation but also as a complication of another organ infection. Approximately 5% of all patients with sepsis, ca. 20% of patients with bacterial meningitis and up to 40% of patients with bacterial endocarditis suffer from a stroke as a complication. This article summarizes the key characteristics of these inflammatory causes of stroke and particularly focuses on the current recommendations for diagnostic and therapeutic management.
UNASSIGNED: Entzündliche Schlaganfallursachen sind häufig und stellen oft eine diagnostische und therapeutische Herausforderung dar, da es hierzu kaum randomisierte Studien gibt und für viele Konstellationen keine klaren Leitlinienempfehlungen existieren. Nach Veröffentlichung der Empfehlungen der Europäischen Schlaganfallgesellschaft zur primären Angiitis des zentralen Nervensystems (PACNS) im letzten Jahr hat die Deutsche Gesellschaft für Neurologie (DGN) in diesem Jahr eine sehr klare Leitlinie zur Diagnostik und Therapie der PACNS herausgegeben und die Empfehlungen für die systemischen Vaskulitiden aktualisiert. Häufig treten Schlaganfälle jedoch nicht nur infolge einer primären Gefäßentzündung auf, sondern auch als Komplikation einer anderen Organinfektion. So erleiden ca. 5 % aller PatientInnen mit einer Sepsis, ca. 20 % der PatientInnen mit bakterieller Meningitis und bis zu 40 % der PatientInnen mit bakterieller Endokarditis als Komplikation einen Schlaganfall. Unser Artikel fasst die wichtigsten Charakteristika dieser entzündlichen Ursachen von Schlaganfällen zusammen und fokussiert hierbei insbesondere auch auf aktuelle Empfehlungen zum diagnostischen und therapeutischen Management.

BACKGROUND: The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology.
METHODS: All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained.
RESULTS: The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071).
CONCLUSIONS: Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

BACKGROUND: Current risk score models for predicting mortality in infective endocarditis (IE) include data often unavailable in registries, limiting their use for confounding adjustment in population-based research.
METHODS: This study assessed the Danish Comorbidity Index for Acute Myocardial Infarction (DANCAMI) for its ability to predict 30-day, 1-year, and 5-year mortality in IE patients, compared to the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The study included all adult Danish patients with first-time IE from 1995 to 2021. The area under the receiver operating characteristic curve (AUC) was estimated using logistic regression to measure discriminatory performance for all-cause and cardiovascular mortality at the specified time intervals. A baseline model included age and sex, while extended models incorporated continuous comorbidity scores.
RESULTS: We identified 8966 patients with IE. Mortality rates were 12% at 30 days, 26% at 1 year, and 36% at 5 years. For all-cause mortality, AUCs for the baseline versus DANCAMI models were 0.64 vs. 0.69 at 30 days, 0.66 vs. 0.73 at 1 year, and 0.72 vs. 0.79 at 5 years. For cardiovascular mortality, AUCs for baseline versus DANCAMI models were 0.67 vs. 0.69 at 30 days, 0.67 vs. 0.69 at 1 year, and 0.70 vs. 0.71 at 5 years. CCI and ECI demonstrated comparable AUCs to the DANCAMI model.
CONCLUSIONS: DANCAMI improved discrimination of short- and long-term mortality in IE patients and may be used for confounder adjustment similarly to CCI and ECI.

Bacterial endocarditis (BE) is a severe infection of the endocardium and cardiac valves caused by bacterial agents in dogs. Diagnosis of endocarditis is challenging due to the variety of clinical presentations and lack of definitive diagnostic tests in its early stages. This study aims to provide a research literature analysis on BE in dogs based on text mining (TM) and topic analysis (TA) identifying dominant topics, summarizing their temporal trend, and highlighting any possible research gaps. A literature search was performed utilizing the Scopus® database, employing keywords pertaining to BE to analyze papers published in English from 1990 to 2023. The investigation followed a systematic approach based on the PRISMA guidelines. A total of 86 records were selected for analysis following screening procedures and underwent descriptive statistics, TM, and TA. The findings revealed that the number of records published per year has increased in 2007 and 2021. TM identified the words with the highest term frequency-inverse document frequency (TF-IDF), and TA highlighted the main research areas, in the following order: causative agents, clinical findings and predisposing factors, case reports on endocarditis, outcomes and biomarkers, and infective endocarditis and bacterial isolation. The study confirms the increasing interest in BE but shows where further studies are needed.

OBJECTIVE: To analyze the clinical characteristics of Brucella endocarditis (BE) and observe the factors related to death to provide guidance for clinical treatment.
METHODS: This study examined all patients with BE admitted to The First People\'s Hospital of Kashi Prefecture between January 2017 and November 2023. Clinical characteristics and follow-up outcomes were collected for analysis.
RESULTS: This study revealed 774 cases of brucellosis and 14 cases of BE, with an overall incidence rate of 1.88%. Most of the patients were male (71.43%) and lived in areas where brucellosis is common. Patients ranged in age from 26 to 68 years. Common symptoms reported among patients included chest tightness and fatigue, and a significant portion also presented with congestive heart failure. Most patients exhibited normal white blood cell counts (WBC) but had elevated levels of C-reactive protein (CRP). Transthoracic ultrasound (TTE) revealed cardiac valve vegetation in all patients, along with positive blood cultures. Six patients (42.86%) completed heart surgery, and ten (71.43%) completed anti-infection treatment. Six patients died, five of whom did not undergo surgery. The other patient with Marfan syndrome died after surgery. Sex, WBC count, neutrophil (NEUT) and total bilirubin (TBIL) were significant factors associated with regression in BE patients (P < 0.05) according to univariate analysis.
CONCLUSIONS: Patients with BE in Kashi have a severe clinical presentation at diagnosis, but early detection with improved cardiac ultrasound and aggressive treatment can improve the prognosis.

Over 21 months, 12 patients with invasive Candida infections detected during the course of treatment of bacterial endocarditis, including 11 with candidemia, were identified. Invasive Candida infections can occur as a complication of bacterial endocarditis and may occur more frequently in patients with injection drug use and broad-spectrum antibiotic exposure.

An 11-year-old male neutered American bulldog was presented for evaluation of thrombocytopenia, acute onset of ataxia, and vomiting. A new murmur was auscultated on physical examination. Transthoracic echocardiographic examination revealed a bicuspid aortic valve, vegetative lesions on the aortic valve, and continuous shunting from the aortic root to the left atrium through an aorta to left atrial fistula. The dog was euthanized due to its guarded prognosis and critical condition. Pathological examination confirmed presence of a bicuspid aortic valve, aorto-left atrial fistula, and aortic infective endocarditis. Antemortem blood culture revealed two unusual organisms: Achromobacter xylosoxidans and Fusobacterium mortiferum.

Streptococcus thoraltensis is a rare species, part of the viridans streptococcus group, found initially in rabbits and pigs, which can be vancomycin-resistant. We present the case of a 65-year-old patient, a smoker and chronic alcohol consumer with chronic obstructive pulmonary disease (COPD) and multiple dental foci who had been diagnosed with bacterial endocarditis caused by Streptococcus thoraltensis. The particular elements of the case consisted of an atypical clinical presentation with diarrheal stools, abdominal pain, concomitant damage to the aortic and tricuspid valves, the presence of large vegetations (>2 cm), and a vancomycin-resistant strain of Streptococcus thoraltensis. The evolution of the patient was unfavorable due to septic embolisms, respiratory failure requiring orotracheal intubation, and septic and cardiogenic shock. Infections with Streptococcus thoraltensis are challenging to treat because of the severity of the clinical form it causes and the pattern of antibiotic resistance in this germ. Based on our brief review, Streptococcus thoraltensis is an extremely rare human pathogen previously described as the etiologic agent of infectious endocarditis in only one case.

BACKGROUND: Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA).
METHODS: A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables.
RESULTS: No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur.
CONCLUSIONS: Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks.
CONCLUSIONS: Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.