Endocarditis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

Overview

Many types of organism can cause infective endocarditis. These are generally isolated by blood culture, where the patient's blood is sampled under sterile conditions, and any growth is noted and identified. It is therefore important to draw blood cultures before initiating antibiotic therapy. 70% of cases of endocarditis are due to the following three pathogens; Streptococcus viridans, Staphylococci and Enterococcus.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

• Candida albicans
• Clostridium septicum
• Enterococcus
• HACEK organisms
• Pseudomonas
• Staphylococcus aureus
• Streptococcus bovis
• Streptococcus viridans

Causes by Organ System

Cardiovascular	Acute rheumatic fever, aneurysm of sinus of valsalva, aortic insufficiency, aortic stenosis, aortic valve regurgitation, aortic valve stenosis, asymmetric septal hypertrophy, atrial myxoma, atrioventricular block, Austrian triad , bacterial endocarditis, Becker fibroblastic endocarditis, bicuspid aortic valves , calcific aortic stenosis, calcific valvular disease, cardiac catheterization , cardiac myxoma, cardiac surgery , cardiomegaly, carditis, central venous catheter, cerebrovascular accident, cholesterol emboli syndrome, coarctation of the aorta , congenital heart disease , coronary artery fistula, Ebstein's anomaly, Eisenmenger's syndrome, embolism, first degree AV block, hypertrophic cardiomyopathy, hypoplastic left heart syndrome, infective endocarditis, Libman-Sacks endocarditis, Loeffler endocarditis, marantic endocarditis, mesenteric ischemia, mitral regurgitation, mitral stenosis, mitral valve prolapse, mitral valve replacement, myocardial rupture, nonbacterial thrombotic endocarditis, papillary muscle dysfunction, patent ductus arteriosus, prosthetic heart valves, pulmonary atresia, pulmonic regurgitation, rheumatic heart disease , right ventricular outflow tract obstruction, second degree AV block, shock, stroke, structural heart disease, subacute endocarditis, tetralogy of Fallot, third degree AV block, tricuspid insufficiency, tricuspid regurgitation, tricuspid stenosis, valvular heart disease, ventricular septal defect
Chemical / poisoning	No underlying causes
Dental	Dental extractions, dental implants, dental sepsis, root canals procedure, rothia dentocariosa
Dermatologic	Behcet disease, scarlet fever
Drug Side Effect	Aminoglycoside, cocaine, daptomycin, flucloxacillin, fusidic acid, heroin, intravenous drug use, metronidazole, narcotic, pefloxacin, penicillin, streptomycin, vancomycin
Ear Nose Throat	Adenoidectomy
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic & Genito-Uriner	Biliary tract surgery, endoscopic retrograde cholangiopancreatography , peritoneovenous shunts for ascites, sclerotherapy , splenic infarction, Whipple disease
Genetic	Ehlers-Danlos syndrome, mitogen-activated protein kinase 9, parathyroid hormone receptor 1, Turner syndrome
Hematologic	Antiphospholipid syndrome, chronic eosinophilic leukemia, hypereosinophilic syndrome
Iatrogenic	Cystoscopy,iatrogenic infection
Infectious Disease	Abiotrophia, acremonium, acute rheumatic fever, aseptic meningitis, austrian triad , bacteremia, bacterial endocarditis, bacteroides, bartonella, brucellosis, campylobacteriosis, candida albicans, capnocytophaga canimorsus, cardiobacterium hominis, cat scratch fever, clostridium sordellii, coagulase-negative staphylococci, corynebacterium, coxiella burnetii, diphtheria , eikenella corrodens, enterococci , enterococcus faecalis, erysipelas, erysipeloid of rosenbach, erysipelothrix rhusiopathiae, fever, finegoldia magna, fungi , gemella haemolysans, gemella morbillorum, gonorrhea , granuloma, group A streptococcus , HACEK organisms, haemophilus aphrophilus, haemophilus parainfluenzae, haemophilus paraphrophilus, hiv, iatrogenic infection, infective endocarditis, kingella kingae, lactobacillus rhamnosus, legionella pneumophila, listeria monocytogenes, loiasis , melioidosis, meningococcemia, methicillin-resistant staphylococcus aureus, micrococcus, mycobacterium avium-intracellulare, mycobacterium boenickei, mycobacterium brisbanense, mycobacterium fortuitum, mycobacterium houstonense, mycobacterium neworleansense, mycobacterium tuberculosis, neisseria gonorrhoea, neisseria sicca, non-HACEK gram-negative bacteria, pasteurella multocida, postoperative septicemia, propionibacterium acnes, pseudomonas alcaligenes, pseudomonas mendocina, psittacosis, Q fever, rat-bite fever, rheumatic fever, rothia dentocariosa, salmonellosis , scarlet fever, sepsis, septic arthritis, septicemia , serratia, staphylococcus aureus, staphylococcus epidermidis, staphylococcus lugdunensis, streptobacillary rat-bite fever, streptobacillus, streptococcus bovis, streptococcus milleri, streptococcus mitis, streptococcus mutans, streptococcus pneumoniae, streptococcus sanguinis, streptococcus suis, streptococcus viridans, streptococcus, syphilis, trichinella spiralis,tropheryma whipplei, trypanosoma cruzi, tuberculosis , typhoid fever, vancomycin-resistant enterococci, Whipple disease
Musculoskeletal / Ortho	Ehlers-Danlos syndrome, sclerotherapy
Neurologic	Antiphospholipid syndrome, aseptic meningitis, Austrian triad, cerebrovascular accident, stroke, ventriculoatrial shunts for hydrocephalus
Nutritional / Metabolic	Ornithine transcarbamylase
Obstetrics & Gynecology	Antiphospholipid syndrome, Pregnancy
Oncologic	Atrial myxoma, cancer, cardiac myxoma, chronic eosinophilic leukemia, paraneoplastic syndrome
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Respiratory tract procedures
Renal / Electrolyte	Chronic hemodialysis, hemodialysis, nephrotic syndrome, urinary casts
Rheum / Immune / Allergy	Acute rheumatic fever, antiphospholipid syndrome, autoimmune disease, Behcet disease, immune complex disease, lupus, paraneoplastic syndrome, polymyalgia rheumatica, rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus
Trauma	No underlying causes
Urologic	Cystoscopy, prostatic surgery
Miscellaneous	Surgery

Causes in Alphabetical Order

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3

Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis

Epidemiological features	Common Microorganism(s)
Injection drug use	S. aureus oxacillin-resistant strains Coagulase-negative staphylococci β-Hemolytic streptococci Fungi Aerobic Gram-negative bacilli, including Pseudomonas aeruginosa
Indwelling cardiovascular medical devices	S. aureus Coagulase-negative staphylococci Fungi Aerobic Gram-negative bacilli Corynebacterium sp
Genitourinary disorders Genitourinary infection Genitourinary manipulation pregnancy Delivery Abortion	Enterococcus sp Group B streptococci (S agalactiae) Listeria monocytogenes Aerobic Gram-negative bacilli Neisseria gonorrhoeae
Chronic skin disorders	S. aureus β-Hemolytic streptococci
Poor dental health, dental procedures	Viridans group streptococci “Nutritionally variant streptococci” Abiotrophia defectiva Granulicatella sp Gemella sp HACEK organisms
Alcoholism, cirrhosis	S pneumoniae β-Hemolytic streptococci Bartonella sp Listeria sp Aeromonas sp
Burn patients	S. aureus Aerobic Gram-negative bacilli, including Pseudomonas aeruginosa Fungi
Diabetes mellitus	S. aureus β-Hemolytic streptococci S pneumoniae
Early ( < 1 y) prosthetic valve placement	Coagulase-negative staphylococci S. aureus Aerobic Gram-negative bacilli Fungi Corynebacterium sp Legionella sp
Late ( > 1 y) prosthetic valve placement	Coagulase-negative staphylococci S. aureus Viridans group streptococci Enterococcus species Fungi Corynebacterium sp
Dog–cat exposure	Bartonella sp Pasteurella sp Capnocytophaga sp
Contact with contaminated milk Contact with infected farm animals	Brucella sp Coxiella burnetii Erysipelothrix sp
Homeless, body lice	Bartonella sp
AIDS	Salmonella sp S pneumoniae S. aureus
Pneumonia, meningitis	S pneumoniae
Solid organ transplant	S. aureus Aspergillus fumigatus Enterococcus sp Candida sp
Gastrointestinal lesions	S bovis Enterococcus sp Clostridium septicum