[Infectious endocarditis from the morphologic viewpoint: on the pathology and clinical aspects of 97 autopsy cases].

In continuous autopsy material between 1978 and 1987 an infectious endocarditis was present in 97 cases of 8745 postmortem examinations. Hospital acquired or iatrogenic infections were at the top of the list with 60% contribution and intravasal devices, cardiovascular or abdominal surgery acting as predominant entrance spots of the infection. In community acquired disease the portal of entry could not be ascertained in most of the cases. The spectrum of causative organisms showed staphylococcus aureus in first position (37%), followed by enterococci (20%), candida (12%) and gram-negative rods (10%). Streptococcus viridans could be isolated in only one case. The majority of patients already had cardiac valve lesions before the onset of infection (48%), immune-defence tangent illnesses (47%) and/or were treated immunosuppressively (14%). In many of the patients, however, no predisposing factors could be established. Factors determining the clinical outcome were - independent of the localization - the local destruction (47%), purulent and non-purulent myocarditis (58%), fresh myocardial infarction (17%) and embolization to various organs (76%), whereby the central nervous system was affected to a high degree (43%). Only 39% of the analyzed cases were discovered at lifetime; especially mural (n = 10) and tricuspidal (n = 9) infections were overlooked. In spite of highly suspicious infection parameters, blood-cultures were drawn from only 59% of the patients; however, an antibiotic therapy had been given to 85%. Only through an early diagnosis before serious complications set in, the poor prognosis of infectious endocarditis can be improved by specific chemotherapy and well-timed surgical measures.