Non-cardiac Manifestations

Almost half the patients will have distal seeding of septic emboli causing non-cardiac manifestations. This is most apparent in the skin, meninges, spleen, eyes and kidneys, and it can cause significant symptoms.

Infection of blood vessels leads to mycotic aneurysms that are prone to rupture.

Approximately 40% of patients will develop neurological symptoms during the course of their illness; these are usually related to micro abscesses, which rarely require surgical intervention.

Immune complex deposition can result in glomerulonephritis and renal dysfunction.

During the illness there can be constant shedding of emboli. In particular, vegetations of more than 10 mm in size and mitral valve vegetations are more prone to embolise.

Adequate treatment:

  • Reduces the rate of embolisation by 10-fold
  • Provides prompt resolution of systemic constitutional symptoms
  • Provides rapid improvement of renal dysfunction

However, continued embolisation is not a marker of treatment failure – this can persist despite adequate bacterial clearance.