Infective Endocarditis and COVID 19: A Systematic Review

Pramod Theetha Kariyanna¹, Amog Jayarangaiah², Jeewendra Dulal³, Apoorva Jayarangaiah⁴, Sushruth Das², George Jojo Punnakudiyil⁵, Ashkan Tadayoni⁶, Michael Freilich⁶ and Isabel M. McFarlane^6,

¹Division of Interventional Cardiology, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Morningside/Beth Israel Hospitals, New York City, NY-10025, U.S.A.

²Trinity School of Medicine, 925 Woodstock Road, Roswell, GA 30075, U.S.A.

³Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside, New York City, NY-10025, U.S.A.

⁴Division of Hematology-Oncology, Department of Internal Medicine, Albert Einstein College of Medicine/ Jacobi Medical Center, Bronx, N.Y.-10461, U.S.A.

⁵Division of Advanced Cardiac Imaging, Department of Cardiology, St. Francis Hospital and Heart Center, 100 Port Washington Blvd., Roslyn, NY 11576

⁶Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, U.S.A.

Cite this paper:
Pramod Theetha Kariyanna, Amog Jayarangaiah, Jeewendra Dulal, Apoorva Jayarangaiah, Sushruth Das, George Jojo Punnakudiyil, Ashkan Tadayoni, Michael Freilich and Isabel M. McFarlane. Infective Endocarditis and COVID 19: A Systematic Review. American Journal of Medical Case Reports. 2021; 9(7):380-385. doi: 10.12691/ajmcr-9-7-11

Abstract

Coronavirus Disease-19 (COVID-19) is a pandemic caused by severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 is known to cause a wide variety of cardiovascular manifestations, including myocarditis, pericarditis, myocardial infarction, stroke, thrombus, pulmonary embolism and acute ventricular failure In this paper, we explore cases of infective endocarditis (IE) that occurred in patients who were concurrently (not sure if they were concurrently infected but if so, makes the sentence smoother and easier to understand) infected with COVID-19 and discuss its association in contributing to factors that can ultimately lead to the development of infective endocarditis. Some of these factors that contribute to IE in COVID-19 include severe inflammatory response, endothelial damage and dysfunction and immunosuppression caused by medications that are used to treat COVID-19. In this systematic review, 12 papers detailing 15 pertinent cases of IE following an infection with COVID-19 were identified. Data from these cases were tabulated and analyzed. The ages of the patients ranged from 20-70 years, with 73% of the patients developing IE of native heart valves and the remaining 27% developing IE of mechanical and bioprosthetic valves. The three most common organism implicated were Enterococcus faecalis (28.57%), Methicillin Resistant Staphylococcus aureus (MRSA) (14.28%), and Methicillin Sensitive Staphylococcus aureus (MSSA) (14.28%). Medical management of these cases involved antibiotic therapy and was reported in 80% of the cases, while only one patient (6.67%) underwent surgical valve replacement. The mortality rate of the patients in this review was quite high at 38%, and other major complications included cardioembolic stroke (20%) and septic embolization to the extremities (6.67%). COVID-19 infection results in a severe inflammatory response caused by a variety of mechanisms. This severe degree of widespread inflammation may result in damage to the endocardium, thus creating an environment to which microorganisms can adhere to and colonize. Additionally, the immunosuppressive medications used in a COVID-19 infection can result in an increased risk of developing infections that have the potential to spread to the endocardium via a hematogenous route. Physicians should be aware of occurrences of IE in COVID-19, as delay in diagnosis and management may cause significant morbidity and mortality.

Keywords:
Coronavirus Disease-19 (COVID-19) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infective endocarditis

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