Valvular Heart Disease

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Valvular heart disease of HIV-infected patients occurs as a bacterial or mycotic endocarditis. The most frequent germ is staphylococcus aureus, being detected in more than 40 % of HIV-infected patients with bacterial endocarditis. Further pathogens include streptococcus pneumoniae and hemophilus influenzae (Currie 1995). Mycotic forms of endocarditis, which may also occur in patients who are not intra venous drug abusers, mostly belong to aspergillus fumigatus, candida species or cryptococcus neoformans.

Signs of infective endocarditis include fever (90 %), fatigue, and lack of appetite. An additional heart murmur may also be present (30 %). In these cases, repeated blood samples should be taken and transesophageal echocardiography performed (Bayer 1998). Due to the fact that the detection of the infectious agent is often difficult, an antibiotic therapy has to be started early, even without the microbiology results.

In most cases, previously damaged valves are affected. Therefore, antibiotic prophylaxis is recommended in all persons with a previously damaged endocardium and planned interventional procedure, e.g. dental work or operations on the respiratory or gastrointestinal tract.

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