Group B Streptococcal Endocarditis: Report of Seven Cases and Review of the Literature, 1962-1985

Infective endocarditis is an uncommon manifestation of group B streptococcal disease. Sevencases of group B streptococcal endocarditis are reported herein. Another fifty-five cases published in the literature since 1962 are reviewed: the male to femaleratio was 1.4:1. The averageage was 53.8 years, and 45% of patients were60 years of age or older. Two cases of nonsocomial endocarditis and two casesof polymicrobialendocarditis wereidentified. There were five cases of prosthetic valveendocarditis. Mitral and aortic valvular involvementwere present in 48% and 29% of cases, respectively. Underlying heart disease was found in more than half of the cases. Rheumatic heart disease was the commonest underlying cardiac condition. Noncardiac underlying conditions included diabetes mellitus, alcoholism, pregnancy, intravenousdrug abuse, and genitourinary disease. Onset was varied as was initial presentation of the disease. Large arterial thrombi were common. Overall mortality was 43.5%. Penicillin is the treatment of choice for group B streptococcal endocarditis. However, based on in vitro and in vivo studies as well as case reports, some authors feel that the combination of penicillinand an aminoglycoside is a superior regimen. Cephalothin or vancomycin are alternatives for patients who are allergic to penicillin.