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OBJECTIVE: To describe postdischarge survival rates and late complications in non-intravenous drug users (non-IVDUs) after treatment of infective endocarditis (IE). PATIENTS AND METHODS: This prospective study consists of consecutive cases of IE in non-IVDUs seen between January 1, 1994, and August 31, 2005. Patient treatment (ie, pharmaceutical and/or surgical) and cardiac valve involved in infection (ie, aortic and/or mitral; whether valve was native or prosthetic) were recorded. Patient follow-up, to March 31, 2007, occurred at 1, 2, 3, and 4 years. Complications, survival, and mortality were statistically analyzed. RESULTS: During the study period, 230 episodes of IE in 222 non-IVDUs were attended. A total of 143 patients (64%) were discharged from the hospital. Mean +/- SD age of discharged patients was 61+/-17 years. Survival at 1-, 2-, 3-, and 4-year follow-up was 88%, 82%, 76%, and 67%, respectively. Survival was similar for patients with native-valve IE and those with prosthetic-valve IE. The only independent predictors of long-term mortality after discharge were age (hazard ratio, 1.04; 95% confidence interval, 1.01-1.06+/- P=.002) and comorbidity (Charlson index HR, 1.33; 95% confidence interval, 1.18-1.49; P<.001). Surgery during hospitalization showed no clear association with long-term survival. Six patients (4%) had 8 recurrent episodes of IE (1.3% per patient-year). All recurrent episodes happened at 3 months or later after discharge and involved either microorganisms that were of different strains than those of the initial episodes (3 cases) or patients who had suboptimal pharmaceutical or surgical therapy. Only 5 patients (3%) underwent valvular surgery after discharge. CONCLUSION: Among non-IVDUs discharged after treatment for IE, 4-year mortality was 33%, and mortality increased with age and comorbidity. Recurrent endocarditis was uncommon in properly treated patients. Survival was similar for patients with native-valve IE and those with prosthetic-valve IE. Survival was also similar for patients who underwent surgery during hospitalization and those who did not. [ABSTRACT FROM AUTHOR]

Cytomegalovirus [CMV] is a frequent infection in solid organ transplant recipients and the mRNA COVID-19 vaccine has been associated with transient lymphopenia, which could be a risk factor to consider for CMV replication. A 51-year-old man with arterial hypertension and a history of repaired complex congenital heart disease, which required a heart transplant [HT] in 2019. He had a high risk CMV missmatch (D+/R-). Routine HT follow up tests after the first year were normal, with neither signs of rejection nor allograft vascular disease. His immunosuppressive treatment consisted in Tacrolimus 5 mg once a day, Mycophelonate 500 mg twice a day, and Prednisone 5 mg a day. 77 weeks after his heart transplant, two doses of mRNA COVID-19 vaccine were inoculated separated by 28 days. After 4 days of the second dose, he developed fever, diarrhea, and general malaise. The physical findings were abdominal pain, slight hepatomegaly and several painful gum lesions. Laboratory tests showed severe lymphopenia; and elevated C-reactive protein. CMV by polymerase chain reaction was tested positive with 228.356 copies/ml. The decision was to admit him and to initiate intravenous ganciclovir 5 mg/kg twice a day and to reduce the immunosuppressive treatment. He completed a course of 15 days with ganciclovir, and then continued with valganciclovir 900 mg twice a day. Early after ganciclovir start, clinical manifestations gradually disappeared. Due to persistent lymphopenia, mycophenolate was switched to everolimus. After 60 days of antiviral treatment, CMV loading was below detection range (Image 1). The probability of favoring CMV replicability after mRNA COVID-19 vaccine has not been yet described. We here present a case of CMV primoinfection closely related in time with a full mRNA COVID-19 vaccine administration. We hypothesize that lymphopenia and a high risk CMV could be factors to consider at the time of mRNA COVID-19 vaccine administration. A close CMV monitoring should be advised in this scenario. [ABSTRACT FROM AUTHOR]