A pacemaker may be the focus of endocarditis. The infection may be indolent and require a high index of suspicion to diagnose.
Risk factors:
(1) prosthetic valve
(2) diabetes
(3) bacteremia from other cause (UTI, other)
Clinical and laboratory features:
(1) chills and fever
(2) elevated ESR and CRP
(3) leukocytosis
(4) anemia
(5) microscopic hematuria
(6) positive blood cultures
Transesophageal echocardiography is helpful in identifying vegetations.
Sites of infection:
(1) pacemaker leads, which may show vegetations
(2) pacemaker pouch/pocket
A broad range of pathogens may be involved. While Staphylococcus aureus and other Staphylococcus species are common, HACEK group, enterics and uncommon bacteria may be the cause.
Complications:
(1) septic emboli
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