• Alpha Madu, Tochi Alex-Okoro, Abosede Okoduwa, and James Cotton.
• Internal Medicine Trainee, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. Electronic address: alpha.madu@nhs.net.
• Clin Med (Lond). 2024 Apr 20: 100205100205.

ObjectiveThe objective of this review was to gain new insight into the rare condition, Austrian syndrome: the triad of endocarditis, meningitis, and pneumonia caused by Streptococcus pneumoniae.MethodsA systematic review of case reports was conducted using the PRISMA guideline. Cases were rigorously screened to meet a set of well-defined inclusion criteria. Relevant data was aggregated and reported using descriptive statistics.ResultsSeventy-one cases from 69 case reports were included in the final review. The mean age was 56.5 years with a male-to-female ratio of 2.4:1. Alcoholism was reported in 41% of patients. Altered mental state (69%) and fever (65%) (mean temperature on admission = 38.9°C) were the commonest presenting symptoms. The mean duration of symptoms before presentation to the hospital was 8 days. The aortic valve was most commonly affected (56%). The mean duration of antibiotic therapy was 5.6 weeks. Seventy percent of patients were admitted to the intensive care unit (ICU). Fifty-six percent of patients had valvular surgery. The average length of stay in the hospital was 36.9 days. Mortality was recorded in 28% of patients.ConclusionAustrian syndrome is rare but deadly. The true incidence is unknown but is commoner in middle-aged men and in alcoholics. Affected patients are usually critically unwell, often requiring ICU admission and prolonged hospital stays. Treatment is aggressive including prolonged courses of antibiotics and often, surgery. Despite these, the case fatality rate is high, with death occurring in over a quarter of patients. Surgery appears to be associated with better prognosis.Copyright © 2024. Published by Elsevier Ltd.

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