The clinical features of this complex infection have changed in the past several decades. It is now an infection of older people, and mitral-valve prolapse is the most common predisposing cardiovascular problem in developed countries. In contrast, rheumatic heart disease is an important predisposing problem in developing countries. This review article provides a comprehensive assessment of this serious infectious disease, including diagnostic challenges, cardiovascular and neurologic complications, and approaches to therapy.

https://www.nejm.org/doi/pdf/10.1056/NEJMra010082

Infective endocarditis in adults.

The results of surgical and non-surgical treatment of active infective endocarditis in 182 patients over a 10-year period were analyzed. Heart failure, annular and myocardial abscesses, heart block, and coronary embolism, seen most frequently with staphylococcal and fungal endocarditis, were the primary causes of death in both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). In NVE, surgery significantly improved the survival in patients with moderate or severe heart failure (P less than 0.05) and in all patients with staphylococcal endocarditis (P less than 0.03). In PVE, surgery significantly influenced survival in patients with moderate or severe heart failure (P less than 0.05) and in the entire group with late PVE (P less than 0.01). Early surgery is recommended for patients with native valve endocarditis and moderate or severe heart failure; those patients with staphylococcal NVE, regardless of hemodynamic state, should undergo early valve replacement. Early surgery is recommended for PVE patients with moderate or severe heart failure. We also recommend early valve replacement for early and late staphylococcal PVE.

Treatment of infective endocarditis: a 10-year comparative analysis.

OBJECTIVE The aim of the research was to demonstrate that the early diagnosis of infective endocarditis influences significantly the results of treatment. METHODS The following clinical analysis covered 56 patients, aged 18 to 81 (the average age--50 years) with infective endocarditis treated in the years 1998-2000. Data from patient history, physical examination, laboratory investigations and treatment were analysed. Apart from clinical symptoms for infective endocarditis diagnosis, also blood cultures and echocardiography were important. MAIN OBSERVATIONS Infective endocarditis was present in 24 patients (42.8%) with heart defects, 7 (12.5%) with prosthetic heart valves, and 4 (7.1%) treated with haemodialysis. RESULTS In 38 (67.8%) individuals, the echocardiography showed vegetations, and in 14 (25.0%) other abnormalities. Blood cultures were positive in 33 (58.9%) patients. Fever was present in 47 (83.9%) patients. The progression of heart failure appeared in 26 (46.4%) individuals. The average time of antibiotic therapy was 34 days. 11 (19.6%) patients died. 9 (16.1%) individuals had cardiosurgery operations. CONCLUSIONS Early diagnosis of infective endocarditis is substantial as it improves patients' prognosis as to health and life.

Infective endocarditis in adults

Analysis of 95 necropsy patients with active infective endocarditis (AIE) involving 128 native cardiac valves (aortic = 59, mitral = 48, tricuspid = 20, and pulmomic = 1) disclosed 27 patients with ring abscesses involving 30 valves: the aortic valve ring was infected in 24 patients and only an atrioventricular valve ring (mitral in two, and tricuspid in one) in three patients. Comparison of the following parameters showed no significant differences between the 27 patients with and the 68 patients without ring abscess: age, sex, antibiotic treatment or length of treatment, status of the cardiac valve(s) before infection, and the kind of infecting organism. Comparison of the following parameters, however, showed significant (P less than 0.05) differences between the 27 patients with and the 68 patients without valve ring abscess: 1) infection of the aortic valve; 2) occurrence of valvular regurgitation of recent origin; 3) presence of pericarditis; 4) presence of high degree of atrioventricular block; and 5) short duration of symptoms leading to severe debility or death. These five features, therefore, serve as a clinical clues to the presence of valve ring abscess in patients with AIE.

Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients

Background: Intravenous drug use is an increasingly common condition predisposing to infective endocarditis. Data on infective endocarditis in intravenous drug users are limited. Objective: To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users. Methods: Cohort study of intravenous drug users with native valve infective endocarditis. Results: A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases [67%] in men and 41 cases [32%] in women) with a mean (±SD) age of 37±7 years. The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%). The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%). Twenty-three patients (18%) underwent surgery, and two (9%) of them died. One hundred two patients (82%) were treated medically, and nine (9%) of them died. Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%). Conclusions: Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%. (Arch Intern Med. 1995;155:1641-1648)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=INTEMED&articleId=620871&pdfFileName=archinte_155_15_013.pdf

Clinical Features, Site of Involvement, Bacteriologic Findings, and Outcome of Infective Endocarditis in Intravenous Drug Users

The records of 28 patients with bacterial endocarditis and aortic valve insufficiency were studied to determine clinical indications for valve replacement before bacteriologic cure can be ...

Aortic Insufficiency in Bacterial Endocarditis

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Aortic Insufficiency in Bacterial Endocarditis