Infective endocarditis

Infective endocarditis
Other namesBacterial endocarditis
A mitral valve vegetation caused by bacterial endocarditis.
SpecialtyCardiology, infectious disease
SymptomsFever, small areas of bleeding into the skin, heart murmur, feeling tired, low red blood cells[1]
ComplicationsValvular insufficiency, heart failure, stroke, kidney failure[1][2] Blood clot in a lung artery (pulmonary embolism)[3] Enlarged and painful spleen, kidney damage, damage to the distal extremities such as fingers and toes.[4]
CausesBacterial infection, fungal infection[1]
Risk factorsValvular heart disease including rheumatic disease, congenital heart disease,[5] artificial valves, hemodialysis, intravenous drug use, electronic pacemakers[6][7]
Diagnostic methodBased on symptoms, blood cultures, ultrasound[1]
TreatmentAntibiotics, heart surgery[1]
Prognosis25% risk of death[6]
Frequency5 per 100,000 per year[6]

Infective endocarditis is an infection of the inner surface of the heart (endocardium), usually the valves.[1] Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count.[1][8] Complications may include backward blood flow in the heart, heart failure – the heart struggling to pump a sufficient amount of blood to meet the body's needs, abnormal electrical conduction in the heart, stroke, and kidney failure.[1][2][8][9]

The cause is typically a bacterial infection and less commonly a fungal infection.[1] Risk factors include valvular heart disease, including rheumatic disease, congenital heart disease, artificial valves, hemodialysis, intravenous drug use, and electronic pacemakers.[6][7][5] The bacteria most commonly involved are streptococci or staphylococci.[1] Diagnosis is suspected based on symptoms and supported by blood cultures or ultrasound of the heart.[1] There is also a noninfective form of endocarditis.[1]

The usefulness of antibiotics following dental procedures for prevention is unclear.[10] Some recommend them for people at high risk.[1] Treatment is generally with intravenous antibiotics.[1] The choice of antibiotics is based on the results of blood cultures.[1] Occasionally heart surgery is required.[1] The number of people affected is about 5 per 100,000 per year.[6] Rates, however, vary between regions of the world.[6] Infective endocarditis occurs in males more often than in females.[1] The risk of death among those infected is about 25%.[6] Without treatment, it is almost universally fatal.[1] Improved diagnosis and treatment options have significantly enhanced the life expectancy of patients with infective endocarditis, particularly with congenital heart disease.[5]

  1. ^ a b c d e f g h i j k l m n o p q r "Infective Endocarditis – Cardiovascular Disorders". Merck Manuals Professional Edition. September 2017. Retrieved 11 December 2017.
  2. ^ a b Njuguna B, Gardner A, Karwa R, Delahaye F (February 2017). "Infective Endocarditis in Low- and Middle-Income Countries". Cardiology Clinics. 35 (1): 153–163. doi:10.1016/j.ccl.2016.08.011. hdl:1805/14046. PMID 27886786.
  3. ^ "Endocarditis". Mayo Clinic. Retrieved June 4, 2022.
  4. ^ "Endocarditis". Cleveland Clinic. Retrieved 2022-06-09.
  5. ^ a b c Verzelloni Sef, A; Jaggar, SI; Trkulja, V; Alonso-Gonzalez, R; Sef, D; Turina, MI (22 March 2023). "Factors associated with long-term outcomes in adult congenital heart disease patients with infective endocarditis: A 16-year tertiary single-centre experience". European Journal of Cardio-Thoracic Surgery. 63 (5). doi:10.1093/ejcts/ezad105. PMID 36946284.
  6. ^ a b c d e f g Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana JM, Vidal B, Almela M, Quintana E, Llopis J, Moreno A, Miro JM (12 April 2017). "The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century". Current Infectious Disease Reports. 19 (21). doi:10.1007/s11908-017-0574-9. PMID 28401448. S2CID 24935834.
  7. ^ a b Habib, G; Lancellotti, P; Antunes, MJ; Bongiorni, MG; Casalta, JP; Del Zotti, F; Dulgheru, R; El Khoury, G; Erba, PA; Iung, B; Miro, JM; Mulder, BJ; Plonska-Gosciniak, E; Price, S; Roos-Hesselink, J; Snygg-Martin, U; Thuny, F; Tornos Mas, P; Vilacosta, I; Zamorano, JL (21 November 2015). "2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)". European Heart Journal. 36 (44): 3075–3128. doi:10.1093/eurheartj/ehv319. PMID 26320109.
  8. ^ a b Kumar M, Anstadt EJ, Lopetegui Lia N, Siddiqi MH (May 2019). "Streptococcus viridans Endocarditis Affecting All Four Valves". Cureus. 11 (5): e4635. doi:10.7759/cureus.4635. PMC 6623990. PMID 31312561.
  9. ^ Merkler, Alexander E.; Chu, Stacy Y.; Lerario, Michael P.; Navi, Babak B.; Kamel, Hooman (2015-08-11). "Temporal relationship between infective endocarditis and stroke". Neurology. 85 (6): 512–516. doi:10.1212/WNL.0000000000001835. ISSN 1526-632X. PMC 4540247. PMID 26163428.
  10. ^ Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, Lockhart P, Roberts N, Shanson D, Thornhill M, Heneghan CJ, Prendergast BD (June 2017). "Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis" (PDF). Heart. 103 (12): 937–944. doi:10.1136/heartjnl-2015-309102. PMID 28213367. S2CID 25918810.