++
For further information, see CMDT Part 35-09: Infective Endocarditis
+++
Essentials of Diagnosis
++
Fever
Underlying valvular disease or prosthetic endovascular material
Positive blood cultures
Evidence of vegetation on echocardiography
Evidence of systemic emboli
+++
General Considerations
++
Important factors that determine the clinical presentation
Acute presentation
Subacute presentation
Caused by viridans strains of streptococci, enterococci, other bacteria (including intracellular bacteria), yeasts, and fungi
Systemic and peripheral manifestations may predominate
Predisposing valvular abnormalities include
A variety of congenital heart disorders
Rheumatic involvement of any valve
Bicuspid aortic valves
Calcific or sclerotic aortic valves
Hypertrophic subaortic stenosis
Mitral valve prolapse
Rheumatic disease is no longer the major predisposing factor in developed countries
Regurgitation lesions are more susceptible than stenotic ones
+++
Native valve endocarditis
++
Most commonly due to
S aureus, and no longer streptococcal species, is now the leading cause
Gram-negative organisms and fungi account for a small percentage
In individuals who inject drugs
+++
Prosthetic valve endocarditis
++
++
++
Fever
Presents in virtually all patients
However, may be low grade (< 38°C) in elderly individuals and in patients with heart failure or kidney failure
Rarely, there may be no fever at all
Duration of illness is a few days to a few weeks
Nonspecific symptoms are common
Initial symptoms and signs of endocarditis