Overview
What is infective endocarditis (IE)?
What are classic signs of infective endocarditis (IE)?
What are the signs of neurologic disease in infective endocarditis (IE)?
What are symptoms of subacute native valve endocarditis (NVE)?
What is the role of the Duke diagnostic criteria in infective endocarditis (IE)?
What are the major blood culture diagnostic criteria for infective endocarditis (IE)?
What are the major echocardiographic diagnostic criteria for infective endocarditis (IE)?
What are the minor diagnostic criteria for infective endocarditis (IE)?
How many criteria must be met for a definitive diagnosis of infective endocarditis (IE)?
What is the initial treatment of infective endocarditis (IE)?
How is infective endocarditis (IE) defined?
When was infective endocarditis (IE) first identified and described?
What causes infective endocarditis (IE)?
Why is infective endocarditis (IE) difficult to treat?
How is infective endocarditis (IE) categorized?
What are the classic characterizations of infective endocarditis (IE)?
What is the difference between acute and subacute native valve endocarditis (NVE)?
What causes prosthetic valve endocarditis (PVE)?
What causes IV drug abuse (IVDA) infective endocarditis (IE)?
Where does infective endocarditis (IE) due to infections of implantable pacemakers occur?
What is nosocomial infective endocarditis (NIE)?
How have the clinical characteristics of infective endocarditis (IE) evolved?
What is the pathogenesis of infective endocarditis (IE)?
What is the role of bacterial clumping in the pathogenesis of subacute infective endocarditis (IE)?
How is a thrombus produced in acute infective endocarditis (IE)?
What is the role of the Venturi effect in the pathogenesis of infective endocarditis (IE)?
Where can nonbacterial thrombotic endocarditis form?
What are features of microorganisms that commonly produce infective endocarditis (IE)?
What is the pathogenesis of pacemaker infective endocarditis (IE)?
Which procedures can cause bacteremia in the pathogenesis of infective endocarditis (IE)?
How do bacteria colonize the heart valves in the pathogenesis of infective endocarditis (IE)?
Which antibodies are increased in subacute endocarditis?
What is the microscopic appearance of acute bacterial endocarditis?
What are the underlying causes of native valve endocarditis (NVE)?
What are the causes of prosthetic valve endocarditis (PVE)?
What are the causes of IV drug abuse (IVDA) infective endocarditis (IE)?
What are the causes of nosocomial infective endocarditis (IE)?
Which patient groups are more likely to develop fungal endocarditis?
Which symptoms are associated with the different etiologic agents of infective endocarditis (IE)?
What are the risk factors for infective endocarditis (IE)?
What is the incidence of infective endocarditis (IE) in the US?
What is the prevalence of infective endocarditis (IE) among different age groups?
What is the mortality rate for infective endocarditis (IE)?
What are the cure rates for native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE)?
How effective are oral antibiotics in the treatment of infective endocarditis (IE)?
What is the role of early valvular surgery in reducing mortality from infective endocarditis (IE)?
Which factors affect the mortality rate of infective endocarditis (IE)?
What are the NICE guidelines for infective endocarditis (IE) patient education?
Presentation
What are the presenting symptoms of infective endocarditis (IE)?
Which history suggests subacute infective endocarditis (IE)?
What history suggests acute infective endocarditis (IE)?
How are acute infective endocarditis (IE) and subacute infective endocarditis (IE) differentiated?
What comorbid conditions may be the source of bacteremia in infective endocarditis (IE)?
What are the symptoms of early subacute native valve endocarditis (NVE)?
Which factors affect the rate of embolization in native valve endocarditis (NVE)?
What are the renal symptoms of infective endocarditis (IE)?
What causes lumbosacral back pain in subacute infective endocarditis (IE)?
What are the symptoms of bacteria-free infective endocarditis (IE)?
What are the symptoms of early acute infective endocarditis (IE)?
What are the symptoms and complications of IV-drug-abuse (IVDA) infective endocarditis (IE)?
What are the characteristics and complications of prosthetic valve endocarditis (PVE)?
What are the characteristics and complications of pacemaker infective endocarditis (IE)?
What are the characteristics and complications of nosocomial infective endocarditis (NIE)?
What are the classic signs of infective endocarditis (IE)?
What are the less common signs and symptoms of infective endocarditis (IE)?
Which physical findings suggest subacute infective endocarditis (IE)?
Which physical findings suggest acute infective endocarditis (IE)?
What are possible complications of infective endocarditis (IE)?
What are the most common complications of infective endocarditis (IE)?
Which factors increase the risk of complications from infective endocarditis (IE)?
What is the prevalence of embolization in infective endocarditis (IE)?
What are the possible complications of acute infective endocarditis (IE)?
How does age affect risk for complications of infective endocarditis (IE)?
DDX
What is the role of the Duke criteria in the diagnosis of infective endocarditis (IE)?
What are the major blood culture criteria for infective endocarditis (IE)?
What are the major echocardiographic criteria for infective endocarditis (IE)?
What are the minor criteria for infective endocarditis (IE)?
What are the rejection criteria for the diagnosis of infective endocarditis (IE)?
Which other conditions should be considered in the workup of infective endocarditis (IE)?
What are the differential diagnoses for Infective Endocarditis?
Workup
What is the role of blood cultures in the diagnosis of infective endocarditis (IE)?
Why is infective endocarditis (IE) a diagnostic challenge?
How is continuous bacteremia identified in the workup of infective endocarditis (IE)?
Which baseline lab studies should be performed in the workup of infective endocarditis (IE)?
Which lab findings are characteristic of infective endocarditis (IE)?
What does a positive blood culture indicate in the diagnosis of infective endocarditis (IE)?
What is the procedure for obtaining blood cultures in the workup of infective endocarditis (IE)?
How is a catheter infection associated with infective endocarditis (IE) diagnosed?
What causes culture-negative infective endocarditis (IE)?
Which pathogens cause culture-negative infective endocarditis (IE)?
When should a diagnosis of fungal infective endocarditis (IE) be considered?
How is a diagnosis of pacemaker infective endocarditis (IE) confirmed?
What is the role of echocardiography in the diagnosis of infective endocarditis (IE)?
What is the advantage of TTE in the workup of infective endocarditis (IE)?
When is Doppler ultrasonography indicated in the workup of infective endocarditis (IE)?
Which conditions are associated with valvular thrombi in infective endocarditis (IE)?
What is the role of TEE in the diagnosis of infective endocarditis (IE)?
When are TEE and TTE contraindicated in the workup of infective endocarditis (IE)?
Which findings on echocardiography are predictive of complications of infective endocarditis (IE)?
What radiographic findings suggest complications of infective endocarditis (IE)?
Which studies may be helpful in the diagnosis of infective endocarditis (IE)?
Treatment
What are the major goals of therapy for infective endocarditis (IE)?
What is the emergency department (ED) treatment of infective endocarditis (IE)?
How should antibiotics be chosen for the treatment of infective endocarditis (IE)?
How and where should antibiotics be administered in the treatment of infective endocarditis (IE)?
What are the AHA treatment guidelines for native valve endocarditis (NVE)?
What are the treatment options for enterococcal prosthetic valve endocarditis (PVE)?
When is vancomycin contraindicated in the treatment of infective endocarditis (IE)?
What is the role of linezolid in the treatment of infective endocarditis (IE)?
When should daptomycin be used in treatment of infective endocarditis (IE)?
What is the treatment for HACEK microorganisms in infective endocarditis (IE)?
What is the treatment for culture-negative native valve endocarditis (NVE)?
What is the treatment for culture-negative prosthetic valve endocarditis (PVE)?
Which antibiotics are used in the treatment of less common pathogens in infective endocarditis (IE)?
Why is prosthetic valve endocarditis (PVE) difficult to treat?
What is the treatment for penicillin-sensitive S viridans prosthetic valve endocarditis (PVE)?
What is the treatment for enterococcal prosthetic valve endocarditis (PVE)?
What is the treatment for fungal endocarditis?
What is the treatment for IV drug abuse (IVDA) infective endocarditis (IE)?
What is the role of bactericidal tests in the management of infective endocarditis (IE)?
What is the traditional approach to treatment of S aureus bacteremia in infective endocarditis (IE)?
What is the treatment of S aureus bacteremia in infective endocarditis (IE)?
What is the role of anticoagulation in the treatment of infective endocarditis (IE)?
When is surgery indicated for the treatment of native valve endocarditis (NVE)?
When is surgery indicated for the treatment of prosthetic valve endocarditis (PVE)?
What is the role of surgery for treatment of metastatic infections in infective endocarditis (IE)?
When is surgery indicated for the treatment of pacemaker infective endocarditis (IE)?
What are the NICE guidelines for prophylaxis against infective endocarditis (IE)?
What is the prevalence of infective endocarditis (IE) caused by bacteremia from invasive procedures?
When is prophylaxis against infective endocarditis (IE) indicated?
Are coronary artery stents a risk factor for infective endocarditis (IE)?
How can nosocomial infective endocarditis (NIE) be prevented?
When is antibiotic prophylaxis against pacemaker infective endocarditis (IE) indicated?
How does antibiotic prophylaxis prevent infective endocarditis (IE)?
How is successful antibiotic prophylaxis of infective endocarditis (IE) achieved?
What is a limitation of the AHA guidelines for antibiotic treatment of infective endocarditis (IE)?
What are the treatment considerations and potential pitfalls for infective endocarditis?
What specialist consultations are indicated in the treatment of infective endocarditis (IE)?
What monitoring is indicated following treatment of bacteremia in infective endocarditis (IE)?
How should the development of complications of infective endocarditis (IE) be monitored?
How common is relapse of infective endocarditis (IE)?
Guidelines
Medications
What treatment approach is most likely to be successful in infective endocarditis (IE)?
Which medications in the drug class Penicillins are used in the treatment of Infective Endocarditis?
Which medications in the drug class Carbapenems are used in the treatment of Infective Endocarditis?
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Acute bacterial endocarditis caused by Staphylococcus aureus with perforation of the aortic valve and aortic valve vegetations. Courtesy of Janet Jones, MD, Laboratory Service, Wichita Veterans Affairs Medical Center.
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Acute bacterial endocarditis caused by Staphylococcus aureus with aortic valve ring abscess extending into myocardium. Courtesy of Janet Jones, MD, Laboratory Service, Wichita Veterans Affairs Medical Center.
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A middle-aged man with a history of intravenous drug use who presented with severe myalgias and a petechial rash. He was diagnosed with right-sided staphylococcal endocarditis.
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This is a magnified portion of a parasternal long axis view from a transthoracic echocardiogram. There is a small curvilinear vegetation on the mitral valve as indicated. The patient presented with a headache and fever, and CT scan of the brain revealed an occipital hemorrhage. The patient had a history of intravenous drug use and multiple blood cultures grew Staphylococcus aureus.
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A young adult with a history of intravenous drug use, endocarditis involving the tricuspid valve with Staphylococcus aureus, and multiple septic pulmonary emboli. Pulmonary lesions on chest radiograph are most prominent in the right upper lobe with both solid and cavitary appearance.
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Mitral valve: endocarditis with valve destruction and vegetation. Note the posterior leaflet of the mitral valve, with an irregular vegetation on the atrial surface, resulting in valve destruction at the commissure between the anterior leaflet and the posterior leaflet.
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Aortic valve: healed endocarditis. Note the gaping hole with the fibrous rim, and a small strand at the free edge. The hole is at the line of closure. The affected valve is the left cusp. Note the right noncoronary cusp (immediate to the left in this image) demonstrates a small, multichanneled fenestration at the commissure, immediately adjacent to similar fenestrations in the left coronary cusp. These are physiologic lesions occurring with age and are unrelated to endocarditis.
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Aortic valve: bicuspid, with infectious endocarditis. In this excised valve, note the bulky vegetations on the ventricular surfaces, with distortion of the valve surfaces.
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Mitral valve: postrheumatic, with infectious endocarditis. A defect is seen in the scarred valve, with focal surface hemorrhage. The patient also underwent aortic valve replacement, as there was contiguous infection.
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The surface of the valves, in most cases, demonstrates areas of acute neutrophilic inflammation with admixed fibrin and platelets. Degenerated bacterial colonies are seen at the left. Also, areas of microcalcification may mimic bacterial deposits.
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Infectious endocarditis, subacute phase. Hemorrhage and prominent granulation tissue with neovascularity is apparent throughout. This aortic valve showed fibrin exudate on the ventricular surface (below), with more prominent organization and granulation on the aortic surface (above).
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Infectious endocarditis, surface of valve leaflet with fibrin; higher magnification of previous image. A chronic infiltrate is seen, just under the denuded thrombosed surface, with primarily macrophages and focal macrophage giant cells.
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Bioprosthetic valve with endocarditis. Note the large bacterial colony (staphylococci by culture) in the absence of significant inflammation; the xenograft tissue is not viable, and nuclear detail is not apparent.