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Injecting illicit substances epidemic and infective endocarditis
Ioannis Starakis1, Elias E Mazokopakis
1Internal Medicine Department, Patras University Hospital, Rion-Patras, Greece. istarakis@yahoo.com
Insights
Infective endocarditis (IE) is a serious concern for intravenous drug abusers (IVDAs). This review comprehensively covers IE in IVDAs, focusing on epidemiology, diagnosis, and treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Infective endocarditis (IE) is a critical concern in intravenous drug abusers (IVDAs).
- While historically associated with right-sided heart valves, left-sided IE is increasingly reported in this population.
- Despite advances in imaging, understanding right-sided IE in IVDAs requires further attention.
Purpose of the Study:
- To comprehensively review the epidemiology, predisposing factors, clinical features, complications, diagnosis, treatment, and prognosis of IE in IVDAs.
- To highlight distinctive and exclusive features of IE in individuals who inject illicit substances.
- To provide an updated perspective on this serious condition.
Main Methods:
- Literature review of published reports on IE in IVDAs.
- Synthesis of information regarding epidemiological trends.
- Analysis of clinical presentations, diagnostic modalities, and therapeutic strategies.
Main Results:
- Right-sided endocarditis constitutes approximately 10% of all IE cases and is strongly linked to illicit drug injection.
- An increasing trend of left-sided valve involvement in IE among IVDAs has been observed.
- Despite improved diagnostic capabilities, challenges remain in fully understanding right-sided IE.
Conclusions:
- IE remains a significant risk for IVDAs, necessitating high clinical suspicion.
- The evolving patterns of IE, including increased left-sided valve involvement, require ongoing vigilance.
- A comprehensive understanding and tailored management approach are crucial for improving outcomes in this patient group.
Abstract:
Infective endocarditis (IE) is not the most frequent infection acquainted in intravenous drug abusers (IVDAs). On the other hand, all physicians should keep a high index of suspicion and always consider this possibility when they are dealing with an infectious process in this special population group. Since Sir William Osler, at the turn of the previous century, first described IE, there have been tremendous alterations in the very nature of this serious and possibly fatal disease. Right-sided endocarditis accounts for almost 10% of all IE episodes and has been correlated most commonly with injection of illicit drugs. However, recent reports have proposed that left-sided valves' participation is seen more often now than in the past. Although, the advances in medicine and especially modern imaging techniques have expanded our capacity to identify IE, there are still some gray areas in our ability to fully comprehend right-sided IE. Hussey et al. [1] were the first to distinguish IE as a distinct impediment of IV narcotics abuse in 1950. Although, many reports have been published since then arguing about the aspects of this medical entity, we will try here to comprehensively review the epidemiology and predisposing factors, clinical features and complications, diagnosis, treatment and prognosis of this disease, emphasizing on those distinctive or exclusive features seen in IE patients who are injecting illicit substances.
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