Infective endocarditis.

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Infectious endocarditis (IE) diagnosis is often delayed due to nonspecific and variable clinical presentations.
• While the Duke criteria have improved diagnosis, IE remains a significant challenge with stable incidence.
• Predisposing factors are shifting towards degenerative valvular disease and intravascular foreign material.

Purpose of the Study:

• To highlight the diagnostic challenges and evolving epidemiology of infectious endocarditis.
• To emphasize the importance of early diagnosis and prompt, multidisciplinary management.
• To discuss the complications, treatment strategies, and factors influencing mortality in IE.

Main Methods:

• Review of clinical, bacteriological, and echocardiographical findings integrated by Duke criteria.
• Analysis of epidemiological trends, predisposing factors, and complications.
• Evaluation of current treatment paradigms including antibiotic therapy and cardiac surgery indications.

Main Results:

• IE frequently presents with atypical symptoms, complicating early diagnosis.
• Complications include heart failure (approx. 50%) and embolic events (approx. 33%), often occurring early in treatment.
• Staphylococcus aureus with artificial valves increases risk of perivalvular abscesses.

Conclusions:

• Prompt initiation of high-dose, tailored antibiotic therapy (4-6 weeks) is essential.
• Early cardiac surgery is often required ( >50% of patients) and associated with better outcomes.
• Despite advances, mortality remains high due to aggressive pathogens and an aging, comorbid population.