Infective Endocarditis: Diagnosis and Treatment

Area of Science:

• Cardiology
• Infectious Diseases
• Pathology

Background:

• Infective endocarditis (IE) originates from damage to the heart's endothelial lining, creating an infection nidus.
• This nidus provokes a cytokine-mediated inflammatory response, promoting platelet aggregation and thrombus formation.
• Bacterial or fungal pathogens in the bloodstream can adhere to thrombi, leading to colonization, proliferation, and vegetation development on heart valves.

Purpose of the Study:

• To outline the pathogenesis of infective endocarditis.
• To identify common causative pathogens.
• To emphasize diagnostic and therapeutic strategies for IE.

Main Methods:

• Review of the pathophysiology of infective endocarditis.
• Identification of prevalent bacterial pathogens: Staphylococcus aureus, Streptococcus, and Enterococcus species.
• Clinical presentation, diagnostic evaluation (blood cultures, echocardiography, 2023 Duke Criteria), and treatment modalities.

Main Results:

• Fever is the most common symptom in acute IE; subacute cases may present without fever.
• A new or worsening heart murmur is a characteristic clinical sign.
• Staphylococcus aureus, Streptococcus, and Enterococcus species account for over 80% of bacterial IE cases.

Conclusions:

• Infective endocarditis requires consideration in patients with unexplained fever or sepsis.
• Prompt diagnosis using blood cultures, echocardiography, and the 2023 Duke Criteria is essential.
• Initial management involves empiric intravenous antibiotics, source control, multidisciplinary consultation, and monitoring for complications, with potential need for surgical intervention and antibiotic prophylaxis.