[Infective endocarditis. Recent progress in its epidemiology, clinical picture and therapy. Comments on cases]

Infective endocarditis (IE) may be considered as a disease in evolution because of changes occurred in the last decades in epidemiologic and clinical aspects. M-mode, two-dimensional, Doppler and color Doppler echocardiography allowed major advances in diagnosis and management of patients with IE. More recently, transesophageal echocardiography has been introduced in clinical practice with excellent results, because of unsurpassed quality of images able to early recognize small vegetations and complications of infective process. The authors report 13 cases of IE observed from March 1991 to March 1993. Streptococcus viridans was detected in 46% of cases and enterococcus species in 23%. Culture negative endocarditis represented 31% of total cases. Mitral valve was most frequently involved (67% of cases of native valves), followed by aortic valve (22%) and tricuspid valve (11%). In 30% of cases a prosthetic valve was involved. A presumed portal of entry has been identified, in 69% of cases, in oral cavity during dental procedures; in 2 cases an asymptomatic colonic carcinoma was detected. Diagnostic sensitivity of transesophageal echocardiography was 100%. Only 1 patient died during hospitalization. Cardiac surgery was performed in 4 patients (33%). The antibiotic drug teicoplanine has been successfully employed in 54% of cases.