Infective endocarditis: a narrative review

Abstract

Infective endocarditis is a serious infection of the endocardium, which is the inner layer of the heart. It can be caused by bacteria, fungi, and other microorganisms, and occurs when these agents invade the heart, usually through the bloodstream. The epidemiology of infective endocarditis varies, with higher incidence in patients with risk factors such as pre-existing heart diseases, cardiac prostheses and implantable devices, intravenous drug use, and invasive procedures. The signs and symptoms of infective endocarditis may vary, depending on the acuteness of the infection. Acute clinical manifestations may include high fever, chills, sweating, chest pain, fatigue, and changes in mental status. Subacute manifestations may be more subtle, with intermittent fever, weight loss, anemia, and small skin spots called petechiae. The diagnosis of infective endocarditis is based on clinical criteria, laboratory tests, and imaging exams. The Duke criteria, which take into consideration clinical signs and symptoms, laboratory results, and imaging findings, are essential for diagnosis. Other diagnostic tools may include echocardiography, blood cultures, and additional imaging exams such as SPECT-CT. Treatment often starts empirically and is then modified to become more specific to the identified pathogen. In some cases, surgical treatment may be necessary to remove infected tissue or repair damaged heart valves. Treatment is individualized for each patient, taking into consideration the severity of the infection, the causative agent, and the patient's clinical conditions. In conclusion, infective endocarditis is a serious infection of the heart that can be caused by various infectious agents. Diagnosis is based on clinical criteria and complementary exams, and treatment is complex, involving antimicrobial therapy, surgical treatment, and other therapeutic approaches. It is important to be aware of the risk factors, signs and symptoms, as well as the options for diagnosis and treatment of this condition in order to promote proper management and improve clinical outcomes for patients affected by infective endocarditis.