Infective endocarditis

Abstract

Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease--mostly chronic rheumatic heart disease--IE now tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices, and patients exposed to healthcare-associated bacteremia. As a result, skin organisms (for example, Staphylococcus spp.) are now reported as the pathogen in these populations more often than oral streptococci, which still prevail in the community and in native-valve IE. Moreover, progress in molecular diagnostics has helped to improve the diagnosis of poorly cultivable pathogens, such as Bartonella spp. and Tropheryma whipplei, which are responsible for blood-culture-negative IE more often than expected. Epidemiological data indicate that IE mostly occurs independently of medico-surgical procedures, and that circumstantial antibiotic prophylaxis is likely to protect only a minute proportion of individuals at risk. Therefore, new strategies to prevent IE--including improvement of dental hygiene, decontamination of carriers of Staphylococcus aureus, vaccination, and, possibly, antiplatelet therapy--must be explored.

Infective Endocarditis in Elderly: From Etiology to Treatment and Prevention

“…Эти бактерии обладают активной способностью к прикреплению и колони-зации поврежденных клапанов благодаря своим поверхностным белкам -адгезинам, способствую-щим фиксации к экстрацеллюлярным матричным белкам эндокарда [13,30].…”

Importance of Dermatology in Infective Endocarditis

“…IE is a rare disease with 2 to 6 per 100 000 persons affected per year (Que, 2011). Classically described in young patients after chronic rheumatic heart disease.…”

Getting to the heart of the matter: Role ofStreptococcus mutansadhesin Cnm in systemic disease

“…Together with staphylococci and enterococci, the viridans group streptococci account for 80-90% of all IE cases. 9 While relatively rare (3-10 cases per 100,000 individuals), the one year mortality rate for this infection of the heart valves remains at ca. 30%, with treatment options frequently incorporating surgery and long-term administration of antibiotics.…”

“…[12][13][14][15] Upon transiting from the oral cavity to the cardiovascular system, these streptococci must then adhere to the endothelium of the heart valves, where they promote deposition of fibrin and blood platelets to form an infective vegetation (clot). 9,16,17 In this issue, Freires et al 18 utilize a surrogate host expression system to demonstrate that S. mutans surface adhesin Cnm (collagen-binding protein of S. mutans) is essential for this process.…”