Infective Endocarditis Symptoms, Treatment, Surgery, Mortality, Prognosis, Causes, and Hospitals

Infective Endocarditis

1. Definition

Infective endocarditis (IE) is a disease in which pathogens such as bacteria and fungi infect the endocardium of the heart, causing inflammation. This disease mainly occurs in the heart valves, especially where the blood flow in the heart slows down or backflows. Bacteria or fungi invade the heart through the bloodstream and cause infection of the endocardium. Infective endocarditis can severely affect the function of the heart and is a life-threatening disease that can lead to death if left untreated.

2. Characteristics

The main characteristics of infective endocarditis are as follows:

• Bacterial Infection: In most cases, it is caused by bacteria, primarily Streptococcus viridans, Staphylococcus aureus, and Enterococcus.
• Bloodstream Infection: Pathogens reach the heart through the bloodstream, causing inflammation of the endocardium. Pathogens easily settle in areas where blood flow is slow or backflow occurs.
• Heart Valve Damage: When bacteria infect the endocardium, the heart valves are damaged, leading to problems with heart function. This can cause serious problems such as heart failure, abnormal heart sounds, and heart valve closure.
• Complications: If the infection spreads to the heart, it can spread to other organs such as the brain, kidneys, and lungs, causing various complications.

3. Causes

The main causative agents of infective endocarditis are as follows:

• Streptococcus species: Especially the Streptococcus viridans group, bacteria that inhabit the oral cavity and upper respiratory tract.
• Staphylococcus aureus: Bacteria that inhabit the skin and upper respiratory tract, mainly Staphylococcus aureus causes the infection.
• Enterococci: Bacteria found in the large intestine that can cause endocarditis.
• Other bacteria and fungi: Fungi such as Candida can also be causative agents.

These pathogens are often transmitted to the heart through the bloodstream. Conditions that increase the risk of infection include:

• Heart disease: People with pre-existing heart disease (e.g., valvular disease, artificial heart valves) are at higher risk of developing infective endocarditis.
• Bloodstream infection: Bloodstream infections caused by dental procedures, surgery, or intravenous injections can cause infective endocarditis.
• Weakened immune system: It can occur in people with weakened immune systems (e.g., cancer, diabetes, those receiving immunosuppressive therapy).
• Drug abuse: Intravenous drug users have a higher risk of infection.

4. Symptoms

The symptoms of infective endocarditis can vary depending on the location of the infection, the severity of the infection, and the patient's immune status. Common symptoms include:

• Fever: Most patients experience a high fever (above 38°C). Fever is often an early symptom of infection.
• Weight loss, fatigue, lethargy: Systemic symptoms due to infection can cause weight loss and fatigue.
• Changes in heart sounds: Inflammation in the heart can damage the heart valves, causing abnormal heart sounds or a heart murmur.
• Shortness of breath: Difficulty breathing can occur due to heart failure.
• Osler's nodes: Small, painful nodules may appear on the fingertips and toes.
• Bleeding: Small hemorrhagic spots may appear under the fingernails, called splinter hemorrhages.
• Unsteady gait: Neurological symptoms may appear as the infection progresses over time. If it spreads to the brain, stroke symptoms may also occur.

5. Treatment and Surgical Methods

Treatment for infective endocarditis can be divided into antibiotic treatment and surgical treatment.

5.1. Antibiotic Treatment

• Antibiotic Selection: Initial treatment involves hospitalization and the use of strong intravenous antibiotics. Major antibiotics include Penicillin, Vancomycin, Gentamicin, etc., and the appropriate antibiotic is selected according to the type of bacteria infected.
• Treatment Duration: Treatment should last at least 4-6 weeks, and antibiotic treatment is necessary until the infection is completely cured.
• Monitoring: If the infection is not completely eradicated during treatment or the patient's condition worsens, antibiotic treatment may need to be adjusted or other treatment methods considered.

5.2. Surgical Treatment

• Heart valve surgery: If the heart valve is damaged or loses function due to infective endocarditis, surgery may be required to replace or repair the valve. An artificial heart valve may need to be implanted, or the infected part may need to be removed.
• Other surgeries: Surgical treatment may be necessary if the infection spreads to organs other than the heart, or if infected masses block blood vessels and cut off blood flow.

6. Prognosis and Management

The prognosis of infective endocarditis varies greatly depending on the timing of diagnosis and treatment. If treatment begins quickly, serious life-threatening situations can be prevented. However, delayed treatment or the occurrence of complications can be fatal.

6.1. Prognosis

• Prompt Treatment: If treatment is prompt, the infection is successfully eradicated in most cases.
• Occurrence of Complications: The occurrence of complications such as stroke, decreased heart function, and kidney damage can worsen the prognosis. In particular, if the infection spreads to the brain, a stroke can occur.

6.2. Management

• Regular Checkups: Regular checkups are necessary after treatment to monitor the heart condition and continue follow-up treatment.
• Infection Prevention: Prophylactic antibiotics may be used in situations such as dental treatment, surgery, and hemodialysis. Avoiding drug abuse and strengthening the immune system are also important.
• Healthy Lifestyle: Maintaining overall health through a healthy diet, regular exercise, and stress management is important.

Conclusion

Infective endocarditis is a disease that requires early treatment. It is caused by bacterial or fungal infections, and because it has various symptoms and can be accompanied by serious complications, early diagnosis and treatment are important. Antibiotic treatment and surgical treatment should be used appropriately, and consistent management and prevention are necessary after treatment.