Editing Infective endocarditis (section)

{{short description|Infection of the heart's inner surface (endocardium)}}
{{Infobox medical condition
| name = Infective endocarditis
| synonyms = Bacterial endocarditis
| image = Haemophilus parainfluenzae Endocarditis PHIL 851 lores.jpg
| caption = A [[mitral valve]] [[Vegetation (pathology)|vegetation]] caused by bacterial endocarditis
| pronounce = 
| field = [[Cardiology]], [[Infectious disease (medical specialty)|infectious disease]]
| symptoms = [[Fever]], [[petechia|small areas of bleeding into the skin]], [[heart murmur]], feeling tired, [[anemia|low red blood cells]]<ref name=Mer2017/>
| complications = [[Valvular insufficiency]], [[heart failure]], [[stroke]], [[kidney failure]]<ref name=Mer2017/><ref name=Nj2017/> Blood clot in a lung artery (pulmonary embolism)<ref>{{cite news |title=Endocarditis |url= https://www.mayoclinic.org/diseases-conditions/endocarditis/symptoms-causes/syc-20352576 |access-date=June 4, 2022 |publisher=Mayo Clinic |date= }}</ref> Enlarged and painful spleen, kidney damage, damage to the distal extremities such as fingers and toes.<ref>{{cite web | work = Cleveland Clinic |title=Endocarditis |url= https://my.clevelandclinic.org/health/diseases/23068-infective-endocarditis |access-date=2022-06-09}}</ref>
| onset = 
| duration = 
| types = 
| causes = [[Bacterial infection]], [[fungal infection]]<ref name=Mer2017/>
| risks = [[Valvular heart disease]] including [[rheumatic heart disease|rheumatic disease]], [[congenital heart disease]],<ref name="Factors associated with long-term o">{{cite journal |last1=Verzelloni Sef |first1=A |last2=Jaggar |first2=SI |last3=Trkulja |first3=V |last4=Alonso-Gonzalez |first4=R |last5=Sef |first5=D |last6=Turina |first6=MI |title=Factors associated with long-term outcomes in adult congenital heart disease patients with infective endocarditis: A 16-year tertiary single-centre experience. |journal=European Journal of Cardio-Thoracic Surgery |date=22 March 2023 |volume=63 |issue=5 |doi=10.1093/ejcts/ezad105 |pmid=36946284}}</ref> [[artificial valves]], [[hemodialysis]], [[intravenous drug use]], [[electronic pacemaker]]s<ref name=Amb2017/><ref name="auto">{{cite journal |last1=Habib |first1=G |last2=Lancellotti |first2=P |last3=Antunes |first3=MJ |last4=Bongiorni |first4=MG |last5=Casalta |first5=JP |last6=Del Zotti |first6=F |last7=Dulgheru |first7=R |last8=El Khoury |first8=G |last9=Erba |first9=PA |last10=Iung |first10=B |last11=Miro |first11=JM |last12=Mulder |first12=BJ |last13=Plonska-Gosciniak |first13=E |last14=Price |first14=S |last15=Roos-Hesselink |first15=J |last16=Snygg-Martin |first16=U |last17=Thuny |first17=F |last18=Tornos Mas |first18=P |last19=Vilacosta |first19=I |last20=Zamorano |first20=JL |title=2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). |journal=European Heart Journal |date=21 November 2015 |volume=36 |issue=44 |pages=3075–3128 |doi=10.1093/eurheartj/ehv319 |pmid=26320109|doi-access=free }}</ref>
| diagnosis = Based on symptoms, [[blood cultures]], [[ultrasound]]<ref name=Mer2017/>
| differential = 
| prevention = 
| treatment = [[Antibiotic]]s, [[heart surgery]]<ref name=Mer2017/>
| medication = 
| prognosis = 25% risk of death<ref name=Amb2017/>
| frequency = 5 per 100,000 per year<ref name=Amb2017/>
| deaths = 
}}

<!-- Definition and symptoms -->
'''Infective endocarditis''' is an [[infection]] of the inner surface of the heart ([[endocardium]]), usually the [[heart valve|valves]].<ref name=Mer2017/> [[Signs and symptoms]] may include [[fever]], [[petechia|small areas of bleeding into the skin]], [[heart murmur]], feeling tired, and [[anemia|low red blood cell count]].<ref name=Mer2017>{{cite news|title=Infective Endocarditis – Cardiovascular Disorders|url=http://www.merckmanuals.com/en-ca/professional/cardiovascular-disorders/endocarditis/infective-endocarditis|website=Merck Manuals Professional Edition|access-date=11 December 2017|language=en-CA|date=September 2017}}</ref><ref name=":0">{{cite journal | vauthors = Kumar M, Anstadt EJ, Lopetegui Lia N, Siddiqi MH | title = Streptococcus viridans Endocarditis Affecting All Four Valves | journal = Cureus | volume = 11 | issue = 5 | pages = e4635 | date = May 2019 | pmid = 31312561 | pmc = 6623990 | doi = 10.7759/cureus.4635 | doi-access = free }}</ref> Complications may include [[valvular insufficiency|backward blood flow in the heart]], [[heart failure]] – the heart struggling to pump a sufficient amount of blood to meet the body's needs, [[Heart block|abnormal electrical conduction in the heart]], [[stroke]], and [[kidney failure]].<ref name=Mer2017/><ref name=Nj2017>{{cite journal | vauthors = Njuguna B, Gardner A, Karwa R, Delahaye F | title = Infective Endocarditis in Low- and Middle-Income Countries | journal = Cardiology Clinics | volume = 35 | issue = 1 | pages = 153–163 | date = February 2017 | pmid = 27886786 | doi = 10.1016/j.ccl.2016.08.011 | hdl-access = free | hdl = 1805/14046 }}</ref><ref name=":0" /><ref>{{Cite journal |last1=Merkler |first1=Alexander E. |last2=Chu |first2=Stacy Y. |last3=Lerario |first3=Michael P. |last4=Navi |first4=Babak B. |last5=Kamel |first5=Hooman |date=2015-08-11 |title=Temporal relationship between infective endocarditis and stroke |journal=Neurology |volume=85 |issue=6 |pages=512–516 |doi=10.1212/WNL.0000000000001835 |issn=1526-632X |pmc=4540247 |pmid=26163428}}</ref>

<!-- Cause and diagnosis -->
The cause is typically a [[bacterial infection]] and less commonly a [[fungal infection]].<ref name=Mer2017/> Risk factors include [[valvular heart disease]], including [[rheumatic heart disease|rheumatic disease]], [[congenital heart disease]], [[artificial valves]], [[hemodialysis]], [[intravenous drug use]], and [[electronic pacemaker]]s.<ref name=Amb2017/><ref name="auto"/><ref name="Factors associated with long-term o"/> The bacteria most commonly involved are [[streptococci]] or [[staphylococci]].<ref name=Mer2017/> Diagnosis is suspected based on symptoms and supported by [[blood cultures]] or [[Echocardiogram|ultrasound]] of the heart.<ref name=Mer2017/> There is also a [[noninfective endocarditis|noninfective]] form of [[endocarditis]].<ref name=Mer2017/>

<!-- Prevention and treatment -->
The usefulness of [[antibiotics]] following [[dental procedure]]s for prevention is unclear.<ref>{{cite journal | vauthors = Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, Lockhart P, Roberts N, Shanson D, Thornhill M, Heneghan CJ, Prendergast BD | s2cid = 25918810 | title = Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis | journal = Heart | volume = 103 | issue = 12 | pages = 937–944 | date = June 2017 | pmid = 28213367 | doi = 10.1136/heartjnl-2015-309102 | url = http://eprints.whiterose.ac.uk/112532/7/Cahill_et_al_13_12_16.pdf }}</ref> Some recommend them for people at high risk.<ref name=Mer2017/> Treatment is generally with [[intravenous antibiotics]].<ref name=Mer2017/> The choice of antibiotics is based on the results of blood cultures.<ref name=Mer2017/> Occasionally [[heart surgery]] is required.<ref name=Mer2017/>
<!-- Epidemiology and prognosis -->
The number of people affected is about 5 per 100,000 per year.<ref name=Amb2017/> Rates, however, vary between regions of the world.<ref name=Amb2017/> Infective endocarditis occurs in males more often than in females.<ref name=Mer2017/> The risk of death among those infected is about 25%.<ref name="Amb2017">{{cite journal |vauthors=Ambrosioni J, Hernandez-Meneses M, Téllez A, Pericàs J, Falces C, Tolosana JM, Vidal B, Almela M, Quintana E, Llopis J, Moreno A, Miro JM |date=12 April 2017 |title=The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century |journal=Current Infectious Disease Reports |volume=19 |issue=21 |doi=10.1007/s11908-017-0574-9 |pmid=28401448 |s2cid=24935834 |doi-access=free}}</ref> Without treatment, it is almost universally fatal.<ref name=Mer2017/> Improved diagnosis and treatment options have significantly enhanced the life expectancy of patients with infective endocarditis, particularly with congenital heart disease.<ref name="Factors associated with long-term o"/>
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