Infective Endocarditis

Infective endocarditis is an infection of the inner lining of the heart, nearly always on a heart valve. Bacteria, or rarely fungi, enter the bloodstream, settle on the valve and form clumps called vegetations that can destroy the valve and break off to lodge in the brain, kidneys, spleen or limbs.

It is uncommon but serious. It requires weeks of intravenous antibiotics in hospital, and around half of patients also need valve surgery. It is not a condition to travel with; this page is for understanding it and for planning care after the acute illness.

Symptome

• Fever, chills and night sweats lasting more than a few days
• Fatigue, aching muscles and joints, weight loss
• A new or changed heart murmur
• Breathlessness or ankle swelling from a leaking valve
• Small painful spots on fingers or toes, tiny bleeds under the nails or in the eyes
• Stroke symptoms, flank pain or a painful cold limb from emboli
• Blood in the urine

Ursachen und Risikofaktoren

Bacteria reach the blood from the mouth (poor dental health, gum disease, dental procedures), the skin, intravenous lines, dialysis, injected drug use or infections elsewhere. The commonest organisms are Staphylococcus aureus, streptococci from the mouth and enterococci. Risk is highest in people with prosthetic valves or valve repairs, previous endocarditis, congenital heart disease, pacemaker or ICD leads, rheumatic or degenerative valve disease, and in people who inject drugs. It can also affect previously normal valves.

Wie es diagnostiziert wird

• Blood cultures: At least three sets taken before antibiotics; they identify the organism and the right drug.
• Transthoracic echocardiography: First imaging test to look for vegetations and valve leakage.
• Transoesophageal echocardiography: Much more sensitive, and needed for prosthetic valves, abscess and device leads.
• CT, PET-CT or MRI: Detects abscesses around prosthetic valves and silent emboli in the brain and organs.
• Duke criteria: A structured combination of clinical, microbiological and imaging findings used to confirm the diagnosis.

Behandlungsmöglichkeiten

• Intravenous antibiotics: Usually 4 to 6 weeks, chosen from culture results, started in hospital. Selected stable patients finish with outpatient IV or oral step-down therapy.
• Valve surgery: For heart failure from valve destruction, uncontrolled infection or abscess, large vegetations with embolic risk, and most prosthetic valve infections with complications.
• Device extraction: Infected pacemaker or ICD systems must be removed completely.
• Treating the source: Dental assessment and treatment, line removal, addiction services.
• Prevention afterwards: Meticulous oral hygiene, regular dental review and antibiotic prophylaxis before invasive dental work for high-risk patients.

Wenn es dringend ist

If you have a prosthetic valve, congenital heart disease or previous endocarditis and develop an unexplained fever lasting more than 2 to 3 days, see a doctor locally and ask for blood cultures before any antibiotics. Stroke symptoms, severe breathlessness or collapse need an emergency call. Do not fly with suspected endocarditis.

Reisen nach Türkiye zur Behandlung

Acute endocarditis is treated where it is diagnosed. Travel may become relevant later: once infection is cleared and you are stable, a damaged valve may need elective repair or replacement, which can be planned abroad with a stay of about 3 weeks. A second opinion on imaging and the timing of surgery can also be given remotely.

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