Show Summary Details
Page of

Pathophysiology and causes of endocarditis 

Pathophysiology and causes of endocarditis
Pathophysiology and causes of endocarditis

Franck Thuny

and Didier Raoult

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2022. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 19 May 2022

Endocarditis is defined as an inflammation of the endocardial surface of the heart. This may include heart valves, mural endocardium or the endocardium that covers implanted material, such as prosthetic valves, pacemaker/defibrillator leads and catheters. Infective and non-infective-related causes must be distinguished. In most cases, the inflammation is related to a bacterial or fungal infection with oral streptococci, group D streptococci, staphylococci and enterococci accounting for 85% of episodes. Infective endocarditis (IE) is a serious disease with an incidence ranging from 30 to 100 episodes/million patient-years. From various portals of entry (e.g. oral, digestive, cutaneous) and a subsequent bacteraemia, pathogens can adhere and colonize intracardiac foreign material or onto previously damaged endocardium due to numerous complex processes based on a unique host–pathogen interaction. Rarely, endocarditis can be related to non-infective causes, such as immunological or neoplastic. Mortality is high, with more than one-third dying within a year of diagnosis from complications such as acute heart failure or emboli. This disease still remains a diagnostic challenge with many cases being identified and subsequently treated too late. Diagnosis of IE usually relies on the association between an infectious syndrome and recent endocardial involvement. Blood cultures and echocardiography are the main diagnostic procedures, but are negative in almost 30% of cases, requiring the use of more sophisticated techniques. Computed tomography, magnetic resonance imaging and positron emission tomography are promising imaging modalities. Improved understanding of its pathophysiology and the development of relevant diagnostic strategies enables accelerated identification and treatment, and thus an improved prognosis.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.