Infective endocsrditis: modern course and new aspects

An analysis of 300 patients (pts) of the last series with infective endocarditis (IE) was done for evaluation of a modern course of IE (archives: 1200 pts) and revealed the changing patterns of this evolving disease. There has been a significant trend toward an increase in the age of pts with IE. The proportion of pts with IE who have rheumatic heart disease as an underlying lesion ahs decreased from about 60% in pts studied from 1950 to 1970 to about 30 YO in resent series. Etiologically the change is characterized by a reduction of streptococci (from 90% to 35%) and a much higher incidence of staphylococci (from 3% to 30%), gram-negative bacteria and other virulent organisms (from 3% to 15%). The fever was in 70% of cases, arthralgia, splenomegaly and CNS involvement (CT confirmed) were seen not more than in 20% of pts. Significant cardiac murmurs were obtained in 80% ofpts, sep- tic complication - in 12%, micotic aneurysms - in 4%, renal complications - in 30%. Congestive heart failure was the most comman consequence (80%) and the cause of death. Postoperative IE including prosthetic one, right-sided disease and injecting drug users subgroups became the routine forms (20%) of the disease. IE with reducing classic features observed frequently especially in middle-aged pts (30%). Correct early diagnoses were made only in 35% of IE cases.