Editing Endocarditis (section)

==Infective endocarditis==
{{main|Infective endocarditis}}
<!-- Definition and symptoms -->
Infective endocarditis is an [[infection]] of the [[endocardium|inner surface of the heart]], usually the [[heart valve|valves]].<ref name=Mer2017/> Symptoms may include [[fever]], [[petechia|small areas of bleeding into the skin]], [[heart murmur]], feeling tired, and [[anemia|low red blood cells]].<ref name=Mer2017>{{cite web|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> Complications may include [[valvular insufficiency]], [[heart failure]], [[stroke]], and [[kidney failure]].<ref name=Nj2017>{{cite journal|last1=Njuguna|first1=B|last2=Gardner|first2=A|last3=Karwa|first3=R|last4=Delahaye|first4=F|title=Infective Endocarditis in Low- and Middle-Income Countries.|journal=Cardiology Clinics|date=February 2017|volume=35|issue=1|pages=153–163|doi=10.1016/j.ccl.2016.08.011|pmid=27886786|hdl=1805/14046|hdl-access=free}}</ref><ref name=Mer2017/>

<!-- 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 disease]], [[congenital heart disease]], [[artificial valves]], [[hemodialysis]], [[intravenous drug use]], and [[electronic pacemaker]]s.<ref name=Amb2017/> The bacteria most commonly involved are [[streptococci]] or [[staphylococci]].<ref name=Mer2017/>

The diagnosis of infective endocarditis relies on the [[Duke criteria]], which were originally described in 1994 and modified in 2000. Clinical features and microbiological examinations are the first steps to diagnose an infective endocarditis. The imaging is also crucial. Echocardiography is the cornerstone of imaging modality in the diagnosis of infective endocarditis. Alternative imaging modalities as computer tomography, magnetic resonance imaging, and positron emission tomography/computer tomography (PET/CT) with [[Fluorodeoxyglucose (18F)|2-[18F]fluorodeoxyglucose (FDG)]] are playing an increasing role in the diagnosis and management of infective endocarditis.<ref>{{Cite journal |last1=Hubers |first1=Scott A. |last2=DeSimone |first2=Daniel C. |last3=Gersh |first3=Bernard J. |last4=Anavekar |first4=Nandan S. |date=May 2020 |title=Infective Endocarditis: A Contemporary Review |journal=Mayo Clinic Proceedings |language=en |volume=95 |issue=5 |pages=982–997 |doi=10.1016/j.mayocp.2019.12.008|pmid=32299668 |s2cid=215803991 |doi-access=free }}</ref>

<!-- Prevention and treatment -->
The usefulness of [[antibiotics]] following [[dental procedure]]s has changed over time.<ref>{{cite journal|last1=Cahill|first1=TJ|last2=Harrison|first2=JL|last3=Jewell|first3=P|last4=Onakpoya|first4=I|last5=Chambers|first5=JB|last6=Dayer|first6=M|last7=Lockhart|first7=P|last8=Roberts|first8=N|last9=Shanson|first9=D|last10=Thornhill|first10=M|last11=Heneghan|first11=CJ|last12=Prendergast|first12=BD|title=Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis.|journal=Heart|date=June 2017|volume=103|issue=12|pages=937–944|doi=10.1136/heartjnl-2015-309102|pmid=28213367|s2cid=25918810|url=http://eprints.whiterose.ac.uk/112532/7/Cahill_et_al_13_12_16.pdf}}</ref> Prevention is recommended in patients at high risk.<ref name=Mer2017/> Treatment is generally with [[intravenous antibiotics]].<ref name=Mer2017/> The choice of antibiotics is based on the blood cultures.<ref name=Mer2017/> Occasionally [[heart surgery]] is required.<ref name=Mer2017/><ref>{{cite journal |last1=Delgado |first1=V |last2=Ajmone Marsan |first2=N |last3=de Waha |first3=S |last4=Bonaros |first4=N |last5=Brida |first5=M |last6=Burri |first6=H |last7=Caselli |first7=S |last8=Doenst |first8=T |last9=Ederhy |first9=S |last10=Erba |first10=PA |last11=Foldager |first11=D |last12=Fosbøl |first12=EL |last13=Kovac |first13=J |last14=Mestres |first14=CA |last15=Miller |first15=OI |last16=Miro |first16=JM |last17=Pazdernik |first17=M |last18=Pizzi |first18=MN |last19=Quintana |first19=E |last20=Rasmussen |first20=TB |last21=Ristić |first21=AD |last22=Rodés-Cabau |first22=J |last23=Sionis |first23=A |last24=Zühlke |first24=LJ |last25=Borger |first25=MA |title=2023 ESC Guidelines for the management of endocarditis. |journal=European Heart Journal |date=14 October 2023 |volume=44 |issue=39 |pages=3948–4042 |doi=10.1093/eurheartj/ehad193 |pmid=37622656|doi-access=free |hdl=10281/436142 |hdl-access=free }}</ref> Populations at high risk of infective endocarditis include patients with previous infective endocarditis, patients with surgical or transcatheter prosthetic valves or post-cardiac valve repair, and patients with untreated CHD and surgically corrected congenital heart disease.<ref>{{cite journal |last1=Delgado |first1=V |last2=Ajmone Marsan |first2=N |last3=de Waha |first3=S |last4=Bonaros |first4=N |last5=Brida |first5=M |last6=Burri |first6=H |last7=Caselli |first7=S |last8=Doenst |first8=T |last9=Ederhy |first9=S |last10=Erba |first10=PA |last11=Foldager |first11=D |last12=Fosbøl |first12=EL |last13=Kovac |first13=J |last14=Mestres |first14=CA |last15=Miller |first15=OI |last16=Miro |first16=JM |last17=Pazdernik |first17=M |last18=Pizzi |first18=MN |last19=Quintana |first19=E |last20=Rasmussen |first20=TB |last21=Ristić |first21=AD |last22=Rodés-Cabau |first22=J |last23=Sionis |first23=A |last24=Zühlke |first24=LJ |last25=Borger |first25=MA |title=2023 ESC Guidelines for the management of endocarditis. |journal=European Heart Journal |date=14 October 2023 |volume=44 |issue=39 |pages=3948–4042 |doi=10.1093/eurheartj/ehad193 |pmid=37622656|doi-access=free |hdl=10281/436142 |hdl-access=free }}</ref><ref>{{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=2 May 2023 |volume=63 |issue=5 |doi=10.1093/ejcts/ezad105 |pmid=36946284}}</ref>

<!-- 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/> Males are affected more often than females.<ref name=Mer2017/> The risk of death among those infected is about 25%.<ref name=Amb2017>{{cite journal|last1=Ambrosioni|first1=J|last2=Hernandez-Meneses|first2=M|last3=Téllez|first3=A|last4=Pericàs|first4=J|last5=Falces|first5=C|last6=Tolosana|first6=JM|last7=Vidal|first7=B|last8=Almela|first8=M|last9=Quintana|first9=E|last10=Llopis|first10=J|last11=Moreno|first11=A|last12=Miro|first12=JM|last13=Hospital Clinic Infective Endocarditis|first13=Investigators|title=The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century.|journal=Current Infectious Disease Reports|date=May 2017|volume=19|issue=5|pages=21|doi=10.1007/s11908-017-0574-9|pmid=28401448|s2cid=24935834}}</ref> Without treatment it is almost universally fatal.<ref name=Mer2017/>