Cardiovascular VOL. XXII,
Infective Endocarditis: Introduction John P. Phair
T REATMENT resents a
of infective endocarditis reptriumph of modern medicine; paradoxically, however, controversy continues with regard to optimal therapy,’ and outright confusion accompanies discussions of prevention of this disease.’ The contributors to this symposium have not been asked to address these issues, but instead have concerned themselves with reviewing selected aspects of research and clinical problems that have come into focus within the past 2 decades. Dr. Lawrence Freedman and coworkers provided the first convenient animal model of endocarditis in the mid-l 960s. Freedman reviews the numerous investigations of experimental rabbit endocarditis designed to elucidate the pathogenesis of the valvular lesion and the interaction of host defenses with the infecting organisms. In addition, this model has provided the opportunity and the stimulus to reevaluate effective antibiotic therapy and prophylaxis. It has become apparent that, in addition to tissue damage and destruction due directly to the effects of the infecting microorganism, circulating antigen-antibody complexes play a major role in the clinical picture of infective endocarditis. The relationship of the host immune response to the pathogenesis of the multiple-system aspects of endocarditis are presented by Phair and Clarke. A major advance in the therapy of endocarditis has been the demonstration that cardiovascular surgery can save the individual with an acute destructive valvular infection, severe hemodynamic impairment, recurrent major emboli, and,/or infection unresponsive to antimicrobial
No. 3 (November/December),
therapy. Dr. Edward Stinson reviews the recent surgical experience at Stanford in dealing with this type of extremely difficult patient. Cardiovascular surgery has also provided a new group of patients who are at increased risk of developing infectious endocarditis. Dr. Chatrchai Watanakunakorn’s article presents the available information with regard to the prevalance, microbiology, and approaches to treatment of patients with prosthetic valvular infections. Two other major clinical problems have gained prominence in recent years. Dr. Boris Reisberg discusses endocarditis in patients who utilize intravenous drugs. Endocarditis in this population represents a substantial proportion of patients with this infection treated in urban hospitals. Recognition of right-sided valvular involvement, unusual pathogens, and a varied natural history represent unfamiliar aspects of the disease in these patients. Paralleling the increased prevalance of serious infection due to aerobic and anaerobic gram-negative bacilli has been the recognition of cases of endocarditis due to these organisms. Dr. Lewis Weinstein returns to these pages with a classic review of the current status of the epidemiology, clinical features, and the therapy of this small, but seriously ill, subset of patients with endocarditis.
fhe S&ion Medical
of InJktious School, Chicago,
Reprint requests should be addressed to John M.D., Section of Infececlious Disease, Northwestern sity
Medical School, I?‘ I979 by Grune
Chicago, & Strarton.
Ill. 6061 Inc.
P. Phair. Univer-
REFERENCES I, Resnick L, Cohen L: Antibiotic treatment of penicillinsensitive streptococcal endocarditis. JAMA 241:1826-1827. 1979 2. Kaye D: Prophylaxis against bacterial endocarditis: A
dilemma. in Kaplan EL, Taranta AV (eds): AHA Symposium Infective Endocarditis. Dallas, American Heart Aasociation. 1977. pp 67-69