Pathogenic mechanisms in infective endocarditis

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Abstract
Summary Infective endocarditis (IE) can be caused by a wide range of organisms and despite changes in the overall aetiology of disease the major culprits are still the oral streptococci. However, the mechanisms by which this group of organisms cause the disease are only just beginning to be unravelled. For infection to occur it has always been assumed that one of the key events is adherence of organisms to sterile thrombi, although their avoidance of the host's defences and their growth at the site must be equally important for the infection to persist. The major putative virulence factors studied so far are microbial adhesins, including dextran, lipoteichoic acid (LTA) and surface proteins; receptors for plasma adhesive proteins, including fibronectin, fibrinogen and vitronectin; and platelet interactive molecules, including some of the above and unidentified factors causing platelet aggregation. Of these, no single one has yet emerged as the most important in IE and, as in most biological systems, an important role could be played by several factors simultaneously.

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