Diagnosis of Infective Endocarditis

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Abstract
INFECTIOUS endocarditis (IE) is a serious disease, the diagnosis of which is often difficult. Because of the highly variable clinical manifestations of endocarditis, different sets of diagnostic criteria have been used to direct and standardize case definitions both in clinical practice and in scientific work. The first distinct case definition for IE was proposed by Pelletier and Petersdorf1 in 1977. A few years later, von Reyn et al2 presented a modification to this schema with the aim of improving the sensitivity and specificity of these diagnostic criteria. According to the von Reyn classification, histopathologic evidence is a prerequisite for a case to be diagnosed as definite IE, while the likelihood of IE is evaluated on the basis of blood culture findings, presence of fever and various heart conditions either predisposing to or indicative of IE, and occurrence of vascular manifestations. Evidently, these diagnostic criteria are most sensitive in diagnosing subacute endocarditis. During recent decades, however, the frequency of subacute IE has decreased, with a simultaneous increase in acute and prosthetic valve endocarditis.3-6 This epidemiologic trend accentuates the weaknesses of the von Reyn diagnostic criteria. Another major impediment is their failure to incorporate the results of modern echocardiography, despite their indisputable value in guiding clinical decisions.