Chahoud Jad, Sharif Yakan Ahmad, Saad Hala, Kanj Souha S
From the *Department of Internal Medicine, School of Medicine, University of Texas Health Science Center, Houston, TX; †Division of Cardiology, Department of Internal Medicine, University Hospital Rostock, Rostock, Germany; and ‡Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Cardiol Rev. 2016 Sep-Oct;24(5):230-7. doi: 10.1097/CRD.0000000000000095.
Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis.
在首次描述右侧感染性心内膜炎（RSIE）60年后，它仍然给所有医学从业者带来挑战。流行病学数据显示，由于全球静脉药物使用者数量激增以及中心血管导管和植入式心脏设备使用增加，其发病率呈上升趋势。RSIE与左侧感染性心内膜炎的不同之处不仅仅在于受累心脏瓣膜的位置。它们有不同的临床表现、诊断结果和预后；因此，需要不同的管理策略。RSIE通常没有心脏杂音和全身性栓塞，而肺栓塞及其相关并发症在临床表现中占主导地位。RSIE的诊断延迟是由于其初始表现与其他疾病相似所致。这种延迟可能会导致并发症。除了植入式心脏复律除颤器患者需要经食管超声心动图外，经胸超声心动图可初步确诊。RSIE的各种因素可能会增加死亡率和发病率，如三尖瓣赘生物大小、真菌病因以及HIV患者的低CD4细胞计数。传统上，苯唑西林和万古霉素分别用于治疗对甲氧西林敏感和耐药的金黄色葡萄球菌。最近，达托霉素已显示出有前景的结果，这导致其获得美国食品药品监督管理局（FDA）批准用于治疗金黄色葡萄球菌血症及相关的RSIE。本文的目的是提供关于RSIE的全面更新，包括流行病学、发病机制、微生物学、诊断、管理和预后。
