DeWitt D E, Paauw D S
University of Washington School of Medicine, Seattle, Washington, USA.
Am Fam Physician. 1996 May 1;53(6):2045-9.
Injection drug use is an important risk factor for endocarditis. The clinical manifestations of endocarditis associated with injection drug use differ from those in person who do not use drugs. Endocarditis in drug users more often affects the right side of the heart and presents with fever and pulmonary emboli rather than left-sided emboli. Blood cultures and echocardiography are the mainstay of diagnosis; these tests are particularly helpful in identification of endocarditis associated with injection drug use because of the high frequency of right-sided valvular involvement and the low incidence of culture-negative endocarditis in this population. Since staphylococcal species are the dominant causative organism, penicillin and an aminoglycoside are the treatments of choice. Injection drug users with left-sided endocarditis or with symptomatic human immunodeficiency virus infection have poor prognoses.
注射吸毒是心内膜炎的一个重要危险因素。与注射吸毒相关的心内膜炎的临床表现与非吸毒者不同。吸毒者的心内膜炎更常累及心脏右侧，表现为发热和肺栓塞而非左侧栓塞。血培养和超声心动图是诊断的主要手段；这些检查对于识别与注射吸毒相关的心内膜炎特别有帮助，因为该人群右侧瓣膜受累频率高且血培养阴性的心内膜炎发病率低。由于葡萄球菌属是主要的致病微生物，青霉素和一种氨基糖苷类药物是首选治疗药物。患有左侧心内膜炎或有症状的人类免疫缺陷病毒感染的注射吸毒者预后较差。
