Infective Endoarteritis : Signs, Symptoms, Diagnosis and Treatment

Endoarteritis or endarteritis is one of the inflammatory conditions of the cardiovascular system.¹ While there are many causes of endoarteritis, but when this condition is caused due to an infection, it is termed infective endoarteritis.

Infective endoarteritis occurs when there is inflammation of the inner lining of the arterial wall due to an infection. This may be associated with other conditions of the heart and congenital heart defects as well.

Infective endoarteritis is an intravascular infection of the arteries. Experts believe that during the era before antibiotics and surgical treatments infective endoarteritis was a major cause of death, which accounted for almost half of the deaths in several pooled autopsy series.²

Studies have reported that before the introduction of antibiotic therapy and surgical closure of congenital birth defects, infective endarteritis was the most common cause of death in patients with patent ductus arteriosus (PDA).³

A case study reported that a patient with small, asymptomatic PDA who showed no previous risk developed infective endoarteritis that was complicated by septic pulmonary embolism.³

This suggests that when such heart conditions are present, although they may be asymptomatic, the risk of infection is high. Considering the increased risk of infective endoarteritis in such patients, prophylactic closure of the PDA must be considered to avoid complications.

Symptoms and signs of infective endoarteritis may include features of pneumonia. There may be fever, accompanied with or without breathing difficulty or fatigue. The examination may show signs of cardiovascular abnormalities or the presence of a heart murmur. Some may show signs of bacteremia. Imaging studies like scans may be advised to determine the extent of arterial involvement. Diagnostics tests also include workup to rule out other causes of infection and fever.

Studies have reported that it can be difficult to diagnose and treat infective endoarteritis in children less than two years. It is noted that gram-positive bacteria like Streptococci spp and Staphylococci aureus are the main causative agents that account for about 62-77% of cases while gram-negative rods like Klebsiella pneumoniae for about 4 to 6%.⁴

Treatment of infective endoarteritis mainly includes the use of antibiotics to treat the infection. Usually, once the sterilization process is done, the next line of treatment includes surgery or embolization. However, when this is not possible, surgery or occlusion may be considered under the ongoing antibiotic treatment.²

A 2019 study concludes that the use of antibiotics and surgical correction has improved the outcome of treatment of PDA and hence PDA associated infective endoarteritis (PDA-IE) is becoming rare. However, it can still occur when the PDA is open or when it closes. Hence, it should be considered an infective complication in neonates, small infants, and preterm babies.⁵

In the case of infective endoarteritis in septic neonates showing signs of bacteremia, fever, and a heart murmur; it is necessary to perform transthoracic echocardiography as a part of diagnostic evaluation. Based on this, further investigations can be done and the treatment of infective endoarteritis can be planned.

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