A CASE OF FEVER WITH DIAGNOSTIC DILEMMA

Infective endocarditis (IE) is a potentially life-threatening microbial infection involving the endocardial surface of the heart, most commonly affecting the cardiac valves, but occasionally involving the mural endocardium or implanted intracardiac devices (1). Despite significant advances in diagnostic techniques, antimicrobial therapy, and surgical management, IE continues to be associated with high morbidity and mortality worldwide, with reported in hospital mortality ranging from 15,30% (1). The disease represent a complex interaction between host factors,microbial virulence,and hemodynamic conditions within the heart.The pathogenesis of IE involves transient or sustained bacteremia or fungemia,allowing microorganisms to adhere to damaged endocardial surfaces or prosthetic material(1,2). Endothelial injury leads to deposition of platelets and fibrin, forming sterile thrombotic vegetations that provide a nidus for microbial colonization and needs prolonged duration antibiotic therapy.Subsequent proliferation of organisms within these vegetations results in persistent infection, embolization, and immune- mediated phenomena (1). A wide variety of microorganisms can cause IE, including bacteria and fungi; however, streptococci, staphylococci, and enterococci remain the most common causative agents (2,3).