Endocarditis causes

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Endocarditis Microchapters


Patient Information


Historical Perspective




Differentiating Infective Endocarditis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications & Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

CT scan


Other Imaging Findings

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Medical Therapy


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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Diagnosis and Follow-up

Medical Therapy


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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2] Ogheneochuko Ajari, MB.BS, MS [3]


The majority of cases of infective endocarditis are due to bacteria. Common causes of infective endocarditis include Streptococcus viridans, Staphylococci, and Enterococcus.


Common Causes

Causes by Organ System

Cardiovascular Acute rheumatic fever, aneurysm of sinus of valsalva, aortic insufficiency, aortic stenosis, aortic valve regurgitation, aortic valve stenosis, asymmetric septal hypertrophy, atrial myxoma, atrioventricular block, Austrian triad , bacterial endocarditis, Becker fibroblastic endocarditis, bicuspid aortic valves , calcific aortic stenosis, calcific valvular disease, cardiac catheterization , cardiac myxoma, cardiac surgery , cardiomegaly, carditis, central venous catheter, cerebrovascular accident, cholesterol emboli syndrome, coarctation of the aorta , congenital heart disease , coronary artery fistula, Ebstein's anomaly, Eisenmenger's syndrome, embolism, first degree AV block, hypertrophic cardiomyopathy, hypoplastic left heart syndrome, infective endocarditis, Libman-Sacks endocarditis, Loeffler endocarditis, marantic endocarditis, mesenteric ischemia, mitral regurgitation, mitral stenosis, mitral valve prolapse, mitral valve replacement, myocardial rupture, nonbacterial thrombotic endocarditis, papillary muscle dysfunction, patent ductus arteriosus, prosthetic heart valves, pulmonary atresia, pulmonic regurgitation, rheumatic heart disease , right ventricular outflow tract obstruction, second degree AV block, shock, stroke, structural heart disease, subacute endocarditis, tetralogy of Fallot, third degree AV block, tricuspid insufficiency, tricuspid regurgitation, tricuspid stenosis, valvular heart disease, ventricular septal defect
Chemical / poisoning No underlying causes
Dental Dental extractions, dental implants, dental sepsis, root canals procedure, rothia dentocariosa
Dermatologic Behcet disease, scarlet fever
Drug Side Effect Aminoglycoside, cocaine, daptomycin, flucloxacillin, fusidic acid, heroin, intravenous drug use, metronidazole, narcotic, pefloxacin, penicillin, streptomycin, vancomycin
Ear Nose Throat Adenoidectomy
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic & Genito-Uriner Biliary tract surgery, endoscopic retrograde cholangiopancreatography , peritoneovenous shunts for ascites, sclerotherapy , splenic infarction, Whipple disease
Genetic Ehlers-Danlos syndrome, mitogen-activated protein kinase 9, parathyroid hormone receptor 1, Turner syndrome
Hematologic Antiphospholipid syndrome, chronic eosinophilic leukemia, hypereosinophilic syndrome
Iatrogenic Cystoscopy,iatrogenic infection
Infectious Disease Abiotrophia, acremonium, acute rheumatic fever, aseptic meningitis, Austrian triad , bacteremia, bacterial endocarditis, bacteroides, bartonella, brucellosis, campylobacteriosis, candida albicans, capnocytophaga canimorsus, cardiobacterium hominis, cat scratch fever, clostridium sordellii, coagulase-negative staphylococci, corynebacterium, coxiella burnetii, diphtheria , eikenella corrodens, enterococci , enterococcus faecalis, erysipelas, erysipeloid of rosenbach, erysipelothrix rhusiopathiae, fever, finegoldia magna, fungi , gemella haemolysans, gemella morbillorum, gonorrhea, granuloma, group A streptococcus , HACEK organisms, haemophilus aphrophilus, haemophilus parainfluenzae, haemophilus paraphrophilus, HIV, iatrogenic infection, infective endocarditis, kingella kingae, lactobacillus rhamnosus, legionella pneumophila, listeria monocytogenes, loiasis , melioidosis, meningococcemia, methicillin-resistant staphylococcus aureus, micrococcus, mycobacterium avium-intracellulare, mycobacterium boenickei, mycobacterium brisbanense, mycobacterium fortuitum, mycobacterium houstonense, mycobacterium neworleansense, mycobacterium tuberculosis, neisseria gonorrhoea, neisseria sicca, non-HACEK gram-negative bacteria, pasteurella multocida, postoperative septicemia, propionibacterium acnes, pseudomonas alcaligenes, pseudomonas mendocina, psittacosis, Q fever, rat-bite fever, rheumatic fever, rothia dentocariosa, salmonellosis , scarlet fever, sepsis, septic arthritis, septicemia , serratia, staphylococcus aureus, staphylococcus epidermidis, staphylococcus lugdunensis, streptobacillary rat-bite fever, streptobacillus, streptococcus bovis, streptococcus milleri, streptococcus mitis, streptococcus mutans, streptococcus pneumoniae, streptococcus sanguinis, streptococcus suis, streptococcus viridans, streptococcus, syphilis, trichinella spiralis,tropheryma whipplei, trypanosoma cruzi, tuberculosis , typhoid fever, vancomycin-resistant enterococci, Whipple disease
Musculoskeletal / Ortho Ehlers-Danlos syndrome, sclerotherapy
Neurologic Antiphospholipid syndrome, aseptic meningitis, Austrian triad, cerebrovascular accident, stroke, ventriculoatrial shunts for hydrocephalus
Nutritional / Metabolic Ornithine transcarbamylase
Obstetrics & Gynecology Antiphospholipid syndrome, Pregnancy
Oncologic Atrial myxoma, cancer, cardiac myxoma, chronic eosinophilic leukemia, paraneoplastic syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Respiratory tract procedures
Renal / Electrolyte Chronic hemodialysis, hemodialysis, nephrotic syndrome, urinary casts
Rheum / Immune / Allergy Acute rheumatic fever, antiphospholipid syndrome, autoimmune disease, Behcet disease, immune complex disease, lupus, paraneoplastic syndrome, polymyalgia rheumatica, rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus
Trauma No underlying causes
Urologic Cystoscopy, prostatic surgery
Miscellaneous Surgery

Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis[2]

Epidemiological features Common Microorganism(s)
Injection drug use
Indwelling cardiovascular medical devices
Genitourinary disorders
Genitourinary infection
Genitourinary manipulation
Chronic skin disorders
Poor dental health, dental procedures
  • Viridans group streptococci
  • “Nutritionally variant streptococci”
  • Abiotrophia defectiva
  • Granulicatella sp
  • Gemella sp
  • HACEK organisms
Alcoholism, cirrhosis
Burn patients
  • S. aureus
  • Aerobic Gram-negative bacilli, including
Diabetes mellitus
Early ( < 1 y) prosthetic valve placement
Late ( > 1 y) prosthetic valve placement
Dog–cat exposure
Contact with contaminated milk
Contact with infected farm animals
Homeless, body lice
Pneumonia, meningitis
Solid organ transplant
Gastrointestinal lesions


  1. Murdoch, DR; et al. (9 March 2009). "Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study". Archives of Internal Medicine. 169 (5): 463–73. doi:10.1001/archinternmed.2008.603. PMC 3625651. PMID 19273776.
  2. Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

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