118 Medicine Update 22 Management of Infective

Infective endocarditis (IE) is an endovascular microbial infection of cardiovascular structures (e.g., native valves, ventricular or atrial endocardium) including endarteritis of the large intrathoracic vessels (e.g., in a patent ductus arteriosus, arteriovenous shunts, coarctation of the aorta) or of intracardiac foreign bodies (e.g., prosthetic valves, pacemaker or ICD leads, surgically created conduits) facing the blood stream. INCIDENCE IE continues to remain a serious challenge despite several advances in its diagnosis and treatment. There is considerable uncertainty about the present incidence of the disease; 1.9 to 6.2 annual infections per 100,000 population1,2. The estimated incidence of IE in the West has remained unchanged over the past two decades at l.7-6.2 cases per 100,000 patient years3-5, but such estimates are not available from India. Even assuming the lowest incidence, at least 17,000 episodes of IE must be occurring per year in India6-9