Infective endocarditis is an inflammation caused by bacteria, fungi and other microorganisms (such as viruses, rickettsiae, chlamydia, spirochetes, etc.) directly infecting the heart valves or the endocardium of the ventricular wall. Because of the diversity and lack of specificity of its clinical signs, the diagnosis of infective endocarditis is easy to fall into some misunderstandings, which may lead to misdiagnosis or missed diagnosis, and then delay treatment. The following is a detailed analysis of diagnostic errors in infective endocarditis.
1. The diversity of clinical signs leads to misdiagnosis
Clinical signs
for infective endocarditis include fever, heart murmur, petechiae and ecchymoses, embolic signs, and anemia. However, these symptoms are similar to many other diseases, such as upper respiratory tract infection, chronic pyelonephritis, rheumatic fever and pulmonary infection, so they are easily misdiagnosed. For example, fever is the most common symptom of infective endocarditis, but it is also the least specific symptom. Many other diseases can also cause fever. Similarly, heart murmurs may be caused by other heart diseases, such as valvular heart disease, congenital heart disease and so on.
2. Misinterpretation
of blood culture results
Blood culture is one of the most important methods to diagnose infective endocarditis. However, there are also misunderstandings in the interpretation of blood culture results. First of all, the positive rate of blood culture is not 100%, especially after the start of antibiotic treatment, the positive rate will decrease significantly. Therefore, the possibility of infective endocarditis cannot be completely ruled out in patients who have already been treated with antibiotics, even if the blood culture is negative. Secondly, the results of blood culture may be affected by factors such as sampling time, sampling site and sampling times. If the sampling time is not appropriate or the sampling location is not accurate, it may lead to false negative results. In addition, multiple sampling can improve the positive rate, but it can also increase the pain and cost of patients.
Limitations
of Echocardiography
Echocardiography is an important auxiliary examination method for the diagnosis of infective endocarditis, which can find vegetation, perivalvular abscess and other lesions. However, there are some limitations of echocardiography. First, the sensitivity of echocardiography is not 100%, especially for small vegetations or lesions located in special sites, which may not be accurately identified. Second, the results of echocardiography are influenced by operator skill and equipment performance. Diagnostic differences between different operators may lead to misdiagnosis or missed diagnosis. In addition, there are differences in the diagnostic accuracy of echocardiography for some special types of infective endocarditis, such as native valve infective endocarditis and prosthetic valve infective endocarditis.
4. Neglecting the importance
of immunological examination and blood routine examination
In addition to blood culture and echocardiography, immunological examination and blood routine examination are also important means for the diagnosis of infective endocarditis. However, these tests are often overlooked in the actual diagnostic process. Immunological examination can reflect the body’s inflammatory response status, such as increased erythrocyte sedimentation rate and C-reactive protein, which is helpful for the diagnosis of infective endocarditis. Blood routine examination can provide information about anemia, white blood cell count and platelet count, and changes in these indicators may also indicate the presence of infective endocarditis. However, these tests have limited diagnostic value when used alone due to their lack of specificity, but combined with other test results and clinical signs, they can improve the accuracy of diagnosis.
V. Summary and Suggestions
In order to avoid the misdiagnosis of infective endocarditis, doctors should take into account the patient’s clinical signs, blood culture results, echocardiography, immunological tests and blood routine. For patients with suspected infective endocarditis, blood culture should be performed as early as possible and multiple samples should be taken at different sites to improve the positive rate. At the same time, appropriate echocardiographic examination methods should be selected, and the specific conditions of patients and the characteristics of lesions should be taken into account. In addition, we should pay attention to the importance of immunological examination and blood routine examination, and make a comprehensive judgment combined with other examination results and clinical signs. Through comprehensive analysis and judgment, we can improve the diagnostic accuracy of infective endocarditis and provide timely and effective treatment for patients.
Infective endocarditis
