Infective Endocarditis in Narcotic Addicts

To form a comprehensive picture of endocarditis in narcotic addicts, twenty-nine hospitalized and seven nonhospitalized cases were identified and studied. Sole tricuspid valve involvement was found in only 9%; a bilateral endocarditis involving the tricuspid valve was noted in another 9%. The most commonly affected valves were, in order of frequency, the aortic and the mitral. Staphylococci were isolated in 48% of the hospitalized patients; streptococci were found in 14%; and candida were found in three patients. Gram-negative or no organizisms were isolated in the remaining patients. A history of underlying heart disease was less frequent in the addicts than in age-matched controls. Major embolic episodes were common in these patients, particularly in those with aortic involvement; seven patients died suddenly out of the hospital with cerebral or myocardial emboli. Although there does appear to be an increased frequency of tricuspid and candida endocarditis in the addicts as compared with the controls, the literature is probably seriously biased toward the over-reporting of these unusual cases of endocarditis in addicts.