Infective Endocarditis in Special Populations: Epidemiology, Diagnostic Challenges, and Management Strategies

Figures

• 

  Figure 1. Infective endocarditis associated with native heart tissue and cardiac devices. Included images are examples of an infected septal occlude, mechanical heart valve, biological prosthetic heart valve, native heart valve, LVAD, and pacemaker lead. LA: left atrium; RA: right atrium; LVAD: left ventricular assist device Reprinted under the terms of the Creative Commons Attribution 4.0 International License from Kouijzer et al., Front. Cell Dev. Biol, 2022 [11].

• 

  Figure 2. Scanning electron microscopic images of IE A) Infected native heart valve (200 μm) with B) magnified bacteria (2 μm). C) Infected bioprosthetic valve (200 μm) with D) magnified bacteria on fibrous surface (1 μm). E) Biofilm on pacemaker lead (10 μm) with F) magnified bacteria in fibrillar substrate (2 μm). White arrows indicate bacteria. Reprinted under the terms of the Creative Commons Attribution 4.0 International License from Kouijzer et al., Front. Cell Dev. Biol., 2022 [11].

• 

  Figure 3. LVAD (HeartMate 3) with Candida albicans infection. 18F-FDG PET-CT showed FDG activity in the pericardium, mediastinum, surrounding LVAD pump, driveline, and sternum consistent with deep and superficial LVAD infection. Reprinted under the terms of the Creative Commons Attribution 4.0 International License from Aguilera et al., Front. Cardiovasc. Med., 2021 [62]. LVAD: left ventricular assist device

• 

  Figure 4. ICD patient presented with fever and methicillin-sensitive Staphylococcus aureus (MSSE) bacteremia. Initial TTE done. A) subcostal view with ICD lead in place (red arrow), without evident vegetations. Based on high clinical suspicion for cardiac implantable electronic device infection, a TEE was obtained, which showed a large vegetation attached to the ICD lead prolapsing into the right ventricle (yellow arrow). ICD: Implantable cardioverter-defibrillator Reprinted under the terms of the Creative Commons Attribution 4.0 International License from Aguilera et al., Front. Cardiovasc. Med., 2021 [62].

• 

  Figure 5. Overview of biofilm visualization modalities in IE research A) Crystal violet staining of bacteria in mouse heart tissue. B) SEM image of bacteria in a platelet-fibrin network. C) 3D FIB-SEM of infected phagocytic cells. D) Confocal image of early IE lesions with S. aureus. E) LA-ICP-MS elemental map of infected tissue. F) Fluorescence imaging of myeloid cells blocked by fibrin. G) FISH visualization of S. epidermidis on valve tissue. H) Bioluminescent imaging of S. aureus in rats. White arrowheads indicate bacteria. Images adapted with permission from original publishers. SEM: scanning electron microscopy; FIB-SEM: Focused ion beam SEM; LA-ICP-MS: Laser ablation inductively coupled plasma mass spectrometry; FISH: Fluorescence in situ hybridization Reprinted under Creative Commons Attribution 4.0 International License from Kouijzer et al., Front. Cell Dev. Biol., 2022 [11].