Intravenous Drug Abuse Endocarditis: Its Causes And Symptoms

Endocarditis is infection of the endocardium – i.e. the lining of the heart or the heart valves. It usually is caused by bacteria. Intravenous drug abuse endocarditis develops in those who share contaminated needles when using illicit drugs. The usual causative organism is Staphylococcus or Streptococcus

The bacteria gain entry at the site of injection and then enter the bloodstream and attack the endocardium or the heart valves. By and large, it is seen in young adults who are addicted to illegal drugs. These people may not have any history of heart-related disorders at all.

The treatment is based upon the organism that is causing the infection. Bacterial infection is managed with antibiotics and fungal infection with anti-fungal medicines. Surgical intervention becomes necessary in some cases.

Untreated, the disease results in poor prognosis and is fatal. Timely diagnosis and treatment promise good prognosis.

Symptoms Of Intravenous Drug Abuse Endocarditis

  • Low-grade fever, with chills.
  • Night sweats
  • Lassitude and exhaustion
  • Loss of appetite and weight loss.
  • Headache
  • Joint pains
  • Chest pain and cough
  • A new or changing heart murmur.
  • Arrhythmias
  • Confusion
  • Stroke
  • Formation of septic emboli within the bloodstream.
  • Nausea and vomiting
  • Pain in the abdomen
  • Janeway lesions – tiny, painless, hemorrhagic lumps on the palms and soles.
  • Osler’s nodes – red, painful, raised lesions on the fingers.
  • Intracranial hemorrhage
  • Conjunctival hemorrhage
  • No blood supply to the kidney and spleen resulting in permanent damage.
  • Enlarged spleen
  • Glomerulonephritis
  • Roth’s spots – retinal hemorrhages.

What Are The Causes Of Endocarditis?

Intravenous drug abuse endocarditis is common in young adults because of their risky behavior – use of intravenous illicit drugs. The infection is commoner in men than in women.

Those who are addicted to IV illegal drugs and share contaminated needles, tend to develop the infection. On the other hand, certain other factors can raise your risk for endocarditis. These factors include:

  • Infection due to – abdominal surgery, oral surgery, uro-genital surgery, endoscopy, colonoscopy, trans-esophageal echocardiography, intravascular catheters and poor dental hygiene.
  • Heart valve related causes are – a prosthetic valve, degeneration of the heart valves, and heart valve disease.
  • Heart conditions: About 65 % of the individuals do not have any history of heart diseases; others may have a previous history of endocarditis, rheumatic heart disorder or congenital heart disease.
  • AIDS patients are more at risk for developing endocarditis due to a suppressed immune mechanism.
  • Poorly controlled and uncontrolled diabetes mellitus increase the risk too.
  • Long standing corticosteroid therapy is another important trigger.

In most cases of intravenous drug abuse endocarditis, the cause is bacteria:

  • Staphylococcus aureus
  • Streptococcus sp.
  • Enterococcus sp.
  • HACEK (group of gram-negative bacteria), in rare cases.

The fungus Candida albicans has also been seen in IV drug users. Bacteria, fungi or other microbes gain entry in to the bloodstream and attach to certain areas in the heart.

Usually, the immune system annihilates the dangerous microbes that make it into the bloodstream. Even if the bacteria reach the heart, they may pass through without bringing about an infection. On the other hand, sometimes these microbes cause serious infections which can be life threatening.